Recent Developments & Information
May 29, 2020
“The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols.”Reducing Transmission of SARS-CoV-2, a scientific article (See First Story) (!)
“This virus is here to stay. The question is, how do we live with it safely?”Sarah Cobey, epidemiologist and evolutionary biologist at the University of Chicago.
“The studies show herd immunity protection is unlikely to be reached any time soon.”Michael Mina, epidemiologist at the Harvard T.H. Chan School of Public Health
Index Of Featured Stories & Links
Note: All of stories listed below are included in this Update, but we have included links to the stories upfront so that you can quickly jump to a story if you want
- New Scientific Findings
- Airborne Transmission By Asymptomatics May Be Our Greatest Risk [Recommended]
- C19 Is Likely Airborne
- Cancer, coronavirus are a dangerous mix
- Risk of Permanent Lung Damage
- HCQ and AZN “Need To Be Widely Available and Promoted Immediately for Physicians to Prescribe” as Outpatient Treatment for C19
- Study Prompting WHO to Halt HCQ Trials Questioned
- Projections & Our (Possible) Future
- This virus is here to stay
- The World Is Far From Herd Immunity
- What’s the Risk of Catching Coronavirus From a Surface?
- Concerns & Unknowns
- The mystery of superspreaders
- Heavily Criticized, Florida Leads the Way
- Leading UK Epidemiologist: “Pubs, Nightclubs, Restaurants Could Reopen Without Serious Risk”
- Technology vs. Coronavirus
- Can Apple Watch and Fitbit predict infection?
- The Road Back?
- CDC Recommends Sweeping Changes to American Offices
- Practical Tips
- How to lower your risk at work, school and seeing friends
- Quarantine Isn’t Making Us Gain Weight or Slow Down
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- We do not endorse, and may not agree with, any opinion or view included in this Update. We include a wide spectrum of opinions and views as we believe that it gives perspective on what people are thinking and may give insights into our future.
A. Our World As Seen Through Headlines
- NY Gov. Cuomo to Sign Order Letting Businesses Kick Out People Without Masks
- California Sheriff Won’t Enforce Masks: ‘We Are Not the Mask Police’
- CDC: Coronavirus Fatality Rate 0.26%, 8-15x Lower than Estimates
- Texas Supreme Court Rules Lack Of COVID-19 Immunity Not Enough To Qualify For Mail-In Voting
- Premier League soccer to re-start June 17
- Italy reports less than 100 deaths for 4th time in 5 days
- Brazil cases top 400,000
- South Korea reports alarming jump in cases
- Blue House mulls reinstating strict social distancing measures
- Philippines President to end Manila lockdown
- Denmark decision to partially reopen schools deemed a ‘success’
- New evidence of ‘Community Spread’ found in some African countries
- Pending Home Sales Plummet 35% – Biggest Drop Ever As Buyers Forfeit Deposits
- Your “Immunity Passport” Future Begins To Materialize As Airlines Call For Digital ID Tracking
- Virus Masks Wash Ashore After Vessel Loses 40 Containers In Rough Seas
- Reopening Isn’t About Haircuts, It’s About Relieving Human Suffering
- You Can Now Get Fired For Refusing To Wear A Mask At Work
- What The Failed 55-MPH Speed Limit Law Tells Us About COVID Lockdowns
- Masks Versus No-Masks: Is This The New Symbol Of Tribalism?
- 98.1% Of ‘COVID-19 Deaths’ In Massachusetts Had An Underlying Health Condition
- California Hospitals in Financial Trouble After Preparing for Coronavirus Surge that Never Came
- First Quarter GDP Revised Down to 5% Contraction
- US layoffs climb to 41 million
- Orders for US big-ticket factory goods drop 17.2%
- Casinos Giving Away Free One-Way Flights to Vegas
- Weekly Jobless Claims Fall to 2.1 Million
- Andrew Cuomo Says He Wouldn’t Send His Own Mother to Nursing Home
- India Defies W.H.O. Warning, Backs Hydroxychloroquine for Coronavirus
- Rasmussen Poll Shows 2:1 Support for ‘Hire American’ over ‘Business First’
- Report Shows 43% of Coronavirus Deaths Are in Nursing Homes
- NY Gov. Cuomo: ‘Obligation Is on the Nursing Home’ to Say It Can’t Accept COVID Patients
- Most CNN Employees Won’t Return to Office this Year
- Texas Turns It Around After a Spike in Coronavirus Cases: Deaths, Hospitalizations, Cases on Downward Spiral
- Minneapolis Mayor to Rioters: Please Practice Social Distancing, Wear Masks
- Journalist Flees South Africa After Police Beat Him for Coronavirus Lockdown Reports
- Brazil’s Biggest City Moves to Ease Coronavirus Lockdown
- Pelosi Says Not Wearing Mask ‘Very Selfish’ — While Not Wearing Mask
- Dr. Fauci Calls on Christians to ‘Forestall’ Receiving Communion
- California Hospitals in Financial Trouble After Preparing for Coronavirus Surge that Never Came
- Dr. Fauci changes tune, now says second COVID-19 wave may never happen – and mask wearing is symbolic
- We All Failed”: Gov. Cuomo Admits COVID-19 Projection Models “Were All Wrong,” Yet Clings to the Central Planner’s “Pretense of Knowledge
- Florida’s Evidence Based Reopening Is Working
- Coronavirus still has a foothold in the South
- Stressed out frontline nurses admit they are at a breaking point with 68% planning to quit their jobs
- McDonalds employees allege that managers provided coffee filters, dog diapers as face masks
- As U.S. Ramps Up Reopening, Coronavirus Restrictions Return in South Korea
- Huge post-coronavirus orgy planned to end ‘longest dry spell in all of history’
- World’s largest rodeo cancelled for first time in 124 years
- Scientists create virus that has potential to fight cancer
- The pandemic’s pace is quickening worldwide, with nearly 700,000 new known infections reported in the last week
- More than 40 million people have filed for unemployment benefits since mid-March
- More than a dozen Indian casinos in California have reopened, defying Gov. Gavin Newsom.
- Campgrounds in the West are reopening with new and conflicting laws
- Parts of Washington, D.C., and the Northern Virginia suburbs will start to loosen restrictions on Friday
- Cases are still increasing in Wisconsin, two weeks after the state’s highest court overturned a stay-at-home order
- Cyprus said it would reimburse tourists who contract the coronavirus while on vacation there
- As the CDC recommends workplace changes, millions of the unemployed have more immediate concerns
- As new hot spots emerge, the pandemic may be entering another phase
- Day care centers are reopening. Will children return?
- Countries are opening up, even as their caseloads rise
- Isolated in nursing homes, elderly Americans grieve, adapt – and hope
- The pandemic has exposed nation’s vulnerabilities as U.S. passes 100,000 dead from covid-19
- When Hard Data are ‘Heartbreaking’: Testing Blitz in San Francisco Shows COVID-19 Struck Mostly Low-wage Workers
- Poll Shows Only A Quarter Of African Americans Plan To Get Coronavirus Vaccine
- U.S. to Expel Chinese Graduate Students With Ties to China’s Military Schools
- Senate Bill Latest in Efforts to Revamp US Global Health Security
- Coronavirus lockdowns stopped flu in its tracks
- WHO Foundation Established to Support Critical Global Health Needs
- EU governments ban malaria drug for COVID-19, trial paused as safety fears grow
- A Medical-Delivery Drone Service Gets US Approval Amid Coronavirus
- Coronavirus couples risk meeting to see if sparks fly in person
- Boston Marathon 2020 canceled in historic first
- Champagne sales go flat as Americans stop celebrating during coronavirus
- Asymptomatic coronavirus cases may be more common than suspected (more than 80% may be asymptomatic)
- Half of coronavirus cases in Washington state are under the age of 40
- Hawaii governor to extend traveler quarantine past June
- Healthy people should wear masks only if caring for coronavirus patients, WHO says
- When it comes to reopening, it’s not health vs. wealth — it’s health vs. health
- Lockdowns will enact a price from our kids for a long, long time to come
- ‘Enhanced hurricane season’ could cause even more problems amid coronavirus
- Chicago to resume outdoor dining next week, while NYC still has no plan
- Texas will soon allow outdoor pro sports events to have spectators, but the numbers will be strictly limited
- Most coronavirus patients on cruise were asymptomatic, study says
- AstraZeneca may expose coronavirus vaccine participants to pathogen
- Philippines easing one of world’s longest lockdowns amid record coronavirus spike
- Texas bar owner bans customers from wearing coronavirus masks inside
- Researchers say mutations haven’t made coronavirus more dangerous
- Manhunts after hundreds flee quarantine in Zimbabwe, Malawi
- India battling heat wave, worst locust invasion in decades amid coronavirus
- France will let movie theaters reopen earlier than expected
- Theme parks in Japan reopen with new coronavirus rules
- NYC workers will ‘make their own choices’ for transportation: NYC Mayor de Blasio
- ‘No evidence’ that reopening schools in Finland spread coronavirus faster
- Red Cross says there’s been 208 coronavirus-related attacks on health workers
- Regal movie theater owner Cineworld expects to reopen in July
- Experts say six feet may not be enough distance to stop coronavirus transmission
- In post-quarantine haze, friends spend 7 hours driving to McDonald’s and back
- Prostitutes will return to work in Switzerland before contact sports
B. Key Numbers & Trends
Note: Unless otherwise noted, all changes noted in this Update are since the prior day. Unless otherwise specified, all cases/deaths are confirmed cases/deaths that have been reported.
1. Cases & Tests
- Total Cases = 5,900,907 (+2.0%)
- New Cases (7 day average) = 101,487 (+1.2%) (+1,210)
- Note: New Cases have exceeded 100,000 cases each of the last 2 days, with 116,304 new cases on 5/28, which is the largest number of new cases since the beginning of the pandemic
- Total Cases = 1,768,461 (+1.3%)
- New Cases (7 day average) = 21,080 (-4.1%) (-893)
- Total Number of Tests = 16,331,312 (+458,839)
- Positive Test Rate (7 day average) = 5.7%
- Note: 7 day average of new cases is decreasing while testing is significantly increasing, which is a positive trend
- Worldwide Deaths
- Total Deaths = 361,549 (+1.3%)
- New Deaths (7 day average) = 3,911 (-1.0%) (-38)
- US Deaths
- Total Deaths = 103,330 (+1.2%)
- New Deaths (7 day average) = 997 (-2.3%) (-28)
- 5 Countries with Largest Number of Confirmed Deaths:
|Country||Total Deaths||New Deaths||Deaths Per 1M Population|
|US||103,330||1,223 (-305)||312 (+3)|
|UK||37,837||377 (-100)||558 (+6)|
|Italy||33,142||70 (-47)||548 (+1)|
|France||28,662||66 (-32)||439 (+1)|
|Spain||27,119||1 (+0)||580 (+0)|
- The number of new deaths in all 5 countries declined since the prior day or are stable, as did the number of new deaths on a worldwide basis (72.9% of the decline in new worldwide deaths came from these 5 countries).
- Deaths in these 5 countries = 63.6% of total worldwide deaths (-0.4%), and 37.7% of new worldwide deaths (-2.6%).
- US deaths = 28.6% of total worldwide deaths (+0%), and 26.5% of new worldwide deaths (-2.5%)
- The number of new deaths in the UK remain high as reflected by the increase in deaths of 6 per million of population The number of new deaths in Italy, France and Spain have been reduced significantly as reflected in increases in their respective deaths per million of population. Although the number of deaths in the US resulted in an increase in deaths of 3 per million of population, the US continues to have the lowest number of deaths per 1 million of population among these 5 countries (by a significant margin).
- 5 States with Largest Number of Confirmed Deaths:
|State||Total Deaths||New Deaths 7 Day Avg||Deaths Per 1M Population|
|NY||29,653||110 (+5)||1,524 (+5)|
|NJ||11,412||80 (-5)||1,285 (+8)|
|MA||6,640||70 (+1)||963 (+11)|
|MI||5,372||35 (-4)||538 (+4)|
|PA||5,425||72 (+1)||424 (+8)|
|US||103,330||997 (-28)||312 (+3)|
- All 5 States are led by Democratic Governors and are reopening slowly
- The 7 day average for new deaths for NJ decreased by approx. 6% and the average for MI decreased by more than 10%. The average for PA and MA remained relatively stable. Although the 7 day average for NY has increased by almost 5%, the trend for NY remains positive.
- The number of deaths per million of population of all 5 States exceed the national average by significant amounts, which reflect significant increases in the number of deaths in those States since yesterday. The increases in deaths per million of population in all 5 States also exceed the national average, which reflects that deaths are occurring at higher rates in these 5 States than most of the country.
- We are not aware of any hospitals that are currently under stress or overwhelmed in any of these States.
3. Countries/States To Watch
- Sweden is one of the few countries that did not impose a lockdown and has been cited by the WHO as a model for emerging from lockdowns
|Country||Total Deaths||New Deaths 7 Day Avg||Deaths Per 1M Population|
|Sweden||4,266||56 (+0)||423 (+5)|
- Although per capita deaths in Sweden are substantially less than Spain, Italy and France (among other countries), Sweden’s per capita is much higher than its Nordic neighbors.
- The 7 day average of new deaths for Sweden has stabilized. It is too early to know if the number of new deaths have peaked (and will increase) or have merely paused before increasing further.
- The increase in the number of deaths per 1 million of population remains very high, which reflects a high number of deaths for the population.
- 5 States that Are Reopening Rapidly:
|State||Total Deaths||New Deaths 7 Day Avg||Deaths Per 1M Population|
|GA||1,973||28 (-6)||186 (+4)|
|FL||2,364||31 (-1)||110 (+2)|
|TX||1,623||20 (-6)||56 (+1)|
|OH||2,110||39 (+0)||181 (+5)|
|OK||326||3 (+0)||81 (+1)|
|US||103,330||997 (-28)||312 (+3)|
- All 5 States are led by a Republican Governor
- 7 day averages in new deaths in all 5 States have declined or are stable, which indicates that their reopenings are being managed effectively.
- All 5 States have substantially lower deaths per 1 million of population than the national average. Deaths per 1 million of population in TX, FLA and OK are less than the national average. Deaths per 1 million of population in GA and OH are slightly higher than the national average.
C. New Scientific Findings & Research
1. Airborne Transmission By Asymptomatics May Be Our Greatest Risk
- Respiratory infections occur through the transmission of virus-containing droplets and aerosols exhaled from infected individuals during breathing, speaking, coughing, and sneezing.
- Traditional respiratory disease control measures are designed to reduce transmission by droplets produced in the sneezes and coughs of infected individuals.
- However, a large proportion of the spread of coronavirus disease 2019 (C19) appears to be occurring through airborne transmission of aerosols produced by asymptomatic individuals during breathing and speaking. Aerosols can accumulate, remain infectious in indoor air for hours, and be easily inhaled deep into the lungs.
- For society to resume, measures designed to reduce aerosol transmission must be implemented, including universal masking and regular, widespread testing to identify and isolate infected asymptomatic individuals.
- Humans produce respiratory droplets ranging from 0.1 to 1000 micrometers (μm). A competition between droplet size, inertia, gravity, and evaporation determines how far emitted droplets and aerosols will travel in air.
- Respiratory droplets will undergo gravitational settling faster than they evaporate, contaminating surfaces and leading to contact transmission.
- Smaller aerosols (≤5 μm) will evaporate faster than they can settle, are buoyant, and thus can be affected by air currents, which can transport them over longer distances.
- Thus, there are two major respiratory virus transmission pathways: contact (direct or indirect between people and with contaminated surfaces) and airborne inhalation.
- In addition to contributing to the extent of dispersal and mode of transmission, respiratory droplet size has been shown to affect the severity of disease. For example, influenza virus is more commonly contained in aerosols with sizes below 1 μm (submicron), which lead to more severe infection. In the case the coronavirus, it is possible that submicron virus-containing aerosols are being transferred deep into the alveolar region of the lungs, where immune responses seem to be temporarily bypassed.
- The coronavirus has been shown to replicate three times faster than SARS and thus can rapidly spread to the pharynx from which it can be shed before the innate immune response becomes activated and produces symptoms. By the time symptoms occur, the patient has transmitted the virus without knowing.
- Identifying infected individuals to curb the coronavirus transmission is more challenging compared to SARS and other respiratory viruses because infected individuals can be highly contagious for several days, peaking on or before symptoms occur. These “silent shedders” could be critical drivers of the enhanced spread of the coronavirus.
- In Wuhan, China, it has been estimated that undiagnosed cases of C19 infection, who were presumably asymptomatic, were responsible for up to 79% of viral infections. Therefore, regular, widespread testing is essential to identify and isolate infected asymptomatic individuals.
- As illustrated in the diagram below, masks can reduce airborne transmission. Infectious aerosol particles can be released during breathing and speaking by asymptomatic infected individuals. No masking maximizes exposure, whereas universal masking results in the least exposure.
- Airborne transmission was determined to play a role during the SARS outbreak in 2003. However, many countries have not yet acknowledged airborne transmission as a possible pathway for the coronavirus. Recent studies have shown that in addition to droplets, the coronavirus may also be transmitted through aerosols. A study in hospitals in Wuhan, China, found the coronavirus in aerosols further than 6 feet from patients with higher concentrations detected in more crowded areas. Estimates using an average sputum viral load for the coronavirus indicate that 1 minute of loud speaking could generate >1000 virion-containing aerosols. Assuming viral titers for infected super-emitters (with 100-fold higher viral load than average) yields an increase to more than 100,000 virions in emitted droplets per minute of speaking.
- The World Health Organization (WHO) recommendations for social distancing of 6 feet and hand washing to reduce the spread of the coronavirus are based on studies of respiratory droplets carried out in the 1930s. These studies showed that large, ~100 μm droplets produced in coughs and sneezes quickly underwent gravitational settling. However, when these studies were conducted, the technology did not exist for detecting submicron aerosols. As a comparison, calculations predict that in still air, a 100-μm droplet will settle to the ground from 8 feet in 4.6 s whereas a 1-μm aerosol particle will take 12.4 hours. Measurements now show that intense coughs and sneezes that propel larger droplets more than 20 feet can also create thousands of aerosols that can travel even further.
- Increasing evidence for the coronavirus suggests the 6 feet WHO recommendation is likely not enough under many indoor conditions where aerosols can remain airborne for hours, accumulate over time, and follow air flows over distances further than 6 feet.
- In outdoor environments, numerous factors will determine the concentrations and distance traveled, and whether respiratory viruses remain infectious in aerosols.
- Breezes and winds often occur and can transport infectious droplets and aerosols long distances. Asymptomatic individuals who are speaking while exercising can release infectious aerosols that can be picked up by air streams.
- Viral concentrations will be more rapidly diluted outdoors, but few studies have been carried out on outdoor transmission of the coronavirus. Additionally, the coronavirus can be inactivated by ultraviolet radiation in sunlight, and it is likely sensitive to ambient temperature and relative humidity, as well as the presence of atmospheric aerosols that occur in highly polluted areas.
- Viruses can attach to other particles such as dust and pollution, which can modify the aerodynamic characteristics and increase dispersion. Moreover, people living in areas with higher concentrations of air pollution have been shown to have higher severity of C19. Because respiratory viruses can remain airborne for prolonged periods before being inhaled by a potential host, studies are needed to characterize the factors leading to loss of infectivity over time in a variety of outdoor environments over a range of conditions
- Given how little is known about the production and airborne behavior of infectious respiratory droplets, it is difficult to define a safe distance for social distancing. Assuming the coronavirus virions are contained in submicron aerosols, as is the case for influenza virus, a good comparison is exhaled cigarette smoke, which also contains submicron particles and will likely follow comparable flows and dilution patterns.
- The distance from a smoker at which one smells cigarette smoke indicates the distance in those surroundings at which one could inhale infectious aerosols.
- In an enclosed room with asymptomatic individuals, infectious aerosol concentrations can increase over time. Overall, the probability of becoming infected indoors will depend on the total amount of the coronavirus inhaled.
- Ultimately, the amount of ventilation, number of people, how long one visits an indoor facility, and activities that affect air flow will all modulate viral transmission pathways and exposure. For these reasons, it is important to wear properly fitted masks indoors even when 6 feet apart.
- Airborne transmission could account, in part, for the high secondary transmission rates to medical staff, as well as major outbreaks in nursing facilities. The minimum dose of the coronavirus that leads to infection is unknown, but airborne transmission through aerosols has been documented for other respiratory viruses including measles, SARS, and chickenpox.
- Airborne spread from undiagnosed infections will continuously undermine the effectiveness of even the most vigorous testing, tracing, and social distancing programs. After evidence revealed that airborne transmission by asymptomatic individuals might be a key driver in the global spread of C19, the WHO recommended universal use of face masks. Masks provide a critical barrier, reducing the number of infectious viruses in exhaled breath, especially of asymptomatic people and those with mild symptoms. Surgical mask material reduces the likelihood and severity of C19 by substantially reducing airborne viral concentrations. Masks also protect uninfected individuals from the coronavirus aerosols. Thus, it is particularly important to wear masks in locations with conditions that can accumulate high concentrations of viruses, such as health care settings, airplanes, restaurants, and other crowded places with reduced ventilation. The aerosol filtering efficiency of different materials, thicknesses, and layers used in properly fitted homemade masks was recently found to be similar to that of the medical masks that were tested. Thus, the option of universal masking is no longer held back by shortages.
- From epidemiological data, countries that have been most effective in reducing the spread of C19 have implemented universal masking, including Taiwan, Hong Kong, Singapore, and South Korea. In the battle against C19, Taiwan (population 24 million, first C19 case 21 January 2020) did not implement a lockdown during the pandemic, yet maintained a low incidence of 441 cases and 7 deaths (as of 21 May 2020). By contrast, the state of New York (population ~20 million, first COVID case 1 March 2020), had a higher number of cases (353,000) and deaths (24,000).
- By quickly activating its epidemic response plan that was established after the SARS outbreak, the Taiwanese government enacted a set of proactive measures that successfully prevented the spread of the coronavirus, including setting up a central epidemic command center in January, using technologies to detect and track infected patients and their close contacts, and perhaps most importantly, requesting people to wear masks in public places. The government also ensured the availability of medical masks by banning mask manufacturers from exporting them, implementing a system to ensure that every citizen could acquire masks at reasonable prices, and increasing the production of masks. In other countries, there have been widespread shortages of masks, resulting in most residents not having access to any form of medical mask. This striking difference in the availability and widespread adoption of wearing masks likely influenced the low number of C19 cases.
- Aerosol transmission of viruses must be acknowledged as a key factor leading to the spread of infectious respiratory diseases. Evidence suggests that the coronavirus is silently spreading in aerosols exhaled by highly contagious infected individuals with no symptoms. Owing to their smaller size, aerosols may lead to higher severity of C19 because virus-containing aerosols penetrate more deeply into the lungs. It is essential that control measures be introduced to reduce aerosol transmission.
- A multidisciplinary approach is needed to address a wide range of factors that lead to the production and airborne transmission of respiratory viruses, including the minimum virus titer required to cause C19; viral load emitted as a function of droplet size before, during, and after infection; viability of the virus indoors and outdoors; mechanisms of transmission; airborne concentrations; and spatial patterns. More studies of the filtering efficiency of different types of masks are also needed. C19 has inspired research that is already leading to a better understanding of the importance of airborne transmission of respiratory disease.
2. C19 Is Likely Airborne
- Something has been bothering Kimberly Prather, an aerosol scientist: everything she reads about C19 points to a pathogen that travels through the air.
- There’s how quickly it has spread around the world, studies showing how it spreads through restaurants (maybe by the air conditioning system?), how it attacked a church choir even though they were spread apart while they were singing, how it seems to spread like wildfire on planes and on cruise ships; all of this, she says, Prather should know. She studies aerosols — particles so tiny they float freely through the air, traveling feet or even miles. She runs a large, government-funded research center at the University of California San Diego to study how viruses and other things that come out of the ocean float through the air.
- “A lot of the evidence has been pointing to aerosol transmission of respiratory viruses,” she says. Influenza can be passed through the air, as can the virus that causes SARS. “This particular virus, a lot of evidence is mounting.”
- Prather says she’s been alarmed not to see the CDC or WHO come out with a strong statement that people could catch C19 by breathing it in.
- “It’s just shocking to me, quite honestly, that this has not been factored in.”
- And she believes masks can play a major role in stopping that transmission.
- In an interview with America magazine on May 26, Anthony Fauci, MD, who leads the National Institute of Allergy and Infectious Diseases, referenced aerosol transmission in churches.
- “When you sing, the amount of droplets and aerosol that come out is really, in some respects, scary,” Fauci said.
- In a perspective article for the journal Science, Prather clearly lays out the evidence for aerosol transmission and explains what people need to do to protect themselves. It was quickly picked up on social media.
- When a person coughs or sneezes, they generate large droplets laden with viral particles. Those droplets are heavy and fall to the ground or a nearby surface pretty quickly, within seconds. They are still somewhat wet and sticky when they land. That’s where the 6-foot rule comes in, she says. It’s based on studies of respiratory droplets conducted in the 1930s.
- Science has become much more advanced since then. Prather and others have developed instruments that can “see” very tiny particles — the aerosols. Aerosols are measured in microns, or one one-millionth of a meter. A human red blood cell is about 5 microns in size. These particles are so small that the moisture from a cough or sneeze evaporates while they’re still in the air. They float on air currents. It takes them hours to settle.
- Aerosols, she writes, “can accumulate, remain infectious in indoor air for hours, and be easily inhaled deeply into the lungs.”
- Prather realizes this is a scary thing to be telling people. “I hesitate. I don’t want to freak people out.”
- She also believes knowledge is power.
- “I have to say something because this could actually protect people,” she says. What airborne transmission means, she says, is that 6 feet is not far enough to stand apart. It also means we should probably be wearing masks a lot more often.
- “It’s very fixable. Masks aren’t that big of a deal,” she says. “To me, I look at this as a solution.”
- She points to the success Taiwan has had stopping the spread of the infection. Taiwan has only had a few hundred cases and only seven deaths, even though the country never implemented a national lockdown. Instead, they aggressively tested their citizens, quarantined people who tested positive for 2 weeks, and had everyone wear face masks.
- “If you look at countries that just naturally wear masks when people feel sick … those countries did a lot better than those that did not,” Prather says.
- She wears hers inside and outside, especially if she’s walking outdoors in a place where she can see other people. She tells people to imagine how far they can smell cigarette smoke or a barbecue. That’s how far aerosols can travel between you and another person.
- The good news, she says, is that recent studies have shown that homemade cloth masks can be as effective at blocking the virus as surgical masks. There’s one big caveat, though. They have to fit your face.
- “If you look at all these people who are wearing bandanas, they’re just hanging down. That’s not good because aerosols will just flow right around,” she says. “Aerosols are really light. If you can feel a breeze, they will be in that breeze.”
- That’s one reason why face shields — the plastic covering people are wearing over their faces — don’t work without a mask. Face shields block droplets, but aerosols can still find a way in.
- Finally, even if your mask isn’t perfect, or perfectly worn, it may still do you a world of good. Prather says that’s because the dose of the virus you’re exposed to determines how sick you’ll get.
- “Even if you only cut it back by 70%, the severity of the disease will be much less.”
3. Cancer, coronavirus are a dangerous mix
- New research shows how dangerous the coronavirus is for current and former cancer patients. Those who developed C19 were much more likely to die within a month than people without cancer who got it, two studies found.
- They are the largest reports on people with both diseases in the United States, the United Kingdom, Spain and Canada. In one study, half of 928 current and former cancer patients with C19 were hospitalized and 13% died, which is far more than the various rates that have been reported in the general population.
- Results were published Thursday in the journal Lancet and will be discussed this weekend at an American Society of Clinical Oncology conference being held online because of the pandemic.
- A second study in Lancet from researchers in England of 800 patients with various types of cancer and C19 found an even higher death rate — 28%. The risk rose with age and other health problems such as high blood pressure.
- The studies have big implications: More than 1.6 million new cancers are diagnosed in the United States each year, several million Americans are in treatment now and about 20 million are cancer survivors.
- Dr. Jeremy Warner, a Vanderbilt University data scientist who led the larger study, said the results show the wisdom of measures that many hospitals have taken to delay or modify care for many cancer patients, and the need for people treated in the past to be extra careful now.
- “If they don’t have C19, they want to do anything they can to avoid getting it,” he said.
- “The pandemic is posing incredible demands on the cancer care system” and the new studies show good reason for concern, said Dr. Howard Burris. He is president of the cancer society and heads the Sarah Cannon Research Institute in Nashville, Tennessee.
- “We’re trying to minimize trips to the clinic” and telling older cancer patients and those with lung problems “to be extra vigilant, extra isolated, to stay at home, be careful with family members,” Burris said.
- Nearly half of the patients in Warner’s study were receiving cancer treatment when diagnosed with C19. The others either completed treatment, had not started it, been under observation or had cancer in the past. Researchers included all of these groups because some cancer treatments can affect the lungs or immune system years later and impact the odds of surviving coronavirus, he explained.
- Men seemed to fare worse — 17% of them died versus 9% of women. That might be because breast cancer was the most common tumor type in this group, and women with it tend to be younger and with fewer health problems versus many cancers seen in men that are typically diagnosed at later ages. Smoking also is more common among men.
- The risk of death also seemed higher for patients taking the malaria drug hydroxychloroquine plus the antibiotic azithromycin, but this could be because sicker patients were given those drugs. Of the 928 study participants, 89 took hydroxychloroquine and 181 took the combination.
- The rate of death in patients getting both drugs was 25%, about double the 13% for the group as a whole, Warner said.
- “We do not know if this is cause and effect,” and studies like this can’t prove such a link, he stressed. Use of hydroxychloroquine alone was not tied to a significantly higher risk of death, but there were fewer patients taking it this way. The study now has more than 2,000 patients enrolled and the next analysis will see if the trends stay the same, Warner said.
- Only two of the 270 took the drugs as part of a clinical trial, which “really stood out to me” because of the potential side effects, Warner said. Unless cancer patients are in one of the carefully designed studies that are testing hydroxychloroquine now, “don’t take that drug” on your own, he advised.
4. Risk of Permanent Lung Damage
- C19 may be far less deadly than originally projected – and asymptomatic cases may be even more common than first suspected, but for those who have caught it and come down with symptoms, the disease can result in lasting symptoms, including shortness of breath, lethargy, recurrent fevers, headaches, itchiness and other mystery problems that aren’t going away.
- A top pulmonologist in the Netherlands says that thousands of Dutch residents who have recovered from C19 may be left with permanent lung damage, resulting in decreased lung capacity and difficulty absorbing oxygen.
- According to Leon van den Toorn, Chairman of the Dutch Association of Physicians for Pulmonary Disease and Tuberculosis NVALT, people are underestimating the consequences of the coronavirus.
- “In severe cases, a kind of scar formation occurs, we call this lung fibrosis. The lungs shrink and the lung tissue becomes stiffer, making it harder to get enough oxygen,” Van den Toorn told Dutch newspaper AD (via the NL Times), adding that “there may be thousands of people in the Netherlands who suffered permanent injury to the lungs from corona.”
- Of the 1,200 C19 patients who so far recovered after admission to intensive care, “almost 100% went home with residual damage“, he said to AD. And about half of the 6,000 people who were hospitalized, but did not need intensive care, will have symptoms for years to come.
- So far 45,500 people in the Netherlands tested positive for the coronavirus. Many did not get sick enough to need hospital care. In this group, Van den Toorn expects that permanent problems will be less serious, but still possible.
- Van den Toorn says that patients experiencing lung issues should immediately see a pulmonologist, as “there may be a low oxygen level in the blood, which is harmful to the body.”
- “People with a history of corona infection should be monitored closely to see if recovery is complete,” he added.
1. HCQ and AZN “Need To Be Widely Available and Promoted Immediately for Physicians to Prescribe” as Outpatient Treatment for C19
- A study conducted at Yale School of Public Health by Dr. Harvey Risch and published Wednesday at the American Journal of Epidemiology focused on the use of hydroxychloroquine (HCQ) and azithromycin (AZN) in early outpatient treatment.
- Risch found that in five studies, including two controlled clinical trials, the drugs showed “significant major outpatient treatment efficacy” and concluded HCQ and azithromycin “need to be widely available and promoted immediately for physicians to prescribe.”
- “HCQ+AZN has been widely misrepresented in both clinical reports and public media,” he noted, observing as well that “Remdesivir has shown mild effectiveness in hospitalized inpatients, but no trials have been registered in outpatients.”
- Dr. Risch added:
- HCQ+AZN has been used as standard-of-care in more than 300,000 older adults with multi-comorbidities, with estimated proportion diagnosed with cardiac arrhythmias attributable to the medications 47/100,000 users, of which estimated mortality is <20%, 9/100,000 users, compared to the 10,000 Americans now dying each week.
- Additionally, a cohort study conducted with 3,737 patients in Marseille, France, and published at Méditerranée Infection on Wednesday as well, found treatment with HCQ and AZN was associated with a decreased risk of transfer to the ICU or death, lowered risk of hospitalization for more than ten days, and a shorter period of viral shedding.
- “Early diagnosis, early isolation and early treatment with at least 3 days of HCQ+AZN result in a significantly better clinical outcome and contagiosity in patients with C19 than other treatments,” the study concluded:
- In a column at the Association of American Physicians and Surgeons, Dr. Elizabeth Lee Vliet, wrote of the significance of HCQ, coupled with zinc, to be used at early onset of C19 symptoms.
- “More studies have replicated these findings,” she explained. “HCQ given within the first week of symptoms, especially with zinc, can prevent the virus from entering your body’s cells and taking over, much like people use locks and alarms to stop burglaries”:
- “Waiting until you are in the ICU is like installing home locks and alarm system after burglars have invaded, vandalized your home, and stolen all your valuables,” Vliet added.
Studies and Articles Cited In this Story:
- Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis, by Dr. Harvey Risch, which can be found at Early Outpatient Treatment of Symptomatic, High-Risk Covid-19 Patients that Should be Ramped-Up Immediately as Key to the Pandemic Crisis
- Early Diagnosis and Management of COVID-19 Patients: A Real Life Cohort Study of 3,737 Patients, Marseille, France, which can be found at Early diagnosis and management of COVID-19 patients: a real-life cohort study of 3,737 patients, Marseille, France
- FDA Bureaucrat Brags He Blocked Physician Prescribing of Hydroxychloroquine in Early COVID-19, which can be found at FDA Bureaucrat Brags He Blocked Physician Prescribing of Hydroxychloroquine in Early COVID-19 – AAPS
2. Study Prompting WHO to Halt HCQ Trials Questioned
- The study that led the U.N.’s World Health Organization (W.H.O.) to halt clinical trials of the drug hydroxychloroquine (HCQ) as a treatment for the infection caused by the Chinese coronavirus has been called into question.
- Physicians and researchers are raising concerns about the study, published in the Lancet, that stem from the fact that the source of some of the data for the study could not be determined.
- The study upon which the W.H.O. based its decision reported it found no benefit of HCQ to C19 patients who received the malaria drug since the researchers said they were dying at higher rates and experiencing an increased frequency of heart arrhythmias compared to patients with other viruses.
- The researchers concluded:
- Although observational studies cannot fully account for unmeasured confounding factors, our findings suggest not only an absence of therapeutic benefit but also potential harm with the use of hydroxychloroquine or chloroquine drug regimens (with or without a macrolide [antibiotic]) in hospitalised patients with C19.
- The research team, led by Brigham and Women’s Hospital Heart and Vascular Center in Boston, reported of the 96,000 patients hospitalized with C19 during the study period, about 15,000 received HCQ alone or combined with antibiotics. The control group contained the other 81,000 patients, who were not treated with drugs.
- The authors of the study said among the data they received were those from five Australian hospitals that documented, as of April 21, 600 C19 patients and 73 deaths.
- However, as the Guardian Australia reported, Johns Hopkins University data showed “only 67 deaths from C19 had been recorded in Australia by 21 April. The number did not rise to 73 until 23 April.”
- “The data relied upon by researchers to draw their conclusions in the Lancet is not readily available in Australian clinical databases, leading many to ask where it came from,” the report noted.
- In response to Guardian Australia’s questions about the data, the Lancet replied the study’s lead author said he received his data from a healthcare data analytics company called Surgisphere, the founder of which admitted they had mixed up data from an Asian hospital with those from Australia.
- While the Surgisphere founder said the data error did not alter the findings of the study, Dr. Allen Cheng, an infectious disease physician from Alfred Health in Melbourne, said the names of the Australian hospitals should be made public and that he had never heard of Surgisphere.
- “Usually to submit to a database like Surgisphere you need ethics approval, and someone from the hospital will be involved in that process to get it to a database,” Cheng told Guardian Australia. “If they got this wrong, what else could be wrong?”
- He also questioned the fact that the Lancet study had only four authors.
- “Usually with studies that report on findings from thousands of patients, you would see a large list of authors on the paper,” he said. “Multiple sources are needed to collect and analyse the data for large studies and you usually see that acknowledged in the list of authors.”
- Other physicians tweeted their concerns about the Lancet study.
E. Projections & Our (Possible) Future
1. This virus is here to stay
Embracing that reality is crucial to the next phase of America’s pandemic response
- There’s a good chance the coronavirus will never go away.
- Even after a vaccine is discovered and deployed, the coronavirus will likely remain for decades to come, circulating among the world’s population.
- Experts call such diseases endemic — stubbornly resisting efforts to stamp them out. Think of measles, HIV, chickenpox.
- It is a daunting proposition — a coronavirus-tinged world without a foreseeable end. But experts in epidemiology, disaster planning and vaccine development say embracing that reality is crucial to the next phase of America’s pandemic response. The long-term nature of C19, they say, should serve as a call to arms for the public, a road map for the trillions of dollars Congress is spending and a fixed navigational point for the nation’s current, chaotic state-by-state patchwork strategy.
- With so much else uncertain, the persistence of the novel virus is one of the few things we can count on about the future. That doesn’t mean the situation will always be as dire. There are already four endemic coronaviruses that circulate continuously, causing the common cold. And many experts think this virus will become the fifth — its effects growing milder as immunity spreads and our bodies adapt to it over time.
- For now, though, most people have not been infected and remain susceptible. And the highly transmissible disease has surged in recent weeks, even in countries that initially succeeded in suppressing it. Left alone, experts say, it will simply keep burning through the world’s population.
- “This virus is here to stay,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago. “The question is, how do we live with it safely?”
- Combating endemic diseases requires long-range thinking, sustained effort and international coordination. Stamping out the virus could take decades — if it happens at all. Such efforts take time, money and, most of all, political will.
- Americans have only started to wrap their heads around the idea, polls show. U.S. leaders and residents keep searching for a magic bullet to bring the pandemic to an abrupt end: Drugs that show even a hint of progress in the petri dish have sparked shortages. The White House continues to suggest summer’s heat will smother the virus or that it will mysteriously vanish. A vaccine — while crucial to our response — is not likely to eradicate the disease, experts say. Challenges to vaccination are already becoming clear, including limited supply, anti-vaccine opposition and significant logistical roadblocks.
- Meanwhile, some states are rushing headlong into reopening their economies. Even those moving more cautiously haven’t developed tools to measure what’s working and what isn’t — a crucial feature for any prolonged scientific experiment.
- “It’s like we have attention-deficit disorder right now. Everything we’re doing is just a knee-jerk response to the short-term,” said Tom Frieden, former director of the Centers for Disease Control and Prevention. “People keep asking me, ‘What’s the one thing we have to do?’ The one thing we have to do is to understand that there is not one thing. We need a comprehensive battle strategy, meticulously implemented.”
- People also keep talking of returning to normal, said Natalie Dean, a disease biostatistician at the University of Florida. But a future with an enduring coronavirus means that normal no longer exists. “As we find different ways to adapt and discover what works, that’s how we’re going to start reclaiming parts of our society and life,” she said.
An urgent intermission
- America now finds itself in a moment of transition. Infections are declining in some states, even as they rise in others with worrisome emerging hotspots.
- What’s missing during this interlude, experts say, is a sense of urgency.
- Arriving at this moment of transition required countrywide shutdowns, soaring unemployment and devastating blows to our economy and mental health. All that effort was supposed to buy us time to think, plan and prepare, said Irwin Redlener, director of Columbia University’s National Center for Disaster Preparedness.
- “What’s concerning is that I don’t see any signs the federal government has learned any lessons and is doing anything differently to prepare for the next waves,” he said.
- Leaders desperately need to shift their response from short-term crisis management to long-term solutions, he and other experts say.
- Communities should be thinking about installing doors that don’t require grasping a handle, and re-engineering traffic signals so pedestrians don’t have to push crosswalk buttons, said Eleanor J. Murray, an epidemiologist at Boston University.
- In coming years, robots and automated lines could become ubiquitous in meatpacking plants, which have experienced some of the country’s worst outbreaks. Families may have to make diagnostic tests routine ahead of visits to grandparents. Once-mocked office cubicles of a bygone era may become the rage again, replacing open-floor plans now found at many companies. Paid sick time might become a necessity for jobs of all types. And heading to work while under the weather may no longer be seen as an act of admirable American can-do spirit but instead a threat to co-workers and the bottom line.
- More immediately, states should be using this time to craft quick-response systems and protocols. With hundreds of cities and counties reopening, think of each as a mini laboratory yielding valuable data on what will work against the virus in coming years. But most still lack the tools to capture that data, said Cobey, the University of Chicago epidemiologist, whose models have been used by Illinois leaders.
- The metrics being employed by states remain crude: daily number of deaths, hospitalization rates and confirmations of cases long after people show symptoms. All lag behind the actual transmission of the coronavirus by at least one to three weeks.
- “We desperately need better data and fast. It blows my mind that we still don’t have it,” Cobey said.
- What’s needed are more sophisticated testing strategies, say experts, that could serve as canaries in the coal mine — increasing our speed and ability to detect surges in the virus. States could select certain populations or areas to test extensively. They could establish a handful of sites that test only patients who have developed symptoms in the last four days, to increase sensitivity to sudden increases in transmission.
- “You need testing strategies that allow you to put on brakes quickly enough to stop surges,” said Cobey, who has pleaded with state leaders to implement such strategies.
- Another idea researchers have proposed is universally testing pregnant women to measure the asymptomatic spread of the virus — among people who have been infected but don’t show symptoms. The women could be an ideal sample testing population because they already visit hospitals for delivery and maternity checkups.
- One hospital in New York tested every pregnant woman who came in to deliver and found 15% had the coronavirus. Most of those testing positive — 88% — showed no symptoms, a sign of how crucial such testing could be.
- Living long-term with the virus also means addressing the mental health effects. There’s an assumption among many leaders, experts say, that increases in depression and anxiety are a temporary problem that will eventually disappear along with the virus.
- But for some people, the trauma, fear and stress will accumulate and fester like a wound if left unaddressed, said Paul Gionfriddo, president of the advocacy group Mental Health America. “The psychological recovery is going to be as important as the economic and logistical parts of this.”
‘Prevention always sounds easy’
- America’s yearning for a quick fix has turned in recent days toward a vaccine, now being portrayed as a solution that will quash the virus once and for all.
- But the world has achieved that only once, with smallpox — a measure of just how difficult it is for vaccines to wipe out diseases. And it took nearly two centuries after the discovery of a vaccine — and an unprecedented international effort — to vanquish smallpox, which stole hundreds of millions of lives.
- Eventually, many experts believe this coronavirus could become relatively benign, causing milder infections as our immune systems develop a memory of responses to it through previous infection or vaccination. But that process could take years, said Andrew Noymer, a University of California at Irvine epidemiologist.
- Barney Graham, deputy director of the federal government’s Vaccine Research Center, said emerging plans for vaccination are already stretching as far out as a decade.
- “I’m thinking about things in different stages or eras,” Graham said. “We had a discussion this morning about what can be ready before this winter of 2021, what could be ready for 2021-2022, and what kind of regimen or vaccine concepts would we want after this has settled into a more seasonal virus.”
- The success of those vaccines will hinge on distribution — a complicated, logistically fraught process.
- In the first few years of a vaccine, global demand will far outstrip what manufacturers are able to supply. Roughly 60 to 80% of the world’s population needs to be inoculated to reach herd immunity — that point when enough people have become resistant to a virus that it has difficulty spreading widely. Without international agreements worked out beforehand, the short supply could devolve into bidding wars, hoarding and ineffective vaccination campaigns.
- In the United States, the crucial job of distribution will depend on federal and local health departments, which have already shown signs of limited capacity and competence amid this pandemic. As a preview to the chaos that might ensue, the U.S. government’s rollout of the first and only treatment for C19, remdesivir, has been described by hospitals as confusing, unfair and lacking transparency.
- “We also assume that everyone will want the vaccine because of the devastation this virus has caused, but that’s a big assumption,” said Howard Koh, a top U.S. health official during the 2009 H1N1 flu pandemic. “Prevention always sounds easy, but it’s not.”
- America already has vaccines for measles and the seasonal flu, which can be deadly. And yet the health-care system struggles every year to convince people to get those shots.
- Looking further down the road, many top experts believe it’s critical that U.S. leaders start planning for the next pandemic now — even as they contend with this one — because of the short attention span and lack of political and public support for preparedness the country has shown in past decades.
- “We’ve seen this story so many times before,” Koh said. “As soon as the crisis is over, people will go back to whatever is the new normal and they will move on.”
Our future selves
- The struggle to get people to think long-term, of course, is not new to public health.
- We know that smoking can kill us. Yet, it is still responsible for 1 of every 5 deaths in the United States.
- “The problem is people putting the present ahead of the future,” said Frieden, who led the CDC from 2009 to 2017.
- To bridge the divide between present and future, the CDC launched an ad campaign during Frieden’s tenure in which former smokers showed in graphic detail the consequences of lighting up: the removal of their jaw. Having to speak through an electronic voice box. The emotional devastation to their families.
- The campaign caused more than 16.4 million people to try to quit smoking between 2012 and 2018 and about 1 million to quit for good, the CDC estimates. “We found a way to show them their future selves,” said Frieden, now president and CEO of a health initiative called Resolve to Save Lives.
- The challenge in this pandemic is few such shortcuts remain to push U.S. leaders and the public into forward-thinking actions. The CDC has been sidelined by the White House and blocked from holding public briefings. Meanwhile, the Trump administration has made clear its priority is restarting the economy.
- Increasingly, leading experts believe many Americans won’t make the shift toward long-range thinking until the virus spreads more widely and affects someone they know.
- “It’s like people who drive too fast. They come upon the scene of an accident, and for a little while, they drive more carefully, but soon they’re back to speeding again,” said Michael T. Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.
- “Contrast that with people who have lost someone to drunk driving,” he said. “It mobilizes them and becomes a cause for them. Eventually, everyone is going to know someone who got infected or died from this virus.
- “That’s what it may take.”
2. The World Is Far From Herd Immunity
- The coronavirus still has a long way to go. That’s the message from a crop of new studies across the world that are trying to quantify how many people have been infected.
- Official case counts often substantially underestimate the number of coronavirus infections. But in new studies that test the population more broadly, the percentage of people who have been infected so far is still in the single digits.
- The numbers are a fraction of the threshold known as herd immunity, at which the virus can no longer spread widely.
- The precise herd immunity threshold for the coronavirus is not yet clear; but several experts said they believed it would be higher than 60%.
Herd immunity estimate
- At least 60% of population
New York City
- 19.9% have antibodies (May 2)
- 17.5% have antibodies (May 21)
- 11.3% have antibodies (May 13)
Wuhan (returning workers)
- 10% have antibodies (April 20)
- 9.9% have antibodies (May 15)
- 7.3% have antibodies (May 20)
- 7.1% have antibodies (May 13)
- Even in some of the hardest-hit cities in the world, the studies suggest, the vast majority of people still remain vulnerable to the virus.
- Some countries – notably Sweden, and briefly Britain – have experimented with limited lockdowns in an effort to build up immunity in their populations. But even in these places, recent studies indicate that no more than 7 to 17% of people have been infected so far. In New York City, which has had the largest coronavirus outbreak in the United States, around 20% of the city’s residents have been infected by the virus as of early May, according to a survey of people in grocery stores and community centers released by the governor’s office.
- Similar surveys are underway in China, where the coronavirus first emerged, but results have not yet been reported. A study from a single hospital in the city of Wuhan found that about 10% of people seeking to go back to work had been infected with the virus.
- Viewed together, the studies show herd immunity protection is unlikely to be reached “any time soon,” said Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health.
- The herd immunity threshold for this new disease is still uncertain, but many epidemiologists believe it will be reached when between 60% and 80% of the population has been infected and develops resistance.
- A lower level of immunity in the population can slow the spread of a disease somewhat, but the herd immunity number represents the point where infections are substantially less likely to turn into large outbreaks.
- “We don’t have a good way to safely build it up, to be honest, not in the short term,” Dr. Mina said. “Unless we’re going to let the virus run rampant again – but I think society has decided that is not an approach available to us.”
- The new studies look for antibodies in people’s blood, proteins produced by the immune system that indicate a past infection. An advantage of this test is that it can capture people who may have been asymptomatic and didn’t know they were sick. A disadvantage is that the tests are sometimes wrong — and several studies, including a notable one in California, have been criticized for not accounting for the possibility of inaccurate results or for not representing the whole population.
- Studies that use these tests to examine a cross section of a population, often called serology surveys, are being undertaken around the country and the world.
- While these studies are far from perfect, said Carl Bergstrom, a professor of biology at the University of Washington, in aggregate they give a better sense of how far the coronavirus has truly spread – and its potential for spreading further.
- The herd immunity threshold may differ from place to place, depending on factors like density and social interaction, he said. But, on average, experts say it will require at least 60% immunity in the population. If the disease spreads more easily than is currently believed, the number could be higher. If there is a lot of variation in people’s likelihood of becoming infected when they are exposed, that could push the number down.
- All estimates of herd immunity assume that a past infection will protect people from becoming sick a second time. There is suggestive evidence that people do achieve immunity to the coronavirus, but it is not yet certain whether that is true in all cases; how robust the immunity may be; or how long it will last.
- Dr. Mina of Harvard said to think about immunity in the population as a firebreak, slowing the spread of the disease.
- If you are infected with the virus and walk into a room where everyone is susceptible to it, he said, you might infect two or three other people on average.
- “On the other hand, if you go in and three out of four people are already immune, then on average you will infect one person or fewer in that room,” he said. That person in turn would be able to infect fewer new people, too. And that makes it much less likely that a large outbreak can bloom.
- Even with herd immunity, some people will still get sick. “Your own risk, if exposed, is the same,” said Gypsyamber D’Souza, a professor of epidemiology at Johns Hopkins University. “You just become much less likely to be exposed.”
- Diseases like measles and chickenpox, once very common among children, are now extremely rare in the United States because vaccines have helped build enough herd immunity to contain outbreaks.
- We don’t have a vaccine for the coronavirus, so getting to herd immunity without a new and more effective treatment could mean many more infections and many more deaths.
- If you assume that herd protection could be achieved when 60% of the population becomes resistant to the virus, that means New York City is only one-third of the way there. And, so far, nearly 250 of every 100,000 city residents has died. New York City still has millions of residents vulnerable to catching and spreading this disease, and tens of thousands more who are at risk of dying.
- “Would someone advise that people go through something like what New York went through?” said Natalie Dean, an assistant professor of biostatistics at the University of Florida. “There’s a lot of people who talk about this managed infection of young people, but it just feels like hubris to think you can manage this virus. It’s very hard to manage.”
- In other cities, serology surveys are showing even smaller shares of people with antibodies. The quality of these studies is somewhat varied, either because the samples weren’t random or because the tests were not accurate enough. But the range of studies shows that most places would have to see 10 or more times as many illnesses – and possibly, deaths – to reach the point where an outbreak would not be able to take off.
- The serology studies can also help scientists determine how deadly the virus really is. Currently, estimates for what’s called the infection fatality rate are rough. To calculate them precisely, it’s important to know how many people in a place died from the virus versus how many were infected. Official case rates, which rely on testing, undercount the true extent of infections in the population. Serology helps us see the true footprint of the outbreak.
- In New York City, where 20% of people were infected with the virus by May 2, according to antibody testing, and where more than 18,000 had died by then, the infection fatality rate appears to be around 1%.
- For comparison, the infection fatality rate for influenza is estimated at 0.1 percent to 0.2%. But the way the government estimates flu cases every year is less precise than using serology tests and tends to undercount the number of infections, skewing the fatality number higher.
- But even if the fatality rates were identical, C19 would be a much more dangerous disease than influenza. It has to do with the number of people who are at risk of getting sick and dying as the disease spreads.
- With the flu, only about half the population is at risk of getting sick in a given flu season. Many people have some immunity already, either because they have been sick with a similar strain of flu, or because they got a flu shot that was a good match for the version of the virus they encountered that year.
- That number isn’t high enough to fully reach herd immunity — and the flu still circulates every year. But there are benefits to partial immunity in the population: Only a fraction of adults are at risk of catching the flu in a normal year, and they can spread it less quickly, too. That means that the number of people at risk of dying is also much lower.
- C19, unlike influenza, is a brand-new disease. Before this year, no one in the world had any immunity to it at all. And that means that, even if infection fatality rates were similar, it has the potential to kill many more people. 1% of a large number is bigger than 1% of a smaller number.
- “There aren’t 328 million Americans who are susceptible to the flu every fall at the beginning of the flu season,” said Andrew Noymer, an associate professor of public health at the University of California, Irvine. “But there are 328 million Americans who were susceptible to this when this started.”
1. What’s the Risk of Catching Coronavirus From a Surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen.
- Fears about catching the coronavirus from contaminated surfaces have prompted many of us to spend the past few months wiping down groceries, leaving packages unopened and stressing about touching elevator buttons.
- But what’s the real risk of catching C19 from a germy surface or object?
- The question has been on people’s minds lately, and there was some confusion after the CDC made some edits to its website last week. Social media sites and some news outlets suggested the agency had downgraded its warnings and that surface transmission was no longer a worry.
- The C.D.C. subsequently issued a news release to clarify that indirect contact from a contaminated surface — what scientists call fomite transmission — remains a potential risk for catching C19.
- “Based on data from lab studies on C19 and what we know about similar respiratory diseases, it may be possible that a person can get C19 by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes,” the agency wrote. “But this isn’t thought to be the main way the virus spreads.”
- So does this mean we can catch coronavirus from touching a doorknob? Catching a Frisbee? Sharing a casserole dish?
- The answer, in theory, is yes, which is why you need to wash your hands often and avoid touching your face. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals.
- “What they’re saying is that high touch surfaces like railings and doorknobs, elevator buttons are not the primary driver of the infection in the United States,” said Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. “But it’s still a bad idea to touch your face. If someone who is infectious coughs on their hand and shakes your hand and you rub your eyes — yes, you’re infected. Someone’s drinking from a glass, and you pick it up near the rim and later rub your eyes or mouth, you’re infected.”
- Here’s how fomite transmission works. An infected person coughs or sneezes on their hands. Some of the droplets may splash onto a nearby surface, or the person spreads the germs by touching a faucet or countertop before washing his hands. Studies show that coronavirus can last up to three days on plastic and steel, but once it lands on a surface, the amount of viable virus begins to disintegrate in a matter of hours. That means a droplet on a surface is far more infectious right after the sneeze — not so much a few days later.
- Next, you have to come along and touch the contaminated surface, pick up enough viable virus on your hands, and then touch your eyes, nose or mouth. If all goes well for the virus, you will get sick.
- “There’s a long chain of events that would need to happen for someone to become infected through contact with groceries, mail, takeout containers or other surfaces,” said Julia Marcus, an infectious disease epidemiologist and assistant professor in the department of population medicine at Harvard Medical School. “The last step in that causal chain is touching your eyes, nose or mouth with your contaminated hand, so the best way to make sure the chain is broken is washing your hands.”
- An outbreak associated with a shopping mall in Wenzhou, China, may have been fueled by fomite transmission. In January, seven workers who shared an office in a shopping mall became ill when one of their co-workers returned from Wuhan. The mall was closed, and public health officials tracked two dozen more sick people, including several women who had shopped at the mall, as well as their friends. None of them had come into contact with the original sick office workers. The researchers speculated that a women’s restroom or the mall elevators had been the source of transmission.
- Other studies have used invisible fluorescent tracers — fake germs that glow under black light — to track how germs are spread from surfaces. The findings are unnerving.
- In one series of experiments, 86% of workers were contaminated when spray or powder tracers were put on commonly touched objects in an office. When tracer powder was put on a bathroom faucet and exit doorknob, the glowing residue was found on employees’ hands, faces, phones and hair. From a shared phone, the tracer spread to desktop surfaces, drinking cups, keyboards, pens and doorknobs. A contaminated copy machine button added a trail of fluorescent finger prints transferred to documents and computer equipment. And just 20 minutes after arriving home from the office, the fake germs were found on backpacks, keys and purses, and on home doorknobs, light switches, countertops and kitchen appliances.
- A video making rounds on the internet shows how the black light experiment works. The glow germs are put on the hands of just one diner at a buffet, but by the end of the meal, everyone at the table has come into contact with the glowing germs. The video explains why scientists discourage the sharing of food during a viral outbreak.
- But while those experiments show how germs can spread on surfaces, the microbe still has to survive long enough and in a large enough dose to make you sick. Eugene M. Chudnovsky, a professor at the City University of New York, notes that surfaces are not a particularly effective means of viral transmission. With the flu, for instance, it takes millions of copies of the influenza virus to infect a person through surface-to-hand-to-nose contact, but it may take only a few thousand copies to infect a person when the flu virus goes from the air directly into the lungs.
- Dr. Chudnovsky, a theoretical physicist whose research has focused on the spread of the airborne infection, said a similar pattern is likely to be true for the new coronavirus, but the exact numbers are not known.
- “I believe the CDC is right when it says that surface transmission is not a dominant one,” said Dr. Chudnovsky. “Surfaces frequently touched by a large number of people, like door handles, elevator buttons, etc., may play a more significant role in spreading the infection than objects touched incidentally, like food packages delivered to homes.”
- The bottom line is that the best way to protect ourselves from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing our hands, not touching our faces and wearing masks.
- “Hand washing is important not only for fomite transmission, but also for person-to-person transmission,” said Dr. Daniel Winetsky, a postdoctoral fellow in the division of infectious diseases at Columbia University. “The respiratory droplets we produce when speaking, coughing and sneezing fall mostly onto our hands, and can fall onto other people’s hands if they are within six feet from us.”
Also See Surfaces Are ‘Not the Main Way’ Coronavirus Spreads, C.D.C. Says, which can be found at Not the Main Way
G. Concerns & Unknowns
1. The mystery of superspreaders
- A small percentage of people — called superspreaders — may be responsible for a large number of C19 infections, research is starting to indicate.
- Why it matters: While there’s no method to detect who these people are before they infect others, there are ways to control behaviors that cause superspreading events — a key issue as states start to reopen and debate what types of events are OK.
- The latest: Three recent studies by the London School of Hygiene & Tropical Medicine, Tel Aviv University and the Institute for Disease Modeling in Washington, which have not yet been peer-reviewed, came to similar conclusions: Roughly 10% of C19 cases appear to have caused around 80% of new infections.
- It reflects the law of the “vital few,” where a small number (between 5% and 20%) are responsible for the majority of cases, says Eric Topol, executive vice president of Scripps Research, who’s also tweeted about it.
- Indoor congregations — such as at churches, prisons, meatpacking plants and nursing homes — offer the highest risk, he says.
- “These places, they deserve even tighter scrutiny for contact tracing. … If you focused on tracing from these venues, these settings, that would be a wise use of resources,” Topol adds.
- Case in point: Allison James, a CDC epidemic intelligence service officer assigned to the Arkansas Department of Health, investigated a superspreader event in March at a church where 35 out of around 92 attendees fell ill, resulting in three deaths.
- Similar clusters of C19 cases have been reported in other places of worship, conferences, night clubs and parties.
- As states begin reopening, if people choose to attend in-person services, James says she hopes they follow CDC safety guidelines.
- “Superspreader events can sometimes give an outbreak a new trajectory, or allow it to sustain itself in a way that it wouldn’t” otherwise, Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security, tells Axios.
- What’s happening: Why some people are superspreaders remains unknown. The person’s genetics, immune system, how much virus they shed, and their behavior (such as how they speak, if they wash their hands often, if they socialize with large groups) likely play a role.
- Topol says research is targeting this phenomenon because “if we knew the genomics or immunologic markers that these people have, maybe there’s something we could do.”
- But Adalja says, “It’s less about the biology than it is about the habits and interactions that individuals with the virus have, and what types of events they go to which puts them into contact with many different people in a way that spreads the virus.”
- The bottom line: Understanding how superspreading works could help to fine-tune responses to the coronavirus pandemic — and curb it.
1. Heavily Criticized, Florida Leads the Way
- For a moment in April, the Internet tried to cancel Florida. Photos showing crowds flocking to Jacksonville Beach amid the C19 pandemic brought the hashtag #FloridaMorons to the top of Twitter. The media eagerly spun scenes of ignorant spring breakers endangering themselves and others. Nearly two months after America’s first case of coronavirus, here was Florida’s Republican governor, Ron DeSantis, joining neighboring state Georgia’s “experiment in human sacrifice” by letting locals lift restrictions on their own.
- Nearly a month later, Jacksonville’s Duval County reports new C19 hospitalizations in the single digits. Rates of hospitalizations, cases, and deaths remain steady across Florida. So far, fewer Floridians have died of the novel coronavirus than in New York’s nursing homes alone (2,259 compared with 5,800, at least). More than half of the state’s known cases of C19 are found in just four South Florida counties—the top out-of-state destinations for fleeing New Yorkers. As Politico recently concluded, “Florida just doesn’t look nearly as bad as the national news media and sky-is-falling critics have been predicting for about two months now.”
- There’s still a lot that we don’t know about mitigating C19, but Florida’s approach—a decentralized health response with targeted lockdowns and quarantines reinforced by voluntary social distancing—appears to have worked. Other populous states adopting this approach, such as Tennessee, have seen similar success. Governor DeSantis’s experience suggests that it is possible to keep a lid on the coronavirus even while gradually reopening.
- Florida is large and diverse. North Florida and the Panhandle are the reason for the saying that the farther north you go in Florida, the further south you get; the I-4 corridor, running from Tampa through Orlando to Daytona Beach, is pure Middle America. South Florida is the polyglot “New Havana,” a bubbling melting pot between the Gulf and Gold Coasts. Unsurprisingly, then, DeSantis gave counties leeway in responding to C19. “The epidemic is not going to affect this state uniformly,” he told National Review.
- Miami-Dade County, for instance, shuttered all its nonessential businesses before New York City, and it was local leaders who first closed many of Florida’s beaches and cracked down on large gatherings. When Florida did issue a stay-at-home order (two days after New York), it targeted the state’s 4 million seniors and residents with underlying medical conditions. Statewide rules issued on April 1 broadly limited “nonessential” activities and business, but by this point Floridians had already imposed their own restrictions on themselves.
- Meantime, the state government in Tallahassee was ramping up testing and issuing personal protective equipment (PPE), ultimately totaling more than 7 million masks and a million gloves. By late April, the state was conducting some 12,000 daily C19 tests, with capacity for more, and drive-through facilities alone had conducted more than 100,000 tests by early May. (New York, by contrast, was doing 20,000 tests daily in mid-April, at least 100,000 below what it needed, considering the size of its outbreak.) State-based labs were soon running 30,000 samples daily. Decentralizing testing has meant that Jacksonville’s testing volume, for instance, now runs far above federal guidelines. And the state’s rate of positive samples—a sign of testing capacity relative to size of outbreak—stands at 2.41 percent as of May 24, well below the World Health Organization’s threshold of 5 percent for safely reopening.
- Florida’s response to C19 focused on nursing homes. More than a third of the nation’s Covid deaths have occurred among the residents and staff of long-term-care facilities—a share that jumps as high as 80 percent in Minnesota and West Virginia. Florida counts more than 350,000 people living or working in such facilities, and the state has one of the highest shares of residents over the age of 65. At the start of the outbreak, Florida deployed rapid-response teams to these facilities to test, treat, and, if necessary, isolate or quarantine residents testing positive for the virus. The state issued PPE to these facilities and mandated its use. While New York was moving sick patients into nursing homes, Florida was moving them out. On March 15, DeSantis prohibited the transfer of C19-positive patients into long-term-care facilities and established Covid-only homes for getting residents out who could not be properly isolated or treated. By contrast, New York governor Andrew Cuomo—celebrated in the media, while DeSantis was condemned—required that infected patients be admitted into nursing homes, where Cuomo himself had said the virus could spread “like fire through grass.”
- As DeSantis saw growing numbers of cases from out-of-state visitors, he promptly ordered travelers to self-quarantine for 14 days, a measure that the governor believes “no doubt” saved lives. Florida’s targeted, data-driven approach to tackling the coronavirus may be the most realistic strategy when many are still trying to understand how C19 spreads—and how to stop it. The Department of Health produces a daily report for the governor tracking the outbreak and new hotspots, such as state prisons, or The Villages, a sprawling retirement community with more than 125,000 people, which hasn’t had a single resident hospitalized for more than a week. Contrary to what recent media coverage would suggest, Florida’s C19 open-data dashboard has earned praise from officials like Dr. Deborah Birx, the White House Coronavirus Task Force coordinator.
- DeSantis is not the only governor whose performance is largely uncredited. Tennessee’s governor Bill Lee is an unsung hero of the pandemic. Lee declared a state of emergency in March and told residents to “do your part, stay apart.” The state’s largest cities—Nashville, Memphis, and Knoxville—issued stay-at-home orders as cases appeared, but Lee held off on statewide mandates. Studies have since shown that such early, targeted lockdowns, combined with state guidance, appear to be more effective at mitigating the spread of the virus than late-stage total lockdowns. Lee focused on ramping up Tennessee’s testing capacity, ultimately hitting more testing benchmarks than any other state. During the height of the pandemic, Tennessee’s testing rate was three times that of neighboring Kentucky—and all tests were provided free of charge, regardless of symptoms.
- Lee’s performance—and its media treatment—contrast sharply with that of neighboring governor Andy Beshear of Kentucky. Louisville’s Courier-Journal has praised Beshear’s response while declaring that Lee has “taken more heat than Prince’s Hot Chicken for his slow response to the coronavirus outbreak.” Even an ocean away, Beshear won praise: the U.K.’s Guardian celebrated his “quick pandemic response, his calm, empathetic briefings” and likened him to “Mr. Rogers.” Yet Kentucky has now suffered more deaths than Tennessee from the virus, though the latter state’s population is half again larger.
- In states such as Tennessee and Florida, where lockdowns are ending, infection rates are declining, not increasing, as JPMorgan Chase found, “even after allowing for an appropriate measurement lag.” Rising case counts, where they occur, have more to do with increases in testing capacity than renewed outbreaks. This should encourage some humility from observers who feared the worst with reopening, especially in a media environment overwhelmingly concentrated in the blue, urban hubs that have suffered so much more from this viral outbreak than the redder states now likelier to reopen. Even today, after the virus has spread to all corners of the country, the Tri-State area alone accounts for 43 percent of the nation’s deaths. Indeed, the closer one gets to New York City, the higher the death toll from C19. No wonder that, at the height of the pandemic, some 420,000 people fled the Big Apple to its suburbs and to South Florida.
- Florida’s beaches and businesses are slowly opening, county by county, and life is returning to a semblance of normalcy. Retailers and restaurants, hair and nail salons, gyms and hotels are opening with reduced occupancy; soon, “phase two” will allow gatherings of up to 50 people and further loosen occupancy limits. Partially opened Tampa was among the first U.S. cities to let restaurants extend dining space onto closed streets and open sidewalks, helping them stay in business while preserving social distancing.
- Florida considers numerous factors in deciding when and how to reopen, such as whether the state is controlling the virus’s spread, containing new cases, ensuring hospital capacity, and monitoring vulnerable populations. It turns out that most Americans are not heedlessly returning to “normal” as viral videos suggest, but are wearing masks and social distancing on their own, including in Florida.
- The United States has reached a grim milestone: 100,000 deaths from C19. In addition to its toll in lives, the virus has also ushered in an economic downturn as deep as the Great Depression nearly a century ago, with more than 38 million Americans having filed for unemployment. Each state’s experience differs, with each paying its own price in lives or livelihoods. Governors should be judged by their own state’s record going into and coming out of this crisis. It’s a standard that surely elevates governors like Ron DeSantis and Bill Lee—and likely condemns Andrew Cuomo.
2. Leading UK Epidemiologist: “Pubs, Nightclubs, Restaurants Could Reopen Without Serious Risk”
- A prominent Oxford epidemiologist has reportedly called for a more rapid exit from Britain’s lockdown, saying the coronavirus pandemic is “on its way out” of Britain after infecting as much as half the population.
- Professor Sunetra Gupta says there would be a “strong possibility” that pubs, nightclubs and restaurants in Britain could reopen without serious risk from C19.
- The professor of theoretical epidemiology at the University of Oxford said the UK had most likely erred on the side of over-reaction in its handling of the crisis, suggesting imposing the lockdown itself was one such misstep.
- Prof Gupta told unherd.com the Government had brought in the lockdown based on the worst-case scenario modelling of the Imperial College London.
- In March, Imperial College’s workings suggested C19 had a deaths-to-cases ratio of as high as 1.4%, reducing to 0.66% when allowing for undiagnosed cases.
- Prof Gupta’s Oxford team produced a rival model, also in March, speculating as much as 50% of Britain’s population may have already been infected, and suggesting an infection fatality rate as low as 0.1%, which she says would be far lower now.
- Asked for her updated ratio, Prof Gupta said the epidemic had “largely come and is on its way out in this country” and that the [current fatality] rate would be “definitely less than one in 1,000 and probably closer to one in 10,000”, or between 0.1% and 0.01%.
- Prof Gupta said the Government’s defense of the lockdown was that it was based on a plausible, “or at least a possible”, worst case scenario.
- “The question is, should we act on a possible worst case scenario, given the costs of lockdown?
- “It seems to me that given that the costs of lockdown are mounting, that case is becoming more and more fragile,” she said.
- Prof Gupta called for a “more rapid exits from lockdown” based on factors such as “who is dying and what is happening to the death rates”.
- She said it was feasible Britain could have fared better with the C19 crisis by doing “nothing at all” or at least by concentrating on protecting the people most vulnerable to the disease.
- “Remaining in a state of lockdown is extremely dangerous from the point of view of the vulnerability of the entire population to new pathogens,” she said.
- “Effectively we used to live in a state approximating lockdown 100 years ago, and that was what created the conditions for the Spanish Flu to come in and kill 50,000,000 people.”
- Whilst accepting it is hard to prove on current evidence, Prof Gupta said there was a “strong possibility” the UK could return to normal without great risk.
I. Technology vs. Coronavirus
1. Can Apple Watch and Fitbit predict coronavirus?
- Research is expanding into whether wearable devices such as an Apple Watch or Fitbit could track a person with coronavirus or the flu, or perhaps detect and even predict the onset of disease in a wearer.
- The potential for such data-driven advances could be reassuring as the nation reopens after the shutdown to prevent the spread of the virus, which causes the C19 disease. More than 1 in 5 Americans (21%) already wear some type of smartwatch or fitness tracker, according to Pew Research Center.
- Fitbit has announced its own Fitbit C19 Study to “help determine whether Fitbit can help build an algorithm to detect C19 before symptoms start,” the company says in a recent blog post. It is seeking participants who are 21 or older and have had or currently have C19 or flu-related symptoms.
- Fitbit, along with Apple, is also collaborating with the Stanford Healthcare Innovation Lab on its C19 Wearables Study. “We hope to be able to predict the onset even before any symptoms start,” the researchers say on the Stanford study’s signup page.
- The Stanford lab is looking for people who use a wearable and have had a confirmed or suspected case of coronavirus, been exposed to a known or suspected case or are among frontline essential personnel such as health care workers or grocery store workers.
- In addition to Apple Watch and Fitbit wearables, the lab is also seeking wearers of Empatica and Garmin devices, Oura Ring, and other wearables that measure heart rate. (The study plans to have Android support for its MyPHD app so Galaxy Fit and Galaxy Watch devices can be used more easily. Currently, those devices must connect the Samsung Health app to Apple Health.)
- Also already underway is the Scripps Research Translational Institute’s DETECT (Digital Engagement & Tracking for Early Control & Treatment) Study to monitor heart rates as a possible way to detect and track coronavirus, flu and other viral infections. As in the other studies, users share the health data captured by the Apple Watch, Fitbit and Garmin devices. For more information on the study, go to the DETECTStudy.org site.
- Earlier this year, Scripps’ first study on using wearable device data to study flu outbreaks was referenced in The Lancet as “encouraging proof of concept in this direction.”
- Scripps researchers expanded the flu study to see if tracking of data (heart rate, activity, and sleep) using the MyDataHelps mobile app can help predict whether someone will eventually get the flu, C19 or other illness.
- “In light of the ongoing flu season and the global pandemic of C19, we see enormous opportunity to improve disease tracking for improved population health,” says Jennifer Radin, PhD, the epidemiologist leading the DETECT study.
- [NOTE: We’ve mentioned the necessity of buying a pulse oximeter to help monitor your oxygen saturation levels in the event you or someone you know becomes infected. Fitbit and Garmin sell smartwatches with pulse oximeter sensors, and Apple has the sensor but hasn’t activated the technology yet.]
J. The Road Back?
1. CDC Recommends Sweeping Changes to American Offices
- Upon arriving at work, employees should get a temperature and symptom check.
- Inside the office, desks should be six feet apart. If that isn’t possible, employers should consider erecting plastic shields around desks.
- Seating should be barred in common areas.
- And face coverings should be worn at all times.
- These are among sweeping new recommendations from the Centers for Disease Control and Prevention on the safest way for American employers reopening their offices to prevent the spread of the coronavirus.
- If followed, the guidelines would lead to a far-reaching remaking of the corporate work experience. They even upend years of advice on commuting, urging people to drive to work by themselves, instead of taking mass transportation or car-pooling, to avoid potential exposure to the virus.
- The recommendations run from technical advice on ventilation systems (more open windows are most desirable) to suggested abolition of communal perks like latte makers and snack bins.
- “Replace high-touch communal items, such as coffee pots, water coolers, and bulk snacks, with alternatives such as prepackaged, single-serving items,” the guidelines say.
- And some border on the impractical, if not near impossible: “Limit use and occupancy of elevators to maintain social distancing of at least 6 feet.”
- The CDC, the nation’s top public health agency, posted the guidelines on its website as states are beginning to lift their most stringent lockdown orders. Shops, restaurants, beaches and parks are reopening in phases. But white-collar office employees at all levels mostly continue to work from home, able to function effectively with laptops, video conferencing and Slack.
- You can read the CDC guidelines here: COVID-19 Employer Information for Office Buildings
- Some of the measures are in keeping with what some employers are already planning, but other employers may simply decide it’s easier to keep employees working from home.
- “Companies, surprisingly, don’t want to go back to work,” said Russell Hancock, president and CEO of Joint Venture Silicon Valley, a nonprofit think tank that studies the region. “You will not see the drum beat and hue and cry and rush to get back to the office.”
- Citing extreme examples like Twitter, which has said it may never return to corporate office space, Mr. Hancock said that he has heard similar things from both Silicon Valley companies and those outside the region. Many are planning to stay safe by thinning who is required to come to work, along with making plans consistent with the CDC guidelines.
- “Incessant disinfecting of surfaces, cleansing out your HVAC,” he said, referring to the ventilation system, “opening windows, ventilation, all of those things.”
- Tracy Wymer, vice president of workplace for Knoll, Inc., a large office-furniture company, who has been in discussions with numerous companies about the safest way to reopen, said he agreed with much of what the CDC was advising but he added that a big part of successful reopening would involve employee compliance.
- “The biggest factor is the work force and the personal responsibility they must take in making this reality work,” he said.
- The CDC addressed that part too, reiterating what has become a kind of national mantra: regular hand washing of at least 20 seconds; no fist bumps or handshakes; no face touching.
- The CDC recommended that the isolation for employees should begin before they get to work — on their commute. In a stark change from public policy guidelines in the recent past, the agency said individuals should drive to work — alone.
- Employers should support this effort, the agency said: “Offer employees incentives to use forms of transportation that minimize close contact with others, such as offering reimbursement for parking for commuting to work alone or single-occupancy rides.”
- Smaller companies also have already been discussing how to reopen, some with the kinds of ideas the CDC is recommending. But there are distinctive challenges in many offices. For instance, those that do not have windows that open to the outside, permitting ventilation; have little or no access to outdoor space; or are small and open, with floor plans that were de rigueur just six months ago and now are verboten.
- Peter Kimmel, the publisher of FMLink, a publication serving the facilities management industry, said that the CDC guidelines are “a good checklist of what needs to be done.”
- But they also raise numerous questions, he said, including how social distancing will work. “This means many fewer workplaces per floor, reducing the density considerably. Where will the remaining workers be housed? Will the furniture work in the new layout?” he asked.
- “While there are many solutions, these often require substantial thought and a budget that likely doesn’t exist,” he said.
- Mobify, a Vancouver-based company with 40 employees that helps build digital storefronts for major retailers, moved back into its office last week and has already made a number of the changes recommended by the CDC The building’s landlord now requires mask use in the elevator. Other changes the company made on its own.
- “One person per table. We put arrows on the floor so people will go to the restroom one direction and come out the other,” said Igor Faletski, the company’s chief executive. “No more shared food. Sanitation stations with wipes.”
- At the same time, he said, there may be a larger force at work: the impulses of the workers themselves.
- “Since we opened up last week, only five employees have come in,” he said. “Because the office is quite big, there was room for people to sit in different corners.”
K. Practical Tips & Other Useful Information
1. How to lower your risk at work, school and seeing friends
- The coronavirus is still circulating yet many countries are taking steps to relax restrictions. If you have been asked to return to work or send your children back to school, how can you minimize the risk of infection to yourself and your family?
- Although there are still many unknowns about the virus, a growing amount of data on how it transmits and survives on surfaces can guide our decisions.
- You are most likely to catch the coronavirus by spending a long time near an infected person in an enclosed space. Researchers in Guangzhou, China, examined how the virus was transmitted between 347 people with confirmed infections and the people they had contact with. They found that the risk of the infection being passed on at home or by repeated contact with the same person was approximately 10 times greater than the risk of passing it on in a hospital and 100 times greater than doing so on public transport (medRxiv, doi.org/dwgj).
- “The virus spreads more in communal areas with higher numbers of people passing through”
- Outside the home, it is difficult to rank the relative risks, because environments vary so widely. However, “what we can say is that the coronavirus spread tends to be higher in communal areas where there are higher numbers of people passing through, or in areas where there is more physical engagement with the surroundings, for example door handles, desks and computer keyboards”, says Seema Jasim at the MRC-University of Glasgow Centre for Virus Research, UK.
- The risk also seems to be higher when people are more physically active. Investigations into a cluster of cases in the South Korean city of Cheonan revealed that eight fitness instructors became infected with the virus after attending a 4-hour Zumba workshop. Some of them subsequently passed it on to students during classes which involved high intensity exercise in a small indoor studio (Emerging Infectious Diseases, doi.org/ggwpjz).
- “The moist, warm atmosphere coupled with turbulent air flow generated by intense physical exercise can cause more dense transmission of isolated droplets,” writes the team that conducted the study. However, students attending smaller yoga and pilates classes in the same space didn’t become infected.
- Regular, thorough handwashing is still advised. It remains unclear how long the virus can survive and remain infectious on surfaces, but this is still thought to be a significant route of transmission.
- “If surfaces have been contaminated with droplets from an infected person, there might be sufficient virus to infect a person who touches the surface and subsequently transfers the virus to their mouth, nose, eyes or face,” says Margaret Hosie, also at the MRC-University of Glasgow Centre for Virus Research. “However, if they wash their hands thoroughly with soap and warm water for a minimum of 20 seconds, any virus on their hands will be destroyed.”
- A recent study revealed that handwashing six to 10 times a day is associated with a 36% reduction in the risk of becoming infected with the coronavirus (Wellcome Open Research, doi.org/dwgk).
- Because soap dissolves the virus’s fatty outer envelope, washing with water but no soap isn’t as effective. Alcohol hand rubs work, but are only necessary where there is no access to handwashing facilities, says Hosie.
- Many people need or are being asked to travel to work, while in some countries exercising outdoors is permitted. So how can you minimise the risk in these circumstances?
- “Whatever you’re doing outdoors, a 2-metre distance [from other people] should be enough,” says Lena Ciric at University College London. This is based on observations that large, virus-packed droplets from infected people tend to settle within a few metres of their source. “Smaller droplets, carrying fewer virus particles, can travel further but will be dispersed by air currents quickly,” says Ciric.
- But more research is needed to understand the role of small, aerosol particles in transmitting the virus. A recent study suggested that droplets may be carried as far as 8 metres in clouds of moist, turbulent air, such as those produced by sneezing (JAMA Insights, doi.org/ggqtj4). The study didn’t, however, test if such clouds could transmit the virus or what would happen to similar clouds in an outdoors setting.
- For getting to work, modes of transport that avoid other people, such as walking, cycling or driving in your own car, are the lowest risk. Car sharing may be the next safest option, assuming the driver is only giving lifts to a limited number of people. Taxis carry numerous passengers, so there is a risk of contracting the virus from surfaces like seats and door handles, or from the driver speaking, coughing or sneezing.
- If these options aren’t available, that leaves public transport. People who travel on buses or trams during the winter flu season may be approximately six times more likely to develop a respiratory infection than those who don’t use public transport.
- If you do have to use it, there are things you can do to reduce your risk. The amount of time you spend near other transport users matters, says Anders Johansson at the University of Bristol, UK, who has modelled disease transmission in crowds and on the London Underground.
- Besides trying to avoid the busiest stations and travelling times, it is worth considering the amount of time you spend navigating stations. Those with long underground passages – especially if they involve encountering people walking in the opposite direction – are best given a wide berth, and changing trains is also best avoided. These “usually mean you spend a longer time in the station, and are mixed together with people coming from various different parts of the city, if not the country”, says Johansson.
- The risk of exposure may be slightly lower on buses, trains and trams with outdoor platforms, but once inside the vehicle, infection risk depends on how well passengers can spread themselves out and how many are getting on and off. “If you stand next to the door of the bus, there will be lots of people passing by you at close distance,” says Anders.
- Simulation of respiratory disease transmission on aircraft has found that moving around the cabin increases a person’s risk of encountering an infected passenger, while those seated by windows tend to have the lowest contact with other people.
- When travelling, continue to be mindful of surfaces. The aircraft transmission study identified tray tables, seat belts and lavatory handles as high-risk objects, but hand or grab rails, payment terminals and protective plastic screens can also harbour viruses.
- Countries vary in their advice on face coverings when getting about. So far, the evidence suggests there may be a small benefit to wearing some kind of face covering, as these seem to lower the extent to which sick people spread the virus. In addition, face coverings may help protect vulnerable people who temporarily enter high-risk places like hospitals – but using medical masks can deprive healthcare workers of protective equipment.
Risks at work
- There are reasons to be nervous about indoor workspaces. A study in Japan that followed up the contacts of 110 infected people concluded that the chance of catching the coronavirus in a closed environment is more than 18 times greater than in an open-air environment. Super-spreading events, where an infected individual passes the coronavirus onto many others, were also more likely to occur indoors (medRxiv, doi.org/dwgn).
- Some indoor environments may be riskier than others. During the C19 outbreak in Wuhan, China, researchers sampled air from various locations in two hospitals. Viral RNA was detected in an intensive care unit, in staff changing areas and in a small, unventilated toilet (Nature, doi.org/ggtgng). Hosie says poorly ventilated areas are likely to have a higher risk of infection. “Good ventilation means changing the air within the space regularly, not just cooling and recirculating the same air,” says Ciric.
- Another study from Wuhan revealed desktops, computer keyboards, doorknobs and hand sanitiser dispensers to be the most contaminated surfaces within hospitals. More virus was detected on these than on gloves, eye protection and face shields used in the hospitals (medRxiv, doi.org/ggqtpr). Regularly disinfecting high-contact surfaces and shared objects is therefore essential – as is washing your hands after touching them.
- Workplace schedules can also be tweaked to reduce the chances of people mixing. “Maybe everyone doesn’t need to arrive or go for their lunch break at the same time,” says Johansson. “You might not think that staggering the time when people start work is a big deal, but in the case of a big warehouse it could make a massive difference because you wouldn’t necessarily have a massive crowd waiting outside for when the door opens.”
- Clear plastic screens may be useful for workers whose roles mean they encounter large numbers of people and make social distancing difficult, such as supermarket checkout staff, pharmacists or medical receptionists. “In these settings, they would act as a physical barrier to airborne droplets,” says Jasim.
- But how effective they are depends on their size and how well they are fitted. “They can also become a risk if they are not regularly cleaned,” says Ciric. Face coverings may also benefit workers who need to interact with many people.
Returning to school
- From the data published so far, children seem less likely to acquire the infection than adults, and when they do, they are less likely to develop serious symptoms. Although a small minority do become seriously ill – including with a newly identified inflammatory syndrome – this is also true of many other viral illnesses.
- “In a pandemic, where so many people are being infected without any prior immunity, it is perhaps no surprise that some people are getting inflammation during the later stages,” says Saul Faust at the University of Southampton, UK. “We do need to understand it better. But what is clear is that for children, it is a very small number and they are almost all getting better, although some do need hospital treatment.”
- There is also little evidence of schools and nurseries being major breeding grounds for infection, so far – although this is difficult to assess because many countries closed their schools relatively early in the pandemic.
- Some new reassurance comes from a report by the Children’s Commissioner for England, whose team has interviewed the managers of 44 nurseries that are attached to NHS hospitals and have remained open. Three have reported a confirmed case of C19 in a child and eight have reported a suspected case, but they have found no evidence of child-to-child transmission within the nurseries.
- And although 19 nurseries reported a confirmed or suspected case of C19 among their staff, in 10 cases the manager stated that it wasn’t caught from the nursery, while in the remaining cases the source was unclear. Similarly, in New South Wales, Australia, just two out of 735 students contracted the virus after attending schools where there were nine infected children and nine infected adults.
- On the other hand, opening schools may prompt an increase in cases among the general population. Denmark, which reopened its primary schools on 15 April, did report an increase in the R number – the average number of people each case goes on to infect – from 0.6 to 0.9 in the following two weeks, but this has since dropped again.
- Even if children don’t seem to spread the virus as much as some people had feared, for some families, the risks of sending their children back to school or nursery will outweigh the benefits. “Of course, you have to consider each family’s circumstances, and the risk changes if you have a mum or dad who has cancer, or a grandfather who is living in the same house who has hypertension, or the only after-school childcare available to you is grandma, who has cancer,” says Faust. “But if it’s your child’s health you’re most worried about, the risk to them appears low.”
- However, waiting a while longer could reduce this risk even more. On 22 May, a group of independent scientists announced that modelling suggests that delaying plans to reopen schools in the UK on 1 June by two weeks would halve the risk to children, while waiting until September could reduce the risk even further.
Meeting up with friends and family
- Evidence suggests that infection in the home, and between family members, is a significant source of viral transmission, and visiting people at home is still not allowed in many countries. Because transmission risk is probably much lower in the open air and can be reduced by maintaining a distance of 2 meters, it is probably safer to meet with people from outside your household in uncrowded outdoor spaces.
- But what if you and a friend have both been strictly self-isolating? Would it then be safe to visit each other? Generally, you would expect any symptoms of an infection to have developed, and viral shedding to have largely ceased, 14 days after catching the virus. This may also be true of asymptomatic cases. “In both instances, at the end of the 14-day period they would be considered non-infectious,” says David Heymann at the London School of Hygiene & Tropical Medicine.
- This may suggest that, if you have remained at home for the past 14 days and had no external contact, you are unlikely to be carrying the virus.
- However, there have been reports of the virus persisting in the body for longer than two weeks. An analysis by US researchers calculated that 97.5 per cent of people who develop C19 symptoms do so within 11.5 days of exposure, but they estimated that for every 10,000 individuals quarantined for 14 days, about 101 of them would develop symptoms after this period (Annals of Internal Medicine, doi.org/dph3). A study in China reported incubation periods ranging from 0 to 33 days, and suggested an 18 or 21-day quarantine would catch far more cases (medRxiv, doi.org/dwgp).
- For this reason, people should remain cautious about visiting other people, especially if they know they have been infected or have encountered other infected people. Additionally, if either of you are in groups deemed vulnerable to C19, Heymann suggests you both wear masks as an extra precaution when getting together.
2. Quarantine Isn’t Making Us Gain Weight or Slow Down
- Are stay-at-home orders causing us to gain weight and lose activity? Are we sleeping less and checking our temperatures more? Working out or hardly working? We dove into data from around the world to find out.
- There is no doubt the pandemic has changed many people’s daily habits around the globe. But some common assumptions about the effect this is having on our bodies just don’t add up when we look at the data. Read on to find out the sometimes surprising lockdown lowdown on weight, sleep, activity, temperature, and night heart rate—and what this might mean.
Weight gain under quarantine
Everyone is making bread, but maybe they aren’t eating it?
- You can’t go on social media these days without being confronted by people showing off their culinary skills. Everyone suddenly seems to be making bread (and bragging about their starters), crafting decadent desserts, and producing elaborate meals. At the same time, these stay-at-home master chefs moan about all the weight they are surely going to gain. No doubt maintaining a healthy weight is important, but lots of articles talk of weight gain during this time like it’s a foregone conclusion, and how to avoid it. And when people share on social media that they’ve lost weight, others seem shocked, like it’s a magic trick to be able to do it at this time.
- But although many fear self-isolation is leading to excessive comfort food weight gain, Withings has found that, actually, most people haven’t put on that many extra pounds. In fact, in the U.S., only 37% of people have gained more than a pound, with the average U.S. weight gain at only .21 pounds (.095 kg). Other countries have seen similar weight gain trends of people gaining around a half of a pound or less. Globally, during self-isolation:
- United Kingdom: the average person has gained .35 lbs (.16 kg)
- Germany: the average person has gained .41 lbs (.189 kg)
- China: the average person has gained .55 lbs (.25 kg)
- Italy: the average person has gained .42 lbs (.195 kg)
- France: the average person has only gained .19 lbs (.084 kg)
- Obviously we can’t say for sure why this is. But perhaps it is because activity hasn’t decreased that much (more on that below), and perhaps it’s because research shows home-cooked meals are healthier because they cause people to eat more nutritious foods and take in fewer calories. So while we may be consumed by cooking and/or drooling over other people’s popovers, we aren’t packing on extra pounds.
Activity under lockdown
Maybe needing to walk around people makes you gain steps?
- There is no doubt that being cooped up makes getting enough steps a challenge. However, Withings found many Americans aren’t letting self-isolation completely slow them down.
- In the U.S., people have only decreased their daily steps by an average of 7% during self-isolation compared to 12% globally. New York, with its strict self-isolation guidelines, saw the largest decrease in daily steps —22%. Surprisingly, some states have even registered increases in activity. Average daily steps have been higher in Indiana (increased 16%), Connecticut (increased 11%), West Virginia (increased 9%), Ohio and Michigan (both states increased 6%), and Louisiana (increased 4%).
- How has activity been impacted in other countries? We got that.
- The United Kingdom has seen its activity levels impacted similarly to the U.S., with average daily steps decreasing by 8%.
- Germany has actually increased activity levels by 1% during self-isolation.
- China saw the biggest impact, with steps decreasing by over half (56%) in Hubei. However, now that the country has lifted its self-isolation guidelines, the country is back up to its usual average steps.
- Italy has also had a big decrease in daily steps, with their average steps decreasing by 28%.
- France is similar to Italy, seeing daily steps decrease by 27%.
Workouts when social distancing
Downward dogging and disappearing into the woods are all the rage…
- How are people staying active? Not much of a surprise here. YouTube yogis have seen great growth during the pandemic, and in our data, hard same.
- Globally, people have really ramped up their yoga (increased by 42%), started hiking more (increased by 34%), hit the indoor cycles (increased 19%) and are running more (increased by 18%). Activities that include special equipment, gym access or specific courts have clearly taken a hit, including playing tennis (decreased by 66%), swimming (decreased by 53%), playing badminton (decreased by 50%) and running indoors (decreased by 39%).
Sleep & self-isolation
Tons more sleep when stuck at home—a pipe dream?
- Schedules have been upended and many people are reporting bouts of insomnia, as well as especially vivid dreams they’re having faced with the threat of C19.
- But although we are closer to our beds than usual, Withings data shows that people aren’t sleeping a lot more. Americans are, on average, sleeping just 12 minutes longer a night than before self-isolation. In terms of going to bed, Americans are, on average, going to bed 11 minutes later than usual and waking up almost 26 minutes later than usual. No doubt not needing to get kids to school or make a morning commute is leading to a later wake-up time.
- Withings Sleep Score is a measurement users get each morning of their previous night’s sleep. It shows how well they slept overall. They receive a score out of 100 points based on 6 key inputs, including duration of sleep, regularity of sleep and number of interruptions. In the U.S., Withings users have seen their Sleep Score increase by an average of 2 points during self-isolation.
- As for sleep in other countries, it’s interesting that the country that has gained the least weight (France) has also seen the biggest sleep increase. The effect of sleep on weight is one we’ve seen many times. Here are the details:
- United Kingdom: sleeping an average of 15 minutes more per night. Sleep Score increased by 2.58 points. People in the U.K. to bed around 8 minutes earlier than usual and woke up 9 minutes and 25 seconds later.
- Germany: sleeping around 8 minutes and 27 seconds more per night. Sleep Score increased by 1.94 points as people went to bed almost 11 minutes earlier than usual and woke up 1 minute earlier than usual.
- China: slept an average of 17 minutes and 25 seconds more per night during self-isolation. Sleep Score increased by 2.12 points, as bedtime was 12 minutes and 38 seconds later than usual and wake time around 32 minutes later than usual.
- Italy: sleeping around 17 minutes and 39 seconds more per night. Sleep Score increased by 2.76 points. Users in Italy went to bed 2 minutes and 23 seconds later than usual and woke up 23 minutes later than usual.
- France: had an average of 20 minutes and 40 seconds more sleep each night. Sleep Score increased by 3.09 points. We see users went to bed less than a minute earlier than usual and woke up 23 minutes and 27 seconds later than usual.
Overnight Heart Rate
Declaring “last call” may have made hearts beat slower…
- An elevated or abnormal sleep heart rate could be caused by a number of short-term factors, including the use of tobacco or alcohol before bed. Other causes may include stress, vigorous exercise before bed, room temperature, or illness. Elevated sleep heart rate is particularly prevalent during weekends when alcohol consumption is most common.
- Now, with many bars closed, distilleries making hand sanitizer, and scores of beer kegs not being drunk after events were cancelled, it is perhaps not surprising that according to Withings data, during self-isolation, people have had fewer sleep heart rate anomalies or irregularities, especially on the weekends. In the U.S., night heart rate anomalies have decreased by 43% during the weekends and by 34% during the week. This compares to a global decrease of 45% on the weekends and 34% during the week.
- Looking at other countries, we saw a similar decrease.
- United Kingdom: night heart rate anomalies have decreased by 44% during the weekends and 38% during the week.
- Germany: night heart rate anomalies have decreased by 44% during the weekends and 27% during the week.
- China: night heart rate anomalies have decreased by 30% during the weekends and—surprisingly—increased by 3% during the week.
- Italy: night heart rate anomalies have decreased by 66% during the weekends and 54% during the week.
- France: night heart rate anomalies have decreased by 60% during the weekends and 50% during the week.
Some think they’re hot…
- With fever being a major symptom of C19, people have been, quite understandably, rushing to take their temperatures. The use of our smart temporal thermometer, Withings Thermo, nearly tripled in the early weeks of the outbreak, with people taking their temperatures multiple times a day. However, despite concerns, those registering fever temperatures have not changed compared to the seasonal norm.
- We hope this data helps shed light on our current situation. For more, see our recent blog post on how to stay healthy at home.
- This study was conducted by Withings, analyzing the anonymous aggregated data from over 2 million users, with at least 100,000 in each country. To create the data around the self-isolation time period for each country, Withings set each country’s start of self-isolation and included data from that date to April 18, 2020. The self-isolation data was compared to aggregated data from January 1, 2020, to the self-isolation date for each country.
- We hope this data helps shed light on our current situation. For more, see our recent blog post on how to stay healthy at home.
[Note: While we find the data interesting, we are skeptical that the customers of Withings represent average Americans. For example, it seems unlikely that many Americans would buy expensive scales or other health-related equipment. We note that some news media stories are reporting that the average American has gained 5 pounds during the lockdowns, which is a materially different conclusion than reached by Withings.]