We know that the number of reported COVID deaths is likely much higher than the actual toll of the virus, but determining the real number isn’t easy.
Nature reports, “In times of upheaval—wars, natural disasters, outbreaks of disease—researchers need to tally deaths rapidly, and usually turn to a blunt but reliable metric: excess mortality.… It can help epidemiologists to draw comparisons between countries, and, because it can be calculated quickly, it can identify COVID-19 hotspots that would otherwise have gone undetected. According to data from more than 30 countries for which estimates of excess deaths are available…there were nearly 600,000 more deaths than would normally be predicted in these nations for the period between the onset of the pandemic and the end of July (413,041 of those were officially attributed to COVID-19)…. But this high-level metric has several flaws. It cannot distinguish between those who are dying of the disease and those who succumb to other factors related to the pandemic, such as disruptions to regular health care, which can delay treatments or mean that people do not seek medical care. It relies on accurate, timely reporting of deaths, which can be limited owing to underdeveloped death-registration systems, or might even be intentionally suppressed. And as with so many other aspects of the pandemic, the statistic has become politicized—a way for countries to claim superiority over one another.”
CNN reports, “Twitter on Sunday took down a tweet containing a false claim about
coronavirus death statistics that was made by a supporter of the baseless QAnon conspiracy theory—a post that
President Donald Trump had retweeted earlier in the day. The tweet—which has
been replaced with a message saying, ‘This Tweet is no longer available because it violated the Twitter Rules’…claimed that the US Centers for Disease Control and Prevention had ‘quietly’ updated its numbers ‘to admit that only 6 percent’ of people listed as
coronavirus deaths ‘actually died from COVID,’ since ‘the other 94 percent had 2-3 other serious illnesses.’ That's not what the CDC said. As of Sunday at 4 pm ET, Twitter had not removed a second [retweet by the President] that spread the same false claim. The second tweet, by Trump campaign adviser Jenna Ellis, linked to an article on the right-wing website Gateway Pundit that was based on the QAnon supporter's tweet.”
ABC News quotes Fauci: “Let there not be any confusion. It's not 9,000 deaths from COVID-19. It's 180,000-plus deaths. The point that the CDC was trying to make was that a certain percentage of [deaths] had nothing else but COVID.”
If You’re in a Hurry
Antibody Politics
Ahead of the Republican National Convention, the US President and the head of the US FDA announced an
emergency use authorization for convalescent plasma for the treatment of COVID-19.
STAT reported, “’Today’s action will dramatically expand access to this treatment,’ Trump said at a White House news conference Sunday afternoon. He called the EUA a ‘truly historic announcement’ and said that convalescent plasma has been proven to reduce mortality by 35 percent, which he called a ‘tremendous number.’” HHS Secretary Azar said, “We dream in drug development of something like a 35 percent mortality reduction. This is a major advance in the treatment of patients.” However, as
STAT reported, “An FDA staffer who reviewed the data on convalescent plasma…was far less enthusiastic, writing that the data ‘support the conclusion that [convalescent plasma] to treat hospitalized patients with COVID-19 meets the ‘may be effective’ criteria for issuance of an EUA. Adequate and well-controlled randomized trials remain nonetheless necessary for a definitive demonstration of…efficacy and to determine the optimal product attributes and the appropriate patient populations for its use.’”
The next day FDA’s Hahn dialed back the enthusiasm in a
twitter thread, saying, “I have been criticized for remarks I made Sunday night about the benefits of convalescent plasma. The criticism is entirely justified. What I should have said better is that the data show a relative risk reduction not an absolute risk reduction.” The twittersphere was not convinced.
TAG replied with more context: “A relative risk reduction with a very wide CI, cherry-picked at 7 days instead of 30, from a relatively small retrospective subgroup analysis (total n=1076) that compared mortality outcomes among recipients of arbitrarily defined ‘high’ or ‘low’ antibody plasma.”
Science Magazine quotes several concerned researchers, including “Eric Topol, a cardiologist who directs the Scripps Research Translational Institute, [who] says the EUA ‘again represents the FDA caving directly to Trump pressure,’ as he believes it did when it issued an EUA (later rescinded) for hydroxychloroquine treatment for COVID-19. ‘It sadly and unacceptably exemplifies loss of independent FDA assessment of evidence and data overridden by political pressure,’ Topol says. Many scientists worry the same could happen in future decisions about EUAs for COVID-19 vaccines—with far greater potential consequences because vaccines presumably will be given to hundreds of millions of healthy people.”
A week later
Bloomberg reports, “A panel of experts convened by the National Institutes of Health undercut an emergency authorization issued just days ago by US regulators, saying there’s not enough evidence to recommend use of convalescent plasma for hospitalized coronavirus patients…. In an escalation of a dispute between federal agencies, the NIH advisers said an analysis of a study showed ‘no difference in 7-day survival overall’ among those who received plasma containing high amounts of antibodies.” Read the full
NIH statement.
“Ignore the CDC”
Former NIH director Harold Varmus and Rockefeller Foundation President Rajiv Shah write in a
New York Times op-ed that changes by CDC to COVID testing guidelines “will undermine efforts to end the pandemic, slow the return to normal economic, educational and social activities, and increase the loss of lives…. Like other scientists and public health experts,
we have argued that more asymptomatic people, not fewer, need to be tested to bring the pandemic under control. Now, in the face of a dysfunctional CDC, it’s up to states, other institutions and individuals to act.” They argue, “The CDC, the federal agency that should be crushing the pandemic, is promoting policies that prolong it. That means that local, state and organizational leaders will have to do what the federal government won’t.”
Vaccine Science/Research
NBC News reports, “Phase 3 clinical trials for the much-anticipated
Oxford COVID-19 vaccine are set to begin in the United States…The University of Wisconsin is one of dozens of test sites in the US for the vaccine candidate, made by AstraZeneca in partnership with the UK's University of Oxford. Wednesday's trial will mark the start of the third phase 3 trial in the US for a COVID-19 vaccine, following Moderna and Pfizer…. The AstraZeneca trial will include "diverse racial, ethnic and geographic groups who are healthy or have stable underlying medical conditions, including those living with HIV, and who are at increased risk of infection from the SARS-CoV-2 virus," according to a
company press release.”
The Atlantic reports on a shortage of monkeys for US research on COVID treatments and vaccines. “Primate research in the US is expensive and often controversial, making it challenging even in normal circumstances. The pandemic has made acquiring monkeys even harder.” The story notes that the shortage of monkeys is leading researchers to examine how much research needs to be done using monkeys and “is also forcing scientists to think creatively about how to reduce the number of animals needed for research…. Different NIH-funded centers are trying to use one group of animals as controls in experiments across different labs. In a typical randomized controlled trial, the control animals are the ones not given the treatment, so they serve as a baseline for comparison. Having the control group and the treated groups in different labs is unusual; to make sure that small changes from lab to lab don’t affect the results, scientists have to be extremely careful to harmonize their protocols. ‘It’s really impressive,’ Roberts says. ‘I’ve been involved in nonhuman-primate research for 37 years, and I’ve never, ever seen this degree of coordination between different research institutes.’”
Kaiser Health News reports that Fauci has said, “A
COVID-19 vaccine could be available earlier than expected if ongoing clinical trials produce overwhelmingly positive results…. The Data and Safety Monitoring Board could say, ‘The data is so good right now that you can say it's safe and effective,’ Fauci said. In that case, researchers would have ‘a moral obligation’ to end the trial early and make the active vaccine available to everyone in the study, including those who had been given placebos—and accelerate the process to give the vaccine to millions…. Fauci…said he trusts the independent members of the DSMB—who are not government employees—to hold vaccines to high standards without being politically influenced. Members of the board are typically experts in vaccine science and biostatistics who teach at major medical schools.
The
New York Times reports on researchers who are developing their own COVID vaccines for themselves, friends and family. “Each DIY effort is motivated, at least in part, by the same idea: Exceptional times demand exceptional actions. If scientists have the skills and gumption to assemble a vaccine on their own, the logic goes, they should do it. Defenders say that as long as they are measured about their claims and transparent about their process, we could all benefit from what they learn. But critics say that no matter how well-intentioned, these scientists aren’t likely to learn anything useful because their vaccines are not being put to the true test of randomized and placebo-controlled studies. What’s more, taking these vaccines could cause harm—whether from serious immune reactions and other side effects, or offering a false sense of protection.
Vaccine Politics
The
Washington Post reports, “The Trump administration said it will not join a global effort to develop, manufacture and equitably distribute a
coronavirus vaccine, in part because the World Health Organization is involved, a decision that could shape the course of the pandemic and the country’s role in health diplomacy. More than 170 countries
are in talks to participate in the COVID-19 Vaccines Global Access (COVAX) Facility, which aims to speed vaccine development, secure doses for all countries and distribute them to the most high-risk segment of each population.”
STAT reports, “an advocacy group has asked the Department of Defense to investigate what it called ‘an apparent failure’ by Moderna (
MRNA) to disclose millions of dollars in awards received from the Defense Advanced Research Projects Agency in patent applications the company filed for vaccines.” Knowledge Ecology International argues that $20 million in grants to the company “’likely’ led to the creation of its vaccine technology” that was used to develop COVID and other vaccines. KEI argues this means, “US taxpayers would have an ownership stake in vaccines developed by the company.”
The
Financial Times reports, “The head of the US Food and Drug Administration has said he is willing to bypass the normal approval process to authorise a COVID-19 vaccine as soon as possible—but has insisted he will not do so to please President Donald Trump. In an interview with the
Financial Times, Stephen Hahn said his agency was prepared to authorise a vaccine before Phase Three clinical trials were complete, as long as officials believed the benefits outweighed the risks. But he defended his embattled organisation against accusations that it was rushing the process to boost Mr. Trump’s re-election prospects.”
Newsweek reports WHO’s chief scientist said, “emergency use approval for any coronavirus vaccine candidate is not something that should be done ‘lightly.’ ‘The emergency use authorization or licensing is something that has to be done with a great deal of seriousness and reflection,’ Chief Scientist Dr. Soumya Swaminathan said. ‘It's not something that you do very lightly.’”
Victor Zonana writes in a
Washington Post op-ed on what lessons learned from political promises about HIV vaccines should teach us: “Lesson one: Humility is in order for those who predict a vaccine is just around the corner. Lesson two: We should hedge our big bet on vaccines, giving equal priority and funding to treatment research.” He asks, “what if all the current candidates fail or offer just limited protection? What if immunity wanes after a few months? What if the first vaccines protect young people but are useless for at-risk seniors? What if vaccines have unacceptable—or even fatal—side effects?” Zonana notes, “More than 30 years ago, a small band of AIDS activists—many fighting for their own lives—changed history by demanding better treatments. Let’s follow their example, hedge our bets, and give equal priority and funding to COVID-19 treatment research.”
A
McClatchyDC story headlined, ‘
Urgent’ request sent to states in push for coronavirus vaccine delivery by Nov. 1, reports on a letter to governors from CDC’s Redfield which asks them “to do everything in their power to eliminate hurdles for vaccine distribution sites to be fully operational by Nov. 1.” The story says, “Delivery firms have received guidance from Trump administration officials to prepare freezer farms in the heartland and get ready to load vaccines onto trucks no later than Nov. 1.”
Vaccine Access
STAT reports on a new
draft report from the US National Academies of Sciences, Engineering, and Medicine “that aims to prioritize groups to receive COVID-19 vaccine.” The report “focuses on who is at risk, rather than using job categories or ethnic groups to determine who should be at the front of the line…in the end the panel of experts that wrote the priority setting framework [chose]…to focus on the factors that create the risk for some people of color—systemic racism that leads to higher levels of poor health and socioeconomic factors such as working in jobs that cannot be done from home or living in crowded settings.” The recommendations prioritize “health workers in high risk settings and first responders” for the very first vaccines, followed by “adults of any age who have medical conditions that put them at significantly higher risk of having severe disease,” then critical risk workers—people in industries essential to the functioning of society—as well as teachers and school staff; people of all ages with an underlying health problem that moderately increases the risk of severe COVID-19; all older adults not vaccinated in the first phase; people in homeless shelters and group homes, and prisons; and staff working in these facilities. Young adults, children, and workers in essential industries not vaccinated previously would make up the third priority group. Remaining Americans who were not vaccinated in the first three groups would be offered vaccine during a fourth and final phase.”
Vaccine Confidence
The Hill reports, “A third of Americans say they would not get a coronavirus vaccine if one were available due to concerns about potential side effects, according to an
Ipsos survey for the World Economic Forum. The poll found 33 percent of Americans disagreed with the statement “If a vaccine for COVID-19 were available, I would get it.” At least 17 percent of somewhat disagreed while 16 percent strongly disagreed…. The Ipsos poll showed that vaccine intent in the U.S. was lower than the average across the 27 countries surveyed.”
STAT reports on a Baltimore minister fighting vaccine hesitancy in his community. “Researchers have
already raised concerns about the number of Americans who are wary of the vaccines in development for COVID-19, and particularly the number of Black Americans,
who are far more likely to say they are skeptical. Given the country’s history of mistreating Black patients in medical studies, King understands why the congregants of his Black Baptist church may hesitate to get the vaccine when it’s available. King is hoping he can combat that skepticism the same way he’s convinced his congregants to wear masks and stay home when they can—through his weekly sermons. And he’s hoping to take those teachings national. He’s already working alongside both academic and religious institutions in Baltimore and beyond to broaden his reach before a potential vaccine is approved.”
Pushing Herd Immunity
The
Washington Post says, “One of President Trump’s top medical advisers is urging the White House to embrace a controversial “herd immunity” strategy to combat the pandemic, which would entail allowing the
coronavirus to spread through most of the population to quickly build resistance to the virus, while taking steps to protect those in nursing homes and other vulnerable populations, according to five people familiar with the discussions. The administration has already begun to implement some policies along these lines, according to current and former officials as well as experts, particularly
with regard to testing.”
CNN reports, “About 2 million Americans could die in the effort to achieve herd immunity to the coronavirus” according to Dr. Leana Wen.
Treatment News
The Guardian and other outlets report “Studies around the world have confirmed that steroids can save lives in the COVID-19 pandemic, leading to new
recommendations from the World Health Organization that doctors should give them to severely ill patients…. The drugs reduce the risk of death in these seriously ill patients by 20 percent, according to a meta-analysis of the results of the seven trials covering a total of 1,703 patients, published in the
Journal of the American Medical Association. Three of the trials have also been published separately in the journal.”
Inequities in the US
The
New York Times reports that in the US, children of color, “are infected at higher rates than white children, and hospitalized at rates five to eight times that of white children. Children of color make up the overwhelming majority of those who develop a life-threatening complication called multisystem inflammatory syndrome, or MIS-C. Of more than 180,000 Americans who have died of COVID-19, fewer than 100 are children, according to the Centers for Disease Control and Prevention. But children of color comprise the majority of those who have died of COVID-19.” Researchers and healthcare providers say the reasons are not genetic but related to life circumstances. As one notes, “I know exactly what’s happening to those kids. Their parents are frontline, blue-collar or essential workers.”
Congresswoman Karen Bass writes in the
Washington Post that despite the disproportionate impact of COVID on communities of color, “the most promising covid-19 vaccine trials are
reportedly failing to recruit participants of color. This threatens the trials’ validity, since vaccine candidates can vary in effectiveness across different racial and ethnic groups. It is also potentially catastrophic for people of color, who are
disproportionately represented among front-line and essential workers — and who are suffering the worst health and economic effects of this pandemic. She argues, “Pharmaceutical companies must not be allowed to hide data by lumping racial and ethnic groups together: Disaggregated data on enrollments by age, gender, race and ethnicity should regularly be made available to Congress and the public before the trials begin. And vaccines should only be made available to the public if they have been proved effective for everyone, in trials that represent the true diversity of our nation.”
COVID on the African Continent
The
Wall Street Journal reports that a lack of testing in many African countries likely means deaths from COVID-19 are being undercounted. “The paucity of data—combined with reports from several nations of spikes in deaths from respiratory illnesses—is raising fears that a silent epidemic could be raging in parts of the continent. Official coronavirus cases in sub-Saharan Africa have doubled in the past month to more than one million, but the official death rate—at 20,000—remains significantly lower than those of less-populous Europe and the US, according to World Health Organization data…. African nations average around 5,000 tests per one million people, according to data from the African Union, compared with nearly 500,000 tests per one million people in the United Arab Emirates and 200,000 in the US Three quarters of tests in sub-Saharan Africa have been conducted by four nations—South Africa, Kenya, Ghana and Ethiopia—meaning that data from the rest of the continent is perilously scarce.”
The Observer (Uganda) reports, “Praised by the World Health Organisation (WHO) as a model country in the fight against the spread of the novel coronavirus, Uganda is now seemingly headed into the same trajectory as other badly-hit countries, if events of the last few weeks are any indicator. Interviews with COVID-19 patients, their relatives and medical experts, help explain how the country’s rather good fight got off its rails.
Pregnancy and COVID
An
article on the WHO website reports, “New research findings published today in the
BMJ help to shed light on the risks of COVID-19 for pregnant women and their babies. The paper suggests that pregnant women seen at the hospital with suspected or confirmed COVID-19 are less likely to experience a fever or muscle pain, but if they develop severe disease they are more likely to need intensive care than non-pregnant women with COVID-19. This is first paper of a ‘living systematic review’; ongoing, global, research which is collecting and synthesising data on the situation for pregnant women with COVID-19 in countries worldwide.
Face Coverings
The
New York Times reports, “Face shields and valved masks—two options many people find more comfortable than cloth face coverings—appear to be less effective at blocking viral particles than regular masks, a new study shows. The Centers for Disease Control and Prevention
had already stated that clear plastic face shields and masks equipped with vents or valves are not recommended, because of concerns that they don’t adequately block viral particles. But the new research, which uses lasers to illuminate the path of coughs, offers
a striking visual demonstration of how large plumes of particles can escape from behind a face shield or vented mask.”
Understanding Spread
Washington Post reports, “a
sweeping study of nearly 800 coronavirus genomes, conducted by no less than 54 researchers…has found that viruses carrying the [Biogen] conference’s characteristic mutation infected hundreds of people in the Boston area, as well as victims from Alaska to Senegal to Luxembourg. As of mid-July, the variant had been found in about one-third of the cases sequenced in Massachusetts and 3 percent of all genomes studied thus far in the United States. The study, which was
added Tuesday to the preprint website MedRxiv, is probably the largest genomic analysis of any US outbreak so far and is among the most detailed looks at how coronavirus cases exploded in the pandemic’s first wave.”
Data Crisis
Nature reports, “Experts told
Nature that political meddling, privacy concerns and years of neglect of public-health surveillance systems are among the reasons for the dearth of information in the United States…. Without up-to-date, reliable information on who is infected, why and where, US scientists, policymakers and the public must instead rely on media reports and independent efforts to consolidate data, such as the
COVID Tracking Project from magazine
The Atlantic and the
COVID-19 Dashboard compiled by researchers at Johns Hopkins University in Baltimore, Maryland. But data from news outlets are not necessarily comprehensive or universally trusted, and the dashboard doesn’t detail where transmission is happening. There is an urgent need for such information, says Caitlin Rivers, an epidemiologist at Johns Hopkins, because people are returning to work, to socializing and to schools. That means that precisely tailored interventions are more important than ever. ‘It’s not enough to just tell people to be cautious.’”
This Week in Mis-/Dis-information
A
New York Times op-ed by two physicians says, “Seven months into the worst pandemic of our lifetime, the virus continues to spread alongside medical myths and health hoaxes. False news is not a new phenomenon, but it has been amplified by social media. A
new report about Facebook from AVAAZ, a nonprofit advocacy organization that tracks false information, shows how widespread and pervasive this amplification is…. We see the consequences in the clinic and the emergency room. Patients question our evidence-based medical guidance, refuse safe treatments and vaccines, and cite Facebook posts as ‘proof’ that COVID-19 is not real.”
Re-infection?
One of the burning questions about this virus is whether or not people can be reinfected and how long immunity might last.
Vox and several other outlets report on a case of a Hong Kong man who was confirmed to be reinfected. “A 33-year-old man has been reinfected with SARS-CoV-2, the virus the causes the COVID-19 disease. There have been
anecdotal reports of reinfections in the US, but this time researchers have clearer evidence: They
determined the genetic signature of the second infection did not match that of the first…. On this topic of reinfection, we can be reassured: The report, if corroborated, is in line with what immunity
experts have been telling us is possible with this virus. The most important detail: The man was not symptomatic during his second infection, which shows that his immune system
did respond to the virus.
STAT reports, “The case raises questions about the durability of immune protection from the coronavirus. But it was also met with caution by other scientists, who questioned the extent to which the case pointed to broader concerns about reinfection…. Even if the Hong Kong case is an outlier, it points to a few implications: For one, people who have recovered from COVID-19 should also be vaccinated, the researchers said. And they should continue following precautions like wearing a mask and physical distancing.” The research was announced via press release. And the researchers say a peer reviewed article is forthcoming.
More Evidence for Aerosol Transmission
CIDRAP reports, “Two studies published late last week in
Clinical Infectious Diseases highlight the role of airborne spread of COVID-19 and the importance of efficient ventilation systems. One study found that patients can exhale millions of viral RNA particles per hour in the early stages of disease, and the second tied an outbreak affecting 81 percent of residents and 50 percent of healthcare workers at a Dutch nursing home to inadequate ventilation. The peer reviewed studies are
here and
here.
The Personal
American novelist Jesmyn Ward writes of her partner’s death as the pandemic began in
Vanity Fair: “I brought him to the emergency room, where after an hour in the waiting room, he was sedated and put on a ventilator. His organs failed: first his kidneys, then his liver. He had a massive infection in his lungs, developed sepsis, and in the end, his great strong heart could no longer support a body that had turned on him. He coded eight times. I witnessed the doctors perform CPR and bring him back four. Within 15 hours of walking into the emergency room of that hospital, he was dead. The official reason: acute respiratory distress syndrome. He was 33 years old.”
Resource of the Week
A new online MIT
course,
COVID-19, SARS-CoV-2 and the Pandemic, is free and open to the public and features lectures by Bruce Walker, David Baltiimore, Tony Fauci and others. Details
here.
Meals on Heels
The
Washington Post reports on a San Francisco program that aims to help unemployed performers and spread cheer, “’Meals on Heels,’ which gives people in and around San Francisco the opportunity to order dinner and drinks for delivery or pickup, with a lip-syncing performance by a drag queen or king…. [It] was supposed to be a one-time deal, a fun way to give a few of the club’s regular performers who have been out of work since March the chance to earn money. When word got out about the drag on-demand service, so many people called the club asking about when they could request a performance that Drollinger made it a weekly offering.” Watch an
AP story with performances.
