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Welcome to the first issue of AVAC's COVID News Brief, which provides a curated perspective on what COVID news is worth your time. Given the rapidly changing research landscape, we've decided to make these previously internal updates widely available. As a subscriber to AVAC’s Advocates’ Network or Weekly NewsDigest, we thought you might be interested! If you'd like to sign up to receive this weekly briefing, please subscribe here ([link removed]) .
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** Table of Contents
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* The Other Epidemic (#epidemic)
* The Disproportionate Impact of COVID-19 on Communities and People of Color (#impact)
* How Will the Protests Affect COVID-19 Cases in the US? (#protests)
* Ways (#ways) You Can Help (#ways)
* Global Shifts in the Pandemic: Cases rise in Latin America (#global)


* Trump pulls US out of WHO (#trump)
* Hydroxychloroquine (#hydroxy)
* New Data on Remdesivir (#newdata)
* Herd Immunity Continues to Elude; a Call for Herd Awareness (#herd)
* Reminders About Language (#language)
* Fauci (#fauci)
* Good Resources to Bookmark (#bookmark)

"We are HIV and global health advocates and activists, and our work is fundamentally about social justice and human rights. In the United States, police brutality is a moral, ethical and public health crisis that must be addressed by every one of us." - AVAC ([link removed])


** The Other Epidemic
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The American Medical Association, the American Public Health Association and the National Medical Association (“the collective voice of African American physicians and the leading force for parity and justice in medicine and the elimination of disparities in health”) argued that police brutality is a public health emergency.

AMA ([link removed]) : “AMA policy recognizes that physical or verbal violence between law enforcement officers and the public, particularly among Black and Brown communities where these incidents are more prevalent and pervasive, is a critical determinant of health and supports research into the public health consequences of these violent interactions…To help confront this systemic issue in our society, the AMA urges other leading health organizations to also take up the mantle of intolerance for police brutality and racism…Excessive police force is a communal violence that significantly drives unnecessary and costly injury, and premature morbidity and death. Our country—our society—demands more.”

APHA ([link removed]) : “Racism attacks people’s physical and mental health. And racism is an ongoing public health crisis ([link removed]) that needs our attention now!...We refuse to be silent, and we call for you to join us in our advocacy for a healthier nation. At the American Public Health Association, every moment of our waking hours is poured into finding better, more healthful lives for all, so everyone has a chance to breathe. It’s our life-blood.”

NMA ([link removed]) : “The killing of George Floyd is another reminder of the lingering effects of institutional racism in many communities throughout these United States. The conduct of these police officers is reprehensible and requires a full criminal and administrative investigation. The National Medical Association is calling for a national response that includes (but is not limited to):
1. Comprehensive reforms mandating national uniform implicit bias and anti-racism training for all law enforcement agencies.
2. Immediate development of a federal office responsible for the review of all fatal police excessive-use-of-force cases occurring in local jurisdictions.
3. Uniform reporting of all deaths by law enforcement utilizing the US Standard Death Certificate.
4. The immediate discontinuation of police practices that include life threatening maneuvers like the 'chokehold' and the practice of placing weight or force, by any means, on a restrained person's neck which is particularly vulnerable to injury that can easily result in death as in the case of Freddie Gray and now George Ford. Any occurrence of these unauthorized and potentially life-threatening practices being used by law enforcement should result in immediate dismissal and formal investigation of the officer/officers involved.
5. All police officers are required to voluntarily report any witnessed unauthorized or excessive use of police force by a fellow officer. An omission of reporting such instances is considered an act of complicity.”

Christian Science Monitor ([link removed]) looks at the twin epidemics, quoting a history professor who says, “The twin public health emergencies the US is facing are COVID-19 and the long-standing 'virus' of systemic racism…Fighting them will require a fundamental reconceptualization of what community means…."

Courthouse News ([link removed]) quotes a Columbia University epidemiologist: “These dual pandemics of COVID infection and mortality, and disparities and structural inequalities and racism coexist. And so while I, as an epidemiologist, a person who cares about humanity, I’m concerned for people getting infected with COVID…I’m also concerned about racism, and the persistence of racism in American society.”

Thompson Reuters Foundation ([link removed]) reports "Floyd's death, at the hands of a white police officer who knelt on his neck for nearly nine minutes, has reignited anger over longstanding social and economic inequality between the country's white and black communities.” The article provides statistics that illustrate racial disparities.

A commentary in STAT ([link removed]) begins, "This is my nightmare: COVID-19 meets racism meets the killing of yet another Black person by a police officer.” The author, Lauren Powell ([link removed]) , writes, "Floyd's death, at the hands of a white police officer who knelt on his neck for nearly nine minutes, has reignited anger over longstanding social and economic inequality between the country's white and black communities. This is my nightmare: COVID-19 meets racism meets the killing of yet another Black person by a police officer.” She concludes, "The layers of pain and anguish are unspeakable and the Black community is the only one told to swallow the pain and move on. This time, we refuse to.”

Vox ([link removed]) reports, "America’s crises are boiling over, one into another. Amid the coronavirus pandemic, masses of people are taking to the streets to protest police brutality after the death of George Floyd in Minnesota and other victims of racial violence. These two stories are linked. They are both public health stories. The link is systemic racism.”

The Hill ([link removed]) reports "several leading health groups are speaking out against police brutality, calling it a public health issue that leads to poorer health outcomes for communities of color, especially during a pandemic."

Grio ([link removed]) has published “An open letter to my white ‘friends’ who remain silent,” by journalist Blue Telusma who says, “We are now well past the point of politeness and it is time for YOU to disrupt that Lilly white bubble your kinfolks keep retreating to after killing us. But don’t you DARE, in 2020, hide behind your face mask and convince yourself that it’s okay to remain silent. Because if you do, in my eyes you are complicit in this mess. A mute accomplice, but an accomplice nonetheless. And no amount of “but I’m a liberal, I just don’t know what to say” rhetoric is going to make me see otherwise. Cowards like you are how we got here in the first place. No more excuses. SAY SOMETHING BEFORE THEY KILL ANY MORE OF US.”

The New York Times ([link removed]) sums up the place we find ourselves in in the US this week: “They are parallel plagues ravaging America: The coronavirus. And police killings of black men and women.” The Times quotes a Minneapolis pastor: “I hear messages from community members trying to deliberate whether or not they’re going to show up. They don’t want to catch COVID-19 and spread COVID-19 if they happen to be an asymptomatic carrier,” he said. “But there’s a deep feeling of we have to do something because our city is burning.” “Rashawn Ray, a sociologist and fellow at the Brookings Institution, said one crucial difference between the two plagues is that the coronavirus, like past diseases, may one day dissipate with a vaccine or medical breakthrough. 'We’ve never gotte
n to a place where racism is not a significant part of everyone’s life in the United States,' he said.”


**
The Disproportionate Impact of COVID-19 on Communities and People of Color
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More data is emerging about the impact of COVID on communities of color. NPR ([link removed]) reports “Until a few weeks ago, racial data for COVID-19 was sparse. It's still incomplete, but now 48 states plus Washington D.C., report at least some data; in total, race or ethnicity is known for around half of all cases and 90 percent of deaths. And though gaps remain, the pattern is clear: Communities of color are being hit disproportionately hard by COVID-19…NPR's analysis finds that in 32 states plus Washington D.C., blacks are dying at rates higher than their proportion of the population. In 21 states, it's substantially higher, more than 50 percent above what would be expected. For example, in Wisconsin, at least 141 African
Americans have died, representing 27 percent of all deaths in a state where just 6 percent of the state's population is black.”

AMP research labs ([link removed]) reports that “The latest overall COVID-19 mortality rate for Black Americans is 2.4 times as high as the rate for Whites and 2.2 times as high as the rate for Asians and Latinos… Data for Indigenous Americans is severely limited, but Indigenous people are dying above their population share in Mississippi (by 3 percentage points), Arizona (by 17 points) and, most dramatically, in New Mexico (by 47 points).”


**
How Will the Protests Affect COVID-19 Cases in the US?
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While it’s too early to know the impact of large numbers of people coming in close contact with one another on COVID cases, public health experts are concerned. AP ([link removed]) reports, “Health experts need newly infected people to remember and recount everyone they’ve interacted with over several days in order to alert others who may have been exposed and prevent them from spreading the disease further. But that process, known as contact tracing, relies on people knowing who they’ve been in contact with — a daunting task if they’ve been to a mass gathering….It’s unclear if the protests themselves will trigger large new outbreaks. The protests were outside, where infections don’t spread as readily as indoors. Also, many of the protesters were wearing masks and much of the contact was likely
less-hazardous “transient” moments of people moving around, passing each other…”

The Washington Post ([link removed]) reports, “The rules of the COVID-19 pandemic ([link removed]) , so recently learned at considerable inconvenience, have been discarded on the streets in recent days. Protesters frequently find it impossible to stay six feet apart, to avoid hand-to-hand contact or to dodge the respiratory droplets of their shouting, chanting comrades amid the swirling chaos. And because the virus can be spread by people with no symptoms, it can be impossible to figure out whom to avoid.” The story quotes the mayor of Atlanta: “If you were out protesting last night, you probably need to go get a COVID test
this week…There is still a pandemic in America that’s killing black and brown people at higher numbers.”

New York Times ([link removed]) asks “Will Protests Set Off a Second Viral Wave?” The story notes many experts believe the outdoors may make it more difficult to pass on the virus, but quotes one medical historian who has looked at parades and the 1918 flu pandemic and says, “Yes, the protests are outside, but they are all really close to each other, and in those cases, being outside doesn’t protect you nearly as much. Public gatherings are public gatherings—it doesn’t matter what you’re protesting or cheering. That’s one reason we’re not having large baseball games and may not have college football this fall.” The story notes that yelling, tear gas and pepper spray, protesters penned into tight places and other realities of large urban protests may increase vulnerability to infection.

The Atlantic ([link removed]) reports, “The virus seems to spread ([link removed]) the most when people yell (such as to chant a slogan), sneeze (to expel pepper spray), or cough (after inhaling tear gas). It is transmitted most efficiently in crowds and large gatherings ([link removed]) , and research has found that just a few contagious people can infect ([link removed]) hundreds of susceptible people around them. The virus can spread especially easily in small, cramped places, such as police vans and jails…. The pandemic and unrest together
have trapped the country in a bind. The demonstrations oppose police brutality. But peaceful, masked protesters—and the journalists covering them—have sometimes been met with an overly aggressive police response.”

If you are protesting or planning to protest, Vice ([link removed]) looks at ways to protect yourself from many dangers, including COVID-19 spread. And here’s a helpful twitter thread ([link removed]) on harm reduction for protest in pandemics from Gregg Gonsalves.



** Ways You Can Help
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There are lots of ways to get involved in the essential work to combat racism and actively engage in anti-racist work. Consider donating money, attending protests (wear a mask!), and amplifying the voices of Black leaders. Below are a handful of the many resources and groups to support, if you need a place to start.
1. The Black Lives Matter ([link removed]) Movement
2. The NAACP’s Legal Defense and Educational Fund: [link removed] ([link removed])
3. Color of Change: [link removed] ([link removed])
4. Community Bail Funds: a way for you to support protestors nationwide! [link removed] ([link removed])
5. Campaign Zero: dedicated to police reform via a 10 point plan aimed to reduce police violence: [link removed] ([link removed])
6. Anti-racism resources: bit.ly/ANTIRACISMRESOURCES ([link removed])



** Global Shifts in the Pandemic: Cases rise in Latin America
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AFP ([link removed]) reports that “Four of the 10 countries showing the greatest number of new COVID-19 cases over the last 24 hours were in Latin America…novel coronavirus cases are spreading quickly in Latina America. Brazil, Peru, Chile and Mexico are experiencing the largest daily increases, while the numbers are on the rise in Argentina, Bolivia, Colombia and Haiti.”


**
Trump Pulls US Out of WHO
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STAT News ([link removed]) reports that many experts expressed concern over the US president’s announcement that he was ending the US relationship with WHO late last week reporting that, “An American withdrawal from the World Health Organization could wreak profound damage on the global effort to eradicate polio and could undermine the world’s ability to detect and respond to disease threats….”

The IDSA ([link removed]) tweeted strongly condemned the president’s actions. “As ID physicians on the front line of combating the current global crisis, we stand strongly against @POTUS ([link removed]) 's decision to leave @WHO ([link removed]) . We will not succeed against this pandemic, or any future outbreak, unless we stand together, share information and coordinate actions.

In a related story, CNN ([link removed]) reports “Donald Trump has spent decades spreading and sowing dangerous misinformation about disease outbreaks—from falsely suggesting AIDS can be transmitted through kissing to warning Americans not to get vaccinated and falsely suggesting vaccines can cause autism.”


** Continued Concern About – and Politicization of – Hydroxychloroquine, but No Clear Answers Yet
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There is continued uncertainty and concern over the use of hydroxychloroquine. Jon Cohen sums it up succinctly in a tweet pointing to an article in Science ([link removed]) trying to lay out the issues and concerns: “The hydroxychloroquine story has been whack from the get go. It just got whacker.”

New York Times ([link removed]) reports “More than 100 scientists and clinicians have questioned the authenticity of a massive hospital database that was the basis for an influential study published last week ([link removed]) that concluded that treating people who have COVID-19 with chloroquine and hydroxychloroquine did not help and might have increased the risk of abnormal heart rhythms and death.” The concerns come in an open letter to The Lancet and “come at a time of increasing debate about the risks of the rush to publish new medical findings about COVID-19….”

Lancet ([link removed](20)31290-3/fulltext) first published an “expression of concern” pending hearing more from the authors. On Thursday, as we were preparing to send this out, Lancet ([link removed]) retracted the paper, writing “today, three of the authors of the paper, ‘Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis’, have retracted their study. They were unable to complete an independent audit of the data underpinning their analysis. As a result, they have concluded that they ‘can no longer vouch for the veracity of the primary data sources.’"

STAT ([link removed]) reports that WHO “is resuming a clinical trial exploring whether the malaria drug hydroxychloroquine can effectively treat COVID-19, after pausing enrollment in the study to review safety concerns about the drug.”

New York Times ([link removed]) reports “The United States has delivered two million doses of a malaria drug to Brazil for use in the fight against the coronavirus ([link removed]) pandemic, and the two countries are embarking on a joint research effort to study whether the drug is safe and effective for the prevention and early treatment of COVID-19, the White House announced Sunday.”

NEJM ([link removed]) reports on a randomized trial looking at hydroxychloroquine as postexposure prophylaxis for COVID-19. The study of 821 asymptomatic participants found that “After high-risk or moderate-risk exposure to COVID-19, hydroxychloroquine did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.” In an accompanying commentary ([link removed]) Mike Cohen argues that, “The advocacy and widespread use of hydroxychloroquine seem to reflect a reasonable fear of SARS-CoV-2 infection. However, it would appear that to some extent the media and social forces—rather than medical evidence—are driving clinical decisions and the global COVID-19 research agenda.” He asks, “What are we to do with the results of this trial?” After noting several considerations, especially for ongoing
hydroxychloroquine post-exposure trials, Cohen concludes, “The results reported by Boulware et al. are more provocative than definitive, suggesting that the potential prevention benefits of hydroxychloroquine remain to be determined.”


**
New Data on Remdesivir
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CNN ([link removed]) and other outlets report that “A five-day course of the antiviral drug remdesivir sped recovery in moderately ill patients with pneumonia from COVID-19, drugmaker Gilead Sciences announced in a statement ([link removed]) ...” One expert quoted says, “'These improvements are not dramatic' and 'not a game changer’…‘Remdesivir is one of the only drugs to show some promise, but the benefits are not large and we need to have more transparent data before we can form a good judgment.’"


**
Herd Immunity Continues to Elude; a Call for Herd Awareness
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New York Times ([link removed]) reports on “a crop of new studies across the world that are trying to quantify how many people have been infected…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 novel coronavirus is not yet clear; but several experts said they believed it would be higher than 60 percent.”

In a video on Devex ([link removed]) , Dr. Jonathan Quick, the Rockefeller Foundation’s new pandemic chief, “spoke of the importance of ‘herd awareness,’ by which he means a critical mass of the population knowing enough about wearing masks and other mitigation techniques to reduce disease spread. Quick sees this level of awareness as a step before a vaccine creates so-called ‘herd immunity’.”


** Reminders About Language
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An opinion piece on Open Democracy ([link removed]) says that in the narrative around COVID “a deeply problematic story of war has come to dominate the public imagination….It is easy to understand why the narrative of battle is attractive. It attributes agency to us at a time when we feel helpless, with few weapons to fight a virus with no cure and no vaccination. Instead of positioning us as passive victims, the narrative of war turns us into courageous soldiers in a fight against a common enemy. For political leaders, the rhetoric of war is a convenient way of conveying the gravity of the situation and justifying emergency legislation and the suspension of certain fundamental rights. But we are not soldiers, and this is not a war. Using war metaphors to ascribe agency to patients, healthcare workers and the public as a whole is profoundly problematic.” Instead the authors suggest we narrate the pandemic “as an open-ended
story of a point in history at which humankind faces the opportunity to choose between different routes to different futures. We stand at a historical crossroads in which political decisions will save or cost millions of lives.”

A Nature podcast ([link removed]) asks “Do researchers and frontline clinicians have a moral obligation to communicate science around the coronavirus?” Epidemiologist Sandro Galea says “Our job is to help the world see how we can bridge the science to the very real practical decisions that the world has to make to create a healthier world…There has been this mismatch between what we do not know and our capacity to communicate what we do not know, and to inform policy that needs to be made anyway. Those have been glaring gaps in my assessment.”

Fauci

STAT ([link removed]) ’s Helen Branswell interviews Fauci on a number of issues. He’s “not impressed” with maskless people packing bars or with Moderna’s release of early vaccine data by press release, although “sees reason for cautious optimism about Moderna’s vaccine, and others.” Sticking to the possibility of a vaccine by year end he “acknowledged the world will have limited data on the new vaccines when they are deployed, and may have to balance the need to save lives with the possibility of some adverse events.” He notes the importance of having several vaccine candidates in testing: “If one vaccine proves efficacy in a clinical trial and another vaccine is behind it but it’s getting the same correlate of immunity you could bridge data and facilitate the approval of the second and the third one based on the efficacy of the first one.”


** Good Resources to Bookmark
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Earth Institute’s Andrew Revkin ([link removed]) goes live on Facebook and YouTube every Friday as with “some of the world's most experienced pandemic-focused journalists and policy experts join the Earth Institute's Andy Revkin in a review of the biggest news and miscues of the week and discussion of what to watch for next. The regulars are Pulitzer winner and MSNBC analyst Laurie Garrett, longtime NBC science correspondent Bob Bazell, Jon Cohen of Science Magazine and Wendy Wertheimer, who for decades worked on epidemic policy with top leadership at the NIH and World Health Organization.”

A frequently updated Nature ([link removed]) page promises to “wade through the literature on the new coronavirus—and summarize key papers as they appear.” Recent papers highlighted look at the link between a positive test and infectiousness, a study that “supports the use of masks and preventative measures such as nasal cleansing” and a systematic review that found “children and adolescents under the age of 20 are much less likely than adults to become infected by the new coronavirus.”

BBC’s ([link removed]) Coronavirus in Africa tracker.


**
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