More than six months into the pandemic, we’re learning more about the how the virus acts and how we might fight it. But there is still much we don’t know. This week, like every week of this COVID-19 journey, brought both clarity and confusion. As the scientific picture comes more into focus, the political picture in many countries becomes ever less clear.

As both a testament to how desperate the world is for solutions and how research timelines have changed–likely forever–witness the speed at which the drug dexamethasone moved through a process that usually takes months or years: “It’s very, very rare that you announce results at lunchtime, and it becomes policy and practice by tea time, and probably starts to save lives by the weekend.” This from Recovery trial PI Martin Landray to Science.
 

Airborne

After 200+ researcher published an open letter in Clinical Infectious Diseases, WHO is changing its stance on whether or not the virus can be airborne. NBC News reports WHO “acknowledged ‘emerging evidence’ of the airborne spread of the coronavirus.” A WHO expert said, “The WHO is working on a scientific brief summarizing what's known about coronavirus transmission.” In an article that is a must read explainer, The New York Times says, “The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants.” One expert says, “We should be placing as much emphasis on masks and ventilation as we do with hand washing. As far as we can tell, this is equally important, if not more important.”
 

Impact on Black and Brown People

The New York Times and other outlets reported over the weekend on racial disparities in the US. The Times sued the CDC to get access to data that shows very clearly how much more the virus is impacting Black and Brown people. “Black and Latino people have been disproportionately affected by the coronavirus in a widespread manner that spans the country, throughout hundreds of counties in urban, suburban and rural areas, and across all age groups…. Latino and African-American residents of the United States have been three times as likely to become infected as their white neighbors, according to the new data, which provides detailed characteristics of 640,000 infections detected in nearly 1,000 US counties. And Black and Latino people have been nearly twice as likely to die from the virus as white people, the data shows.”

The Grio reports that in the US, “A disheartening report claims that nearly 4 in 10 Black and Hispanic households with children are struggling with food insecurity during the coronavirus pandemic. Non-white families are now twice as likely to be food insecure.”

Reuters reports on the first cases of COVID-19 found in camps at the US border. “Three asylum seekers have tested positive for coronavirus in a sprawling encampment steps from the US border in Matamoros, Mexico, marking the first cases in a settlement that advocates have long viewed as vulnerable amid the pandemic.”
 

Need for More Order in the Research Enterprise

STAT reports, “In a gigantic feat of scientific ambition, researchers have designed a staggering 1,200 clinical trials aimed at testing treatment and prevention strategies against COVID-19 since the start of January. But a new STAT analysis shows the effort has been marked by disorder and disorganization, with huge financial resources wasted…. experts say the analysis shows that huge amounts of energy have been expended on haphazard efforts, often without a clear strategy to improve the odds that results would actually inform the care of patients. Faced with intense pressure to develop drugs and vaccines at previously unimaginable speed to push back a global pandemic, researchers may have actually slowed down the rate of progress.” Susan Desmond-Hellmann, former CEO of the Bill and Melinda Gates Foundation is quoted. “She noted that vaccines, in contrast, are being developed in a more methodical way—and wished that research on new drugs had been more organized, rather than simply trying whatever was available.”

Science reports, “In a sea of small, single institution studies, Recovery, with 12,000 patients and hundreds of participating hospitals, stands out—and offers lessons for the few other megatrials, organized by WHO and other bodies, which have been slow off the mark…. Meanwhile dozens of small trials competed for patients in many countries, most of them focusing on the same drugs, such as hydroxychloroquine. ‘I don’t understand why everyone was looking at the same thing,’ Yazdanapanah says. ‘I think we can do better.’ Susanne Herold, an expert on pulmonary infections at the University of Giessen, agrees. ‘There needs to be more coordination both within countries and across borders.’”
 

Vaccine News

Medscape reports NIH director Francis Collins told a senate hearing that “deciding who will get the eventual vaccine in what order and ensuring equal access by racial and ethnic groups require oversight by an entity outside the federal government… He disclosed that Operation Warp Speed (OWS) is in talks with the National Academy of Medicine (NAM) to perform that role.”

Reuters says Dr. Fauci told JAMA that “COVID-19 vaccine candidates will enter late-stage clinical studies by the end of the month, with others beginning in August, September and October…. ‘We may be able to at least know whether we are dealing with a safe and effective vaccine by the early winter, late winter, (or) beginning of 2021…’” 

STAT reports, “An experimental COVID-19 vaccine being developed by the drug giant Pfizer and the biotech firm BioNTech spurred immune responses in healthy patients, but also caused fever and other side effects, especially at higher doses. The first clinical data on the vaccine were disclosed… in a paper released on medRXiv, a preprint server, meaning it has not yet been peer-reviewed or published in a journal. 
 
Washington Post reports on messenger RNA vaccines. “This promising—but unproven—new generation of vaccine technologies is based on deploying a tiny snip of genetic code called messenger RNA to trigger the immune system. It has never before been approved for use…. Elegant in theory, efficacious in the laboratory but untested in the real world, the possible RNA vaccines are especially attractive because they might be cheaper, easier and faster to manufacture on a massive scale—at least one team boasts it could partner with producers in developing countries to provide millions of vials for as little as $5 a pop.”

Science says, “the apparent speed at which an Indian government agency aims to test and approve a homegrown COVID-19 vaccine has created an uproar among scientists both in India, which is increasingly overwhelmed by the new coronavirus, and abroad. A letter leaked on Twitter on Friday suggests the first vaccines could be rolled out by 15 August, which would leave far too little time for proper testing, critics say. The Indian Academy of Sciences calls the timeline “unreasonable and without precedent.”  

Reuters says, “AstraZeneca’s experimental COVID-19 vaccine is probably the world’s leading candidate and most advanced in terms of development, the World Health Organization’s (WHO) chief scientist said on Friday…. Swaminathan said Moderna’s COVID-19 vaccine candidate was ‘not far behind’ AstraZeneca’s, among more than 200 candidates, 15 of which have entered clinical trials.”

The newest company to make a vaccine deal with the US is "Novavax, a Maryland company that has never brought a product to market." The New York Times reports in “the largest deal to date from Operation Warp Speed,” the company will get $1.6 billion. “The deal would pay for Novavax to produce 100 million doses of its new vaccine by the beginning of next year—if the vaccine is shown to be effective in clinical trials.”
 

Antibody Hope?

Luciana Borio and Scott Gottlieb write in the Wall Street Journal “the path to a vaccine can be long and complex….With so many uncertainties, vaccines aren’t likely to be available widely until next year. That means we need to pursue other potential antidotes. One promising option is monoclonal antibodies—lab-produced molecules engineered to mimic antibodies that occur naturally in response to an infection or vaccine. Like natural antibodies, the lab versions bind to the virus and prevent its spread. Regeneron, Vir, Eli Lilly and others are developing this class of drugs for Covid. Several are in clinical trials. 

In tweeting a link to the op-ed, Jon Cohen says, “It's been two months since I wrote this article about monoclonal antibodies, and it's become increasingly obvious to me that they offer the best near term hope of sparing our ICUs. The question may come down to supply, not safety and efficacy.” Cohen’s article is here.
 

Vaccine Hesitancy

Finding safe and effective vaccines is only one hurdle toward getting the world out of this pandemic. Vaccine hesitancy seems to be growing in many countries. Science reports, “health communication experts say they need to start to lay the groundwork for acceptance now, because the flood of misinformation from antivaccine activists has surged…. Recent polls have found as few as 50 percent of people in the United States are committed to receiving a vaccine, with another quarter wavering. Some of the communities most at risk from the virus are also the most leery: Among Black people, who account for nearly one-quarter of US COVID-19 deaths, 40 percent said they wouldn’t get a vaccine in a mid-May poll by the Associated Press and the University of Chicago. In France, 26 percent said they wouldn’t get a coronavirus vaccine.”

The Guardian reports, “Nearly one in six Britons will refuse a coronavirus vaccine if and when one becomes available, and a similar number are unsure whether they will get one, according to a survey.”
 

Determining Disease Severity and Lethality

A Nature piece looks at how researchers are trying to determine what drives COVID-19 severity. “Tracing the evolution of SARS-CoV-2 is fundamental for informing the public-health policies needed to limit disease spread. Dissecting the underlying causes and mechanisms of perturbed immune defences, such as the depletion of CD3⁺ T cells and the heightened pro-inflammatory response, as well as determining the crucial clinical and molecular hallmarks of COVID-19, are of paramount importance for the design of treatment strategies and effective vaccines. Zhang et al. lay some essential groundwork that should aid in these Herculean tasks, and their work raises key questions that will need to be answered if we are to limit this pandemic and try to prevent a future one.”

Donald McNeil in the New York Times looks at the quest to understand how deadly COVID-19 is. “A firm estimate could help governments predict how many deaths would ensue if the virus spread out of control. The figure, usually called the infection fatality rate, could tell health officials what to expect as the pandemic spreads to densely populated nations like Brazil, Nigeria and India. In even poorer countries, where lethal threats like measles and malaria are constant and where hard budget choices are routine, the number could help officials decide whether to spend more on oxygen concentrators or ventilators, or on measles shots and mosquito nets.” He notes that WHO recently said “consensus for now was that the I.F.R. is about 0.6 percent—which means that the risk of death is less than 1 percent. Although she did not note this, 0.6 percent of the world’s population is 47 million people, and 0.6 percent of the American population is 2 million people. The virus remains a major threat.”

COVID-19 Impact on Women and Girls

Reuters reports that “Kenya's president on Monday ordered an investigation into rising reports of violence against women and girls—including rape, domestic violence, female genital mutilation (FGM) and child marriage—a result of coronavirus restrictions. Lockdowns to curb the spread of the new coronavirus have fuelled an upsurge in gender-based violence across the world, with women and girls more isolated and vulnerable to abuse and exploitation, say women's rights campaigners.”

AP reports that some sex workers in Africa lack the food they need to take their HIV meds. The information comes from a Lancet commentary which says, “Sex workers are among the most marginalized groups…it is crucial that disruption to health services does not further reduce access to HIV treatment.” AP quotes Winnie Byanyima, “We are seeing sex workers in Africa being denied the support others are given, like food. Some are being shamed and run out of their homes and called the source of corona.”

ProPublica reports, “The [US] CDC had been asserting that pregnant women don’t seem to be at higher risk for severe complications from the virus. As recently as late May, a spokesperson told ProPublica, ‘Current evidence shows pregnant women have the same risk of severe illness from COVID-19 as adults who are not pregnant.’ Then, the agency abruptly changed its tone. In its first examination of U.S. data on COVID-19 in pregnancy, the CDC found that expectant mothers with the virus had a 50 percent higher chance of being admitted to intensive care and a 70 percent higher chance of being intubated than nonpregnant women in their childbearing years.

COVID-19 Impact on Everything Else

AllAfrica reports, “Schools in Kenya will not re-open until 2021 due to fears of COVID-19 infections which has started taking toll in the country. Education Cabinet Secretary Professor George Magoha said it will not be practical and safe to re-open schools because the peak period for the virus infections is just starting.”

Medpage Today reports on data from AIDS2020 on the impact of COVID-19 on PrEP use in Boston. “Lapses in refills for HIV pre-exposure prophylaxis (PrEP) skyrocketed during the COVID-19 outbreak, with significant declines in PrEP initiations, as well as testing for sexually transmitted infections at an HIV clinic in Boston, a researcher said at the virtual International AIDS Conference (IAC). PrEP refill lapses increased as the pandemic grew in 2020, from 140 in January to 407 in April, while new PrEP starts declined by 72 percent, from 122 per month to 34 per month….”

CNN reports on a report from IAS, “As health services around the world continue to focus their resources on ending the coronavirus pandemic, they threaten to derail decades of hard-won progress in the response to HIV, TB and many other diseases…. Models by the World Health Organization, Stop TB partnership and Imperial College London have predicted that such disruptions [to health services] could lead to over 1 million extra deaths across these three diseases.”

The Washington Post reports, “Suspected overdoses nationally jumped 18 percent in March, 29 percent in April and 42 percent in May, data from ambulance teams, hospitals and police shows…. Nationwide, federal and local officials are reporting alarming spikes in drug overdoses—a hidden epidemic within the coronavirus pandemic. Emerging evidence suggests that the continued isolation, economic devastation and disruptions to the drug trade in recent months are fueling the surge.

A WHO press release outlines the restart of mass polio immunizations in Burkina Faso. “As immunization campaigns resume, World Health Organization (WHO) teams at both regional and country offices have developed guidance for countries and frontline workers to ensure their safety and that of the children and their families.”

Smell Tests Not Temp Checks

Smell tests might be a better way than temperature checks to determine illness, reports STAT. “Because many contagious people have no symptoms, using temperature checks to catch them is like trying to catch tennis balls in a soccer net: way too many can get through…. However, a growing body of science suggests a simple fix: make smell tests another part of routine screenings…. As experts have cast around for other screening tools, some have zeroed in on smell tests, which could be as simple asking people to identify a particular scent from a scratch-and-sniff card. Though not a universal symptom, loss of smell is one of the earliest signs of COVID-19 because of how the virus acts.”

Mask Denialism

The US continues to be split largely along political lines about mask wearing. Kaiser Health News reports on pleas from nurses to wear masks. One is “distraught that some Americans see mandates for face coverings as an infringement upon their rights instead of a show of solidarity with health care workers.” Another posted on Facebook, “If I’m wrong, you wore a silly mask and you didn’t like it…If I’m right and you don’t wear a mask, you better pray that all the nurses aren’t already out sick or dead because people chose not to wear a mask. Please tell me my life is worth a LITTLE of your discomfort?”

In an open letter to the American public, the American Hospital Association, American Medical Association and American Nurses Association plead for Americans to wear masks: “as physicians, nurses, hospital and health system leaders, researchers and public health experts, we are urging the American public to take the simple steps we know will help stop the spread of the virus: wearing a face mask, maintaining physical distancing, and washing hands. We are not powerless in this public health crisis, and we can defeat it in the same way we defeated previous threats to public health—by allowing science and evidence to shape our decisions and inform our actions.”

Contagion Live reports that “despite being within the age group at highest risk for severe SARS-CoV-2 infection, a recent survey of elderly adults from 27 countries suggests that the population is not inherently more willing to socially isolate and should not be assumed to be more compliant with coronavirus disease 2019 (COVID-19) response measures. In the survey, which was published in PLOS ONE, elderly adults even expressed a lower willingness to wear a mask outside the home than younger respondents.

MentalFloss lays out the information you need about your ability to breathe while wearing a mask. Spoiler alert: you won’t get carbon dioxide poisoning.

PPE Save Lives

Medscape reports, “Health workers who have appropriate personal protective equipment (PPE) including protective suits, masks, gloves, goggles, face shields, and gowns don't develop COVID-19 symptoms or test positive for SARS-CoV-2, a Chinese study suggests.”

Early Hope for Potential Treatments

FierceBiotech reports “The virus that causes COVID-19, SARS-CoV-2, cannot grow and spread through the body without the help of a protein called polymerase. Now researchers at Columbia University and the University of Wisconsin-Madison have identified several molecules that interfere with the polymerase reaction—and some of them are already FDA-approved to treat other viruses. The researchers identified five existing drugs that can shut down the polymerase reaction, they reported in the journal Antiviral Research. They include medicines used to treat HIV, cytomegalovirus, and hepatitis B.

New Tests Coming

The New York Times reports, “researchers around the world are working on the next generation of coronavirus tests that give answers in less than an hour, without onerous equipment or highly trained personnel. The latest so-called point-of-care tests, which could be done in a doctor’s office or even at home, would be a welcome upgrade from today’s status quo: uncomfortable swabs that snake up the nose and can take several days to produce results…. But most of the new contenders are still in early stages, and won’t be available in clinics for months.”
 

Rising Numbers in Africa

AllAfrica reports, “As of July 7, the confirmed cases of COVID-19 from 55 African countries have reached 492,858. Reported deaths in Africa have reached 11,658 and recoveries 237,041. South Africa has the most reported cases–205,721, with deaths numbering 3,310. Other most-affected countries include Egypt (76,222 cases), Nigeria (29,286), Algeria (16,404), and Ghana 21,077).”

BMJ reports WHO “does not believe that Africa harbours large numbers of undetected COVID-19 infections, said its regional director Matshidiso Moeti, although ‘there is underestimation of cases.’…. Only about 4 percent of the world’s cases and 2 percent of global deaths from covid-19 have been recorded on the continent, following a strong early public health response from many African governments. But cases have been spiking faster lately, particularly in South Africa, where the lockdown was strict and early but where international travelers arrive in greater numbers than other African countries….”

A study in the International Journal for Equity in Health found in “16 countries in sub-Saharan Africa indicate that, on average, only 33.5 percent of households with an observed handwashing place at home have water and soap.”

Higher Case Fatality Rate in India

The Wire reports, “India’s Case Fatality Rate is Highest Among South Asian Countries…. A high CFR in a country implies that a high fraction of the reported COVID-19 patients are succumbing to the disease. It highlights shortcomings in healthcare strategies related to the general quality of health, access to healthcare, early detection of patients, proper triage, care of critical patients, etc.”

Science Not Politics

The Washington Post writes, “Fifty-seven former government scientists and public health officials of both parties called on Monday for a science-based approach to the coronavirus pandemic and criticized the Trump administration for marginalizing science and expertise in its response.” The statement says, “To the federal employees working on the front lines of this pandemic, preparing our country for any—resurgence of COVID-19, we say: keep speaking out. We support you. You stand as a xxxxxx against the spread of misinformation and the diversion of public health policies and programs to suit political goals.”

On Tuesday, the Trump administration followed through on a threat to leave WHO, sending a formal letter to the UN Secretary General, according to the New York Times and other outlets. The move “[cuts] off one of the organization’s biggest sources of aid…. By law, the United States must give the organization a year’s notice if it intends to withdraw, and meet all the current financial obligations in the current year. AVAC, TAG and Health Gap condemned the move, arguing it is “short-sighted and dangerous, and will cost more lives and deepen economic devastation in the United States and around the world, which are already reeling from the ongoing COVID-19 pandemic.”

Politico reports, “Frustrated by President Donald Trump’s handling of the coronavirus response, major public health organizations are mounting a widespread defense of the Centers for Disease Control and Prevention over worries the administration is sidelining its own experts and undermining trust in public health officials across the country. The nearly 350 public health organizations, advocacy groups and local health departments are urging Health and Human Services Secretary Alex Azar — who has fallen in lockstep with the White House on key markers of the coronavirus response — to play a more prominent role in shielding the CDC from political interference.”

Common Dreams reports “a Chinese state-controlled newspaper has blamed the Trump administration's mishandling of the COVID-19 pandemic to cause the spread of the virus to go ‘completely out of control.’ Describing the disease as a ‘US epidemic’, the paper warned that the administration's failure poses a threat to the rest of the world. ‘Lies are dominating US society's recognition of the epidemic,’ the Global Times wrote.” This follows the US president and other administration officials calling SARS-CoV-2 the China virus, the Wuhan virus, using racial slurs to describe the virus and blaming China for developing and/or spreading the virus. As the article reports Trump advisor Peter Navarro claimed on MSNBC that “’They spawned the virus, they hid the virus, they sent hundreds of thousands of Chinese nationalists over here to seed and spread the virus before we knew’…. He claimed the virus ‘probably’ came from a Chinese lab and argued, ‘this looks like a weaponized virus’ and that the ‘Chinese communist party’ is responsible for forcing Americans to ‘stay locked in our homes and lose our jobs.’”

BBC reports, “Brazil's President Jair Bolsonaro has tested positive for coronavirus…. Mr. Bolsonaro has repeatedly played down risks of what he has called the ‘little flu’, saying he would not be seriously affected. He has opposed lockdowns, which he says hurt the economy…. He said he was taking hydroxychloroquine—championed by US President Donald Trump—and azithromycin, an antibiotic, to treat the illness. Neither has been proven to be effective against the virus.”
 
CNN reports, “The commissioner of the US Food and Drug Administration on Sunday declined to defend President Donald Trump's unfounded claim that 99 percent of coronavirus cases are ‘totally harmless’ and repeatedly refused to say whether Trump's remark is true or false….” Hahn said, "What I'll say is that we have data in the White House task force. Those data show us that this is a serious problem. People need to take it seriously.”
 
NBC News reports, “After several months of mixed messages on the coronavirus pandemic, the White House is settling on a new one: Learn to live with it. Administration officials are planning to intensify what they hope is a sharper, and less conflicting, message of the pandemic next week…At the crux of the message, officials said, is a recognition by the White House that the virus is not going away any time soon—and will be around through the November election.” The story sparked a twitter conversation between infectious disease docs Peter Hotez and Carlos del Rio.

• Hotez: Seriously? "We need to live with it" Does this mean we're officially changing E Pluribus Unum to "We're OK" Or the official policy of #USA is now "We can't do hard things and I still don't get that science thing". Hopefully the report is not true
• Del Rio: It is really upsetting. Are we giving up? Is that OK? Do we agree?
• Hotez: Our fight has just begun. We are a great nation and as RNA viruses go, this is one of the less clever ones. We can easily crush #COVID19. Just a matter of prioritizing science and pragmatism ahead of the nonsense. I can’t understand why everyone in the White House is so wimpy. It’s not that hard. Every nation except us has stopped #COVID19. Create a command center in ATL at CDC, make an evidence-based plan, implement, look after the poor vulnerable, communicate to the American people. WTF.
• Del Rio: Amen Peter! Let’s do it! #WeAreID

 

What’s New in Immunity?

CNN reports, “Spain's large-scale study on the coronavirus indicates just 5 percent of its population has developed antibodies, strengthening evidence that a so-called herd immunity to COVID-19 is ‘unachievable,’ the medical journal the Lancet reported on Monday. The findings show that 95 percent of Spain's population remains susceptible to the virus. Herd immunity is achieved when enough of a population has become infected with a virus or bacteria—or vaccinated against it—to stop its circulation.”

Rising Cases, but Not Rising Deaths… Yet

Vox reports, “There is something confounding about the US’s new coronavirus spikes: Cases are rising, but the country is seeing its lowest death counts since the pandemic first exploded.” Public health experts warn not to be complacent. “The novel coronavirus, SARS-Cov-2, is a maddeningly slow-moving pathogen—until it’s not. The sinking death rates reflect the state of the pandemic a month or more ago, experts say, when the original hot spots had been contained and other states had only just begun to open up restaurants and other businesses…. That means it could still be another few weeks before we really start to see the consequences, in lives lost, of the recent spikes in cases. And in the meantime, the virus is continuing to spread. By the time the death numbers show the crisis is here, it will already be too late. Difficult weeks will lie ahead.”

The Washington Post reports Dr. Fauci “called recent focus on the coronavirus’s decreasing mortality rate in the United States a ‘false narrative,’ while President Trump continued to tout those numbers on Twitter…. ‘It’s a false narrative to take comfort in a lower rate of death,’ said Anthony S. Fauci, a member of the White House coronavirus task force, during a news conference. He said that the country has gotten better at treating people and that the average age of virus patients is dropping.”
 

WHO Stops Hydroxychloroquine Trial

UPI reports, “The World Health Organization announced Saturday that it discontinued its trial on hydroxychloroquine's effect on COVID-19 patients in hospitals. WHO said in a statement that it accepted a recommendation from the Solidarity Trial's International Steering Committee that it stop the testing of the drug.”

More on Dexamethasone

New Scientist has an explainer on dexamethasone, “the first medicine shown to reduce deaths from COVID-19. It belongs to a class of drugs called steroids, which damp down the immune system. Our immune response is normally what saves us from attack by viruses and bacteria, but in people with severe COVID-19, it seems to overreact. Immune cells congregate in the lungs, releasing high levels of immune signalling chemicals called cytokines, which attract yet more immune cells, in a vicious circle known as a cytokine storm. This leads to excessive inflammation in the lungs, with fluid leaking into the air spaces, hindering intake of oxygen. Steroid drugs like dexamethasone are often used to treat other diseases caused by an overreactive immune system, like allergies, and have also been used previously to treat people in intensive care with lung inflammation.”
 

Remdesivir Price and Access

Activists and others continued to hammer Gilead for the price of the drug.

The Los Angeles Times reports the company is also “coming under scrutiny for agreements that activists say will restrict global access to remdesivir…. The Foster City, Calif.-based company has signed confidential licensing deals with nine pharmaceutical manufacturers—including seven in India—that would prevent the generic version of the drug from being distributed in dozens of countries, including the US, that account for nearly half the world’s population.”

CNBC says “Mylan will launch a generic version of Gilead Sciences' Covid-19 antiviral remdesivir in India at 4,800 rupees [$64], about 80 percent below the price tag on the drug for wealthy nations…. Mylan said it would manufacture remdesivir in India at its injectables facilities and was working toward expanding access for patients in the 127 low- and middle-income countries where it is licensed by Gilead Sciences to do so.”

The US bought up almost all supplies of remdesivir as The Guardian reports. One public health physician tweeted, “US buys up world stock of #remdesivir & no other country will be able to buy it for at least 3 monoths. We are getting a sneak peek at how the US can be expected to behave once a vaccine is available Can we finally agree that the IP regime needs dismantling?”

Health News Review rounds up some of the international response to the US action: “It sometimes helps to see the US as others see us.  This time it’s viewed as a ‘chilling move,’ ‘shocking,’ ‘disappointing…inappropriate,’ or, as Dr. Brophy wrote, ‘the apotheosis of a self-centered nation.’”

A comment in The Guardian concludes, “What Trump knows best is that the only thing that matters in business is money. Unfortunately, this also applies during a pandemic, when whoever has the most money can afford the most vaccines and essential medicines, too.”
 

Impact on Other Research

Endpoint News reports on COVID-19’s significant impact on clinical research: “The majority of disrupted clinical trials are in Phase II, at 44.8 percent, followed by Phase I with 26.1 percent, Phase III with 21.7 percent, and Phase IV with 7.4 percent,” says Brooke Wilson, associate director, trials intelligence at GlobalData. “Of these trials, 12 percent are specifically Pivotal/Registrational, giving an indication that there will be an impact on regulatory approvals in the future…. The big focus now will be how fast the developers can move these delayed trials along, or replace them with fresh efforts. Regulatory groups on both sides of the Atlantic have been helping out with new rules that allow trials to continue, when possible, with home drug delivery and at-home monitoring and the use of telemedicine a more common feature.”
 

Some Good News for PLWHIV

aidsmap reports that “People with HIV did not suffer worse outcomes after admission to hospital with COVID-19, a study of admissions at a major London hospital has reported. The findings were presented as part of the virtual 23rd International AIDS Conference (AIDS 2020) by Dr Ming Lee and colleagues at Guy’s and St Thomas’s Hospital, London. Indeed, the study found that after controlling for age and other confounding factors, people with HIV experienced more rapid improvement in their condition or were discharged from hospital more quickly than matched HIV-negative patients.”