— John Moore and Ian Wilson in STAT

This week in Los Angeles, California, a city with some of the best healthcare infrastructure in the world in one of the richest states in the richest country in the world, ambulance crews were told not to transport patients who had little hope of survival to hospitals and there was a shortage of oxygen as hospitals were overwhelmed with critically ill patients.

AP reports, “California hospitals struggling with a skyrocketing coronavirus surge are trying to prepare for the possibility that they may have to ration care for lack of staff and beds—and hoping they don't have to make that choice….” Guidelines posted on one hospital’s website read, “If a patient becomes extremely ill and very unlikely to survive their illness (even with life-saving treatment), then certain resources... may be allocated to another patient who is more likely to survive."

Los Angeles is in the news this week, but this pattern of overwhelmed hospitals is playing out once again in communities across the globe.
 

If You Are in a Hurry

• Read Vox on what the new variants of the virus may mean for vaccines and other interventions.
• Read about a new model from the US CDC that shows more than half of infections come from asymptomatic spread in The Washington Post.
• Read a commentary in Foreign Policy that argues for lifting intellectual property restrictions for COVID vaccines.
• Read South Africa activist Mark Heywood in The Maverick on what government and civil society need to do to ensure vaccine access and uptake.
• See how social science and health communications can overcome vaccine hesitancy in Scientific American.
• Read Ugandan health reporter and trainer Esther Nakkazi’s blog post remembering mentors lost to COVID.
• Read Africa CDC director John Nkengasong on the puzzle of the COVID-19 pandemic in Africa in Science.
• Listen to an NPR story on how COVID is exacerbating child hunger in Afghanistan.
• Read how HIV vaccine research has paved the way for COVID vaccines in The Wall Street Journal.

 

Mutations

 
Mutations discovered in the UK and South Africa that appear to make the virus more transmissible have been found in multiple other countries and are driving some of the spikes in cases seen across the globe.
 
Vox reports in an article that provides good plain language background on the mutations and what they may mean that “As of January 5, the UK variant had been found in 40 other countries and the South Africa variant in six, according to the World Health Organization. On Thursday, the WHO’s Europe director called on countries to urgently enhance their coronavirus controls and ‘flatten the steep vertical line’ of rising cases.”
 
Nature reports, “labs worldwide are racing to unpick the biology of these viruses. Scientists want to understand why SARS-CoV-2 variants identified in the United Kingdom and South Africa seem to be spreading so quickly, and whether they might diminish the potency of vaccines or overcome natural immunity and lead to spate of reinfections….”
 
STAT reports that a mutation found in the South African variant and in one identified in Brazil, “changes a part of the virus that your immune system’s antibodies get trained to recognize after you’ve been infected or vaccinated. Lab studies show that the change could make people’s antibodies less effective at neutralizing the virus. The mutation seems to help the virus disguise part of its signature appearance, so the pathogen might have an easier time slipping past immune protection.” STAT reports the mutation would not render vaccines ineffective, but possibly less effective. “Essentially, the mutation is getting attention because it appears more likely to have some effect on vaccines than other mutations that have emerged, though scientists are still trying to test that hypothesis. The more contagious variant raising global alarms, which was first seen in the United Kingdom and is referred to as B.1.1.7, is not thought to have mutations that will greatly affect vaccines, the evidence so far indicates.”
 
The Washington Post reports, “The mutant variant of the novel coronavirus first seen in Britain is likely to be present in much of the United States. Although the variant has so far been detected in a very small fraction of infections, it shows signs of spreading and may become significantly more common in coming weeks….” according to the CDC. The CDC has also released new information and guidance about the new variants. The Post also notes, “The rise of variants also could limit the efficacy of monoclonal antibody treatments because such therapeutics are very narrowly focused and potentially could be eluded by a single mutation.”
 
A commentary in JAMA notes, “It is possible that mutations in spike that are ‘good’ for the virus right now could also make it less fit in the context of population-level immunity in the future. Defining these dynamics, and their potential influence on vaccine effectiveness, will require large-scale monitoring of SARS-CoV-2 evolution and host immunity for a long time to come.”
 
Researcher Eric Topol tweeted “If we wanted to get serious vs B.1.1.7—get N95/K95 masks to all and enforce their use—get rapid home testing big supply to each household for daily use—amp up digital, mobility, genomic and wastewater surveillance 100X—vaccinate 24/7 like it's an emergency. Because it is.”
 
Al Jazeera profiles Nigerian virologist Sunday Omilabu who is sequencing viruses in the country to determine if a new variant found there is driving an uptick in COVID cases. He argues, “We need to be monitoring the virus, we need to sequence. If we sequence then we would have more information about what is in circulation and then, of course, we need to continue with surveillance, we need to monitor how active the virus is in the environment… so the public health experts, they have work to do and then government must support all these.”
 

Asymptomatic Spread

 
The Washington Post reports on a new model from CDC that finds “People with no symptoms transmit more than half of all cases of the novel coronavirus…. Fifty-nine percent of all transmission came from people without symptoms, under the model’s baseline scenario. That includes 35 percent of new cases from people who infect others before they show symptoms and 24 percent that come from people who never develop symptoms at all.”
 

Treatment News

 
The Economist reports on results of a study of two arthritis drugs for COVID treatment. “The two drugs, called tocilizumab and sarilumab, are currently used to reduce inflammation in patients with arthritis. Hyper-inflammation, whereby the immune system goes into overdrive and destroys the organs, is how COVID-19 tends to kill…. They are both made of antibodies that block the effect of interleukin-6, a protein that stokes the immune response and has been prominent in patients with COVID-19…. The drugs are not cheap, and so may be beyond the means of developing countries.”
 
NPR reports, “Many doses of the monoclonal antibody drugs [manufactured by Regeneron and Eli Lilly] that treat mild to moderate COVID-19 are sitting unused around the country. There are logistical problems with providing these drugs and skepticism over whether they work. But two major health systems have had good success in deploying these medications, and they're reporting hopeful results.” The antibodies were granted emergency use authorization by the US FDA based on data from a small number of patients. Some doctors now report good effects in real world use, but as NPR reports, “Unlike a clinical trial, this real-world experience doesn't have a randomized comparison group, so doctors can't say for sure that these patients are faring better.”
 
IPS News reports on the “ANTICOV COVID-19 clinical trial, aimed at identifying treatments that prevent mild cases from progressing to severe forms of the disease… The trial will investigate home-based treatments to help prevent local health systems from being overwhelmed.”
 
The New York Times reports, “A small but rigorous clinical trial in Argentina has found that blood plasma from recovered COVID-19 patients can keep older adults from getting seriously sick with the coronavirus—if they get the therapy within days of the onset of the illness…. The results, published Wednesday in the New England Journal of Medicine, are some of the first to conclusively point toward the oft-discussed treatment’s beneficial effects.”
 

Calls to Change Vaccine Dosing Regimens

 
In an attempt to stretch vaccine doses and potentially provide coverage for more people sooner, some countries and health authorities are looking at deviating from the doses and timing shown to be effective in clinical studies. STAT reports, “In an extraordinary time, British health authorities are taking extraordinary measures to beat back COVID-19. But some experts say that, in doing so, they are also taking a serious gamble. In recent days, the British have said they will stretch out the interval between the administration of the two doses required for COVID-19 vaccines already in use—potentially to as long as three months, instead of the recommended three or four weeks. And they have said they will permit the first dose and second dose for any one person to be from different vaccine manufacturers, if the matching vaccine is not available.”
 
The New York Times reports, “A top official of Operation Warp Speed floated a new idea on Sunday for stretching the limited number of COVID-19 vaccine doses in the United States: Halving the dose of each shot of Moderna’s vaccine to potentially double the number of people who could receive it.” But the FDA released a statement saying, “We have been following the discussions and news reports about reducing the number of doses, extending the length of time between doses, changing the dose (half-dose), or mixing and matching vaccines in order to immunize more people against COVID-19. These are all reasonable questions to consider and evaluate in clinical trials. However, at this time, suggesting changes to the FDA-authorized dosing or schedules of these vaccines is premature and not rooted solidly in the available evidence. Without appropriate data supporting such changes in vaccine administration, we run a significant risk of placing public health at risk, undermining the historic vaccination efforts to protect the population from COVID-19.”
 
Reuters reports, “European countries rolling out the Pfizer-BioNTech COVID-19 vaccine should be flexible on the time between the first and second doses…. The WHO’s Hans Kluge said it was important to strike a balance between making the most of limited supplies of vaccines and protecting as many people as possible.
 

Vaccine Access

 
More vaccines were approved by more countries, but a unified plan for equitable global equitable distribution remains unclear.
 
Reuters reports the COVAX facility aims to start delivering vaccines to poorer countries in January. “Until now, wealthier nations including Britain, European Union members, the United States, Switzerland and Israel have been at the front of the queue for vaccine deliveries from companies including Pfizer and partner BioNTech, Moderna and AstraZeneca. The WHO on Dececember 31 extended its emergency use listing to Pfizer-BioNTech’s vaccine and is now reviewing vaccines from AstraZeneca and China’s Sinopharm for similar status, as well as talking to Moderna and Russia’s Gamaleya Institute over their own shots.” A WHO official says, “So the facility has access to over 2 billion doses of vaccine. We will start to deliver those vaccines probably by the end of January, and if not, then certainly by early February and mid-February.”
 
VOA reports South Africa health minister “Zweli Mkhize said the country will receive one million vaccine doses by the end of January, and another half million in February, both from the Serum Institute of India. The first doses, he says, will go to health workers.”
 
The Guardian reports, “Kenya has ordered 24 million doses of the COVID-19 vaccine developed by AstraZeneca and expects them to start arriving in the second week of February, its health minister said. The East African nation of around 47 million people has so far reported 97,398 cases of COVID-19 and 1,694 deaths. Its economy is also reeling from pandemic-related disruptions…. Priority for vaccination will be given to health sector workers and other essential workers like teachers, the minister said.”
 
Reuters reports, “The European Union should send coronavirus vaccines to its Balkan neighbours and do more to combat the virus in Ukraine, 13 of the EU’s foreign ministers said in a joint letter to the bloc’s executive on Wednesday. [The letter said] said the EU would not be safe from COVID-19 until countries on its borders could also recover from the pandemic.”
 
A commentary in Foreign Policy argues “The easiest way to make vaccines truly available to all is to freely license every effective vaccine formula so that generic producers can manufacture the vaccine anywhere. This approach would overcome the short-run limits on production, which come from intellectual-property restrictions that constrain production to specific firms. Doing away with this barrier would ensure that the vaccines are produced and sold by many actors in a competitive marketplace, and made available to the public at the least cost.” The authors argue, “It is vital—and not too late—to pursue a public alternative to private monopolies so as to ensure adequate production, efficient distribution and accessible pricing of a vaccine for COVID-19. This is essential not just to offer the world the fastest pathway out of the health, social and economic crisis caused by the current pandemic, but to offer it the best means out of future pandemics too.”
 
South Africa activist Mark Heywood writes in The Maverick, “Over the last week, South Africa has witnessed a growing conflict between government on the one hand and civil society and the scientific community on the other over the absence of a strategy and urgent plan to roll out COVID-19 vaccines. The polarisation feels like the bad old days of AIDS.” Heywood argues for unity saying, “We need unity if government and civil society (who basically are on the same side) are to speak with one voice and counter a deadly campaign of misinformation that, like AIDS denialism, is being spread by social media in communities to sow distrust in and active resistance to COVID-19 vaccines. We need to monitor this misinformation campaign and have a united effective communication campaign to block it.” He argues, “Today, civil society still has a critical role to play in ensuring that safe and efficacious vaccine access is determined by science and medicine, not blocked by either profiteering, corruption or the geopolitics of big powers like China or Russia who might link vaccine access to economic favours and expanding spheres of influence.”
 

Brazil Grants EUA to Chinese Vaccine

 
AFP reports, “Chinese-developed COVID-19 vaccine CoronaVac showed at least 78-percent effectiveness in final-stage clinical trials in Brazil, officials announced Thursday, saying they would apply for emergency approval from the Brazilian regulatory agency to begin a vaccination campaign…. Turkey, which also helped carry out Phase 3 tests of CoronaVac, said last month the vaccine had shown effectiveness of 91.25 percent in its trials. Sinovac has not yet released worldwide results from the tests, which are also being carried out in Chile and Indonesia.”
 
The New York Times reports, “In anticipation of approval, the vaccine, CoronaVac, has already been shipped around the world as countries prepare for mass inoculation campaigns. Sinovac has sold more than 300 million doses, mostly to low- and middle-income countries, accounting for about half of the total doses that China says vaccine makers were capable of producing in 2020… China has set its sights on supplying the developing world with a COVID-19 vaccine, in a push to position itself as a leader in health diplomacy after its failures in the early days of the outbreak. It also wants to burnish its credentials in science by becoming a major player in the global vaccine business.”
 

Turning to Social Science to Address Vaccine Hesitancy

 
Scientific American reports that “Social science offers valuable lessons about ways to convince those who are hesitant about the shots…. For the reluctant and distrustful, it will take targeted actions and communication strategies that speak to the specific concerns of each group to move them toward accepting the new vaccines.”
 

A Reporter Looks Back

 
Veteran STAT reporter Helen Branswell looks back at a year of reporting full time on COVID-19. A year ago her first story was headlined “Experts search for answers in limited information about mystery pneumonia outbreak in China.” She says, “It never occurred to me—and I’m sure I’m not alone in this—that the United States would handle a pandemic worse than almost any other country, and definitely worse than peer countries. The US spent a lot of time and buckets of money on pandemic preparedness in the mid-aughts, but you wouldn’t know it from the country’s response to the COVID pandemic.”
 

Remembering Mentors Lost to COVID

 
Veteran health reporter and trainer Esther Nakkazi writes in a blog post for the Health Journalists Network in Uganda; “It is not possible to honor all the health workers, advocates, and media personnel who have died of COVID-19 but telling the story of Dr. Charles Kiggundu and Patrick Luganda may serve as a tribute to them and others.” Makkazi notes that, “Scientists like Dr. Kiggundu all over the world are gems, hard to come by so losing him is going to create a void in that space that is very hard to fill.” Of Mr. Luganda, she writes: “He loved to tell stories, use illustrations as he was training, and speak in different languages that simplified science and technology to the basics.”
 
A column in The Eagle (Nigeria) pays tribute to three professors who died of COVID. “Each time a professor dies, I say to myself: what a waste! All the learning, gone. All the intellect, perished. The research, the knowledge, and quest for more knowledge, kaput. Sheer waste!... On Tuesday this week, our country recorded 1,354 new cases of Coronavirus infections. It was the highest daily record so far, and deaths have hit 1,319…. The second wave of Coronavirus is not smiling at all.”
 

The Puzzle of the COVID-19 Pandemic in Africa

 
In a commentary in Science Africa CDC director John N. Nkengasong and colleague Justin M. Maeda write, “The puzzle of the COVID-19 pandemic in Africa can partly be explained by decisive measures taken early to prepare the continent. However, more data are needed to complement what is routinely collected through surveillance and response to understand the different pieces of the puzzle that contribute to the pattern of the pandemic in Africa. Serosurveys and the use of genomic epidemiology can help to better understand disease spread. Further understanding of factors that influence viral pathogenesis and clinical spectrum of disease, and the impacts on endemic infections (HIV, tuberculosis, and malaria), are needed. Efforts to understand attitudes to COVID-19 vaccines are also a priority.” The Star (Kenya) reporting on the commentary writes, “Africa CDC also credits the decisive and timely response by African people. On February 22, all African ministers of health met in Addis Ababa and adopted a joint continental strategy to limit transmission, limit deaths, and limit social and economic harms and impacts on other endemic diseases. After that countries like Kenya shut down early, enforced masking and curfews to date. While the measures devastated the economy, they also bought time for the country to sensitise people and upgrade health facilities.”
 
In a World Bank Blog, several Bank employees outline how science capacity in Africa has been a game changer for the COVID response. They argue, “The COVID-19 pandemic has revealed that solutions ought to be developed in Africa and adapted to the African context” and outline how laboratory and research capacity developed over the past decade is ensuring better local response to the pandemic.  
 

The Pandemic and Other Health Issues

 
The longer the pandemic continues, the more severe the impact has become on broader health and development. NPR reports on child hunger and starvation in Afghanistan. “A December report from the United Nations finds that nearly half of all children younger than 5 in Afghanistan, a total of some 3.1 million, are facing acute malnutrition. That's a 16 percent jump since June 2020…. The line is thin between hunger and starvation, and Afghanistan's weak economy, dealt a blow by the pandemic closures, threatens to push more families over the edge….”
 
Nicholas Kristoff writes in a New York Times column headlined Starving Children Don’t Cry, that “The world had pretty much licked famine, until 2020. The last famine declared by the United Nations authorities was in a small part of South Sudan for a few months in 2017—but now the UN warns that famine is looming in Yemen, South Sudan, Burkina Faso and northeastern Nigeria, with 16 other countries slightly behind in that trajectory toward catastrophe…. The biggest cause of the global crisis is the coronavirus pandemic, but only indirectly. Outside of the rich world, the casualties are not octogenarians with the virus so much as children dying of hunger because of economic disruptions, or middle-aged adults dying of AIDS because they can’t get medicines.”
 
A commentary in New Times (Rwanda) says that “Since the pandemic was first declared, governments have prioritized fighting COVID-19 across all levels of the health system. Countries reallocated resources to strengthen pandemic response teams and ensure provision of essential supplies. In the process, efforts to tackle [neglected tropical diseases (NTDs)] were ended or fell to the bottom of countries’ to-do-lists…. It is estimated that NTDs infect over 1.5 billion people, or 24 per cent of the world’s population. In Africa, intestinal worms are the most common NTDs among children. Untreated NTDs lead to cognitive impairment and developmental disabilities, and severe forms can cause malnutrition and death.”
 
A STAT opinion piece by the CEO of Novartis argues, “As the pandemic rips across the world, taking lives and devouring health resources and economies, it is also creating a void in which other debilitating and deadly diseases are left undiagnosed and untreated. That means we aren’t merely facing a once-in-a-century pandemic. We’re facing a syndemic: the confluence of several epidemics.” He argues, “the global health community needs to collectively support health systems in low- and middle-income countries, which are disproportionately affected by COVID-19 and other streams of the syndemic. As long as SARS-CoV-2, the virus that causes COVID-19, continues to spread in some of these countries, it will continue to pose a global threat.”
 

Decades of Basic Science and HIV Research Helped COVID Vax Development

 
John Moore and Ian Wilson write in STAT, “the COVID-19 vaccines did not come from nowhere. Decades of research by tens of thousands of scientists worldwide put in place the essential knowledge and methods that underpinned their rapid development…. Decades of work, first on the corresponding HIV spike protein and then its counterparts from other viruses, including SARS, MERS, and seasonal coronaviruses, showed how best to design and produce the SARS-CoV-2 version.” They argue, “Funding scientific research is buying an insurance policy for a better future. The benefits are not always apparent, and sometimes become visible only over many years. 2020 is a case in point: The nation’s existing research infrastructure laid the groundwork for COVID-19 vaccines to be designed within weeks of the emergence of a deadly virus and produced within months. We cannot know when the next global health crisis will hit, but we do know that continuing to support medical science is essential for a rapid and effective response when it does.”
 
The Wall Street Journal reports that “In part, the world can thank decades of frustrating and often fruitless research to find a vaccine” for HIV for the speedy development of COVID vaccines. Fauci is quoted: “Everything we do with every other pathogen spins off of things we’ve learned with HIV….” The article concludes, “Fittingly, some scientists say that current work on combating COVID-19 may, in turn, finally produce an HIV vaccine….’ We’re just going to learn so much about the immunology, about manufacturing, about delivery, about how to dose, how to boost,’ says Sharon Lewin….”
 

COVID and HIV

 
POZ reports that over time “larger studies began to show that people with HIV and COVID-19 indeed might have a modestly increased risk for poor outcomes, including death.” One study “recently reported in a preprint that during the initial wave in New York City, people with HIV and COVID-19 had a higher rate of hospitalization than HIV-negative people” and a Lancet HIV study looking at HIV and COVID infections in the UK National Health Service found “After adjusting for age and sex, people with HIV had nearly a threefold higher risk of death than HIV-negative people; the difference appeared to be even larger for Black people, who had more than a fourfold higher risk. However, the disparity appeared to be greater early in the pandemic and then diminished….” A study in Cape Town, South Africa found that “After adjusting for age, sex and other comorbidities, HIV-positive people—even those on antiretroviral treatment with viral suppression—were more than twice as likely to die from COVID-19, and 8.5 percent of COVID-19 deaths were attributable to HIV. Among hospitalized patients, however, HIV conferred a more modest added risk.”
 

Partisanship and the Pandemic

 
A research article in Science Advances found that “Rampant partisanship in the United States may be the largest obstacle to the reduced social mobility most experts see as critical to limiting the spread of the COVID-19 pandemic…. Partisanship is a far more important determinant of an individual’s response to the COVID-19 pandemic than the impact of COVID-19 in that individual’s local community. The implications of this are consequential. The COVID-19 pandemic in the United States is currently as much a political problem as it is a public health problem. Given the differences in perceptions and behavior we document between Democrats and Republicans exposed to the same level of COVID-19 in their local communities, simply highlighting the public health concerns associated with COVID-19 seems unlikely to encourage the collective decline in social mobility that is required to help mitigate the further spread of the pandemic. Instead, political leadership—especially by Republicans—seems essential for changing the partisan-related differences we document in individuals’ behaviors and opinion.”
 

Not Throwing Away His Shot

 
Surgeon Dorry Segev tweeted a video of a “tribute to #COVID19 science. And #Hamilton. Oh, and some fun actual facts about mRNA” in which he raps that he is “not throwing away my shot… hey yo I want my vaccine.”