🦠 COVID-19: do it for the 80 million children

📊 Daily Data Brief: June 17, 2020, 06:03 GMT (❗️Previous data: June 14, 2020, 05:58 GMT)

Cumulative case: 8,265,174 (+392,490cumulative cases 

Active cases:  3,496,367 (+98,624) (this is the number of currently infected patients)

Total Deaths:  446,149 (+13,674)

Serious/Critical Cases: 54,592 (+485)

Recovered:  4,322,658 (+280,192)

Source: Worldometers

1) Seven-day rolling average of new deaths (ECDC data).

Showing a chart from the FT today highlighting the worrying situation in Brazil, Mexico, India and Russia and Iran (NEW❗️). 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)


The US seems to have accepted the new normal of 20,000 new cases per day (as covered in two articles and a Twitter thread) while Beijing is going back into lockdown for 137 cases over a week (one article).

A lot of people are talking of the second wave, while we are still drowning in the first one. As we fail to be decisive in our actions individually, regionally and at the federal level we are putting 80 million children around the world at risk as their vaccine programme from non-COVID19 diseases have come to an end from lack of resources (one article). A very thoughtful and comprehensive article on the mental toll that this pandemic has taken on the younger generation during lockdown. Two further powerful incentives to do all we can to suppress COVID-19 as fast as we can and with the measures we know to work.

On the more positive side, a trial in the UK found that the cheap steroid dexamehtanose could save lives in patients needing oxygen or ventilation. It is the most promising news on the drug side since the start of the pandemic. A number of people are still holding judgment until the full data is released, particularly following high-profile study retraction on hydroxychloroquine recently. A great thread and interview of Carl T Bergstrom one of the more skeptical voices on the study.

Bob Wachter also reminds us that we should not expect seasonality given the recent rebound in cases in warm US states. We should have known this from the Brazil epidemic for a while… It appears that hope more than reasons and responsibility is driving our assessment of where we stand.

We urgently need to do it to save lives near us from COVID-19 and for millions of children around the world from other vaccine-preventable diseases.


🦠Article of the day: Andrew Joseph writes “Rising Covid-19 cases and hospitalizations underscore the long road ahead” for STAT news. (Link)

A sobering article on what lies ahead in the US, as cases flare up in certain states upon reopening. It looks as if Americans are accepting the 20,000 or so new cases per day as the ‘new normal’ and it seems unlikely for now that governors would revert to shelter-at-home holders in the future.

A number of governors claim they have built enough spare ICU capacity to handle a surge. Even though some states have built up a testing-tracing capacity during the lockdown phase, in most cases it has not reached the required level for successful containment of flare-ups. As Joseph points out, it is misleading to claim that the higher case numbers in the US is simply due to increased testing and not a cause of particular concern. Worryingly, the positive rate of tests has also recently gone up implying that a lot of the virus spread is not captured by authorities.

We have yet to see the potential spread form the protests in the data given that hospitalisation is often 12 days from infections.

As the title says it is “the long road ahead”.


🦠 Tweet of the day: Bob Wachter (Chair of Medicine at UCSF) tweets a sobering set of charts showing rebound in cases in US States where outside temperature is already high.

What is rather surprising is that there was still widespread hope that there would be a recess in the summer. A bit like the concept of ‘Second Wave’, the seasonality of a virus is anchored in people’s mind as to follow that of the flu, even though the ‘it’s like the flu’ when talking about SARS-CoV-2 has subsided.

Bob Wachter @Bob_Wachter
Hope that the "virus will go away in summer" is fading fast. (Charts:
nyti.ms/39ZbBaG; #=total cases, shaded=last 14d). Virus is unchanged and ~95% of people remain vulnerable. If we return to our old ways, zero reason to believe we won't see a surge in cases and deaths.

🛑 Thread of the day: Professor Kilpatrick (Dept. Ecology & Evolutionary Biology, UCSC), writes a thread which could be titled: “What now?” (Twitter thread).

The first tweet lays out a no-nonsense assessment of what our options are. Unfortunately and as Kilpatrick narrates in this tread we are not doing very well o the alternatives.

Kilpatrick highlights two paths forward to contain SARS-CoV-2 whilst avoiding lockdown:

As Joseph noted in his article of the day, time has been too short to build up ‘T-CT-I’ and states/countries have fallen short for now. While getting where they need to is complex, it is doable as other countries have shown.

T-CT-I capacity will continue to build but will require additional time. Whilst ‘Personal behaviour’ seems the short term viable option, Kilpatrick makes a grim but true assessment:

For him public messaging is the area which needs focus and funding, if we are to avoid a disaster and put to waste all the sacrifices of the first lockdown.


💊 The RECOVERY trial on dexamethasone:

The Press: Michelle Roberts writes “Coronavirus: Dexamethasone proves first life-saving drug” for the BBC. The headline was emphatic and objectively no drug before dexamethasone had a legitimate claim to such a headline.

As we will see below, some lamented the partial data release of the news, while others thought that it was important to release early to save lives. The good news if the preliminary data released is peer-reviewed and confirmed is that the drug is cheap (£5.40/day), readily available and easy to administer. The study led by Peter Horby at Oxford University claims that it saves 1 in 8 lives amongst patient requiring a ventilator, and one in 25 lives for patients requiring oxygen. (Link)


Let us turn to more critical assessments of the press release on dexamethasone

Twitter Thread 1:Dr. Nahid Bhadelia (infectious diseases physician at Boston University)

Bhadelia’s main criticism is that the data and methodology have not been shared alongside the release. On balance her summary is positive:

Twitter Thread 2: CT Bergstrom (Professor of Biology at University of Washington and author of forthcoming book “Calling Bullshit”) is a bit more critical.

Like Dr Bhadelia he would like to see data and methodology and laments the sensational headline as he correctly states that more objectively "It's an incremental step, not a panacea.”


Contrasting policies and politicisation of science:

🇨🇳 Stephen McDonell comments on “Coronavirus in Beijing: 27 neighbourhoods not allowed to leave as spike continues” for BBC News. What a difference of headline and policy measures taken for the flare-up of cases in Beijing (137 news cases in the past week) versus for example the 1,000 new daily cases in Arizona.

While US states reopen with far higher daily case number, and potentially less test-trace-isolate capacity than in China, this recent flare up has prompted the following restrictions in Beijing:

“At least 27 neighbourhoods have been classed as medium risk and one neighbourhood, near the market, is high risk.

People in medium or high-risk areas cannot leave the city. People in low-risk areas can leave, but need to test negative first.”

It begs the question as to why US states and China have such different policies with the same virus. (Link)

📃 Denise Show writes “Science, politics and trolls: How Carl Bergstrom became a voice of clarity on the coronavirus” for NBC news. This is a great interview of a professor of biology who has been a stellar contributor during this pandemic working up to 100 hours a week to inform the public. As Chow summarises:

“Bergstrom has been using his platform to cut through the politics to educate the public, elevate the voices of other scientists and fight back against claims that are misleading or downright false.”

Bergstrom has been surprised by the level of politicisation of the pandemic. In a passage, he points out that climate researches have taken his surprise as naïveté:

“I was saying, ‘I can’t believe this is politicized — it’s just science,’ and the climate change people were just rolling their eyes,” he said. “I’m sure they were like, 'You poor, innocent biologist, you have no idea.'”

This pandemic has and continues to expose the sub-optimal interfaces of science with the public and policy makers, and how this might have sadly resulted in worsening the crisis. The parallel with climate risk while relevant is somewhat worrying.

Great interview of someone who has contributed relentlessly to combat misinformation and shown how a platform like Twitter can also allow such an important work to be done and disseminated at scale. Unfortunately, he does not comment whether the benefits outweigh the drawback. Maybe it will be something he covers in his forthcoming book, or maybe he believes that it can only be solved at the individual level with methodology and will. (Link)

🇺🇸 Scott Gottlieb and Yuval Levin write “New Rules for Covid Summer: Be Flexible and Vigilant” for the Wall Street Journal. A very sensible article outlining a pragmatic way forward in a country “with such fractured politics”, but also within a timeline which few amongst both the public and leaders seem to accept:

“This new phase of the pandemic doesn’t pose a binary choice for the country. It requires leaders to respond to both scientific evidence and public opinion in measured, flexible ways—to help build the patience to get through what could be a hard fall and winter.”

(Link)

Collateral damage in children:

🧒 Andrea Petersen writes “The Toll That Isolation Takes on Kids During the Coronavirus Era” in the Wall Street Journal. A thoughtful and comprehensive article on the psychological toll which physical distancing is taking on the younger generations:

Dimitri Christakis, a director of the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute says:

“It is immensely important to be physically present the younger you are. Social emotional learning happens when they are physically present with peers learning to negotiate and share. You can’t do that over Zoom.” 

When the debate raged about school reopening, the mental health aspects raised in this article were either taking second stage or not mentioned at all. It is time to bring them more prominently in the debate as the science around SARS-CoV-2 and children continues to advance. (Link)

❗️Jan Hoffman and Ruth Maclean write Slowing the Coronavirus Is Speeding the Spread of Other Diseases” in the New York Times. The focus on COVID-19 pandemic has depleted resources to fight other diseases such as measles, diphtheria, poliovirus and cholera. What is at stake:

“At stake is the future of a hard-fought, 20-year collaboration that has prevented 35 million deaths in 98 countries from vaccine-preventable diseases, and reduced mortality from them in children by 44 percent, according to a 2019 study by the Vaccine Impact Modeling Consortium, a group of public health scholars.”

This shows how dependent poorer countries are on public health international assistance and how sadly their population, and in particular children are suffering from the lack of resources to fight a pandemic and other dangerous vaccine-preventable diseases at the same time.

Some countries are restarting their vaccine programmes. Mr. Maphosa, a Managing Director at GAVI (a public–private global health partnership with the goal of increasing access to immunisation in poor countries), said,

“If the pandemic cleared within three months, he believed the international community could catch up with immunizations over the next year and a half.”

When you wear a mask, social distance, work from home or follow recommended hygiene measure, do it to saves lives around you, but also thinking about the 80 million children whose vaccinations within the year will depend on rapidly containing the COVID-19 pandemic.

(Link)

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

  1. 💉 (❗️NEW) “Coronavirus Vaccine Tracker” by Jonathan Corum and Carl Zimmerfrom the New York Times.

    “The status of all the vaccines that have reached trials in humans, along with a selection of promising vaccines still being tested in cells or animals.”

    (Link)

  2. 🇺🇸 (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.”

    (Link)

  3. 🦠  “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.”

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

  5. 🇺🇸  “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)

  6. 🌎 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)

  7. 🇺🇸  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)

  8. 💊 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)