View this email in your browser ([link removed])
AVAC's weekly COVID News Brief provides a curated perspective on what COVID news is worth your time.
“As community-based organizations that work to promote scientific research literacy and broaden informed participation in clinical trials, we are concerned that proponents of human challenge studies fail to appreciate the potential to exacerbate mistrust of science. This mistrust is widespread and not necessarily irrational—there is a grim historical record of abuse in research, particularly of people of color. The apparent eagerness to embrace putting people at risk of death or other complications—both known and as yet unknown—from COVID-19 threatens to undermine the critical tenet that science now places the highest priority on the welfare of research participants.”
-- AVAC and TAG ([link removed]) - Statement on Human Challenge Studies for COVID-19 Vaccine Development ([link removed])


** Latest Global Stats
------------------------------------------------------------
July 23, 2020
Confirmed Cases
15,265,081 Recovered
8,708,362 Deaths
624,370
Source: Center for Systems Science and Engineering, Johns Hopkins University ([link removed])


** Table of Contents
------------------------------------------------------------
* If You're in a Hurry (#hurry)
* It Was a Big Week for Vaccines (#big)
* The Challenges of Challenge Trials (#challenge)
* Antivaxxers Fuel Mistrust (#antivax)
* Call for Scientists and Journalists to Work Together (#call)
* Understanding COVID Disparities (#understanding)
* Returning to School (#returning)
* What Do We Know About Immunity This Week? (#immunity)
* What if We Get Two Pandemics? (#whatif)
* COVID-fueled Burnout (#burnout)
* Long-term Effects for Young People (#effects)
* Treatment News (#treatment)
* Human Rights (#human)


* Rwanda (Maybe Voluntary) Testing Success (#rwanda)
* Economic distress (#distress)
* Impacts on Global Health and HIV (#impacts)
* This Week in Mis/Disinformation and Nuanced Information (#week)
* Call to Invest in Community Health Workers in Africa (#invest)
* Latin American Success (#latin)
* Regulators Concerns (#regulators)
* Lower Rates of Preemies Impact on Birthrates (#lower)
* COVID and Women (#women)
* On Testing (#testing)
* This Week in COVID Politics (#politics)
* This Week in Baseball (#baseball)

The trajectory this week is all too predictable. The world broke more records in COVID cases and deaths continue to mount up. Politicians continue to be in opposition to science all too often. AP ([link removed]) reports that “Signs of governments reassessing their coronavirus response were scattered around the world Sunday, with the mayor of Los Angeles saying the city was reopened too quickly, Ohio’s governor warning his state is ‘going the wrong way,’ Hong Kong issuing tougher new rules on wearing face masks and Spain closing overcrowded beaches.” The US President appeared to have shifted his stance on face masks, tweeting that “many people say that it is Patriotic to wear a face mask when you can’t socially distance.” It remains to be seen whether or not Americans who have been opposed to mask wearing will shift in light of this. If they don’t, projections from IHME ([link removed]) for COVID deaths in the US
are devastating. Newsweek reports, “The US daily death toll is currently projected to be around 815 by November 1…. This daily death toll projected for November 1 could be reduced by over 66.4 percent if "universal masks" were applied across the country, the institute noted.” Daily deaths could fall to 273 if 95 percent of Americans wore masks.

As politics continued to play a prominent role in the virus response in many communities and countries, science continued to move forward with the search for treatments, tests and vaccines, with some successes to provide the good news this week.



** If You’re in a Hurry
------------------------------------------------------------
* Listen to The New York Times ([link removed]) Daily Podcast on vaccine hesitancy
* Read Axios ([link removed]) on the state of the global race for a coronavirus vaccine
* Read how Uruguay is defeating COVID in Foreign Policy ([link removed])
* Read an op-ed in The New York Times ([link removed]) calling for scientists and journalists to join forces to help ensure preprints are understood
* Read first person accounts of young people who “want to share stories of the wreckage COVID-19 has wrought in their lives” at CNN ([link removed])
* Check out the New York Times ([link removed]) Coronavirus Drug and Treatment Tracker
* But read about some concerns about it in a Health News Review ([link removed]) post
* Learn more about vaccine hesitancy and how antivaxxers are targeting African-Americans with concerns about research in the Washington Post ([link removed]) and The New York Times ([link removed])
* Then Read about a pro-vaccine campaign in Fast Company ([link removed])
* Check out the Union of Concerned Scientists ([link removed]) new online resource ([link removed]) with tips on how to spot and stop the spread of disinformation around COVID-19


**
It Was a Big Week for Vaccines
------------------------------------------------------------
Axios ([link removed]) rounds up where we are in the race for a vaccine, laying out recent data and news from the frontrunner vaccines and laying out the issues ahead with quotes from key experts, including Zeke Emanuel, who says, "Seven months after we got the genome, to have three vaccines in phase three is literally unprecedented. If in six to eight months we get a license, that will be, again, totally unprecedented in world history”. But her also warns, “Getting something approved doesn't protect you from COVID.”

AP ([link removed]) reports on the Moderna vaccine: “The first COVID-19 vaccine tested in the US revved up people’s immune systems just the way scientists had hoped…as the shots are poised to begin key final testing…. The experimental vaccine, developed by [NIAID] and Moderna Inc., will start its most important step around July 27: A 30,000-person study to prove if the shots really are strong enough to protect against the coronavirus.”

STAT News ([link removed]) reports, “A COVID-19 vaccine being developed by Oxford University and the drug giant AstraZeneca generated an immune response in a study of roughly 1,000 patients, according to interim results published Monday. The data, published in the medical journal the Lancet ([link removed](20)31604-4) , also show that the vaccine caused side effects… in about 60% of patients. All of the side effects were deemed mild or moderate, and all resolved themselves over the course of the study…. AstraZeneca said that, because of the results, it is likely that future studies will test giving patients two doses of the vaccine…. The Lancet also published results of another vaccine, from the Chinese biotech CanSino…. The Phase 2 results showed that, as was seen in the Phase 1 data, the vaccine induced neutralizing antibody responses — which could be
vital to preventing the disease’s dangerous symptoms — in most subjects. But further study continues to show that this vaccine works better in some people than others. And among those it didn’t work as well in were people aged 55 and older, a key target for COVID-19 vaccination.”

The New York Times ([link removed]) reports the US government issued a ~$2 billion dollar contract to Pfizer and the German biotech BioNTech for up to 600 million doses of their mRNA coronavirus vaccine. Pfizer is unique among the other Operation Warp Speed candidates in that it turned down a contract for earlier R&D efforts and has only contracted for doses and distribution. “We didn’t accept the federal government funding solely for the reason that we wanted to be able to move as quickly as possible with our vaccine candidate into the clinic” said their Chief Business Officer.

An editorial in The Lancet ([link removed](20)30192-4.pdf) argues, “The entire world is united in facing the emergency of the…COVID-19 pandemic: we are at war, but together against a common enemy. In this battle, health-care workers and researchers fight back…from the clinic and the laboratory…. The race for a vaccine moves fast, as the need for a solution is evident, but we cannot forget that safety is of the highest importance….But reasons for concern have arisen too. In vitro and few in vivo studies on SARS-CoV and MERS-CoV have suggested that antibodies against the virus could cause immune-enhanced disease, either by enhancing infection into target cells, or by increasing inflammation and severity of pulmonary disease. This issue raises the possibility that similar events might occur with SARS-CoV-2 infection. Eng Eong Ooi and colleagues from Duke-NUS Medical School (Singapore) describe in a review in Press at EBioMedicine the potential
effect of such risk, and the importance of adopting strategies for mitigating the risks right at the outset while developing vaccines or therapeutic antibodies.”

Fierce Biotech ([link removed]) reports, “The series of COVID-19 vaccine data sets coming this month are probably the most sought after, read and interrogated trial results ever released. The global economy, our health present and future, and our very way of life depends almost exclusively on having a safe, effective vaccine that can artificially (and much more safely) create the herd immunity we need to go “back to normal,” if there can be such a thing. AstraZeneca and the University of Oxford, Pfizer and BioNTech, Moderna, CanSino and CureVac are all now in human testing trying to find a shot that will end the misery of lockdowns, viral anxiety and massive job losses, with all but CureVac (which only recently started human testing) reporting broadly encouraging, though still very early, results this month…We don’t have a working defense against this virus yet, and even the more optimistic tones suggesting we could
have one by the fall are being rowed back. Even if we did, it would be in short supply, with questions on safety and efficacy likely still to be answered. These data are a peek at how things might work, but little more. As hard as it is, we need to wait for better answers.”

USA Today ([link removed]) reports, At a time when some Americans ([link removed]) are concerned about the safety of a COVID-19 vaccine, tens of thousands have already volunteered to help bring one into existence. As of Monday, more than 138,600 people had signed up to take part in testing. ‘That’s why we’re optimistic that we’re going to be able to get the trials enrolled in an expeditious way. I think we can do what we need to do,’ said Dr. Anthony Fauci….”

An op-ed in Devex ([link removed]) by Amref Health Africa staff argues, “It starts and ends with the communities. Communities will drive the success or failure of the COVID-19 ([link removed]) vaccine trials and immunization uptake. Scientists, policymakers, and public health experts must start involving communities now as discussions and plans progress toward finding a vaccine—not after the scientific breakthrough but before.”

Medscape ([link removed]) reports that pharma executives appearing before congress agreed on “particularly the need to begin immediately to build public trust in future COVID-19 vaccines.”

An op-ed in Rwanda’s New Times ([link removed]) argues the “At the end of the day, this is going to come down to who is either able to buy the vaccines or to mass-produce and distribute the vaccine. If life is going to return to normal on a timeline set by Africans, then Africa through the African Union has to pool together its resources and have in place a framework for a COVID-19 vaccine fund for Africa.”

The New York Times ([link removed]) Daily Podcast tackles vaccine hesitancy in the US, with health reporter Jan Hoffman talking about how widespread it is. “So if you think you have someone in mind who you think is the archetype of someone who opposes vaccines, you absolutely do not. It crosses racial lines. It crosses socioeconomic backgrounds, educational backgrounds. It crosses political affiliation.”

Politico ([link removed]) reports on an Indian “vaccine entrepreneur” who “plans to save the world from coronavirus — and then radically remake the international pharma landscape.” Adar Poonawalla’s company is“the world’s biggest vaccine manufacturer…. [and] he’s on a mad dash to work out deals with the most promising coronavirus vaccine developers to manufacture the immunizations on a global scale… Poonawalla believes that the sheer urgency of the virus—and the fact that coronavirus anywhere is a threat to people everywhere—should prompt a reassessment of patent and intellectual property laws that limit access to immunizations in the developing world, while simultaneously jacking up their price in wealthier countries.” Poonawalla argues, “It shouldn’t be that the wealthiest nations buy up all the IP and technology then restrict the other nations from being able to produce and have equitable access
for vaccines. Your survival shouldn’t be determined by where you live.” India Today ([link removed]) quotes Poonawalla,"We have said that we want to give half of our (vaccine) production to India and the other half to other countries on a pro-rata basis every month. The government has been supportive. We need to understand that this is a global crisis and people across the world need to be protected. It's important that we equally immunise the entire world.”



** The Challenges of Challenge Trials
------------------------------------------------------------

Jon Cohen writes in Science ([link removed]) that for challenge trials to take place, “two key elements are taking shape: a large corps of volunteers willing to take part in a ‘human challenge’ trial, and the well-understood lab-grown virus strains needed for the studies.” Cohen reports, “the challenge trials will require large amounts of strains of SARS-CoV-2 that are grown in a biosafety level 3 laboratory under strict ‘good manufacturing practices.’ Based on how readily the strains infect tissue cultures, developers can carefully calibrate the doses. Hill’s lab at Oxford—which is formally collaborating with 1Day Sooner—and Curative Inc., a biotech startup in Los Angeles that makes diagnostics for the disease, have both agreed to make the challenge strains.” The challenge strains are estimated to be ready by September, at which point, “according to the WHO proposal, trials should recruit vol
unteers to test three different doses to find one that causes mild respiratory illness in 70 percent of people. WHO estimates it will take 2 months after viral strains are made and characterized to launch a challenge study…. And if conventional trials have failed to identify a good candidate by then, challenge trials could help triage the more than 150 COVID-19 vaccines being developed.”

AVAC and TAG ([link removed]) launched a “Statement on Human Challenge Studies for COVID-19 Vaccine Development,” arguing that “As community-based organizations that work to promote scientific research literacy and broaden informed participation in clinical trials, we are concerned that proponents of human challenge studies fail to appreciate the potential to exacerbate mistrust of science. This mistrust is widespread and not necessarily irrational—there is a grim historical record of abuse in research, particularly of people of color. The apparent eagerness to embrace putting people at risk of death or other complications—both known and as yet unknown—from COVID-19 threatens to undermine the critical tenet that science now places the highest priority on the welfare of research participants.”



** Antivaxxers Fuel Mistrust, Especially Among African Americans
------------------------------------------------------------
The Washington Post ([link removed]) reports, “the possibility that anti-vaccination leaders—who have already made common cause with those dismissing the risks of the pandemic and protesting state safety restrictions—could further undermine faith in a vaccine among people of color is profoundly worrisome for public health officials.” Fauci is quoted saying,“it was vital not only to build African Americans’ trust in the vaccine that is ultimately developed but also to persuade them to participate in clinical trials, ensuring that the medicines are safe and effective for all racial and ethnic groups.” Prominent anitvaxxers like Robert Kennedy Jr have long attempted to enlist minority communities in vaccine denial, and the Post reports, “amid the social fracturing surrounding COVID-19 and the ferment over racial injustice that has swept the United States following the killing of George Floyd in police
custody, there are signs that the anti-vaccine movement’s message is gaining new traction.”

The New York Times ([link removed]) reports, “the repeated assurances of near-miraculous speed [in developing a covid vaccine] are exacerbating a problem that has largely been overlooked and one that public health experts say must be addressed now: persuading people to actually get the shot. A growing number of polls find so many people saying they would not get a coronavirus vaccine that its potential to shut down the pandemic could be in jeopardy. Distrust of it is particularly pronounced in African-American communities, which have been disproportionately devastated by the virus. But even many staunch supporters of immunization say they are wary of this vaccine. The Times reports on a report ([link removed]) that notes “although billions of federal dollars were pouring into biomedical research for a vaccine, there seemed
to be virtually no funding set aside for social scientists to investigate hesitancy around vaccines. Focus groups to help pinpoint the most effective messaging to counter opposition, the authors said, should get underway immediately.”

Fast Company ([link removed]) reports on a pro-vaccine campaign. “A new advocacy campaign is designed to mobilize the majority to speak out to help fight misinformation, at a time when the end of the current pandemic will hinge in part on the public’s willingness to be vaccinated…. The new campaign aims to activate the majority of the public who do support vaccines, educating them on the latest strands of misinformation that are circulating online and giving them the facts to be able to make persuasive counterarguments. It also asks them to flag inaccurate posts on social media.”



** Call for Scientists and Journalists to Work Together
------------------------------------------------------------

The authors of an op-ed in The New York Times ([link removed]) “and a group of over 100 scientists ([link removed]) are calling for American scientists and journalists to join forces to create a rapid-review service for preprints of broad public interest. It would corral a diverse contingent of scientists ready to comment on new preprints and to be responsive to reporters on deadline. This would provide journalists reliable access to independent scientists to help deal with today’s growing stream of preprints…. The public and policymakers must demand this kind of scrutiny before they turn the latest science on COVID-19 or anything else into policy or individual action.”

A JAMA ([link removed]) viewpoint argues that “because of the urgency to implement the findings of research to stem the pandemic and its effects, clear and complete communication of study results is even more important than usual. Government reports, journalism, talk shows, and public relations news releases from industry and academic institutions have often failed to communicate the results of studies well, and these failures have important consequences.” The authors say, “races are underway in parallel: to find answers to perplexing coronavirus questions, to announce research findings to clinical and scientific colleagues, and to report those findings to a confused and concerned global audience. There are no winners in these races if harm—even though unintentional—is wrought by the dissemination of hurried, incomplete, biased misinformation. Trust in science, medicine, public relations, and journalism may be in jeopardy in the intersection where
these professions meet. Time—even a few moments daily—can help prevent harm. Any professional communicating about this pandemic should spend such time to reflect on how the words and the data matter, and then act accordingly.”



** Understanding COVID Disparities
------------------------------------------------------------

Science ([link removed]) looks at the “huge hole” in COVID testing data that hides much of the racial and ethnic disparities of the pandemic in the US: “To understand which neighborhoods and communities face raging outbreaks and why, researchers need demographic information, including race and ethnicity, on who gets tested and who tests positive. But even as the US testing infrastructure improves, testing remains sparse in many low-income and minority neighborhoods, and race and ethnicity information is missing for about half of reported COVID-19 cases nationwide.”

In an essay ([link removed]) in Scientific American a Diné or Nahavo storyteller “explains how disadvantage and injustice have shaped her people’s encounter with COVID-19.” She says, “We have every social ill you can think of, and COVID has made these vulnerabilities more apparent. I look at it as a monster that is feasting on us—because we have built the perfect human for it to invade…. It seems to me that COVID has revealed a lot of truths, everywhere in the world. If we were ignorant of the truth, it is now revealed; if we were ignoring the truth, it is now revealed. This truth is the disparity: of health, wellbeing and human value. And now that the truth has been revealed, what are we going to do about it?”

Sahan Journal ([link removed]) reports a good news story: “Minnesota Department of Health is organizing COVID-19 testing events across the state that offer residents a chance to be tested without worrying about immigration status or a lack of health insurance. State officials have been working with local public health officials to pinpoint locations, and with advocacy groups to get the word of a testing event out into the community. They say it’s important for everyone in Minnesota that anyone can get tested, even if they are undocumented and lack health insurance.



** Returning to School
------------------------------------------------------------

Across the globe policy makers, communities and families are struggling with decisions about returning to school and decisions and guidelines differ greatly from place to place.

An opinion piece in Time ([link removed]) says that many US colleges and universities plan to reopen in the coming weeks and months with a variety of measures in place to protect students and others, but notes that “the campus experience includes bringing students together in dormitories, dining halls, athletic training, parties, bars and clubs—gatherings that would risk becoming ‘superspreading events.’” The story notes that Taiwan is an example of opening safely: “Rather than leaving individual universities to piece together their own plans, Taiwan’s Ministry of Education produced a national strategy ([link removed]) for college campuses….With this huge array of protective measures on campus, Taiwanese universities were able to reopen successfully and see a total ([link removed]) of just seven confirmed university-based cases by June 18, and only four new cases
nationwide since then.”

Bloomberg ([link removed]) reports, “As the school year draws near, children and teens represent a ballooning percentage of COVID-19 cases in the US as the youngest Americans increasingly venture outside their homes and are able to get tested. While the US Centers for Disease Control and Prevention has long maintained on its website ([link removed]) that those younger than 18 make up only 2 percent of cases ([link removed]) , state data paints a much less rosy picture. California and Mississippi, for instance, are recording rates nearing 10 percent of overall cases. Florida has found that about a third of all children tested there ([link removed]) are
infected.”

AP ([link removed]) reports, “The options for African students to keep studying while schools remain closed because of the coronavirus pandemic seem varied, but the reality for many is that they will fall behind and possibly drop out of school forever—worsening inequality on an already unequal continent… some African governments have announced measures to support learning from home. But many have been hindered by a lack of reliable electricity and poor internet connectivity. Even newspapers into which learning materials are inserted are not affordable for many in the region. In Uganda, for instance, annual per capita income was less than $800 in 2019, according to World Bank data. Uganda’s government has pledged to distribute 10 million radios and over 130,000 solar-powered TV sets, but authorities have failed to honor past promises, including giving a free mask to everyone.”



** What Do We Know About Immunity This Week?
------------------------------------------------------------

A perspective in Science ([link removed]) says “aging immunity may exacerbate COVID-19” and argues that “reducing inflammation may be a therapeutic strategy for enhancing immunity in older people.” The authors conclude, “The search for an effective vaccine for COVID-19 should also consider the decreased vaccination efficacy in older individuals that may be associated with inflammaging. Therefore, the effective treatment of COVID-19 patients may require a combination of anti-inflammatory and antiviral regimes to complement vaccination against the virus.”

The Washington Post ([link removed]) reports, “Only a small proportion of people in many parts of the United States had antibodies to the novel coronavirus as of this spring, indicating most of the population remains highly susceptible to the pathogen,” according to a new CDC data published in JAMA ([link removed]) . “The agency also reported the number of actual coronavirus infections is probably far higher — by two to 13 times — than reported cases…. In New York City, almost 24 percent of the population had antibodies as of early May—the highest proportion by far of any of the locations but still far below the 60 to 70 percent threshold for herd immunity….”

The Atlantic ([link removed]) reports, “A new study from King’s College London inspired a raft of headlines suggesting that immunity might vanish in months. The truth is a lot more complicated—and, thankfully, less dire.” The story presents mostly optimistic theories about immunity from a number of experts and concludes, “The race to understand COVID-19 is an unprecedented global effort, and each study is like a little square-inch snapshot of one massive mural. News consumers feeling jerked around by headlines that are alternatively optimistic and devastating should remember this: We are still facing a dangerous disease and learning more every week, but the immune system is a big, complicated place. No single study looking at one part of that big, complicated place should convince you that a vaccine is doomed and the pandemic will be with us forever.”



** What if We Get Two Pandemics?
------------------------------------------------------------

The Atlantic ([link removed]) looks at the possibility of dual pandemics, arguing that “Viruses aren’t sporting. They will not refrain from kicking you just because another virus has already knocked you to the floor. And pandemics are capricious. Despite a lot of research, ‘we haven’t found a way to predict when a new one will arrive,’ says Nídia Trovão, a virologist at the National Institutes of Health. As new diseases emerge at a quickening pace, the only certainty is that pandemics are inevitable. So it is only a matter of time before two emerge at once.” The fact that the world is on alert for COVID and the social distancing and masking being practiced could help contain a second pandemic. But, the author warns, “this future is easier to imagine in countries like South Korea, New Zealand, and Germany, which have successfully controlled COVID-19. It seems less likely in nations like the US, Brazil, Russia, and India,
which are stretched and struggling.”



** COVID-fueled Burnout
------------------------------------------------------------

Forbes ([link removed]) reports, “with the COVID-19 pandemic, everyone is working flat-out to battle the virus and mitigate damage in other areas of global health ([link removed]) . While travel stress might have eased, other new stressors are in play - from the stress of staying productive while working at home, to job lay-offs, salary cuts, and budget reductions. Zoom fatigue ([link removed]) is affecting everyone. The impact of the pandemic on women is increasingly visible ([link removed]) . The pandemic is disproportionately and severely disrupting mothers’ careers
([link removed]) . Since women account for a majority of the global health workforce ([link removed]) , the impact of this pandemic on women has serious downstream consequences for the entire field.”



** Long-term Effects for Young People
------------------------------------------------------------

CNN ([link removed]) reports on young people who “want to share stories of the wreckage COVID-19 has wrought in their lives. Those patients can potentially experience permanent lung damage, including scarring and reduced lower respiratory capacity. Their stories are a warning from millennials to millennials: Don't play the odds with coronavirus because this disease could permanently damage your body.”

Business Insider ([link removed]) reports, “Most young people infected with the coronavirus won't become seriously ill, but a growing number of them ([link removed]) have reported being sick for weeks on end. The nation's top disease expert, Dr. Anthony Fauci, said it may take a while to know whether they have long-term illnesses….’It's the people who really get knocked out badly, particularly those who require hospitalization, that it's going to take months to a year or more to determine if there are any long-lasting, deleterious consequences of the infection,’ Fauci said during a conversation ([link removed]) with Facebook CEO Mark Zuckerberg on Thursday. ‘We just don't know that now. We haven't had enough time.’"



** Treatment News
------------------------------------------------------------

The New York Times ([link removed]) updated its “Coronavirus Drug and Treatment Tracker,” providing an updated list of 19 of the most-talked-about treatments for the coronavirus. While some are accumulating evidence that they’re effective, most are still at early stages of research. We also included a warning about a few that are just bunk.” Two of the three debunked treatments were proposed by President Trump.

A Health News Review ([link removed]) post says several experts have expressed concerns about the NYT tracker on twitter and elsewhere, with one critic tweeting ([link removed]) , “NYT reporters cobbling together something overnight without process or expertise is downright dangerous and seems from the outside to be arrogant. Synthesizing studies like this is very hard work. It takes lots of time and study to build up the required expertise. Even then experts disagree and thus we often have many experts working together with special methods to build consensus and rate evidence. The fact that there were such massive changes within first 24 hours shows how poorly thought out this was. Rather than updating, this should have been taken down with a serious mea culpa.”

BBC ([link removed]) reports on preliminary results of a study of a protein called interferon beta which the body produces when it gets a viral infection. The protein is inhaled directly into the lungs of patients with coronavirus, using a nebuliser, in the hope that it will stimulate an immune response. The initial findings suggest the treatment cut the odds of a COVID-19 patient in hospital developing severe disease—such as requiring ventilation—by 79 percent.” The results are not peer reviewed and are of a small study of 101 patients. The New York Times ([link removed]) says, “In theory, administering interferon to patients could invigorate its defenses in the early stages of illness. But giving patients interferon without eliciting serious side effects has proved challenging. The symptoms of a seasonal flu, for example, are largely produced by the mobilization of the body’s interferon
response, scientists said.

Medscape ([link removed]) reports, “Full results of a randomised clinical trial into low-dose dexamethasone ([link removed]) confirmed earlier preliminary findings that it could save the lives of up to a third of hospitalised patients with severe respiratory complications from COVID-19. The peer reviewed results were published in NEJM ([link removed]) . In an editorial in NEJM ([link removed]) Lane and Fauci write, “For the field to move forward and for patients’ outcomes to improve, there will need to be fewer small or inconclusive studies and more studies such as the dexamethasone trial… Despite the decreases in death and complications that are likely to result from appropriate treatment of patients with remdesivir and
dexamethasone, far too many people with COVID-19 will die. It is our responsibility in the global medical research community to rapidly design, implement, and complete studies of the most promising therapeutic agents and vaccines against this disease.”

A statement ([link removed]) from the University of Michigan reports that “Critically ill COVID-19 patients who received a single dose of a drug that calms an overreacting immune system were 45 percent less likely to die overall, and more likely to be out of the hospital or off a ventilator one month after treatment, compared with those who didn’t receive the drug, according to a new study by a team from the University of Michigan.”

The lower risk of death in patients who received intravenous tocilizumab ([link removed]) happened despite the fact that they also had twice the risk of developing an additional infection, on top of the novel coronavirus.” The results of the small RCT of 154 patients was published after peer review.

Fierce Biotech ([link removed]) reports on a lab study of the drug “heparin, which is widely used to treat and prevent blood clots. The RPI team discovered that SARS-CoV-2 binds tightly to heparin, making the drug a potential “decoy” that could serve as a way to neutralize the virus before it can infect healthy cells. They reported the finding ([link removed]) (PDF) in the journal Antiviral Research….The RPI researchers are proposing that heparin be used as a stopgap measure against COVID-19 until a vaccine is found. The drug could be delivered in an inhaled form to people who have been exposed to COVID-19, they suggested.”

Reuters ([link removed]) reports, “The malaria drug touted by US President Donald Trump as a COVID-19 treatment was ineffective for patients with a mild version of the disease in a study conducted by researchers at the University of Minnesota.” The peer reviewed data was accompanied by an editorial that said the data “provides strong evidence that hydroxychloroquine offers no benefit in patients with mild illness."



** Human Rights
------------------------------------------------------------

Human Rights Watch ([link removed]) reports, “Since the arrival of the novel coronavirus to Colombia, armed groups in several parts of the country have imposed curfews, lockdowns, and other measures to prevent the spread of the virus. To enforce their rules, the groups have threatened, killed, and attacked people they perceive are failing to comply.”

The Chronicle ([link removed]) (Zimbabwe) reports that a lockdown and other government policies in the town of Gweru is having a major impact on livelihoods and families. “Economically active men and women of Gweru are now stuck in their homes with no source of income, no recreation and entertainment facilities. Households are silently becoming centres of violence and conflict…. Confinement to the home increases tensions that can promote the breakdown of an already weakened family dynamic and bring serious risks of violence. A spokesperson for a woman’s advocacy organization says, ““It is clear that the Government’s commitment to safeguarding and sustaining the lives of vulnerable citizens has been questionable in light of COVID-19. The Government made a huge assumption that homes are safe, but it is disappointingly clear that homes are not safe for women. There is no adequate information regarding gender-based
violence reporting mechanisms and online support services for victims of gender-based violence outlined in the Covid-19 response initiatives to protect women and girls at risk.”

A new report ([link removed]) from Amnesty International ([link removed]) says that “analysis of available data has revealed that more than 3000 health workers are known to have died from COVID-19 worldwide—a figure which is likely to be a significant underestimate.” In addition, “Amnesty International documented cases where health workers who raise safety concerns in the context of the COVID-19 response have faced retaliation, ranging from arrest and detention to threats and dismissal.”

BBC ([link removed]) reports, “A Zimbabwean journalist who recently exposed alleged government corruption involving coronavirus supplies has been charged with inciting public violence. Hopewell Chin'ono live-streamed his arrest before being told to put his phone down.”



** Rwanda’s (Maybe Voluntary) Testing Success
------------------------------------------------------------

NPR’s Goats and Soda Blog ([link removed]) reports, “In some places in the world right now, getting tested for COVID-19 remains difficult or nearly impossible. In Rwanda, you might just get tested randomly as you're going down the street.” Rwanda has implemented a plan in which everyone is offered testing that takes only a few minutes. “Nsanzimana [director general of the Rwanda Biomedical Center] says the testing is voluntary, although some others say refusal is frowned upon.” The widespread testing along with contact tracing and quarantine have kept Rwanda’s COVID cases low.



** Economic Distress
------------------------------------------------------------

The Economist ([link removed]) reports on “one of the first detailed analyses of the economic effects of COVID-19 in a developing country… published on July 15th, show how the pandemic has impoverished South Africa—and made one of the world’s most unequal countries even more so. According to the research, one in three people who earned an income in February did not do so in April. About half of the erstwhile earners were permanently laid off, rather than furloughed, suggesting that the effects of the pandemic will be long-lasting. South Africa’s eye-wateringly high unemployment rate—30 percent as of the first quarter of 2020—is set to rise further.”



** Impacts on Global Health and HIV
------------------------------------------------------------

Contagion Live ([link removed]) reports “a modeling study from Imperial College shows the COVID-19 pandemic may have significant effect on mortality among other infectious disease patients.”

A Science ([link removed]) commentary argues against continued postponement of measles vaccinations. “Postponement of measles campaigns prioritizes panic-driven policies for controlling COVID-19 without consideration of these policies' costs. If children are not immunized within the correct age window, they forgo benefits of lifelong immunity. Whole cohorts of children may be left unprotected. We must balance priorities of containing COVID-19 with efforts to control other high-transmission disease threats in poor countries, especially those affected by conflict”

Reuters Foundation ([link removed]) reports that “Campaigners fear the impact of COVID-19 on treatment and on education and prevention efforts could mean a spike in new HIV infections or in deaths in Jamaica. Even before the pandemic, about 14,000 HIV positive Jamaicans were not accessing care, said Ivan Cruickshank, executive director of the Caribbean Vulnerable Communities Coalition (CVCC). ‘COVID has affected the response significantly in that the clients are not able, because of lockdown... to access services as they normally should.’”

A commentary in The Conversation ([link removed]) says, “The effect of the COVID-19 pandemic on the continuum of care in HIV is emerging as a substantial and longstanding one with dire consequences. It poses threats to HIV prevention, testing and treatment. As public health researchers, we are concerned ([link removed]) that COVID-19's rapid transmissibility and the impending threat to overwhelm already fragile healthcare facilities is endangering the gains made with HIV…. Like other countries around the world, South Africa responded with a lockdown to slow the rate of infection and prepare the healthcare system. But the redirection of resources has had enormous consequences for the provision of healthcare services for other diseases, in particular HIV programmes.”



** This Week in Mis/Disinformation and Nuanced Information
------------------------------------------------------------

A doctor writes in an opinion piece in Huffpost ([link removed]) calling for “a new medical diagnostic code: ([link removed]) Misinformation. (Diagnostic codes are a combination of letters or numbers used to identify disease and reasons for patient encounters, for the purpose of medical charting, billing and research.)” She argues, “Many false claims are circulating about the virus, which leads to harmful consequences to patients. Patients are panicked and confused, and in some cases, this is leading them to do things like ingesting harsh chemicals or overdosing on herbal treatments. Because there is not a dedicated diagnostic code for misinformation, many physicians don’t see it as a primary focus for a patient visit and are not motivated to get further training about it.

The Union of Concerned Scientists ([link removed]) last week “launched a new online resource ([link removed]) with tips on how to spot and stop the spread of disinformation around COVID-19. Disinformation (intentionally false or misleading information) is especially dangerous when it happens during a public health crisis. Its spread can undermine the recommendations of public health officials, for example, making people less likely to take science-based precautions that protect their health and diminishing their trust in expert guidance.”

Slate ([link removed]) looks at how public health experts’ advice and information has changed over time and how they communicate that, noting that, “Health advice is often subject to change, or can even vary depending on which expert you ask, as anyone who has waded through nutrition advice or inspected the claims ([link removed]) on wellness products knows. Experts are well-informed humans who are ultimately making judgment calls…. Even honest failures in communicating nuance, or good-faith guesses that turn out to be wrong, can erode public trust.



** Call to Invest in Community Health Workers in Africa
------------------------------------------------------------

A commentary in The Lancet ([link removed](20)31532-4/fulltext) argues that “Trillions of dollars have been committed in just over 6 months for the COVID-19 response globally. A COVID-19 vaccine or therapy will take months to become commercially available and likely longer to access in low-income countries. If a vaccine, treatment, or reliable diagnostic is available, adoption in places with shortages of human resources for health will be a struggle. A comparative US$2 billion annual investment to bolster [community health workers] as a health system strengthening platform for primary care is a drop in the ocean. Now is the time to invest in community health systems in sub-Saharan Africa and avert a greater crisis.”



** Latin American Success
------------------------------------------------------------

Foreign Policy ([link removed]) reports, “As of July 20, Uruguay has only 1,054 total confirmed cases, 33 deaths, and more than 920 patients recovered—with only 99 active cases…. Uruguay’s success in coping with COVID-19 is not only a result of immediate actions, but also rooted in institutional strengths that the nation has been growing for years. In addition to being among the countries with the least poverty in Latin America, ([link removed]) Uruguay is one of the few countries in the region where the population has full access to basic services, ([link removed]) such as running water and electricity, as well as high rates of internet connection.”



** Regulators’ Concerns
------------------------------------------------------------

Politico ([link removed]) spoke with European Medicines Agency director Guido Rasi about how regulators are working together across borders. “The talks between drug agencies are about how to manage the smaller than usual amount of data they have at their disposal as they decide whether to approve a COVID-19 drug and, maybe, a vaccine. The regulators are concerned about the small studies drugmakers and biotech companies are using to test vaccines, according to Rasi. ‘This fragmentation is going to produce a lot of underpowered studies with inconclusive data — with a good signal, but inconclusive,’ he said. The drip-drip of information appearing in the media about the good results coming out for different medicines or vaccines under development amounts to a public relations competition that developers are playing among themselves, Rasi said.”



** Lower Rates of Preemies; Impact on Birthrates
------------------------------------------------------------

The New York Times ([link removed]) reports, “This spring, as countries around the world told people to stay home to slow the spread of the coronavirus, doctors in neonatal intensive care units were noticing something strange: Premature births were falling, in some cases drastically…. They don’t know what caused the drop in premature births, and can only speculate as to the factors in lockdown that might have contributed. But further research might help doctors, scientists and parents-to-be understand the causes of premature birth and ways to prevent it, which have been elusive until now.”

The Washington Post ([link removed]) reports “It’s still too early to say for sure, but initial trends suggest spikes in some parts of the world and declines in others. Broadly speaking, birthrates should continue to drop in many higher-income countries and climb in many poor and middle-income nations, where the UN Population Fund (UNFPA) projects that pandemic-driven disruptions in access to contraception could lead to millions of unplanned pregnancies.”



** COVID and Women
------------------------------------------------------------

In a Foreign Affairs ([link removed]) commentary Melinda Gates writes, “Every day brings new examples of the ways in which women are being left behind by the world’s response to the pandemic. There are women in labor ([link removed]) being turned away from overburdened hospitals; domestic workers whose lost income won’t be replaced by stimulus funding; adolescent girls who cannot continue their education online because their communities frown at the sight of a phone in the hands of a woman. ‘Gender-blind is not gender-neutral’ is a refrain among advocates for women and girls. In this crucial moment, it must also be a call to action. If policymakers ignore the ways that the disease and its impacts are affecting men and women differently, they risk prolonging the crisis and slowing economic recovery. But if they use this
emergency as an opportunity to replace old systems with new and better ones, countries can build back more prosperous, more prepared, and more equal.”



** On Testing
------------------------------------------------------------

reports, “From a turnaround of 24 hours when the virus first struck in Kenya in March, it is now taking more than seven days to get results. Meanwhile, those tested go on with their lives and may infect others. The lack of testing kits, staff and closure of testing centres has exacerbated the situation…. Kenya recorded the highest number of COVID-19 infections on Saturday, when Health minister Mutahi Kagwe announced 688 infections in a single day.”

The Hill ([link removed]) reports the FDA “has issued an emergency use authorization for Quest Diagnostics to begin pooled testing—a testing technique increases capacity, allowing up to four test samples to be tested at once. The authorization comes as the US tries to contain a massive resurgence of COVID-19….”

The Rockefeller Foundation ([link removed]) published a National COVID-19 Testing & Tracing Action Plan. The Foundation’s expert panel says, “An effective testing strategy will require the country to ramp up to where it can administer at least five million diagnostic tests and 25 million screening tests a week within three months, with the acknowledgment that we will need still more than that. This must be combined with rigorous and extensive contact tracing and supported isolation. Getting to the goal of at least 30 million weekly tests, with the majority of those being screening tests, is the only way to beat back COVID-19.”



** This Week in COVID Politics
------------------------------------------------------------

A careful reader will have noticed by this point that politics is a recurring theme in many of the stories above as it has been from the beginning of this pandemic. There was significant political maneuvering this past week and plenty of coverage dissecting it.

The New York Times ([link removed]) and other outlets report, “President Trump abruptly departed on Tuesday from his rosy projections about the coronavirus, warning Americans from the White House briefing lectern that the illness would get worse before widespread recovery…. But even as he acknowledged that the outbreak would worsen, the president continued to maintain, without evidence, that ‘the virus will disappear.’”

The fallout continued from the Trump administration’s attempts to discredit Fauci, there continues to be news and analysis of the Trump administration’s botched COVID response and concerns continue about how the US government is collecting and sharing data after the CDC data collection was moved to HHS.

The New York Times ([link removed]) reports, “The roots of the nation’s current inability to control the pandemic can be traced to mid-April, when the White House embraced overly rosy projections to proclaim victory and move on.” The Times reports that these projections came from Birx: “A highly regarded infectious diseases expert, she was a constant source of upbeat news for the president and his aides, walking the halls with charts emphasizing that outbreaks were gradually easing. The country, she insisted, was likely to resemble Italy, where virus cases declined steadily ([link removed]) from frightening heights. On April 11, she told the coronavirus task force in the Situation Room that the nation was in good shape. Boston and Chicago are two weeks away from the peak, she cautioned, but the numbers in Detroit and other hard-hit cities
are heading down.”

Salon ([link removed]) reports, “Birx relied on an optimistic model ([link removed]) that depended on everyone doing everything exactly right, while Fauci had a more realistic view of probable human behavior and listened to reports on the ground as well as the statistical data. As things got worse, Birx's rosy scenarios were chosen over Fauci's darker predictions. Trump didn't want to hear bad news ([link removed]) and Birx was there to give him what he needed.”

MedPage Today ([link removed]) reports that “The Department of Health and Human Services (HHS) debuted its new COVID-19 dashboard ([link removed]) on Monday, and the department's data chief said it will provide even more data than the CDC's old one did…. Most healthcare groups were initially unhappy with the data switch. The move to cut CDC out of the loop is ‘troubling and, if implemented, will undermine our nation's public health experts,’ Infectious Diseases Society of America (IDSA) President Thomas File Jr. said in a statement last Tuesday ([link removed]) . ‘Placing medical data collection outside of the leadership of public health experts could severely weaken the quality and availability of data, add an additional burden to already overwhelmed hospitals and add a new challenge to the US pandemic
response.’"

Laurie Garrett tweeted ([link removed]) , “The #COVID19 ([link removed]) data that was stripped from @CDCgov ([link removed]) to be processed by a private company for @HHSGov ([link removed]) —it's live now. And the numbers make no sense to me….”

In a New York Times ([link removed]) oped Senator Elizabeth Warren argues, “Those who frame the debate as one of health versus economics are missing the point. It is not possible to fix the economy without first containing the virus. We need a bold, ambitious legislative response that does four things: brings the virus under control; gets our schools, child care centers, businesses, and state and local governments the resources they need; addresses the burdens on communities of color; and supports struggling families who don’t know when the next paycheck will come.”

AP ([link removed]) reports, on a speech by the UN secretary-general, who said “’we are at the breaking point,’ then made a sweeping call Saturday to end the global inequalities that sparked this year’s massive anti-racism protests and have been further exposed by the coronavirus pandemic. ‘COVID-19 has been likened to an X-ray, revealing fractures in the fragile skeleton of the societies we have built. It is exposing fallacies and falsehoods everywhere: The lie that free markets can deliver health care for all, the fiction that unpaid care work is not work, the delusion that we live in a post-racist world, the myth that we are all in the same boat.’”



** This Week in Baseball
------------------------------------------------------------

A tweet ([link removed]) from the Washington Nationals baseball team announced Tony Fauci will throw out the ceremonial first pitch of the season. "Dr. Fauci has been a true champion for our country during the COVID-19 pandemic and throughout his distinguished career, so it is only fitting that we honor him as we kick off the 2020 season and defend our World Series Championship title.”
Got this from a friend? Subscribe here. ([link removed])

============================================================
Our mailing address is:
** [email protected] (mailto:[email protected])

** unsubscribe from this list ([link removed])
** update subscription preferences ([link removed])