Buyer Beware: Covid-19 Vaccine Maker Moderna Is Valued In The Stratosphere – Forbes

As Indian firms scramble to develop a vaccine for coronavirus, experts feel that research in the country is still at a nascent stage and any concrete breakthrough is not likely within a year.

The Indian government and private firms have stepped up efforts to develop a vaccine to halt the spread of COVID-19 which has claimed over 3,700 lives with more than 1,25,000 cases in the country.

PM CARES Fund Trust has decided to allocate Rs 100 crore for support to coronavirus vaccine development efforts.

Referring to a vaccine to fight the virus, a PMO statement had said that it is the most pressing need and Indian academia, start-ups and industry have come together in cutting-edge vaccine design and development.

The Department of Biotechnology has been made a central coordination agency to identify pathways for vaccine development. Naming the Indian firms working on vaccines for COVID-19, Gagandeep Kang, executive director of the Translational Health Science and Technology Institute, Faridabad, had said last month that while Zydus Cadila is working on two vaccines, Serum Institute, Biological E, Bharat Biotech, Indian Immunologicals, and Mynvax are developing one vaccine each. The WHO has listed Serum Institute of India, Zydus Cadila, Indian Immunologicals Limited and Bharat Biotech from India among the firms involved in developing a vaccine.

Leading virologist Shahid Jameel said Indias vaccine manufacturing capacity is quite remarkable and at least three Indian companies - Serum Institute, Bharat Biotech and Biologicals E are at the forefont, working with international partners to manufacture a vaccine for COVID-19. Research on a COVID vaccine in India is at a very early stage of development and any candidates are likely to reach animal trials only by the end of the year, he told PTI. However, Indian vaccine companies have a lot of capacity and expertise, and are likely to play a significant role in bringing new COVID-19 vaccines to the market. This experience is important for institutions, industry and regulators to work together, and prepare for the future, said Jameel, a Shanti Swarup Bhatnagar Prize winner for Science and Technology and the current Chief Executive Officer of Wellcome Trust/Department of Biotechnologys India Alliance.

CSIR-Centre for Cellular & Molecular Biology (CCMB) Director Rakesh Mishra said, From what we know, we are not at an advanced stage of vaccine development at the moment. There are lots of ideas and companies initiating vaccine development process but there is nothing on trial in terms of vaccine candidates, he told PTI.

There are many efforts going on with different approaches like somebody wants to use the whole virus or a particular protein so there are multiple processes being deployed, he said.

Many Indian companies are collaborating with foreign institutions.Other countries are at much advanced stage than us. Some are going into third stage trials. There is no company testing vaccine in India yet and they are in the pre-clinical stage of preparation, he said.

India is quite behind because of a number of reasons like the coronavirus came to India two-three months later so we did not have the (inactivated) virus to test or even the urgency, Mishra said, adding that the Chinese and US are quite ahead in the vaccine development. If a comparison has to be made we are well behind international efforts, he said.

The novel coronavirus strain was isolated and characterised at the Indian Council of Medical Researchs National Institute of Virology, Pune, and the vaccine candidate has been transferred to Bharat Biotech International Limited (BBIL) to develop a fully indigenous vaccine for COVID-19. Once the vaccine is ready it will go for animal trials to be followed by human clinical trials to assess its safety and efficacy which will take at least one year, a senior ICMR official told PTI.

The BBIL is working towards developing killed virus vaccine which usually provides good immunogenicity, the official said, adding that by entering the body it will create antibody against the infection.

The polio drops which are given to children have live attenuated virus, while the polio injection contains killed virus, the official said explaining the different approaches used in developing a vaccine.

The BBIL is continuously working in this direction and as soon as they get the right formulation they will move towards animal challenge studies followed by human clinical trials, the official said.

Kang, in a webinar held by India Alliance, said there are two separate aspects that relates to vaccines of COVID-19, one is to use existing products and the second is to see if new vaccines can be made. In terms of projects to develop vaccines there are around 90 plus projects around the world that have initiated to develop new vaccines which use different kinds of technologies. Some are using old technologies like make an inactivated virus and spike protein and other using new technologies that allow you to respond rapidly like using messenger RNA vaccines, Kang said.

Every new technology is being applied for making COVID-19 vacines, he said.

The Indian firms along with their foreign collaborators are racing against time to develop a vaccine against COVID-19 with over 52 lakh cases and over 3.35 lakh fatalities across the globe. PTI UZM/PLB/ASK ZMN

We need vaccines, immunologist Jacob Glanville says. He knows about combating infections; the fast-talking, curly-haired former Pfizer staff scientist has spent years searching for a universal flu vaccine, and his San Francisco-based startup Distributed Bio spearheads a variety of vaccination projects. As one might expect, his team is working diligently to find biopharmaceutical tools to fight Covid-19, but heres the twist: Its opting out of the scientific communitys sprint to find a vaccine. Instead, Distributed Bio is part of a parallel coronavirus research scramble: the hunt for antibody treatments.

Along with a wide mix of research teams in laboratories across the world, Glanville is pursuing antibody treatments as a complementary tool to fight Covid-19. Unlike vaccines, antibody treatments dont produce lasting protection against a disease. Instead, these treatments are meant to equip bodies with tools to immediately (albeit temporarily) fight off an infection, or prevent an imminent contagion.

This is partly a matter of timing. Vaccines take forever, Glanville says. Traditional trials require administering the vaccine to healthy people, then observing whether they develop immunity. Proving efficacy necessitates waiting. And waiting. Even though buzzy biotech companies like Moderna have managed to leap into human trials in a matter of months, many researchers still doubt the optimistic immunization timelines put forth by politicians and pundits. I think antibodies have a faster pathway to deployment, says Robert Carnahan, the associate director of the Vanderbilt Vaccine Center, which is also working on its own antibody treatment research. We either let everybody get the disease or we get a vaccine, and antibodies can bridge us to that moment where we have it.

When exposed to viruses, immune systems create antibodies, proteins that protect the body from foreign substances. This is happening to people who are fighting SARS-CoV-2 around the world. The antibodies linger in their blood after symptoms subside, protecting them from further infection. Right now, the blood plasma from recovered coronavirus patients can be transfused into people who are currently fighting the disease, as a way to introduce effective antibodies into their systems. Using blood from recovered patients to fend off disease is an old treatment, and convalescent serum has been used to treat MERS, SARS, and Ebola patients. So far, it appears convalescent serum can help people who are infected with Covid-19 recover. However, it has several major drawbacks. The most obvious is a matter of scale. Theres a finite supply of convalescent blood in the world, so it simply isnt possible to harvest enough of it, even if every single previously infected person happily gave blood every week. Collecting and distributing the blood is also a complicated, labor-intensive process.

And there's another problem, which is that the process just isn't that efficient. Each donor's blood would contain antibodies to a wide swath of previous infections, not just Covid-19. So the number of antibodies in their serum that can actually fight this particular virus might be very low. Antibody treatments apply the logic of convalescent serum and refine its concept by creating more targeted, potent, and scalable versions of the kinds of antibodies we produce that can banish Covid-19, produced en masse in labs rather than drained from human arms. Ideally, the treatment process itself would also be much less cumbersome than the serum infusion. You might be able to do a subcutaneous injection, like an outpatient procedure, Glanville says.

Read all of our coronavirus coverage here.

Of course, the therapeutic dose is currently only a hypothetical. Scientists are still in the arms race portion of their research, and its not clear which type of antibody treatment will pull ahead. Many already believe they have pinpointed effective antibodies and have evidence that they can neutralize Covid-19. But they still need to make sure the antibodies that look promising in a laboratory setting will work when introduced into infected animals, and then that they will work when introduced into infected humansand then that they can be mass-produced in a safe, cost-effective, and timely manner. There are a lot of different approaches that people are trying, all of which hold promise, says Yale University chemistry professor David Spiegel, who also cofounded a New Haven-based pharmaceutical company called Kleo Pharmaceuticals. It's experimental science.

From a spike in domestic violence and restricted access to family-planning services to disproportionate economic impact, the lockdown measures put in place to stop the outbreak are hurting women and their basic rights a lot more than men. Previous epidemics of Ebola and Zika have resulted in major setbacks for women and girls in the regions most affected by the outbreaks -- and experts and activists are warning the same thing is happening globally right now.

A CNN analysis earlier this year found that in the countries for which data was available, men were 50% more likely than women to die after being diagnosed with Covid-19. But experts say focusing purely on health data is dangerous.

"We think about this crisis in very narrow terms, only focusing on the health impacts, but we're missing the bigger picture," said Julia Smith, a researcher at the Simon Fraser University in Canada. Smith is working on a multi-year project looking at the wider impact of the pandemic.

"Men are having worse health outcomes if they become infected, but when we think about the secondary impacts, here we see that women are being disproportionately affected," she added.

Smith said that when marginalized groups are underrepresented at the decision-making table, their rights and needs are often forgotten. "And unfortunately, women's rights are almost always an afterthought in any crisis situation," she said.

Many activists say it was painfully obvious that such abuse would increase in a lockdown situation. Numerous studies have shown that stressful events such as economic downturns or natural disasters often lead to higher instances of gender-based violence.

"When we think about pandemic preparedness, the same way we should be thinking of having enough front-line health workers or protective equipment, we should be thinking about any quarantine or social distancing measures having impact on gender based violence, especially within the family."

"But these women have already experienced the violence ... we need to respond to the issue before the rates go up," Smith said.

This has potentially dangerous effects. Studies have shown that the number of stillbirths and maternal deaths increased in some countries hit by Ebola, because women were unable to access the appropriate services.

And the lack of access to family planning has long-term consequences that will be felt beyond the pandemic, according to Lunz. "Whenever women do not have control over their own bodies, over how many children they want and when they want to have a family, these women and their children and their families are kept in poverty."

"A lot of the industries that are being most affected by the outbreak -- tourism and other service industries, care work sector -- those industries tend to be dominated by women," Smith said.

And while many countries have stepped in to provide help to people who lost their jobs, many women are likely slipping through the cracks. "When you think about economic recovery, we'll need to consider that bailout packages focus just on formal employment and women are disproportionately informal workers, so we need to think about how should we be targeting them," O'Donnell said.

At the same time, many more women than men have found themselves on the front lines of the battle against the virus. According to the World Health Organization, 70% of the global health and social care workers are women.

Women around the world are also still responsible for the majority of unpaid childcare and housework. According to estimates by the UN, women spend on average 4.1 hours a day doing unpaid care and domestic work, compared to 1.7 hours spent by men.

Single parents, most of whom are women, are hit hardest by school closures. Lunz said the crisis will likely affect women's careers in the long term, setting back the quest for equality. "What we know from history, when women do not have access to resources and are not independent and cannot sustain themselves, they are dependent on someone else."

"Autocratic leaders and toxic leaders are always the biggest threat to women's rights," Lunz said.

"That is what history shows, and that's what we are seeing now, looking at Viktor Orban for example, it was last week that the parliament in Hungary, where his party has a majority, passed the law which restricts the country from making the Istanbul Convention from becoming law." The Istanbul Convention is the world's first legally binding treaty entirely dedicated to combating violence against women.

"The whole situation is crazy," Marbn Castro said. "Before we put in a measure, we have to think how it's going to affect all the people in our society -- women, children, minorities, homeless people ... this has not happened, the measures have been put in for and by middle-aged men who are not thinking about anyone else."

Reporting was contributed by Julfikar Ali Manik, Ian Austen, Peter Baker, Nicholas Bogel-Burroughs, Jos Mara Len Cabrera, Stephen Castle, Damien Cave, Michael Cooper, Steven Erlanger, Tess Felder, Jacey Fortin, Jeffrey Gettleman, Abby Goodnough, Denise Grady, Maggie Haberman, Christine Hauser, Mike Ives, Jennifer Jett, Yonette Joseph, Sheila Kaplan, Annie Karni, Gina Kolata, Anatoly Kurmanaev, Mark Landler, Judith Levitt, Ernesto Londoo, Louis Lucero, Sarah Mervosh, Raphael Minder, Zach Montague, Sharon Otterman, Richard C. Paddock, Tariq Panja, Elian Peltier, Daniel Politi, Suhasini Raj, Adam Rasgon, Stanley Reed, Luis Ferr Sadurn, Edgar Sandoval, Choe Sang-Hun, Marc Stein, Matt Stevens, Sheryl Gay Stolberg, Sabrina Tavernise, Katie Thomas, Anton Troianovski, Hisako Ueno, Shalini Venugopal, James Wagner, Sui-Lee Wee, Noah Weiland, Jin Wu and Elaine Yu.

What you need to know this weekend:Texas reports 54,509 cases and 1,506 deaths

[4:45 p.m.] Texas reported 1,060 more cases of the new coronavirus Saturday, an increase of about 2% over the previous day, bringing the total number of known cases to 54,509. Ward County reported its first case Saturday; over 85% of the states 254 counties have reported at least one case.

Harris County has reported the most cases, 10,526, followed by Dallas County, which has reported 8,477 cases. See maps of the latest case numbers for each county and case rates per 1,000 residents.

The state has reported 26 additional deaths, bringing the statewide total to 1,506 an increase of about 2% from Friday. Harris County reported one additional death, bringing its total to 217 deaths, more than any other county.

As of Saturday, 1,688 patients are known to be hospitalized in Texas. Thats an increase of 110 patients from Friday. At least 870,935 tests have been conducted. Chris Essig

[4:05 p.m.] An outbreak at a recently opened immigrant detention center outside of Abilene has left more than one-quarter of its residents infected with COVID-19, the El Paso Times reported Saturday.

The outbreak at the Bluebonnet Detention Center in rural West Texas is the second-largest among the nation's 49 immigration detention centers that have seen positive cases.

The center, originally meant to be a state prison, opened just before Christmas and is run by Management and Training Corp., or MTC, and houses 417 men and women. Of those, 111 have tested positive, along with six of the center's 118 staff members, the newspaper reported.

Previous detention center outbreaks have led to strained relations between local leaders and private contractors in Texas. Earlier this month, Frio County commissioners demanded answers from officials with the GEO Group after the virus took hold at the South Texas ICE Processing Center in Pearsall, south of San Antonio. Jeremy Schwartz

Houstons Museum of Fine Arts will reopen Saturday, becoming the nations first major art museum to do so since the coronavirus pandemic began, Texas Monthly reports. Among the planned safety measures are required masks for visitors older than 2, temperature checks, and museum staff opening and closing all doors. The 300,000-square-foot building will be open to 900 visitors at a time, or 25% of its capacity, and 6 feet of social distancing will be enforced, according to Texas Monthly. Emily Goldstein

Have they been anywhere? Have they been afraid to go out of their house? This is a scam by the Democrats to steal the election.

Texas is expected to release its latest coronavirus figures Saturday afternoon. The state reported 1,181 more cases of the new coronavirus Friday, an increase of about 2% over the previous day, bringing the total number of known cases to 53,449. It also reported 40 additional deaths, bringing the statewide total to 1,480 an increase of about 3% from Thursday. See maps of the latest case numbers for each county and case rates per 1,000 residents.

Some White House officials suggest deaths are overcounted. Experts disagree.

As the United States continues its advance toward 100,000 coronavirus deaths, a grim milestone the country is expected to reach in the coming days, President Trump and members of his administration have begun questioning the official coronavirus death toll, suggesting the numbers are inflated.

Last Friday, Mr. Trump told reporters that he accepted the current death toll, but that the figures could be lower than the official count, which now totals more than 95,000.

Most statisticians and public health experts say he is wrong; the death toll is probably far higher than what is publicly known. People are dying at their houses and nursing homes without ever being tested, they say, and deaths early this year were likely misidentified as influenza or described only as pneumonia.

Dr. Deborah L. Birx, the White Houses coronavirus response coordinator, has said publicly that the American health care system incorporates a generous definition of a death caused by Covid-19.

There are other countries that if you had a pre-existing condition, and lets say the virus caused you to go to the I.C.U., and then have a heart or kidney problem some countries are recording that as a heart issue or a kidney issue and not a Covid-19 death, she said at a White House news conference last month.

In a brief interview on Thursday, Dr. Birx stressed that there had been no pressure to alter data. But concerns about official statistics are not limited to the death toll, or to administration officials.

Epidemiologists said they were stunned to learn that the C.D.C. is combining tests that detect active infection with those that detect recovery from Covid-19 a system that muddies the picture of the pandemic but raises the percentage of Americans tested as President Trump boasts about testing.

Experts said that data from antibody tests and active virus tests should never be mixed.

It just doesnt make any sense, said Natalie Dean, a biostatistician at the University of Florida. All of us are really baffled.

Epidemiologists, state health officials and a spokeswoman for the C.D.C. said there was no ill intent; they attributed the flawed reporting system to confusion and fatigue in overworked state and local health departments that typically track infections not tests during outbreaks.

Trump demands that governors let houses of worship reopen.

President Trump stepped into the culture wars again on Friday, taking the side of some religious leaders against governors who have moved slowly in reopening places of worship amid the pandemic.

Without any clear authority to do so, Mr. Trump said that he was calling houses of faith, including churches, synagogues, and mosques, essential services and urged governors to reopen them right now.

Today I am identifying houses of worship churches, synagogue and mosques as essential places that provide essential services, Mr. Trump said at a hastily scheduled briefing at the White House on Friday. Some governors have deemed liquor stores and abortion clinics as essential but have left out churches and other houses of worship. Its not right.

After he spoke, the Centers for Disease Control and Prevention issued a number of long-delayed guidelines with suggestions for steps that houses of worship can take to curb the spread of the virus. Among them was a recommendation that religious officials defer to the directive of state and local governments.

Still, the president threatened to override the governors if they did not follow his order, though it was not immediately clear what powers he was claiming. I call upon governors to allow our churches and places of worship to open right now, he said. If theres any question, theyre going to have to call me, but theyre not going to be successful in that call.

When the C.D.C. recently released a set of guidelines for reopening, its report largely mirrored an earlier draft version that the White House had rejected because Trump administration officials worried that the suggestions infringed on religious rights.

On Friday the C.D.C.s new guidelines for religious communities suggested that they consider a number of limitations to keep congregations safe. Among them:

Take steps to limit the size of gatherings in accordance with the guidance and directives of state and local authorities.

Consider suspending or at least decreasing use of a choir/musical ensembles and congregant singing, chanting, or reciting during services or other programming, if appropriate within the faith tradition. The act of singing may contribute to transmission of Covid-19, possibly through emission of aerosols.

Consider temporarily limiting the sharing of frequently touched objects that cannot be easily cleaned between persons, such as worship aids, prayer rugs, prayer books, hymnals, religious texts and other bulletins, books, shared cups, or other items received, passed or shared among congregants.

Mr. Trump said Friday at the White House that the nation needs religion. In America, we need more prayer, not less, he said. He left without taking questions.

David Postman, the chief of staff for Gov. Jay Inslee of Washington, said the state didnt know what the presidents comments meant and noted the state had not seen any formal order. We dont believe the president has the ability to dictate what states can and cannot open, Mr. Postman said.

Were not ready, she said. Honestly, that would be reckless. Its Friday. Theyre not ready.

States differ on their approaches to religious services during the pandemic.

It was not clear what authority President Trump was invoking on Friday when he called for governors to allow our churches and places of worship to open right now, and threatened to override them if they did not. Soon after he spoke, though, the C.D.C. issued guidelines urging faith leaders to take steps to limit the size of gatherings in accordance with the guidance and directives of state and local authorities.

States and localities have been taking a variety of approaches to religious services since the outbreak began.

Houses of worship were already allowed to operate in more than half of the states, though many remain under social distancing instructions and many individual churches, synagogues and mosques have decided to remain closed for safety.

There have been tensions in places that still have restrictions in place. In California, more than 1,200 pastors signed a declaration protesting the states restrictions on in-person services and pledged to reopen their churches by May 31 even if the restrictions are not lifted. Gov. Gavin Newsom, a Democrat, said Friday that the state was working with faith leaders on guidelines to reopen in a safe and responsible manner that would be released by Monday at the latest.

The states guidelines, which will distinguish between megachurches and smaller venues, deal with the configuration of pews and sanitation protocols, the governor said.

In Illinois, Gov. J.B. Pritzker said on Friday that he would continue to operate on the basis of science and data in deciding when it was safe for houses of worship to open.

Im as anxious as anybody to make sure that our churches, our mosques, our synagogues open back to where they were before Covid-19 came along, Mr. Pritzker said. Were gradually moving in that direction. But theres no doubt the most important thing is, we do not want parishioners to get ill because their faith leaders bring them together.

The presidents call to let in-person services resume came just before one of the biggest Muslim holidays of the year, Eid al-Fitr, which starts Saturday night.

Washington State currently allows drive-in services, where congregants remain in their vehicles, and allows houses of worship to bring in personnel to broadcast and stream videos of services. Officials there have been working with an interfaith group to develop guidelines on how religious institutions can safely open up for more in-person activities.

And in some states, houses of worships were never required to close. In Pennsylvania, religious institutions were exempt from a stay-at-home order, though Gov. Tom Wolf has advised religious leaders not to hold in-person services or large gatherings to protect people from the virus.

Gov. Gretchen Whitmer of Michigan, who on Friday extended the states stay-at-home order through June 12, has banned large gatherings but also said that houses of worship would not be subject to penalties, leaving the decision in the hands of religious leaders. Many churches, synagogues and mosques there decided to remain closed anyway, and those that are reopening often remain under strict guidelines, including limiting the number of congregants who could enter.

In hard-hit New York, Gov. Andrew M. Cuomo moved this week to allow religious gatherings of up to 10 people to resume as long as attendees wear masks and maintain social distance. The announcement was particularly significant for Jewish congregations, where a minyan, defined as 10 people over 13, is required for a worship service.

Birx expresses concerns about case levels in Los Angeles, Chicago and Washington.

One testing measure shows that coronavirus cases are persisting at worrisome rates in three major metropolitan areas Los Angeles, Chicago and Washington, D.C. that are still under stay-at-home orders, a top White House official said on Friday.

We have concerns of where cities have remained closed and metros that have remained closed but have still persistent high number of cases, Dr. Deborah L. Birx, the White Houses coronavirus response coordinator, told reporters at a news conference. She said officials from the Centers for Disease Control and Prevention were working with local officials in the three cities to really understand where these new cases coming from, and what do we need to do to prevent them in the future.

Dr. Birxs concern did not suggest that the case rates in the three regions were spiking to alarming new levels, but rather that they were not dropping at the same rate as in many other cities.

Dr. Birx singled out the Washington area which includes the district as well as parts of Maryland and Virginia and said it led the country in the percentage of positive test results, a measure different from total coronavirus cases. Among those who have tested positive is the former N.B.A. all-star Patrick Ewing, now the mens basketball coach at Georgetown University in Washington, who announced on Twitter on Friday that he had the virus.

Unlike New York, the Washington area has seen no dramatic decline in positive test rates or emergency room visits, Dr. Birx said.

Further complicating the picture, Mayor Muriel E. Bowser of Washington said on Thursday that the city could begin a phased reopening as early as May 29, pointing to figures that showed a downward trend in spread of the virus for almost two weeks. Yet on the same day, Washington, D.C., and Virginia announced single-day highs in cases.

The Washington regions high positive-test percentage comes despite reassuring news in most states: 42 have a rate under 10 percent of positive test results as part of a rolling, seven-day average, Dr. Birx said.

The New York area, which includes Jersey City and Newark, is seeing steeper declines by that test result measure, Dr. Birx said. And cities that have been especially hard hit, such as Detroit, Boston and Miami, now have more promising daily case counts.

Ahead of a holiday weekend, beach towns are telling N.Y.C. residents to stay away.

In the Hamptons, the locals have put up barricades to limit parking and deployed enforcement officers to ticket outsiders. Jersey Shore towns have banned short-term leases and Airbnb rentals. And on Long Island, the Suffolk County executives office taunted Mayor Bill de Blasio of New York City: Do your job. Figure out a plan to safely reopen your beaches.

Since the pandemic began, tensions have flared over whether too many New York City residents have decamped to outlying vacation areas, potentially taking the virus with them. But now the region appears on the brink of a full-fledged (and nasty) battle over beaches, touched off by the citys decision to keep its shoreline closed.

In normal times, start of beach season on Memorial Day weekend incites a mass migration from New York to Long Island, the Jersey Shore and, to a lesser extent, Connecticut. But the extension of beach closings in New York City has led to a backlash from local officials in those areas, who say they fear that their shorelines will be overwhelmed by an exodus of sun-starved New Yorkers blocked from their own beaches, which can in normal times attract a million people a day.

To maintain social distancing, beaches across the region are moving to limit access to everyone, and special rules have also been adopted to keep outsiders away.

The Justice Department on Friday backed an Illinois Republicans effort to invalidate the states stay-at-home order, the latest effort by the federal government to undermine governors coronavirus measures.

The U.S. attorney for the Southern District of Illinois argued in a legal brief that Gov. J. B. Pritzker, a Democrat, had exceeded his authority by extending his executive order for more than 30 days.

The brief came in response to a directive from Attorney General William P. Barr that department lawyers review stay-at-home orders around the country to ensure that civil liberties are protected.

Since Mr. Barrs request, the Justice Department has increasingly asserted itself in arguing over the legality of states sweeping orders in response to the coronavirus pandemic.

Under our system, all public officials, including governors, must comply with the law, especially during times of crisis, Eric Dreiband, the head of the departments civil rights division, said in a statement. On Friday, Mr. Dreiband also warned in a letter to Mayor Eric Garcetti of Los Angeles that a long-term lockdown could be illegal.

The move in Illinois came in a lawsuit that was filed by Darren Bailey, a Republican state representative whose fellow lawmakers kicked him out of the building in which they had gathered because he refused to wear a mask. Mr. Bailey had asked an Illinois court to declare the governors order invalid. The governor this week sought to have the case transferred to federal court, a move the Justice Department also said was wrong.

Airlines are permitted to stop flying to dozens of U.S. cities.

The Transportation Department said late Friday that it would tentatively allow 15 airlines to stop flights to about 60 mostly small and midsize cities, though none of the destinations stand to lose service entirely.

American Airlines would be allowed to stop flying to airports in Worcester, Mass., and Aspen, Colo. Delta Air Lines would be able to stop service to Erie, Pa., and Flint, Mich. United Airlines would be able to stop flights to Fairbanks, Alaska; Kalamazoo, Mich.; and Myrtle Beach, S.C., among other locations.

None of the cities would be left without service, the agency said, because it granted exemptions only if other airlines still flew there. Some of the affected regions are also served by other airports.

The decision is rooted in the federal stimulus act passed in late March. Under that law, any airline that received federal assistance is required to maintain a minimum number of flights to locations that it had served before the pandemic. But the law also allowed the Transportation Department to grant exceptions, which it has done regularly for weeks.

The Department of Homeland Security late Friday provided exemptions for certain professional athletes from its travel restrictions that Trump administration officials have said are crucial to preventing the spread of the coronavirus.

The department said in a statement that foreign baseball, basketball, golf, hockey and tennis players, as well as their families and essential staff members, would be allowed to enter the United States. In his push to reopen the economy, President Trump has encouraged sports commissioners to resume play.

Professional sporting events provide much-needed economic benefits, but equally important, they provide community pride and national unity, said Chad F. Wolf, the acting secretary of the Department of Homeland Security. In todays environment, Americans need their sports.

In late January, the administration prohibited foreign travelers who had been in China within the previous 14 days from coming to the United States. The administration later put similar restrictions in place for those from Iran and many European countries, including Britain.

The order on Friday said that allowing the athletes into the United States was within the national interest. But homeland security officials have defended using health authorities granted to the surgeon general to rapidly turn away asylum-seeking migrants at the southwestern border.

As businesses navigate the pandemic, summer internships are sacrificed.

When she found out in mid-March that she had landed an internship with an education nonprofit in Washington, Lydia Burns, a senior at the University of Louisville, called her mother to celebrate.

The euphoria lasted all of a week. As she worked on a paper the next Tuesday, Ms. Burns got an email from the nonprofit: The internship was canceled because of the coronavirus pandemic. She burst into tears.

I feel like I had such a strong plan, she said. I knew what I was going to do I had been working for it all of college. Now I dont know what Im going to do.

For millions of college students, internships can be a steppingstone to full-time work, a vital source of income and even a graduation requirement.

But like so much else, summer internships have been upended by the pandemic, with a wide range of major companies, including tech firms like Yelp and entertainment behemoths like the Walt Disney Company, canceling programs and rescinding offers. Instead, students who had hoped to experience an office setting for the first time are instead looking for work at fast-food restaurants.

The early-stage trial, published in the Lancet, was conducted by researchers at several laboratories and included 108 participants. Subjects who got the vaccine mounted a moderate immune response to the virus, which peaked 28 days after the inoculation, the researchers found.

A vaccine to the new coronavirus is considered to be the best long-term solution to ending the pandemic and helping countries reopen their societies. Nearly 100 teams worldwide are racing to test various candidates.

On Monday, Moderna announced that its RNA vaccine appears to be safe and effective, based on results from eight people in its trial. On Wednesday, researchers in Boston said a prototype vaccine protected monkeys from coronavirus infection.

The vaccine reported today was created with another virus, an adenovirus called Ad5 that easily enters human cells.

But the virus is one that many people already have been exposed to, and some experts have worried that too many already have antibodies to Ad5, limiting its usefulness as a way to deliver a vaccine.

Although the vaccine did elicit some immune response, the results are based on data from just a short period. It is not clear how long-lasting the protection might be.

Apart from pain at the injection site, close to half of the participants also reported fever, fatigue and headaches, and about one in five had muscle pain.

The participants knew whether they were receiving a low, medium or high dose, however, which may have influenced their perceptions of the side effects.

Deadly diseases could surge after disruptions to vaccination programs.

The widespread interruption of routine immunization programs around the world during the coronavirus pandemic is putting 80 million children under 1 year old at risk of contracting deadly, vaccine-preventable diseases, according to a report Friday by the World Health Organization, UNICEF and Gavi, the Vaccine Alliance.

The groups surveyed 129 poor and middle-income countries and found that 68 had some degree of disruption of vaccine services through clinics and through large inoculation campaigns.

Many public health experts say they are worried that deaths from diseases including cholera, rotavirus and diphtheria could far outstrip those from Covid-19 itself.

But officials are now moving toward a cautious risk-benefit analysis.

Employers are preparing to test their workers as they return to offices.

As the country reopens, employers are looking into how to safely bring back their workers. One recurring question: Should they be tested for the new coronavirus?

Some businesses are moving ahead. Amazon plans to spend as much as $1 billion this year to regularly test its work force, while laying the groundwork to build its own lab near the Cincinnati airport.

Las Vegas casinos are testing thousands of employees as they prepare to return to work, collecting nasal samples in convention halls. Gov. Steve Sisolak of Nevada is hoping to reopen the states gambling industry by June 4, he said on Friday.

And Major League Baseball, eager to begin its season, is proposing a detailed regimen that involves testing players and critical staff members multiple times a week.

While public health experts and government officials have emphasized that widespread testing will be critical to reopening, state and federal agencies have given little clear guidance on the role employers should play in detecting and tracking the virus.

Despite rapid advancements in testing, many limitations remain. Diagnostic tests, for example, only detect infections during a certain period. And antibody tests alone should not be used to make decisions about when people can return to work, the Association of Public Health Laboratories and Council of State and Territorial Epidemiologists warned.

Some public health officials also said that broad-based testing might have unintended consequences.

We dont want people to get a false sense of security, said Karen Landers, a district medical officer with the Alabama Department of Public Health, which is not recommending that employers test all workers.

Guidelines from the C.D.C. making the rounds online this week are clarifying what we know about the spread of the virus.

The virus does not spread easily via contaminated surfaces, according to the agency. For those who were worried about wiping down grocery bags or disinfecting mailed packages, the news headlines highlighting this guidance in recent days might have brought some relief.

But this information is not new; the agency has been using similar language for months. If anything, the headlines have pulled into sharper focus what we already know. The virus is thought to spread mainly from one person to another, typically through droplets when an infected person sneezes, coughs or talks at close range even if that person is not showing symptoms.

The C.D.C.s website also says that touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes is a possible way for people to become infected. But those are not thought to be the main way the virus spreads.

Editors note:This is a live account of COVID-19 updates fromSaturday, May 23,as the day unfolded.Click hereto find resources and the latest extended coverage of the pandemic.

phase two of Washingtons reopening only days away, Gov. Jay Inslee said Friday some counties wont be able to open small businesses like barbershops, hair salons and in-store dining by June 1 under his four-part coronavirus plan.The announcement didnt say which counties would see those delays, but Inslees office released numbers ranking counties by the criteria he used earlier this week to make 10 additional counties eligible to start the second phase before June 1. Heres more on what each phase means.

While churches and other house of worship in Washington remain closed under Inslees plan, President Donald Trump on Friday deemed them essential and called ongovernors to allow them to reopen this weekend. If governors dont abide by his request,he will override them, he said though its unclear what authority he has to do so.

Throughout Saturday, on this page, well be posting updates from Seattle Times journalists and others on the pandemic and its effects on the Seattle area, the Pacific Northwest and the world. Updates from Friday can be found here, and all our coronavirus coverage can be foundhere.

The following graphic includes the most recent numbers from the Washington State Department of Health, released Friday.

State health officials confirmed 320 new COVID-19 cases in Washington on Saturday night, including five more deaths.

The recent update brings the state's totals to 19,585 cases and 1,055 deaths, according to the state Department of Healths (DOH) data dashboard. The dashboard reports 3,256 total hospitalizations in Washington.

So far, 316,276 tests for the novel coronavirus have been conducted in the state, per DOH. Of those, 6.2% have come back positive.

Paige Cornwell

As of 9 p.m. Saturday, the Washington State Department of Health had not updated its numbers of confirmed COVID-19 cases and deaths since May 22. The Seattle Times' graphic currently reflects numbers as of May 21.

Once the state provides new data, we will update our daily graphic with the latest COVID-19 numbers in Washington state, as usual, at seattletimes.com and in the print edition.

Paige Cornwell

The Northwest Folklife Festival announced in April that the Seattle Center institution is postponed. The postponement marks the first time in 49 years that the festival will not be held over Memorial Day weekend. A makeup date was not given. Instead, Folklife is offering online programming.

View the photo gallery here.

Alan Berner

Twenty-one of Washingtons 39 counties have now been approved to move into the second stage of Gov. Jay Inslees four-phase coronavirus recovery planfollowing the governors expansion of criteriathis week that allowed more counties to apply for reopening.

The second phase of recovery allows several kinds of businesses, including hair salons and restaurants, to welcome back customers two months after Inslees stay-at-home order went into effect, albeit with some with restrictions.

As of this week, counties that have fewer than 10 new COVID-19 cases per 100,000 people over the span of 14 days were allowed to apply for reopening with the Department of Health (DOH). To be approved for Phase 2, counties must also demonstrate that their hospitals are prepared to handle a return of the disease.

Ten smaller counties had been approved to reopen earlier this month. By Saturday, DOH had approved 11 more: Adams, Cowlitz, Grant, Grays Harbor, Island, Jefferson, Lewis, Mason, Pacific, San Juan and Spokane counties.

Read the full story here.

Sydney Brownstone

Kittitas County health officials are directing all residents to wear a face covering if they are indoors, or in a confined public setting with anyone who doesnt live in their household, to slow the spread of COVID-19.

The directive, effective Saturday, applies to spots like grocery and commercial retail stores, restaurants and public transportation. The Kittitas County Public Health Department advises residents to use cloth masks, scarves and bandanna coverings to conserve medical-grade masks for health-care workers.

Residents who violate the directive wont be issued a citation; the directive may and should be used to educate, encourage and persuade individuals to wear face coverings, according to the health department.

There have been 66 positive cases of COVID-19 and zero deaths reported in Kittitas County, according to the Washington State Department of Health. More than half the cases are connected to an outbreak at Twin City Foods in Ellensburg.

Paige Cornwell

Though Washington State Ferries has advised customers to limit travel on ferries, the agency reported a two-hour wait Saturday afternoon for drivers departing from Mukilteo to Whidbey Island and a one-hour wait for drivers in Edmonds for the ferry to Kingston.

Travelers on ferries are encouraged to wear face coverings, and drivers should remain in their vehicles whenever possible. Some ferry sailings may limit the number of walk-on passengers, according to the agency.

About 500,000 people typically ride a ferry over Memorial Day weekend each year. On Friday, ridership was down between 7% and 81% on each route compared to the Friday before the holiday last year, according to Washington State Ferries data.

Paige Cornwell

A coronavirus outbreak has infected 24 employees and shut down the Philadelphia Macaroni Co. plant in Spokane.

The company confirmed Friday that 24 workers out of 72 tested positive for COVID-19 this week, just as state officials Friday declared Spokane County ready to reopen parts of its economy after two months of pandemic lockdown.

In a news release, the company says it has tested all of its employees and disinfected the facility. It said it is evaluating a reopening timeline.

The outbreak led to a jump in Spokane Countys confirmed COVID-19 cases. Spokane had gone the entire month of May with no more than five COVID-19 cases reported every day. But there have been 31 confirmed cases reported in the county in the last two days.

Employees at the Philadelphia Macaroni plant have been working throughout the pandemic with increased safety protocols, such as more sanitation processes and employee training. The company is considered an essential business, and makes the pasta that goes into macaroni and cheese.

Philadelphia Macaroni requires employees to wear masks, and employees are screened before they enter the factory. The company is working with the Spokane Regional Health District to conduct contact tracing as well as to determine further outbreak prevention measures.

Read the whole story here.

The Spokesman-Review

Under normal circumstances in a presidential-election year, Puget Sound voters might encounter numerous local government tax requests on summer or fall ballots.But in 2020, political considerations have been reshaped by the coronavirus crisis.

The King County Library System had planned to ask voters in August for a property tax levy to raise about $75 million a year in additional revenues. But officials have called that off.

With these things, timing is everything. Now is not the right time to ask the voters, said Lisa Rosenblum, executive director of the 50-library system.

The best bet to reach the November ballot in King County is a property tax increase for Harborview Medical Center, which County Executive Dow Constantine sent to the county council last month.

Backed by unions that represent health care and construction workers, the proposal would authorize a 20-year, $1.74 billion bond to build a new hospital tower and carry out other upgrades at the only Level 1 trauma center in Washington. The annual average cost over that time would be $68 for a home of median assessed value.

Seattle also may ask voters to approve a bus service tax. A so-called Amazon tax on large corporations in Seattle could qualify as an initiative, though the virus has complicated signature collecting.

Several other potential measures appear dead in the water. In addition to the county libraries levy, a county transit tax has been ruled out, and the odds are stacked against a county arts tax. Officials in Snohomish and Pierce counties also said they plan no countywide tax ballot measures this year.

Read the whole story here.

Jim Brunner and Daniel Beekman

The coronavirus may still be spreading at epidemic rates in 24 states, particularly in the South and Midwest, according to new research that highlights the risk of a second wave of infections in places that reopen too quickly or without sufficient precautions.

Researchers at Imperial College London created a model that incorporates cellphone data showing that people sharply reduced their movements after stay-at-home orders were broadly imposed in March. With restrictions now easing and mobility increasing with the approach of Memorial Day and the unofficial start of summer, the researchers developed an estimate of viral spread as of May 17.

It is a snapshot of a transitional moment in the pandemic and captures the patchwork nature across the country of COVID-19, the disease caused by the virus. Some states have had little viral spread or crushed the curve to a great degree and have some wiggle room to reopen their economies without generating a new epidemic-level surge in cases. Others are nowhere near containing the virus.

The model, which has not been peer reviewed, shows that in the majority of states, a second wave looms if people abandon efforts to mitigate the viral spread.

Theres evidence that the U.S. is not under control, as an entire country, said Samir Bhatt, a senior lecturer in geostatistics at Imperial College.

Read the whole story here.

The Washington Post

Some Washington religious leaders are rejecting President Trump's call to restart large, in-person worship gatherings.

Trump on Friday labeled churches and other houses of worship "essential" and called on governors to let them reopen this weekend despite coronavirus lockdowns. He also threatened to "override" governors who defy him.

In a statement Friday, the Washington Catholic State Conference said the public celebration of Mass was suspended "not out of fear, but out of our deepest respect for human life and health."

The statement was signed by Seattle Archbishop Paul Etienne, as well as Yakima Bishop Joseph Tyson, Spokane Bishop Thomas Daly, and Auxiliary Seattle Bishops Eusebio Elizondo and Daniel Mueggenborg.

Their statement added:"Our love of God and neighbor is always personal and not partisan. While we share the desire to bring people back to Mass as quickly as possible, we will wait to schedule our public worship when it is safe and we are prepared to do so."

Etienne and the other leaders said they are preparing parishes across the state for eventually re-opening in a manner that "not only is safe, but is liturgically reverent." No date for reopening has been set.

A similar message came from the Council on American-Islamic Relations-Washington (CAIR-WA), which said while religious services are "an essential part of our faith" right now "public gatherings are not an option."

The statement by Masih Fouladi, executive director of CAIR-WA, said at a time when healthcare workers are risking their lives "we must do our part" to protect the workers and the public.

Fouladi added: "And we will not follow the lead of a President who suggests injecting people with disinfectants and who refuses to follow basic CDC guidelines like wearing a mask in public."

He said mosques and Muslim leaders "are doing everything they can to keep people safe and connected to their faith as we approach the end of Ramadan and prepare for Eid" and would continue to follow the guidance of Gov. Jay Inslee and public-health officials.

Jim Brunner

A woman wearing a face mask and goggles walks through LAX airport in Los Angeles on Friday. Apu Gomes/AFP via Getty Images hide caption

A woman wearing a face mask and goggles walks through LAX airport in Los Angeles on Friday.

Each week we answer pressing coronavirus questions. We'd like to hear what you're curious about. Email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions."

How big a risk is it to catch the virus through your eyes? Should people be wearing eye protection?

Virologist and epidemiologist Dr. Joseph Fair recently became ill, and he believes he got COVID-19 through his eyes. Fair told NBC's Today from his hospital bed last week that he had been on a crowded flight two weeks earlier, and though he wore a mask and gloves and wiped down his seat, he didn't have any protection over his eyes. "You can still get this virus through your eyes, and epidemiologically, it's the best guess I have of probably how I got it," Fair said. He said his symptoms started three or four days later, though his four tests for the virus were negative.

The notion that you can get the virus through your eyes isn't new, but it has been little discussed compared with the risk of infection through the nose and mouth.

The CDC says that while the nose and mouth are the main avenues by which someone catches the coronavirus, "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."

"Based upon what we know, I would say that the possibility of acquiring it on the surface of your eye is possible. It's certainly plausible," says Dr. Thomas Steinemann, a spokesperson for the American Academy of Ophthalmology and professor of ophthalmology at MetroHealth Medical Center in Cleveland.

"Any sort of open mucosa [mucous membrane] is a chance for a droplet to land there and get into your body," says Dr. Abraar Karan, a physician at Harvard Medical School. But while it's known that the virus can be transmitted through the eyes, "it's hard to quantify exactly what the risk is in terms [of] through the eye specifically."

For most cases, it's impossible to determine with certainty the initial avenue of someone's infection that is, whether a person was infected via their mouth, nose or eyes. And the evidence so far suggests that eyes are not a primary mode of transmission.

If a lot of people were being infected through their eyes, there would be more COVID-19 patients with conjunctivitis inflammation of the eyes, also known as pink eye.

If the virus invades and infiltrates your conjunctiva the clear tissue covering the white part of your eye and the inside of your eyelids likely "there's going to be inflammation or redness in your eyes," Steinemann says. Of course there are many other causes for conjunctivitis, though, so getting pink eye doesn't necessarily mean you have COVID-19.

So far, studies have found that among hospitalized COVID-19 patients, only a small percentage of those who had the fluid in their eyes swabbed for the virus did in fact test positive for the virus in their eyes.

It should be noted, though, that eye swabbing is not standard practice for COVID-19 patients in part because most people don't have much eye fluid, so swabbing it is uncomfortable.

And there's another reason why eyes are not a likely way to be infected with the coronavirus: The pathway from your eyes into your respiratory system is less direct than via your nose and mouth.

If an infectious person coughs or sneezes in your face, and you breathe in through your mouth or nose, not only are you going to receive a sizable viral dose, "you're going to get a fairly direct hit into your airways," Steinemann says.

But to infect you via your eyes, the virus would have to penetrate your eyes' mucous membrane, be washed by tears behind your cheeks into your nasal cavity, and then flow from the nose into your throat. "It's a more circuitous route," says Steinemann.

Our eyes have a number of defense mechanisms that help protect against infection, like eyelids that blink to cover the eye and tears that contain immunoglobulins that fight invaders.

"You blink really easily any time even a puff of air goes near your eye," says Dr. Emily Landon, hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine. "So if somebody coughs or sneezes near you, you're really likely to close off your eyes. That's good. Whereas your mouth and nose don't do that."

A Starbucks employee wears a face shield and mask as she makes a coffee drink at Ronald Reagan Washington National Airport in Arlington, Va., last week. Andrew Caballero-Reynolds/AFP via Getty Images hide caption

A Starbucks employee wears a face shield and mask as she makes a coffee drink at Ronald Reagan Washington National Airport in Arlington, Va., last week.

What precautions should you take to protect your eyes?

The basic precautions against the coronavirus still hold when it comes to your eyes, says Steinemann: Wash your hands, practice social distancing and "don't touch your face" also means don't rub your eyes.

With some airlines now asking flight attendants to wear safety goggles Qatar Airlines is the latest to announce this plan the general public might wonder: Should others do the same?

Karan says that in health care settings, eye coverings are immensely important. "We definitely don't go into [coronavirus patients'] rooms without eye coverings." He says other jobs that require people to work face-to-face, like a barber, might also choose to wear a full-face clear plastic shield.

Steinemann also says whether you need eye protection depends on your job. If you work in an office where you don't have to be in close proximity to people to others, you should be fine without eye protection.

On the other hand, he says, "if you are in close proximity to somebody screaming at you or talking to you or coughing in your face, or if you work in a hospital, suctioning people who are in an intensive care unit those types of situations are extremely high risk, not only to your nose and your mouth, but also to your eyes. In a high-risk situation, I would definitely recommend the use of a full-face shield and goggles."

You don't need to be wearing a face shield on your walk around the neighborhood or your visit to the grocery store, he notes. For those situations, he recommends wearing a mask and practicing good hygiene and social distancing.

And what about the case of the virologist on the packed airplane?

Steinemann says if he was on a crowded airplane and unable to keep distance from other passengers, "Yeah, I think I might wear a face shield and a goggle in that setting."

Landon says that she has face shields at her home but has not yet found an activity where it felt necessary for her family to wear them. "But I am going to ask my mom to wear one when she takes a plane home from Florida if I let her take the plane home from Florida."

Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

It hasnt even been five months since health officials in Wuhan, China, reported unusual pneumonia cases to the World Health Organization.

But those five months have been the most active in the history of epidemiology. Since that report, weve learned so much about the coronavirus. One of the most important lessons? How the disease is spread.

In particular, so-called superspreading events seem to be a major cause of infections. One London School of Hygiene analysis suggested that 80% of the secondary transmissions were caused by just 10% of infected people. In other words, if you want to avoid getting COVID-19, one of your major focuses should be avoiding a superspreading event.

So as Utahns leave their homes and reengage with society, we thought now would be a good time to scour the research to note where these events have been documented and where they havent. We can also learn about the circumstances that led to each superspreading event, and do our best to avoid them.

The result is the following compendium, in alphabetical order, of public places and the lessons we can learn.

Because of South Koreas frankly incredible contact tracing operation, we know a lot about these cases. Researchers say 5,517 people attended the five spots the man visited during the timeline of possible spread. But because these were gay clubs and homosexuality isnt always accepted in Korea many wrote down fake names upon entry. As a result, Korean health officials hadnt been able to contact about 700 of them as of May 13.

We also know a lot about the secondary cases. For example, a 25-year-old teacher got the virus at one of those clubs and later infected 11 people, including five students at the school. As a result, 1,000 members of the church that those students attend have been told to stay home and monitor for symptoms.

In all, over 35,000 people have been tested in relation to this cluster. 35,000! And 8,500 police officers were deployed to stop the outbreak. In reaction, South Korea pushed back opening schools one week. But about a month later, Koreas efforts to quarantine those associated with the cluster seem to have worked.

Dance floors are probably incompatible with social distancing.

High-capacity bars and clubs are going to be potential locations of superspreading events.

Japanese public broadcaster NHK, in consultation with local health experts, got 10 people to dine at a buffet. They put fluorescent paint on the hands of one person to simulate the virus after a sneeze or cough. After 30 minutes, they turned the black light on to see where the virus had gotten.

The answer: everywhere. Peoples hands, faces, plates, napkins, and more were covered with the virus-simulating paint.

Salad bar restaurants like Souplantation and Sweet Tomatoes have decided to permanently close. In Utah, during the moderate and low stages of virus risk, buffets must be served by a restaurant employee; they cant be self-serve.

Self-serve buffets probably create an unmanageable amount of viral spread.

In January, an asymptomatic woman who had recently been to Wuhan took a bus with 66 other passengers to a worship event at a Buddhist temple. She felt sick after returning home.

The ride was 50 minutes each way and passengers stayed in the same seats on both legs of the trip. Of the 66 passengers, 24 were infected. There was no statistically significant correlation between how close the passengers sat to the woman labeled IP below and whether or not they got the disease. Many further than 6 feet away caught it.

The bus air-conditioning was set to recirculation mode. The studys authors note that all passengers who sat next to a window on the left side of the bus where the air-conditioning vents were remained healthy other than the one person who sat next to the sick woman, but they dont know if thats by chance or due to air circulation patterns.

In closed, small environments, virus transmission can occur throughout a room.

Keeping outside ventilation high on buses seems to be a worthwhile goal.

Bus drivers should receive protective gear to prevent infection.

The choir met every Tuesday evening until March 10. At that last meeting, 61 members were present and chairs were arranged close together in six rows of 20 with many empty chairs. They practiced for 40 minutes together, for 50 minutes separated into two smaller groups, and then for 45 minutes sang together again. There was a 15-minute break between the second and third session for oranges and cookies, but many didnt eat.

No one reported physical contact between members and most everyone left immediately after practice. Hand sanitizer was distributed.

But, in the end, 53 of the 61 contracted the coronavirus. Three were hospitalized, two died. Interestingly, the CDC did find someone who had coldlike symptoms in the choir beginning March 7 that person is the most likely Patient Zero in this case, but its not certain that person was responsible for the spread.

This seems to happen repeatedly. The Amsterdam Mixed Choir gave a performance March 8, then 102 out of 130 singers tested positive. Fifty members of the Berlin Cathedral Choir tested positive as well.

Singing appears to significantly raise the likelihood of transmission.

On Tuesday, the CDC released a report about a rural Arkansas church. The pastor and his wife began feeling sick March 10 and 11 after hosting a three-day childrens event a few days earlier.

The event included 1.5 to 2 hours of indoor church services on each day. The children also competed each day to collect offerings from adults. There was some singing, in which most children and some adults took part. On one day, the church hosted a buffet.

After an investigation, another husband and wife said they were symptomatic during the childrens event. On March 11, the church hosted a Bible study, though the pastor said people followed social distancing procedures.

In all, 92 people attended the church between March 6 and 11, and of the 45 tested, 35 became infected, seven were hospitalized, three died.

The Washington Post has a good review of what happened in a church in South Korea on a larger scale. Patient No. 31 in South Korea went to her Shincheonji church while sick, and a month later, the cluster had accounted for 5,080 cases, more than half that nations total. Wow.

Churches can be the site of community-changing superspreading events.

High-risk activities like singing and buffets may make church gatherings more dangerous.

This story is heartbreaking.

In February, a man who had recently traveled out of state attended a close family friends funeral in Chicago. He was experiencing minor symptoms at the time. The night before, he attended a potluck-style meal with the family of the deceased, and reported hugging some of them. Four of those he hugged would contract the virus. One died.

Three days after the funeral, the same condolence-giving, out-of-state-traveling man went to a birthday party for a member of his own family, which nine people attended. The man embraced others and shared food. Seven of the nine became infected; two of them died.

Some of the people this man infected passed the virus on to others, including a fellow churchgoer and health care professionals.

This one poor guy went to a funeral and birthday party and it led to the infection of 16 people and three deaths. We know more about the disease than we did in February. Dont be that guy.

Avoid hugging and sharing food, especially while sick.

One manager concealed a report of coronavirus in his store in the Shandong province of China. Later, 17 people tested positive.

But theres relatively little evidence that says grocery stores are the site of superspreading events, and given that they have stayed open throughout the crisis, youd think wed know by now. There was one study that used a computer model for how airborne particles would spread in a grocery store, but a computer model isnt reality.

Constant movement in spacious buildings probably helps prevent exposure to coronavirus droplets.

In Cheonan, South Korea, a workshop for Zumba fitness instructors Zumba is surprisingly big in Korea was held Feb. 15. Of the 27 instructors in attendance, eight eventually tested positive.

These instructors then went to their communities and taught two 50-minute Zumba classes each week. By March 9, less than a month later, there were 112 cases tied to this Zumba workshop; 57 were students of the positive instructors, the rest secondary infections from those students. In all, those classes had 217 students attend, for an infection rate of about 26%.

Of the eight positive instructors, there were two who led most of the classes where people got sick. One held a class in a gym that had five students but three got infected. Later, another COVID-19 positive instructor taught Pilates and yoga to 25 people in that same room. None got the virus.

Two hypotheses: Either the Pilates instructor wasnt as contagious as the Zumba instructor, or high-intensity dance classes like Zumba mean more heavy breathing and therefore more virus-laden droplets than low-intensity Pilates.

Gyms can quickly spread the coronavirus, especially when instructors become infected.

High-intensity workouts may be more dangerous than low-intensity workouts, though thats unclear.

In Wenzhou, China, 34 people were infected in a shopping mall. The clusters first recorded case involved a person who worked on the malls seventh floor, where it quickly spread to other nearby employees.

A few days later, staff who worked on lower floors started getting the disease, and a few days after that, customers started getting infected.

However, the staff with the virus on the floors below No. 7 and the customers who tested positive all denied knowingly coming into contact with one another. Its possible they all brought the disease to the mall separately, but given that they all developed symptoms at nearly the same time and the high number of cases associated with this mall, its unlikely. Everyone did share restrooms and elevators, which could explain spread from floor to floor or store to store.

In another case in Tianjin, China, 21 people were infected in a mall department store: six staff, and 15 customers over the course of five days. The store was especially crowded for Chinese New Year, so reports were that up to 10,000 people would need to be quarantined because they visited during the outbreak period. The studys authors struggled to figure out the diseases spread through the store staff and customers.

Thanks to high traffic numbers, one mall or large store can infect many people, even though the likelihood of any individual customer being infected is low.

In early March, the South Korean version of the CDC was informed about an outbreak in a call center in a 19-story building. The first 11 floors are commercial offices the call center is on floors 7-9 and 11. Residents in apartments live on the floors above that.

In response, South Korea just started testing everyone. That included 811 people at the call center, 111 people who work in the floors below, 203 people who live in the apartments above, and 20 visitors.

Of those 1,145 people, 97 tested positive and 94 of them worked on the 11th floor in the call center. The other three worked on the 10th or ninth floor. In fact, 89 of the 97 worked on the same side of the same floor of the call center. Positive cases are in blue.

As the study notes, residents and employees in the building had frequent contact in the lobby or elevators, but as you can see, widespread transmission didnt occur there. The vast majority of it happened in the 11th floor on one side of the call center.

The most dangerous method of transmission in an office is spending a long time near an infected person.

Using shared facilities like restrooms with an infected person appears to be less dangerous.

Spending a short amount of time with an infected person, like on an elevator ride, is not especially dangerous.

Jobs with frequent talking, like call centers, do appear to have elevated risk for superspreading.

We dont have any direct studies on COVID-19s transmission on airplanes, but we do have some on a related coronavirus: SARS-CoV-1.

On one plane, a 72-year-old infected man with a cough in seat 14-E of a flight from Hong Kong to Beijing ended up passing SARS to 18 passengers and two flight attendants. The flight was about three hours long. While those seated at the very front and very back of the plane were safe, those infected included those within several rows of the man, including on the other side of the aisle.

Other planes studied, however, did not have that level of transmission. As researchers studied the introduction of SARS to France, a nearly 15-hour flight from Hanoi to Paris infected only two of the 69 people aboard. On two other flights with an infected SARS passenger, only one person out of 561 people was infected. Both of those flights were shorter, though, just 90 minutes long.

A recent opinion piece in The Washington Post from Joseph Allen, a professor of exposure assessment science at Harvard, asserted that You dont get sick on airplanes any more than anywhere else, because the ventilation system requirements for airplanes meet or exceed CDC regulations for COVID-19 rooms in hospitals.

Dont go on a plane with a cough. Everyone should wear a mask.

If there is someone with a cough, those viral particles can likely travel more than 6 feet, but probably not throughout the plane.

The odds of an outbreak on any individual plane trip are low.

In Wisconsin, 400,000 people went to various polling locations to vote in the April 7 primary election. Since then, people have wanted to know whether the in-person voting led to a spike in coronavirus cases.

At the end of April, the Wisconsin Department of Health announced that 52 voters or poll workers had tested positive so far. However, it wasnt clear if that was more than the normal number of cases youd expect.

Three studies have looked at the issue since. One, released April 28 by a team from a Milwaukee hospital, found that coronavirus rates actually declined in the 10 days after the voting when compared to the 10 days before it.

A second study released a day later from researchers at Stanford looked at hospitalization rates as well, and also didnt find any increase after the election.

However, a third study released May 11 found that counties with higher numbers of in-person voting per location did have higher coronavirus rates after the election. Researchers estimated that when the number of voters per location increased by 100, a 3.5% increase in coronavirus rates was found.

Regardless, the election clearly did not cause a huge spike, like some doomsayers predicted. This could be due to the precautions polling places and voters took, or it could be that quick interactions like voting are unlikely drivers of coronavirus transmission.

In-person voting either has a small or neutral impact on coronavirus spread when precautions are taken.

There were 18 coronavirus cases split evenly, nine students and nine staff. But out of 863 close contacts with those people of which 384 were tested only two secondary cases were discovered: one in a high school, and one in a primary school. Thats a tiny transmission rate.

However, the schools werent necessarily operating as normal. Many kids chose to stay home, which may have made social distancing more feasible. Large assemblies were avoided, and more outdoor classes were held.

Still, because schools have been closed nearly everywhere, were not certain that the virus cant effectively spread in classrooms. And theres still a lot of mystery here: Serology studies show that kids are getting the virus somehow, and viral load studies are showing kids have just as much virus in their throats as adults, so why havent we witnessed spread in schools?

Schools are a significant source of spread for other diseases like influenza, but so far, not the coronavirus. We dont know why.

A individual who has contact with an infected child in a school is unlikely to be infected.

Sports venues and stadiums

It was a great day for Atalanta. On Feb. 19, the Italian soccer team from Bergamo defeated Spains Valencia 4-1 in the Champions League, the pinnacle of European soccer. About 40,000 people from Bergamo went to watch the match in the San Siro stadium in Milan.

It also led to a virus explosion in Bergamo a week later.

Its very probable that 40,000 Bergamo citizens in the stands of San Siro, all together, exchanged the virus between them, Bergamo Mayor Giorgio Gori said on Facebook. So many Bergamaschi that night got together in houses, bars to watch the match and did the same.

A journalist who covered the match was Bergamos second positive case. And then 35% of Atalantas staff tested positive. More than a third of Valencias players would eventually test positive. The director of health there called the match a biological bomb.

This can happen on a smaller scale, too. On March 6, 2,800 people showed up for sectional basketball semifinals at a high school in Lawrence, Ind. While testing wasnt widespread, five of the attendees would later die, and at least a dozen others tested positive or had virus symptoms. Decatur County, Indiana had a per-capita death rate that was twice as high as any other Indiana county they blamed their spread on another high school basketball game.

Getting thousands or tens of thousands of people together in one building can result in community-changing biological bombs."

Sports celebrations (singing, hugging, cheering) could potentially mean more spread.

Cheap and easy antigen tests that detect proteins of the new coronavirus (yellow) in samples from a person are coming, but they arent perfect.

By Robert F. ServiceMay. 22, 2020 , 3:35 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

After a painfully slow rollout of diagnostic testing for active coronavirus infections across the country, some 400,000 people a day in the United States may now receive such a test, estimates suggest. Yet a few public health experts say sending people back to work and school safely and identifying new outbreaks before they spread out of control could require testing much of the U.S. population of 330 million every day. Others suggest checking roughly 900,000 people per day would be enough.

Either way, nearly all the current tests to diagnose infections work by identifying the genetic material of the virus, a technology that will be difficult to scale up much further. There will never be the ability on a nucleic acid test to do 300 million tests a day or to test everybody before they go to work or to school Deborah Birx, White House coronavirus response coordinator, said at a press conference last month.

Birx and others have touted another option: antigen tests, which detect the presence of viral proteins in a biological sample, such as saliva or tissue swabbed from the nasal cavity. Antigen tests are typically cheap, return results in minutes, and, like the genetic tests, reveal an active infection. They already exist for strep throat, influenza, tuberculosis, HIV, and other infectious diseases. But so far, only one antigen test for SARS-CoV-2, the coronavirus that causes COVID-19, has received emergency use authorization from the U.S. Food and Drug Administration (FDA).

Can it or other antigen-based methods solve the testing problem? Some scientists are optimistic, whereasothers remain skeptical, noting that such tests can be far less accurate than nucleic acid tests and may not be as easy to scale up as proponents claim. What everyone wants is for a test to be cheap, accurate, and fast, says Geoffrey Baird, a laboratory medicine specialist at the University of Washington, Seattle. You can only ever have two of those.

Developing an antigen test is not that easy to do, says Werner Kroll, senior vice president for research and development at Quidel, a California-based company that received the greenlight from FDA for its test earlier this month. Rather than performing all the analytical steps inside an expensive dedicated machine at a lab or a doctors office, as is done with tests for the DNA or RNA of virus, antigen tests build most, if not all, those steps into a paperlike strip that returns a simple yes or no answer, much like pregnancy tests.

Its a lab on a swab, says Stephen Tang, president and CEO of Orasure, a diagnostics company developing its own antigen test for SARS-CoV-2. With most setups, a sample of bodily fluid is collected using a nasal swab or related procedure, then mixed with a few milliliters of a liquid, typically a sterile buffer solution. A few drops are spotted on one end of a test strip. Capillary forces pull the liquid over copies of two different antibodies specific for the same viral protein. If both antibodies spot their targeta positive testthe strip generates a signal, often a color change. This signal is generally read out by a person visually, although some setups use small readers to improve the accuracy.

What triggers the signal can differin some tests the antibody bindings set off a chemical reaction or expose a fluorescent marker joined to one antibody. Another test in contention for FDA approval produces an electrical readout after antibodies on an electrochemical sensor bind to their target antigen.

The challenge is finding the right antibodies, says Lee Gehrke, a virologist at the Massachusetts Institute of Technology, who has developed an antigen test for SARS-CoV-2 that E25Bio, a company he co-founded, is now evaluating. Both antibodies must bind to a single viral protein, such as the spike protein SARS-CoV-2 uses to enter cells, but at separate sites. You have to find two antibodies that dont interfere with each other, Gehrke says. Those same antibodies also cant cross react to proteins from other coronavirusesall of which have their own spikes, for exampleor anything else. Antibodies often stick to other things nonspecifically, Baird says.

Another challenge is weak signals. Genetic tests use the polymerase chain reaction (PCR) to amplify tagged DNA or RNA sequences, making it easy to reliably identify just a few copies of a virus. That gives PCR tests for the SARS-CoV-2 virus about a 98% sensitivity and near perfect selectivity, meaning almost every active infection is detected and only in very rare cases does someone uninfected receive a positive test. (Many false negatives, a result indicating an infected person is free of the virus, result not from the tests deficiencies, but from poor samples, which can be difficult to collect with nasal swabs.)

Antigen tests dont amplify their protein signal, so they are inherently less sensitive. To make matters worse, that signal gets diluted when samples are mixed with the liquid needed to enable the material to flow across test strips. As a result, most antigen tests have a sensitivity of anywhere between 50% and 90%in other words, one in two infected people might incorrectly be told they dont have the virus. Last month, Spanish health authorities returned thousands of SARS-CoV-2 antigen tests to the Chinese firm Shengzhen Bioeasy Biotechnology after finding the tests correctly identified infected people only 30% of the time, according to a report by the Spanish newspaperEl Pais.

Quidel executives say the companys initial SARS-CoV-2 test meets FDAs minimum of 80% sensitivity. (That means it could still generate false negative results 20% of the time.)A revised sample preparation protocol that doesnt require dilution of the nasal swab is expected to boost that figure to nearly 90%, but thats still below the 98% sensitivity of state-of-the-art PCR tests.

Antigen tests, however, bring advantages to the table as well. Because they dont require the expensive equipment and chemicals needed to perform PCR, they can be more easily used as point-of-care tests in doctors offices, urgent care centers, hospitals, and even at companies and schools. They also dont require trained specialists, making them cheaper to administeralthough there are a few point-of-care PCR tests, most still involve sending a sample to a lab for manual processing.

And the fast results from an antigen test mean that people who test positive can be isolated quickly, before they risk infecting others. Even if the tests have a 10% false negative rate, people could easily be tested repeatedly, making it likely that anyone missed on the first round would be flagged on the second, says Doug Bryant, Quidels president and CEO.

Another advantage is scalability. Once researchers settle on effective antibodies, the tests are easy to manufacture in bulk, and running them doesnt require additional reagents as PCR tests do. Quidel says it expects to ship 282,000 tests this week and 1 million tests per week by early June. Ultimately, Bryant says the company should be able to produce 84 million tests per year.

Thats still well below the 300 million tests per day that would allow most every person in the United States to have a daily SARS-CoV-2 check, Birxs ambitious hope. (One recent model from the Harvard Global Health Institute said 900,000 diagnostic tests a day in the United States would be enough to have confidence most infections were being caught before an outbreak grew big.) But other companies, including OraSure, which expects to file for FDA emergency use authorization in September, say they expect to rapidly scale up to providing tens of millions of coronavirus antigen tests as well. The demand for such tests, which could cost as little as $1 or less, could be even greater in developing countries without a broad network of centralized labs.

Taken together, the advantages of antigen tests provide real hope that they will be very valuable for stemming this pandemic, says Bettina Fries, chief of infectious diseases at Stony Brook University.

Baird and others are less confident. Not all antigen tests are as simple to read as a pregnancy test. Quidels test requires using a $1200 toaster-size reader to achieve the relatively high sensitivity it has. And even though 43,000 Quidel readers already exist for other antigen tests, most are in the United States, making the test harder to put into use overseas.

Otto Yang, an infectious disease expert at the University of California, Los Angeles, says the tests modest sensitivity is a bigger hurdle. Even a test with the 90% sensitivity and 100% specificity that Quidel is aiming for could misinform more than help. Assuming the virus has a prevalence of about 1% and such a test is given to 1000 people, 10 would correctly be told they are infected whereas100 people will be mistakenly told they dont have the virus. Given how readily SARS-CoV-2 spreads, a misdiagnosis is worse than no diagnosis, Yang says.

Fries doesnt agree. Even if the sensitivity [of antigen tests] is not perfect, if you test over and over you will pick up those cases, she says. We need to let go of the notion that all the tests have to be perfect.