Amid Ongoing COVID-19 Pandemic, Governor Cuomo Announces Eighth Region on Track to Hit Benchmark to Begin Reopening Tuesday May 26th | Governor Andrew M. Cuomo Skip to main content
After Meeting Contact Tracing Metric, Mid-Hudson ValleyWill JoinCapital Region,Western New York, Central New York, North Country, Finger Lakes, Southern Tier and Mohawk Valley Regions, Which Have Met the Seven Metrics Required to Begin Reopening
IfNumber of Deaths Continues to Decrease andTracing is Online,Long Island Could Reopen Wednesday,May 27th
State is Partnering with Advantage Care Physicians to Establish 15 New Testing Sites at Medical Centers Downstate
New York State Now Has More Than 760 Testing Sites
Reminds New Yorkers to Vote in the Wear a Mask New York Ad Contest by Monday, May 25th
Confirms1,772Additional Coronavirus Cases in New York State - Bringing Statewide Total to359,926; New Cases in50Counties
Amid the ongoing COVID-19 pandemic, GovernorAndrew M.Cuomo today announced that the Mid-Hudson Valley is on track to meet all seven metrics required to begin phase one of the state's regional phased reopening plan startingTuesday,May 26th,joining the Capital Region, Western New York, Central New York, North Country, Finger Lakes, Southern Tier and Mohawk Valley Regions. The Mid-Hudson Valleyhas now identified enough contact tracers to meet the state's guidelines, and the tracers are being trained in preparation for the Mid-Hudson Valley entering phase one, which includes construction; manufacturing and wholesale supply chain; retail for curbside pickup and drop-off or in-store pickup; and agriculture, forestry and fishing. On Long Island, the number of deaths is continuing to drop and contract tracing is coming online, and if this trend continues Long Island could be ready to open by Wednesday,May 27th. Business guidance for phase one of the state's reopening plan is availablehere. A guide to the state's "NY Forward Reopening" Plan is availablehere. The state's regional monitoring dashboard is availablehere.
Audio Photos
Governor Cuomo also announced the state is partnering with Advantage Care Physicians to establish 15 new testing sites at medical centers downstate, including testing centers in low-income and minority communities.NewYork State now has more than 760 testing sites across the state. The Governor also encouraged eligible New Yorkers to visitcoronavirus.health.ny.govto find a nearby testing site and get tested.
The Governor also reminded New Yorkers to vote in the state's Wear a Mask New York Ad Contest, which was launched by the Governor on May 5th and is being overseen by his daughter Mariah Kennedy Cuomo. New Yorkers can vote for the winning ad until Monday May 25th atWearAMask.ny.gov.The winning ad will be announced on Tuesday, May 26th, and that ad will be used as a public service announcement.
The numbers are going down every day and we're making real progress to stop the spread of this virus, and now we're focusing on reopening
"The numbers are going down every day and we're making real progress to stop the spread of this virus, and now we're focusing on reopening,"Governor Cuomo said."Reopening hasbeen different in differentregions all across the state, but each region has to meet the same criteria to reopen and we are keeping New Yorkers informed with where each region stands. We don't want a region to reopen before its ready, and the Mid-Hudson Valley Region has now met all the criteria necessary to begin reopening on Tuesday. Thishas been a tough situation, but New Yorkers are toughand we've shown how tough we really are here."
Finally, the Governor confirmed1,772additional cases of novel coronavirus, bringing the statewide total to359,926confirmed cases in New York State. Of the359,926total individuals who tested positive for the virus, the geographic breakdown is as follows:
County
Total Positive
New Positive
Albany
1,770
14
Allegany
44
0
Broome
485
17
Cattaraugus
78
4
Cayuga
76
3
Chautauqua
72
9
Chemung
136
1
Chenango
118
0
Clinton
95
1
Columbia
359
3
Cortland
38
1
Delaware
74
2
Dutchess
3,793
26
Erie
5,552
155
Essex
36
0
Franklin
20
1
Fulton
193
4
Genesee
191
2
Greene
217
2
Hamilton
5
0
Herkimer
100
5
Jefferson
72
0
Lewis
19
0
Livingston
114
0
JOHNSTON, Iowa University of Iowa health care officials want Iowans to keep on social distancing, washing their hands and wearing masks to help control the spread of the coronavirus pandemic.
We do have one final ask for everyone, Suresh Gunasekaran, CEO of University of Iowa Hospitals and Clinics, said during Gov. Kim Reynolds daily news briefing Friday. The improving circumstances in our state are because Iowans are doing their part practicing good safety habits such as maintaining social distancing, wearing masks, hand sanitizing. (We) encourage each and every one of you to keep that up as we continue well into our recovery.
Early on, Reynolds said, Iowa saw models projecting staggering numbers of positive cases, hospitalizations and deaths across our state that would threaten to cripple our health care system.
Reynolds said the states health care systems have not been overwhelmed, thanks to Iowans taking personal responsibility and the efforts of health care personnel, such as those at UIHC, who described efforts there to test more than 10,000 Iowans and serve patients with coronavirus-related symptoms.
As Iowa continues to open businesses, entertainment venues and school-sponsored summer activities, maintaining good social practices will remain vital.
16 deaths
Sixteen more deaths were reported Friday, including the first COVID-19 death in Cerro Gordo County. That brings the states total to 64 this week and 419 overall at the time of the governor's news briefing, according to the Iowa Department of Public Health. Three deaths were recorded in Dubuque County and two each in Polk and Marshall counties.
By Friday evening, the number of COVID-19 deaths had grown to 433, according to the IDPH's coronavirus website.
A Test Iowa site will open in Marshall County, along with sites in Sioux Center and Burlington, Reynolds announced.
A Test Iowa site in Sioux City that opened May 4 closed on Friday. Reynolds said one in 11 Woodbury County residents have been tested, with a majority of the tests being done by Sioux City-area health care providers, who will continue to provide testing.
Iowans are doing a great job. Continue to do what youre doing and were going to continue to see the positive outcome, Reynolds said.
Testing update
Key to that positive outcome, Reynolds said, will be an increase in the availability of testing.
As of this week, testing criteria now allows any Iowan to be tested, regardless of symptoms or potential exposure to the virus. First, they must complete an assessment at testiowa.com and schedule an appointment at a test site.
The expanded testing was announced Thursday and by Friday morning, 1,700 appointments had been scheduled.
As Iowans return to work in retail, food services and health care, first responders and law enforcement are at higher risk of exposure at work. The Test Iowa sites including one at Kirkwood Community College in Cedar Rapids are a resource that you can use at any time to ensure your health and well-being, the governor said.
Reynolds also reported that after 10 days of testing, she is no longer in modified quarantine after her meeting with Vice President Mike Pence, who was exposed to a staff member who tested positive for COVID-19.
Most at risk
The overwhelming majority of COVID-19 deaths are among older Iowans or those with underlying health issues. More than 50 percent of the deaths were residents of long-term care facilities, Reynolds said. Public health data shows there are 32 outbreaks and 219 deaths in long-term care facilities.
Of the 119,469 Iowans tested for COVID-19, 16,415 or 13.7 percent were positive.
As of Friday morning, Polk County had recorded 3,493 positive cases followed by Woodbury with 2,462, Black Hawk, 1,661, and Linn, 915. Polk also had the most deaths, 92. Linn had 74, Black Hawk, 37, Muscatine, 35, and Tama and Woodbury, 23 each.
Over the weekend, the state will be conducting planned system maintenance so some agency websites, including coronavirus.iowa.gov, may be down or not updating, Reynolds said. The websites will not reflect current information, which will be released via news releases.
Last week, President Trump stood in the Rose Garden and told the assembled press corps that hundreds of millions of doses of a coronavirus vaccine would be available by the end of 2020, just seven months away.
Its called Operation Warp Speed. That means big, and it means fast, Trump said.
Itd be a scientific miracle if a vaccine is ready by then. Developers face two mountainous hurdles on the path toward a coronavirus vaccine: proving that what theyre making is safe and effective, and producing it in vast quantities. Hurdling even that first barrier within a year would be an astonishing achievement. The fastest vaccine ever developed, approved for the mumps in 1967, still took four years.
Nearly everything about the COVID-19 pandemic is breaking the charts, and if there was ever a time for pharmaceutical companies to deliver on their promises, itd be now. Some vaccine development records have already been shattered: it only took 65 days from the time the coronavirus genome was posted online for the pharmaceutical company Moderna to inject the first clinical trial volunteer with an experimental vaccine. Now, more than 100 groups all over the world say theyre working on a coronavirus vaccine.
There are countless points in the vaccine development process where candidates could stall, fail, or fade away. One vaccine that looks safe in a small group of people might show side effects when its tested in a larger study. Another could only protect half of the people who get it from COVID-19 or offer a small amount of protection, but not enough to make a difference in the pandemic. A vaccine could work well enough, but be hard to manufacture quickly and in large quantities.
While there are scores of vaccine candidates in development, there are only a few ways for companies to make a vaccine. Each strategy has its own set of advantages or disadvantages, and keeping those in mind is one way to evaluate any bits of exciting or discouraging vaccine news.
The Verge talked to University of Colorado immunologists Rosemary Rochford and Ross Kedl to break down the likelihood that each vaccine strategy would make it over the finish line.
But before we jump into the types of vaccines, lets start with the basics:
Vaccines work by tricking your immune system into thinking that its being attacked by a virus. Your immune system then churns out antibodies that are honed to that virus. That way, if youre exposed to that virus in the future, your body can quickly squash it out before it makes you sick.
Triggering that immune response takes two main components: a bit of the virus so the body knows what its looking for and some kind of irritant to stir the immune system into action against that viral bit.
If I just put purified protein under your skin, nothing would happen. You have to get the immune system kicked up, Rochford says.
The different approaches to vaccine development package those two components in different ways. Rochford says its good to see developers working on all of the possible options. I think we need all hands on deck. Any way we can go at this. We have to throw everything at it and see what sticks, she says.
Heres a rundown of the four basic approaches scientists are throwing at the virus:
Gene-based vaccines are the much-hyped underdog in the race to create a coronavirus vaccine. Most of the vaccine candidates that grabbed headlines or sent the stock market soaring are gene-based. Moderna, which was the fastest to start testing its vaccine in volunteers in the US, has a gene-based vaccine. So does Pfizer, which is also in clinical trials.
Instead of directly delivering bits of virus to the immune system for target practice, gene-based vaccines give the body tools to make them on its own. The vaccines are made up of pieces of genetic material, either mRNA or DNA, that encode the instructions for making the protein. The mRNA or DNA then enters cells, which read the instructions and churn out copies of the protein for the immune system to rally against.
Rather than producing the vaccine outside the patient, you make the patient make their own vaccine, Kedl says.
Most of the coronavirus vaccines that use this method are introducing the gene that encodes a bit of protein on the outside of the virus called the spike protein. The virus depends on the spike protein to break into cells and replicate. If the immune system is trained to recognize and block that protein, the virus cant attack cells and continue to spread.
Pros: These types of vaccines are relatively easy for companies to make once they know the genetic sequence theyre targeting. Thats why Moderna was able to get a vaccine ready and start testing it in people so quickly. Theyre also easy to manufacture: if they work, companies could quickly generate millions of doses. From a manufacturing standpoint, if you could shift everything to a nucleotide system, that would be brilliant, Kedl says.
Cons: But despite their simplicity and decades of work, gene-based viruses are still largely experimental, at least for people. Theres never been a gene-based vaccine approved by the Food and Drug Administration. If a gene-based coronavirus vaccine makes it over the finish line, it would be the first of its kind.
mRNA and DNA vaccines sometimes work well in animals like mice, but they have previously sputtered out when theyre introduced to humans, Kedl says. He says it may be because these vaccines arent good enough at spurring the immune system to create antibodies.
Inactivated virus vaccines are the kind that you may have learned about in high school biology class. Scientists can take a virus and kill it with heat or radiation rendering it harmless, but still recognizable by the immune system. A handful of Chinese companies are developing coronavirus vaccines using this method. One company, Sinovac, showed that its vaccine could protect monkeys from COVID-19. Human trials are ongoing.
Pros: These types of vaccines have been around for decades, and scientists understand them well. Theyre the type of vaccine that Jonas Salk created to fight polio. This is sort of a bread and butter thing to do, Rochford says.
Because these vaccines contain the whole (but non-replicating) virus, theyre good irritants for the immune system. Its got bacterial cell walls and all sorts of viral capsules and proteins and things that stimulate immunity very robustly, Kedl says.
Cons: Unlike gene-based vaccines, though, inactivated virus vaccines are hard to make. Manufacturers have experience with them, but they have to grow and then zap massive amounts of virus. Its a slow process. Its really hard to scale up and create enough of that, Rochford says. The immunity generated by these types of vaccines also tends to fade, and people may need booster shots.
Whole virus vaccines are also more likely to come with side effects, like mild fevers or muscle soreness. But Kedl thinks that people will take some soreness if it means theyll be immune to COVID-19. Global tolerance to injection reactions is probably pretty high, he says.
A whole, live vaccine is one of the best ways to create long-lasting immunity. Thats the strategy used to make vaccines for the measles and the chickenpox. Theyre made from live but heavily weakened versions of the viruses. The viruses are so weak that they dont make you sick, but they still make your body think its infected and set off the immune system.
It takes a long time to alter a virus so that it becomes weak and safe enough to be used as a vaccine, though. To speed things up, vaccine developers arent even attempting to do that with the entire coronavirus. Instead, some teams are inserting sections of the coronavirus gene into weakened, live versions of other viruses.
These viruses, called adenoviruses, usually cause symptoms like diarrhea or pink eye. Scientists have already broken them down to a weakened state so that theyre harmless. The University of Oxford, which is promising vaccines by September, has built its candidate using an adenovirus.
These vaccines work a bit like the gene-based vaccines: the engineered adenovirus dumps a piece of genetic material from the coronavirus, usually the piece that encodes the spike protein, into cells. Then, the cells create copies of the protein. In this case, though, the adenovirus is in charge of activating the immune system which, because its a live virus, it does very well.
Pros: Because this vaccine is based on a weakened, but living, virus, the immune system mounts a strong response against it. When a live, attenuated, vaccine works, they tend to give you longer immunity and a more robust and more durable immunity, Kedl says. With these vaccines, one shot may be enough you wouldnt need a booster.
Cons: Even though we regularly use live virus vaccines, the adenovirus platforms are still experimental. Theyve never been used for infectious diseases. Theres also a concern, Rochford says, that some people may be immune to the adenovirus thats shepherding the coronavirus gene into the body. Adenoviruses circulate through the human population, she says. Even though research groups are using adenoviruses that are relatively uncommon, some people may have seen them before so the vaccine wouldnt work for them.
Protein subunit vaccines directly deliver the specific bit of the virus scientists want people to develop antibodies against (rather than the gene for the protein). For the coronavirus, in most cases, thats the spike protein. These vaccines contain copies of the spike protein and a bit of something to stimulate the immune system.
The HPV vaccine uses this method, and its the approach many scientists are taking in their efforts to create a universal flu vaccine.
Pros: Scientists are familiar with this approach, and its worked well for other types of diseases. We very much know exactly what we have to be going after, Kedl says. Because the vaccine only contains a piece of the virus, its also less likely to trigger side effects.
Cons: Because these vaccines only use a piece of a virus, they sometimes arent able to push the body to generate a strong enough immune response, even with a good irritant built in. People often need multiple shots to build up enough immunity to the disease. Thats why, for example, most people get multiple doses of the HPV vaccine. During a pandemic, creating enough vaccines to give each person one shot is already a challenge.
Building the protein is also a challenge, Rochford says. Developers have to make sure that the version of the spike protein they build has the same properties as the one thats naturally on the virus. Batching them up to scale is very challenging. Its not impossible, but its a challenge, she says.
Theres a long history in vaccinology of trying multiple approaches to the same end goal, Rochford says. Its particularly important for efforts to develop a coronavirus vaccine: no one knows which strategy or which vaccine candidate will work best.
Winnowing down the slate of candidates takes time. Companies are starting the laborious process of testing vaccines in increasingly larger groups of people, and theyll have to wait to see if someone actually develops immunity to a disease after theyre given a trial vaccine. You have to wait around, Kedl says. You cant speed that up. They also have to watch for any safety concerns, either short-term side effects or problems that crop up over time.
Testing dozens of options simultaneously, though, ups the likelihood that a few will be successful. Well probably need more than one to work. A single company with a single, effective vaccine wont be able to make enough to meet the demand of the entire world.
We have to spray it with whatever weve got and hope for the best, Rochford says. Hopefully, that best comes sooner rather than later.
A worker wipes down surfaces on a New York City subway car to disinfect seats during the coronavirus outbreak. The CDC is clarifying its guidance on touching surfaces after a change to its website triggered news reports. Andrew Kelly/Reuters hide caption
A worker wipes down surfaces on a New York City subway car to disinfect seats during the coronavirus outbreak. The CDC is clarifying its guidance on touching surfaces after a change to its website triggered news reports.
The Centers for Disease Control and Prevention is clarifying its guidance to prevent the coronavirus from spreading, hoping to clear up confusion over whether a person can contract the disease by touching surfaces that have the virus on them. The agency said "usability improvements," including a headline change on its webpage about preventing viral infection, seemed to trigger news stories saying its guidelines have changed.
"Our transmission language has not changed," CDC spokesman Benjamin Haynes told NPR.
The main source of the coronavirus's spread, the agency said, is through respiratory droplets from an infected person who coughs, sneezes or talks in close proximity to someone else.
"COVID-19 spreads mainly through close contact from person to person," Haynes said. "While it may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes, this is not thought to be the main way the virus spreads."
A number of news outlets, including The Washington Post, noted this week that the CDC had reorganized information on its page titled "How COVID-19 Spreads."
Last month, the page listed "Spread from contact with contaminated surfaces and objects" under its own subheading, just below a similar subhead on "Person-to-person spread."
The page now lists surfaces and objects in a new subsection titled "The virus does not spread easily in other ways."
On both the current version of the page and the older one, the CDC says of surface transmission, "This is not thought to be the main way the virus spreads, but we are still learning more about this virus."
The CDC said people should continue to clean and disinfect dirty surfaces that could be harboring the virus.
"Transmission of SARS-CoV-2 to persons from surfaces contaminated with the virus has not been documented," the agency says on its page about disinfecting surfaces. But it adds, "Current evidence suggests that SARS-CoV-2 may remain viable for hours to days on surfaces made from a variety of materials."
South Korean soldiers wearing protective masks sit at a temperature screening point at Incheon International Airport, South Korea, on March 9. SeongJoon Cho/Bloomberg via Getty Images hide caption
South Korean soldiers wearing protective masks sit at a temperature screening point at Incheon International Airport, South Korea, on March 9.
South Korea's Center for Disease Control has reassuring news about people with COVID-19 who test positive for the coronavirus weeks after their symptoms have resolved.
Health officials there studied 285 patients who tested negative for the virus after recovering, but weeks later tested positive again. The question in this and similar situations is whether a positive test in this circumstance means that these people can still spread the virus.
To find out, the scientists followed up with nearly 800 of those people's personal contacts, such as family members. They found no evidence that they had contracted the virus from the people who had a fresh positive result. The scientists also tried to grow the virus in secretions from these patients. They could not.
As a result of these findings, published online Tuesday, the South Korean CDC no longer recommends that people in this situation be isolated. Their contacts do not need to be quarantined, though health officials do plan to continue investigating cases of people who have tested positive again after having had a negative test.
The study is shedding some light on the natural course of COVID-19. It's providing hints, but not definitive information, about how to handle patients who continue to test positive for the coronavirus long after their symptoms have resolved.
The persistence of the virus in some people "seems to be a normal thing that happens," says Dr. Aaron Hess, an anesthesiologist at the University of Wisconsin School of Medicine and Public Health.
He and his colleagues encountered this conundrum as well. They were testing patients who had recovered from a bout of COVID-19 and had offered to donate blood plasma to use as part of an experimental treatment. The researchers tested a group of patients at least two weeks after they had recovered, just to make sure they weren't still producing virus. Eleven patients, representing 13% of their sample, still tested positive, "and this was a little surprising," he said.
The test, known as PCR (for polymerase chain reaction), looks for genetic material from the virus. Both in the case of the Wisconsin study and that from South Korea, the level of genetic material from the virus in the sample was very low, Hess notes. That's consistent with the idea that it's simply biological residue, not signs of an active viral infection.
"Having a positive PCR test after you've recovered in no way implies that you're infectious," Hess says. But it's still not clear when a positive result is worry-free.
It's also not clear whether health officials in the United States will change their procedures based on the results from South Korea. "Unfortunately, what we don't have here in the U.S. is the kind of widespread testing and systematic contact tracing that might make you more confident in saying that you would be comfortable not re-isolating people who are positive," Hess says.
Scientists are trying to gather enough data about this to have more definitive answers about when it's safe for a recovered patient to go back to work or to return to a nursing home, even if the PCR test shows signs of the coronavirus.
"I think it's situations like this that are going to teach us a lot about all of the possibilities that surround the clinical infection of COVID-19," says Dr. Brian Conway, medical director of the Vancouver (Canada) Infectious Diseases Center.
Conway has been studying a related mystery. He has a patient who apparently recovered, only to fall ill again not just once, but twice.
After her initial bout with COVID-19, she was well for 10 days "and then developed very significant symptoms for another week," Conway says. She recovered again, but 10 days later she got the same symptoms. Again, she recovered, "and then finally has been better over the past week or 10 days."
The woman lives with four other people who were sick with COVID-19. "An interesting possibility that needs to be considered is that she passed the infection on to them. They became sick. She became well, then they passed the infection back to her," he says.
Conway is trying to figure out whether she actually caught the disease three times or whether she's had one continuous but highly variable infection. He is planning to test blood samples from her taken during the course of the disease to see what he can learn.
The case is apparently rare. There are only a few reported in the scientific literature, including one from Italy and a report from China. So most people who have recovered from COVID-19 shouldn't fret. But unusual cases often shed light on the biology of a disease.
One pressing question is whether COVID-19 will end up being more like coronaviruses that can cause colds. For that disease, immunity fades quickly and reinfection can follow. Alternatively, it could be more like the measles, which usually causes a single bout of disease followed by a lifetime of immunity.
There may also be clues that apply to vaccine development, Conway suggests. "There may be different kinds of antibodies that provide different kinds of protection," he says. That could be valuable information for vaccine developers.
Conway says as of now, his patient and her family are all better. "Let's see what we can learn from this, to help us understand not only how the virus behaves, but how to counsel similar family units going forward."
You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.
People wait in line to get food distributed by the National Guard in Chelsea, Mass., on April 16. Harvard researchers found areas with more poverty, people of color and crowded housing had higher mortality rates for the coronavirus. Joseph Prezioso/AFP via Getty Images hide caption
People wait in line to get food distributed by the National Guard in Chelsea, Mass., on April 16. Harvard researchers found areas with more poverty, people of color and crowded housing had higher mortality rates for the coronavirus.
Much is still unknown about the coronavirus, including a full picture of perhaps its most important impact: who it has killed.
The Centers for Disease Control and Prevention says that "current data suggest a disproportionate burden of illness and death among racial and ethnic minority groups." The death toll is also incomplete, because not everyone who dies of COVID-19 is counted under that cause of death, among other reasons.
Racial, ethnic and socioeconomic data about people who have died of COVID-19 are not all readily available either. So researchers at Harvard instead looked at the cities, towns and ZIP codes of people who have died of all causes. They compared the number of people who have died against what would be expected in a normal year, or "excess deaths."
What they found is "inequality on top of inequality," says Jarvis Chen, a social epidemiologist at the Harvard T.H. Chan School of Public Health.
The team of researchers looked specifically at Massachusetts. Areas with "widespread economic segregation and heavy concentrations of poverty, people of color, and crowded housing" had higher mortality rates compared with everywhere else from the beginning of the year through April 15, they found.
"These are communities in which people may be working 'essential jobs,' where they're unable to practice physical distancing," Chen tells NPR's Mary Louise Kelly.
"These are communities where people are living in crowded conditions so that if one person in a household gets infected, it's very difficult for them to isolate and protect the other people in their households," he explains. "These are also communities in which people may not be getting access to testing or to care. And so that increases their risk of dying if they do get infected."
Chen and his colleagues say the findings help governments and support groups target their efforts to stem the virus's spread over the next year.
"We're probably going to see more waves as we go through this next year. And so knowing what we did and what we did wrong the first time around will help us understand better how to direct the resources," Chen says.
"So, for example, creating resources for people in communities to be able to isolate. So housing or temporary housing for people who test positive so that they can protect their families is really important," he says. "Knowing where to direct PPE as it becomes more available so that not just the essential workers in hospitals, but also essential workers in things like public transportation or grocery store workers, those populations can get the PPE that they need. And also directing testing to communities who need it the most. Those things could be really important."
Listen to the full interview at the audio link above.
The ethical challenges that have arisen so far in the coronavirus pandemic largely boil down to the age-old struggle between individual freedoms and the public good. Issues like restricting movement and commerce to protect community health or requiring health care workers to treat infected patients, even at the risk of getting infected themselves, are specific examples of this larger dilemma. These debates, even in the United States where rugged individualism is celebrated, have been settled for the most part in favor of the common good.
Ethical questions in the next phase of the pandemic are bound to be more fractious. They will turn from our common goal of maximizing the greater good to brokering disagreements between individual groups that may not be so easy to resolve.
The development of a vaccine is bound to raise ethical questions like these: Who should get it first? How will we judge claims to it? How will we give priority to different groups or communities?
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These issues may come up sooner than expected. The biotechnology company Moderna has tested a new vaccine on eight patients that appeared to be safe and stimulated an immune response against SARS-CoV-2, the virus that causes Covid-19. Other vaccine candidates are in the pipeline. Oxford University scientists, for example, have announced they will begin testing of a new coronavirus vaccine in 6,000 volunteers. If the vaccine is effective, it could be available by early fall (though most experts say an effective vaccine wont be available till next year).
But as weve seen with viral testing kits, manufacturing and distribution problems will almost immediately create shortages, at least in the short term. To quickly manufacture the nearly 8 billion doses required to protect everyone on the planet will be impossible.
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When a vaccine comes on the market, the U.S. Centers for Disease Control and Prevention and other advisory groups will issue guidelines on who should get first dibs. The top tier will include health care and other workers whose jobs are considered essential in the pandemic. People most likely to die if stricken may also get priority.
But these are just guidelines. The ultimate decisions on who gets vaccinated will be made by state and local health departments and community hospitals interpreting the federal guidelines.
The decisions will be fraught, as different groups jockey for their place in line. There will be disagreements.
In Texas during the 2009 H1N1 influenza pandemic, for example, some health care providers werent sure if they should interpret vaccination guidelines from the CDC as giving priority to police officers and firefighters. Others in the state argued that school nurses and teachers should be in the top tier. Some senior citizens were perplexed that they werent considered a priority.
When we eventually reach the point of having a vaccine in hand but in short supply, I worry that disadvantaged communities, which have been among the hardest hit by Covid-19, will be left out. In state after state, black and brown communities are disproportionately infected and dying.
In New York City, for example, blacks and Latinos are dying at twice the rate of the general population. In Chicago, African-Americans account for nearly 70% of coronavirus deaths but make up 30% of the citys population. In Los Angeles, people in low-income neighborhoods are three times as likely to die as those in wealthier neighborhoods.
The reasons behind these differences arent fully known, but almost certainly include poor community infrastructure like lack of stable housing, lack of health insurance, and social segregation. Minorities tend to experience worse outcomes in a plethora of diseases; there was no reason to think that their outcomes in this pandemic would be any different.
Residents in these communities will need the vaccine as much as if not more than wealthy and connected citizens. To ensure they get their fair share, they will need representation to advocate for their interests when allocation decisions are made. They have the right to know how authorities will distribute the vaccine to their neighborhoods, as transportation problems may hinder their ability to go to hospitals or other vaccination sites.
If doctors are prioritized for getting the vaccine, will the delivery persons, grocery store clerks, and home health aides who often live in underserved communities also be given preference? Not giving due priority to these communities will only deepen their mistrust in the health care system that is already present and was worsened by debacles like the bungled rescue efforts after Hurricane Katrina.
Covid-19 does not respect borders. Rates of infection and deaths in countries in Africa have been lower than in Europe, Asia, and the United States, but there is every reason to believe they will eventually bear a disproportionate share, as they have from other infectious diseases over the past century. Poor countries have less money to buy vaccines and drugs even though they might eventually have more need for them. We must plan now to ensure they get their share of Covid-19 therapies.
Rationing antiviral drugs and other therapies has largely been absent in the U.S. during the Covid-19 pandemic, largely because no treatment has been shown to be of clear-cut benefit. That will change if and when a vaccine becomes available, and difficult choices will need to be made about allocation.
To meet that challenge head on, the CDC must develop a plan with input from the states to ensure that the vaccine is available wherever it is most needed and that disadvantaged communities in this country get their fair share. The plan must communicate clearly why certain groups will receive priority for early vaccination. It should also include a means to evaluate and rapidly redress grievances in the allocation process.
If we are to avoid worsening mistrust in health care and in government and possibly even social strife, we need transparent and ethical federal guidelines for distributing a Covid-19 vaccine now, before we must begin making the difficult decisions about allocating it.
Sandeep Jauhar is a cardiologist at Northwell Health in New York. His most recent book is Heart: A History (Farrar, Straus and Giroux, 2018).
Novel coronavirus disease 2019-nCoV
Moderna is front and center in the race to develop a vaccine for Covid-19. In a press release on Monday it stated, With todays positive interim Phase 1 data and the positive data in the mouse challenge model, theModernateam continues to focus on moving as fast as safely possible to start our pivotal Phase 3 study in July and, if successful, file a BLA (Biologics License Application).
The company has also been cited by Dr. Anthony Fauci who expressed "cautious optimism" Friday about the initial results from a coronavirus vaccine trial which were widely celebrated this week and said it remains "conceivable" that a vaccine for the deadly pathogen could be available by the end of the year per an NPR report.
[I am not in a position to offer judgment on the medical aspects of Modernas trial results and outlook. What I am providing are the historical financial results of the company, how the stock is valued and what it could mean for the shares.]
Historical financial results
Moderna has not sold any products to generate revenue. It has relied upon collaboration revenue from other companies and grants to fund its research. These are perfectly fine ways to generate revenue, but at some point in time the company needs to successfully develop products that can be sold. The company has 23 mRNA development candidates in its portfolio with 13 in clinical studies.
Moderna development pipeline
Below are 2016 to 2019 revenue, net losses and operating cash flow results.
Its revenue stream is erratic
2016: $108 million
2017: $206 million
2018: $135 million
2019: $60 million
Average the past four years: $127 million
Bottom line losses are growing
2016: $(230) million
2017: $(270) million
2018: $(402) million
2019: $(514) million
Negative operating cash flows means capital must be consistently raised
Deferred revenue between 2016 and 2017 essentially offset each other.
2016: Positive $164 million
2017: Negative $(162) million
Without the deferred revenue imbalance cash flows were
2016: Negative $(97) million
2017: Negative $(169) million
2018: Negative $(331) million
2019: Negative $(459) million
At least it doesnt have any debt
As of December 2019 Moderna had just over $1.1 billion in cash and short-term investments and an additional $160 million in long-term investments. Its total assets were $1.6 billion versus only $415 million in total liabilities, with no debt. Its balance sheet is strong but given its large negative cash flows it needs to be.
Shares are valued at 25.6x its market cap to revenue
Since the company is losing money using a PE ratio doesnt work, so the fallback is to use a market cap to revenue ratio.
Moderna had 353.1 million shares outstanding as of its March quarter results and 371.2 million as of April 30, per its 10-Q filing. With the stock closing at $69 on Friday its market cap is $25.6 billion.
Determining what revenue to use for the analysis is a bit challenging. In the March quarter the company only generated $8.4 million in revenue vs. $16 million a year ago. It did receive $483 million from the U.S. governments BARDA (Biomedical Advanced Research and Development) group in April for its Covid-19 work, but expects its coronavirus expenses to essentially match the amount of this grant.
There are multiple vaccines that generate over $1 billion in sales per year and Mercks total vaccine business generated $8.4 billion in revenue last year, according to Bernstein.
Assuming that Moderna can successfully develop and manufacture a vaccine for Covid-19 this analysis uses $1 billion in revenue per year for the company. It could be higher than this, but there could also be multiple vaccines available and Moderna may not be successful.
Using $1 billion the companys market cap to ratio would be 25.6x.
Concept of SARS-CoV-2 or 2019-ncov coronavirus
How does this compare to other pharmaceutical companies
This is a bit of an apples to oranges comparison since Moderna is and will be much smaller but will have a higher growth rate than these large companies. However, it does provide some reference on how highly valued Moderna is. These figures are based on 2019 revenue and Fridays market caps.
ABBV
AstraZeneca
Genetech/Roche
Merck
Pfizer
These 5 companies market cap to revenue average is 4.8x.
Modernas share price could be 60% too high or just about right
Giving Moderna a 10x market cap to revenue ratio would be just over twice the 4.8x valuation of the five large pharmaceutical companies. At a 10x ratio and using $1 billion in revenue per year gives a $10 billion market cap. Unfortunately, at Modernas current share price of $69 it has a market cap of $25.6 billion or 156% higher than the calculated value.
If it was valued at 10x revenue the share price would be $27, or lower by 61%, or where it was in March. To support the current share price with a 10 times market cap to revenue ratio the company will need to consistently generate $2.6 billion in revenue per year or at least be on a path to this level.
Getting there may be doable. It could come from a higher revenue stream from a very successful Covid-19 vaccine or a combination of the other 22 mRNA development candidates in the companys pipeline.
It does appear that the share price increase above $25 in the March timeframe is largely or entirely due to its work on its coronavirus vaccine. If that is the case the increase from $25 to $69 has added $16 billion in market cap. Working back using a 10x market cap to revenue ratio would mean that Modernas Covid-19 revenue will need to reach $1.6 billion in revenue per year. Of course a higher valuation multiple will lower the revenue bar, but a lower valuation multiple would raise it.
Moderna stock price
Scientists have warned there could be major delays in producing a Covid-19 vaccine if current UK infection rates remain low and lengthy waiting times are needed to show if candidate products are working. As a result, some researchers insist that ministers must now consider implementing radical alternative measures to speed up vaccine development.
In particular, they argue that Britain should consider deliberately infecting volunteers involved in vaccine-testing projects in line with World Health Organization proposals to set up such human challenge trials. Earlier this month, the WHO issued a 19-page set of guidelines on how these trials might operate.
However, other UK scientists have reacted with horror at the proposal to implement human challenge trials for a Covid-19 vaccine on the grounds that these could cause serious illness and possibly deaths of volunteers who had been deliberately infected with the virus.
The dilemma was summed up by Jonathan Ives of the Centre for Ethics in Medicine at Bristol University. If we were to do this, we would be asking healthy people to put their wellbeing and their lives at risk for the good of society at large. On the other hand, taking that risk could speed up vaccine development and save many, many lives. So I think there could be grounds for going ahead with challenge trials, though it would be based on a very finely balanced argument.
Figures released last week suggest about 7% of the UK population may have already been infected with Covid-19 virus, a relatively low level of infection that poses problems for testing vaccines. A sufficient number of volunteers has to be exposed to the virus to see if a vaccine protects them or not. But if their chances of being in contact with an infected person are low, it will take a long time to demonstrate the efficacy of a vaccine candidate.
As a result, scientists have proposed that human challenge trials could be introduced to test a vaccine quickly and so save thousands of lives by preventing future infections. Levels of infection in the community are already low, and if this virus behaves like other respiratory diseases and coronaviruses, there may be even lower levels over the summer, said Professor Lawrence Young of Warwick University Medical School. There will not be enough people secreting the virus to be in contact with volunteers in vaccine projects. It is just not going to work.
Young argues that human challenge trials should be considered very seriously for the UK. These would involve giving volunteers either a placebo or a vaccine, as is normally done in trials. But instead of waiting to find out how the two groups fare without interference, scientists would deliberately infect them with the Covid-19 virus. This would very quickly show if a vaccine works or not.
Only very healthy young people around the age of 25 who have given informed consent would be used, added Young, who points out that such trials have already been used to test the efficacy of vaccines for flu and the common cold.
Only very healthy young people around the age of 25 who have given informed consent would be used
However, these ailments pose relatively low risks to volunteers. Covid-19 can have serious side-effects, mainly for the elderly but also in a few rare cases of young, apparently healthy people. This point is acknowledged by Young. Before we went ahead with challenge trials, we would need to have developed some very effective therapy an anti-viral drug perhaps that could be used in the few cases where something went seriously wrong.
This latter point has been stressed by WHO in its guidelines for human challenge trials. It suggests the least risky group to infect would be those aged 1830 years. Only 1% of this group end up hospitalised with Covid-19, while fatality rates are around 0.03%. Challenge studies should then be conducted in specialised facilities, with especially close monitoring and ready access to early supportive treatment for participants, add the guidelines.
The idea of carrying out human challenge trials for a Covid-19 vaccine was also backed by Professor Arpana Verma, of Manchester University. Vaccines give us the ability to protect the most vulnerable people in society. That is one of their key strengths. So I think it would be entirely justifiable to go ahead with such trials.
But the proposal was firmly opposed by immunologist Professor Eleanor Riley of Edinburgh University. Challenge studies are done for many diseases but only when strict criteria are followed. Firstly, the virus should be really well studied and its clinical behaviour understood in detail. It should also be incapable of causing severe illness in healthy individuals, or there should be a highly effective drug to clear the infection. None of these criteria are met for Covid-19, and I would be very concerned to hear challenge studies were being planned.
The crucial point is that we should be thinking now whether we want to go ahead with human challenge trials, said Young. We shouldnt wait until we have a vaccine candidate on our hands and not know what to do with it.
A new survey by Yahoo News and YouGov has found that 44% of Republicans believe that Bill Gates will use the COVID-19 vaccination to implant a location-tracking microchip into the vaccine recipient, a conspiracy theory that has gained traction among fringe groups and conservative pundits.
The survey also found that 26% of Republicans do not believe the false microchip vaccine narrative, while 31% remained undecided on the topic. Half of the people surveyed who use Fox News as their main source of TV news also believe the debunked theory.
However, the poll also noted that 19% of Democrats, 24% of Independents, and 15% of people who use MSNBC as their source of TV news also believe the microchipping myth.
For the survey, YouGov conducted an online interview of a "nationally representative" group of 1,640 US adults who were a part of YouGov's opt-in panel between May 20 and 21. There is about a 3% margin of error.
An earlier Yahoo News and YouGov poll also found that only 55% of Americans surveyed would want the coronavirus vaccine when it becomes available. The rest were either unsure (26%) or did not plan on receiving the vaccine (19%).
President Donald Trump has said that he is "very confident" that a coronavirus vaccine will be ready by the end of the year, while experts have predicted that the vaccine development could take up to 12 to 18 months to prepare.
Mike Cohen/Getty Images for The New York Times
According to data by media analysis group Zignal Labs, over 16,000 posts on Facebook related to Bill Gates and coronavirus vaccine misinformation have been liked and commented almost 900,000 times, the New York Times reported in April.
However, Facebook isn't the only platform used to spread these conspiracies. On YouTube, the 10 most popular videos about Gate's purported microchipping vaccine have received over 5 million views, according to the same New York Times and Zignal Labs report.
On Twitter, images and tweets describing Bill Gates as a "deep state puppet" who wants a vaccine in order to control the population are also being posted and circulated.
These social media platforms have tried to take steps to curtail the anti-vaccination or coronavirus misinformation movement on its website. On May 11, Twitter announced that it would start labeling "misleading" coronavirus information. Last year, YouTube announced that it would demonetize videos on its platform that are pushing the anti-vaccine agenda.
YouTube and Facebook also recently took down the 26-minute "Plandemic" movie from its platforms. The debunked film featured discredited scientist Judy Mikotivs' claims that the US and vaccine companies created the coronavirus pandemic for profit.
However, the Bill Gates conspiracy theorists don't just live online in the form of bots and fringe theorists on social media. Public figures like Roger Stone and Laura Ingraham have also been pushing this same message.
Bill Gates has been a longtime supporter of vaccinations, and so far, Gates has donated $300 million to coronavirus vaccine efforts, according to Vox.
