— Connie Celum in New England Journal of Medicine

 

ABC News reports, “The head of emergencies at the World Health Organization said Monday the agency's “best estimates” indicate roughly 1 in 10 people worldwide may have been infected by the coronavirus—more than 20 times the number of confirmed cases—and warned of a difficult period ahead. Dr. Michael Ryan…said the figures vary from urban to rural areas, and between different groups, but that ultimately it means ‘the vast majority of the world remains at risk.’ He said the pandemic would continue to evolve, but that tools exist to suppress transmission and save lives.” UN News reports that “WHO chief Tedros Adhanom Ghebreyesus said 10 countries account for 70 per cent of all reported cases and deaths, and just three countries account for half.” 
 
COVID cases continue to rise in many countries around the world and some countries are experiencing resurgences. The New York Times reports, “More than 40 percent of patients hospitalized in intensive care units in the Paris region have COVID-19, the French authorities said this week, warning that local hospitals were coming under increasing strain from an influx of new cases…. Aurélien Rousseau, the head of the health authority for Ile-de-France, warned that COVID-19 patients could take up half of all intensive care units within the next 10 to 15 days if new restrictions put in place over the past week did not make an impact.”
 
The Star (Kenya) reports, “More COVID -19 tests will equal more cases. That's what Health Cabinet Secretary Mutahi Kagwe said Wednesday when confirmed 321 new cases from 4,342 samples tested. The figure was the highest in recent weeks…. The ministry has been focusing the testing on areas considered high-risk and hotspots.”
 
In The Conversation the leads of the COVID-19 team in the African Academy of Sciences look at why African COVID deaths have been lower than other regions. “The emerging picture is that in many African countries, transmission has been higher but severity and mortality much lower than originally predicted based on experience in China and Europe. We argue that Africa’s much younger population explains a very large part of the apparent difference. Some of the remaining gap is probably due to under reporting of events but there are a number of other plausible explanations. These range from climatic differences, pre-existing immunity, genetic factors and behavioural differences.”
 

If You’re in a Hurry

• Read a NEJM editorial urging Americans to vote out the current administration. It’s the first time in the journal’s 208-year history that it has taken a stand on a political candidate.
• Read a STAT profile of Jorge David Gutierrez, a COVID vaccine recruiter trying to help ensure diversity in the Moderna trial.
• Read about lab technologist Lynda Nalumansi’s radio show to answer COVID questions for refugees in Uganda via the UN Foundation.
• Read a NEJM commentary that looks at how to leverage lessons from the response to Ebola and HIV to maximize impact in the COVID response.
• Read Medscape and CNN on companies looking for emergency use authorizations from the US FDA for monoclonal antibody cocktails. 
• Read STAT on why a US October surprise vaccine seems less and less likely.
• Read what the head of the UK’s vaccine taskforce thinks is needed to get pandemic vaccines out to all who need them in Nature.
• Then read John Nkengasong and colleagues on what’s needed to ensure access to vaccines in Africa in Nature.
• Read a Medscape data dive that looks at what we know about transmission and follow that with a Nature data dive on the evidence for mask use.
• Read The New York Times on Donald Trump as “the largest driver of…falsehoods involving the pandemic.”

 

“Pandemic Fatigue”

 
The Guardian reports, “The World Health Organization has said European countries will need to “move beyond biomedical science” to overcome COVID-19 as “pandemic fatigue” and new infections rapidly rise across the continent. Hans Kluge, the WHO’s Europe director, said that while fatigue from months of uncertainty and disruption was measured differently in different countries, aggregated survey data from across the region suggested that in some cases it had reached levels of over 60 percent. Medical science alone would not be enough to get through the crisis, he warned, with authorities needing the “courage and empathy” to listen properly to the public and develop policies based on a better understanding of people’s needs and behaviours.”
 
The Economist reports, “Since March YouGov, a pollster, has asked people in 24 countries about measures they have taken to avoid infection. The results suggest that people are less vigilant today than they were only a few months ago. Early in the pandemic, in April, nearly two-thirds of respondents said they were avoiding touching objects in public; by September, just over half were taking this precaution. A similar shift can be seen across a range of other safety measures including handwashing, social distancing in public spaces and quarantines.”
 

Learning from Ebola and HIV

 
A NEJM commentary by Connie Celum and several other eminent researchers looks at how to leverage lessons from the response to Ebola and HIV to maximize impact in the COVID response. They write, “First and foremost, those epidemics have taught us that interventions must be based on sound science. As in the early days of AIDS, we face many uncertainties about the epidemiology, clinical presentation, and natural history of a new virus. SARS-CoV-2 science is therefore evolving quickly, which adds to the complexity of decision making, communication, and development and sustainability of public trust. Yet COVID-19 presents an important opportunity for smart deployment of our hard-won knowledge. HIV/AIDS has taught us the value and imperative of involving affected communities in planning and implementation of research and care. And both HIV and Ebola have shown that accurate and timely local information are required to enable and guide tailored interventions; public health and medical experts should heed the slogan ‘Know your epidemic’ and target interventions accordingly.”
 

White House COVID Cluster

 
Since the news broke late last week that US President Trump had tested positive for COVID-19, the story has evolved rapidly, with several government officials and others associated with the president also testing positive. Trump was hospitalized and received multiple COVID treatments, some of them still experimental. The story continues to dominate the news cycle.
 
The New York Times reports, “Despite almost daily disclosures of new coronavirus infections among President Trump’s close associates, the White House is making little effort to investigate the scope and source of its outbreak…. Instead, it has limited its efforts to notifying people who came in close contact with Mr. Trump in the two days before his COVID diagnosis Thursday evening. It has also cut the Centers for Disease Control and Prevention, which has the government’s most extensive knowledge and resources for contact tracing, out of the process.”
 
Axios reports, “Several White House reporters have tested positive and many are trying to figure out whether they and their families need to quarantine.”
 
Medscape reports, “President Trump may be home after spending three nights in the hospital for coronavirus treatment, but he's not ‘out of the woods yet,’ Dr. Anthony Fauci said on CNN. Noting that ‘it's still early’ in Trump's recovery, Fauci said that many coronavirus patients have relapses after feeling better. ‘It's no secret that if you look at the clinical course of people, sometimes when you are five to eight days in, you can have a reversal,’ Fauci said.”
 
AP reports, “The special treatment President Donald Trump received to access an experimental COVID-19 drug raises fairness issues that start with the flawed health care system many Americans endure and end with the public’s right to know more about his condition, ethics and medical experts say.” AP quotes Dr. Steven Joffe, medical ethics chief at the University of Pennsylvania: “I think there is something wrong with the privileged, the president, getting special treatment that’s not available to the rest of us,” he said. “There’s so much injustice in our health care system, with so many people not even having access to the basics,” that the favoritism shown Trump is “a symptom of a much larger problem.”
 
The New York Times reports, “President Trump, releasing a direct-to-camera video of himself addressing the nation, said Wednesday that getting COVID-19 had been a “blessing” and claimed he would provide hundreds of thousands of doses of unapproved drugs to Americans free of charge….” The drug in question is “an experimental antibody cocktail, still in clinical trials, that is produced by Regeneron. It is impossible to know if the treatment has cured the president or even if he has beaten the disease.… And the Regeneron antibody cocktail is not the only drug that Mr. Trump was prescribed. He has also been taking the antiviral drug remdesivir, as well as the dexamethasone, a steroid.” The Guardian reports, “Trump’s latest claims echoed his previous endorsements of unapproved treatments – from hydroxychloroquine to bleach. Even if the drug is effective, it has not yet been granted emergency authorization for use by the general public.”
 
Vanity Fair notes, “it’s a glaring irony that, with the president’s life on the line, none of the miracle cures flogged by Trump, his administration, and his supporters have been administered to the patient in chief. No hydroxychloroquine, the old malaria drug and purported “game changer” that proved to do more harm than good. No convalescent plasma, which was rolled out last month with wild overstatements about its effectiveness. No oleandrin, a substance extracted from a toxic shrub and touted as a miracle by the CEO of MyPillow, a Trump donor.”
 

Monoclonal Antibodies in the Spotlight

 
Trump’s treatment has put antibodies in the spotlight, especially as he promised emergency use authorizations and free access to them in a recent video.
 
FiercePharma reports, “just days after Regeneron published early data on its antibody cocktail to treat COVID-19, the world found out the president of the US was taking it. What followed was a run-up for Regeneron shares, a series of shout-outs from President Donald Trump and a fair share of media appearances for the company's co-founders. The high-profile attention is a rare public relations bump that can’t be bought—and one the company seems at ease leveraging…. However, the Regeneron media tour may have come with a boomerang. There is a limit to the number of compassionate use requests Regeneron can fulfill, and, as Schleifer noted, they're exceptions. Fewer than 10 people have received the Regeneron therapy outside of clinical trials, including Trump. Both Schleifer and Yancopoulos said that puts them in a difficult situation. Schleifer pushed the decision back to the FDA, which would authorize emergency use, adding to CNBC that the drug already meets ‘a lot’ of the FDA's standard for that sort of approval.”
 
Medscape reports, Lily “says it has asked the US government to allow emergency use of an experimental antibody therapy based on early results from a study that suggested the drug reduced symptoms, the amount of virus, hospitalizations, and ER visits for patients with mild or moderate COVID-19. Eli Lilly and Company announced the partial results Wednesday in a news release; they have not yet been published or reviewed by independent scientists. Its drug is similar to one that President Donald Trump received on Friday from Regeneron Pharmaceuticals Inc. These medicines supply concentrated versions of specific antibodies to help the immune system clear the coronavirus that causes COVID-19. They're given as a one-time treatment through an IV.”
 
CNN reports, “Regeneron says it has applied to the US Food and Drug Administration for emergency use authorization for its experimental monoclonal antibody therapy, the same antibody cocktail given to President Donald Trump Friday after he was diagnosed with the virus. The biotechnology company confirmed it had submitted the application for the authorization in a statement on its website Wednesday night. ‘Under our agreement with the US government for the initial doses of REGN-COV2, if an EUA is granted the government has committed to making these doses available to the American people at no cost and would be responsible for their distribution,’ the statement said. ‘At this time, there are doses available for approximately 50,000 patients, and we expect to have doses available for 300,000 patients in total within the next few months.’ Regeneron's experimental antibody treatment is still in large-scale clinical trials, but has been available for compassionate use, something the FDA has to approve on an individual basis, like it did for the President.”
 
In a twitter thread physician-scientist Eric Topol says it’s hard to know if the Regneron antibodies helped Trump and lays out some of the research and issues with monoclonal antibodies.
 
The New York Times reports "The antibody cocktail for COVID-19 that President Trump touted on Wednesday afternoon was developed with cells originally derived from fetal tissue, a practice that his administration has moved to restrict. In June 2019, the Trump administration suspended federal funding for most new scientific research involving fetal tissue derived from abortions…. Remdesivir, an antiviral drug Mr. Trump received, also was tested using these cells.... In July, the International Society for Stem Cell Research sent a letter to the Human Fetal Tissue Research Ethics Advisory Board at the National Institutes of Health, urging the board to allow fetal tissue to be used to develop treatments for COVID-19 and for other diseases.”
 

Neurological Symptoms

 
The New York Times reports, “Nearly a third of hospitalized COVID-19 patients experienced some type of altered mental function—ranging from confusion to delirium to unresponsiveness—in the largest study to date of neurological symptoms among coronavirus patients in an American hospital system.

And patients with altered mental function had significantly worse medical outcomes, according to the study, published on Monday in Annals of Clinical and Translational Neurology. The study looked at the records of the first 509 coronavirus patients hospitalized, from March 5 to April 6, at 10 hospitals in the Northwestern Medicine health system in the Chicago area.”
 

Economic Impact

 
Africa Times reports “The COVID-19 pandemic is expected to push as many as 150 million more people into extreme poverty by 2021, the World Bank says, marking the first time in 20 years that the number of those in such poverty will rise. ‘The pandemic and global recession may cause over 1.4 percent of the world’s population to fall into extreme poverty,’ said World Bank chief David Malpass, as the organization released its full report Tuesday.”
 
South China Morning Post reports, “The World Bank has added its voice to calls for wealthy nations, including China, to cancel debts to poor countries to help them weather  the coronavirus storm, saying efforts so far were important but inadequate.”
 
Bloomberg reports a boom in travel shows China’s economy may be moving beyond the pandemic. “With the COVID-19 pandemic largely under control in China, the Golden Week holiday is putting on display the country’s confidence in its economic rebound and its public health measures. Through the first four days of the week-long holiday that started Oct. 1, some 425 million people traveled domestically, according to the Ministry of Culture and Tourism, nearly 80 percent of last year’s throngs.
The surge of activity stands in stark contrast to the rest of the world—the global tourism industry is expected to lose at least $1.2 trillion in 2020—and underscores the relative strength of China’s economic recovery. As of September, the OECD forecast a 1.8 percent expansion this year, putting China alone among the Group of 20 on pace to expand.”
 
Devex reports, “Nearly half of UK-based development NGOs expect to lay off staff members amid economic pressures caused by the pandemic, according to a survey, with 10 percent of organizations saying they will likely have to make more than one-fifth of their workers redundant.

Forty-six percent of organizations polled by Bond, a network for NGOs, said they had made staff redundant or were likely to because of COVID-19. And despite their bigger budgets, staff at larger organizations were more at risk. The pandemic disrupted public fundraising activities for NGOs, while the UK aid budget was stripped of £2.9 billion this year as the broader economy suffered. Half of all the NGOs surveyed said they had experienced funding cuts as a consequence of the government cuts, according to the survey.”
 

Politics

 
A Nature editorial says the journal plans to cover more politics, arguing that “The coronavirus pandemic, which has taken more than one million lives so far, has propelled the science—politics relationship into the public arena as never before, and highlighted some serious problems. COVID-related research is being produced at a rate unprecedented for an infectious disease, and there is, rightly, intense worldwide interest in how political leaders are using science to guide their decisions—and how some are misunderstanding, misusing or suppressing it. And there is much interest in the fluctuating relationship between politicians and the scientists who governments consult or employ.”
 
A NEJM editorial argues, “COVID-19 has created a crisis throughout the world. This crisis has produced a test of leadership. With no good options to combat a novel pathogen, countries were forced to make hard choices about how to respond. Here in the United States, our leaders have failed that test. They have taken a crisis and turned it into a tragedy…this election gives us the power to render judgment. Reasonable people will certainly disagree about the many political positions taken by candidates. But truth is neither liberal nor conservative. When it comes to the response to the largest public health crisis of our time, our current political leaders have demonstrated that they are dangerously incompetent. We should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs.” The New York Times says of the editorial, “Throughout its 208-year history, The New England Journal of Medicine has remained staunchly nonpartisan. The world’s most prestigious medical journal has never supported or condemned a political candidate. Until now.” CNN quotes NEJM editor Dr. Eric Rubin: "The reason we've never published an editorial about elections is we're not a political journal and I don't think that we want to be a political journal—but the issue here is around fact, not around opinion. There have been many mistakes made that were not only foolish but reckless and I think we want people to realize that there are truths here, not just opinions." 
 
The New York Times reports, “Rick Bright, a senior vaccine scientist who said he was demoted this spring for complaining about “cronyism” and political interference in science, resigned his final government post on Tuesday, saying he had been sidelined and left with nothing to do…. One of his lawyers said on Tuesday, Dr. Bright ‘remains very concerned’ about the politicization of science from the White House, especially with the arrival from Stanford’s Hoover Institution of Dr. Scott W. Atlas, a neuroradiologist 
without training in epidemiology or infectious diseases. Dr. Atlas’s aversion to mask wearing and his belief that “herd immunity” could stop COVID-19 have made him a favorite of President Trump’s.”
 
Nature writes that may experts, “suggest that the majority of the lives lost in the United States could have been saved had the country stepped up to the challenge earlier. Many experts blame Trump for the country’s failure to contain the outbreak, a charge also levelled by Olivia Troye, who was a member of the White House coronavirus task force. She said in September that the president repeatedly derailed efforts to contain the virus and save lives, focusing instead on his own political campaign.”
 
ISGlobal reports on a new COVID-SCORE questionnaire developed by “the Barcelona Institute for Global Health (ISGlobal), the City University of New York Graduate School of Public Health (CUNY SPH) and other international institutions…[is] an easy and reliable tool to evaluate the public perception of governmental response to the COVID-19 pandemic.” Initial results from 19 countries shows “the average score varied considerably between countries—from 35.76 out of a maximum of 100 for Ecuador to 80.48 for China, the country whose response was rated most positively. Countries in Asia tended to have higher scores, while Latin-American and European countries were among those with lowest scores.”
 
The Washington Post reports the US states’ “patchwork pandemic response has led to wide disparities in data reporting and even in definitions for basic medical concepts. In the absence of federal standards, states have adopted divergent and sometimes scientifically questionable approaches to disease control, which experts say have allowed the virus to spread.”
 

US October Vaccine Surprise Looking Less Likely

 
STAT reports, “The race for a COVID-19 vaccine slowed on Tuesday, as both US regulators and the head of the Trump administration’s Operation Warp Speed initiative tapped ever so softly on the brakes. The Food and Drug Administration released strengthened rules for authorizing any COVID-19 vaccine on an emergency basis. And Moncef Slaoui, co-chair of Operation Warp Speed, revealed that the government’s vaccine fast-tracking effort has urged manufacturers not to apply for emergency use authorization until they have significant amounts of vaccines to deploy. That could push back even the first such authorization—expected to be for a vaccine being made by Pfizer and BioNTech, if it proves to be effective—into sometime in mid- to late November.
 
NBC reports The Food and Drug Administration said Tuesday that manufacturers of COVID-19 vaccines will need to follow tens of thousands of study participants for at least two months to look for any possible safety issues before the agency would consider authorization. Given the timeline of when clinical trials began, the new guidance indicates that the earliest a COVID-19 vaccine might get an emergency use authorization would be the end of November—not Election Day, as President Donald Trump has previously touted.
 
Kaiser Health News reports, “As trust in the Food and Drug Administration wavers, several states have vowed to conduct independent reviews of any COVID-19 vaccine the federal agency authorizes. But top health experts say such vetting may be misguided, even if it reflects a well-founded lack of confidence in the Trump administration—especially now that the FDA has held firm with rules that make a risky pre-election vaccine release highly unlikely. At least six states and the District of Columbia have indicated they intend to review the scientific data for any vaccine approved to fight COVID-19, with some citing concern over political interference by President Donald Trump and his appointees. Officials in New York and California said they are convening expert panels expressly for that purpose.”
 

Vaccine Research and Trials

 
A Washington Post editorial argues, “In the United States, preparing for challenge trials on scientific, regulatory and ethical fronts should be part of those extraordinary efforts. Such preparation is underway, with particular emphasis on the myriad ethical considerations raised when volunteers put themselves at risk. While challenge trials would rightfully have to clear a very high ethical bar to proceed, it’s worth noting that society routinely accepts contributions from brave individuals who step forward in risky and uncertain situations in service of a greater good, including soldiers and those who volunteer for perilous rescue missions. Such contributions are extraordinary but not unprecedented.” Read a statement from AVAC and TAG on ethical conduct of human challenge trials. 
 
Reuters reports, “Private contractors hired by Moderna Inc to recruit volunteers for its coronavirus vaccine trial failed to enroll enough Black, Latino and Native American participants to determine how well the vaccine works in these populations, company executives and vaccine researchers told Reuters…. To make up for the shortfall, Moderna slowed enrollment of its late-stage trial and instructed research centers to focus on increasing participation among minority volunteers, the company said. The effort is being bolstered by academic researchers who have longstanding relationships with organizations in Black and other minority communities. Five investigators working on the Moderna trial said in interviews that commercial site investigators quickly filled a large portion of the 30,000-person study with mostly white volunteers.”
 
STAT profiles Jorge David Gutierrez a COVID vaccine recruiter. He works “to recruit the communities of color that have been alienated by American medicine, left out of clinical research, hit hardest by the pandemic. ‘If we want to make sure this vaccine works for everyone, then we need to include everyone,’ he said.” Recruiters have to overcome a lot of fears among immigrants: “People also wonder about the American government’s involvement in the project and what that means for participants. ‘Is this the Trump vaccine?’ Gutierrez remembered people saying. ‘Are they going to ask me about my citizenship, my legal status?’”
 
Jon Cohen reports in Science, “Primate researchers in the United States have banded together in a push for an ambitious monkey study that would do head-to-head comparisons of the leading COVID-19 vaccine candidates. Although 10 candidates are already undergoing large-scale tests in people, proponents of the monkey plan say those clinical trials may not deliver the comprehensive data needed to choose the safest and most effective vaccines. The comparison trial in monkeys, in contrast, could shed light in a matter of weeks on how the candidates stack up on measures including potential side effects, the strength of immune responses they trigger, and how well they protect against infection and disease.”
 

Vaccine and Treatment Access

 
Vox looks at racial equity for COVID vaccine distribution in the US. As plans are made for vaccine distribution, “two options—a race-based approach and a place-based approach—have emerged as dominant possibilities when it comes to ensuring equity toward minority groups. But each has pros and cons. Let’s break them down so we can tease out which approach works better, and whether there might be a third option…. Failure to reach the populations that are most vulnerable would be a tragedy for them, and a disaster stretching well beyond this pandemic. It would further entrench people of color’s well-founded mistrust of the medical system, which could increase hesitancy to get other sorts of vaccines in the future, leading to more infectious outbreaks and more deaths.”
 
The head of the UK’s vaccine taskforce writes in Nature, “The obstacles to getting pandemic vaccines out to the world when, and if, evidence of safety and efficacy do come in. Most of the logistics that will slow delivery are getting scant attention. We must plan for these, to speed things up without compromising safety…. Often, the problem is not the science or the clinical trials, but the infrastructure. We must take pains now to make sure this does not stall future pandemic vaccines.”
 
Reuters reports, “The European Commission said on Wednesday it had agreed with US company Gilead to buy additional doses to treat about 3,400 patients of its COVID-19 drug Remdesivir, amid shortages of the medication in Europe. The move comes as the bloc is under pressure to expand its limited stocks of the antiviral drug as COVID-19 cases and hospitalisations rise on the continent. Several European countries have said they were experiencing shortages of the drug, whose global stock has been secured almost entirely by the United States.”
 
John Nkengasong and colleagues write in a Nature comment, “Africa needs a coordinated strategy to develop, finance, manufacture and deliver vaccines across the continent. For the past few months, the Africa Centres for Disease Control and Prevention (Africa CDC) in Addis Ababa, where we work, has been developing this, with leaders from the African Union and in global health…. To vaccinate 60 percent of its population (the estimated minimum requirement for herd immunity³), Africa will need about 1.5 billion doses of vaccine. (Its population is 1.2 billion, and most vaccine candidates require two doses.) The cost of the vaccine and of building systems and structures required for delivery is estimated at between $7 billion and $10 billion, according to Africa CDC. For comparison, the 2020 US PEPFAR budget was $6.9 billion…. A ‘whole of Africa’ coordinated approach is needed to prepare for the development, purchase, access and roll-out of a COVID‑19 vaccine. That must be built now. Success will require collaboration between political leaders on the continent and those elsewhere, including the WHO, Gavi, CEPI, regulatory agencies, implementing partners, donors and the private sector.”
 
Biopharma Drive reports, “Moderna will not enforce patent rights related to its experimental coronavirus vaccine during the pandemic, announcing Thursday that its leadership feels "a special obligation under the current circumstances" to address the global health crisis.” A HealthGAP statement says, “Moderna should not be lionized for taking baby steps on access when we are in a race for our lives. Moderna is bowing to relentless international pressure from civil society—the activists and access to medicines experts working to save lives even as the Trump administration and other governments refuse to stand up to Big Pharma. But Moderna knows that this non-enforcement-of-patents concession is meaningless without a commitment to share not only the patents, but also all the information, know-how, data, and biologic resources needed for other qualified vaccine manufacturers to produce the vaccine economically and at scale to meet global need. Moderna should fully commit to sharing all necessary rights and knowledge through the WHO COVID-19 Technology Access Pool (C-TAP), with no artificial time limitation based on the severity of the pandemic.” STAT news earlier reported that, “the governments of India and South Africa have asked the World Trade Organization to waive some provisions in a trade agreement governing intellectual property rights so that medical products can be more easily accessed, especially by low-income countries.”
 
Reuters says, “China is in talks to have its locally-produced COVID-19 vaccines assessed by the World Health Organization, as a step toward making them available for international use, a WHO official said on Tuesday. Hundreds of thousands of essential workers and other groups considered at high risk in China have been given locally-developed vaccines even as clinical trials had not been fully completed, raising safety concerns among experts. Socorro Escalate, WHO’s coordinator for essential medicines and health technologies in the Western Pacific region, told a news conference conducted online that China had held preliminary discussions with WHO to have its vaccines included in a list for emergency use.”
 

What Do We Know About Transmission?

 
A Medscape data dive looks at what we know about transmission: “the risk for transmission is complex and multidimensional. It depends on many factors, including contact pattern (i.e., duration, proximity, activity), individual factors, environmental factors (i.e., outdoor, indoor), and socioeconomic factors (i.e., crowded housing, job insecurity).”
 
NPR reports, “The [US] Centers for Disease Control and Prevention now says the coronavirus can be spread through airborne particles that can linger in the air "for minutes or even hours"—even among people who are more than 6 feet apart…. For months, many experts who study the airborne transmission of viruses have been warning that the coronavirus can spread through the air. Last month, many experts cheered when the CDC seemed to address the issue, posting an update that suggested that aerosols—tiny airborne particles expelled from a person's mouth when they speak, sing, sneeze or breathe—might be among the most common ways the coronavirus is spreading. But the agency took down that guidance a few days later, saying it was a draft proposal that was posted to its website in error. The CDC's latest guidance stops short of calling airborne transmission ‘common.’"
 
A letter published in Science argues, “There is overwhelming evidence that inhalation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents a major transmission route for coronavirus disease 2019 (COVID-19). There is an urgent need to harmonize discussions about modes of virus transmission across disciplines to ensure the most effective control strategies and provide clear and consistent guidance to the public.”
 

Data Review for Masks

 
Nature looks at the evidence for mask use. “The science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease…. most scientists are confident that they can say something prescriptive about wearing masks. It’s not the only solution, says Gandhi, ‘but I think it is a profoundly important pillar of pandemic control’. As Digard puts it: ‘Masks work, but they are not infallible. And, therefore, keep your distance.’”
 

COVID and Women

 
NPR reports on the “COVID-19 Global Gender Response Tracker, released on Monday. The database analyzes more than 2,500 responses to the pandemic in 206 countries and territories from March to August—and assesses whether those measures address violence against women and girls, women's economic security and support for unpaid caregiving.”
 

COVID and Pregnancy

 
National Geographic reports on the largest analysis to date on the impact of COVID on pregnant people. The study “found that COVID-19 symptoms lingered in many of the study participants, which included 594 pregnant or recently pregnant people, most of whom were not hospitalized. Half of the participants still reported illness after three weeks, while 25 percent were still recovering after two months or longer. (The typical duration for mild cases is two weeks).
 

COVID and Latinx Immigrants in the US

 
A JAMA perspective looks at experiences of providing care to Latinx patients, some undocumented, in Baltimore affected by COVID. “Immigrants who had been systematically excluded from the safety net feared interacting with institutions. A woman who lived in a shared home said her brother could build a separate drywalled room in an afternoon so she could go home rather than to the isolation hotel, since the hotel sounded “too good to be true.” When asked to see another patient who had declined discharge to the convention center (a field hospital for people who needed a lower level of care), we found a young man terrified of being sent to the “detention center.” After years of anti-immigrant rhetoric and policy, the fear and mistrust in this community was understandable, painful, and palpable.”
 

Call for Universal Health            

 
UN News reports, “Launching his latest policy brief, “COVID-19 and Universal Health Coverage”, Secretary-General António Guterres called on everyone to draw ‘hard lessons’ from the pandemic, for which the world was not prepared. One of those lessons, he said, ‘is that under-investment in health can have a devastating impact on societies and economies.’ The pandemic revealed utterly inadequate health systems, yawning gaps in social protection, and major structural inequalities within and between countries, added Mr. Guterres.” 
 

What Do We Know About Immunity This Week?            

 
The New York Times published an explainer looking at how our immune systems respond to a COVID19 infection. “To quash the virus, the immune system unleashes an arsenal of powerful weapons. Sometimes these turn inward and destroy healthy tissues. Combatting this friendly fire has become as crucial a part of the COVID-19 treatment strategy as subduing the virus itself.”
 
National Geographic reports, “Some prominent leaders wonder if herd immunity created as people are naturally infected with SARS-CoV-2 coronavirus would be enough to restore society to working order. For evidence, they point to hard-hit epicenters such as New York City, where approximately 20 percent of the residents have been infected and the caseload has been low and steady for months. This sustained recovery must be due to herd protection, they argue. But based on simple math, past experiences with outbreaks, and emerging evidence from the ongoing pandemic, this claim is a fantasy.”
 

Disinformation Superspreader

 
The New York Times reports, “Of the flood of misinformation, conspiracy theories and falsehoods seeding the internet on the coronavirus, one common thread stands out: President Trump.

That is the conclusion of researchers at Cornell University who analyzed 38 million articles about the pandemic in English-language media around the world. Mentions of Mr. Trump made up nearly 38 percent of the overall ‘misinformation conversation,’ making the president the largest driver of the ‘infodemic’—falsehoods involving the pandemic.”
 
NPR reports, “Facebook and Twitter took measures to screen against misinformation after President Trump put posts on both sites that falsely claimed COVID-19 is less deadly than the flu in ‘most populations.’ Facebook took down Trump's post, saying that users are not allowed to make false claims about the severity of the pandemic. The social network says the post broke its rules against harmful misinformation. Twitter allowed the president's tweet to stay up with a warning label.”
 
The Wire reports, “Scientists can approach the social disease of misinformation the same way they address real, biological diseases, say experimental psychologist Briony Swire-Thompson and political scientist David Lazer of Northeastern University. Writing in the 2020 Annual Review of Public Health, they explore questions of exposure, susceptibility and transmission of health-related misinformation.”
 

Research News

 
CIDRAP reports, “the combination drug lopinavir-ritonavir [an HIV treatment] is not recommended for hospitalized COVID-19 patients because it doesn't significantly shorten hospital stay or lower the risk of needing mechanical ventilation or of dying, according to a study yesterday in The Lancet.”
 
A perspective in NEJM argues, “more than 3 million people in the United States are known to have been infected with SARS-CoV-2.  If every study registered on clinicaltrials.gov as of mid-June meets its target enrollment, less than 4 percent of those diagnosed with COVDI-19 will have been enrolled in a randomized, controlled trial. In the face of a new disease in dire need of proven treatments, every patient not offered enrollment in a well-designed, well-conducted study represents a missed opportunity to advance scientific knowledge, develop therapeutic strategies, and ultimately improve care for everyone who will come next.”
 

Longhaulers

 
In JAMA, Carlos del Rio and colleagues look at long-term health consequences of COVID. They conclude, “It is imperative that the care of this vulnerable patient population take a multidisciplinary approach, with a thoughtfully integrated research agenda, to avoid health system fragmentation and to allow the comprehensive study of long-term health consequences of COVID-19 on multiple organ systems and overall health and well-being. Furthermore, such an approach will provide the opportunity to efficiently and systematically conduct studies of therapeutic interventions to mitigate the adverse physical and mental health effects among hundreds of thousands, if not millions, of people who recover from COVID-19. Longer-ranging longitudinal observational studies and clinical trials will be critical to elucidate the durability and depth of health consequences attributable to COVID-19 and how these may compare with other serious illnesses.”
 

Co-infections

 
The Hindustan Times reports, “With cases of dengue and Covid-19 both on the rise, doctors at the All India Institute of Medical Sciences (AIIMS) in Delhi say they have recorded at least 20 cases of co-infection of the two diseases—a situation that presents a problem for diagnosis and treatment…. It also presents a challenge in treatment—COVID-19 patients are often given anti-coagulants to prevent clotting, but the medicine increases the risk of bleeding, which can lead to a shock in dengue patients with low platelet counts.”
 

COVID and Abortion

 
Bhekesisa published a comment from Marie Stopes South Africa on abortion access during lockdown. “Before the pandemic hit South Africa, Marie Stopes was conducting just over 2,000 terminations per month across the country. But when the economic lockdown was enforced, our caseloads drastically reduced. It was important that we found another way to help people in need of terminations to have one—or they may have resorted to illegal, unsafe abortions.” The organization set up a telehealth service to help clients manage terminations. “[I]n July, four months after Marie Stopes set up its self-managed abortion service in response to the lack of access to safe abortions during lockdown, the popularity of the service had increased so much that we conducted more than 700 terminations via telemedicine in that month alone.”
 
The Washington Post reports, “Across the globe, the pandemic has made it harder for women and girls to access reproductive services, as clinics close and barriers to medical care rise. The United Nations warned that millions of unintended pregnancies could result, with some 47 million women potentially cut off from modern contraception. Some programs and policies have succeeded in thwarting this trend, such as Britain’s expansion of telemedicine for self-managed abortions. Global groups like Women on Web provide virtual consultations and help deliver abortion pills to homes, a way to bypass local restrictions.” The Post looks at the impact of the pandemic on abortion in 6 countries.
 

Contact Tracing

 
The New York Times reports, “Despite repeated vows by Western nations to develop “world-beating” testing and tracing operations, those systems have been undone by a failure of governments to support citizens through onerous quarantines or to draw out intimate details of their whereabouts. That has shattered the hope of pinpoint measures replacing lockdowns and undermined flagging confidence in governments. Beholden to privacy rules, Western officials largely trusted people to hand over names to contact tracers. But that trust was not repaid, in large part because governments neglected services that were crucial to winning people’s cooperation: a fast and accurate testing system, and guarantees that people would be housed, fed and paid while they isolated.”
 
WHO’s Dr Ibrahima Soce Fall writes in Al Jazeera that “While most countries got on board with testing, many in the developed world were less receptive to contact tracing. Some countries believed they were well organised enough to be able to manage any epidemic. They saw contact tracing—something used successfully to help track and contain outbreaks of Ebola in West Africa and the Democratic Republic of the Congo, and the Plague in Madagascar—as a mechanism only poor countries use. They were completely wrong.
 

Endangered Languages May Be Wiped Out by COVID    

 
The Washington Post reports, “As the coronavirus burns its path through the world, it has pushed into territories that shelter some of the world’s most endangered languages, worrying vulnerable peoples and linguists alike. By targeting the elderly, the virus is disproportionately striking down the last remaining speakers of ancient languages that were already threatened by globalization, development and the growing hegemony of a few global languages.”
 

This Week in Fauci

 
Jon Cohen interviews Fauci in Science on the status of the response, the prospects for a vaccine and why Fauci is not afraid to speak his mind. Fauci: “I’m walking a fine line of being someone who is not hesitant to tell the president and the vice president what they may not want to hear. There are some people in the White House who, even when I first started telling it like it was in the task force meetings, they were like, ‘Oh my goodness.’ That’s when I got that nickname ‘the skunk at the picnic.’ When they would strike an optimistic note, I would say, ‘No, wait a minute.’ I used my experience with the activists during the early years of the AIDS pandemic to say, ‘If you really want to know what’s going on, you have got to talk to the people in the trenches.’”
 
With the US Thanksgiving holiday coming in a few months, a twitter thread reporting on an online conversation with Fauci and American University students says, “Dr. Fauci says his daughters will be gathering ‘on Zoom’ for Thanksgiving instead of traveling to be with him. ‘That's my decision, I'm not going to criticize those who do it differently. Look at your own situation,’ Fauci says.” AU also reports, “Regarding people who are skeptical of him, Fauci says, ‘Maybe 50 percent of you hate me because you think I'm trying to destroy the country, but listen to me for six weeks or so, and do what I say, and you'll see the numbers go down.’"
 

Faster, Cheaper Tests from Nigeria

 
CNN reports, “Scientists in Nigeria have developed a cheaper and faster COVID-19 test kit that will enable testing to be ramped up in a place that has faced kit shortages and chronic under-testing of a massive population, according to the country's health authorities. The new test is cheaper than other PCR tests—the most common type of test—and can give results in less than 40 minutes, the Nigerian Institute of Medical Research (NIMR) said.”
 

Lifesaving Tips Via Radio

 
The UN Foundation reports on a weekly radio show in Uganda where “lab technologist Lynda Nalumansi helps refugees in Uganda learn more about the virus…’While you are out there, around other people, in the market, or at the hospital, or at work, always remember to keep social distance,’ she advises on her show…. In July alone, 70 listeners called in to Nalumansi’s radio show, and she and local health officials answered a total of 102 questions. The questions included concerns about whether it is safe to share masks with a spouse; if a thermometer can be used to check for the virus; whether COVID-19 is sexually transmitted; and logistical questions about where masks can be purchased in the area.”