“The World Health Organization reported a record one-day increase in global coronavirus cases on Sunday, with the total rising by 307,930 in 24 hours,” according to Reuters. “COVID-19 infections are still rising in 58 countries, including surges in Argentina, Indonesia, Morocco, Spain and Ukraine, according to a Reuters analysis.”
 
The New York Times reports, “The coronavirus is out of control and is the ‘No. 1 global security threat in our world today,’ the United Nations secretary general, António Guterres, said Wednesday…. Mr. Guterres called for greater cooperation to develop and distribute an affordable vaccine and criticized what he called ‘deadly misinformation’ that could dissuade people from getting vaccinated.”
 

If You’re in a Hurry

 

• Read a Devex op-ed by Global Fund director Peter Sands warning that hard won gains against infectious diseases could be wiped out by COVID.
• Read a provocative article in Science that looks at an argument by some researcher that including prisoners in COVID vaccine studies “could offer outsize health benefits.”
• Read a CNN story about the disproportionate impact of COVID on Hispanics, Blacks and American Indian/Alaska Natives children.
• Read a BBC report about a small trial to test whether inhaling a COVID vaccine might be more effective than the traditional jab.
• Read CNN on a new poll from KFF that shows Americans’ concerns about an October surprise COVID vaccine.
• Read the New York Times on an important step in vaccine developer transparency—the biotech company Moderna released a 135-page document on Thursday that spells out the details of how it is conducting the late-stage trial of its coronavirus vaccine, and how safety and efficacy will be determined.
• Then, if you haven’t already, check out AVAC’s resources to help you watchdog the regulatory process.
• Read a Daily Maverick piece about the challenges of translating COVID terms into indigenous languages.
• Read Yahoo about Mongolia’s COVID success based in part of a nomadic lifestyle and a history of dealing with zoonotic diseases.

 

A World in Disorder

 
Reuters reports, “A collective failure by political leaders to heed warnings and prepare for an infectious disease pandemic has transformed ‘a world at risk’ to a ‘world in disorder’, according to a report on international epidemic preparedness.” A report from The Global Preparedness Monitoring Board, “said world leaders had never before been so clearly forewarned of the dangers of a devastating pandemic’, and yet they had failed to take adequate action.”
 
An anthropologist writes in Nature, “Just last year, the United States was considered one of the countries best equipped to confront a virus such as SARS-CoV-2. Others included the United Kingdom, Brazil and Chile—nations ranked by the comprehensive Global Health Security (GHS) Index as being among the world’s most prepared. Yet since the pandemic began, these countries have delivered some of the worst outcomes…. One thing these countries have in common is ‘exceptionalism’—a view of themselves as outliers, in some way distinct from other nations. Their COVID-19 responses suggest that exceptionalist world views can be associated with worse public-health outcomes.”
 

Mongolia’s Success

 
Yahoo reports, “While parts of Europe and the Americas struggle through a second wave of coronavirus, there is one country that is being held up as a quiet achiever in the global pandemic – and a surprising one at that. Mongolia shares a border which China—where the pandemic is believed to have originated—and lacks the healthcare system of wealthier countries…. But the country hasn’t recorded a single COVID-19 death and has no community transmission to speak of. Unlike many Western countries, Mongolia was uniquely prepared and ready to deal with a global virus pandemic, says Professor Li Narangoa from the ANU’s Mongolia Institute…. A nomadic lifestyle that involves living in close quarters with animals has meant a history of dealing with zoonotic disease outbreaks. When news of the novel coronavirus spread, it was just the latest episode.”
 

Pandemic Politics

 
The COVID response has become a major issue in the very consequential US Presidential race. Wired reports in a story headlined America’s Top Science Journal Has Had It With Trump, on the “crusade” by the editor of the journal Science, “calling out the ways Donald Trump's administration has ignored, misunderstood, and misused science for political gain. Now Thorp’s editorial page is at the forefront of a movement—with scientists casting aside the old stereotype of apolitical disinterest. On Wednesday, even the venerable magazine Scientific American endorsed a presidential candidate for the first time in its 175-year history. (It was Joe Biden.)” Wired references a Science editorial which says, “As he was playing down the virus to the public, Trump was not confused or inadequately briefed: He flat-out lied, repeatedly, about science to the American people. These lies demoralized the scientific community and cost countless lives in the United States.”
 
AP reports that US Presidential candidate Joe Biden “said Wednesday that while he trusts what scientists say about a potential coronavirus vaccine, he doesn’t trust President Donald Trump. His comments come as the debate over a vaccine—how it will be evaluated and distributed when it’s ready—has taken center stage in the presidential race…He went on to declare: ‘I trust vaccines, I trust scientists, but I don’t trust Donald Trump, and at this moment, the American people can’t, either.’”
 
STAT reports on interviews with current and former CDC insiders. “Many say Redfield is not doing enough to safeguard the reputation of the CDC and the integrity of its work, and that he is failing to successfully fend off political interference that is eroding Americans’ trust in the organization…. In recent days, first Politico and then other news organizations have reported that officials in Washington have been attempting to revise or delay the publication of scientific reports in the CDC’s online journal Morbidity and Mortality Weekly Report. MMWR, as it is better known, is a bedrock of public health. It is where the first reports of AIDS cases in the United States were published; it is where public health workers seeking the latest on an outbreak or a disease first turn.”
 
The Union of Concerned Scientists posted a blog outline their worries for science in the US. They write, “While many presidential administrations have been complicit, the activities of the Trump administration have laid bare the inherent weaknesses in existing protections for science. Since 2017, political officials have stunted or stalled scientific research, retaliated against government scientists, weakened science advisory committees, left appointed scientific positions vacant, and undermined career staff…. Science has been essential as the world seeks to prevent, treat, and manage the spread of COVID-19. This pandemic has showcased the heroic determination of scientists and researchers, who have already made revolutionary discoveries at unprecedented speed—but with 177,000 people dead in the United States already, this pandemic also reveals the high cost of ignoring the science. The collective contribution of government-supported science is incalculable. In the months and years to come, the federal government must ensure that this science is protected, and that federal scientists and employees can perform their vital duties. The public good depends on it.”
 
CNN reports, “A majority of Americans, 62 percent, believe political pressure from the Trump administration will cause the US Food and Drug Administration to rush approval of a coronavirus vaccine before Election Day on November 3, according to a new health tracking poll from the Kaiser Family Foundation. The KFF poll, conducted between August 28 and September 3, found 85 percent of Democrats, 61 percent of independents and 35 percent of Republicans believe the FDA would cave to pressure from President Donald Trump and push through a COVID-19 vaccine before ensuring it is safe and effective…. If a COVID-19 vaccine was ready and available for free before the upcoming election, just over half of respondents, 54 percent, said they would not get one, while 42 percent said they would.”
 

CDC Director on Masks and Vaccines

 
Axios reports, “CDC director Robert Redfield suggested in a Senate Appropriations subcommittee hearing on Wednesday that face masks are "more guaranteed" to protect against the coronavirus than a vaccine, citing the potential for some people to not become immune to the virus after receiving the shot. ‘These face masks are the most important, powerful public health tool we have. And I will continue to appeal for all Americans, all individuals in our country, to embrace these face coverings. I've said if we did it for 6, 8, 10, 12 weeks, we'd bring this pandemic under control,’ he said.”
 
CNN reports, “Responding to Redfield's congressional testimony, Trump took his pushback against the doctor—who he appointed to lead the CDC—a step further, contradicting the agency head on two accounts: the timeline for a coronavirus vaccine and the effectiveness of masks compared with inoculation.”
 
Following that, Redfield tweeted, “I 100 percent believe in the importance of vaccines and the importance in particular of a #COVID19 vaccine. A COVID-19 vaccine is the thing that will get Americans back to normal everyday life. The best defense we currently have against this virus are the important mitigation efforts of wearing a mask, washing your hands, social distancing and being careful about crowds. #COVID19”
 

Vaccine News

 
Reuters reports, Coronavirus vaccines being developed in China may be ready for use by the general public as early as November, an official with the Chinese Center for Disease Control and Prevention (CDC) said. China has four COVID-19 vaccines in the final stage of clinical trials. At least three of those have already been offered to essential workers under an emergency use programme launched in July.”
 
The New York Times reports China “is using the prospect of [a vaccine’s] discovery in a charm offensive aimed at repairing damaged ties and bringing friends closer in regions China deems vital to its interests,” offering a low or no cost vaccine to countries across Africa, Asia and Latin America. “China’s vaccine pledges, on top of earlier shipments of masks and ventilators around the world, help it project itself as a responsible player as the United States retreats from global leadership. Beijing’s moves could also help it push back against accusations that the ruling Communist Party should be held responsible for its initial missteps when the coronavirus first emerged in China in December.”
 
CNBC reports on a new CDC plan for vaccine distribution, noting that CDC “outlined a sweeping plan Wednesday to make vaccines for COVID-19 available for free to all Americans. In the plan, the CDC said it anticipates a coronavirus vaccine will initially be granted an emergency use authorization before a full formal approval.” The plan calls for the US government “to transport a coronavirus vaccine to distribution sites across the US within 24 hours after the Food and Drug Administration grants an emergency authorization or approval…” NPR notes “we know that once the FDA green lights a vaccine, there won't be enough to give it to 300 million Americans. By the end of the year, there could be tens of millions of doses if things go right. Still, the government is going to have to prioritize. The plan is that health care workers, people with underlying medical conditions, the elderly and essential workers will be first. And as for everyone else, the CDC Director Robert Redfield told the Senate committee this morning that most Americans wouldn't receive a COVID-19 vaccine until summer or early autumn of 2021. However, later in the day, President Trump contradicted that timeline. He told White House reporters he thinks the CDC director was confused and that distribution could start as soon as October and is going to go much faster.”
 
The New York Times reports on concerns that pharma companies are withholding vital information about their COVID trials. “It’s standard for drug companies to withhold details of clinical trials until after they are completed, tenaciously guarding their intellectual property and competitive edge. But these are extraordinary times, and now there is a growing outcry among independent scientists and public health experts who are pushing the companies to be far more open with the public in the midst of a pandemic that has already killed more than 193,000 people in the United States. These experts say American taxpayers are entitled to know more since the federal government has committed billions of dollars to vaccine research and to buying the vaccines once they’re approved. And greater transparency could also help bolster faltering public confidence in vaccines at a time when a growing number of Americans fear President Trump will pressure federal regulators to approve a vaccine before it is proved safe and effective.”
 
A later New York Times report says, “the biotech company Moderna released a 135-page document on Thursday that spells out the details of how it is conducting the late-stage trial of its coronavirus vaccine, and how safety and efficacy will be determined…. The document suggests that the first analysis of the trial data may not be conducted until late December, and that there may not be enough information then to determine whether the vaccine works. Subsequent analyses, scheduled for March and May, are more likely to provide an answer.”
 
BBC reports UK researchers are starting a small trial of an inhaled vaccine. “Delivering doses directly to the lungs might give a better immune response than conventional jabs, they say…. The Imperial College London team will use two frontrunners already in development - the Oxford one recently paused in trials and one from Imperial that entered human testing in June.”
 
STAT reports “Pfizer and BioNTech are moving to enlarge the Phase 3 trial of their COVID-19 vaccine by 50 percent, which could allow the companies to collect more safety and efficacy data and to increase the diversity of the study’s participants. The companies said in a press release that they would increase the size of the study to 44,000 participants, up from an initial recruitment goal of 30,000 individuals…. The companies also said that the change will allow the study to include a more diverse population. The companies said the study will now include adolescents as young as 16, people with stable HIV, and those with hepatitis C or hepatitis B.”
 
Hindustan Times reports, “Russia’s sovereign wealth fund has agreed a deal to sell 100 million doses of its COVID-19 vaccine, Sputnik-V, to a major listed pharmaceutical company in India…. Clinical trials of the Russian vaccine in India are expected to follow and to be held jointly with this firm, the source said. Both the trials and supply deal depend on domestic regulatory approval.” The vaccine has not yet been through efficacy trials, but is being offered to some frontline workers in Russia.
 
Al Jazeera reports, The United Arab Emirates (UAE) has granted emergency approval for the use of a coronavirus vaccine, six weeks after human trials in the Gulf state started. … ‘The vaccine will be available to our first line of defence heroes who are at the highest risk of contracting the virus,’ said the National Emergency Crisis and Disaster Management Authority in a tweet.”
 
A blog post on the FDA website by commissioner Hahn and Peter Marks, director of the FDA Center for Biologics Evaluation and Research write, “One of the agency’s highest priorities is ensuring the quality, safety and effectiveness of vaccines. This deep and abiding commitment is something that we consider essential to engendering the public’s trust in vaccines.” They lay out the measures FDA is taking and concluded decisions about an emergency use authorization or FDA approval, “will be firmly rooted in science. We are committed to expediting the development of COVID-19 vaccines, but not at the expense of sound science and decision making. We will not jeopardize the public’s trust in our science-based, independent review of these or any vaccines. There’s too much at stake.”
 

Should Prisoners Be Recruited for Vaccine Trials?           

 
Science looks at the ethical issues around recruiting people who are incarcerated for COVID vaccine trials, reporting that in the US, “Prisoners…have borne a heavy burden of COVID-19, with more than 125,000 US prisoners infected, and more than 1000 dead. But prisoners have also been excluded from the trials out of concern that they might be coerced into participating or exploited if they do. Now, some researchers argue that including prisoners in studies could offer outsize health benefits. Correctional facilities have experienced many COVID-19 outbreaks and are structurally unsuited to social distancing (among other precautions). And so, the researchers argue, like other people at high risk of catching the disease, prisoners should be allowed to participate in clinical trials.” In an interview two experts outline many of the thorny ethical issues around doing such research in a prison setting.
 

Will People Take a Vaccine When There Is One?             

 
A new Lancet study maps vaccine confidence across 149 countries from 2015 to 2019. The authors note, “The determinants of vaccine uptake across the globe show strong consistency, with being male or having fewer years of education associated with decreased chances of uptake. Positive information-seeking behaviours and trusting health-care workers more than other sources such as one's social circle for medical and health advice were associated with increased chances of uptake.” Contagion Live quotes study author Heidi Larson: “It is vital with new and emerging disease threats such as the COVID-19 pandemic, that we regularly monitor public attitudes to quickly identify countries and groups with declining confidence, so we can help guide where we need to build trust to optimise uptake of new life-saving vaccines.”
 

Look to 2021 or 2022 for “Normal”

Yahoo reports Dr. Soumya Swaminathan, WHO chief science officer is warning, “We're looking at 2022 at least before enough people start getting the vaccine to build immunity. So, for a long time to come, we have to maintain the same kind of measures that are currently being put in place with physical distancing, the masking and respiratory hygiene. Those will have to continue after the vaccine starts getting rolled out, because we need 60 percent to 70 percent of the population to have immunity before you will start seeing a dramatic reduction in transmission of this virus. We also don't know how long these vaccines will protect for—that's the other big question mark: How long does immunity last? And it's possible that you will need a booster.”
 
In an op-ed in the New York Times, pediatrician Aaron E. Carroll warns, “Until we see convincing evidence that a vaccine has a large population-level effect, we will still need to mask and distance and restrain ourselves. Too many of us won’t. Too many will believe that the vaccine has saved them, and they will throw themselves back into more normal activities. That could lead to big outbreaks, just as winter hits at its hardest…. As Dr. Fauci [has said], ‘If you’re talking about getting back to a degree of normality which resembles where we were prior to COVID, it’s going to be well into 2021, maybe even towards the end of 2021.’”
 

Treatment News

 
AP reports, “A drug company says that adding an anti-inflammatory medicine to a drug already widely used for hospitalized COVID-19 patients shortens their time to recovery by an additional day. Eli Lilly announced the results Monday from a 1,000-person study sponsored by the US National Institute of Allergy and Infectious Diseases. The results have not yet been published or reviewed by independent scientists, but the government confirmed that Lilly’s statement was accurate…. All study participants received remdesivir, a Gilead Sciences drug previously shown to reduce the time to recovery, defined as being well enough to leave the hospital, by four days on average. Those who also were given baricitinib recovered one day sooner than those given remdesivir alone.” STAT quotes Scripps’ Eric Topol: “This is a good start. A lot is pinned not only on Lilly but on the whole family of these [monoclonal antibodies], because even though they’re expensive and they’re not going to make a gajillion doses, they could make a big difference in the whole landscape of the pandemic.”
 
A NEJM perspective from Moncef Slaoui, Shannon E. Greene, and Janet Woodcock lays out Operations Warp Speed’s (OWS) work on COVID treatments. They say, OWS “also aims to combat COVID-19 by improving the use of existing therapies and providing additional treatment options. We hope in this way to ameliorate the pandemic as we wait for the US population to be fully immunized…. We have used three criteria to select candidate therapeutics to support: timeliness, robust science, and ability to manufacture quickly at scale.” They conclude, “Developing a vaccine by January 2021 will represent remarkably speedy scientific progress. But with therapeutics, we may be able to make inroads against the virus before we can fully deploy a vaccine. With mounting death tolls, increasing case burdens, and public confusion, we face an enormous task. We are taking essential steps toward bringing therapies to the American public as soon as possible.”
 
Ashe News (Nigeria) reports, “The Minister of Science and Technology, Dr Ogbonnaya Onu, has inaugurated a Ministerial Committee on herbal remedies and natural compounds towards developing a homegrown treatment for COVID-19 pandemic. The committee has eminent scientists and Fellows of the Nigerian Academy of Science (NAS) as members. Onu explained that the committee was set up to authenticate claims by researchers, scientists and traditional medicine practitioners on herbal remedies, natural compounds and non-pharmaceutical items for the treatment of the disease.

Reuters reports, “The world's largest randomised trial of potential medicines for COVID-19 is to add Regeneron's experimental antiviral antibody cocktail REGN-COV2 to the drugs it is testing in patients hospitalised with the disease. The UK RECOVERY trial, which has been testing a range of potential COVID-19 treatments since it began in April, will compare the effects of adding REGN-COV2 - a lab-manufactured monoclonal antibody - to standard care.”
 

A Pandemic Within a Pandemic

 
A NEJM perspective focuses on issues with intimate partner violence (IPV) in the US, concluding, “The COVID-19 pandemic has put a spotlight on numerous ongoing public health crises, including violence within the home. As state mandates relax and people begin to live a new version of normal, clinicians, public health officials, and policymakers cannot stop addressing the layers of social inequities in our communities and the ways in which they affect people’s access to care. The pandemic has highlighted how much work needs to be done to ensure that people who experience abuse can continue to obtain access to support, refuge, and medical care when another public health disaster hits.”
 

Disparities

 
The Washington Post reports on a trend for US cities (plus three states) “that have passed legislation or made a formal declaration in the past year that racism is a public health crisis. The push to highlight racism as a public health threat, one that shortens lives and reduces quality of life in a manner similar to smoking or obesity, gained even more momentum in the summer. The coronavirus pandemic and police brutality have emerged in recent months as inescapable crises that have killed non-White people at disproportionately higher rates.” Democrats in congress have also “introduced bill that would formally identify systemic racism as a public health crisis in the United States.”
 
Medscape reports on a study from a British hospital that found “Contrary to expectations, the risk of COVID-19 infection among hospital staff at the height of the coronavirus pandemic was lowest among intensive care clinicians and highest among hospital cleaners…. The study authors suggest the type of personal protective equipment (PPE) worn may be key to these differences. Intensive care units were designated high-risk environments, and the use of enhanced PPE including class 3 filtered face piece respirators were mandated. In contrast, fluid-resistant surgical masks were recommended in other clinical areas. There was also an ethnic divide: workers of BAME backgrounds were nearly twice as likely to have already had the infection as their white colleagues.
 
CNN reports, “Children and teens from minority groups are disproportionately hit by coronavirus, just as older adults are, according to the findings of a new report from the US Centers for Disease Control and Prevention. Children from ethnic and racial minorities, those with underlying health conditions and those between the ages of 18 and 20 are more likely to die…. Hispanics, Blacks and American Indian/Alaska Natives were disproportionately affected.  A total of 44 percent of the 121 who died were Hispanic children, 29 percent were Black children, 4 percent were American Indian/Alaska Natives and 4 percent were Asian or Pacific Islander. While these groups represent 41 percent of the US population under the age of 21, they accounted for approximately 75 percent of deaths in that age range. Fourteen percent of the deaths were in white children.”
 
ProPublica reports, “The Louisiana Legislative Black Caucus called the practice of sending infected coronavirus patients home to die ‘disturbing’ after ProPublica found that one New Orleans hospital system had done so numerous times…. The legislators’ demands follow reporting by ProPublica that found that while many hospitals around the country decided not to use home hospice care for coronavirus patients—due to the infectious nature of the disease and the unpredictable and sometimes difficult-to-control symptoms—Ochsner Health, the largest hospital network in Louisiana, sent COVID-19 patients in New Orleans home with hospice care. Several families said that Ochsner staff pressured them into discontinuing treatment, even as they pushed back. In the dozens of cases ProPublica examined, every patient who died after the hospital sent them home was Black.”
 

Sobering Report from Gates Foundation

 
The Gates Foundation’s Goalkeeper’s report analyzes “the damage the pandemic has done and is still doing—to health, to economies, and to virtually everything else… [and argues] for a collaborative response.” They warn, “the longer it takes us to realize that [nations must work together], the longer it will take (and the more it will cost) to get back on our feet.” The report says, “Consider vaccine coverage, which is a good proxy measure for how health systems are functioning. Our data partner, the Institute for Health Metrics and Evaluation (IHME), found that in 2020 coverage is dropping to levels last seen in the 1990s. In other words, we’ve been set back about 25 years in about 25 weeks.”
 
STAT reports on an interview with Bill Gates who “sounded exasperated at times as he described the badly bungled launch of COVID-19 testing, the enlisting of a neuroradiologist—rather than an epidemiologist or infectious diseases specialist—to help guide the White House’s response decisions, and the recent move to discourage testing of people who have been in contact with a known case but who aren’t yet showing symptoms. ‘You know, this has been a mismanaged situation every step of the way…. It’s shocking. It’s unbelievable—the fact that we would be among the worst in the world.’” STAT reports, “Gates did credit the administration for the work it has done to fast-track development of COVID-19 vaccines, through the initiative known as Operation Warp Speed. Even there, though, he feels the administration’s unwillingness to support efforts to help low- and middle-income countries to buy pandemic vaccine is self-defeating.”
 
The Guardian quotes Melinda Gates “Ultimately, it’s our choice as a global community whether we face another lost decade or not. We know what can be done to restart vaccination campaigns. We know what it takes to maintain essential health services during a crisis. We know a lot about the kind of inclusive policies needed to help people withstand the economic shock. It comes down to a question of political will and working together beyond our own borders. COVID-19 doesn’t determine that. We do.”
 

Disease Denialism

 
Writing in BMJ Gregg Gonsalves draws on an analogy for the current US government COVID denialism: the early 2000’s in South Africa, “when the President of the Republic, Thabo Mbeki, rejected mainstream views about HIV/AIDS, denying that the human immunodeficiency virus caused the disease and that antiretroviral therapy, saving lives around the rest of the world, was akin to poison. The entire state apparatus was overhauled to ensure that the President’s views became national policy, with his health minister Manto Tshabalala-Msimang, following Mbeki’s lead on HIV and suggesting that beetroot, garlic, lemons, and African potatoes were better than AIDS drugs for the disease….” Gonsalves writes, “by August, with Fauci and Birx thrown out of the room where decisions get made, Trump started reading from the book of disease denialism. Now everything they were doing all along, not testing enough, not ramping up production of personal protective equipment, not funding states and cities to ramp up contact tracing and isolation, pushing for the reopening of schools and businesses was all part of the plan all along.” He concludes, “All hail the new American disease denialism. Like in South Africa, we will look back on this time and the hundreds of thousands of deaths we could have avoided with sound, science-based leadership, with a mix of sorrow, anger, and disbelief. Now, like then, the resolution to the dire situation we are in is a political one. Our pandemic future hangs on the election in November.”
 

COVID or Smoke Inhalation?

 
As wildfires rage in the western US, Kaiser Health News reports, “hospitals and health facilities are reporting an influx of patients with problems most likely related to smoke inhalation…. [But] facilities already strapped for testing supplies and personal protective equipment must first rule out COVID-19 in these patients, because many of the symptoms they present with are the same as those caused by the virus.
 

COVID and HIV

 
CDC’s Jono Mermin writes in a Medscape commentary that only a small fraction of those in the US at risk for HIV receive PrEP and “as dismal as that reality is, the COVID-19 pandemic has made it even worse because now, accessing care at the places where PrEP is prescribed is harder to do.” He outlines how people can still get access to PrEP during the pandemic.
 
POZ reports, “Current evidence shows that people living with HIV are at increased risk of death due to COVID-19. But the indirect effects of the pandemic are also worrying. Disruptions to health services could mean people don’t get antiretroviral therapy (ART), which would result in more deaths and more infections (because viral loads are higher in untreated patients, they are more likely to transmit to others). So far, this worst-case scenario has not happened, although some countries are struggling to maintain services. One innovation that seems to be helping is multi-month dispensing—a simple approach that helps people fit treatment into their lives and keeps them out of overburdened clinics. Even after COVID is under control, this will be a more effective, efficient way to dispense ART.” POZ notes, “The [Gates Foundation’s Goalkeeper’s report] does offer a glimmer of hope. Although the pandemic has taken the world a step back from progress, we can act now to prevent even worse outcomes. Innovations such as new ways to distribute meds and conduct contact tracing of people with COVID-19, the report notes, will help. As will vaccine research and the financial support of nations such as the United States.”
 

COVID and Infectious Diseases

 
In a Devex op-ed Global Fund director Peter Sands writes that the fund’s latest annual Results Report shows programs, “saved 6 million lives in 2019 alone. That represents 20 percent more than the previous year and brings the total number of lives saved since 2002 to 38 million. But he warns, “The reality is that the results from 2020 will look very different. In addition to direct deaths from the new coronavirus itself, the knock-on effects of the COVID-19 pandemic on the fight against HIV, TB, and malaria could be catastrophic. In 2020, we could lose all we have achieved in the previous decade.” Sands says, “The battle against COVID-19 cannot be considered in isolation. We must view this not just as a fight against a specific virus, but as a catalyst to finish the fights against HIV, TB, and malaria and to strengthen preparedness against future pathogens by building resilient and sustainable systems for health. In the fight against infectious diseases as formidable as these, no one is truly safe until everyone is safe.”
 

Easing Lockdowns

 
Business Tech reports South Africa President Cyril Ramaphosa announced in a national address “that the country has ‘withstood the storm’ in its fight against the coronavirus and that the data shows a clear downward trend in the country. However, he cautioned that ‘by any measure we are still in the midst of a deadly epidemic’ and said that the most important task is ensuring that the country is not hit by a second wave of infections as is being seen internationally.” BBC reports, “South Africa shut its borders at the star of the lockdown, but President Ramaphosa said that international travel would resume from 1 October. Those arriving in South Africa must present a negative coronavirus test taken within three days of travel.” The Standard reports Ramaphosa said, “Travel may be restricted to and from certain countries that have high infection rates. A list of those countries will be published and it will be based on the latest scientific data that we will be able to get from those countries."
 
The New York Times reports, “In the early days of the pandemic, President Emmanuel Macron exhorted the French to wage ‘war’ against the coronavirus. Today, his message is to ‘learn how to live with the virus.’…Europeans, for the most part, are putting to use the hard-won lessons from the pandemic’s initial phase: the need to wear masks and practice social distancing, the importance of testing and tracing, the critical advantages of reacting nimbly and locally. All of those measures, tightened or loosened as needed, are intended to prevent the kind of national lockdowns that paralyzed the continent and crippled economies early this year.”
 
Contagion Live reports, “public health officials from the Indian Public Health Association, the Indian Association of Epidemiologists, and the Indian Association of Social and Preventive Medicine, all joined for a joint statement to push the government to end the lockdowns. Moreover, this group emphasized that these restrictions should be replaced with widespread testing efforts. In their call to action, the joint statement noted that the nationwide lockdown, which began in March, has been disjointed as it was relaxed but still upheld in several cities…. Overall, the authors emphasize that these haphazard, disjointed lockdowns are limited in their efficacy and efforts should be focused on enhancing testing capacity, as well as targeted approaches for high-risk populations.”
 

Namibia Says Investments in Healthcare System Will Pay Off           

 
The Namibian Sun reports, “Namibia's post-COVID-19 health system is likely to set the country on track towards a universal healthcare system, given the generous investments during the pandemic response.
These are the sentiments of the health ministry's executive director, Ben Nangombe, who says the country has in just six months increased its number of isolation beds from four to over 1,200 for mild COVID-19 cases.
 

Impact on Education

 
Nature reports on the efforts of universities to develop programs to frequently test students. One program at an Illinois school “has been touted as a model system….” One of the developers of the program says, “We’re now doing more than 10,000—sometimes 15,000—tests per day. That’s about 2 percent of the testing done in the entire United States.” The mass testing program is helping the school find and trace COVID cases. But the school still saw a spike in cases as they reopened. “When we put the whole programme in place, we did a bunch of modelling to try to understand how student socialization was going to integrate with the fast, recurrent testing…. What we didn’t model for is that people would choose to go to a party if they knew that they were positive. The overwhelming majority of our students have done a great job, but unfortunately, a small number of students chose to make very bad decisions that led to a rise in cases.”
 
The Washington Post reports that as school has restarted in the US, at least six teachers have died from COVID-19. “It isn’t clear whether any of the teachers were infected at school, and many quarantined to avoid exposing students and other staff members. But their deaths have renewed fears that school campuses will become a breeding ground for the virus, spreading the illness as communities grapple with how to balance the need to educate children with properly addressing the pandemic.”
 
Bhekisisa reports on an increase in child marriage brought on by school closures during lockdowns. “Dr Faith Mwangi-Powell, chief executive at Girls Not Brides, a global partnership of more than 1 300 civil society organisations from more than 100 countries committed to ending child marriage, says there was growing evidence that school closures had led to a rise in gender-based violence. ‘School was a safety net for many and this situation disadvantages girls more than boys because they are more likely to be married off, seen as a burden by families facing economic hardship,’ she says…. The UN’s population agency, UNFPA, said in April that as many as 13 million more child marriages could take place over the next 10 years because of a six-month COVID-19 shutdown of schools and family planning services combined with increasing economic hardship.”
 
The Standard (Kenya) reports on new guidelines for school reopenings. “According to the new rules, school activities, including teaching and learning, should take place outside classrooms or lecture halls.
However, in cases where learning must take place in enclosed rooms, institutions must create space between learners to prevent possible COVID-19 infections…. Education Cabinet Secretary George Magoha admitted that implementing this proposal in schools will be a challenge and hinted that the Government may rely on face masks for each learner to lessen the impact.”
 

Rise in Rates of Stillbirths Around the World     

 
Nature reports, “A slew of studies from around the world has reported a disturbing trend: since the coronavirus pandemic started, there has been a significant rise in the proportion of pregnancies ending in stillbirths, in which babies die in the womb. Researchers say that in some countries, pregnant women have received less care than they need because of lockdown restrictions and disruptions to health care. As a result, complications that can lead to stillbirths were probably missed, they say.”
 

What Do We Know About Herd Immunity This Week?  

 
A Nature comment says, “there is little evidence to suggest that the spread of SARS-CoV-2 might stop naturally before at least 50 percent of the population has become immune. Another question is what it would take to achieve 50 percent population immunity, given that we currently do not know how long naturally acquired immunity to SARS-CoV-2 lasts (immunity to seasonal coronaviruses is usually relatively short lived), particularly among those who had mild forms of disease, and whether it might take several rounds of re-infection before robust immunity is attained. … Likewise, how a previous infection would affect the course of disease in a re-infection, and whether some level of pre-existing immunity would affect viral shedding and transmissibility, is unknown.” The authors note, “At this stage, only non-pharmaceutical interventions, such as social distancing, patient isolation, face masks and hand hygiene, have proven effective in controlling the circulation of the virus and should therefore be strictly enforced. Potential antiviral drugs that reduce viral loads and thereby decrease transmission, or therapeutics that prevent complications and deaths, may become significant for epidemic control in the coming months. This is until vaccines become available, which will allow us to reach herd immunity in the safest possible way.”
 

COVID Impact on Clinical Research

 
Nature reports, “Since COVID-19 emerged in January 2020, it has caused unprecedented disruption of clinical trials and ongoing patient care. Around 1,000 organizations have reported trial disruption, consistent with a reported ~80 percent decrease in new patients entering trials per site in April 2020 compared with April 2019…. COVID-19 altered the conduct of ongoing trials, with investigators reporting 57 percent of patient interactions and 79 percent of interactions between sponsors and contract research organizations (CROs) taking place remotely.” The authors conclude, “COVID-19 has demonstrated that sponsors and investigators can achieve in weeks what was previously thought to require months or years, and highlighted the humanitarian importance of efficient, robust and definitive clinical research. The industry’s actions over the next 1–2 years may determine fundamental pivots for how medicines are developed, giving each stakeholder an opportunity not only to adapt but to shape the future clinical trial paradigm.”
 

COVID and the Brain

 
Nature reports that researchers are trying to understand neurological impacts of COVID. “The list now includes stroke, brain haemorrhage and memory loss. It is not unheard of for serious diseases to cause such effects, but the scale of the COVID-19 pandemic means that thousands or even tens of thousands of people could already have these symptoms, and some might be facing lifelong problems as a result.
Yet researchers are struggling to answer key questions—including basic ones, such as how many people have these conditions, and who is at risk. Most importantly, they want to know why these particular symptoms are showing up.”
 

COVID and Sex

 
Techround reports, “The sexual health charity Terrence Higgins Trust (THT) has said that wearing a mask during sex and avoiding kissing are vital practices in helping to prevent COVID-19 from spreading…. A study published by YouGov found that 22 percent of Brits would wear a mask during sex…” The full THT guidelines are on their website.
 
Lifehacker reminds readers, “if you’re at risk for an STD, you should make sure to seek out testing, even if it’s more inconvenient than usual.” The article notes, “Between clinic closures and supply shortages, a lot of tests have been delayed, as testing rates plunged over the past several months.” Another down side to unproven COVID treatments being touted by some politicians and others is “a shortage of azithromycin, one of the antibiotics commonly used to treat chlamydia and gonorrhea.”
 

Fighting Dis-/Mis-information

 
New Telegraph Nigeria reports on a media roundtable organised by the Nigerian Academy of Science to help put science at the center of the response. One expert noted, “The fear factor will not dispel the myths, but the war against it should be led by scientific evidence and this will come about through collaborative work. ‘It will come about by learning from all the countries of the world and most importantly by educating the public including school children.’”
 
SciDevNet reports on a roundtable with researchers discussing now to combat misinformation. “People need to understand the motivations behind misinformation and fake news campaigns to be able to tackle them, physicist Julia Tagüeña, from the National Autonomous University of Mexico” said. “Politicians, public agencies and the media must strive to create a public arena where differing, but evidence-based, views are welcome, says science communications consultant Olle Bergman. ‘The public should be taught that science is a process where different research groups offer different explanations and recommendations,’ he said.”
 

Motivating Behavioral Change

 
A commentary on FiveThirtyEight looks at issues around finding the best research to help motivate behavioral change or influence policy around COVID. “Often, a simple question like, “What research should policy makers and practitioners use to help combat the pandemic?” is surprisingly difficult to answer.” The author notes, “The racial disparities in the pandemic have been so stark that early estimates suggest that about one in 2,000 of the entire Black population in the US has died from COVID-19. It is therefore imperative we consider these different experiences of the coronavirus when considering what research we should use when responding to the pandemic. Who is included in the data we’re using? And who isn’t? If we heavily weigh the opinions and other data gathered from one group as we design interventions, what happens to other groups? These real-world differences matter, and matter greatly. We have to ask ourselves those questions as scientists and remember that—especially in times like the pandemic era we’re living in—we’re betting people’s lives on the answers to those questions.”
 

Do You Speak COVID?

 
Daily Maverick (South Africa) reports, “When the COVID-19 pandemic hit, a whole new set of terms entered our lexicon. Broadcasters, translators and language practitioners had to scramble to find ways to translate them into indigenous languages…. Dr Bulelwa Nokele, an IsiXhosa language specialist, points out that ‘some of the new words will be accepted; others will be rejected by the communities. Those that are accepted will then become part of the IsiXhosa lexicon….’ Linguist Pule Welch says ‘if you are dealing with issues around particular technical topics—in this case, epidemiology—you need to go to the experts in the field, who, in this case are traditional healers.’”
 

What Will Be Good in the Post-Pandemic World?           

 
BuzzFeed reports on a Reddit conversation prompted by the question, “What positive impacts do you think will come from COVID-19?" Among the answers, “Companies (and schools) will not force people to come in when they are sick”; “…it's going to lower barriers to work for people with disabilities. … Remote work holds promise and opportunity for a vast pool of talent who have been sidelined because they can't get to the interview or don't get the role because they showed up with braces or a wheelchair’; "Drive-in movies are making a comeback”; "People with the flu/cold wearing masks and taking precautions to not infect others”; and "Curbside cocktails.”