Amid the coronavirus pandemic, many Americans have embraced the idea of "flattening the curve," or slowing the spread of the virus over a number of months so that fewer people become infected and need health care at any given time.
A key assumption of this strategy is that around the same number of people will eventually be infected with COVID-19, but just over a longer time period. Many models predict this period, which would require intermittent lockdowns, could last well over 18 months.
But one veteran public health scholar says we can take a different path to more swiftly and forcefully bring an end to COVID-19.
"The aim is not to flatten the curve," Dr. Harvey Fineberg, president of the Gordon and Betty Moore Foundation, a philanthropic organization in Palo Alto, California, and past president of the U.S. National Academy of Medicine, wrote in an editorial published Wednesday (April 1) in the New England Journal of Medicine. "The goal is to crush the curve."
Fineberg argues we can defeat COVID-19 in just 10 weeks if we take a "concerted and determined" approach.
"I think we're thinking too defensively about what we should and could do against the coronavirus," Fineberg told Live Science. "If it is a war, and I believe that's a proper metaphor, then we should fight it like a war. That means we should fight to win to vanquish the foe, not to let it persist and hassle us for an indefinite period."
In the editorial, Fineberg outlines six steps the country should take to accomplish this goal.
First, President Donald Trump should appoint a commander in charge of the coronavirus response. This person is not a "coordinator," but rather someone who has the authority "to mobilize every civilian and military asset needed to win the war," Fineberg wrote. Each governor should also appoint a commander with similar authority at the state level.
"If we don't have a unified command structure with that person in charge who can help guide and make the strategic choices, then I think we can't execute successfully," Fineberg said.
Second, America needs to carry out millions of diagnostic tests in the next two weeks. Such a strategy was successfully used in South Korea to contain COVID-19. These tests are needed to "trace the scope of the outbreak" and make informed decisions about managing patients, he said. "Testing is our form of intelligence" in the military sense, Fineberg told Live Science.
Third, all health care workers should have access to ample supplies of personal protective equipment (PPE), Fineberg said. "We wouldn't send soldiers into battle without ballistic vests; health workers on the front lines of this war deserve no less."
Next, the population should be divided into five groups, Fineberg said. These include those infected with COVID-19; those presumed to be infected based on symptoms but who initially test negative; those exposed to someone with COVID-19; those who are not known to have been exposed to or infected with COVID-19; and those who recover from COVID-19.
People in the first two groups can be hospitalized if they are very sick or placed in "infirmaries" (such as a converted convention centers) if they have mild to moderate disease, he said. People who have been exposed to COVID-19, but don't yet show symptoms, may be quarantined in hotels for two weeks.
Finally, those who have recovered from COVID-19, and are, in theory, immune, may be able to go back to work. This category, which would require the use of antibody-based tests to identify, "would be a game-changer in restarting parts of the economy more quickly and safely," Fineberg said. Researchers in Germany have already started a large study to find out how many people in the country are immune to COVID-19, which could allow officials to issue "immunity passes" to allow people to return to work, The Guardian reported.
Fifth, intense efforts should be made to "mobilize the public" in the fight against coronavirus. "Everyone has a part to play and virtually everyone is willing," Fineberg wrote. For example, the U.S. postal service and other delivery companies could deliver surgical masks and hand sanitizer to every American household, Fineberg said. If everyone wears a mask, people who are infected but don't yet show symptoms would be less likely to spread the disease, he added.
And sixth, researchers should continue fundamental, "real-time" research into COVID-19 to examine questions such as who is at higher risk of death from the disease and whether those who haven't yet caught the virus could safely return to work under certain conditions.
It will also be critical to learn from our experiences in real time for example, when we start to open up parts of the economy in different parts of the country and adjust responses accordingly.
"Different communities will be at different stages of success and readiness," Fineberg said. We can see how well and safely certain strategies are working and then "crank it up more widely throughout the country."
Fineberg acknowledged that "all these things, everything I'm describing is hard to do and has many pitfalls in execution." But the alternative to not trying is the "catastrophe that's unfolding before us."
Dr. Courtney Gidengil, a senior physician policy researcher at RAND Corp. and a pediatric infectious disease specialist in Boston, said the editorial is an "interesting article and framework" for what needs to be done to address COVID-19. "These are really thoughtful and important steps that should already be under consideration."
"In a perfect world if we could undertake these steps aggressively and immediately that would give us the best chance" of crushing the curve, Gidengil said.
But the big question is how feasible it is to get these things to happen quickly enough to make a difference. "The more quickly these steps are implemented" the closer we'll be to achieving the goal, she said.
Another major challenge is the risk of having the virus come back into the country from another part of the world. "In terms of truly containing it, we really need high levels of immunity" against the virus, Gidengil said. Immunity could come through a vaccine (which is likely at least a year away) or through recovered patients. "Because we live in such a globalized world, it's just very difficult to guarantee the virus won't be imported again."
David Hutton, an associate professor of health management and policy at the University of Michigan School of Public Health, agreed that "to really 'defeat' this in the long term and get back to 'business as usual' we will need a highly effective treatment or a vaccine." Until the virus is totally controlled on a global scale "constant vigilance" is needed, he said.
Hutton does think it's possible to re-open the economy by June, as China is beginning to do. But he noted that strict measures are still in place there, including temperature checkpoints and surveillance applications on people's phones. Such measures could be more challenging in the United States, where people may be less willing to share private information, he said.
Another important issue is that, even if we get the number of infections down so that containment is possible, we will need an "army of efficient, effective public health workers" to perform contact tracing, Hutton said. This involves tracking down contacts of patients, testing and isolating them, "to stop this virus from spreading like wildfire again," he said.
However, as Live Science previously reported, one company is working on building a voluntary app that can use location data to automatically notify other users if someone near them tests positive. If widely adopted, it could potentially cut down the work for such public health workers.
Originally published on Live Science.
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ByGeorge Spencer
"Mindboggling." That's how Aaron Tobian, a pathologist and director of the Division of Transfusion Medicine at Johns Hopkins Hospital, describes the speed of the spread of the COVID-19 virusand Johns Hopkins' lightning-fast response to the pandemic.
"When it started to hit the home front and there were no treatments, everybody started saying, 'We need to act, and we need to act now,'" says Tobian, who has a joint appointment in the Department of Epidemiology at the Bloomberg School of Public Health. "And that's when people at Hopkins started coming together and said, 'Let's try to do something here.'"
That "something" is one step closer to reality. Under the leadership of immunologist Arturo Casadevall, Johns Hopkins has spearheaded the use of a convalescent serum therapy, a potential COVID-19 treatmentwith an old pedigree. On March 24, the U.S. Food and Drug Administration began allowing researchers to request emergency authorization for its use. Within three days hospitals in Houston and New York City started treatments, and now under a FDA "expanded access program" soon "a very large number" of U.S. hospitals will follow suit, according to Tobian.
On Friday, the FDA approved a clinical trial specifically for Johns Hopkins that will allow its researchers to further test the therapy as a means of preventing otherwise healthy people, notably front-line medical staff, from getting sick. FDA approval is pending for a second Hopkins clinical trial on patients who are slightly or moderately ill to see if the serum will keep them out of ICUs and help bring them back to health.
Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak
In recent weeks, Casadevall has led a team of physicians and scientists from around the United States to establish a network of at least 40 hospitals and blood banks in 20 states that can begin collecting, isolating, and processing blood plasma from COVID-19 survivors. People who recover from an infection develop antibodies that circulate in the blood and can neutralize the pathogen. Researchers hope to use the technique to treat critically ill COVID-19 patients and boost the immune systems of health care providers and first responders. Currently there are no proven drug therapies or effective vaccines for treating the novel coronavirus.
"At the end of January, I knew this disease was going to get out of China, and I knew there was a huge history of the use of plasma and serum in the 20th century," says Casadevall, a Bloomberg Distinguished Professor of molecular microbiology and immunology and infectious diseases at the Johns Hopkins Bloomberg School of Public Health and School of Medicine. "This [medical effort] has become a juggernaut We're racing to deploy this."
Thousands of survivors might soon line up to donate their antibody-rich plasma, according to physicians. But that's only if early promising studies on the therapy done in China are confirmed by U.S. trials that show "dramatic effects and improvements" in patients, according to Tobian. He is optimistic the therapy will do just that. "I absolutely think this could be the best treatment we have for the next few months."
Image caption: Aaron Tobian, a pathologist and director of the Division of Transfusion Medicine at Johns Hopkins Hospital
Image credit: Will Kirk / Johns Hopkins University
This passive-antibody therapy has been used since the 1890s to combat diseases as wide-ranging as measles, SARS, Ebola, H1N1 flu, and polioand holds the promise of keeping the virus at bay until a vaccine can be developed. (Current estimates are that a vaccine for emergency use could be available by early 2021.) During the SARS outbreak in 20022003, an 80-person trial of convalescent serum in Hong Kong found that people treated with it within two weeks of showing symptoms had a higher chance of being discharged from hospital than did those who weren't treated.
The beauty of the therapy, says Casadevall, is that it involves the well-establishedand safemethod of blood donation. Except in this case, survivors' plasma (or serum), which contains the antibody to COVID-19, is separated from red blood cells and transfused into the three categories of recipients: the critically ill as a last-stop "compassionate care" measure; patients who are slightly or moderately ill to keep them out of ICUs and off scarce ventilators, and front-line medical workers to prevent them from getting sick. Nearly a cup of the serum (200 milliliters, or one unit) would be administered to each recipient, according to Tobian, with each donor providing enough serum for up to four patients. (Each donor, depending on body size, can provide two to four units.)
Casadevall had the vision for this treatment. He also had the wisdom not to micromanage his team of doctors, whom he set free to create their own fast-flowing mini-teams. Together, they united with peers around the world in a marathon of selfless, round-the-clock work toward an urgent common goalto overwhelm and crush the COVID-19 virus. "Looking forward to another day of working with an incredible set of colleagues," tweeted Casadevall in late March. "Day began at 4 a.m. and will go to near midnight." In this process, doctors, researchers, and regulators from as far away as Israel and Ethiopia banded with Hopkins doctors to create treatment protocols, open labs, win regulatory and institutional approvals, identify donors, compile data, and organize and share vital information. The research effort received a welcome boost in late March with a gift of $3 million from Bloomberg Philanthropies and $1 million in funding from the state of Maryland.
"We usually spend a year preparing for the next flu season," says Andy Pekosz, vice chair of the Department of Molecular Microbiology and Immunology at the Bloomberg School of Public Health. "What we do for flu in a year, we're trying to do in a month for COVID-19. Our window of acting is a small one." The fast-spreading coronavirus has already killed at least 70,000 people around the world, with nearly 1,300,000 total confirmed cases. Numbers that continue to grow.
From the beginning, Casadevall knew he faced more than a medical problem. Plasma therapy's history was unknown to most people, so he needed to draw public attention to his cause. Realizing a medical journal commentary would reach a limited audience, Casadevall shopped around an editorial that urged the use of convalescent serum. The essay, published in the Feb. 27 edition of The Wall Street Journal, told the story of an ingenious Pottstown, Pennsylvania, doctor who in 1934 arrested a measles outbreak at a boys boarding school by using serum therapy. "A remarkable victory against a highly contagious disease," Casadevall wrote.
Image caption: Arturo Casadevall
Casadevall fired off the essay to dozens of colleagues who encouraged him in his plan to also publish a scholarly paper that conveyed sufficient technical information to prove to the medical community he had done his homework. In four days, he and long-time collaborator Liise-anne Pirofski, head of the infectious diseases department at the Albert Einstein College of Medicine in New York City, wrote what Casadevall calls "maybe the most important paper in my life"'The Convalescent Sera Option for Containing COVID-19,' which appeared in the Journal of Clinical Investigation on March 13. Written in the cool, precise language of clinical experts, the paper concluded, "We recommend that institutions consider the emergency use of convalescent sera and begin preparations as soon as possible." But its final sentence carried a sharp and decidedly unscholarly sounding warning"Time is of the essence."
The result? "Everything took off," says Casadevall. "Its publication coincided with the major increase in cases in the United States. The media jumped on it."
Had it not been for a tropical pet bird whose guano infected its owner in 1995, Casadevall's path might never have crossed with that of infectious disease specialist Shmuel Shoham, an associate professor of medicine at the School of Medicine. "That was how we bonded," recalls Shoham, who hammered out the first protocol for the treatment of potential COVID-19 patients.
Back then Casadevall was at Albert Einstein in the Bronx while Shoham was at Boston University, but thanks to a mutual friend, they co-authored a ground-breaking paper in the Annals of Internal Medicine that was picked up by The New York Times. Their research proved the hitherto unknown link between human fungal illness and "cockatoo poo," as Shoham puts it.
Over the years, their careers took them to different cities and in separate directions, but when Casadevall arrived at Hopkins five years ago, they renewed their friendship and became key collaborators again. In mid-February, when Italy reported mounting cases, Shoham began thinking: "If there's a hole in the boat, it doesn't matter if it's on my side or your side, we're all going down. If this is happening in Italy, there is absolutely no reason why this could not happen in Baltimore." Then he saw a tweet from Casadevall: "Plasma is going to be the solution." At first, Shoham pushed back, saying the therapy hadn't worked on influenza patients. But those patients were too ill, Casadevall replied, and in a flurry of back-and-forth tweets, he won over his colleague to his point of view.
With the virus beginning to rage in the U.S., Casadevall convened a 7:30 a.m. conference call on March 4, five days after his WSJ op-ed appeared, with a group from Hopkins' Division of Infectious Diseases. Shoham hopped on the call while driving to work. "I told them we had to do [something]," Casadevall recalls. "This was something that was just not on the radar screen. There was silence, and I said, 'We're going to need a protocol.'"
Shoham volunteered to write it. Although he typically spends two-thirds of his time with patients, by fortunate happenstance he had few patients on his calendar, and that gave him time to dive into COVID-19. By the next day he had pounded out the bare bones of a protocol to prevent infection by administering the plasma to those who had been exposed. "It was sort of a really messy protocol with highlights like a 'This Space Left Intentionally Blank' place holder," Shoham says. He finished a more detailed, but still rudimentary, draft in time for Casadevall's next conference call a few days later.
Casadevall fired off the protocol to a Mayo Clinic colleague, who converted it into one for the treatment of early-to-moderate disease, which Hopkins doctors further refined and revised in collaboration with Mayo doctors. This pattern of rapid, long-distance collaboration would be repeated endlessly among other doctors for other needs in the days to come.
"All of a sudden, centers all over the country were saying, 'Oh, my God, this is something we can do.' So, then we had big conference calls with dozens of centers," says Shoham, who is now the FDA's principal investigator for the prophylaxis study, which makes him responsible for all execution and oversight of clinical research on that protocol.
The team had to know how to collect donor serum and how to transfuse it. So, pathologist Tobian and his colleague Evan Bloch, an associate professor of medicine, came aboard. Today, Tobian and Bloch help lead the transfusion group. "We get emails every single day from other hospitals on how we start collection, how we work on the regulatory aspects," Tobian says. "And we're in touch with transfusion medicine physicians across the nation numerous times a day." The pace has been "crazy," adds Bloch, a specialist in neglected infectious diseases.
In a sign of these high-tech times, Casadevall has never met either man. "I don't even know what Evan Bloch looks like," he says, "and I talk to him all the time. These men are magnificent. They rise to the occasion." In-person meetings happen but are mostly regarded as "a luxury" they can't afford because they would put people at risk, says Shoham.
To analyze the serum, Casadevall called in Pekosz. Until March, Pekosz, a basic researcher, had not thought he would be so directly involved in such an effort. But after Casadevall shared his plans, Pekosz realized some of his work could support the need to measure antibodies in the blood before transfusions were done.
"It became a whirlwind, a tornado we got swept up in, part of a massive effort to treat patients and make a direct impact on the pandemic," says Pekosz. In late March, Casadevall emailed Pekosz to say Vice Provost for Research Denis Wirtz had provided $250,000 in funding to launch a new lab to assess COVID-19 antibody responses in serum earmarked for the hospital's patients.
"Arturo said I needed to set up a lab to do this because this may be a really daunting task in terms of the number of patients we want to treat," Pekosz recalls. "At that point, I really understood, 'Wow, this is going to be a beast unto itself.'"
A big piece of Pekosz's jobbesides supervising six new lab employees, a staff that may soon doubleentails advising other hospitals on how to proceed. "I can't even remember the number of institutions that have contacted me who want to do the same thing. We're trying to work with them to be as close to each other's test results as possible, so we can have consistency across sites."
After Casadevall's initial burst of enthusiasm and organizational action, he confesses there was a moment when things seemed dark. "You realize the magnitude of what you're trying to do, and, in particular, you realize there could be huge regulatory issues," he says. He reminded himself that projects like this had been done by prior generations and in other countries, and with determination, he says, "I never for a minute doubted we could pull it off."
The FDA's approval process is a two-edged sword, according to Shoham, who says one of the biggest issues is the regulatory environment. Seemingly antiquated FDA requirements have sometimes left doctors shaking their heads. A submission of an IND (the application for an investigational new drug) is not official unless it is physically mailed with numerous copies of paperwork. "We could have sent an email [with PDF attachments]," says Tobian, referring to an IND that Hopkins prepared. "Instead we [were] trying to find who can make all these photocopies and send a FedEx package, and everyone's mostly been told they need to be working from home."
Nonetheless, neither he nor Casadevall believes the old-fashioned delivery system slowed the FDA's decisions or their work. "The FDA has an impossible job," Casadevall says. "I would never criticize them. They are working really hard. Their job is safety, and our job is to get this done."
Lysander, the Spartan admiral who conquered Athens in 405 B.C., is Casadevall's hero. "He did something that was unheard of at the time," Casadevall marvels. "He spared the city, and by sparing the city, he preserved Athens.
"To me, my heroes are always humanistspeople who do their job, but there is a humane aspect to how they do it," he says. "The greatest thing about being human is the capacity for empathy, the ability to care for others and be optimistic in the worst of times."
Casadevall's team lavishes praise on his leadership. "He is a force of nature," says Shoham. Brilliant, charismatic, enthusiastic, and generous is how Bloch describes him.
"Arturo pulled off what few people could do," Pekosz adds. "He got multiple institutions across the nation to pull together in this project to create the momentum that led the FDA to say, 'We have to do this, because people are moving forward.' There was such a groundswell of enthusiasm for this approach, the FDA had to pay attention to us."
Arturo Casadevall
For most of the team, there's been little rest for weeks. When asked how much sleep he's been getting, Bloch replies, "Last night wasn't badabout four to five hours. It's just continuous work through weekends, through nights." What drives him is partly the worst-case scenario forecasts he reads which he says are "frightening. You're thinking about the people in the backgroundthe health, social, and economic impacts. Having insight into what is going on can be a little bit stressful."
"There isn't going to be a day off for many, many months," Casadevall says.
People in medicine often think about delayed gratification, according to Shoham, because they never know whether some bit of knowledge they possess today might be needed tomorrow for an unforeseen reason.
"We're not thinking about the next thing," he says. "This is it. This is the one."
Results from the trials in the two New York City hospitals are expected around the end of April. How widely serum therapy is used after that for the time being remains unclear.
"We want now to get the clinical trials done," Casadevall insists. "Compassionate use is going to be available [in the trials]. Convalescent sera is going to be used in the country, there's no question about that. It's already been deployed in Europe. I think the next task is to learn if, when, and how to use it, and for that, we have to do clinical trials."
The Red Cross is seeking people who are fully recovered from COVID-19 and may be able to donate plasma to help current patients with serious or immediately life-threatening COVID-19 infections, or those judged by a health care provider to be at high risk of progression to severe or life-threatening disease. For more information, visit the website of the American Red Cross.
WASHINGTON, D.C. The Centers for Disease Control and Prevention has awarded $8 million to Illinois to support the state's response to the COVID-19 pandemic. U.S. Senators Tammy Duckworth and Dick Durbin say $6.3 million will go throughout the state and $1.7 million has been awarded to Chicago. This adds to the CDC's previous funding of $27.3 million across Illinois and $12.2 million for Chicago.
"Our nation's health care system and state and local health departments are on the front lines as we work to defend Americans from COVID-19, and this funding will critical in providing them with the resources they need to continue their vital work during this public health pandemic," Duckworth said. "Keeping Illinoisans healthy and minimizing the impact of COVID-19 is crucial right now, and I'll keep working alongside Senator Durbin to help bring home more federal resources and funding to limit the spread of the virus causing this disease."
The Senators say this funding will go toward lab equipment, supplies, staffing, shipping, infection control, surge staffing, monitoring of individuals, and data management. They explained the funds will also supplement a cooperative agreement to state jurisdictions through the Emerging Infections Program to strengthen surveillance capability.
"Our state and local public health departments are at the forefront of this crisis and this federal funding will help them continue their critical work of mitigating and preventing further spread of coronavirus," said Durbin. "Senator Duckworth and I remain committed to ensuring that Illinois receives the federal support it urgently needs during this pandemic."
The Georgia Department of Public Health confirmed on Wednesday that a 60-year-old man from Forsyth County has died from COVID-19, the second local death caused by the novel coronavirus since the outbreak began.
It's not known whether the individual had underlying medical conditions, and no further information was made available by the DPH.
There have been 362 confirmed deaths statewide from COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, according to the DPH's latest daily status report at 12 p.m., up from 348 on Tuesday, though official counts likely lag actual deaths due to delays in reporting death certificate data, according to the Centers for Disease Control and Prevention.
Forsyth County's first COVID-19 related death was reported March 24: an 87-year-old man also with no known underlying medical conditions.
Symptoms of COVID-19 can include fever, cough and breathing trouble. Most develop only mild symptoms, but some people, usually those with other medical complications, develop more severe symptoms, including pneumonia, which can be fatal.
Forsyth County had 99 confirmed cases of COVID-19 by Wednesday afternoon, according to the DPH, the same number reported Tuesday night.
Conventional diagnostic tests for the novel coronavirus may give false-negative results about 30% of the time, meaning people with an active COVID-19 infection still test negative for the disease, according to news reports.
"Unfortunately, we have very little public data on the false-negative rate for these tests in clinical practice," Dr. Harlan M. Krumholz, a professor of medicine at Yale University and director of the Yale New Haven Hospital Center for Outcomes Research and Evaluation, wrote in an opinion piece in The New York Times. However, preliminary research from China suggests that the most common type of COVID-19 test, known as a reverse transcriptase polymerase chain reaction (RT-PCR) test, may give false-negative results about 30% of the time.
The Chinese research has not yet been peer-reviewed, but anecdotally, Krumholz's colleagues have expressed concern that the false-negative rate may be even higher in the U.S., he wrote.
"A lot of my patients who have symptoms, who I clinically think have COVID-19, are testing negative," Dr. Alain Chaoui, head of Congenial Healthcare, a practice with 50,000 patients across five locations in Massachusetts, told The Boston Globe.
RT-PCR tests work by detecting bits of viral genetic material present in a patient's mucus, saliva and cells at the very back of their nasal cavity, where the nose meets the throat, Live Science previously reported. Doctors collect patient samples using a long, skinny swab and then apply chemicals to the sample to eliminate everything apart from the viral genetic material, called RNA. Enzymes added to the sample jump-start a chemical process that transcribes the RNA into DNA, which can then be processed in a machine and copied many times over.
With enough DNA copies on hand, scientists can then apply fluorescent tags to the sample that bind to specific bits of genetic material and glow once attached. The glow announces the presence of SARS-CoV-2, the virus that causes COVID-19.
Related: 10 deadly diseases that hopped across species
"The good news is that the tests appear to be highly specific: If your test comes back positive, it is almost certain you have the infection," Krumholz wrote. But RT-PCR tests might give false-negative results for a number of reasons, he added.
In one scenario, the initial swab sample may not always collect enough genetic material to provide an accurate test. This problem may arise more often in patients who do not show many symptoms at the time of their test, the Globe reported. In addition, the standard nasopharyngeal swab, wherein a long instrument is wriggled and rotated to the very back of the nasal cavity, can be both difficult for clinicians to perform and uncomfortable for patients to endure, Krumholz wrote.
Alternatively, false-negative results may result from how tests are processed in the laboratory or what specific chemicals are applied to each sample, Krumholz noted.
If false-negative results prove fairly common, what should people do if they receive one?
Chaoui told The Boston Globe that he is advising all his patients who test negative for the virus to assume they are infected, regardless, and quarantine themselves until they are symptom-free for at least 72 hours. Krumholz shared a similar sentiment in the Times. At UMass Memorial Medical Center in Worcester, epidemiologist Dr. Richard Ellison told the Globe that the hospital is now retesting patients who received a negative test but have symptoms of the novel coronavirus, in an attempt to cut down on false negatives.
"For now, we should assume that anyone could be carrying the virus," Krumholz wrote. "If you have had likely exposures and symptoms suggest Covid-19 infection, you probably have it even if your test is negative."
That said, no diagnostic test provides accurate results 100% of the time, and the tests developed by the U.S. Centers for Disease Control and Prevention are highly sensitive to the coronavirus, Dr. Larry Madoff, medical director of the Bureau of Infectious Disease at the Massachusetts Department of Public Health, wrote in a statement, according to the Globe.
"No test detects every case and there is no current 'gold standard' to compare [the COVID-19 tests] to," he wrote. "Testing may be falsely negative if the test is obtained too early or too late compared to infection, or if the sample isnt obtained or processed correctly."
Originally published on Live Science.
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The inseparable couple had been married for more than 51 years and were living in Boynton Beach, Florida, in retirement. Neither of them had any serious health conditions. Then in mid-March, they started feeling ill.
On Sunday, they both died -- six minutes apart -- due to complications from Covid-19, their son Buddy Baker said.
Stuart Baker was 74. Adrian Baker was 72.
"Until it touches you or touches somebody you know or you hear a story, you kind of feel removed from it," Baker, president and CEO of Exclusive Sports Group, told CNN. "... Hopefully my parents' passing doesn't go in vain."
At first, the family was optimistic
Baker detailed the events leading up to his parents' passing in a phone interview with CNN.
About three weeks ago, Stuart and Adrian went to the doctor after they weren't feeling well, according to Baker. They were eventually sent home.
A few days later, their symptoms still hadn't improved so their doctor recommended that they visit the hospital. Baker said that they were also sent home from the hospital and told to self-quarantine until they felt better.
"This is pre- the world shutting down, pre- the NCAA tournament getting canceled, so you're still not thinking this is going to be something which is life threatening," he said.
Baker said he'd call to check on his parents regularly, but their health didn't seem to be improving. One day, they seemed to be on the up, and then the next day, they'd be feeling worse again.
After a few more days, on March 19, they were told to return to the hospital. Baker's father, who had a fever and also had asthma, was admitted. His mother, who did not have a fever, was not.
Despite the circumstances, Baker said he and his family were optimistic. They were talking to Stuart regularly on his phone, and it seemed like he'd be able to push through.
About 48 hours later, his father was admitted to the ICU -- but the family was still hopeful. Stuart went from being on 60% oxygen to 50%, a sign that things were going in the right direction.
Then, the couple started to deteriorate
Meanwhile, Baker's mother was at home. Though she didn't have a fever or other worrying symptoms, knowing that her husband was in the hospital was taking a serious toll on her mentally.
"We just thought that was the result of my dad being away from her for the last five days, which was very very very infrequent in their lives together," Baker said.
Baker said he and his sister would visit their mother a few times a day, sitting outside the garage while their mom sat inside. Then on March 24, they got a call from the hospital. Their father had tested positive for Covid-19 and the doctor said it didn't look like he would make it.
The call was shattering, Baker said. They didn't want to upset their mother with the news, and decided to take her to the hospital as a precautionary measure. They wanted to see if she too could be tested, though because she had no fever or other related symptoms, they thought she would be fine.
Within 45 minutes of their mother being checked in, Baker said the doctor called to report that her oxygen levels were very low. She wouldn't make it either.
With their parents' organs failing, Baker said he and his sister decided to move their parents to hospice care at the counsel of medical professionals. His mother and father were both moved to the same room and taken off ventilators to be comfortable. Within minutes of each other, they had passed.
"They were as compatible and inseparable as two human beings have ever been married and existed on earth," Baker said.
Baker's message for others
On Thursday, Baker, his three children and his sister's family gathered for his parents' memorial service in Boynton Beach. The service was live-streamed for other friends and relatives and watched by people all over the world, he said.
"Hopefully people hear our story and it motivates them to do the right thing," he said. "By doing that, maybe it won't affect them or it won't affect their family but maybe they help another family not endure the pain and agony that me and my sister and our kids and the rest of our family are enduring right now."
Baker said he hopes his family's story can be a catalyst for change. He's calling on people to listen to what health officials have been saying: practice social distancing, wash their hands regularly and most importantly, stay at home.
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A popular bit of identicaland heavily reshared Facebook copypasta suggests that people who had a bad cough in November or December 2019 anywhere in the world, evidently have probably already experienced COVID-19 coronavirus disease without their knowing it.
The Facebook posts read as follows:
Quick question everyone. Who got sick in November or December and it lasted 10 to 14 days, [raising-hand emoji] with the worst cough that wouldnt go away? [raising-hand emoji] it was horrible!
If you can answer yes, then you might of had the coronavirus. There were no test and the flu test would come back negative anyway. They called it a severe upper respiratory infection.
You guys lived through that. Quit letting the media control you. Now give me back my toilet paper, sports, etc
This post is an opinion, not a fact. Im asking a question [shrugging emoji]
The message is conspiratorial in nature, implying the impetus for current social-distancing policies is media control. As cases and deaths from COVID-19 continue to grow at exponential rates across much of the world, this latter implication is self-evidently without merit, and the notion that a prior cough grants you current immunity to the disease is inherently dangerous.
It is, however, factual to state that scientists are not confident they fully understand when or where SARS-CoV-2, the novel coronavirus responsible for COVID-19, first started infecting humans. Does this mean its possible you have already had the disease without knowing it? Scientists say thats quite unlikely, but that gaps in our knowledge about the origin and timing of the pandemic make it impossible to completely rule out at the moment.
The earliest reports from Chinese health officials regarding what would become known as COVID-19 implicated the Huanan fish market in Wuhan, China, as the source of the viral outbreak and Dec. 8, 2019, the day of its first recorded case. Most of the unexplained viral pneumonia cases in Wuhan [at] this time have a history of exposure to the market, a report from the city of Wuhan read in early January 2020.
Later, however, when a large team of Chinese researchers published a case study on Wuhans early COVID-19 cases, they revealed that only 27 of 41 patients had been exposed to the Huanan seafood market and that the first case had no known connection to it. Speaking to Science Magazine, Daniel Lucey, an infectious disease specialist at Georgetown University, said that 13 cases with no link to the proposed origin was a big number and that the data demonstrate that the virus came into that marketplace before it came out of that marketplace.
Responding to questions from Science, the corresponding author on that early case study, Bin Cao, wrote, It seems clear that [the] seafood market is not the only origin of the virus, and that to be honest, we still do not know where the virus came from now. According to the South China Morning Post, Chinese government documents now trace the first confirmed case to a Nov. 17 illness contracted by a 55 year-old from Hubei province which contains Wuhan.
Lucey, writing in a blog post for the Infectious Diseases Society of America, argued:
If initial and potentially repeated animal-person transmission, followed by subsequent person-to-person transmission, could have begun in October-November or earlier in 2019, then patients with pneumonia due to infection with the novel coronavirus [] could have started to spread across Wuhan, and by infected-travelers leaving Wuhan to other locations.
The possibility of earlier cases and an uncertain geographic origin form the basis of the suggestion that an illness suffered by a person in November or December could have been COVID-19. Robert Garry, an infectious disease expert at Tulane University who has published on the origins of SARS-CoV-2, told Snopes by email that the notion was very unlikely but that without rigorous, global serological testing (in short, examining blood samples for antibodies), we wont have enough evidence to rule out that possibility:
SARS-CoV-2 or a close progenitor was circulating in China for a period of time November or December or even before before the cluster of cases of severe pneumonia allowed the identification of COVID-19.
Can we rule out that travels from China went to the US or elsewhere and set off small clusters of COVID cases that never got established? Seems very unlikely, but we wont really know for sure until these serological tests are perfected.
The information available still points to China as the origin of the pandemic. The first documented COVID-19 case in the United States occurred in Washington state after an individual returned to the United States from Wuhan on January 15, 2020. The first cases in Japan and South Korea were documented in people who had come from Wuhan as well.
In sum, the likelihood that many of the severe upper respiratory infections that occurred in the world in November and December 2019 were actually COVID-19 is astronomically low. The likelihood that earlier pockets broke out in non-Chinese areas prior to December 2019 is also low, but impossible to rule out with current data.
One thing that is certain: If you had a cough in late 2019, that is absolutely not proof of your immunity to COVID-19. Treating it as such would endanger your own health, the health of people you interact with, and the safety of your community.
Experts draw attention to the hidden sorrows of the SARS-CoV-2 virus on people with Parkinsons disease.
Experts from Radboud University, Nijmegen in the Netherlands, have published a commentary article in the Journal of Parkinsons Disease, highlighting the hidden sorrows of the SARS-CoV-2 virus on people with Parkinsons disease.
Stay informed with live updates on the current COVID-19 outbreak and visit our coronavirus hub for more advice on prevention and treatment.
In particular, the authors highlight the way stress and lack of physical activity can adversely affect the experience of people who have Parkinsons disease.
The SARS-CoV-2 virus has rapidly and radically changed the behavior of millions of people around the world. As a response to the pandemic, governments have introduced various emergency policies to limit social interaction in an attempt to slow the spread of the disease until scientists find a vaccine.
People with Parkinsons disease face particular challenges. There is no definite data on the relationship between Parkinsons disease and COVID-19. Scientists know that the leading cause of death in people with Parkinsons disease is pneumonia and that pneumonia is also a key symptom of COVID-19.
However, according to the authors of the commentary article, the social restrictions that governments have instigated may significantly affect people with Parkinsons.
Parkinsons disease is a type of neurodegenerative disorder. According to the National Institute on Aging, it results in joint stiffness, shaking, and difficulties moving. It typically affects people over the age of 60, and it worsens over time.
Parkinsons occurs when neurons in a persons brain die. These cells produce dopamine, and it is this reduction of dopamine that causes the symptoms of Parkinsons. Scientists do not yet know precisely why this happens, and, currently, there is no cure.
According to the authors of the commentary article, people with Parkinsons disease are more likely to experience stress, anxiety, and depression.
As the authors note:
The pathophysiology of [Parkinsons disease] puts patients at an increased risk of chronic stress, and a further worsening of this may well be one of the hidden sorrows of the COVID-19 pandemic.
The authors also suggest that the increased stress of social isolation may reveal latent forms of Parkinsons disease and that stress may increase the rate at which a persons dopamine-producing neurons die off. However, this is something that scientists have only demonstrated in animal studies.
As well as the adverse effects of stress, the authors also point out that reduced opportunities to do physical activity may also cause problems for people with Parkinsons disease.
As the authors note, Many people are now largely, and sometimes, completely stuck at home, being unable to go out for a regular walk, let alone to see their physiotherapist or attend a fitness class.
They highlight research that suggests being physically active in particular, engaging in high-intensity aerobic exercise may reduce the speed at which the symptoms of Parkinsons disease develop.
The authors also speculate that non-motor issues related to Parkinsons, such as insomnia or constipation, may even get worse through a lack of physical activity.
Despite the significant challenges people with Parkinsons disease may experience, the authors also note positives that may emerge from the pandemic.
The simultaneous experience shared by millions of people may mean that researchers can carry out effective research into the relationship between stress and Parkinsons.
In particular, the authors suggest that researchers could investigate why it is that some people can cope with stress better than others. This may be invaluable in the future for interventions that focus on the mental health of people with Parkinsons.
The authors also note that an inability to go out regularly has led to an increase in the number of digital and remote exercise classes available to people with Parkinsons disease. These exercise initiatives are now much easier to access, and they could remain a valuable resource for those people with Parkinsons once the pandemic is over.
While it is important to bear these potential positives in mind, what is clear from the commentary article is the importance of understanding the varying ways in which the SARS-CoV-2 virus can affect different groups of people.
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BOONE COUNTY, Ill. (WIFR) -- The Boone County Health Department says that a resident in their 80s has died from complications of COVID-19. Officials with the department say the family gives permission to release the gender of their loved one with this statement, "She was a brave soil who will be missed greatly by her family and friends."
"I am deeply troubled by the news that we've lost one of our own: the first COVID-19 related death in Boone County," says Amanda Mehl, Public Health Administrator. "Boone County is with this patient's family and loved ones in mourning her loss and honoring her memory.
The health department previously announced that this resident had tested positive for COVID-19, the number of confirmed cases in the county is at seven.
Healthcare partners and first responders in Boone County have been in close communication with the Boone County Health Department and regional colleagues to monitor, respond, and help limit the spread of the disease.
Moderna Therapeutics, a biotech company based in Cambridge, Mass., has shipped the first batches of its COVID-19 vaccine. The vaccine was created just 42 days after the genetic sequence of the COVID_19 virus, called SARS-CoV-2, was released by Chinese researchers in mid-January. The first vials were sent to the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) in Bethesda, MD, which will ready the vaccine for human testing as early as April.
NIH scientists also began testing an antiviral drug called remdesivir that had been developed for Ebola, on a patient infected with SARS-CoV-2. The trial is the first to test a drug for treating COVID-19, and will be led by a team at the University of Nebraska Medical Center. The first patient to volunteer for the ground-breaking study is a passenger who was brought back to the US after testing positive for the disease aboard the Diamond Princess. Others diagnosed with COVID-19 who have been hospitalized will also be part of the study.
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Remdesivir showed encouraging results among animals infected with two related coronaviruses, one responsible for severe acute respiratory syndrome (SARS) and another for causing Middle East respiratory syndrome (MERS). Volunteers will be randomly assigned to receive either the drug or a placebo intravenously for 10 days, and they will have blood tests and nose and throat swabs taken every two days to track the amount of virus in their bodies. Even if the drug shows some efficacy in keeping blood levels of SARS-CoV-2 from growing, it could help to contain spread of the infection.
Modernas vaccine against COVID-19 was developed in record time because its based on a relatively new genetic method that does not require growing huge amounts of virus. Instead, the vaccine is packed with mRNA, the genetic material that comes from DNA and makes proteins. Moderna loads its vaccine with mRNA that codes for the right coronavirus proteins which then get injected into the body. Immune cells in the lymph nodes can process that mRNA and start making the protein in just the right way for other immune cells to recognize and mark them for destruction.
As Dr. Stephen Hoge, president of Moderna, told TIME earlier this month, mRNA is really like a software molecule in biology. So our vaccine is like the software program to the body, which then goes and makes the [viral] proteins that can generate an immune response. That means that this vaccine method can be scaled up quickly, saving critical time when a new disease like COVID-19 emerges and starts infecting tens of thousands of people.
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