🦠 The second act of the COVID-19 tragedy

📊 Daily Data Brief: July 15, 2020, 01:51 GMT (❗️July 11, 2020, 01:12 GMT)

Cumulative case: 13,273,044 (+656,465cumulative cases 

Active cases:  4,950,556 (+223,376) (this is the number of currently infected patients)

Total Deaths:  576,490   (+14,451)

Serious/Critical Cases: 59,278 (+382)

Recovered:  7,745,998 (+418,638)

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

Two articles of the day. How do we get science centre stage again is an excellent opinion piece by historian John Barry who wrote a book about the Spanish Flu. The current CEO of the Bill and Melinda Gates Foundation writes about what to expect on vaccines as Moderna release its first paper on its candidate.

A critical video doubting that a country which failed the simple will succeed when it comes to the vaccine.

Two great threads. One clarifying (still) why lockdowns were necessary and whether they have served their purpose the first time around. Another thread about the prevalence of significant long term side effects amongst patients who survive COVID-19. It is also becoming increasingly clear that SARS-CoV-2 is not a respiratory disease only.

Burgundy is now on the map in the US and that is bad news.

A lot of scientific papers and reviews in the article section on: 1) Adverse immune response to vaccine or viral antibodies, 2) Aerosol vs droplet transmission of SARS-CoV-2 and why universal masking in certain settings has become warranted, 3) a literature review of what we know about immunity to other coronaviruses.

On the policy side, a great round up of policy measures which the US can apply urgently to potentially avoid a second lockdown, and a pragmatic and well argumented op-ed by Scott Gottlieb on re-opening schools in the US.

Articles of the day:

🇺🇸 Article 1: John Barry (author of “The Great Influenza: The Story of the Deadliest Pandemic in History”) writes “Politics Won’t Stop the Pandemic” in the New York Times. (Link)

Barry is a historian who studied The Great Influenza. Travelling in time with a historian might help the US get out of its politicisation of everything (including science) and the disaster that politics has brought to date in not containing COVID-19.

Barry starts with:

“When you mix science and politics, you get politics”

He should have added two conditions for this statement to become true: for as long as 1) the public delegates to federal, regional or local governments the understanding of science, and 2) scientists delegate the public messaging about their science to agency and governments.

Fauci rightly urged in a video previously featured in the Corona Daily, that citizens have societal responsibilities in reducing the spread of COVID-19 (“Societal responsibilities and hopefully government leadership”). However this assumes that they have the knowledge to exercise those urgent responsibilities.

A number of scientist will argue that news publishing and scientific publishing are very different, the former dealing with opinion. What has been clearly demonstrated in this pandemic (and should have been with climate risk), is that you cannot prevent people, journalists, and politicians to form opinions about science. It is even more likely to happen in the urgency of a pandemic, when science progressing might wrongly appear to non-scientists as science contradicting itself.

Fortunately there has been exceptional learnings in SARS-CoV-2 in a relatively short period of time to inform the public and policy makers about the best course of action given the current knowledge.

It was both the lack of knowledge and preparation which initially required draconian lockdowns to be put in place. As Barry knows, the same happened during The Great Influenza, and cities which refused to accept this reality had to repeatedly go into lockdown (two or even three times in some cases).

The goal of pandemic policy is to get cases down through a multi-prong approach. As Barry writes only then are you able to have the option to open school safely:

“To reopen schools in the safest way, which may be impossible in some instances, and to get the economy fully back on track, we must get the case counts down to manageable levels — down to the levels of European countries.”

For Barry this is the Americans’ second chance to do the right thing. There will be as many ‘chances’ as it takes the public to learn but the delay in seizing one of them at the earliest will be a disaster for public health and the economy.

💉Article 2: Penny M. Heaton (CEO Bill and Melinda Gates Foundation) writes “The Covid-19 Vaccine-Development Multiverse” for the New England Journal of Medicine as Moderna/NIH publish their Phase 1 trial paper in the same journal (Link).

The published Moderna results are ‘encouraging’ to use the words of its CEO Stephane Bancel, as the company embarks on a Phase 3 trials with 30,000 patients starting on July 27.

Heaton’s wealth of experience in vaccine development including failures produces an article which both explains how so many vaccine candidates are entering Phase 3 trial only six months after the sequencing of SARS-CoV-2 and warns (or outlines) the risks and areas of concern going forward.

A level-headed article on vaccine at a time when the public, the companies developing them and Operation Warp Speed all understandably want to be the bearer of positive news.

🇺🇸 Video of the day: “Can a country which failed at delivering PPE to healthcare worker succeed at distributing a vaccines?”. Ed Yong expresses his doubts when talking to Christiane Amanpour. Yong has been one of the stellar writer during this pandemic and he is skeptical that a country which has so badly failed in its fight pre-vaccine can successfully deliver a vaccine globally. (Link)

🦠 Threads of the day

❗️Thread 1: “Misunderstanding and misusing lockdowns” by Abraar Karan (Harvard Medical school) (Link)

This is another thread, whose aim is to avoid repeated lockdowns in places where the spread has become uncontrolled. It echoes Barry’s article of the day on a specific, draconian and hated policy tool which governors might have to use again for saving lives and restarting the economy sooner.

🦠 Thread 2: “Don’t only look at death numbers, on the long term effects of COVID-19” by Greg Gonsalves (Assistant Professor Yale School of Public Health) (Link)

Critics of restricting public health measures had recently focused the narrative in the US on the fact that the pandemic was less deadly even though case numbers were surging. Even though this assertion is no longer true, Gonsalves provides in a series of tweets a number of references describing the long term side effects of COVID-19.

There is also an excellent review article published in Nature Medicine yesterday “Extrapulmonary manifestations of COVID-19” which also drives home the non-lung potential impact of SARS-CoV-2 on a number of organs.

Taken together these writings demonstrate how narrowly focusing on deaths numbers and the respiratory manifestation of COVID-19 underestimates the true human cost and broad sequelae potential of this dreadful disease.

🇺🇸 Image of the day: “America started blushing so we added burgundy”, on the decision of Covid Exit Strategy to add Bruised Red to the US map. The case surge was so dire in some state that the previous state color scale no longer represented adequately the situation in the US, that states exhibiting ‘uncontrolled spread’ are now coloured in ‘Bruised Red’ (Link)

💉 Ann M Arvin et al. publish“A perspective on potential antibody-dependent enhancement of SARS-CoV-2” in Nature. The lead author in this review, and some of her co-authors work at Vir Biotechnology, one of he two companies leading the race to develop monoclonal antibodies as therapeutic against COVID-19.

It echoes the article of the day written by Penny M Heaton by discussing what is known as ADE (antibody-dependent enhancement) when a patient is administered viral antibodies or produces such antibodies upon vaccine inoculation. Triggering ADE is a known risk factor for any vaccine candidate and one which cannot be assessed for COVID-19 given our current knowledge and the inability to fully understand both the correlates of immunity and differentiate between severe viral infection and immune enhanced infection in relation to SARS-CoV-2.

It highlights why both vaccine and viral antibodies trial could potentially have setbacks as they move through clinical trials. (Link)

🏫 Scott Gottlieb writes “Schools Can Open Safely This Fallin the Wall Street Journal. A well articulated article summarising first what we know about likelihood of both infection (and severity of disease) and transmission of SARS-CoV-2 by children of various ages.

Gottlieb believes that schools can reopen with the appropriate measures, whilst acknowledging like Abraar Karan that it will be more difficult if uncontrolled spread occurs in the school’s county.

It is also for this reason, that he advocates for broad decentralisation powers as to the decision to open or not, and the adequate safety measures to implement depending on the local state of the epidemic. (Link)

🦠😷 Michael Klompas et al. write “Airborne Transmission of SARS-CoV-2 Theoretical Considerations and Available Evidence” for JAMA Network. (Link)

This has been one of the best explainer on the rather technical aspect of the transmission of SARS-CoV-2 via droplets and/or aerosols. It is again one area where knowledge gaps persists, but where a good policy decision on wearing masks can already be taken.

The authors make the important distinction between generating or transmitting via aerosols:

“Demonstrating that speaking and coughing can generate aerosols or that it is possible to recover viral RNA from air does not prove aerosol-based transmission; infection depends as well on the route of exposure, the size of inoculum, the duration of exposure, and host defenses.”

They also explain why wearing masks (which could less effective in preventing aerosol transmission) is likely to reduce transmission:

What this means in practice is that keeping 6-feet apart from other people and wearing medical masks, high-quality cloth masks, or face shields when it is not possible to be 6-feet apart (for both source control and respiratory protection) should be adequate to minimize the spread of SARS-CoV-2 (in addition to frequent hand hygiene, environmental cleaning, and optimizing indoor ventilation).

A great piece of science communication on what has been a politically (and even scientifically) charged issue.

🇺🇸 Helen Branswell writes “How to fix the Covid-19 dumpster fire in the U.S.” for STAT news. Branswell has interviewed a number of experts of what measures to implement to avoid a second lockdown. Apart from quoting some of the most visible experts in this pandemic, Branswell aggregates a list of sensible recommendations which can be implemented to get the US epidemic sustainably under control. (Link)

🐀 José da Silva writes “Banksy paints London Underground train with sneezing rat not wearing face mask” in The Art Newspaper. The UK has had one of the worst uptake on mask wearing, with the government reluctant until today to mandate it in certain settings (Coronavirus: Face masks and coverings to be compulsory in England's shops).

The public messaging has been confusing and has appeared contradictory at times. Masked artist Banksy has gone in the London underground and painted sneezing rats to help convince the public of wearing masks.

Who wants to get a virus from a rat? (Link)

The Review Corner:

🦠Alan Sariol, Stanley Perlmam publish “Lessons for COVID-19 immunity from other coronavirus infections” in Cell Immunity. From vaccine and viral antibodies trials, to understanding whether/how herd immunity could be achieved, understanding what we know about immunity to other and more studied coronaviruses is key to progressing as science fills its knowledge gaps on SARS-CoV-2. It is sound and common for scientist to look at related virus to help them in vaccine and other therapeutic R&D, and guide policy. This is what the authors have done and this review by Sariol and Perlman is very comprehensive. (Link)