AUSTIN, Texas A new analysis of COVID-19 outbreaks in 58 cities has found that places that took longer to begin implementing social distancing measures spent more time with the virus rapidly spreading than others that acted more quickly.
In a new paper from epidemiological researchers at The University of Texas at Austin, now in press with the CDCs journal Emerging Infectious Diseases, researchers studied cities throughout China and analyzed when first cases were detected, when social distancing measures were implemented and when the outbreak was considered contained. The team found that every day a city delayed in implementing social distancing measures after the appearance of a first case added 2.4 days to the length of the outbreak.
Every day saves time, saves effort, saves people becoming infected and probably saves lives, said Lauren Ancel Meyers, a professor of integrative biology who leads the UT Austin COVID-19 Modeling Consortium. This is particularly important as we think about the coming weeks and months.
The findings are applicable both to communities experiencing their first outbreaks and those that may see a resurgence in the coming months, Meyers said. Waiting a week after early signs of resurgence might require about 17 more days of social distancing to slow the spread of the pandemic, according to the data.
It will be difficult to consider strict interventions again, but acting early upon signs of resurgence will mean fewer days of social distancing orders, said Spencer Fox, associate director of the UT Austin COVID-19 Modeling Consortium and co-author on the paper.
Our findings have implications for the timing of interventions in U.S. cities, Meyers said. The impact of delays may be particularly important for communities that are prone to rapid transmission, such as nursing homes, colleges, schools and jails. We need concrete plans for when and how to respond to rising cases to prevent unnecessarily long and costly restrictions.
To determine when an outbreak had been contained, scientists look at case counts and determine the reproduction number, a measurement that shows how many people will be infected by one infectious person. If the reproduction number drops below 1, scientists consider the outbreak contained.
Other studies into the impact of delaying social distancing measures have used modeling to estimate a link between the time of measures being taken and the effect on outbreaks. By contrast, this study used on-the-ground data to determine the link between cities taking measures to contain the virus and rates of the virus spreading.
The study was not able to determine which social distancing measures were most effective, but it showed that the timing of the first measure, regardless of the type, had a big impact.
We provide direct, data-driven evidence that the timing of interventions has a substantial impact on how long an outbreak lasts, how effective our interventions are and, ultimately, how many people might be infected and die from the virus, Meyers said.
Although the study looked at cities experiencing the earliest days of an outbreak, the findings are also relevant for cities in the middle of an outbreak, Meyers said.
In addition to Fox and Meyers, Zhanwei Du of UT Austin, Xiaoke Xu of Dalian Minzu University, Lin Wang of the University of Cambridge, Benjamin J. Cowling of the University of Hong Kong and Alison P. Galvani of the Yale School of Public Health contributed to the research. The research was funded by the National Institutes of Health and the National Natural Science Foundation of China. The UT COVID-19 Modeling Consortium is made possible, in part, by the generous support of Titos Handmade Vodka.
NEW YORK (AP) Protests erupting across the nationover the past week and law enforcements response to them are threatening to upend efforts by health officials to track and contain the spread ofcoronavirusjust as those efforts were finally getting underway.
Health experts need newly infected people to remember and recount everyone theyve interacted with over several days in order to alert others who may have been exposed, and prevent them from spreading the disease further. But that process, known as contact tracing, relies on people knowing who theyve been in contact with a daunting task if theyve been to a mass gathering.
And the process relies on something that may be suddenly be in especially short supply: Trust in government.
These events that are happening now are further threats to the trust we need, said Dr. Sandro Galea, dean of the Boston University School of Public Health. If we do not have that, I worry our capacity to control new outbreaks becomes more limited, he said.
Government officials have been hoping to continue reopening businesses, churches and other organizations after months of stay-at-home orders and other infection-prevention measures. But health experts also hoped that any reopening would be accompanied by widespread testing, contact tracing and isolation to prevent new waves of illness from beginning.
Over the past week, protests sparked bythe death of George Floyd,a black man who died after a white Minneapolis police officer pinned a knee to his neck, have involved thousands of people gathered tightly together in large crowds in more than 20 cities nationwide.
Its unclear if the protests themselves will trigger large new outbreaks. The protests were outside, where infections dont spread as readily as indoors. Also, many of the protesters were wearing masks, and much of the contact was likely less-hazardous transient moments of people moving around, passing each other, said Dr. William Schaffner, an infectious diseases expert at Vanderbilt University.
But, still, experts worry that public efforts to contain the disease in the futurecould be undermined.
In Los Angeles, the citys mayor announced Saturday that COVID-19 testing centers were being closed because of safety concerns related to violent protests. Testing in Minneapolis will be affected because some of the clinics that provide the service have been damaged in the protests, according to a city government spokesperson.
Reduced testing could be giving the virus another head start, Schaffner said.
And contract tracing, which is only just getting going in several states, is an even bigger concern. It involves people who work for or with health departments asking intimate questions about where a person has been and who theyve been talking to and getting full, truthful answers in return.
In this current environment which has enhanced or brought forth a mistrust of governmental authority, it might make them disinclined to speak with anyone in government, Schaffner said.
That is especially true inblack communities trying to copewith episodes of police violence and longstanding frustrations with how they have been marginalized and mistreated by people who work for government agencies. And those are the communities that have beenhardest hit by the coronavirusin the U.S. and most in need of public health measures to help control it.
In a press conference Saturday, Minnesota Public Safety Commissioner John Harrington used the term contact tracing when describing an investigation into arrested protesters there. He said the goal is to see if there are crime or white supremacy organizations that have played a role and to understand how do we go after them, legally, Harrington said.
But Harringtons use of contact tracing by law enforcement may complicate the job of help health workers as they try to track the viruss spread, some experts said.
That was an abuse of the word contact tracing. That is not what contact tracing is, said Dr. Tom Frieden, former director of the federal Centers for Disease Control and Prevention.
Contact tracing is a service to patients and their contacts to provide services for patients and warning for contacts. It has nothing to do with police activity. Nothing, said Frieden, who currently president of Resolve to Save Lives, a nonprofit that works to prevent epidemics.
Galea said he hopes many people will separate in their minds the contact tracing done by public health workers from crime investigations by the police. But, he added, I do think sometimes its difficult to make a distinction when you feel marginalized by, and targeted by, the the entire government.
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Fears that Iran is in the grip of a second wave of coronavirus have been reinforced, with the health ministry saying 3,000 new cases were recorded in 24 hours the highest figure for two months.
The Islamic Republic, one of the worst-hit countries in the Middle East, started easing its lockdown in April after a drop in deaths.
Its leaders have been reluctant to acknowledge that they may have lifted restrictions prematurely. They have argued that a recent rise in new infections was confined to certain provinces and that the number of deaths was relatively low. At the weekend the president, Hassan Rouhani, said most restrictions had now been lifted, pointing to the opening of 40,000 mosques, as well as shops and offices. Despite a clear reversal of fortunes in the past fortnight, few newspapers appeared willing to acknowledge that the virus had not been conquered.
But health ministry officials on Monday sent out a dire warning about complacency, saying the battle was far from over.
The health minister, Saeed Namaki, said he was witnessing sad scenes across the country. Unfortunately, he said, corona is going to score a goal in the 90th minute if some officials and the people believe that corona is over. If we neglect the situation we will go backwards. People, have mercy on us, lets have mercy on ourselves, government officials are getting tired.
The latest figures showed 2,979 new infections in the previous 24 hours, taking the total of infections in Iran to 154,445. The daily figure is the highest since 1 April. The comparative figure for 1 May was 802 new infections.
The number of deaths is also starting to rise again, with 81 dead in the previous 24 hours, the highest figure since 27 April. A total of 8,778 have died since Irans outbreak began.
Namaki said he had been disturbed by the lack of social distancing on public transport. Theslightest negligence can destroy all successes and tarnish our reputation in the international arena, he said.
Contrary to some messaging by Irans leadership that the virus was weakening, he said that it had become more dangerous. Last week we had cases of patients dying at the age of 32 or 42 without any underlying disease, due to coronavirus, he said.
My colleagues and the deputies of the ministry of health are working around the clock and traveling to one province every day to control this epidemic, but we are dealing with local issues and behaviours that could lead to the return of the peak of the disease. Wedding celebrations, he warned, would turn into funerals soon afterwards.
He said the virus was most dangerous in the south-west province of Khuzestan, but infections were also rising in Kermanshah, Hormozgan, Sistan and Baluchestan. The health ministry claimed adherence to social distancing rules had dropped from 90% to 40%, and that promised new buses for Tehran had not materialised, leading to overcrowding. Those not wearing masks on Tehran public transport should be banned from travelling, Namaki said.
Experts both at home and abroad have voiced scepticism aboutIrans official figures, saying the real toll could be much higher.
Health officials have repeatedly raised the alarm about Khuzestan onIrans south-western border with Iraq. Khuzestan remains at red, the highest level onIrans colour-coded risk scale, and is the only province where the government has reimposed a lockdown.
Iranian authorities have been under intense internal pressure to lift restrictions and get the economy, already shattered by sanctions, back moving. Nearly $2.5bn of damage has been done in 13 sectors of the economy, according to government estimates. Inflation is projected to settle at 24% next year.
Meanwhile, a senior Iranian lawmaker said on Monday that around 230 people were killed in the street protests against Irans petrol price rises last November.
It was the first time Iran had even semi-officially disclosed the scale of the protest. Motjaba Zulmoor, the head of the Iranian parliaments National Security Commission said 52 of those killed were government officials and the remainder were 78 street protesters mainly killed while attacking governmentbuildings.
Zulmoor claimed 2,000 protesters were injured and 5,000 officials, but gave no number for those detained. He blamed foreign media for the wave of attacks, andsaid the police were forced to intervene when assaults started on police centres.
An Iranian government spokesman also attacked Donald Trump for his policing of the current protests against racism and police brutality, saying it showed he had no authority to advise others on human rights issues.
Airborne aerosols were generated during speech, sneezing, and during nasal endoscopy procedures in an otolaryngology clinic, reinforcing the importance of universal source control during the COVID-19 epidemic, researchers found.
In a simulated clinical setting, speech and nasal endoscopy generated significant airborne aerosols, though simulated sneezing generated the largest number of airborne aerosols, reported Benjamin Bleier, MD, of Massachusetts Eye and Ear Infirmary in Boston, and colleagues.
While a surgical mask helped to partially mitigate airborne aerosol generation, an N95 respirator helped to contain airborne particle generation, the authors wrote in Otolaryngology -- Head and Neck Surgery.
Bleier told MedPage Today that evidence that SARS-CoV-2, the virus that causes COVID-19, has high viral load in the nasopharynx is concerning for healthcare providers in general, but especially for otolaryngologists. A nasal endoscopy involves inserting a scope inside a patient's nose, which initiates "direct contact between the instrument and the airway tissue, causing the patient to perform involuntary behavior," such as coughing or sneezing, he explained.
And most literature supports the idea that talking generates more aerosols than coughing, as Bleier noted that prior research supports the idea that "talking alone is worrisome for aerosol generation, even in a closed environment with someone infected."
"In an environment where testing is not widely available or reliable, we have to adopt the posture of universal source control," he said. "We have to assume all patients are positive [for COVID-19] and treat them as such."
For doctors, even in the clinic setting, this means full personal protective equipment (PPE): gown, gloves, mask, and goggles or eye protection. Because of airborne aerosols the patient generates in the room, this also means engineering control, Bleier added, such as the heating, ventilation, and air conditioning system turning over the air supply in the room.
"Close the room for an hour, let the air circulate, clean all surfaces, and then the next patient can come in," he said.
Bleier and his team even proposed a solution for otolaryngologists who have to do nasal endoscopies: a version of the N95 mask, with a small piece of latex glove stapled to the inside and outside. The scope is passed through that section of the mask, with the latex providing a seal adequate to prevent pathogen transmission.
Bleier said that in addition to having both patients and providers be masked, it is also important to ensure that patients don't pull down their masks.
"Even though it wasn't statistically significant, it has the potential to release airborne particles into the room. Data alone suggests the mask needs to remain on the patient's mouth," he said.
Bleier's group also focused on surgical procedures specific to otolaryngologists by using different surgical instruments in a cadaver head. The team found that transnasal drill and cautery use were both associated with significant airborne particulate matter production under surgical conditions.
Bleier said his group's study helped "peel back the veil" on the aerosols to which healthcare providers are exposed, which has gained a heightened importance in this era of COVID-19.
"We always have been, but we just weren't paying attention to it," he said. "This will have a long-term effect on the precautions we take."
Last Updated May 27, 2020
Molly Walker is an associate editor, who covers infectious diseases for MedPage Today. She has a passion for evidence, data and public health. Follow
Disclosures
Bleier disclosed support from Olympus, Medtronic, Karl Storz, Sinopsys, Baxter, 3D Matrix, and Thieme, and holding patents for "Treatment of Sinusitis Through Modulation of Cell Membrane Pumps," "Inhibition of Cystatins for the Treatment of Chronic Rhinosinusitis,"and "Methods of Delivery of Pharmaceutical Agents," and noted that he is working with industry to develop source control solutions for endoscopic procedures that may include an equity position in the future.
VALLEY CITY, N.D. (NewsDakota.com) There is one additional case of COVID-19 confirmed in Barnes County. The individual is a male in his 20s who has been isolating at home. This newly confirmed case brings the county total to 5, with just one considered active.
City-County Health District (CCHD) reminds the public that certain people are at higher risk of getting very sick from COVID-19 including older adults and people who have serious chronic medical conditions like heart disease, diabetes and lung disease, according to the Centers for Disease Control (CDC).
Recent data shows that the virus is also affecting younger people, said Theresa Will, Administrator for City-County Health District. About 30 percent of confirmed COVID-19 cases have been among people between 20-44 years old, Will said of the Centers for Disease Control and Prevention report.
Everyone can help reduce the spread of COVID-19 and other respiratory infections by: Avoiding close contact with others as much as possible Washing hands often with soap and water for at least 20 seconds Avoiding touching of the eyes, nose, and mouth Cleaning and disinfecting frequently touched objects and surfaces Wearing a cloth face covering in public settings where distancing is difficult
Its important that we dont misunderstand what our low number of cases means for Barnes County. A low number does not mean were out of the woods, it means we must remain vigilant in exercising personal responsibility to help slow the spread, said Will.
CCHD reminds the public that as we enter phase 2 of North Dakotas Smart Re-Start, contact journaling is important. Keep a daily list of who youve come in contact with and utilize the free CARE 19 mobile app to help you remember locations youve visited.
For the most timely information and updates related to COVID-19 in North Dakota, visit the NDDoH website at www.healthy.nd.gov/coronavirus. Follow City-County Health District on Facebook for Barnes County updates or call 701-845-8518.
Budrul Chukrut | SOPA Images | Getty Images
U.S. drugmaker Merck on Tuesday said it plans to work alongside nonprofit scientific research organization IAVI to develop a potential vaccine against the coronavirus.
The news helped send Merck shares up about 3% during the premarket.
The announcement comes as drugmakers pause other clinical trials and scramble to find an antidote for Covid-19, which has infected more than 5.5 million people worldwide and killed over 346,000.
Most experts agreecould take 12 to 18 months to roll out a safe vaccine to the market. And, even if an effective vaccine becomes available, many have warned of significant logistical challenges around distributing enough doses for the global population.
In a statement, Merck and IAVI said their vaccine candidate would use the recombinant vesicular stomatitis virus technology that is the basis for its Ebola Zaire virus vaccine which was the first rVSV vaccine approved for use in humans.
Ebola Zaire is one of six known species within the genus Ebola virus, an acute deadly illness. The virus causing the current outbreak in the Democratic Republic of Congo, and the 2014 to 2016 West African outbreak, belongs to the EbolaZaire virus species, according to the World Health Organization.
Designed and engineered by IAVI scientists in New York, the vaccine candidate for Covid-19 is in preclinical development. Clinical studies are expected to start this year.
If approved, Merck said both organizations would work together to develop the vaccine and "make it accessible and affordable" worldwide.
Last month, WHO Director General Dr. Tedros Adhanom Ghebreyesus said it was important that, when a vaccine is ready, it could be equitably distributed across the globe.
"There should not be a divide between the haves and the have-nots," he stressed.
President Donald Trump has voiced ambitions for a vaccine to be developed and distributed by the end of 2020, in a project called "Operation Warp Speed."
However, medical experts including Dr. Anthony Fauci, the U.S. government's top infectious disease expert have cast doubt on Trump's goal, expressing skepticism over the time frame.
Dr. Mark Feinberg, IAVI president and CEO, said the rVSV-based vaccine strategy represented a "promising approach to combating the novel coronavirus pandemic."
Merck and IAVI said the rVSV vaccine platform uses an attenuated strain of vesicular stomatitis virus, a common animal virus that has been modified to express proteins that stimulate an immune response.
The plan, they continued, was to "leverage experience" gained with this platform during the development of Merck's rVSV-based vaccine for Ebola Zaire.
Separately, Merck said it plans to acquire privately held Themis, a company focused on vaccines and immune-modulation therapies for infectious diseases and cancer, foran undisclosed cash payment.
Upon completion of the deal, Themis would then become a wholly owned subsidiary of Merck.
Watch Merck CEO Ken Frazier in an exclusive interview on CNBC at 4 p.m. ET.
CNBC's Chloe Taylor contributed to this report.
The first phase of the trial will test whether the therapy is safe and well-tolerated; those results are expected in late June. The first Covid-19 patients being treated with the therapy are hospitalized at New York University's Grossman School of Medicine in New York, Cedars-Sinai in Los Angeles and Emory University in Atlanta, the company told CNN.
If the trial ultimately shows the treatment is effective against Covid-19, it could be available by autumn, according to the Indianapolis-based company.
Scientists at AbCellera and the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases selected those they thought would be most potent and Lilly scientists engineered the treatment, known as a monoclonal antibody therapy. This approach has worked to treat other illnesses; there are monoclonal antibody therapies that treat HIV, asthma, lupus, Ebola and some forms of cancer.
It's not clear if such a therapy will work against Covid-19, but when this treatment was used on on cells in the lab, it blocked the ability of the virus to infect the cells, Skovronsky said. The data is not yet published, but based on those results, scientists got the green light to take the next step and prepare it to be tried in patients.
They also gave it a temporary name.
"We call it LY-CoV555, lucky triple 5," Skovronsky said.
Manufacturing has already begun
This will be a randomized, placebo-controlled, double-blind Phase I trial. Some patients will be receive the medicine and some will receive a placebo, and patients or their doctors won't be informed who received it and who didn't.
If the treatment appears to be safe, the company would move to the next phase of testing in a matter of weeks. The second phase of the trial will involve a larger number of patients, including patients who are not hospitalized, and will test whether the therapy is effective.
The company also plans to study the drug as prevention. The treatment could be used for vulnerable patient populations for whom vaccines might not be a great option, such as the elderly or people who have chronic disease or compromised immune systems.
Eli Lilly has already begun manufacturing the antibody therapy in large quantities so it could be tested and potentially for use in patients beyond the trial. Under non-pandemic circumstances, the companies would usually wait to find out if it worked first before it started making it.
"If it does work, we don't want to waste a single day, we want to have as much medicine as possible available to help as many people quickly," Skovronsky said.
In trials over the next several months, Lilly says it will test different mixtures of a few of the other antibodies scientists think might provide protection. The optimal scenario, though, Skovronsky said, is if they only need one antibody at a relatively low dose.
"The more antibodies are mixed together, higher doses, the more difficult it is to manufacture," Skovronsky said. "But if it has to be two antibodies, higher doses, or even three antibodies mixed together at higher doses, we'll do whatever it takes to make effective medicine for patients."
Other antibody therapies in development
Eli Lilly isn't the only company working on antibody treatments. Several US teams have cloned antibodies to Covid-19 and many are close to testing in patients. Regeneron Pharmaceuticals has said it hopes to start human trials this month and to have a treatment by the end of the summer.
"This approach definitely has promise and it is something we need," said Dr. Peter Hotez, a vaccine specialist at Baylor University School of Medicine who is not involved in this research. He said the challenge with Covid-19 is that there are two phases to the disease -- the initial viral infection phase and then the host response, or the inflammatory response. Generally, a treatment like this is more likely to be effective if a patient gets it early in the course of the illness, when the virus is still replicating.
"That's always the problem with treating Covid-19 with monoclonal antibodies -- if you wait until things are pretty far along, like including patients that are already on the ventilator, it may not have any clinical impact," Hotez said.
If it works though, it could also be useful if, for example, a patient in a nursing home tested positive for Covid-19, and such a treatment could be given to others at the facility; for a first responder that had just been exposed to a patient with Covid-19; or for health care workers, Hotez said.
One challenge Hotez noted: Monoclonal antibody therapies tend to be "pretty expensive," he said.
Typically, such treatments would take many years to develop, but Covid-19 treatments are on an accelerated schedule. Pharmaceutical companies have said that government approvals that normally take weeks have sometimes come within a day.
"It's really been a privilege to be able to operate in this kind of environment," Lilly's Skovronksy said. He said he and others in the pharmaceutical industry have wondered if the same collaboration and urgency could be applied to treatments for other diseases like cancer or Alzheimer's.
"For many of us, this feels a little like a moonshot or a Manhattan Project, where so many scientists are working together at breakneck speeds," Skovronksy said. "Surely there will be other advances that come of this."
Dr. Slaouis had an extensive web of financial interests, faces potential conflicts of interest, and should resign all drug and biotech board seats, U.S. Sens. Bob Menendez (D., N.J.), Elizabeth Warren (D., Mass.), and nine other Democratic colleagues urged in a letter to the White House. Slaoui should also disclose ties to firms making COVID-19-related products, and divest holdings in such firms, the senators wrote.
At the protest outside City Hall in support of George Floyd on Saturday, people were spaced more than 6 feet apart the recommended minimum for reducing the spread of the coronavirus. Most wore masks.
Could the protests here and elsewhere lead to a spike in COVID-19 cases? How about other recent outdoor events with large clusters of people, such as a Lake of the Ozarks pool party in Missouri on Memorial Day weekend?
The answer in either case will not be known for days, as symptoms from any new infections might not show up until two weeks after exposure.
There is one reason for cautious optimism: The events took place outside. Research to date suggests the coronavirus is far more likely to spread indoors, especially in poorly ventilated spaces.
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Yet Philadelphias own history suggests the open air is no guarantee. In 1918, a spike in deaths from influenza has been attributed to a parade that drew more than 200,000 attendees along Broad Street.
Joel Hersh, former director of the bureau of epidemiology at the Pennsylvania Department of Health, is among those worried that history may repeat itself.
The odds are not good that you would escape all these demonstrations without having somebody be positive, he said. I think its another disaster waiting to happen.
Should someone at any mass event later test positive, public health officials will have difficulty notifying individuals who may have been exposed, he said.
