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This past week, the numbers of people infected and the numbers of death continued to grow. The epicenter of the pandemic shifted somewhat away from the US and Western Europe toward other parts of the world as we reached the highest numbers of daily reported new cases yet. The Hill reports “more than 136,000 people tested positive for the coronavirus across the globe on Sunday, a new apex that has officials at the World Health Organization (WHO) warning that the worst of the pandemic is still ahead…WHO Director-General Tedros Adhanom Ghebreyesus said the number of confirmed cases is rising rapidly in South America and South Asia, which accounted for three-quarters of Sunday's new cases. African nations are reporting higher rates of infection, and Eastern Europe and Central Asia are becoming areas of concern.”
Worst Nightmare
The New York Times and several other outlets reported that in an address to the BIO conference, Tony Fauci "delivered a grim assessment of the devastation wrought around the world by the coronavirus, describing COVID-19 on Tuesday as his “worst nightmare”—a new, highly contagious respiratory infection that causes a significant rate of illness and death. ‘In a period of four months, it has devastated the whole world.’” On prospects for a vaccine, “Dr. Fauci said he was ‘almost certain’ that more than one would be successful.”
If one thing is certain in the response to COVID, it’s the ongoing uncertainty. In the push to get information out to the public as fast as possible, we’re seeing researchers and public health officials sometimes having to walk information back or clarify messages frequently. This is the first time a pandemic response has been the center of global attention day in and day out. We saw it last week with the retraction of two papers on hydroxychloroquine and it continued this week with questions about asymptomatic spread.
WHO Says Asymptomatic Spread Rare; Other Say Not So Fast on That; WHO Walks It Back
On Monday, Medscape, CNBC and other outlets report that WHO has reported that asymptomatic spread of COVID-19 is “rare.” WHO’s Maria Van Kerkhove tweeted a link to a WHO summary on mask wearing that says, "Comprehensive studies on transmission from asymptomatic individuals are difficult to conduct, but the available evidence from contact tracing reported by Member States suggests that asymptomatically-infected individuals are much less likely to transmit the virus than those who develop symptoms." In a press conference, Van Kerkhove said, "From the data we have, it still seems to be rare that an asymptomatic person actually transmits onward to a secondary individual." Medscape reports that “This announcement came on the heels of the publication of an analysis in the Annals of Internal Medicine, which suggested that as many as 40-45 percent of COVID-19 cases may be asymptomatic. In this paper, the authors, Daniel P. Oran, AM, and Eric J. Topol, MD, of the Scripps Research Translational Institute in La Jolla, Calif stated: ‘The likelihood that approximately 40-45 percent of those infected with SARS-CoV-2 will remain asymptomatic suggests that the virus might have greater potential than previously estimated to spread silently and deeply through human populations.’"
This information came as time WHO changed its stance on wearing masks: calling for nations to encourage the general public to wear fabric masks in areas where there continues to be intense spread of the novel coronavirus—and for all health workers and caregivers to wear medical masks throughout their shift while in clinical areas.” (CNN) See WHO’s updated Q&A on masks.
Some critics immediately pushed back on WHO’s claims about asymptomatic spread. Andy Slavitt, an Obama administration health official, laid out concerns in a twitter thread, saying that he believes “this was an irresponsible statement even though it was based on legitimate observations.” Slavitt notes “WHO said up until a week ago that people didn’t need to wear masks. They then changed their minds. I asked—does this mean people don’t need to where masks? They said no. People should wear masks.”
On Tuesday, Axios and other outlets reported that, “The World Health Organization clarified comments an official made on Monday that called asymptomatic transmission of the coronavirus "very rare," saying in a press conference that these carriers do take part in spreading the virus but that more information is needed to know by how much… The WHO said it regrets saying that asymptomatic spread is "very rare." Slavitt’s twitter thread on the WHO walk back raises a number of good points about public health communication “public health communication isn’t ancillary to public health. It is the central component in battling it,” and this, which really sums up where we are in trying to understand so much about this virus: “We are going to have to follow the messy scientific process of 2 steps forward, 1 step back. We will end up learning things which contradict what we believed. Scientists can’t be blamed for sharing what they know when they know it....”
Race and COVID-19
In a commentary in Scientific American anthropologist Clarence Gravlee writes, “There is still plenty we don’t know about COVID-19, but one fact is inescapable: African Americans are disproportionately represented among the dead. Although the numbers are incomplete, the non-profit APM Research Lab estimates that, as of May 27, the overall death rate from COVID-19 is 2.4 times greater for African Americans than it is for white people. He writes that, “much of the public and scientific reaction has…invoked baseless ideas about unknown genes that make African Americans vulnerable to the virus, rather than focusing on abundant evidence for the devastating biological consequences of systemic inequality and oppression. He concludes, “thanks to decades of careful research, we know that what we gloss as ‘race’ corresponds poorly to genetic variation and we know that racism is deadly. An ethical, scientific response to COVID-19 demands that we honor the highest standards of evidence in evaluating genetic guesswork, while measuring the biological costs of systemic racism and intervening to stop it.”
ProPublica says, “Black lives are being lost to COVID-19 at twice the rate of others. For…that’s one more reason to be on the street. ‘If it’s not police beating us up, it’s us dying in a hospital from the pandemic,’ one said…When speaking out against the loss of black lives, it is tough to separate those who die at the hands of police from those who die in a pandemic that has laid bare the structural racism baked into the American health system. Floyd himself had tested positive for the coronavirus. Eighteen black protesters interviewed by ProPublica were well aware that black lives were being lost to the virus at more than twice the rate of others, and that societal barriers have compounded for generations to put them at higher risk.”
COVID-19 and Protests
As protests sparked by the police murder of George Floyd continued into a second week, the New York Times reports that many healthcare workers are joining protests. “Many say they view the deaths of black people at the hands of police as a public health issue. But they also express worries that large gatherings will cause a second wave of COVID-19 cases, and they are balancing their involvement with calls for protesters and police officers to adhere to public health guidelines. For some black physicians, the protests, like the pandemic, are a reminder of the unequal health risks that black Americans face.”
Medscape reports, “Healthcare workers participating in the growing #WhiteCoats4BlackLives protest against racism say it is a chance to use their status as trusted messengers, show themselves as allies of people of color, and demonstrate that they are intimately familiar with how racism has contributed to health disparities, like those on vivid display during the COVID-19 pandemic.”
The Guardian reports on protests in Nairobi against police brutality. “’We are here to protest against police killing us in the name of protecting us from corona. The police have killed us more than corona,’ said another protester, Sobukwe Nonkwe, 30, a filmmaker, whose friend was shot and killed by the police…. At least 15 people have been killed by police, and 31 people injured since the curfew was imposed, the Independent Policing Oversight Authority (IPOA) said last week.”
AP reports on “concern that the chemical agents could increase the spread of the coronavirus. The chemicals are designed to irritate the mucous membranes of the eyes, nose and throat. They make people cough, sneeze and pull off their masks as they try to breathe. Medical experts say those rushing to help people sprayed by tear gas could come into close contact with someone already infected with the virus who is coughing infectious particles. Also, those not already infected could be in more danger of getting sick because of irritation to their respiratory tracts….it will take weeks before the effect might show up in rising COVID-19 case numbers. If cases increase, there are other factors that could share the blame, such as shouting, singing and, for thousands who were arrested, being confined in close spaces with others.”
NPR’s Goats and Soda blog reports “In the midst of the coronavirus pandemic, the World Health Organization took time at its daily press conference to address another pressing issue: the wave of protests against police violence and racial injustice…‘WHO fully supports equality and the global movement against racism. We reject discrimination of all kinds,’ said WHO Director-General Tedros Adhanom Ghebreyesus on June 8.”
The Delicate Balance of Science Communications Timing (and Politics)
The Aspen Institute’s GOOD10: The Pandemic Issue includes a conversation between Ivan Oransky, the co-founder of Retraction Watch and Elisabeth Bik, a microbiologist who “studies publicly available scientific papers to sniff out potential irregularities in the images that suggest research fraud, later seeking retraction of the offending paper from the journal’s publisher.” Among other things they discuss the good and bad of preprint papers. Bik states, “there’s this delicate balance where on one hand we want to spread results really fast as scientists, but on the other hand, we know it’s incomplete, it’s rushed and it’s not great. This might be hard for the general audience to understand…there’s also so many papers that come out now on preprint servers and most of them are not that great, but there are some really good studies in there. It’s hard to find those nuggets of really great papers. There’s just a lot of papers that come out now.” Bik notes that she stepped back from looking at COVID-19 papers for a time, “because I just felt that a lot of these papers on COVID-19 became so politically divisive that if you tried to be a scientist and think critically about a paper, you were actually assigned to a particular political party or to be against other political parties. It’s hard for me to be sucked into the political discussion and to the way that our society now is so completely divided into two camps that seem to be not listening to each other.”
In a STAT article, How the world can avoid screwing up the response to COVID-19 again, 11 experts weigh in on what should be done by policymakers and others. One clear call is for better communication: “The public needs clearer information, even when that information is merely an acknowledgement that some facts about the virus remain unknown and the course of the pandemic isn’t currently predictable. And it should be steeped in science and fact, not politics.” Epidemiologist Marc Lipsitch is quoted: “I think the communications have been deliberately bad. The plan all along in this country has been to minimize it and try to prop up the stock market and try to pretend it’s less bad than it is.”
The New York Times provides a great primer on how to read a scientific paper, noting that new readers of science papers should be “advised the scientific paper is a peculiar literary genre that can take some getting used to. And also bear in mind that these are not typical times for scientific publishing.” Advice from the author includes, “When you read through a scientific paper, it’s important to maintain a healthy skepticism. The ongoing flood of papers that have yet to be peer-reviewed—known as preprints—includes a lot of weak research and misleading claims. Some are withdrawn by the authors. Many will never make it into a journal. But some of them are earning sensational headlines before burning out in obscurity…. Science has always traveled down a bumpy road. Now it is in an extraordinary rush, with the world looking for every new preprint and peer-reviewed paper in the hope that some clue will emerge that helps save millions of lives. Yet our current plight does not change the nature of the scientific paper. It’s never a revelation of absolute truth. At best, it’s a status report on our best understanding of nature’s mysteries.”
This Week in Mis/Disinformation and the Infodemic
The Guardian reports that “While teams around the world race to create a vaccine for COVID-19, the anti-vaxxers are racing to convince people that it will be dangerous.” Prof Julie Leask, one of Australia’s top experts on vaccination uptake, says, “While misinformation online is a problem, there is a much more complex reality. Leask talks about vaccine acceptance as a five-layer pyramid. At the base, the fattest part, are the people who will vaccinate. Then there are increasingly smaller, but increasingly resistant layers. There are the ‘cautious acceptors’. Then there are the ‘hesitant acceptors’, followed by the ‘selective vaccinators’ who might accept certain vaccines but will reject others. At the sharp peak of the pyramid are the decliners, those who won’t vaccinate. Part of that small group are the anti-vaccination activists…. Leask is worried that a focus on the hardcore anti-vaxxer movement is a distraction from the banal reasons families fail to prioritise the jab. And she’s also concerned that people sitting on the metaphorical vaccination fence might just be pushed over the wrong side by zealots who force the issue, or by punitive measures such as ‘no jab, no play’ legislation.”
Columnist Nicole Nguyen in the Wall Street Journal reports on “doomscrolling. Also known as “doomsurfing,’ this means spending inordinate amounts of time on devices poring over grim news—and I can’t seem to stop. My timeline used to be a healthy mix of TikTok memes and breaking-news alerts. Now the entire conversation is focused on two topics: the pandemic and the protests.” She quotes tech expert David Jay: “When we look at doomscrolling related to COVID-19, the protests and the election, all deeply intersecting with one another, there are numerous actors that are very sophisticated at disseminating misinformation shaping the narratives of these crises.” She notes, “In a recent lengthy Medium post, Barry Schnitt, a former Facebook communications executive, published a warning: ‘You know what’s engaging as heck? Wild conspiracy theories and incendiary rhetoric. Put together a piece of content that comes to you from a trusted source (i.e., your friend) and Facebook making sure you see the really tantalizing stuff, and you get viral misinformation.’”
Digaday reports on Craig Silverman, media editor of BuzzFeed News, who says, “We are in a version of the information apocalypse.” Silverman notes that polarized media sites are “breeding grounds for conspiracies” and warns “these media sites do not have to solely be sharing false information, but they could share unverified or misleading information, or put out counter-programming that distracts from other news going on in the world.”
Observatory of Education Innovation looks at “words that infect the perception of facts” noting that “It is indeed revealing that a single word, ‘viral,’ presents both sides of the coin, both in naming this crisis and forging our reality around it…. Sharing and managing information is not a pathology; it is a decision by those who produce the information and direct it to the echo chambers, as well as those who replicate it. The difference between cells and people is that we have awareness and a capacity for learning and critical thinking. The success of this ‘misinformation virus’ lies in how much we seem to forget this.”
BBC’s Business Daily Podcast looks at why Bill Gates is “the ‘voodoo doll’ of COVID conspiracies.”
A preprint on fighting COVID misinformation presents “evidence that people share false claims about COVID-19 partly because they simply fail to think sufficiently about whether or not content is accurate when deciding what to share.” The authors say their findings “suggest that nudging people to think about accuracy is a simple way to improve choices about what to share on social media.”
The Ever-Complicated Vaccine Story
The New York Times reports, “A prominent British laboratory is forming a special partnership that would sidestep the drug industry to sell a potential vaccine against the coronavirus without profits or licensing fees in Britain and in low- and middle-income countries.” The story quotes Robin Shattock, the lead scientist on the project: “If successful, he said, the vaccine’s lower cost could appeal to the large donor organizations that typically supply low-income countries, which make up much of the world. It could also provide a cheaper alternative in affluent countries…to make the vaccine as widely and cheaply available as possible, Professor Shattock said, Imperial College is creating what it calls a ‘social enterprise’—a special-purpose, for-profit company chartered to sell the inoculation.”
Zeke Emmanuel and Paul Offit imagine a scenario in a New York Times op-ed: “Oct. 23, 2020, 3 p.m., at a hastily convened news conference, President Trump announces that the Food and Drug Administration has just issued an Emergency Use Authorization for a coronavirus vaccine. Mr. Trump declares victory over COVID-19, demands that all businesses reopen immediately and predicts a rapid economic recovery.” They warn, “Given how this president has behaved, this incredibly dangerous scenario is not far-fetched. In a desperate search for a political boost, he could release a coronavirus vaccine before it had been thoroughly tested and shown to be safe and effective.” Noting that one of the early vaccines, soon to be in efficacy trials, could “reveal many patients are developing high levels of antibodies to the coronavirus without severe side effects,” but warn, “If only 20,000 participants receive the vaccine, serious but rare side effects might be missed. If such harms eventually arise, it could further erode a fragile vaccine confidence and threaten the ability to get enough people vaccinated to establish herd immunity. That would be a disaster.”
CNN reports “A retired major general who helped develop vaccines and ran the Walter Reed Army Institute of Research warns that it ‘could be terrible’ if political pressure rushed a COVID-19 vaccine. ‘I trust the FDA won't roll over for politics, but there's always a possibility. Trump is not a very good scientist, to say the least,’ said Dr. Philip Russell, a retired major general and former commander of the US Army Medical Research and Development Command… ‘I would hope the FDA stands fast and demands enough safety data that we won't kill somebody with it….’” CNN notes, “When asked if political pressure could push a vaccine out before it's ready, Collins gave his personal assurance that a vaccine will not be put on the market before it's ready. ‘As a scientist, a physician and the director of the National Institutes of Health, we will make these decisions solely on the basis of the evidence for individual vaccines. This will not be influenced by other factors that might put people at risk,’ he said.”
Vaccine researchers John Moore and PJ Klasse, in a preprint, “address issues that relate to the rapid ‘Warp Speed’ development of vaccines to counter the COVID-19 pandemic.” They conclude that “an effective vaccine that is too complex to make in bulk, or is difficult to formulate, is highly unstable without refrigeration or freezing, is challenging to administer or that requires too many doses over a prolonged period may represent a Pyrrhic victory for science, but not the answer to the problems faced by the societies that science serves. The complexities of developing a vaccine at ultra-short notice are best tackled by the melding of minds irrespective of wherever the bodies are geographically located. Will this happen? We hope so, but fear it may not.”
A panel discussion in the New York Times Magazine looks to answer the question Can a Vaccine for COVID-19 Be Developed in Record Time? It’s a long read, but lays out several of the critical issues from the perspectives of key experts including Siddhartha Mukherjee, Dan Barouch, Peggy Hamburg, Susan Weiss and George Yancopoulos. They all agree that there is unprecedented cooperation, as Barouch says, “From a research perspective, I have never seen such collaborative spirit, such open sharing of materials, data, protocols, thoughts and ideas among academic groups, industry groups, government groups and the clinicians on the front lines.”
Bhekesisa reports “Cape Town scientists are hoping that a new study involving a common tuberculosis (TB) vaccine will show if it can help protect people at a high risk of COVID-19 from the disease and tell us more about how our immune system works. But the trial has been criticised for allegedly failing to provide participants—many of whom are healthcare workers—with masks and gloves.” The article notes, “what constitutes that minimum standard of care—and whether that should be based on what’s locally or internationally available—remains debated…. On Friday, seven advocacy organisations, including the Vaccine Advocacy Resource Group, issued a statement saying that all COVID-19 clinical studies should ensure participants have access to free personal protective equipment (PPE), such as masks and gloves, as part of their standard of care—this includes in the TASK study.”
Science reports, “Senior Catholic leaders in the United States and Canada, along with other antiabortion groups, are raising ethical objections to promising COVID-19 vaccine candidates that are manufactured using cells derived from human fetuses electively aborted decades ago. They have not sought to block government funding for the vaccines, which include two candidate vaccines that the Trump administration plans to support with an investment of up to $1.7 billion, as well as a third candidate made by a Chinese company in collaboration with Canada’s National Research Council (NRC). But they are urging funders and policymakers to ensure that companies develop other vaccines that do not rely on such human fetal cell lines and, in the United States, asking the government to ‘incentivize’ firms to only make vaccines that don’t rely on fetal cells.”
Shutdowns Worked (Really Well in Some Places), Now What?
The Washington Post reports that “Shutdown orders prevented about 60 million novel coronavirus infections in the United States and 285 million in China, according to a research study…. A separate study from epidemiologists at Imperial College London estimated the shutdowns saved about 3.1 million lives in 11 European countries, including 500,000 in the United Kingdom, and dropped infection rates by an average of 82 percent, sufficient to drive the contagion well below epidemic levels.” The two reports, published simultaneously Monday in the journal Nature, used completely different methods to reach similar conclusions. They suggest that the aggressive and unprecedented shutdowns, which caused massive economic disruptions and job losses, were effective at halting the exponential spread of the novel coronavirus.
A preprint looks at Social distancing across vulnerability, race, politics and employment: How different Americans changed behaviors before and after major COVID-19 policy announcements. The study authors conclude, “variation in behavioral drivers including vulnerability, race, political affiliation, and employment industry demonstrates the need for targeted policy messaging and interventions tailored to address specific barriers for improved social distancing and mitigation.”
The New York Times reports on a survey of 511 epidemiologists: “Many epidemiologists are already comfortable going to the doctor, socializing with small groups outside or bringing in mail, despite the coronavirus. But unless there’s an effective vaccine or treatment first, it will be more than a year before many say they will be willing to go to concerts, sporting events or religious services. And some may never greet people with hugs or handshakes again…. One thing the epidemiologists seemed to agree on was that even when they return to normal activities, they will do them differently for a long time, like socializing with friends outside or attending worship services online. A majority said it would be more than a year before they stopped routinely wearing a mask outside their homes.”
AP reports, “As many countries gingerly start lifting their lockdown measures, experts worry that a further surge of the coronavirus in under-developed regions with shaky health systems could undermine efforts to halt the pandemic, and they say more realistic options are needed…. Brazil, Mexico, South Africa, India and Pakistan are among countries easing tight restrictions, not only before their outbreaks have peaked but also before any detailed surveillance and testing system is in place to keep the virus under control. That could ultimately have devastating consequences, health experts warn.”
The Shifting Epicenter of the Pandemic
Vox and other outlets report on emerging “international hot spots” of COVID, including Brazil, India, Iran, Mexico, Russia, South Africa and new regions in the US. Wafaa El-Sadr is quoted: “In Asia, India is the country of most concern, due to the large population [and] vastness of the country as well as the easing of restrictions that is ongoing. It is also likely that deaths are underreported particularly from rural areas.” On South Africa, Chris Beyrer says, “Health and housing disparities there make for an explosive potential for black South Africans in crowded townships.”
The New York Times reports, “Globally, known cases of the virus are growing faster than ever with more than 100,000 new ones a day. The surge is concentrated in densely populated, low- and middle-income countries across the Middle East, Latin America, Africa and South Asia.”
Getting Accurate Counts (or Not)
Getting an accurate count of cases, deaths and recoveries has been challenging. The Washington Post reports “fewer than half the states are following federal recommendations to report probable novel coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact…. A Washington Post review found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York. That is one reason government officials and public health experts say the virus’s true toll is above the US tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths—benchmarks that shape policymaking and public opinion on the pandemic.
AP reports that “Brazil’s government has stopped publishing a running total of coronavirus deaths and infections in an extraordinary move that critics call an attempt to hide the true toll of the disease in Latin America’s largest nation…. On Friday, the federal Health Ministry took down a website that had showed daily, weekly and monthly figures on infections and deaths in Brazilian states. On Saturday, the site returned but the cumulative numbers of infections for states and the nation were no longer there. The site now shows only the numbers for the previous 24 hours.”
New York Times reports, “Lawmakers and health experts quickly attacked Mr. Bolsonaro in unusually blistering terms. Not only did they condemn the government’s decision to withhold comprehensive statistics as deaths and contagion continue to soar, but they roundly criticized the Bolsonaro administration’s repeated practice of playing down the danger of the virus, regardless of what scientists and his own health ministers may say…Brazil is suffering the highest daily number of deaths in the world—often over 1,000 a day—and the government has stopped reporting the cumulative toll of the outbreak.”
BBC reports that “Tanzania's President John Magufuli has declared the country "coronavirus-free" thanks to prayers by citizens…. The World Health Organization (WHO) has expressed concern over the government's strategy on COVID-19.” Uganda-based journalist Grainne Harrington tweeted, “President Magufuli says #Tanzania free is of COVID-19 thanks to prayer. Meanwhile Tanzanian truck drivers coming into #Uganda are showing up positive.”
The Guardian reports on a number of countries. “Concern mounted…over the spread of coronavirus in Africa and elsewhere, with Nigeria confirming 600 deaths from a previously undetected outbreak and South Africa warning its pandemic could last up to two years…. Nigeria’s health ministry said 50 percent to 60 percent of 979 ‘mysterious’ deaths in Kano, the country’s second largest city, were linked to the virus, with most happening in a single week in April. Similar investigations are under way in eight other states that reported unexplained deaths.”
The Financial Times lays out some of the key numbers for COVID-19, including what we know about fatality rates (“typically in the 0.5 to 1 per cent range”). They report, “R0, the basic reproduction number in a population with no immunity and no containment measures, may have been above 3 in the early stages of the epidemic in Europe and North America, social distancing has pushed R below 1 in most countries. The UK government’s science advisers estimate that it is currently between 0.7 and 0.9.” On “superspreaders…emerging evidence suggests that 10 to 20 percent of COVID-19 cases account for 80 percent of transmission.”
Impact on HIV, Other Diseases and Routine Healthcare
We continue to see reports of the COVID-19 lockdowns and other side effects for ongoing health programs. Medscape reports on an analysis in the US that shows “Noninfluenza vaccine rates are tumbling for adults as well as children, owing to the fact that concerns regarding COVID-19 have overshadowed routine care…. In the week of April 6 this year (near the height of the COVID-19 pandemic in the United States) compared with that week in 2019, vaccination rates for adults aged 65 and older dropped 83.1 percent.”
The Atlantic reports “Condoms, birth control and other items are harder to get in the developing world because of the pandemic. That is putting lives at risk…. Because of restrictions on movement and on large gatherings, many people still won’t get the care they need, or will have to adjust their contraceptive method to avoid doctor’s visits…in the short term, women in the developing world are likely to shift from highly effective long-acting reversible contraceptives such as injectables, implants, and IUDs, to condoms or oral contraceptive pills. These methods typically leave more room for human error, because they must be taken daily or used correctly every time for the highest efficacy. All of this means that in a few months’ time, there may well be an increase in demand for abortion care.”
Harlem World Magazine reports that the New York City health department “announced citywide home delivery of safer sex products and HIV self-test kits to supplement sexual and reproductive health services currently available in the city.” Dr. Oni Blackstock, Assistant Commissioner for the Health Department’s Bureau of HIV is quoted: “As New Yorkers have had to adapt to the realities of the pandemic, so have the Health Department’s service models. Door 2 Door and the Community Home Test Giveaway Virtual Program will allow New Yorkers to access sexual health services from the comfort and safety of their own homes.”
News24 reports that in one South African province, “people with TB and HIV have a two to three-fold increased risk of dying of COVID-19, according to data released by the Western Cape health department today. Although the data shows an increased risk, the risk is lower than what researchers expected…. As part of its analysis, the Western Cape reviewed 12,987 COVID-19 cases in its public sector, including 435 deaths. The department found that just over half of COVID-19 deaths were due to diabetes. In contrast, about one in 10 fatalities from the new coronavirus was due to being HIV positive and 2 percent were due to having active TB….”
Open Democracy via the East African reports learning “from 24 interviews across five countries, that the most disrupted HIV-related services were those meant to prevent new infections, especially among populations considered most at risk of HIV. Health workers and sex workers in Uganda, Kenya, South Africa, Nigeria and Mozambique, said they came up with creative ways to ensure registered HIV patients continue receiving drugs: Home deliveries using bikes, multi-month refills, among others. But HIV testing, PrEP, drop-in centres for vulnerable groups and medical male circumcision, were scaled back and sometimes closed completely—all of which are vital in detecting and preventing new infections.”
Hydroxycholoroquine: Hope Still for PrEP Trials as Hope for Treatment and PEP Dims and Politics Intervenes
Science reports that “through the fog of alleged misconduct, hope, hype, and politicization that surrounds hydroxychloroquine, the malaria drug touted as a COVID-19 treatment, a scientific picture is now emerging…. But now three large studies, two in people exposed to the virus and at risk of infection and the other in severely ill patients, show no benefit from the drug. Coming on top of earlier smaller trials with disappointing findings, the new results mean it’s time to move on, some scientists say, and end most of the trials still in progress.” Science reports that hopes are also dimming for hydroxychloroquine as post-exposure prophylaxis after disappointing results published in NEJM last week. Additionally, “A second large PEP trial has come up empty as well, its leader tells Science. Carried out in Barcelona, Spain, that study randomized more than 2,300 people exposed to the virus to either hydroxychloroquine or the usual care. There was no significant difference between the number of people in each group who developed COVID-19, says Oriol Mitjà of the Germans Trias i Pujol University Hospital. Mitjà says he has submitted the results for publication.” However, “many researchers agree that a good case can be made for continuing to test whether hydroxychloroquine can prevent infection if given to people just in case they get exposed to the virus, for instance on the job at a hospital—a strategy called pre-exposure prophylaxis (PrEP). ‘You have a much better chance of preventing something with a weak drug than you have of curing a fully established infection,’ says White, who runs one of the largest PrEP trials….”
Helio quotes researcher Ilan Schwartz on concerns about the rapid publication of COVID-19 research: “Journals like The New England Journal of Medicine and The Lancet are expediting review within 3 or 4 days, which, under normal circumstances, would be unheard of. Certainly, there is a loss of thoroughness that can be expected as a consequence. In addition, the editorial decisions may have been rushed, and general pressure to publish as rapidly as possible, and the urge for primacy—for being the first one to publish a study on a particular topic—all likely contributed to the errors and oversight that occurred.”
A statement from the chief investigators of the RECOVERY trial, a randomised clinical trial to test a range of potential drugs for COVID-19, including hydroxycholoroquine, released on June 5 says that, “We have concluded that there is no beneficial effect of hydroxychloroquine in patients hospitalised with COVID-19. We have therefore decided to stop enrolling participants to the hydroxychloroquine arm of the RECOVERY trial with immediate effect. We are now releasing the preliminary results as they have important implications for patient care and public health…. A total of 1,542 patients were randomised to hydroxychloroquine and compared with 3,132 patients randomised to usual care alone. There was no significant difference in the primary endpoint of 28-day mortality (25.7 percent hydroxychloroquine vs. 23.5 percent usual care; hazard ratio 1.11 [95 percent confidence interval 0.98-1.26]; p=0.10). There was also no evidence of beneficial effects on hospital stay duration or other outcomes.”
Following the retraction from Lancet, the Trump re-election campaign issued a press release claiming that Lancet, the democratic party and others are perpetuating a “war on science” and endangering lives. Many outlets that promote “natural medicine” and conspiracy theories about actual science, used the press release and other information from the Trump administration to attack the scientific process around decisions about hydroxychloroquine trials.
The Human Dimension
Kaiser Health News and The Guardian are documenting those Lost on the Frontlines in the US, almost 600 by their count. “They tend to patients in hospitals, treating them, serving them food and cleaning their rooms. Others at risk work in nursing homes or are employed as home health aides.” The project includes obituaries for several healthcare workers killed by COVID-19.
From Preprints and Press Releases: Surfaces and Blood Type
A preprint seems to suggest that there is not a high risk of contracting SARS-CoV-2 from contaminated surfaces, concluding that “Surfaces in the domestic environment did not show a high contamination rate in this study.”
Several outlets, including the New York Times reported on data from a preprint that “a study by European scientists is the first to document a strong statistical link between genetic variations and COVID-19, the illness caused by the coronavirus…. Having type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.”
Bloomberg reports on a separate study “from genetic-testing giant 23andMe Inc. [that] found differences in a gene that influences a person’s blood type can affect a person’s susceptibility to COVID-19…. Preliminary results from more than 750,000 participants suggests type O blood is especially protective against SARS-CoV-2, the virus that causes COVID-19, the company said on Monday. The findings echo other research that has indicated a link between variations in the ABO gene and Covid-19.”
Remdesivir: Cost, Access, Monkey Research
A BMJ commentary by Gregg Gonsalves and others looks at the potential price of remdesivir, should it be approved. They note that “The Institute for Clinical and Economic Review (ICER), presented three pricing models for remdesivir in the US market: $10 for a 10-day treatment course if the drug is priced ‘at cost,’ or, using a cost-effectiveness model with a willingness to pay threshold of $50,000, $390 if there is no mortality benefit, or $4,500 if there is a mortality benefit…. The price Gilead chooses for remdesivir may also shape the price of the next generation of medicines within the same treatment class, because introductory prices often create anchoring effects.” They write that the price of AZT, the first HIV treatment drug, set at $8,000 per year, then said to be “the most expensive prescription drug in history, set up a ‘firestorm of controversy,’ including early ACT-UP protests.” They conclude, “the public sectors around the world invested heavily in remdesivir and if the drug is established to be effective, it should be made available at a reasonable, evidence-based price. We cannot allow history to repeat itself, from AZT to sofosbuvir, with people unable to access a critical medicine; the first in what may be a generation of antiviral drugs used to treat global pandemic infections.”
CBS reports “The federal government's supply of remdesivir, an FDA-authorized drug that was found to lessen the recovery time for patients hospitalized with the coronavirus, could be tapped out by the end of June, a top official from [HHS] warned….Kadlec told CNN the federal government has been assisting Gilead ‘with some of the supply chain challenges in terms of raw materials and being able to accelerate the process,’ but warned that ‘whatever the supply may be, there may not be enough for everyone who may need it.’"
Reuters reports that “remdesivir prevented lung disease in macaque monkeys infected with the new coronavirus, according to a study published in the journal Nature…. The findings were first reported in April by the US National Institutes of Health (NIH) as a ‘preprint,’ prior to traditional academic validation provided by a medical journal.”
Resources to Bookmark
Dear Pandemic, on Facebook and Twitter, style themselves as “bona fide nerdy girls post real info on COVID-19. We are committed to facts. An interdisciplinary, all-female team of researchers and clinicians with expertise including nursing, health policy/economics, and epidemiology.” They answer questions about COVID-19 and host live chats.
The Africa CDC COVID-19 resource page includes updates on research and policies.
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