| From | AVAC <[email protected]> |
| Subject | COVID News Brief: Can't-touch-this edition |
| Date | August 7, 2020 2:42 PM |
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AVAC's weekly COVID News Brief provides a curated perspective on what COVID news is worth your time.
“The building of that trust must begin today, with a commitment to community engagement in research that is as broad and deep as the research effort itself. Doing this — and supporting smart strategies to pursue scientific innovation at a “pandemic speed” without compromising safety may help end COVID-19. It may also usher in a new era of expedited, inclusive research to address HIV and future pandemics to come.” -- Nandisile Luthuli and Simba Takuva ([link removed])
** Latest Global Stats
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August 7, 2020
Confirmed Cases
19,128,901 Recovered
11,595,480 Deaths
715,555
Source: Center for Systems Science and Engineering, Johns Hopkins University ([link removed])
** Table of Contents
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* If You're in a Hurry (#hurry)
* No Silver Bullet (#silver)
* What Are the Odds of an October Surprise? (#odds)
* Impact on Women and Girls (#girls)
* COVID, TB, HIV and Malaria (#TB)
* How the Virus Defeated America (#defeated)
* Community Engagement in Trials (#trials)
* Ugandan Success (#ugandan)
* Understanding the Spread (#animal)
* Animal Studies of Vaccines? (#animal)
* Vaccine Access and Uptake (#access)
* More on Hydroxychloroquine (#hydroxy)
* COVID Impact on Work and Life (#work)
* New Ways to Pinpoint Outbreaks (#ways)
* This Week in Disinformation and Fighting Back (#week)
* Weighing Racial Inequities (#racial)
* Testing Needs (#testing)
* Antibody Hopes and Fears (#hopes)
* T Cells to the Rescue? (#tcells)
* Ongoing Effects of COVID (#ongoing)
* Human Rights (#human)
* Estimating Cases in Kenya (#kenya)
* South Africa Cases Explode (#SA)
* Cytokine Storms (#storms)
* Russia’s October Plans (#russia)
* Can’t Touch This (#touch)
As much of the world grapples with how to send kids back to school and the long term impact on children, NBC ([link removed]) and other outlets report that UN “Secretary General Antonio Guterres warned Tuesday that the world faces a ‘generational catastrophe’ because so many schools have been closed because of the coronavirus pandemic.” One billion children have been left out of school and experts warn that this could have long term effects on children, families and communities. As with other aspects of the pandemic response in the US, returning to school has become highly politicized.
A NEJM ([link removed]) look at the science and policies around opening schools in the US concludes, “Our sense of responsibility toward children—at the very least, to protect them from the vicissitudes of life, including the poor decision making of adults who allow deadly infections to spiral out of control—is core to our humanity.… School closures have also brought social, economic, and racial injustice into sharp relief, with historically marginalized children and families—and the educators who serve them—suffering the most and being offered the least. For all these reasons, decisions about school reopenings will remain complex and contested. But the fundamental argument that children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial. If we all agree on that principle, then it is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even
part-time this fall.”
The New York Times ([link removed]) reports on missteps in Israel. “Confident it had beaten the coronavirus and desperate to reboot a devastated economy, the Israeli government invited the entire student body back in late May. Within days, infections were reported at a Jerusalem high school, which quickly mushroomed into the largest outbreak in a single school in Israel, possibly the world.”
In a STAT ([link removed]) commentary the surgeon general of California argues, “We don’t know exactly how the social isolation, school closures, and economic disruption, and other stress caused by COVID-19 will affect children’s health, but we know it will. Our hopes of ending the COVID-19 crisis…are in the hands of scientists undertaking the monumental task of finding treatments and vaccines. But we must also recognize the science of early childhood development and systematically put into practice what we know works. That’s the only sure way to give every child a solid chance for a better, healthier future.”
** If You’re in a Hurry
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* Read Ed Yong’s devastating take on the American response in the Atlantic ([link removed]) .
* Then read praise for an amazing and devastating sentence in the Yong piece at Poynter ([link removed]) .
* Listen to a NEJM ([link removed]) interview with Peter Piot on COVID vaccines and his experiences with being sick with COVID-19.
* Read a Medscape ([link removed]) commentary that lays out the evidence on hydroxychloroquine from RCTs and the reason that evidence is so important.
* Read how TB, HIV and malaria are “making a comeback” in the wake of COVID in the New York Times ([link removed]) .
* Read a Bhekisisa ([link removed]) oped about the importance of community engagement in COVID trials.
* Follow that with the Daily Maverick ([link removed]) ’s first person account of volunteering for a trial.
* Read about evidence of how work habits and communication styles have changed for many workers in COVID times in the Washington Post ([link removed]) .
* For a little light relief watch a parody video ([link removed]) of the 1990 MC Hammer classic “Can’t Touch This” written and performed by a high school principal.
** No Silver Bullet
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WHO’s Tedros said this week, “"There's no silver bullet at the moment, and there might never be. For now, stopping outbreaks comes down to the basics of public health and disease control. Testing, isolating and treating patients, and tracing and quarantining their contacts. Do it all,” according to Medscape ([link removed]) and other outlets.
The Washington Post ([link removed]) reports, “In the public imagination, the arrival of a coronavirus vaccine ([link removed]) looms large: It’s the neat Hollywood ending to the grim and agonizing uncertainty of everyday life ([link removed]) in a pandemic…. But public health experts are discussing among themselves a new worry: that hopes for a vaccine may be soaring too high. The confident depiction by politicians and companies that a vaccine is imminent and inevitable may give people unrealistic beliefs about how soon the world can return to normal—and even spark resistance
([link removed]) to simple strategies that can tamp down transmission and save lives in the short term…. A proven vaccine will profoundly change the relationship the world has with the novel coronavirus ([link removed]) and is how many experts believe the pandemic will end. In popular conception, a vaccine is regarded as a silver bullet. But the truth—especially with the earliest vaccines—is likely to be far more nuanced. Public health experts fear that could lead to disappointment and erode the already delicate trust essential to making the effort to vanquish the virus succeed.
A STAT ([link removed]) op-ed by former Senator Bill Frist and others says, “no single vaccine is likely to offer a panacea for this pandemic. And even if it did, it might not accomplish its job if we don’t deal with hesitance to get vaccinated and counter vaccine disinformation. By failing to do these things, we risk a perpetual cycle of infectious disease coupled with persistent economic decline.”
** What Are the Odds of an October Surprise?
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A cadre of New York Times ([link removed]) political reporters write, “Under constant pressure from a White House anxious for good news and a public desperate for a silver bullet to end the crisis, the government’s researchers are fearful of political intervention in the coming months and are struggling to ensure that the government maintains the right balance between speed and rigorous regulation, according to interviews with administration officials, federal scientists and outside experts…. But experts inside and outside the government still say they fear the White House will push the Food and Drug Administration to overlook insufficient data and give at least limited emergency approval to a vaccine, perhaps for use by specific groups like front-line health care workers, before the vote on Nov. 3.
Activist and epidemiologist Gregg Gonsalves writes in The Nation ([link removed]) , “The hype about a SARS-Cov-2 vaccine is so intense, it’s almost inconceivable that the White House won’t roll out something in October as a boost to its fortunes at the voting booths the next month. In fact, leading scientists have warned of an October surprise ([link removed]) , in which, despite insufficient data, the president could instruct Food and Drug Administration Commissioner Stephen Hahn to issue an Emergency Use Authorization, circumventing the normal approval process for vaccines for the sake of political expediency.” Gonsalves argues, “It is crucial that the data from these studies be evaluated properly. In fact, that data should be held to an even higher standard today, given the multiple motives for manipulation. The FDA should empanel a group of outside
experts to review each of the studies, drawn from the best scientists in the country working on immunology, virology, vaccine development, and statistical sciences. We should demand a commitment from FDA Commissioner Stephen Hahn that he will not circumvent proper scrutiny of trial results to please the White House, and explicit assurance that the approval process will proceed by the book and in the open, not via an Emergency Use Authorization decided in-house at the agency.”
** Impact on Women and Girls
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Lancet ([link removed](20)31679-2/fulltext?dgcid=raven_jbs_etoc_email) reports, “UNFPA predicts there could be up to 7 million unintended pregnancies worldwide because of the crisis, with potentially thousands of deaths from unsafe abortion and complicated births due to inadequate access to emergency care…. Similarly, Marie Stopes International (MSI), which works in 37 countries, predicts that the closure of their services would result in up to 9.5 million vulnerable women and girls losing access to contraception and safe abortion services in 2020. That disruption could result in as many as 2.7 million unsafe abortions and 11,000 pregnancy-related deaths.” One expert says to look to the Ebola crisis in West Africa for some solutions: “This can include moving sexual and reproductive health services and care out of hospitals or into the community, or the free distribution [of contraception] at pharmacies or other places where women are not
scared to go.” Another adds, “We're at a point where people are avoiding health systems for fear of COVID-19, so the role of the midwife, the role of the community health worker, the ability of someone to receive contraception of their choice close to their places where they reside is absolutely essential.”
** COVID, TB, HIV and Malaria
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In a long New York Times ([link removed]) article Apoorva Mandavilli writes, “Until this year, TB and its deadly allies, HIV and malaria, were on the run. The toll from each disease over the previous decade was at its nadir in 2018, the last year for which data are available. Yet now, as the coronavirus pandemic spreads around the world, consuming global health resources, these perennially neglected adversaries are making a comeback…. It’s not just that the coronavirus has diverted scientific attention from TB, HIV and malaria. The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.”
** How the Virus Defeated America
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Science reporter Ed Yong takes a deep dive into the American response to COVID in the Atlantic ([link removed]) . Yong writes, “A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.” Yong notes, “Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable.”
Poynter ([link removed]) praises the use of the semicolon in an amazing compound sentence from the article, calling it “the sentence of the year.” The sentence in question: “No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the US had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his
unqualified son-in-law; that an armchair polymath would claim to have a ‘natural ability’ at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, ‘I don’t take any responsibility at all.’”
The Washington Post ([link removed]) references the Yong story and notes, “At times, Trump has treated the situation with the seriousness it obviously demands. In March, he advocated a broad closure of the economy to limit its spread. More recently, he warned of the expansion of the virus in a number of Sun Belt states, weeks after that expansion was underway. These, though, are the exceptions. Even as health advisers like Anthony S. Fauci and Deborah L. Birx are raising louder alarms about the virus’s current course, Trump has returned to his default position: all is well—or, at least, all is as well as it could be. It isn't.” The Post reports, “Birx, the administration's coordinator of its coronavirus response, acknowledged ([link removed]) the reality of the situation in an interview on
Sunday…. ‘It is extraordinarily widespread.’ She cautioned Americans to understand that the virus could spread even in the rural areas that had seemed fairly immune several months ago.”
Nature ([link removed]) reports, “Two decades of pandemic war games failed to account for Donald Trump. The scenarios foresaw leaky travel bans, a scramble for vaccines and disputes between state and federal leaders, but none could anticipate the current levels of dysfunction in the United States…. Looking forward, many hope that the mistakes in handling the coronavirus will spur a fundamental reset in how US policymakers think about pandemic preparedness. This means restructuring health systems, empowering public-health leaders and ensuring that all components function in unison in the event of a crisis.”
Vox ([link removed]) and other outlets report on an Axios video interview ([link removed]) with President Trump which covered a number of issues, including COVID and the US response. “Perhaps the most terrifying part of the interview came early on when Swan peppered Trump with a string of questions about why he isn’t doing more to fight the coronavirus and why the virus has hit the US so much harder than other comparable countries. Asked how he can say the pandemic is under control when roughly 1,000 Americans are dying from COVID-19 each day, Trump said, remarkably, that ‘it is what it is. They are dying. That’s true. It is what it is.... It’s under control as much as you can control it.’”
An opinion piece in the Washington Post ([link removed]) says Birx, “took some time out of her vacation to tell the truth ([link removed]) Sunday, for which her reward from her boss ([link removed]) was the single adjective “pathetic! ([link removed]) ” President Trump has now tempered this tweeted excoriation by insisting he has a “lot of respect ([link removed]) ” for the woman he publicly disrespected. The reality remains: No amount of gushing compliments or massaging statistics can compensate for even a little bit of honesty with
this man. Which makes this public health expert a case study in the quixotic nature of preserving both one’s position and one’s integrity in this White House…. So the ever-composed Birx wobbles on a perilous tightrope. She is trying to be enough of a scientist that she stays credible compared to the loyalists who don’t know anything about science, and enough of a loyalist that she stays useful compared to the scientists who have little interest in being loyal. This is a tenuous gambit, and it will take a keen inner ear for her to maintain her balance.”
** Community Engagement in Trials
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AVAC’s Nandisile Luthuli and HVTN’s Simba Takuva write in Bhekisisa ([link removed]) that for COVID research, “Expedited timelines bring the promise of lives saved, but adapting the standard research process also presents challenges and trade-offs. Concurrently run clinical trial phases may lead to the public misperception that standard ethical and regulatory requirements have been compromised…[and] historically-disenfranchised communities may have different, and more complex concerns around research, given a history that includes exploitation within research and ongoing issues with discrimination and equity in health systems. As such, expedited timelines may heighten suspicions around profit motives, while delayed research may be seen as the de-prioritisation of a disease that disproportionately affects Black communities in South Africa.” They argue “Building research
literacy and ways to engage with people will be critical to ensuring communities participate and support COVID-19 research. Such a broadly representative effort will help guarantee products that are ultimately shown to be effective will be trusted and accepted by those who need them most. The building of that trust must begin today, with a commitment to community engagement in research that is as broad and deep as the research effort itself. Doing this—and supporting smart strategies to pursue scientific innovation at a “pandemic speed” without compromising safety may help end COVID-19. It may also usher in a new era of expedited, inclusive research to address HIV and future pandemics to come.”
The Financial Times ([link removed]) reports “The US government has stepped up efforts to persuade members of minority communities to participate in clinical trials for COVID-19 vaccines, fearing that their historical suspicion of public health authorities will limit the number of volunteers. MHRP’s Nelson Michael is quoted: “The government is going to be developing vaccines at an unprecedented pace. If you’re optimistic, you say, ‘Great, we’re going to have a solution soon,’ But if you don’t trust your government or you’re in a vulnerable population, you may think this is going to be like Tuskegee: ‘They are going to test the stuff on us again and use it for them.’” And advocate “Rob Newells…said it was too late to try to encourage more members of minority groups to participate in the vaccine trials. Instead, he believes the focus should be on helping people who fear being ‘guinea pigs’ to understand the research process so th
ey trust a vaccine when it is approved.” AVAC’s Mitchell Warren says, “We have to work with the hand we are dealt and the hand we are dealt is a politically charged environment where there’s mistrust in government and there’s mistrust in science.”
Advocates have been pressing vaccine developer Moderna to include people living with HIV in the efficacy trial of their vaccine. On Thursday the company tweeted ([link removed]) a short statement saying, “we have heard the preference of the community to be included in the ongoing Phase 3 study in the US…. We have decided to modify the Phase 3 study protocol to include people living with controlled HIV…”
Activist Sharon Ekambaram writes in the Daily Maverick ([link removed]) about her experience taking part in a COVID vaccine trial. She writes about seeing a post on researcher Francois Venter’s FaceBook about the trial and says given South Africa’s history of “thousands of people were being denied antiretrovirals ([link removed]) by the health minister and the then-president who refused to ‘follow the science’…. That is why I am a fundamentalist when it comes to respecting science and understanding its power to help change the world.” She notes, “But Shandukani [clinic] is not only a place where change is tangible—there is hope as well. With the political will and leadership that goes into running this trial, the positivity is very real. It looks like a well-oiled machine running to plan. Files are updated with mountains of notes taken, and
time is spent talking to each and every person who makes the effort to enquire about volunteering. I felt like an important human being. And on both days, there were streams of people coming in to be considered for the trial, including many older womxn like me. I was also told the response from healthcare workers wanting to join the trial was phenomenal.”
Building upon a strong foundation developed largely through HIV and TB research, AVAC ([link removed]) , TAG ([link removed]) and ITPC ([link removed]) are partnering with health advocates, civil society representatives and impacted individuals around the world to launch a COVID Advocates Advisory Board (CAAB). Read the full announcement here ([link removed]) and visit the CAAB website here ([link removed]) .
** Ugandan Success
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Reuters ([link removed]) says, “Uganda’s crumbling public hospitals, doctors’ strikes and corruption scandals make its success in the fight against the new coronavirus all the more unlikely. But the nation of 42 million people has recorded just over 1,200 cases and five deaths since March, a strikingly low total for such a large country.” But the success came at a high cost. “Some pregnant women died in labour, unable to reach hospitals because of travel restrictions. Security forces—criticised by rights groups for abuses—beat and arrested some rule-breakers. Opposition leaders accuse the government of using the pandemic as an excuse to restrict political gatherings and arrest opponents, charges the government
denies. ‘A jobless person is better than a dead person,’ state minister for health Robinah Nabbanja told Reuters. ‘The lockdown was completely justified.’”
** Understanding the Spread
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The Washington Post ([link removed]) reports, “As the death toll escalates ([link removed]) in coronavirus ([link removed]) hot spots, evidence is growing that young people who work outside the home, or who surged into bars and restaurants when states relaxed shutdowns, are infecting their more vulnerable elders, especially family members…. The emerging trend highlights the difficulty of relying on the Trump administration’s strategy of sheltering the most vulnerable while the young and healthy return to work and school.”
** What Can We Learn from Animal Studies of Vaccines?
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Peter Piot talks with the NEJM ([link removed]) editors about COVID vaccines and what the research to date tells us now, including what we can learn from animal challenge studies. A NEJM ([link removed]) article on an animal challenge study concludes, “Vaccination of nonhuman primates with mRNA-1273 induced robust SARS-CoV-2 neutralizing activity, rapid protection in the upper and lower airways, and no pathologic changes in the lung.”
** Vaccine Access and Uptake
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With multiple vaccine in or near efficacy studies, access to eventual vaccines remains a central concern for many. The Washington Post ([link removed]) asked several experts to weigh in on who should get the first available doses. “The decision-making will take place over the next few months and is certain to be controversial, experts said. Officials and experts must address a host of issues, including how much consideration should be given to race and ethnicity because of the disproportionate effect ([link removed]) of COVID-19 on communities of color ([link removed]) . Aside from doctors and nurses, will cafeteria workers and cleaning
staff at hospitals be considered essential personnel? What about teachers who keep schools ([link removed]) running so parents and others can go back to work?”
An Atlantic ([link removed]) article titled When a Vaccine Arrives, People Will Ignore the Anti-Vaxxers argues, “Even if some Americans opt out, the country will still reach herd immunity against COVID-19.” The author concludes, “After a harrowing year, the moment when we—hopefully—identify a safe and effective vaccine against COVID-19 will be a crucial turning point. Though many logistical challenges will remain ([link removed]) , the path out of this terrible pandemic will then be brightly lit. This year has shown us how steep a price pandemics exact for both individual irresponsibility and political incompetence. But though we must reckon with the social failings that have made the pandemic so deadly,
especially in the United States, we should also remember the strengths that might ultimately allow us to vanquish it: individual rationality and collective ingenuity.”
** More on Hydroxychloroquine
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NEJM ([link removed]) reports results from a “a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis…. After high-risk or moderate-risk exposure to COVID-19, hydroxychloroquine did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.”
A Statement from Yale Faculty on Hydroxychloroquine and its Use in COVID-19 published on Medium ([link removed]) argues “that too many are being distracted by the ardent advocacy of our Yale colleague, Dr. Harvey Risch, to promote the assertion that hydroxychloroquine (HCQ) when given with antibiotics is effective in treating COVID-19, in particular as an early therapeutic intervention for the disease….It is critical that we follow the science and where the evidence leads us on a quest to treat and prevent COVID-19. In this climate, it’s important to rely on the data above all else when making clinical or regulatory decisions. Making these kinds of choices guided by personal endorsements outside of the context of the existing scientific evidence is medicine by testimonial and risks people’s lives.”
CNN ([link removed]) reports researchers “published scathing critiques of a study President Trump repeatedly touted on Twitter. That study, published earlier this month ([link removed]) in the International Journal of Infectious Diseases, claimed to show that hydroxychloroquine saved lives….But the study had multiple errors, flaws and biases, according to letters to the journal's editors….’As a result of the flaws in the analysis the conclusions reached in [the study] are invalid,’ Graham Atkinson, an independent consultant in health care policy, wrote in one of the letters ([link removed]) ….In a letter to the editor ([link removed](20)30599-3/fulltext) titled ‘Clarifying the record on hydroxychloroquine for the treatment of patients
hospitalized with COVID-19,’ researchers at the University at Albany said the group that received hydroxychloroquine might have fared better because they were healthier to begin with and received more aggressive treatment.”
A Medscape ([link removed]) commentary looks at the data to date from randomized controlled trials of Hydroxychloroquine. The author concludes, “Science is ever-learning, ever-developing. More trials will come out and we need to integrate those results into these results to make decisions. We need to let new, high-quality evidence change our beliefs. I am willing to do that. I hope that you are too. But I want randomized trials. Because—if I didn't say it enough—randomization ensures that the treatment and control groups are well balanced, and that makes all the difference.”
** COVID Impact on Work and Life
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The Washington Post ([link removed]) reports, “The average workday lengthened by 48.5 minutes in the weeks following stay-at-home orders and lockdowns, and the number of meetings increased by 13 percent, a working paper ([link removed]) published Monday by the National Bureau of Economic Research showed.” Data from the worldwide study “offers a snapshot of how work habits and communication styles have changed for many workers as they tried navigating remote work en masse, especially as the economy worsened, white-collar layoffs mounted and professional anxieties exploded.”
An op-ed in the Washington Post ([link removed]) notes, “If history is any guide, it will be women who bear the brunt of the child-care crisis. Child-care access is strongly associated with maternal labor force participation, and child-care closures will probably lead to more costly career sacrifices for women. During the pandemic, there have been numerous stories about women quitting their jobs because of a lack of child care. One out of four women who reported becoming unemployed during the pandemic said it was because of a lack of child care—twice the rate among men…. The sheer magnitude of the disruption to child care during the pandemic will probably affect women’s labor force participation and earnings trajectories for decades to come.”
** New Ways to Pinpoint Outbreaks
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Bloomberg ([link removed]) reports, “Wastewater surveillance—which Dutch scientists showed in March can identify evidence of the pathogen earlier than testing patients—is one of a handful of strategies around the world being developed to pinpoint emerging hotspots and flare-ups before cases spiral out of control.”
** This Week in Disinformation and Fighting Back
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AP ([link removed]) reports, “Russian intelligence services are using a trio of English-language websites to spread disinformation about the coronavirus pandemic, seeking to exploit a crisis that America is struggling to contain ahead of the presidential election in November…. Officials say the sites promote their narratives in a sophisticated but insidious effort that they liken to money laundering, where stories in well-written English—and often with pro-Russian sentiment—are cycled through other news sources to conceal their origin and enhance the legitimacy of the information.”
A Medscape ([link removed]) commentary says, “In an era when factless ideas ricochet and trend around the world before medical organizations and professionals can address them, we've seen an unprecedented embrace of previously fringe attitudes…. The process [of responding] must begin with recognizing that we are past the point where the problem can be ignored. These false narratives require active countering and correction, whether they emerge fromTikTok ([link removed]) or from health professionals or from the President of the United States…. We need to be relentless in setting the record straight. Rebut the myths. Explain the evidence. Simply state the facts. And we need to do this in an overt spirit of genuine concern—not ‘I can't believe you won't listen to science!’ but instead ‘I am worried about you getting the wrong information, because I want you healthy and
well.’ It is important to make concerted efforts to elevate the voices of experts, and while doing so, drown the noise of those who make false claims. In other words, get them ‘ratioed ([link removed]) .’”
** Weighing Racial Inequities
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A JAMA Network Open ([link removed]) Research Letter lays out issues with CDC’s handling of population data to estimate COVID cases by race. The authors argue that “Use of the CDC’s weighted population distributions to evaluate racial/ethnic inequities in COVID-19 mortality underestimates the excess burden of COVID-19 among Black and Latinx individuals compared with analyses conducted using the total population (unweighted) in the US Census data. According to the CDC, weighting was conducted because ‘COVID-19 deaths are concentrated in certain geographic locations where the racial and ethnic population distribution differs from that of the United States overall.’ The indirect standardization procedure implemented by the CDC is misleading and obviates a key mechanism by which structural racism operates to produce health inequities: social segregation. The CDC approach heavily weights large, urban counties because of their high
proportion of COVID-19 deaths (e.g., New York City) and excludes counties without any COVID-19 deaths….”
** Testing Needs
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Paul Sax headlines a post in NEJM’s HIV and ID Observations ([link removed]) Time to Amplify Our Voices Calling for Inexpensive Rapid Home Testing for COVID-19 and argues that “Prototypes for these tests, or slightly more complex versions, already exist. ([link removed]) So what’s the hold-up? Even though numerous companies and academic groups are working on such tests, there’s no guarantee the FDA will approve them — especially since they’re going to be less sensitive than the gold standard PCR tests we use for symptomatic people. But this lack of sensitivity shouldn’t block availability, since the tests likely will be positive during the few days that people have the highest titers of virus in their respiratory tract, and hence are most contagious…. And a reasonably accurate test with results back quickly is far
better than no test at all—or, as is sometimes happening, a test done with frustrating and potentially dangerous delays in results due to testing backlogs. ([link removed]) ”
** Antibody Hopes and Fears
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Reuters ([link removed]) reports, “Regeneron Pharmaceuticals Inc said on Monday that the COVID-19 antibody drug combination it is developing both prevented and treated the disease in rhesus macaques and hamsters, adding to hope that it might work for people…. Regeneron has already started late-stage clinical trials in humans to assess the antibody treatment’s ability to prevent and treat COVID-19. The company signed a $450 million contract with the US government as part of its Operation Warp Speed program to provide the United States with the treatment if it succeeds.”
Another Reuters ([link removed]) story says, “the next big advance in battling the pandemic could come from a class of biotech therapies widely used against cancer and other disorders—antibodies designed specifically to attack this new virus. Development of monoclonal antibodies to target the virus has been endorsed by leading scientists. Anthony Fauci, the top US infectious diseases expert, called them ‘almost a sure bet’ against COVID-19.”
The New York Times ([link removed]) reports, “In a laboratory in New York City, researchers coaxed a key piece of the coronavirus—its infamous outer “spike”—to mutate so that it became invisible to disease-fighting antibodies ([link removed]) , according to a new study that has not yet been published in a scientific journal. The provocative finding should not set off alarm bells, experts said. The altered spikes were not attached to the real coronavirus, which mutates at a much slower pace than most laboratory viruses. But the study does underscore the need for treatments and vaccines that attack the virus in different ways, so that if the pathogen manages to evade one approach, another will be waiting in the wings.”
The New York Times ([link removed]) reports “Thousands of COVID-19 patients have been treated with blood plasma outside of rigorous clinical trials—hampering research that would have shown whether the therapy worked.” The article notes that tens of thousands of COVID patients have received antibody-laden plasma. “But the unexpected demand for plasma has inadvertently undercut the research that could prove that it works. The only way to get convincing evidence is with a clinical trial that compares outcomes for patients who are randomly assigned to get the treatment with those who are given a placebo. Many patients and their doctors—knowing they could get the treatment under the government program—have been unwilling to join clinical trials that might provide them with a placebo instead of the plasma…. At the height of a public health crisis, the government’s push to distribute an unproven treatment to desperately ill patients as quickly as
possible could come at the cost of completing clinical trials that would potentially benefit millions around the world by determining whether those treatments actually work.”
** T Cells to the Rescue?
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The Financial Times ([link removed]) reports, “Evidence is emerging that T-cells, which can “remember” past infections and kill pathogens if they reappear, have a big influence on how long patients remain resistant to reinfection by COVID-19…. As data emerge from clinical trials of potential COVID-19 vaccines, the extent to which they evoke T-cell immunity will be a focus of attention. Advocates of viral vaccines, which use a harmless genetically engineered virus to carry coronavirus antigens into human cells, are already suggesting that their method is more effective at raising a T-cell response than an alternative approach, which injects coronavirus genes in the form of RNA or DNA into human cells.”
** Ongoing Effects of COVID
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The Guardian ([link removed]) reports, “More than half of people who received hospital treatment for COVID-19 were found to be suffering from a psychiatric disorder a month later, a study has found ([link removed]) . Out of 402 patients monitored after being treated for the virus, 55 percent were found to have at least one psychiatric disorder, experts from San Raffaele hospital in Milan found. The results, based on clinical interviews and self-assessment questionnaires, showed post-traumatic stress disorder (PTSD) in 28 percent of cases, depression in 31 percent and anxiety in 42 percent. Additionally, 40 percent of patients had insomnia and 20 percent had obsessive-compulsive (OC) symptoms.”
** Human Rights
------------------------------------------------------------
The New York Times ([link removed]) reports, “Rights activists say the coronavirus has given the Chinese authorities a new pretext for detaining dissidents. Summary quarantines—often imposed just after detainees, like Mr. Wang, had cleared a previous one—are the latest way to silence dissent, part of a broader campaign under China’s top leader, Xi Jinping, to stamp out activism through arrests, detentions and harsher internet controls, activists say.”
The New York Times ([link removed]) looks at the impact of COVID on sex work in Europe. “In Italy, [sex work] is not illegal, nor is it regulated as an official occupation, making the country’s 70,000 sex workers largely ineligible to receive economic relief. Many have been forced to take their chances by returning to work in order to avoid poverty. In May, organizations that promote the rights of Italian sex workers sought to draw the government’s attention and get support, arguing that the pandemic showed the harm of forcing sex work underground. In other European countries, such as the Netherlands and Germany, sex workers can enter formal contracts with their clients. During the lockdown, those who were officially registered with the government were eligible for economic relief.”
The Guardian ([link removed]) looks at the impact of COVID on slums in India. “COVID-19, has shown it respects no silos. The outbreak has exposed slums as virus hotbeds because of their insanitary and crowded conditions, often with no running water, light or ventilation and with toilets serving hundreds. With no space even to cross your legs, social distancing is a joke. It is the residents of these slums who go to work in affluent homes, offices, and shops – with some carrying the virus. The problem that India ([link removed]) has resolutely ignored for decades – the lack of decent housing for the urban poor – has come to bite the top echelons of society.”
** Estimating Cases in Kenya
------------------------------------------------------------
A preprint ([link removed]) paper Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors estimates “that 1 in 20 adults in Kenya had SARS-CoV-2 antibodies during the study period. By the median date of our survey, only 2093 COVID-19 cases and 71 deaths had been reported through the national screening system. This contrasts, by several orders of magnitude, with the numbers of cases and deaths reported in parts of Europe and America when seroprevalence was similar.”
** South Africa Cases Explode
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Health Policy Watch ([link removed]) reports, “Four months after South Africa implemented one of the strictest lockdowns in the world, it appears that neither lives nor livelihoods have been spared. South African President Cyril Ramaphosa was widely praised for taking decisive action when he introduced one of the fastest and strictest lockdowns in the world in late March…. But four months later, South Africa has the fifth highest COVID-19 caseload in the world after the US, Brazil, India and Russia. It accounts for over half of all African cases and the economic cost of the lockdown seems to have been in vain as the country is following the worst-case scenario sketched by epidemiologists.” Corruption has hampered the response and “Ramaphosa’s promise to address the corruption has been met by skepticism. His administration has so far failed to act against his predecessor, Jacob Zuma, who looted
billions and has brought the economy to its knees…In addition, a number of his key allies in government have been infected with the virus and been forced to step aside. Four Cabinet ministers, three provincial premiers and the treasurer general of the ruling party are amongst those infected. In the meantime, frustration and anger is building in communities as more people lose their jobs and young people lose hope of ever being able to find work.”
** Cytokine Storms
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The New York Times ([link removed]) reports, “Scientists are beginning to untangle one of the most complex biological mysteries of the coronavirus pandemic: Why do some people get severely sick, whereas others quickly recover? In certain patients, according to a flurry ([link removed]) of recent ([link removed]) studies ([link removed]) , the virus appears to make the immune system go haywire….The Times reports research shows that the “coordinated handoff” between cytokines and antibodies and T cells that happens in many infections “seems to break down in people with severe COVID-19.” Recent studies “suggest that treating bad cases of COVID-19 might require an immunological reset—drugs that could, in theory, restore the balance in the body and resurrect lines of communication between bamboozled
cells. Such therapies could even be focused on specific subsets of patients whose bodies are responding bizarrely to the virus…”
** Russia’s October Plans
------------------------------------------------------------
Bloomberg ([link removed]) reports, “Russia plans to start mass vaccinations against Covid-19 in October, with health workers and teachers first in line to get the inoculation against the disease, Health Minister Mikhail Murashko said…. The Gamaleya vaccine is expected to obtain conditional registration in August, meaning trials will still need to be conducted on 1,600 more people, Deputy Prime Minister Tatyana Golikova said Wednesday. Production should begin in September, she said…. While the vaccine has been touted by its developers as safe and potentially the first to reach the public, the data hasn’t been published and the speed at which Russia is moving has raised questions in other countries. Gamaleya is scheduled to begin Phase 3 trials next week in Russia, Saudi Arabia and the United Arab Emirates.”
** Can’t Touch This
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Alabama New Center ([link removed]) reports, “An Alabama high school principal created a parody video ([link removed]) of the 1990 MC Hammer classic “Can’t Touch This” to encourage students to stay healthy at school this year. The rap includes “lyrics like ‘COVID! Is stressing me, all the updates from the CDC. Lysol! Can’t be found, I’ve looked all around this town.’”
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AVAC's weekly COVID News Brief provides a curated perspective on what COVID news is worth your time.
“The building of that trust must begin today, with a commitment to community engagement in research that is as broad and deep as the research effort itself. Doing this — and supporting smart strategies to pursue scientific innovation at a “pandemic speed” without compromising safety may help end COVID-19. It may also usher in a new era of expedited, inclusive research to address HIV and future pandemics to come.” -- Nandisile Luthuli and Simba Takuva ([link removed])
** Latest Global Stats
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August 7, 2020
Confirmed Cases
19,128,901 Recovered
11,595,480 Deaths
715,555
Source: Center for Systems Science and Engineering, Johns Hopkins University ([link removed])
** Table of Contents
------------------------------------------------------------
* If You're in a Hurry (#hurry)
* No Silver Bullet (#silver)
* What Are the Odds of an October Surprise? (#odds)
* Impact on Women and Girls (#girls)
* COVID, TB, HIV and Malaria (#TB)
* How the Virus Defeated America (#defeated)
* Community Engagement in Trials (#trials)
* Ugandan Success (#ugandan)
* Understanding the Spread (#animal)
* Animal Studies of Vaccines? (#animal)
* Vaccine Access and Uptake (#access)
* More on Hydroxychloroquine (#hydroxy)
* COVID Impact on Work and Life (#work)
* New Ways to Pinpoint Outbreaks (#ways)
* This Week in Disinformation and Fighting Back (#week)
* Weighing Racial Inequities (#racial)
* Testing Needs (#testing)
* Antibody Hopes and Fears (#hopes)
* T Cells to the Rescue? (#tcells)
* Ongoing Effects of COVID (#ongoing)
* Human Rights (#human)
* Estimating Cases in Kenya (#kenya)
* South Africa Cases Explode (#SA)
* Cytokine Storms (#storms)
* Russia’s October Plans (#russia)
* Can’t Touch This (#touch)
As much of the world grapples with how to send kids back to school and the long term impact on children, NBC ([link removed]) and other outlets report that UN “Secretary General Antonio Guterres warned Tuesday that the world faces a ‘generational catastrophe’ because so many schools have been closed because of the coronavirus pandemic.” One billion children have been left out of school and experts warn that this could have long term effects on children, families and communities. As with other aspects of the pandemic response in the US, returning to school has become highly politicized.
A NEJM ([link removed]) look at the science and policies around opening schools in the US concludes, “Our sense of responsibility toward children—at the very least, to protect them from the vicissitudes of life, including the poor decision making of adults who allow deadly infections to spiral out of control—is core to our humanity.… School closures have also brought social, economic, and racial injustice into sharp relief, with historically marginalized children and families—and the educators who serve them—suffering the most and being offered the least. For all these reasons, decisions about school reopenings will remain complex and contested. But the fundamental argument that children, families, educators, and society deserve to have safe and reliable primary schools should not be controversial. If we all agree on that principle, then it is inexcusable to open nonessential services for adults this summer if it forces students to remain at home even
part-time this fall.”
The New York Times ([link removed]) reports on missteps in Israel. “Confident it had beaten the coronavirus and desperate to reboot a devastated economy, the Israeli government invited the entire student body back in late May. Within days, infections were reported at a Jerusalem high school, which quickly mushroomed into the largest outbreak in a single school in Israel, possibly the world.”
In a STAT ([link removed]) commentary the surgeon general of California argues, “We don’t know exactly how the social isolation, school closures, and economic disruption, and other stress caused by COVID-19 will affect children’s health, but we know it will. Our hopes of ending the COVID-19 crisis…are in the hands of scientists undertaking the monumental task of finding treatments and vaccines. But we must also recognize the science of early childhood development and systematically put into practice what we know works. That’s the only sure way to give every child a solid chance for a better, healthier future.”
** If You’re in a Hurry
------------------------------------------------------------
* Read Ed Yong’s devastating take on the American response in the Atlantic ([link removed]) .
* Then read praise for an amazing and devastating sentence in the Yong piece at Poynter ([link removed]) .
* Listen to a NEJM ([link removed]) interview with Peter Piot on COVID vaccines and his experiences with being sick with COVID-19.
* Read a Medscape ([link removed]) commentary that lays out the evidence on hydroxychloroquine from RCTs and the reason that evidence is so important.
* Read how TB, HIV and malaria are “making a comeback” in the wake of COVID in the New York Times ([link removed]) .
* Read a Bhekisisa ([link removed]) oped about the importance of community engagement in COVID trials.
* Follow that with the Daily Maverick ([link removed]) ’s first person account of volunteering for a trial.
* Read about evidence of how work habits and communication styles have changed for many workers in COVID times in the Washington Post ([link removed]) .
* For a little light relief watch a parody video ([link removed]) of the 1990 MC Hammer classic “Can’t Touch This” written and performed by a high school principal.
** No Silver Bullet
------------------------------------------------------------
WHO’s Tedros said this week, “"There's no silver bullet at the moment, and there might never be. For now, stopping outbreaks comes down to the basics of public health and disease control. Testing, isolating and treating patients, and tracing and quarantining their contacts. Do it all,” according to Medscape ([link removed]) and other outlets.
The Washington Post ([link removed]) reports, “In the public imagination, the arrival of a coronavirus vaccine ([link removed]) looms large: It’s the neat Hollywood ending to the grim and agonizing uncertainty of everyday life ([link removed]) in a pandemic…. But public health experts are discussing among themselves a new worry: that hopes for a vaccine may be soaring too high. The confident depiction by politicians and companies that a vaccine is imminent and inevitable may give people unrealistic beliefs about how soon the world can return to normal—and even spark resistance
([link removed]) to simple strategies that can tamp down transmission and save lives in the short term…. A proven vaccine will profoundly change the relationship the world has with the novel coronavirus ([link removed]) and is how many experts believe the pandemic will end. In popular conception, a vaccine is regarded as a silver bullet. But the truth—especially with the earliest vaccines—is likely to be far more nuanced. Public health experts fear that could lead to disappointment and erode the already delicate trust essential to making the effort to vanquish the virus succeed.
A STAT ([link removed]) op-ed by former Senator Bill Frist and others says, “no single vaccine is likely to offer a panacea for this pandemic. And even if it did, it might not accomplish its job if we don’t deal with hesitance to get vaccinated and counter vaccine disinformation. By failing to do these things, we risk a perpetual cycle of infectious disease coupled with persistent economic decline.”
** What Are the Odds of an October Surprise?
------------------------------------------------------------
A cadre of New York Times ([link removed]) political reporters write, “Under constant pressure from a White House anxious for good news and a public desperate for a silver bullet to end the crisis, the government’s researchers are fearful of political intervention in the coming months and are struggling to ensure that the government maintains the right balance between speed and rigorous regulation, according to interviews with administration officials, federal scientists and outside experts…. But experts inside and outside the government still say they fear the White House will push the Food and Drug Administration to overlook insufficient data and give at least limited emergency approval to a vaccine, perhaps for use by specific groups like front-line health care workers, before the vote on Nov. 3.
Activist and epidemiologist Gregg Gonsalves writes in The Nation ([link removed]) , “The hype about a SARS-Cov-2 vaccine is so intense, it’s almost inconceivable that the White House won’t roll out something in October as a boost to its fortunes at the voting booths the next month. In fact, leading scientists have warned of an October surprise ([link removed]) , in which, despite insufficient data, the president could instruct Food and Drug Administration Commissioner Stephen Hahn to issue an Emergency Use Authorization, circumventing the normal approval process for vaccines for the sake of political expediency.” Gonsalves argues, “It is crucial that the data from these studies be evaluated properly. In fact, that data should be held to an even higher standard today, given the multiple motives for manipulation. The FDA should empanel a group of outside
experts to review each of the studies, drawn from the best scientists in the country working on immunology, virology, vaccine development, and statistical sciences. We should demand a commitment from FDA Commissioner Stephen Hahn that he will not circumvent proper scrutiny of trial results to please the White House, and explicit assurance that the approval process will proceed by the book and in the open, not via an Emergency Use Authorization decided in-house at the agency.”
** Impact on Women and Girls
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Lancet ([link removed](20)31679-2/fulltext?dgcid=raven_jbs_etoc_email) reports, “UNFPA predicts there could be up to 7 million unintended pregnancies worldwide because of the crisis, with potentially thousands of deaths from unsafe abortion and complicated births due to inadequate access to emergency care…. Similarly, Marie Stopes International (MSI), which works in 37 countries, predicts that the closure of their services would result in up to 9.5 million vulnerable women and girls losing access to contraception and safe abortion services in 2020. That disruption could result in as many as 2.7 million unsafe abortions and 11,000 pregnancy-related deaths.” One expert says to look to the Ebola crisis in West Africa for some solutions: “This can include moving sexual and reproductive health services and care out of hospitals or into the community, or the free distribution [of contraception] at pharmacies or other places where women are not
scared to go.” Another adds, “We're at a point where people are avoiding health systems for fear of COVID-19, so the role of the midwife, the role of the community health worker, the ability of someone to receive contraception of their choice close to their places where they reside is absolutely essential.”
** COVID, TB, HIV and Malaria
------------------------------------------------------------
In a long New York Times ([link removed]) article Apoorva Mandavilli writes, “Until this year, TB and its deadly allies, HIV and malaria, were on the run. The toll from each disease over the previous decade was at its nadir in 2018, the last year for which data are available. Yet now, as the coronavirus pandemic spreads around the world, consuming global health resources, these perennially neglected adversaries are making a comeback…. It’s not just that the coronavirus has diverted scientific attention from TB, HIV and malaria. The lockdowns, particularly across parts of Africa, Asia and Latin America, have raised insurmountable barriers to patients who must travel to obtain diagnoses or drugs, according to interviews with more than two dozen public health officials, doctors and patients worldwide.”
** How the Virus Defeated America
------------------------------------------------------------
Science reporter Ed Yong takes a deep dive into the American response to COVID in the Atlantic ([link removed]) . Yong writes, “A virus a thousand times smaller than a dust mote has humbled and humiliated the planet’s most powerful nation. America has failed to protect its people, leaving them with illness and financial ruin. It has lost its status as a global leader. It has careened between inaction and ineptitude. The breadth and magnitude of its errors are difficult, in the moment, to truly fathom.” Yong notes, “Since the pandemic began, I have spoken with more than 100 experts in a variety of fields. I’ve learned that almost everything that went wrong with America’s response to the pandemic was predictable and preventable.”
Poynter ([link removed]) praises the use of the semicolon in an amazing compound sentence from the article, calling it “the sentence of the year.” The sentence in question: “No one should be shocked that a liar who has made almost 20,000 false or misleading claims during his presidency would lie about whether the US had the pandemic under control; that a racist who gave birth to birtherism would do little to stop a virus that was disproportionately killing Black people; that a xenophobe who presided over the creation of new immigrant-detention centers would order meatpacking plants with a substantial immigrant workforce to remain open; that a cruel man devoid of empathy would fail to calm fearful citizens; that a narcissist who cannot stand to be upstaged would refuse to tap the deep well of experts at his disposal; that a scion of nepotism would hand control of a shadow coronavirus task force to his
unqualified son-in-law; that an armchair polymath would claim to have a ‘natural ability’ at medicine and display it by wondering out loud about the curative potential of injecting disinfectant; that an egotist incapable of admitting failure would try to distract from his greatest one by blaming China, defunding the WHO, and promoting miracle drugs; or that a president who has been shielded by his party from any shred of accountability would say, when asked about the lack of testing, ‘I don’t take any responsibility at all.’”
The Washington Post ([link removed]) references the Yong story and notes, “At times, Trump has treated the situation with the seriousness it obviously demands. In March, he advocated a broad closure of the economy to limit its spread. More recently, he warned of the expansion of the virus in a number of Sun Belt states, weeks after that expansion was underway. These, though, are the exceptions. Even as health advisers like Anthony S. Fauci and Deborah L. Birx are raising louder alarms about the virus’s current course, Trump has returned to his default position: all is well—or, at least, all is as well as it could be. It isn't.” The Post reports, “Birx, the administration's coordinator of its coronavirus response, acknowledged ([link removed]) the reality of the situation in an interview on
Sunday…. ‘It is extraordinarily widespread.’ She cautioned Americans to understand that the virus could spread even in the rural areas that had seemed fairly immune several months ago.”
Nature ([link removed]) reports, “Two decades of pandemic war games failed to account for Donald Trump. The scenarios foresaw leaky travel bans, a scramble for vaccines and disputes between state and federal leaders, but none could anticipate the current levels of dysfunction in the United States…. Looking forward, many hope that the mistakes in handling the coronavirus will spur a fundamental reset in how US policymakers think about pandemic preparedness. This means restructuring health systems, empowering public-health leaders and ensuring that all components function in unison in the event of a crisis.”
Vox ([link removed]) and other outlets report on an Axios video interview ([link removed]) with President Trump which covered a number of issues, including COVID and the US response. “Perhaps the most terrifying part of the interview came early on when Swan peppered Trump with a string of questions about why he isn’t doing more to fight the coronavirus and why the virus has hit the US so much harder than other comparable countries. Asked how he can say the pandemic is under control when roughly 1,000 Americans are dying from COVID-19 each day, Trump said, remarkably, that ‘it is what it is. They are dying. That’s true. It is what it is.... It’s under control as much as you can control it.’”
An opinion piece in the Washington Post ([link removed]) says Birx, “took some time out of her vacation to tell the truth ([link removed]) Sunday, for which her reward from her boss ([link removed]) was the single adjective “pathetic! ([link removed]) ” President Trump has now tempered this tweeted excoriation by insisting he has a “lot of respect ([link removed]) ” for the woman he publicly disrespected. The reality remains: No amount of gushing compliments or massaging statistics can compensate for even a little bit of honesty with
this man. Which makes this public health expert a case study in the quixotic nature of preserving both one’s position and one’s integrity in this White House…. So the ever-composed Birx wobbles on a perilous tightrope. She is trying to be enough of a scientist that she stays credible compared to the loyalists who don’t know anything about science, and enough of a loyalist that she stays useful compared to the scientists who have little interest in being loyal. This is a tenuous gambit, and it will take a keen inner ear for her to maintain her balance.”
** Community Engagement in Trials
------------------------------------------------------------
AVAC’s Nandisile Luthuli and HVTN’s Simba Takuva write in Bhekisisa ([link removed]) that for COVID research, “Expedited timelines bring the promise of lives saved, but adapting the standard research process also presents challenges and trade-offs. Concurrently run clinical trial phases may lead to the public misperception that standard ethical and regulatory requirements have been compromised…[and] historically-disenfranchised communities may have different, and more complex concerns around research, given a history that includes exploitation within research and ongoing issues with discrimination and equity in health systems. As such, expedited timelines may heighten suspicions around profit motives, while delayed research may be seen as the de-prioritisation of a disease that disproportionately affects Black communities in South Africa.” They argue “Building research
literacy and ways to engage with people will be critical to ensuring communities participate and support COVID-19 research. Such a broadly representative effort will help guarantee products that are ultimately shown to be effective will be trusted and accepted by those who need them most. The building of that trust must begin today, with a commitment to community engagement in research that is as broad and deep as the research effort itself. Doing this—and supporting smart strategies to pursue scientific innovation at a “pandemic speed” without compromising safety may help end COVID-19. It may also usher in a new era of expedited, inclusive research to address HIV and future pandemics to come.”
The Financial Times ([link removed]) reports “The US government has stepped up efforts to persuade members of minority communities to participate in clinical trials for COVID-19 vaccines, fearing that their historical suspicion of public health authorities will limit the number of volunteers. MHRP’s Nelson Michael is quoted: “The government is going to be developing vaccines at an unprecedented pace. If you’re optimistic, you say, ‘Great, we’re going to have a solution soon,’ But if you don’t trust your government or you’re in a vulnerable population, you may think this is going to be like Tuskegee: ‘They are going to test the stuff on us again and use it for them.’” And advocate “Rob Newells…said it was too late to try to encourage more members of minority groups to participate in the vaccine trials. Instead, he believes the focus should be on helping people who fear being ‘guinea pigs’ to understand the research process so th
ey trust a vaccine when it is approved.” AVAC’s Mitchell Warren says, “We have to work with the hand we are dealt and the hand we are dealt is a politically charged environment where there’s mistrust in government and there’s mistrust in science.”
Advocates have been pressing vaccine developer Moderna to include people living with HIV in the efficacy trial of their vaccine. On Thursday the company tweeted ([link removed]) a short statement saying, “we have heard the preference of the community to be included in the ongoing Phase 3 study in the US…. We have decided to modify the Phase 3 study protocol to include people living with controlled HIV…”
Activist Sharon Ekambaram writes in the Daily Maverick ([link removed]) about her experience taking part in a COVID vaccine trial. She writes about seeing a post on researcher Francois Venter’s FaceBook about the trial and says given South Africa’s history of “thousands of people were being denied antiretrovirals ([link removed]) by the health minister and the then-president who refused to ‘follow the science’…. That is why I am a fundamentalist when it comes to respecting science and understanding its power to help change the world.” She notes, “But Shandukani [clinic] is not only a place where change is tangible—there is hope as well. With the political will and leadership that goes into running this trial, the positivity is very real. It looks like a well-oiled machine running to plan. Files are updated with mountains of notes taken, and
time is spent talking to each and every person who makes the effort to enquire about volunteering. I felt like an important human being. And on both days, there were streams of people coming in to be considered for the trial, including many older womxn like me. I was also told the response from healthcare workers wanting to join the trial was phenomenal.”
Building upon a strong foundation developed largely through HIV and TB research, AVAC ([link removed]) , TAG ([link removed]) and ITPC ([link removed]) are partnering with health advocates, civil society representatives and impacted individuals around the world to launch a COVID Advocates Advisory Board (CAAB). Read the full announcement here ([link removed]) and visit the CAAB website here ([link removed]) .
** Ugandan Success
------------------------------------------------------------
Reuters ([link removed]) says, “Uganda’s crumbling public hospitals, doctors’ strikes and corruption scandals make its success in the fight against the new coronavirus all the more unlikely. But the nation of 42 million people has recorded just over 1,200 cases and five deaths since March, a strikingly low total for such a large country.” But the success came at a high cost. “Some pregnant women died in labour, unable to reach hospitals because of travel restrictions. Security forces—criticised by rights groups for abuses—beat and arrested some rule-breakers. Opposition leaders accuse the government of using the pandemic as an excuse to restrict political gatherings and arrest opponents, charges the government
denies. ‘A jobless person is better than a dead person,’ state minister for health Robinah Nabbanja told Reuters. ‘The lockdown was completely justified.’”
** Understanding the Spread
------------------------------------------------------------
The Washington Post ([link removed]) reports, “As the death toll escalates ([link removed]) in coronavirus ([link removed]) hot spots, evidence is growing that young people who work outside the home, or who surged into bars and restaurants when states relaxed shutdowns, are infecting their more vulnerable elders, especially family members…. The emerging trend highlights the difficulty of relying on the Trump administration’s strategy of sheltering the most vulnerable while the young and healthy return to work and school.”
** What Can We Learn from Animal Studies of Vaccines?
------------------------------------------------------------
Peter Piot talks with the NEJM ([link removed]) editors about COVID vaccines and what the research to date tells us now, including what we can learn from animal challenge studies. A NEJM ([link removed]) article on an animal challenge study concludes, “Vaccination of nonhuman primates with mRNA-1273 induced robust SARS-CoV-2 neutralizing activity, rapid protection in the upper and lower airways, and no pathologic changes in the lung.”
** Vaccine Access and Uptake
------------------------------------------------------------
With multiple vaccine in or near efficacy studies, access to eventual vaccines remains a central concern for many. The Washington Post ([link removed]) asked several experts to weigh in on who should get the first available doses. “The decision-making will take place over the next few months and is certain to be controversial, experts said. Officials and experts must address a host of issues, including how much consideration should be given to race and ethnicity because of the disproportionate effect ([link removed]) of COVID-19 on communities of color ([link removed]) . Aside from doctors and nurses, will cafeteria workers and cleaning
staff at hospitals be considered essential personnel? What about teachers who keep schools ([link removed]) running so parents and others can go back to work?”
An Atlantic ([link removed]) article titled When a Vaccine Arrives, People Will Ignore the Anti-Vaxxers argues, “Even if some Americans opt out, the country will still reach herd immunity against COVID-19.” The author concludes, “After a harrowing year, the moment when we—hopefully—identify a safe and effective vaccine against COVID-19 will be a crucial turning point. Though many logistical challenges will remain ([link removed]) , the path out of this terrible pandemic will then be brightly lit. This year has shown us how steep a price pandemics exact for both individual irresponsibility and political incompetence. But though we must reckon with the social failings that have made the pandemic so deadly,
especially in the United States, we should also remember the strengths that might ultimately allow us to vanquish it: individual rationality and collective ingenuity.”
** More on Hydroxychloroquine
------------------------------------------------------------
NEJM ([link removed]) reports results from a “a randomized, double-blind, placebo-controlled trial across the United States and parts of Canada testing hydroxychloroquine as postexposure prophylaxis…. After high-risk or moderate-risk exposure to COVID-19, hydroxychloroquine did not prevent illness compatible with COVID-19 or confirmed infection when used as postexposure prophylaxis within 4 days after exposure.”
A Statement from Yale Faculty on Hydroxychloroquine and its Use in COVID-19 published on Medium ([link removed]) argues “that too many are being distracted by the ardent advocacy of our Yale colleague, Dr. Harvey Risch, to promote the assertion that hydroxychloroquine (HCQ) when given with antibiotics is effective in treating COVID-19, in particular as an early therapeutic intervention for the disease….It is critical that we follow the science and where the evidence leads us on a quest to treat and prevent COVID-19. In this climate, it’s important to rely on the data above all else when making clinical or regulatory decisions. Making these kinds of choices guided by personal endorsements outside of the context of the existing scientific evidence is medicine by testimonial and risks people’s lives.”
CNN ([link removed]) reports researchers “published scathing critiques of a study President Trump repeatedly touted on Twitter. That study, published earlier this month ([link removed]) in the International Journal of Infectious Diseases, claimed to show that hydroxychloroquine saved lives….But the study had multiple errors, flaws and biases, according to letters to the journal's editors….’As a result of the flaws in the analysis the conclusions reached in [the study] are invalid,’ Graham Atkinson, an independent consultant in health care policy, wrote in one of the letters ([link removed]) ….In a letter to the editor ([link removed](20)30599-3/fulltext) titled ‘Clarifying the record on hydroxychloroquine for the treatment of patients
hospitalized with COVID-19,’ researchers at the University at Albany said the group that received hydroxychloroquine might have fared better because they were healthier to begin with and received more aggressive treatment.”
A Medscape ([link removed]) commentary looks at the data to date from randomized controlled trials of Hydroxychloroquine. The author concludes, “Science is ever-learning, ever-developing. More trials will come out and we need to integrate those results into these results to make decisions. We need to let new, high-quality evidence change our beliefs. I am willing to do that. I hope that you are too. But I want randomized trials. Because—if I didn't say it enough—randomization ensures that the treatment and control groups are well balanced, and that makes all the difference.”
** COVID Impact on Work and Life
------------------------------------------------------------
The Washington Post ([link removed]) reports, “The average workday lengthened by 48.5 minutes in the weeks following stay-at-home orders and lockdowns, and the number of meetings increased by 13 percent, a working paper ([link removed]) published Monday by the National Bureau of Economic Research showed.” Data from the worldwide study “offers a snapshot of how work habits and communication styles have changed for many workers as they tried navigating remote work en masse, especially as the economy worsened, white-collar layoffs mounted and professional anxieties exploded.”
An op-ed in the Washington Post ([link removed]) notes, “If history is any guide, it will be women who bear the brunt of the child-care crisis. Child-care access is strongly associated with maternal labor force participation, and child-care closures will probably lead to more costly career sacrifices for women. During the pandemic, there have been numerous stories about women quitting their jobs because of a lack of child care. One out of four women who reported becoming unemployed during the pandemic said it was because of a lack of child care—twice the rate among men…. The sheer magnitude of the disruption to child care during the pandemic will probably affect women’s labor force participation and earnings trajectories for decades to come.”
** New Ways to Pinpoint Outbreaks
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Bloomberg ([link removed]) reports, “Wastewater surveillance—which Dutch scientists showed in March can identify evidence of the pathogen earlier than testing patients—is one of a handful of strategies around the world being developed to pinpoint emerging hotspots and flare-ups before cases spiral out of control.”
** This Week in Disinformation and Fighting Back
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AP ([link removed]) reports, “Russian intelligence services are using a trio of English-language websites to spread disinformation about the coronavirus pandemic, seeking to exploit a crisis that America is struggling to contain ahead of the presidential election in November…. Officials say the sites promote their narratives in a sophisticated but insidious effort that they liken to money laundering, where stories in well-written English—and often with pro-Russian sentiment—are cycled through other news sources to conceal their origin and enhance the legitimacy of the information.”
A Medscape ([link removed]) commentary says, “In an era when factless ideas ricochet and trend around the world before medical organizations and professionals can address them, we've seen an unprecedented embrace of previously fringe attitudes…. The process [of responding] must begin with recognizing that we are past the point where the problem can be ignored. These false narratives require active countering and correction, whether they emerge fromTikTok ([link removed]) or from health professionals or from the President of the United States…. We need to be relentless in setting the record straight. Rebut the myths. Explain the evidence. Simply state the facts. And we need to do this in an overt spirit of genuine concern—not ‘I can't believe you won't listen to science!’ but instead ‘I am worried about you getting the wrong information, because I want you healthy and
well.’ It is important to make concerted efforts to elevate the voices of experts, and while doing so, drown the noise of those who make false claims. In other words, get them ‘ratioed ([link removed]) .’”
** Weighing Racial Inequities
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A JAMA Network Open ([link removed]) Research Letter lays out issues with CDC’s handling of population data to estimate COVID cases by race. The authors argue that “Use of the CDC’s weighted population distributions to evaluate racial/ethnic inequities in COVID-19 mortality underestimates the excess burden of COVID-19 among Black and Latinx individuals compared with analyses conducted using the total population (unweighted) in the US Census data. According to the CDC, weighting was conducted because ‘COVID-19 deaths are concentrated in certain geographic locations where the racial and ethnic population distribution differs from that of the United States overall.’ The indirect standardization procedure implemented by the CDC is misleading and obviates a key mechanism by which structural racism operates to produce health inequities: social segregation. The CDC approach heavily weights large, urban counties because of their high
proportion of COVID-19 deaths (e.g., New York City) and excludes counties without any COVID-19 deaths….”
** Testing Needs
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Paul Sax headlines a post in NEJM’s HIV and ID Observations ([link removed]) Time to Amplify Our Voices Calling for Inexpensive Rapid Home Testing for COVID-19 and argues that “Prototypes for these tests, or slightly more complex versions, already exist. ([link removed]) So what’s the hold-up? Even though numerous companies and academic groups are working on such tests, there’s no guarantee the FDA will approve them — especially since they’re going to be less sensitive than the gold standard PCR tests we use for symptomatic people. But this lack of sensitivity shouldn’t block availability, since the tests likely will be positive during the few days that people have the highest titers of virus in their respiratory tract, and hence are most contagious…. And a reasonably accurate test with results back quickly is far
better than no test at all—or, as is sometimes happening, a test done with frustrating and potentially dangerous delays in results due to testing backlogs. ([link removed]) ”
** Antibody Hopes and Fears
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Reuters ([link removed]) reports, “Regeneron Pharmaceuticals Inc said on Monday that the COVID-19 antibody drug combination it is developing both prevented and treated the disease in rhesus macaques and hamsters, adding to hope that it might work for people…. Regeneron has already started late-stage clinical trials in humans to assess the antibody treatment’s ability to prevent and treat COVID-19. The company signed a $450 million contract with the US government as part of its Operation Warp Speed program to provide the United States with the treatment if it succeeds.”
Another Reuters ([link removed]) story says, “the next big advance in battling the pandemic could come from a class of biotech therapies widely used against cancer and other disorders—antibodies designed specifically to attack this new virus. Development of monoclonal antibodies to target the virus has been endorsed by leading scientists. Anthony Fauci, the top US infectious diseases expert, called them ‘almost a sure bet’ against COVID-19.”
The New York Times ([link removed]) reports, “In a laboratory in New York City, researchers coaxed a key piece of the coronavirus—its infamous outer “spike”—to mutate so that it became invisible to disease-fighting antibodies ([link removed]) , according to a new study that has not yet been published in a scientific journal. The provocative finding should not set off alarm bells, experts said. The altered spikes were not attached to the real coronavirus, which mutates at a much slower pace than most laboratory viruses. But the study does underscore the need for treatments and vaccines that attack the virus in different ways, so that if the pathogen manages to evade one approach, another will be waiting in the wings.”
The New York Times ([link removed]) reports “Thousands of COVID-19 patients have been treated with blood plasma outside of rigorous clinical trials—hampering research that would have shown whether the therapy worked.” The article notes that tens of thousands of COVID patients have received antibody-laden plasma. “But the unexpected demand for plasma has inadvertently undercut the research that could prove that it works. The only way to get convincing evidence is with a clinical trial that compares outcomes for patients who are randomly assigned to get the treatment with those who are given a placebo. Many patients and their doctors—knowing they could get the treatment under the government program—have been unwilling to join clinical trials that might provide them with a placebo instead of the plasma…. At the height of a public health crisis, the government’s push to distribute an unproven treatment to desperately ill patients as quickly as
possible could come at the cost of completing clinical trials that would potentially benefit millions around the world by determining whether those treatments actually work.”
** T Cells to the Rescue?
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The Financial Times ([link removed]) reports, “Evidence is emerging that T-cells, which can “remember” past infections and kill pathogens if they reappear, have a big influence on how long patients remain resistant to reinfection by COVID-19…. As data emerge from clinical trials of potential COVID-19 vaccines, the extent to which they evoke T-cell immunity will be a focus of attention. Advocates of viral vaccines, which use a harmless genetically engineered virus to carry coronavirus antigens into human cells, are already suggesting that their method is more effective at raising a T-cell response than an alternative approach, which injects coronavirus genes in the form of RNA or DNA into human cells.”
** Ongoing Effects of COVID
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The Guardian ([link removed]) reports, “More than half of people who received hospital treatment for COVID-19 were found to be suffering from a psychiatric disorder a month later, a study has found ([link removed]) . Out of 402 patients monitored after being treated for the virus, 55 percent were found to have at least one psychiatric disorder, experts from San Raffaele hospital in Milan found. The results, based on clinical interviews and self-assessment questionnaires, showed post-traumatic stress disorder (PTSD) in 28 percent of cases, depression in 31 percent and anxiety in 42 percent. Additionally, 40 percent of patients had insomnia and 20 percent had obsessive-compulsive (OC) symptoms.”
** Human Rights
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The New York Times ([link removed]) reports, “Rights activists say the coronavirus has given the Chinese authorities a new pretext for detaining dissidents. Summary quarantines—often imposed just after detainees, like Mr. Wang, had cleared a previous one—are the latest way to silence dissent, part of a broader campaign under China’s top leader, Xi Jinping, to stamp out activism through arrests, detentions and harsher internet controls, activists say.”
The New York Times ([link removed]) looks at the impact of COVID on sex work in Europe. “In Italy, [sex work] is not illegal, nor is it regulated as an official occupation, making the country’s 70,000 sex workers largely ineligible to receive economic relief. Many have been forced to take their chances by returning to work in order to avoid poverty. In May, organizations that promote the rights of Italian sex workers sought to draw the government’s attention and get support, arguing that the pandemic showed the harm of forcing sex work underground. In other European countries, such as the Netherlands and Germany, sex workers can enter formal contracts with their clients. During the lockdown, those who were officially registered with the government were eligible for economic relief.”
The Guardian ([link removed]) looks at the impact of COVID on slums in India. “COVID-19, has shown it respects no silos. The outbreak has exposed slums as virus hotbeds because of their insanitary and crowded conditions, often with no running water, light or ventilation and with toilets serving hundreds. With no space even to cross your legs, social distancing is a joke. It is the residents of these slums who go to work in affluent homes, offices, and shops – with some carrying the virus. The problem that India ([link removed]) has resolutely ignored for decades – the lack of decent housing for the urban poor – has come to bite the top echelons of society.”
** Estimating Cases in Kenya
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A preprint ([link removed]) paper Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Kenyan blood donors estimates “that 1 in 20 adults in Kenya had SARS-CoV-2 antibodies during the study period. By the median date of our survey, only 2093 COVID-19 cases and 71 deaths had been reported through the national screening system. This contrasts, by several orders of magnitude, with the numbers of cases and deaths reported in parts of Europe and America when seroprevalence was similar.”
** South Africa Cases Explode
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Health Policy Watch ([link removed]) reports, “Four months after South Africa implemented one of the strictest lockdowns in the world, it appears that neither lives nor livelihoods have been spared. South African President Cyril Ramaphosa was widely praised for taking decisive action when he introduced one of the fastest and strictest lockdowns in the world in late March…. But four months later, South Africa has the fifth highest COVID-19 caseload in the world after the US, Brazil, India and Russia. It accounts for over half of all African cases and the economic cost of the lockdown seems to have been in vain as the country is following the worst-case scenario sketched by epidemiologists.” Corruption has hampered the response and “Ramaphosa’s promise to address the corruption has been met by skepticism. His administration has so far failed to act against his predecessor, Jacob Zuma, who looted
billions and has brought the economy to its knees…In addition, a number of his key allies in government have been infected with the virus and been forced to step aside. Four Cabinet ministers, three provincial premiers and the treasurer general of the ruling party are amongst those infected. In the meantime, frustration and anger is building in communities as more people lose their jobs and young people lose hope of ever being able to find work.”
** Cytokine Storms
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The New York Times ([link removed]) reports, “Scientists are beginning to untangle one of the most complex biological mysteries of the coronavirus pandemic: Why do some people get severely sick, whereas others quickly recover? In certain patients, according to a flurry ([link removed]) of recent ([link removed]) studies ([link removed]) , the virus appears to make the immune system go haywire….The Times reports research shows that the “coordinated handoff” between cytokines and antibodies and T cells that happens in many infections “seems to break down in people with severe COVID-19.” Recent studies “suggest that treating bad cases of COVID-19 might require an immunological reset—drugs that could, in theory, restore the balance in the body and resurrect lines of communication between bamboozled
cells. Such therapies could even be focused on specific subsets of patients whose bodies are responding bizarrely to the virus…”
** Russia’s October Plans
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Bloomberg ([link removed]) reports, “Russia plans to start mass vaccinations against Covid-19 in October, with health workers and teachers first in line to get the inoculation against the disease, Health Minister Mikhail Murashko said…. The Gamaleya vaccine is expected to obtain conditional registration in August, meaning trials will still need to be conducted on 1,600 more people, Deputy Prime Minister Tatyana Golikova said Wednesday. Production should begin in September, she said…. While the vaccine has been touted by its developers as safe and potentially the first to reach the public, the data hasn’t been published and the speed at which Russia is moving has raised questions in other countries. Gamaleya is scheduled to begin Phase 3 trials next week in Russia, Saudi Arabia and the United Arab Emirates.”
** Can’t Touch This
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Alabama New Center ([link removed]) reports, “An Alabama high school principal created a parody video ([link removed]) of the 1990 MC Hammer classic “Can’t Touch This” to encourage students to stay healthy at school this year. The rap includes “lyrics like ‘COVID! Is stressing me, all the updates from the CDC. Lysol! Can’t be found, I’ve looked all around this town.’”
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