🦠 COVID-19 | Caring for the long haul

📊 Daily Data Brief: (June 05, 2020, 10:31 GMT) (❗️Previous data: June 03, 2020, 03:14 GMT

Cumulative case: 6,721,612 (+236,041cumulative cases 

Active cases:  3,062,807 (-16,714) (this is the number of currently infected patients)

Total Deaths:  393,548  (+8,864)

Serious/Critical Cases: 55,459 (+931)

Recovered:  3,265,257 (+241,619)

Source: Worldometers

1) Seven-day rolling average of new deaths (updated daily as ECDC releases). Major update with per country graphs now available (Link) (USUKFranceGermanySweden,  Nordic Comparison)

Showing a chart from the FT today highlighting the worrying situation in Brazil, Mexico, India and Russia. Also the FT comparative charts now allow up to 6 countries

2) Rt estimate per State (US) and per country (NEW❗️). This is a new resource link in the data section from a team which has led accuracy in modelling fatalities in the US for the past few weeks. (Link) 

Today’s edition looks at the long-haul.

It starts with an excellent article and Twitter thread of Ed Yong in the Atlantic on the long term effect suffered by these patients which are accounted for in worldwide statistics as ‘recovered’. We still know so little in this area which is one more reason why “herd immunity as strategy” pursued by both the UK (at the beginning) and Sweden are unconscionable.

The Tweet of the day focuses at SARS-CoV-2 transmission through the eyes. Just as universal masking seems to be taking hold around the world, is this going to be the next battleground. It would only seem fitting that we all go publicly around in batman disguise to protect us from bat coronaviruses.

As the economies re-open, businesses need to think about how to best protect their employees and an article in STAT news does a super job at looking at what employers can successfully do for increase safety in the workplace.

Men are more affected than women in this pandemic and researchers are looking at “sex hormones” for clues and treatments.

A well researched article in FT Alphaville dissecting the recently published minutes of UK SAGE, and trying to infer from them the UK non-sensical strategy. A word of caution discussing the article in not trying to draw the wrong conclusions as to accountability or who to blame from reading it. On the same topic Jon Cohen looks at whether scientists have been sufficiently consulted in Trump’s task force shortlisting 5 vaccines and the resulting billions of dollars which these firms will receive. Finally, the Guardian runs investigative journalism piece on the now retracted hydroxychloroquine study published by two peer-reviewed journals.

Finally a must watch podcast led by Bob Wachter at UCSF. If you are not convinced read the Twitter thread outlining what is discussed.

🦠 Article of the day: Ed Yong writes “COVID-19 Can Last for Several Months” for the Atlantic. (Link)

The past articles of Ed Yong have featured in previous editions of the Corona Daily and this new one deservedly appears today. It narrates the story of patients who have suffered ‘mild’ COVID-19 and are accounted in the 3+ million of recovered patients. And yet these feel that even after over two months they do not have their life back and are limited in their activities whilst they recover from COVID-19. Yong compares them to the patients diagnosed with Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) which is a serious, long term illness which affect between “836,000 to 2.5 million people in the U.S. alone” according to the Institute of Medicine.

Similar, to what we are discovering about COVID-19, ME/CFS affects many body systems. The long term and somewhat debilitating effects of COVID-19 has not been heavily featured in the pandemic coverage, and yet its existence has wide policy implications:

“Some survivors will have scar tissue from the coronavirus’s assault on their lungs. Some will still be weak after lengthy stays in ICUs or on ventilators. Some will eventually be diagnosed with ME/CFS. Whatever the case, as the pandemic progresses, the number of people with medium-to-long-term disabilities will increase.”

The medium-to-long-term disabilities witnessed for a number of COVID-19 infected individuals is another reason why “herd immunity as strategy” (the “Swedish Model”) is unconscionable. And yet, as reported in yesterday’s edition it is only when Sweden became the country in the world with the highest per capita death, that Andres Tegnell finally conceded that given what he knows now, his policy was inadequate. It is not even clear that he was taking into account the ‘long-haulers’ depicted in Yong’s article.

Similarly, these long term side effects should weigh significantly against conducting human challenge trials to potentially accelerate vaccine development, particularly as a lot of these ‘long-haulers’ are young patients.

🦠 Thread of the day: Ed Yong goes further and offers a number of references and links for people wanting to go deeper into the long term side effects of COVID-19 including on ME/CFS. (Twitter thread)

🏛 Tweet of the day: just as a number of countries have come around to enforcing universal masking at least in certain public places (with the U.K. one of the latest in public transport), Eric Topol tweets about the risk of transmission through the eyes.

Eric Topol @EricTopol
Why this recent systematic review paper highlighting eye protection is so important
thelancet.com/journals/lance… @TheLancet Even though #SARSCoV2 goes for the nose, it can also get in via the eyes med.umich.edu/kec/pdf/corona… @umichmedicine

🏢 Rajaie Batniji  writes “Optimism not evidence is driving America’s return-to-work strategy” for STAT news. A very exhaustive look at effectiveness of different strategies employers can use to protect their employees (including highlighting the severe limitations of the commonly spread temperature check). Batnijii looks with statistical evidence when available at both “Keeping infected individuals out of the workplace” and “Limiting spread from infected individuals in the workplace”. A very informative read for employers. (Link)

🙍‍♂️ Meredith Wadman writes “Why coronavirus hits men harder: sex hormones offer clues” in Science. She looks at emerging evidence that there could be a potential link between androgens (males hormones such as testosterone) and onset and/or severity of COVID-19. It is why some articles have appeared in the more popular press talking about a link between male baldness and probability of COVID-19 infection.

Scientists and doctors researching the field of androgen-induced conditions such as male baldness and also prostate cancer are already studying this area and trials are underway in the US with an androgen-suppressing drug degarelix. To be continued. (Link)

🏛 Izabella Kaminska writes “Making sense of nonsensical Covid-19 strategy” for FT Alphaville. This is a thorough piece of journalism combing through the Scientific Advisory Group for Emergencies (SAGE) released by the UK government last Friday. Firstly, the UK government must be lauded for releasing them. However and as I will argue maybe timeliness of these releases might actually play in its favour.

I strongly encourage you to read the article, but I think it is equally important to make some observations about the distinction between scientific advice, science and policy making so as not to draw hasty conclusions seeking to apportion blame or absolve any of the three.

For a start, it is important not to confuse science and scientific advice, and to equally think about the interfaces of science, scientific advice and policy makers. It would therefore be wrong to equate SAGE advice with scientific advice (scientific advice could be given in a less structured or more transparent manner for example - such as Independent SAGE) let alone Science. Equally looking at the minutes of SAGE should not absolve theUK government from accountability of its policy under an oft-repeated and convenient slogan like “following the science”.

As the President of the UK Royal Society powerfully argued there is a difference between Science and scientific advice, and "no such thing as following “the” science”. As Venki Ramakrishnan rightfully noted the trust in science stems from "honesty, openness and transparency".

It would equally follow that it is desirable to apply the same principles of "honesty, openness and transparency" at the interfaces of science, scientific advice and policy making. It would serve the policymakers and science in building trust with the public. By doing so the interfaces could be scrutinised and challenged. Not doing so will only result in reducing trust in Science as shown in a recent survey.

Scientific advisors and scientists should insist upon it. Some of the recent public dissent on the UK reopening from members of SAGE should therefore be welcome as going towards more "honesty, openness, transparency" at these interfaces, and the minutes only reflecting the majority consensus of SAGE meetings for a start. (Link).

💉 Jon Cohen writes “Top U.S. scientists left out of White House selection of COVID-19 vaccine shortlist” in Science. Cohen reports on the selection by “Operation Warp Speed” of 5 vaccine candidates from a previously assumed shortlist of 14 candidates.

First the lucky shortlisted are: Moderna, Merck, Oxford/Astra Zeneca, Johnson& Johnson and Pfizer (even though the CEO of the latter has been publicly quoted as being reluctant to take third party money: “We believe we can move faster if we don't have to involve a third party”).

Given that significant public money is involved (several billions of US Dollars), a number of scientists were hoping for more “honesty, openness and transparency". It seems according to the few cited in the article that it has not been the case. One of the most stinging criticism is the fact that these 5 selected vaccines rely only on 3 available technological vaccine platforms and moreover as noted by one of the vaccine researcher at the Baylor College of Medicine :

“Hotez notes that only one of the three technologies reportedly chosen by Warp Speed has led to a vaccine currently on the market: a VSV-based Ebola vaccine approved 6 months ago. “If I were in charge, I would focus, one, mostly on candidates that have a proven track record of making it to licensure, and two, candidates that are going to achieve high titers of virus neutralizing antibodies.”

Even though the novel platforms are the ones which are likely to be the speedier and the ones which China does not have access to, the article suggests that more transparency would have potentially led to a better outcome. (Link)

📃💊 Melissa DaveyStephanie Kirchgaessner and Sarah Boseley write Surgisphere: governments and WHO changed Covid-19 policy based on suspect data from tiny US company” in The Guardian. This is a follow-up article to the controversy on the now retracted study on hydroxychloroquine which governments and the World Health Organisation (WHO) had relied upon for their policies or to suspend clinical trials respectively.

Even though the WHO has now resumed its trial and the actions leading to the paper retraction have been swift, the controversy raises a number of issues which Professor Peter Horby (Nuffield Department of Medicine, University of Oxford) summarises well at the end of the article:

“The very serious concerns being raised about the validity of the papers by Mehra et al need to be recognised and actioned urgently, and ought to bring about serious reflection on whether the quality of editorial and peer review during the pandemic has been adequate. Scientific publication must above all be rigorous and honest. In an emergency, these values are needed more than ever.”


🎬 “Special Medical Grand Rounds” with Bob Wachter (Chair of Medicine, UCSF) (1h 14 min)

“In this UCSF Medical Grand Rounds presentation (June 4, 2020), four world-renowned experts discuss the wide-ranging implications and challenges of the Covid-19 pandemic with regard to the healthcare system, the economy, race, politics, ethics, and history. What will the lasting changes be? What can we learn from history?”

There is also a great Twitter Thread to convince you to watch the whole grandstand over the weekend (8 min read)

📊 A picture is worth a thousand words:  Global (🌎) and local (with relevant flag) visualisation and forecasting tool

  1. 🇺🇸 (NEW❗️) “The COVID Racial Data Tracker

    “The COVID Racial Data Tracker is a collaboration between the COVID Tracking Project and the Antiracist Research & Policy Center. Together, we're gathering the most complete race and ethnicity data on COVID-19 in the United States.”


  2. 🦠  “Science Forum: SARS-CoV-2 (COVID-19) by the numbers” (Link)

    “The COVID-19 pandemic is a harsh reminder of the fact that, whether in a single human host or a wave of infection across continents, viral dynamics is often a story about the numbers. In this article we provide a one-stop, curated graphical source for the key numbers (based mostly on the peer-reviewed literature) about the SARS-CoV-2 virus that is responsible for the pandemic. The discussion is framed around two broad themes: i) the biology of the virus itself; ii) the characteristics of the infection of a single human host.”

  3. 🇺🇸🌎 This model has led accuracy for several weeks in the US. It also does projection for Europe and Rest of the World. (Link)

  4. 🇺🇸  “Is your community ready to reopen?”: A map of the US (50 states and 2,100+ counties) looking at reopening risks with metrics around 3 criteria: 1. Is COVID in retreat? 2. Are we testing enough? 3. Are our hospitals ready? (Link)

  5. 🌎 The Financial Times (visualisation) has a data tracking page which is in front of the paywall, looking at cases and fatality curves for selective countries and metropolitan areas/region. It is not as extensive as the Madlag link below, where you can see static as well as animated images for a greater number of individual countries. (Link)

  6. 🇺🇸  The Johns Hopkins University resource center was the first one I used back in January they have now made available in their latest iteration a county by county dashboard in the US including information about health capacity, insurance coverage, ethnicity and age breakdown of the populatio (Link)

  7. 💊 The "Map of Hope" provides a geographical overview of planned, ongoing and completed clinical trials. It is put together with data from WHO Clinical Trials Search Portal by the Heidelberg Institute for Geoinformation technology. (Link)