🦠 COVID-19 | Masks unmask societies

📊 Daily Data Brief: July 08, 2020, 12:16 GMT (❗️July 05, 2020, 04:43 GMT)

Cumulative case: 11,981,366 (+595,221cumulative cases 

Active cases:  4,508,163 (+100,552) (this is the number of currently infected patients)

Total Deaths:  547,325  (+13,755)

Serious/Critical Cases: 58,238 (-247)

Recovered:  6,925,878 (+480,914)

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)  (NEW❗️changed to RT.live which offers better visualisation of States above whose Rt>1)

3) Rt estimate per Country

The President of the Royal Society speaks up on masks (Article of the day).

The US surge continues (Thread 1), and whilst death numbers are not yet as alarming as the cases surge, experts expect fatalities to follow soon (Video of the day). T-Cell-based immunity whilst important is unfortunately unlikely to be a silver bullet (Thread 2), and the latest Spanish sero-prevalence study makes (if it was still needed) herd immunity as strategy even more unconscionable and adherence to public health measures (the 3 Ws) all the more urgent. Melbourne and Israel citizens having to restrict their lives again after believing that it was “Mission accomplished” is a warning to any individual or region letting up its guard now (Tweet of the day). It is also the tale of California as told by Bob Wachter in the podcast of the day.

School re-openings are a key debate and there is a super article in Science reviewing the key questions and what lies ahead. Novavax vaccine is added to Operation Warp Speed further diversifying the vaccine platforms backed by the US government program.

Overdose are sadly on the rise in the US.

Two articles on science denialism, looking at the valiant and human effort of public health experts with another great article by Ed Yong, but also a belief by H. Holden Thorp that sophisticated data driven platform are need to win agains the deniers and support scientists.

And finally a must read and wonderful article by historian Ada Palmer. As ‘free’ societies expose how insurmountable getting citizens to make the simple and life saving gesture to wear a mask is, it should force all of us into a needed and urgent introspection. It is then up to us to build and reveal the future society we want when it will be safe to unmask again.

😷 Article of the day: “President of the Royal Society urges everyone to wear a face covering” (Link)

In a previous interview of Venki Ramakrishnan on the Andrew Marr show on May 24, it was clear that the President of the Royal Society was in favour of mask wearing in public places.

The article cites two recent studies (here and here), one of which was commissioned by the Royal Society to support the President’s recommendation. The article focuses, or even faults, public messaging thus far for not getting wider uptake on mask wearing particularly in the UK:

“People may rightly ask why you have to wear a mask on a train but not in a shop.  If guidance is inconsistent people will follow their own preferences.”

It also makes the more complex case, that wearing a mask indirectly protects oneself by uniting against the virus and reducing its spread amongst the population:

“If all of us wear one, we protect each other and thereby ourselves, reducing transmission. We lower the chances of future surges and lockdowns which are economically and psychologically disruptive, and we increase the chance of eliminating the virus. Not doing so increases the risk for everyone, from NHS workers to your grandmother.”

In the report commissioned by the Royal Society “Face masks and coverings for the general public: Behavioural knowledge, effectiveness of cloth coverings and public messaging” there is also the result of a poll on mask wearing where the UK fares poorly:

“The SET-C report highlights how far the UK is trailing behind other countries in terms of policy implementation and wearing face coverings.  In late April uptake in the UK was around 25%, compared to 83.4% in Italy, 65.8% in the United States and 63.8% in Spain. All countries, that like the UK, do not have an established culture of face mask wearing, but did have clearly mandated policies.”

It will be interesting to see whether better public messaging, like this powerful recommendation with accompanying evidence, will have the desired effect on mask wearing uptake in the UK.

It might be that beyond quality of public messaging the importance of solidarity in the values of society might be an important factor or that science denialism is becoming increasingly prevalent.

Threads of the day:

Thread 1: “US daily report by the COVID Tracking Project”. (Twitter thread)

This is the daily tread from the excellent COVID Tracking Project. This week’s reporting will be affected by the 4th of July weekend and numbers later on in the week starting today might show state reporting data playing catch up with underreporting in the last few days. It could only make an alarming situation look even worse.

It is also worth highlighting that Florida, one of the surge state, does not yet report hospitalisations and that as it says it will shortly the hospitalisation curve which is already trending upward will further steepen.

It is unfortunately only a matter of time until deaths count follow. This is further supported by a convincing explanation of why the deaths curve has not yet followed the surge seen on cases with the current expected delay of around 4 weeks. Ellie Murray (epidemiologist at Boston University) writes a very good thread giving another plausible explanation as to why deaths surge might be lagging case surges in the US more than previously. It’s a Tweetorial on “Lead time bias”. In a nutshell as the US is testing more, it is also testing a greater proportion of patients earlier, and the previous estimated time between diagnostic and death might be longer.

Thread 2: “An update on T-Cell based immunity” by Benjamin Meyer (virologist at University of Geneva) (Twitter thread)

This thread was in part started by the below excerpt in a comment in the Lancet (“SARS-CoV-2 seroprevalence in COVID-19 hotspots’) co-authored by Isabella Eckerl (Professor at Geneva Centre for Emerging Viral Diseases) and the author of this thread.

“A subset of asymptomatic SARS-CoV-2 cases shows a lower antibody response and titres that wane quickly.12 It is unknown whether these patients are protected by other immune functions, such as cellular immunity. In summary, such individuals would not be detected by serological assays but might confound the true exposure rate.

More specifically Meyer wants to address in his thread two points:

Benjamin Meyer @BenjaminMeyer85
2. There are 2 different points that are discussed at the moment: First, there are some studies, i.e.
tinyurl.com/y8zzf8tw, that show a cross-reactive T-cell response in sample taken before the pandemic, due to previous infection with common cold coronaviruses.


On the first point and as the second tweet above posits Meyer points out that more research needs to be done to establish how key is the T-Cell immunity response in preventing severity of disease.

On the second point and in concluding, whilst Meyer does not refute the possibility of patients not producing any antibodies, he believes that their proportion is marginal and that we should not infer from current finding that we are significantly underestimating how much of the population is immune from the virus through an underreported T-Cell-based immunity with no or low seroconversion.

❗️ Video of the day: “Deaths are going to go back up”according to Scott Gottlieb (former Director of the Food and Drug Administration). (Link)

🇮🇱 🇦🇺Tweet of the day: “Melbourne and Israel dial back” by Adam Kucharski (Professor at London School of Hygiene and Tropical Medicine)

Two ominous occurrences of rolling back openings in two regions which had initially (like California) done well in their first response to the virus. This narrative of lockdown/re-opening, might give a false sense of security to people as it is easy to see people equating re-opening with back to normal. It is not the case as long as the virus circulates, and as Melbourne and Israel show with their second surge starting from a low infection base.

💉 Helen Branswell writes “Novavax, maker of a Covid-19 vaccine, is backed by Operation Warp Speed” for STAT news.

Novavax has received $1.6 billion funding from Operation Warp Speed to support its clinical trials and to expand manufacturing capability, with the objective of supplying 100 million doses to the US starting later in 2020. Stanley Erck, the company CEO, gave further details on the trial timeline:

“Erck said data from the Phase 1 trial should be available by the end of July. Novavax plans to start a Phase 2 trial within a couple of weeks of getting the Phase 1 data, and hopes to launch a large Phase 3 trial, involving roughly 30,000, in the third quarter of the year.”

Of particular note, is the technology platform used by Novavax to develop its vaccine which is protein-based and uses nano-particles to deliver its vaccine. While it adds diversity to the type of vaccines supported by Operation Warp Speed, it should be noted that Novavax has yet to deliver a successful vaccine to market, with its seasonal flu vaccine being the closest - having successfully completed a Phase 3 study earlier in the year. (Link)

❗️ William Wan and Heather Long write “‘Cries for help’: Drug overdoses are soaring during the coronavirus pandemic” for the Washington Post. This well researched article makes for sad reading. As it clearly and soberly states:

“Addiction is a disease of isolation.”

The U.S. has been ravaged by the opioid crisis, and while authorities were hoping that physical distancing would disrupt the drug supply chains and mitigate such rise, the numbers do not support this scenario:

“Suspected overdoses nationally — not all of them fatal — jumped 18 percent in March compared with last year, 29 percent in April and 42 percent in May, according to the Overdose Detection Mapping Application Program, a federal initiative that collects data from ambulance teams, hospitals and police.”

In addition to the increased feeling of isolation which shelter-a-homes have undeniably brought, a lot more addicts are taking drug alone with no one around to call emergency when they overdose.

The US opioid crisis was a lingering and endemic public mental health crisis. The forces, or barriers, which prevented this crisis to be managed and its spread to continue might be the same which make America vulnerable to COVID-19. (Link)

🛑 Ed Yong writes “The Pandemic Experts Are Not Okay” for The Atlantic. Another great article by Yong looking at the health of public health experts and scientists who have been at the forefront of the public messaging battle. Their feeling right now:

“But they’re also very tired, and dispirited by America’s continued inability to control a virus that many other nations have brought to heel. As the pandemic once again intensifies, so too does their frustration and fatigue.”

A lot of these experts at the forefront of this effort, were used to being more amongst themselves and have now been propelled as public figures. Most carry on with the same diligence and passion which made them choose their profession. However, as their area of expertise has understandably taken centre stage, it has exposed the endemic sexism of their profession, exposed them to aggressive trolling and politicisation of their field, as well as have to deal with the emergence of the arm-chair and opportunist epidemiologists.

In spite of all this, some of the older experts have built resilience from their experience as young expert during the emergence of HIV and are acting as mentors to the younger generation. And fortunately they continue to be driven and this article by Ed Yong will be an encouraging ode to their valuable work. (Link)

🇪🇸 Marina Pollán et al. write “Prevalence of SARS-CoV-2 in Spain (ENE-COVID): a nationwide, population-based seroepidemiological study” in The Lancet. A large scale study of sero-prevalence of the virus in one of the hardest hit country. The findings have broad implications for policies and in particular as a powerful anti-dote to the remaining advocate of ‘herd immunity as strategy’. Before delving into the results, let us look at the reported COVID-19 deaths and excess death numbers for Spain: 28,392 deaths and 48,400 excess deaths.

The study was run using two methods to estimate the percentage of population which was already infected by the virus. The results:

Seroprevalence was 5·0% (95% CI 4·7–5·4) by the point-of-care test and 4·6% (4·3–5·0) by immunoassay.

How do the authors interpret their finding:

“The majority of the Spanish population is seronegative to SARS-CoV-2 infection, even in hotspot areas. Most PCR-confirmed cases have detectable antibodies, but a substantial proportion of people with symptoms compatible with COVID-19 did not have a PCR test and at least a third of infections determined by serology were asymptomatic. These results emphasise the need for maintaining public health measures to avoid a new epidemic wave.”

In other words, it is key to maintain wash your hands, watch your distance and wear a mask until a therapeutic or vaccine is found. If one assumes that public policy will go for herd immunity, not only it would be a slow process (during which the economy would not restart properly) but one which would result in an excess death of around 580,000 assuming fatality rate would remain the same and herd immunity would be reached once 60% of the population is seropositive. A non starter. (Link)

🏫 Jennifer Couzin-Frankel, Gretchen Vogel and Meagan Weiland write “School openings across globe suggest ways to keep coronavirus at bay, despite outbreaks” in Science.

A tour de force by the authors addressing questions which both policy makers and parents want answers to:

How likely are children to catch and transmit the virus?

Should children play together?

Should kids wear masks?

What should schools do when someone tests positive?

Do schools spread the virus to the wider community?

What lies ahead?

Whilst we do not yet have all the answers, the authors provide a great review of what we know and what we need going forward on this critical policy issue. (Link)

📣 H. Holden Thorp writes Persuasive words are not enough” for Science. Thorp who is the general editor for the Science family of journals deals in this article with how science communication can and needs to improve in the face of “American science denialism”.

Thorp article can be read in conjunction with a recent report in Vox EU “News media and distrust in scientific expertswhich takes a peek at the “sophisticated, data driven machine” which Thorp believes is at the core of science denialism.

Thorp believe that science is currently losing the race:

“The scientific community is losing the battle against this digital leviathan of misinformation.”

Moreover, he believes that as long as science does not harness the sophisticated tools which the deniers use, it will continue to lose ground. (Link)

📜 Ada Palmer (Professor in the History Department at the University of Chicago) writes “Black Death, COVID, and Why We Keep Telling the Myth of a Renaissance Golden Age and Bad Middle Ages” in her Ex Urbe blog. (Link)

A magnificent and positive read, to drive all of us into action by looking at the question:

“If the Black Death caused the Renaissance, will COVID also create a golden age?”

Far from agreeing to the hypothesis in the first part of the question, Ada Palmer also warns about passivity and the myth of history repeating itself:

“But I do think that both Black Death and Renaissance are useful for us to look at now, not as a window on what will happen if we sit back and let the gears of history grind, but as a window on how vital action is.”

An important and delightful read, and one which makes you want to buy her forthcoming book on this subject.

🎙 Take Two: “Coronavirus: Where California Went Wrong” a conversation between A. Martinez and Bob Wachter (Chair of Medicine at UCSF) (11 min 30 sec) (Link)