How many times has this newsletter started with the words “we reached a milestone?” In the 9 months of this pandemic, we’ve passed many grim milestones and no doubt many more will come. This week brought a major milestone: One million documented COVID-19 deaths globally. The New York Times reports that number is, “more than HIV More than dysentery. More than malaria, influenza, cholera and measles—combined. In the 10 months since a mysterious pneumonia began striking residents of Wuhan, China, COVID-19 has killed more than one million people worldwide as of Monday—an agonizing toll compiled from official counts, yet one that far understates how many have really died. It may already have overtaken tuberculosis and hepatitis as the world’s deadliest infectious disease, and unlike all the other contenders, it is still growing fast.” AP reminds us, “The nearly 1 million people around the world who have lost their lives to COVID-19 have left us a gift: Through desperate efforts to save their lives, scientists now better understand how to treat and prevent the disease—and millions of others may survive.”
 
The Economist looks at “excess mortality” and tries to estimate a more accurate number of COVID deaths. Examining all-cause mortality data from several countries the magazine found, “Between March and August these countries recorded 580,000 COVID-19 deaths but 900,000 excess deaths; the true toll of their share of the pandemic appears to have been 55 percent greater than the official one. This analysis suggests that America’s official figures underestimate the death toll by 30 percent or more…. This means that the real number of deaths to date is probably a lot closer to 300,000 than 200,000.”
 
Reuters has published an article to help explain how researchers estimate the death rate from the virus. “A true mortality rate would compare deaths against the total number of infections, a denominator that remains unknown because the full scope of asymptomatic cases is difficult to measure. Many people who become infected simply do not experience symptoms. Scientists have said the total number of infections is exponentially higher than the current number of confirmed cases, now at 33 million globally. Many experts believe the coronavirus likely kills 0.5 percent to 1 percent of people infected, making it a very dangerous virus globally until a vaccine is identified.”

If You’re in a Hurry

 

• Read Devex on how the pandemic in Africa is not following the same trajectory as the US and Europe and efforts to understand what that means.
• Then read Karen Attiah’s Washington Post op-ed about how racism guided much of the media reporting around COVID in Africa and missed opportunities to learn from Africa’s vast experience responding to pandemics.
• Read a Science Speaks commentary about the perils of politics intervening in the regulatory processes for COVID vaccines.
• Hear from Dr. Fauci why he believes the FDA will do the right thing on a JAMA podcast.
• Then read an op-ed from 7 former FDA commissioners who argue the FDA must stay true to science.
• If you want to know all the ins and outs of vaccines head to a “long and nerdy” tweetorial.
• Read a blog post from activist Tian Johnson on on the critical need for civil society engagement in COVAX.
• Read about the scramble for capacity to produce enough monoclonal antibodies, should they prove effective as treatment in the Washington Post.
• Check out Bloomberg’s in-depth look at COVID cases and deaths in Chicago and the link to racism.

 

Regional Differences

 
Devex reports, “Experts are calling for more study of the COVID-19 pandemic in Africa as ongoing data analysis points to differences in how it is playing out on the continent…. Current data from WHO-Africa shows that the pandemic has largely affected a younger age group. Roughly 91 percent of COVID-19 infections in sub-Saharan Africa are among people under the age of 60, and more than 80 percent of cases are asymptomatic—far higher than the estimated proportion of asymptomatic cases from studies elsewhere in the world.” At a press conference, “Dr. Sam Okuonzi, chairperson of the hospital management board at Arua Regional Referral Hospital in Uganda, noted that the initial predictive COVID-19 models were based on European populations. As such, the rate of transmission and severity of the pandemic has not played out in line with these predictions in Africa.”
 
 

COVID Politics

 
As the November 3^rd Presidential election in the US draws closer, the ins and outs of COVID and politics in the US could easily fill this whole newsletter and then some. While much of the media coverage and issues centered on COVID vaccine development, political machinations around COVID are more widespread and more information comes to light almost daily. But the US is not the only country where politics sometimes drives COVID responses. Here are key highlights from the US and beyond.
 
The National Academies of Science and Medicine released a statement of concern about political interference in science and the pandemic, arguing “Our nation is at a critical time in the course of the COVID-19 pandemic with important decisions ahead of us, especially concerning the efficacy and safety of vaccines. Policymaking must be informed by the best available evidence without it being distorted, concealed, or otherwise deliberately miscommunicated…. Any efforts to discredit the best science and scientists threaten the health and welfare of us all.
 
Nature reports, “Several ongoing coronavirus-vaccine trials could announce game-changing results next month. But as anticipation grows, concerns are growing about whether the vaccines will clear safety trials, what they will achieve if they do and the risk that the approval process will be influenced by politics, or at least seem to be.”
 
In a Science Speaks commentary Mitchell Warren and Uché Blackstock write that “Vaccines are among the most powerful tools we have to reduce health disparities and advance health equity—but only if they are trusted and used. Government approval of any potential vaccine must be based on a process that is transparent, scientifically rigorous and free from political pressure. This is especially true as misinformation and conspiracy theories about vaccines circulate, and public confidence in vaccines falls. The consequences of any vaccine approval that appears to have been influenced by politics would be particularly grave for Black and Latinx communities, who have real reasons to distrust both politicians and drug testing processes, and who are also at significantly increased risk for COVID infection and illness.” They argue, “To protect health in the US and around the world, and advance health equity, we must insist on a COVID vaccine effort that is fast, transparent, thorough and safe, and guided by science, not politics.”
 
CNN reports, “Once a fixture at the administration's coronavirus briefings, Dr. Deborah Birx has confided to aides and friends that she has become so unhappy with what she sees as her diminished role as coordinator of the White House coronavirus task force that she is not certain how much longer she can serve in her position… Birx has told people around her that she is ‘distressed’ with the direction of the task force, describing the situation inside the nation's response to the coronavirus as nightmarish.”
 
Peter Hessler writes in The New Yorker that one Hong Kong vaccine expert told him, “Chinese officials are thinking that Donald Trump might approve a US vaccine before the election…. So, their goal is to have a vaccine approved before that.” He reports, “In the meantime, many Chinese citizens haven’t waited for full approval before getting injected. The state press has reported that hundreds of thousands have already been vaccinated by CNBG, under an emergency-use approval granted by the government. The volunteers include many government officials and pharmaceutical executives who received the two-stage vaccination….”
 
Axios reports, “Robert Redfield, the director of the Centers for Disease Control and Prevention, was overruled when he pushed to extend a "no-sail order" on passenger cruises into next year, according to two sources with direct knowledge of the conversation today in the White House Situation Room…. The undermining of Redfield has been the source of much consternation among public health officials inside the administration, who argue that a politically motivated White House is ignoring the science and pushing too aggressively to reopen the economy and encourage large gatherings.
 
Infectious disease expert Dr William Hanage writes in The Guardian, “Since the first outbreaks of COVID-19 [in the UK] early in the year, scientists and governments have learned a lot about the virus. They’ve learned that the best way to fight it is through testing, tracing and isolating—and they’ve learned what the consequences of not fighting it can be. But the UK seems to be ignoring most of these hard lessons. Instead of evidence-based policy, its response—initially urging people back into offices, outsourcing testing and tracing to corporate giants, and opting for half-measures in the face of a virulent second wave—looks more like policy-based evidence.”
 

Calls for US FDA to Stand for Science

 
With focus on the US FDA as it prepares to review COVID vaccine data and perhaps issue an emergency use authorization for one or more vaccines, there is concern the usually apolitical processes at FDA may be subverted by the current US administration. Multiple op-eds and news stories have tried to lay out what might or might not happen and/or call on the FDA commissioner and others to do the right thing.
 
In a JAMA podcast, Conversations with Dr. Bauchner, Dr. Fauci “said that despite rising concern over political pressure to approve a COVID-19 vaccine prematurely, he is confident the FDA and its scientists will make their decisions in a professional manner and independent of election-year conflicts.”
 
In a Washington Post op-ed seven former FDA commissioners write that the Trump administration is undermining the credibility of the FDA. They say “for decades, when we and our predecessors spoke as FDA commissioners about issues of regulation and people’s health, the public knew we were speaking on behalf of experts whose judgments were grounded in science…. That is changing in deeply troubling ways …With more than 750 Americans on average dying a day from COVID-19, the FDA must be supported to play its unique and essential role. Scientists should make decisions based on data, unfettered by political pressure or the intrusions of ideology or vested interests. Political intrusion only prolongs the pandemic and erodes our public health institutions.”
 
An open letter to FDA commissioner Hahn from regulatory and medical experts warns, “The FDA must remain one of the preeminent public health institutions in the world, as it has been for decades. The FDA’s scientists are highly trained and respected in their fields and perform essential work in protecting Americans from unsafe or ineffective medical products through rigorous evaluation. But in recent months, their ability to do this work in a fair and impartial way appears to have been compromised by political pressure, resulting in several regulatory actions that have threatened the public credibility of the agency.”
 
A NEJM editorial argues, “Without a clear, transparent, and scientifically sound decision-making process, the trust the FDA has built and maintained over the past century is eroding. As potential therapies for COVID-19 come before the FDA for consideration, only an open, rigorous scientific process that relies on high-quality data can assure clinicians and patients that the new approaches are safe and effective. Such a process will be particularly important as the FDA considers emerging candidate SARS-CoV-2 vaccines.”
 
A STAT opinion argues, “The Food and Drug Administration has issued a number of contentious decisions during the COVID-19 pandemic related to investigational products. The controversies that continue to swirl around these decisions stem in part from the agency’s lack of transparency, including its limited explanation and disclosure of the evidence on which it based these decisions…. At this critical juncture, the FDA should look to increase transparency and maximize public trust in its integrity. Sunlight may yet prove to be a disinfectant that helps us fight this pandemic.”
 

Vaccines in the News

 
The Monitor (Uganda) reports, “Uganda is set to start human trials of the COVID-19 vaccine starting November as the country continues the fight against the pandemic, Ministry of Health officials have said. According to the officials, the vaccine called, Self-Replicating RNA, which has been made through a research conducted through a partnership between Uganda Virus Research Institute (UVRI) and Imperial College in the UK, will undergo three different steps before it is recommended for general public use.” An official said “that the first trial will be conducted on 10 Ugandans to see how they respond to the vaccine and its possible side effects on the human body. If it is all successful, the other stage of the trial will be done on about 100 to 200 people before the final stage of a random clinical trial of between 1,000 and 3,000 people.”
 
Medscape reports that Moderna’s COVID vaccine “appears to generate more antibodies in people over the age of 70 than it does in even middle-aged adults. If the antibody responses seen in the study translate into protection against the infection, the results could mean the elderly―the population that has been hardest hit by COVID―could receive strong protection from the shot. According to the CDC, eight out of 10 COVID-19 deaths in the US have been in adults over age 65…. The study was small, with just 10 people included in each group, for a total of 40 people in the study. Results from the phase I trial of the vaccine show that adults over the age of 70 made roughly 3 times as many antibodies after their second dose, compared to adults ages 56 to 70.”
 
Reuters reports, “The US Food and Drug Administration has broadened its investigation of a serious illness in AstraZeneca Plc’s COVID-19 vaccine study and will look at data from earlier trials of similar vaccines developed by the same scientists, three sources familiar with the details told Reuters…. Regulators in the UK, Brazil, India and South Africa have allowed AstraZeneca to resume its clinical trials there…. The FDA, however, wants to determine whether similar side effects emerged in trials of other vaccines designed by AstraZeneca’s coronavirus vaccine partner, researchers at Oxford University, the sources said. That does not mean the agency believes there were safety issues associated with any of these vaccines, they added.”
 
The New York Times reports, “Johnson & Johnson announced that it has begun the final stage of its clinical trials, the fourth company to do…. Johnson & Johnson is a couple of months behind the leaders, but its advanced vaccine trial will be by far the largest, enrolling 60,000 participants. The company said it could know by the end of this year if its vaccine works. And its vaccine has potentially consequential advantages over some competitors. It uses a technology that has a long safety record in vaccines for other diseases. Its vaccine could require just one shot instead of two—important considering that the entire population of the world needs vaccination….”
 
FT reports, “The chief executive of Moderna Therapeutics, one of the companies developing a coronavirus vaccine, dealt a blow to Donald Trump’s hopes of having a jab ready before the US presidential election, saying his company would not be able to apply for authorisation until at least late November. Stéphane Bancel told the Financial Times on Wednesday that Moderna would not be ready to seek emergency use authorisation from the Food and Drug Administration before November 25 at the earliest.”
 
Reuters reports, “Britain is planning to host clinical trials where volunteers are deliberately infected with the new coronavirus to test the effectiveness of vaccine candidates…. So-called "challenge trials" are expected to begin in January at a quarantine facility in London, the report (on.ft.com/2G5o0jP) said, adding that about 2,000 participants had signed up through a US-based advocacy group, 1Day Sooner. Britain said it was working with partners on the potential for human challenge trials without commenting on a specific plan. ‘We are working with partners to understand how we might collaborate on the potential development of a COVID-19 vaccine through human challenge studies,’ a government spokeswoman said.”
 
Bloomberg reports, “Inovio Pharmaceuticals Inc. put a partial hold on a phase 2-3 study of its COVID-19 vaccine after US regulators raised questions about a delivery device used in the inoculation…. The vaccine maker is working to answer questions from the US Food and Drug Administration about the Cellectra 2000 device used in the trial.”
 
The Guardian reports on the Russian vaccine Sputnik 5: “In early September, Gamaleya scientists published the results of phase one and two trials in the Lancet, and a phase three trial is now under way, which should involve 40,000 volunteers being vaccinated in the coming weeks. Even at this early stage, however, the government is pushing ahead with ambitious plans for a broad rollout across the country and beyond…. While the doses for Russians will be produced inside the country, Russia hopes to license production to a number of other countries, including India, and Dmitriev estimated that capacity could be 500m doses a year by next year.” Several scientists outside of Russia, and some within, have expressed concern about the rollout of the vaccine without Phase 3 data.
 
The New York Times quotes Pfizer’s CEO on the company’s vaccine candidate: “Right now, our model — our best case—predicts that we will have an answer by the end of October,” the chief executive, Dr. Albert Bourla, told the “Today” show earlier this month. In other interviews, he has said he expected a “conclusive readout” by then, with an application for emergency authorization that could be filed “immediately.” The Times cautions, “yet by all other accounts, the idea that it will be ready in October is far-fetched. Even if the vaccine shows promising signs in clinical trials—still a big if—the company will not have collected enough data by then to say with any statistical confidence that it is safe and effective.”
 

Vaccine Tweetorial

 
Microbiologist Florian Krammer posted a “long and nerdy” twitter thread on COVID vaccines, with “an overview of the process, the technologies, correlates of protection, the candidates, how they perform in non-human primates and what we know about their performance in humans so far.” If the twitter thread is not wonky enough for you, check out this Nature overview.  
 

Access to COVID Interventions

 
European Commission President Dr. Ursula von der Leyen and WHO Director-general Dr. Tedros Adhanom Ghebreyesus write in The Telegraph, “A global pandemic requires no less than a world effort to end it. None of us will be safe until everyone is safe.  Global access to coronavirus vaccines, tests and treatments for everyone who needs them, anywhere, is the only way out.” They call for world leaders gathered virtually for the UN General Assembly “to come together and resource the ACT-Accelerator. Let us invest in our best chance at a coronavirus-free future for all.”
 
South African-based activist Tian Johnson writes in Medium on the critical need for civil society engagement in COVAX. “Undoubtedly, when a COVID-19 vaccine comes, the world will not have enough. That is the simple and harsh truth. Investing in meaningful, impactful civil society representation can bring forth the perspectives of real-life people from across the world. But it also provides gravely needed accountability and transparency for those same communities about how life and death decisions are being made by COVAX. And in a world where pseudoscience seems to have taken an increasing hold in the utterances of some world leaders, the effort to vaccinate people against COVID-19 may have to contend with reluctance among some communities. If that is true, transparency and accountability around the issue of vaccines may be needed now more than ever. But these dividends will depend on COVAX’s commitment to genuine consultation. The world will be watching. COVAX must ensure that civil society participation is diverse, adequately resourced, free from donor influence and meaningful.”
 
In a video feature on Medscape Articles You Will Definitely Read... Later, “Vinay Prasad, MD, MPH, looks at a paper from JAMA Network Open that surveyed US adults, asking them who they felt should be prioritized to receive the COVID-19 vaccine when it first is made available to the public…. If you poll the American public and you ask them who should get the coronavirus vaccine when there's a limited supply, they will tell you what you hope they would tell you, which is we ought to distribute to the groups that benefit from the vaccine the most. Specifically, they say high priority should be given to frontline healthcare workers…. Children between the ages of zero and 18 who are at high risk of bad outcomes for coronavirus…. People who are over the age of 65 who have co-morbidities that put them at high risk of death from coronavirus…. Finally, essential workers, those people who work at grocery stores, who work as transit drivers, who do the jobs that haven't been able to take a day off…. I think the interesting thing about this research letter is that it confirms what many of us suspect, which is if you're honest with the American people, if you tell them we have a vaccine, but you tell them the truth, that there's not enough to go around, who should we give it to? People tell you the right answer, which is we ought to do the most good we can do with that limited supply.”
 
Fierce Biotech reports, “The Serum Institute of India pledged to make an additional 100 million doses of effective COVID-19 vaccines for low- and middle-income nations in 2021 as part of an expanded distribution effort with Gavi, the Vaccines Alliance, and the Bill & Melinda Gates Foundation….”
 
The Washington Post reports on monoclonal antibodies as a promising treatment for COVID. “They are ‘a real best chance of being a game changer,’ according to Francis S. Collins, director of the National Institutes of Health…. One thing is certain about monoclonal antibodies: If the pandemic keeps raging, there won’t be enough. Unlike conventional pills, these are expensive, injectable drugs synthesized by living organisms in specialized reactors, at a biological cadence that can’t be rushed. A worldwide scramble to find capacity to make the drugs is afoot, with companies striking deals with competitors to increase their manufacturing capabilities.”
 

Vaccine Confidence

 
Devex reports “Data collectors are spreading out through five African nations to conduct a survey for four weeks to see how people feel about a COVID-19 vaccine, according to John Nkengasong, director of the Africa Centres for Disease Control and Prevention…. ‘The world has never vaccinated more than 500 million people in a year, and this will require that we find innovative ways to expand the vaccines using existing health care systems. This is not another typhoid fever vaccination or another polio vaccination; this is really going to be a community vaccination, so we need community engagement,’ he said.”
 
Axios reports on a new poll among Americans that found, “Barely two in 10 Americans would take a first-generation coronavirus vaccine if President Trump told them it was safe—one of several new measures of his sinking credibility…. Given eight scenarios and asked how likely they were to try the vaccine in each case, respondents said they'd be most inclined if their doctor vouched for its safety (62 percent), followed by insurance covering the full cost (56 percent) or the FDA saying it's safe (54 percent). Acting on Trump's assurances came in dead last as an option (19 percent). People said they'd be more likely to take it if they had to pay $100 out of pocket or visit a hospital to get it.”
 

COVID and Racism

 
In an op-ed in The Washington Post Karen Attiah writes, “news reports and opinion articles have posited that corruption and a lack of health-care infrastructure meant that Africa was a ‘time bomb’ waiting to explode. Rampant poverty and a lack of effective governance would cause the dark continent to fall apart under the weight of a public health emergency. The world, the experts said, should prepare to offer aid, loans and debt forgiveness to African governments—in other words, they should prepare to save Africa. No need…. This pandemic has coincided with a global movement challenging anti-Black racism and white supremacy. This should have been a moment for media outlets to challenge corrosive narratives about Africa and the idea that Africans are not capable of effective policy-making. We could be learning from the experiences that Africans and their governments have had with pandemics and viral diseases, including Ebola and AIDS…. Instead, the media has largely ignored the policy successes out of Africa. In doing so, Western media is reinforcing colonial narratives of Black inferiority and the inability of Black nations to govern themselves at all, much less govern better than resource-rich White nations.”
 
Indi Samarajiva, a writer from Sri Lanka writes in Medium on The Overwhelming Racism Of COVID Coverage. He argues that Western media assigns “agency to rich/white nations like Germany or New Zealand but luck to anyone poorer or dark. And it’s just not true. Poorer nations have done better than the rich because they had robust public health responses. Because they worked together. Because they reacted early. These are all lessons worth learning, but the west is unable to learn them because they’re simply too racist to see…. The real story is that places like Vietnam and Mongolia have completely kicked COVID-19’s ass. The real story is that places like Rwanda and Ghana have innovated and survived. There are countless stories like this—from Sri Lanka to Trinidad & Tobago, but you wouldn’t know because we’re not rich or white. But you should know. Because we’re right. This information could save your life.”
 
Bloomberg takes an in-depth look at COVID cases and deaths in Chicago. “Draw a map of Chicago and shade the areas with more poverty, pollution and coronavirus. It will start to look like being Black is a pre-existing condition…. Taylor Roberts, a North Lawndale resident, said that with so many essential workers living nearby, the coronavirus has spread quickly through her community. It has been enormously stressful, as family members coping with high cholesterol, high blood pressure and respiratory illness are staring down the barrel of a potentially fatal virus. ‘I don't think there's any mass initiative to aid people in any way. You suffer and maybe you die, or you don't,’ she said. ‘It's kind of hard to identify what truly is a result of COVID and what is just a result of white supremacy.’”
 

COVID and Stigma

 
All Africa reports “Analyses by researchers at the African Centre for the Constructive Resolution of Disputes (Accord) warn that COVID-19 has provoked responses that violate human rights, slow effective responses to the pandemic and, ultimately, threaten peace…. 22 out of the 55 African Union member states have reported incidents of stigmatisation and discrimination due to COVID-19…. ‘Lessons can be drawn from Africa's fight against the stigma attached to HIV/Aids through community mobilisation – although the threat posed by COVID-19 is different, because it is highly contagious [by proximity alone] As such, non-physical engagements can be undertaken using a variety of media platforms to call for solidarity and to contribute to changing people's attitudes towards those who are at risk of discrimination. And those who have recovered from COVID-19 can be the face of hope to those still having doubts about the virus,’ say the report authors."
 
In a video from Science “journalist Vaishnavi Chandrashekhar discusses the history of disease stigma—from leprosy, to plague, to HIV/AIDS—and how its vitriol and isolation can create a vicious cycle of disease.”
 

COVID Lifestyle Echo Chamber

 
A commentary in Jezebel notes, “If an alien or visitor happened to take a gander at lifestyle journalism over the past six months, they might assume that even though a lot of people are losing their jobs, waiting endlessly for unemployment, or even being evicted, the majority of the country has passed the pandemic baking bread, moving out of cities, and gazing out the window wondering if every day is Wednesday.” Megan Reynolds writes about the peculiar “white, college-educated, upper-middle-class…echo chamber” of lifestyle journalism in the US and warns, “as we stare down the barrel of another long winter, faced with the likelihood of rising rates of infection and the grim prospect of even more deaths, it might be nice to give some space to the people in the back of the room, who have been diligently doing their jobs so the rest of us can sit inside and do ours.
 

COVID and Young People

 
The New York Times reports on a “super healthy” 19-year-old American college student who died, “apparently of neurological complications related to Covid-19.” A family member is quoted: “The doctor said it was a one-in-a-million case—that they’d never seen something progress the way it did. It was a COVID complication that rather than attacking his respiratory system attacked his brain.”
 
CIDRAP reports, “As [US] college students returned to campuses in August, COVID-19 cases in that age-group at the national level more than doubled” according to a report from the CDC…. Details about the COVID-19 spike in college-age adults appear today in Morbidity and Mortality Weekly Report, alongside a separate report on COVID-19 clusters that emerged soon after students returned to a North Carolina university campus.”
 
Healio reports, “From May to September, the average weekly incidence of COVID-19 was around twice as high among children aged between 12 and 17 years compared with children aged 5 to 11 years, according to data published in MMWR.” The report authors “said the findings ‘can provide a baseline for monitoring national trends.’”
 
A new report from United Hospital Fund “estimates that COVID-19 has led to severe, long-lasting, and racially disparate repercussions on children under age 18 in New York State. These include children who have lost a parent or guardian or who have entered poverty or are near poverty as a result of the pandemic…. The analysis estimates that between March and July 2020, 4,200 children experienced a parental death; and 325,000 children have been pushed into or near poverty as a result of the pandemic’s economic downturn.”
 

Alexa, Do I Have COVID-19?

 
Spoiler alert: she can’t tell you. Nature reports on the race “to find vocal biomarkers of COVID-19….” One company has built an app used in Israel, where “people who had tested positive for the coronavirus could participate simply by downloading a Vocalis research app. Once a day, they fired up the app and spoke into their phones, describing an image aloud and counting from 50 to 70…. Other teams are analysing audio recordings of COVID-19 coughs and developing voice-analysis algorithms designed to detect when someone is wearing a face mask.”
 

Research News

 
Contagion Live says, “Regeneron announced…positive data from its trial looking at its investigational antibody cocktail, REGN-COV2, showing it reduced viral load and the time to alleviate symptoms in non-hospitalized patients with COVID-19…. ‘The greatest treatment benefit was in patients who had not mounted their own effective immune response, suggesting that REGN-COV2 could provide a therapeutic substitute for the naturally-occurring immune response,’ George Yancopoulos, MD, PhD, president and Chief Scientific Officer of Regeneron, said.”
 
Medscape reports, “Patients hospitalized with COVID-19 who have sufficient levels of vitamin D show significant reductions in severe outcomes and a lower risk of death compared with insufficient levels, new research shows…. Although this latest research adds to a plethora of data on the potential role of vitamin D in COVID-19, many questions and caveats remain, commented E. Michael Lewiecki, MD.”
 
Reuters reports on promising animal studies of a nasal spray being developed to “to improve the human immune system to fight common cold and flu…. A study on ferrets showed the product dubbed INNA-051, which could be used complementary to vaccines, lowered the levels of the virus that causes COVID-19 by up to 96 percent, the company said.” Human studies could be in 4 months.
 

The k Factor

 
The Atlantic looks at the measure of virus dispersion, known as k. “The definition of k is a mouthful, but it’s simply a way of asking whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once. After nine months of collecting epidemiological data, we know that this is an overdispersed pathogen, meaning that it tends to spread in clusters, but this knowledge has not yet fully entered our way of thinking about the pandemic—or our preventive practices…. In study after study, we see that super-spreading clusters of COVID-19 almost overwhelmingly occur in poorly ventilated, indoor environments where many people congregate over time—weddings, churches, choirs, gyms, funerals, restaurants, and such—especially when there is loud talking or singing without masks. For super-spreading events to occur, multiple things have to be happening at the same time, and the risk is not equal in every setting and activity, Muge Cevik, a clinical lecturer in infectious diseases and medical virology at the University of St. Andrews and a co-author of a recent extensive review of transmission conditions for COVID-19,” says.
 

What Do We Know About Immunity This Week?              

 
Medscape provides an explainer on herd immunity and COVID, in part sparked by a “heated debate at a [senate] committee hearing between Sen Rand Paul and Dr Fauci, when Paul “suggested that the decline in COVID cases in New York City was due to herd or community immunity in the population rather than public health measures, such as wearing masks and social distancing…. [Fauci] rebuked Paul, pointing out that only 22 percent of the city's residents have COVID antibodies. ‘If you believe 22 percent is herd immunity, I believe you're alone in that,’ Fauci told the senator.”  Medscape reports, “Before the COVID pandemic, experts can't recall examples in which governments intentionally turned to natural infection to achieve herd immunity. Generally, such a strategy could lead to widespread illness and death, said Dr. Carlos del Rio, an expert in infectious disease and vaccines at the Emory University School of Medicine.”
‘It's a terrible idea,’ del Rio said. ‘It's basically giving up on public health.’… The bottom line, medical experts say, is that natural herd immunity is an uncertain strategy, and attempts to pursue it could result in a slew of unnecessary deaths. A vaccine, whenever one becomes available, would offer a safer route to community-wide protection.”
 

Germany’s Rockstar Scientist

 
Bloomberg reports on “Germany’s Fauci,” Dr. Christian Drosten. Dorsten and his team developed a test for SARS-CoV-2 over the weekend after the genome of the virus was mapped and published. “By Monday they had a test that could confirm whether someone had been infected by the novel coronavirus. Drosten shared the details with the World Health Organization, which published them on its website, and the test was soon deployed around the world. One place that declined to use Drosten’s test was the US; it came up with its own diagnostic tool, which turned out to be flawed and left the country blind for two months as the virus raged. Germany’s test confirmed the country’s first case on Jan. 27. There were 13 more in the coming days, at the time constituting the largest known cluster outside of China. Authorities sequestered COVID-19 patients, tracked down their recent contacts, and slowed infections…. But Drosten is even more famous in Germany than Fauci is in America, thanks to a wildly successful podcast he introduced in February. Das Coronavirus-Update rocketed to the top of Germany’s podcast rankings, reliably outperforming programs devoted to sex, crime, and even soccer. Its format is simple: As often as five times a week, he spends an hour answering questions about basic science, the latest COVID research, and how societies might navigate the pandemic….”
 

Build Back Better

 
 A commentary in The Standard (Kenya) looks at the potential impact of COVID on urban planning. “How cities are planned is critical for managing infectious diseases. Historically, many urban planning innovations emerged in response to health crises. The global cholera epidemic in the 1800s led to improved urban sanitation systems. Respiratory infections in overcrowded slums in Europe inspired modern housing regulations during the industrial era…. With the widespread nature of COVID-19, is it reasonable to argue that it could possibly be the pandemic that inspires a new way of ‘doing’ urban planning in Africa…. One critical component “relates to the integration of the city’s informal sector into the formal planning process. This is reflected in two ways: non-inclusion of informal settlements (mostly slums) in urban planning practice and lack of planning focus on the informal economy that results in exclusion. The authors also argue, “public health matters should be considered in urban planning. Health outcomes traditionally do not drive urban planning practice in Africa.”
 

Not a Pandemic

 
Richard Horton writes in a Lancet editorial, “Two categories of disease are interacting within specific populations—infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and an array of non-communicable diseases (NCDs). These conditions are clustering within social groups according to patterns of inequality deeply embedded in our societies. The aggregation of these diseases on a background of social and economic disparity exacerbates the adverse effects of each separate disease. COVID-19 is not a pandemic. It is a syndemic. The syndemic nature of the threat we face means that a more nuanced approach is needed if we are to protect the health of our communities.”
 

COVID and HIV

 
Ugonna-Ora Owoh writes in The Body about the challenges COVID-19 and lockdowns have posed for HIV organizations in Nigeria. He writes, “on the intrusion of the novel coronavirus pandemic into the country, the matter became even more exacerbated, with fear and questions lingering among Nigerians living with HIV on whether the COVID-19 virus will worsen their quality of life” and outlines the impact on a number of NGOs delivering services to PLWHIV and others.
 
South African researcher Burtram C. Fielding writes in The Conversation about why rates of COVID infection and deaths in South Africa were not as “dire” as earlier predicted. He writes, “My laboratory recently reviewed what is known at this stage—and what is still unknown—about co-infections of HIV and coronaviruses…. Concern over HIV-positive patients is understandable. But current data from the COVID-19 pandemic—and past experiences with SARS and MERS—suggest that they do not form an at-risk group. This raises the question of whether HIV serves as an immunological shield against more severe forms of the new disease.
What has been quite apparent from the start is that old age and co-morbidities such as obesity, hypertension and diabetes are more telling considerations in both general infections and HIV/SARS-CoV-2 co-infections. Based on what we now know, should a second or even a third wave of COVID-19 be forthcoming, state and health officials should consider a more strategic and targeted approach to containment.
 

COVID Timeline in South Africa

 
Bhekisisa has published a timeline of “how COVID-19 took hold in South Africa,” noting that, “After six months of lockdown restrictions, South Africa has started to open up its businesses and schools and return to the new kind of normal that the coronavirus pandemic has imposed on the world.”
 

COVID’s Impact on Women

 
Devex reports on the “COVID-19 Global Gender Response Tracker, which UN Women and the UN Development Programme launched Monday. The dashboard aims to monitor progress and share best practices in order to support countries in developing social protection and employment responses that prioritize gender equality.”
 
CNET reports that in the US and Canada, “the coronavirus pandemic could wipe out at least six years' worth of progress for women in the workplace, according to a sobering new report from McKinsey and women's advocacy nonprofit Lean In…. According to the report, 1 in 4 women are thinking of either downshifting their careers or leaving the workforce, though men and women have left the workforce at more or less the same rate in years past…. Among women in senior leadership roles, 89 percent reported feeling burned out, compared with 29 percent of men. Forty-seven percent of women said they felt the need to be ‘always on’ compared to 40 percent of men, underlining what the report called the ‘double shift’ of working a full-time job and then putting in hours of child care or household labor.”
 
The Guardian reports, “Women’s voices have been “worryingly marginalised” in reporting of the coronavirus, partly due to the war-like framing of the pandemic, according to a report analysing stories across six countries. Each woman’s voice in news coverage of the crisis is ‘drowned out’ by at least three men, it said…. The report, commissioned by the Bill and Melinda Gates Foundation, and examining the UK, US, Kenya, South Africa, Nigeria and India, said women have been ‘locked out’ of coronavirus decision making at a national level in five of the countries.”
 
A STAT opinion warns, “Vaccines for pregnant women are one of the most important public health measures undertaken globally to reduce disease. Yet the pregnant population is currently barred from participating in COVID-19 vaccine and treatment trials during the pandemic, which means that the health of pregnant women and their fetuses will be an afterthought.”
 

Long Term Effects of COVID

 
Medscape reports, Research presented at the 2020 ESCMID Conference on Coronavirus Disease …shows that persistent fatigue occurs in more than half of patients recovered from COVID-19, regardless of the seriousness of their infection.” The study was among 128 people in Ireland.
 
Reuters reports, “Nine in ten coronavirus patients reported experiencing side-effects such as fatigue, psychological after-effects and loss of smell and taste after they recovered from the disease, according to a preliminary study by South Korea.”
 

Virus Sniffing Dogs

 
The Washington Post reports on corona virus sniffing dogs that will greet passengers at the Helsinki, Finland airport. “The voluntary canine tests will deliver results within 10 seconds and require less than a minute of travelers’ time, said Anna Hielm-Björkman, a researcher at the University of Helsinki who is using the trial to gather data…. Researchers at the University of Helsinki this year found promising indications that dogs can detect the virus. Scientists say only large-scale trials, such as the one to begin Wednesday, can demonstrate just how effective the method will be in practice.”