Dutch models of COVID-19 are designed to help prevent overloading of hospitals and the need to transfer patients.
Jacco Wallinga's computer simulations are about to face a high-stakes reality check. Wallinga is a mathematician and the chief epidemic modeler at the National Institute for Public Health and the Environment (RIVM), which is advising the Dutch government on what actions, such as closing schools and businesses, will help control the spread of the novel coronavirus in the country.
The Netherlands has so far chosen a softer set of measures than most Western European countries; it was late to close its schools and restaurants and hasn't ordered a full lockdown. In a 17 March speech, Prime Minister Mark Rutte rejected working endlessly to contain the virus and shutting down the country completely. Instead, he opted for controlled spread of the virus while making sure the health system isn't swamped with COVID-19 patients. He called on the public to respect RIVM's expertise on how to thread that needle. Wallinga's models predict that the number of infected people needing hospitalization, his most important metric, will taper off next week. But if the models are wrong, the demand for intensive care beds could outstrip supply, as it has, tragically, in Italy and Spain.
COVID-19 isn't the first infectious disease scientists have modeledEbola and Zika are recent examplesbut never has so much depended on their work. Entire cities and countries have been locked down based on hastily done forecasts that often haven't been peer reviewed. It's a huge responsibility, says epidemiologist Caitlin Rivers of the Johns Hopkins University Center for Health Security, who co-authored a report about the future of outbreak modeling in the United States that her center released this week.
Just how influential those models are became apparent over the past 2 weeks in the United Kingdom. Based partly on modeling work by a group at Imperial College London, the U.K. government at first implemented fewer measures than many other countriesnot unlike the strategy the Netherlands is pursuing. Citywide lockdowns and school closures, as China initially mandated, would result in a large second epidemic once measures were lifted, a group of modelers that advises the government concluded in a statement. Less severe controls would still reduce the epidemic's peak and make any rebound less severe, they predicted.
But on 16 March, the Imperial College group published a dramatically revised model that concludedbased on fresh data from the United Kingdom and Italythat even a reduced peak would fill twice as many intensive care beds as estimated previously, overwhelming capacity. The only choice, they concluded, was to go all out on control measures. At best, strict measures might be periodically eased for short periods, the group said (see graphic, below). The U.K. government shifted course within days and announced a strict lockdown.
It's not that the science behind epidemic modeling is controversial. Wallinga uses a well-established model that divides the Dutch population into four groups, or compartments in the field's lingo: healthy, sick, recovered, or dead. Equations determine how many people move between compartments as weeks and months pass. The mathematical side is pretty textbook, he says. But model outcomes vary widely depending on the characteristics of a pathogen and the affected population.
Because the virus that causes COVID-19 is new, modelers need estimates for key model parameters. Wallinga is now confident that the number of new infections caused by each infected person when no control measures are takenwhich epidemiologists call R0is just over two. And he trusts data showing that 3 to 6 days elapse between the moment someone is infected and the time they start to infect others.
From a 2017 survey of the Dutch population, the RIVM team also has good estimates of how many contacts people of different ages have at home, school, work, and during leisure. Wallinga says he's least confident about the susceptibility of each age group to infection and the rate at which people of various ages transmit the virus.
Compartment models assume the population is homogeneously mixed, a reasonable assumption for a small country like the Netherlands. Other modeling groups don't use compartments but simulate the day-to-day interactions of millions of individuals. Such models are better able to depict heterogeneous countries, such as the United States, or all of Europe. The World Health Organization organizes regular calls for COVID-19 modelers to compare strategies and outcomes, Wallinga says: That's a huge help in reducing discrepancies between the models that policymakers find difficult to handle.
In their review of U.S. outbreak modeling, Rivers and her colleagues note that most of the key players are academics with little role in policy. They don't typically participate in the decision-making processes they sort of pivot into a new world when an emergency hits, she says. Rivers argues for the creation of a National Infectious Disease Forecasting Center, akin to the National Weather Service. It would be the primary source of models in a crisis and strengthen outbreak science in peacetime.
Policymakers have relied too heavily on COVID-19 models, says Devi Sridhar, a global health expert at the University of Edinburgh. I'm not really sure whether the theoretical models will play out in real life. And it's dangerous for politicians to trust models that claim to show how a littlestudied virus can be kept in check, says Harvard University epidemiologist William Hanage. It's like, you've decided you've got to ride a tiger, he says, except you don't know where the tiger is, how big it is, or how many tigers there actually are.
Models are at their most useful when they identify something that is not obvious, says Adam Kucharski, a modeler at the London School of Hygiene & Tropical Medicine. One valuable function, he says, was to flag that temperature screening at airports will miss most coronavirus-infected people.
There's also a lot that models don't capture. They cannot anticipate, say, an effective antiviral that reduces the need for hospital beds. Nor do most models factor in the anguish of social distancing, or whether the public obeys orders to stay home. In Hong Kong and Singapore, It's 2 months already [of such measures], and people are really getting very tired, says University of Hong Kong modeler Gabriel Leung. Recent data suggest the virus may be spreading faster again in both cities, putting them on the brink of a major outbreak, he adds.
Long lockdowns to slow a disease have catastrophic economic impacts and may devastate public health themselves. It's a three-way tussle, Leung says, between protecting health, protecting the economy, and protecting people's well-being and emotional health.
The economic fallout isn't something epidemic models address, says Ira Longini, a modeler at the University of Floridabut that may have to change. We should probably hook up with some economic modelers and try to factor that in, he says.
As the virus that causes Covid-19 spreads worldwide, this dashboard offers a snapshot of the crisis right now. Click on a country name to get a more detailed geographic breakdown at the state, province, or county level. Please note that because of limited testing capacity in some areas, the actual number of cases is believed to be higher.
The datasets are drawn from the Johns Hopkins University Center for Systems Science and Engineering, from the COVID Tracking Project,and from USAFacts. In some cases, data on hospitalizations were not available.
This dashboard was produced through a partnership between STAT and Applied XL, a Newlab Venture Studio company. This tool will be updated with new datasets in the future, based on additional reporting and reader input. You can participate by sharing your ideas. What kind of data should we explore next? Let us know.
Bobbi Johnson, a worker at an Amazon warehouse south of Detroit, first saw the rumors on Facebook over the weekend. Kelly McIntosh-Butler, another worker at the facility, heard about them on Monday from her daughter, who works at another Amazon warehouse nearby. But it wasnt until Tuesday, when Johnson and others confronted someone from human resources in the break room, that they received confirmation that someone at the facility had tested positive for COVID-19.
Six workers at the sortation center DTW5 say they only learned of the case from coworkers or after McIntosh-Butler, frustrated with the lack of transparency, tipped off Local Four News, which received confirmation from Amazon Tuesday. In the information vacuum, they are left wondering whether theyve been exposed and whether its safe to continue working. Last week, Johnsons son, who has asthma, began having trouble breathing. This week, her daughter developed a dry cough. She hasnt been able to get either tested, and she worries she was an unknowing vector for COVID-19. She decided to stay home, without pay, to care for her children and avoid potentially spreading the virus.
They should have closed that building down and sanitized that whole building before they let us come in, Johnson tells The Verge. And they should have given everyone a robocall, because you never know if you bumped into that person in the bathroom or anything, because not only are you putting your life at risk, youre putting the people that you come in contact withs lives at stake.
Workers at DTW5 say that after they confronted management, they were told that five workers who had been in contact with the infected person had been informed. Workers feel that is far from sufficient. Their jobs often take them to different parts of the warehouse and they share break rooms, restrooms, and equipment, making it difficult to say precisely who may have been exposed. Many are balancing the need to receive a paycheck with potential risks to themselves and their loved ones, and without being notified of potential exposure, they fear they are making decisions in the dark.
Here I am, a week after being exposed to it, and Ive already been to work three other times, three other days breathing on people, McIntosh-Butler says. This is how this thing is getting out of control right now.
Several workers at DTW5 say they hear hacking coughs, sneezes, and other potential symptoms in the facility, but no one is being screened upon arrival. Though the workers have been told cleaning has been ramped up, they say theyve seen no evidence of it, and that sanitary wipes and other cleaning material is often in short supply or nonexistent. Yesterday, another worker at the facility said she was experiencing COVID-like symptoms, hasnt been able to get tested, and has decided to self-quarantine, according to screenshots shared with The Verge. (Update: Three workers at DTW5 received an automated call on Thursday morning informing them there had been a second confirmed case of COVID-19 at the facility, though several other workers say they have yet to be notified.)
Workers have been diagnosed with COVID-19 at 10 Amazon warehouses in the US so far. At many of them, workers only confirmed the infection after confronting management or hearing news reports. In Jacksonville, Florida, workers learned of a coronavirus case at their warehouse from the local news. At a New York City sortation center last week, the first known case of an Amazon warehouse worker contracting COVID-19, Amazon sent day shift workers home while the company disinfected the facility, but workers on the following shift only learned of the case after getting a text from a workers group. When the night shift arrived, they refused to work, shutting down the facility. On Tuesday, an Amazon worker at a Staten Island fulfillment center tested positive, and again workers received no email, text, or call from Amazon.
At the MDW2 warehouse in Joliet, Illinois, Stephanie Haynes heard through coworkers that someone who works near her had tested positive. She approached someone from human resources, who confirmed it.
Me and some other ladies went to human resources and confronted them about it, and we thought theyll do something as far as shutting the building down or doing a lot of cleaning, Haynes said during a call organized by Athena, a coalition of groups critical of Amazon. Instead, management claimed to have checked the cameras and found that the workers had not been close enough to the infected person to be in danger, Haynes says, and told the workers to continue coming in. The building wasnt shut down management told workers the facility would be cleaned as they worked.
Haynes, who has asthma and whose husband has diabetes, putting them at higher risk from COVID-19, decided to self-quarantine anyway. Though Amazon has said it will provide two weeks paid leave for any workers diagnosed with COVID-19 or placed in quarantine, unless the company calls to recommend she should quarantine, her time away is unpaid. Amazon needs to do a lot more to protect us, she says. We need to know how theyre going to handle things when somebody is in a warehouse and gets sick.
Amazon has the capacity to quickly notify workers. The company frequently messages all workers at a given facility for things like schedule changes or mandatory overtime. When California shut down all non-essential businesses last week, Amazon workers received automated calls telling them they were essential and should continue coming to their warehouses. You guys call us to tell us that were getting extra pay or that we can come in, but nobody was notified that there was a confirmed case? says Johnson at DTW5.
Asked about the lack of notification for workers at DTW5 and elsewhere, Amazon said only that it had made employees aware of confirmed cases and asked anyone in close contact with diagnosed individuals to self-quarantine for 14 days with pay. We are supporting the individuals, following guidelines from local officials, and are taking extreme measures to ensure the safety of all the employees at our sites, the company said in a statement.
Millions of Americans told to stay home have turned to Amazon as a means of getting basic necessities, and the company has embraced its role as an essential service, scaling up operations as governments order other businesses closed. But the situation puts Amazon workers in a difficult position, forced to choose between going without a paycheck or venturing into crowded warehouses where many feel inadequate safety precautions are being taken. On Facebook, workers have begun changing their profiles to read, I cant stay home, I work at Amazon.
More than 1,500 workers have signed a petition calling on the company to improve safety measures, provide sick leave regardless of a COVID-19 diagnosis, and shut down facilities where workers test positive for cleaning. The company says it has implemented new cleaning procedures and taken steps to avoid people crowding together, but workers at DTW5 and elsewhere say cleaning supplies are often lacking, the pace of work doesnt leave them time to use them, and their jobs still require them being in close proximity to each other. While Amazon shut down a returns-processing warehouse in Kentucky Wednesday after three workers tested positive, it has so far refused to close facilities more integral to its distribution network. In Italy and Spain, the companys decision to keep warehouses running despite infections prompted protests and absenteeism.
Amazon, meanwhile, is struggling to staff up to meet surging demand. Last week, the company raised pay by $2 per hour, increased pay for overtime, and announced plans to hire 100,000 workers. Amazon also changed its policies to allow workers to take unlimited time off without pay (previously they would have been fired for taking more than a certain amount), and even before Amazon workers began getting infected, many were choosing to stay home or leave early, fearing an outbreak was inevitable. As orders flood in, delivery times for some items now stretch to a month or more.
A lot of people are coming to work, working two or three hours, and leaving because theyre thinking overexposure is scary, McIntosh-Butler says. Management is mad, and if they tell anybody that we had a positive case, theyre thinking people arent even going to show up to work.
But at DTW5, the fact that workers had to confront management over rumors to learn a coworker tested positive has only heightened their anxiety. One worker said that after HR confirmed the case on Tuesday, more than 100 workers walked out, and now shes weighing whether to work her next shift. She needs to make rent, but shes also in frequent contact with her father, who has cystic fibrosis, potentially making him more vulnerable to COVID-19. Another worker said that as a single mother of three, she cant afford to go without a paycheck, but also fears getting the virus and infecting her kids. Its very scary, she says.
McIntosh-Butlers husband has seen work dry up during the pandemic, but shes only going to work one more shift this week and then stay away. Shell wear a bandana over her face, as many workers at the facility have begun doing, even though she knows it wont do much.
Ill have my $200 check and they can have the rest, McIntosh-Butler says. I just think that its too dangerous right now, because I dont know who Im coming into contact with, and HR isnt taking it seriously.
Update March 26th, 11:30AM ET: The story has been updated with information about a second confirmed COVID-19 case at DTW5. Several workers received an automated call about the case after publication.
Nurses wait for the next patient to be screened for coronavirus at a UW Medicine testing station. (UW Medicine Photo / Randy Carnell)
If gaps in health care resources arent filled, more than 80,000 Americans will die over the next four months due to the coronavirus pandemic, epidemiologists at the University of Washington predict.
The grim forecast based on an analysis of statistics from the World Health Organization, as well as from national and local governments and hospitals is laid out today in a research paper thats being submitted to the MedRxiv preprint server but hasnt yet been peer-reviewed.
Researchers at the UWs Institute for Health Metrics and Evaluation say their forecast takes current policies on social distancing into account. The problem is that shortages of hospital beds and medical supplies are projected to boost the death toll nevertheless.
Peak excess demand is projected to occur in the second week of April, when the researchers predict a shortage of 64,000 beds and more than 19,000 ventilators. The date of peak excess demand by state varies from the second week of April through May, the researchers say.
With those inputs, the computer models project a total of 81,114 deaths in the U.S. over the next four months. Most of those deaths are expected to occur during April, peaking at more than 2,300 deaths per day. That rate is projected to drop below 10 deaths per day sometime between May 31 and June 6.
There are also state-by-state projections of hospital resource usage and deaths. In Washington state, for example, the peak resource use is projected to occur on April 19, the death rate is projected to rise to a maximum of 27 per day, and total COVID-19 deaths are projected to amount to 1,429 through Aug. 4. As of today, Washington states cumulative COVID-19 death toll is 147.
The researchers say patients suffering from other diseases will face increased risk as well. In addition to a large number of deaths from COVID-19, the epidemic in the U.S. will place a load well beyond the current capacity of hospitals to manage, especially for ICU care, they say.
If the forecast proves correct, that suggests a dramatic upswing in the U.S. outbreak. Todays figures from the Coronavirus Research Center at the Johns Hopkins School of Medicine show nearly 1,200 U.S. deaths to date due to COVID-19, out of more than 82,000 confirmed cases.
The global death toll has risen above 23,000, with 523,000 confirmed cases worldwide. Just today, the United States took the top spot on JHUs nation-by-nation tally of confirmed cases, surpassing China and Italy.
The UW teams predictions are couched in statistical caveats. For example, the death toll projection of 81,114 has a 95% confidence interval of 7,977 to 251,059 deaths.
Additional travel restrictions and social distancing policies could make a difference in states that havent taken such measures so far. But based on the modeling, the most urgent measures would be to boost available beds and medical supplies by reducing the demand for medical services not related to COVID-19, and increasing system capacity by any means possible.
These are urgently needed, given that peak volumes are estimated to be only three weeks away, the researchers say.
The preprint research paper, Forecasting COVID-19 Impact on Hospital Bed-Days, ICU-Days, Ventilator-Days and Deaths by US State in the Next Four Months, comes from the IHME COVID-19 Health Service Utilization Forecasting Team under the direction of UW Professor Christopher J.L. Murray.
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Amidst the debate about the Trump administrations response to the COVID-19 coronavirus disease pandemic that began in early 2020, which many critics contended was too slow because the president initially failed to acknowledge the severity of the issue, social media users circulated a meme that supposedly documented a marked contradiction in the U.S. presidents statements on the issue across time:
According to this meme, as late as March 9, 2020, Donald Trump was still criticizing the press for supposedly inflam[ing] the CoronaVirus situation and quoting the U.S. surgeon general as asserting that, The risk is low to the average American. Yet a mere eight days later, according to the meme, Trump claimed he felt it was a pandemic long before it was called a pandemic.
However observers might choose to interpret them, both of these statements are accurately dated and attributed to Trump in the meme. Trump tweeted the first statement on March 9:
The latter was a statement Trump made during a Coronavirus Task Force press briefing from the White House on March 17. As can be seen in the following video (at the 1:05:00 mark), as Trump fielded a question from a reporter about whether his tone on the pandemic had suddenly changed the previous day, he declared, This is a pandemic. I felt it was a pandemic long before it was called a pandemic. All you had to do is look at other countries; I think now its in almost 120 countries all over the world. No, Ive always viewed it as very serious. There was no difference yesterday from days before:
The New York Times chronicled this statement from Trump and contrasted it with others he had made in the weeks leading up to it:
For weeks, President Trump has minimized the coronavirus, mocked concern about it and treated the risk from it cavalierly. On [March 17] he took to the White House lectern and made a remarkable assertion: He knew it was a pandemic all along.
This is a pandemic, Mr. Trump told reporters. I felt it was a pandemic long before it was called a pandemic.
This is what Mr. Trump has actually said over the past two months:
On Jan. 22, asked by a CNBC reporter whether there were worries about a pandemic, the president replied: No, not at all. We have it totally under control. Its one person coming in from China, and we have it under control. Its going to be just fine.
On Feb. 26, at a White House news conference, commenting on the countrys first reported cases: Were going to be pretty soon at only five people. And we could be at just one or two people over the next short period of time. So weve had very good luck.
On Feb. 27, at a White House meeting: Its going to disappear. One day its like a miracle it will disappear.
On March 7, standing next to President Jair Bolsonaro of Brazil at Mar-a-Lago, his club in Palm Beach, Fla., when asked if he was concerned that the virus was spreading closer to Washington: No, Im not concerned at all. No, Im not. No, weve done a great job. (At least three members of the Brazilian delegation and one Trump donor at Mar-a-Lago that weekend later tested positive for the virus.)
On March 16, in the White House briefing room, warning that the outbreak would wash away this summer: So it could be right in that period of time where it, I say, wash it washes through. Other people dont like that term. But where it washes through.
But his assertion that he had long seen the pandemic coming was the most abrupt pivot yet from the voluminous number of claims and caustic remarks he has made about the disease.
Medical staff treat a patient with the novel coronavirus this month in Wuhan, China.
With cases of the new coronavirus disease 2019 (COVID-19) climbing steeply everywhere from Madrid to Manhattan , overwhelming one hospital after another and pushing the global death toll past 17,000, the sprint to find treatments has dramatically accelerated. Drugs that stop the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could save the lives of severely ill patients, protect health care workers and others at high risk of infection, and reduce the time patients spend in hospital beds.
The World Health Organization (WHO) last week announced a major study to compare treatment strategies in a streamlined clinical trial design that doctors around the world can join. Other trials are also underway; all told, at least 12 potential COVID-19 treatments are being tested, including drugs already in use for HIV and malaria, experimental compounds that work against an array of viruses in animal experiments, and antibody-rich plasma from people who have recovered from COVID-19. More than one strategy may prove its worth, and effective treatments may work at different stages of infection, says Thomas Gallagher, a coronavirus researcher at Loyola University Chicago's Health Sciences Campus. The big challenge may be at the clinical end determining when to use the drugs.
Researchers want to avoid repeating the mistakes of the 201416 West African Ebola epidemic, in which willy-nilly experiments proliferated but randomized clinical trials were set up so late that many ended up not recruiting enough patients. The lesson is you start trials now, says Arthur Caplan, a bioethicist at New York University's Langone Medical Center. Make it a part of what you're doing so that you can move rapidly to have the most efficacious interventions come to the front.
To that end, WHO on 20 March announced the launch of SOLIDARITY, an unprecedented, coordinated push to collect robust scientific data rapidly during a pandemic. The study, which could include many thousands of patients in dozens of countries, has emphasized simplicity so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate. WHO's website will randomize patients to local standard care or one of the four drug regimens, using only ones available at the patient's hospital. Physicians will simply record the day the patient left the hospital or died, the duration of the hospital stay, and whether the patient required oxygen or ventilation. That's all, says Ana Maria Henao Restrepo, a medical officer at WHO's Department of Immunization Vaccines and Biologicals.
The design is not blinded: Patients will know they received a drug candidate, and that could cause a placebo effect, Henao Restrepo concedes. But it is in the interest of speed, she says. We are doing this in record time. The agency hopes to start to enroll patients this week.
Rather than taking years to develop and test compounds from scratch, WHO and others want to repurpose drugs that are already approved for other diseases and have acceptable safety profiles. They're also looking at experimental drugs that have performed well in animal studies against the other two deadly coronaviruses, which cause SARS and Middle East respiratory syndrome (MERS). And they are focusing on compounds plentiful enough to treat a substantial number of patients.
For its study, WHO chose an experimental antiviral called remdesivir; the malaria medication chloroquine (or its chemical cousin hydroxychloroquine); a combination of the HIV drugs lopinavir and ritonavir; and that combination plus interferon-beta, an immune system messenger that can help cripple viruses. The treatments would stop the virus by different mechanisms, but each has drawbacks.
Remdesivir, developed by Gilead Sciences to combat Ebola and related viruses, shuts down viral replication by inhibiting a key viral enzyme, the RNA polymerase. It didn't help patients with Ebola in a test during the 2019 outbreak in the Democratic Republic of the Congo. But in 2017, researchers showed in test tube and animal studies that the drug can inhibit the SARS and MERS viruses.
The drug, which is given intravenously, has been used in hundreds of COVID-19 patients in the United States and Europe under what's known as compassionate use, which required Gilead to review patient records; some doctors have reported anecdotal evidence of benefit, but no hard data. Gilead says it is now starting to supply remdesivir under a simpler expanded use designation. Five other clinical trials underway in China and the United States are testing it and may have preliminary results soon. Of the drugs in the SOLIDARITY trial, remdesivir has the best potential, says Shibo Jiang of Fudan University, who works on coronavirus therapeutics.
Like most drugs for acute infections, remdesivir may be much more potent if given early, says Stanley Perlman, a coronavirus researcher at the University of Iowaand that could be a challenge. What you really want to do is give a drug like that to people who walk in with mild symptoms, he says. And you can't do that because it's an [intravenous] drug, it's expensive, and 85 out of 100 people don't need it because they won't develop severe disease.
Chloroquine and hydroxychloroquine have received intense attention because of positive results from small studies and an endorsement from President Donald Trump, who said, I feel good about it. The drugs decrease acidity in endosomes, compartments that cells use to ingest outside material and that some viruses co-opt during infection. But SARSCoV- 2's main entryway is different: It uses its so-called spike protein to attach to a receptor on the surface of human cells. Studies in cell culture have suggested chloroquine can cripple the virus, but the doses needed are usually high and could cause severe toxicity. Researchers have tried this drug on virus after virus, and it never works out in humans, says Susanne Herold, an expert on pulmonary infections at the University of Giessen.
Results from COVID-19 patients are murky. Chinese researchers who treated more than 100 patients touted chloroquine's benefits in a letter in BioScience, but they did not publish data. And WHO says no data has been shared from more than 20 other COVID-19 studies in China using chloroquine or hydroxychloroquine. French microbiologist Didier Raoult and colleagues published a study of hydroxychloroquine in 20 COVID-19 patients that concluded the drug had reduced viral load in nasal swabs. (It seemed to work even better with the antibiotic azithromycin.) But the trial, reported in the International Journal of Antimicrobial Agents, was not randomized, and it didn't report clinical outcomes such as deaths.
Hydroxychloroquine might actually do more harm than good. It has many side effects and can, in rare cases, harm the heartand people with heart conditions are at higher risk of severe COVID-19, says David Smith, an infectious disease physician at the University of California, San Diego. This is a warning signal, but we still need to do the trial, he says. There have also been reports of chloroquine poisoning in people who self-medicated.
Many coronavirus researchers are similarly skeptical of the lopinavir-ritonavir combination. Abbott Laboratories developed the drugs to inhibit the protease of HIV, an enzyme that cleaves a long protein chain during assembly of new viruses. The combination has worked in marmosets infected with the MERS virus, and has also been tested in patients with SARS and MERS, though those results are ambiguous. But the first trial with COVID-19 was not encouraging. When doctors in Wuhan, China, gave 199 patients standard care with or without lopinavir-ritonavir, the outcomes did not differ significantly, they reported in The New England Journal of Medicine on 15 March. The authors say the patients were very ill and treatment may have started too late.
The fourth arm of SOLIDARITY combines these two antivirals with interferon-beta, a molecule involved in regulating inflammation that has lessened disease severity in marmosets infected with MERS. But interferon-beta might be risky for patients with severe COVID-19, Herold says. If it is given late in the disease it could easily lead to worse tissue damage, instead of helping patients, she cautions.
SOLIDARITY is designed to provide a quick, useful verdict, based on the outcomes that are the most relevant for public health, says virologist Christian Drosten of the Charit University Hospital in Berlin. More detailed data could come from an add-on trial in Europe, announced on 23 March by the French biomedical research agency INSERM. To include 3200 patients, it will test the same drugs, including hydroxychloroquine but not chloroquine, and collect additional data such as blood gas levels or lung imaging.
Other approved and experimental treatments are in testing against coronavirus or likely soon to be. They include drugs that can reduce inflammation, such as corticosteroids and baricitinib, a treatment for rheumatoid arthritis. Some researchers have high hopes for camostat mesylate, a drug licensed in Japan for pancreatitis, which inhibits a human protein involved with infection. Other antivirals will also get a chance, including the influenza drug favipiravir and additional HIV antiretrovirals. Researchers also plan to try to boost immunity with convalescent plasma from recovered COVID-19 patients or monoclonal antibodies directed at SARS-CoV-2.
Perlman says the smartest way to test the drugs is in people in early stages of disease who doctors think are most likely to get much worse. How would you determine that? That is the key question, he says. Researchers might find a biomarker in blood that helps them predict disease course.
Crucially, doctors and researchers around the world are tackling the problem with urgency, Henao Restrepo says. This is a crisis like no other and we will have to work together, she says. That is the only way perhaps we are going to find a solution.
On March 5th, as COVID-19 began to reshape American life, I noted here that big tech companies had responded with unusual alacrity. Where they once had been loath to intervene in matters of fact, suddenly Facebook and Twitter were prominently featuring links to high-quality information from the Centers for Disease Control and World Health Organization in their respective feeds and search results. Google followed suit shortly thereafter.
In the weeks since, Big Tech has only accelerated its efforts at doing good. They have donated tens of millions of dollars to relief efforts. They have contributed large stocks of precious N95 masks acquired during last years wildfires to medical organizations. They have added sections to their apps highlighting accurate news about COVID-19. And as unemployment surged, Facebook pledged $100 million in grants to small businesses, and Amazon said it would hire 100,000 people.
In a dramatic change from only weeks before, news about Big Tech has been a bright spot at a time of great fear and, increasingly, of grief. Increasingly, journalists are asking whether the backlash against technology companies that has defined coverage of them for the past three and a half years might have come to an end.
In Wired on Friday, Steven Levy asked the question plainly: has the coronvirus killed the techlash? He writes:
Now that our lives are dominated by these giants, we see them as greedy exploiters of personal data and anticompetitive behemoths who have generally degraded society. Before the pandemic, there was every expectation that those companies would be reined in, if not split apart.
But the deus ex machina of an overwhelming public health crisis has changed things. The pandemic may have the effect of a justifiable war waged by an embattled president with low popularity. While Big Techs misdeeds are still apparent, their actual deeds now matter more to us. Were using Facebook to comfort ourselves while physically bunkered and social distancing. Google is being conscripted as the potential hub of one of our greatest needsCovid-19 testing. Our personal supply chainliterally the only way many of us are getting food and vital suppliesis Amazon.
Who knew the techlash was susceptible to a virus?
At CNBC, Salvador Rodriguez explored the same issue on Saturday, focused on Facebook. After rounding up everything the company had done so far, he said: Facebook wont be able to rebuild trust with the public overnight, but when the company was presented with an opportunity to rebuild goodwill by being proactive and helpful during global health and financial crises, Facebook sprung to action and seized the moment.
Subsequent articles have noted that, however magnanimous tech giants have acted in the crisis so far, they have much to gain from successfully navigating the coronavirus response. In The Information, Cory Weinberg noted that the companies work so far would likely have a recruiting benefit:
It is too early to know how big tech companies might seize the moment. And their own businesses certainly arent immune to economic fallout. But one area where they stand to benefit is recruiting. In recent years, big tech firms have had to compete with fast-growing startups for skilled computer scientists, especially as scandals and questions about abuses of power have tainted the reputations of the bigger firms. But tech workers who once might have preferred the dynamic surroundings of a small startup now might welcome the safer bet of a big enterprise.
One software engineer, who declined to be named to protect his job prospects, said he has been ignoring dozens of emails and calls from recruiters at Facebook in the last few months as he sought to develop his own company or join younger firms. But with venture capital firms expected to pull back from investing in nascent businesses, this month he scheduled an interview with the social media giant. His rationale: Stock gains from an equity package at Facebook could eventually help him self-fund his startup.
And perhaps even more importantly, the crisis represents an opportunity for tech companies to entwine themselves ever more deeply into customers lives. Already Ive had friends who had sworn off Facebook for good return to check on friends and family; will they be so quickly to delete it when a more normal way of life resumes? Amazon Prime may be groaning under the weight of increased demand, but after it gets your family through this crisis, would you ever dream of canceling it?
Daisuke Wakabayashi, Jack Nicas, Steve Lohr and Mike Isaac explore this question in the New York Times:
While Amazon has changed shopping habits for items like books, getting customers to trust it with groceries has been challenging. Now, as more people are forced to stay home, one of the last strongholds of physical retailing may be coming under pressure. [...]
As more customers try different Amazon services, they may create permanent shifts in buying habits, said Guru Hariharan, a former Amazon employee and the founder of CommerceIQ, a company whose automation software is used by major brands like Kelloggs and Kimberly-Clark.
For now, I think the prevailing sentiment is accurate: tech giants have probably turned a corner in public opinion. I imagine that the next time The Verge does its survey of Americans, it will find that the decline in trust has at least slowed, if not entirely reversed. One pressing question is whether that shift in sentiment, assuming its real, will affect the many ongoing state and federal investigations into competition and privacy issues that are still under way. Since late 2016 we have been focused on the problems that emerge from the size of giants like Google, Facebook, and Amazon; in the past several weeks the benefits that come from that size have become more apparent.
Still, its possible that even a perfect response to the COVID-19 crisis could plant the seeds for a future backlash. So much of the frustration with tech companies in recent years has originated from the fact that they are inescapable. Dependence breeds resentment, and the fewer alternatives consumers have to tech giants, the more resentful they are likely to become in time. Its also possible and even likely that tech companies will make significant errors in their handling of the crisis, which could set back any progress they haver made.
But all that can wait for another day. For better and for worse, Americans are relying on technology companies to get them through the next several months. If there was ever a moment for these companies to prove their worth, its now.
Today in news that could affect public perception of the big tech platforms.
Trending up: Volunteers from Amazon, Alphabet, and Apple worked every night for a week to make a website called covidnearyou that tracks the virus as it spreads.
Trending up: The World Health Organization has partnered with Facebook, Twitter, TikTok, and Microsoft for a hackathon dedicated to solving problems related to the coronavirus pandemic.
Ten Amazon warehouses in the United States have had workers test positive for COVID-19. The news comes as the e-commerce giant races to hire 100,000 more workers to meet the rising demand. Heres Jay Greene at The Washington Post:
The company has recently adopted new policies for its warehouses, including more regularly cleaning door handles, stairway handrails, touch screens and more, Levandowski said. Its nixed stand-up meetings, staggered start and break times to aid social distancing, and suspended screening workers as they leave to improve the flow of workers, she said.
Amazon, though, is struggling to get workers all the protection it wants them to have. The company placed orders for millions of face masks to give to employees and contractors who cannot work from home, Bezos wrote in a letter to employees Saturday. Because of the global shortage of those masks, though, very few of those orders have been filled, he wrote.
Also: Amazon told workers at its warehouse in Shepherdsville, Kentucky, that it will keep the facility shut indefinitely after three people tested positive for COVID-19. The workers will continue to receive their scheduled pay. (Matt Day / Bloomberg)
Still, Amazon could come out of this crisis stronger than ever. The shutdown of many retail stores, along with a general anxiety about going out in public, could end up increasing the companys share of overall retail by prompting shoppers to buy more stuff over the internet. (Priya Anand and Ashley Gold / The Information)
Amazon appears to be prioritizing shipments of its own hardware devices, like the Amazon Echo, while delaying distribution of other nonessential items as demand continues to soar. (Priya Anand / The Information)
Singapore is open-sourcing its coronavirus contact-tracing app, called TraceTogether. The app uses Bluetooth to identify people whove been in close contact with COVID-19 patients. Heres Hariz Baharudin at The Straits Times:
Launched last Friday, the TraceTogether app can identify people who have been within 2m of coronavirus patients for at least 30 minutes, using wireless Bluetooth technology. Its developers say the app is useful when those infected cannot recall whom they had been in close proximity with for an extended duration.
For the app to start tracing, the Bluetooth setting on mobile phones has to be turned on.
If a user gets infected, the authorities will be able to quickly find out the other users he has been in close contact with, allowing for easier identification of potential cases and helping curb the spread of the virus.
Russia is using facial-recognition technology to track people who are supposed to self-quarantine. Its also threatening prison time for those who dont self-isolate. (Robyn Dixon / The Washington Post)
Nextdoor has become the place for neighbors to connect, organize, and help one another amid the coronavirus outbreak. But relics of the old Nextdoor are still there, conspiracy theories and all. (John Herrman / The New York Times)
Facebook, Tesla, and Apple have pledged to donate thousands of masks to combat the medical equipment shortages caused by the novel coronavirus. Experts say it makes sense that these companies have vast stockpiles, since California is no stranger to natural disasters. (Blake Montgomery / Daily Beast)
Mark Zuckerberg said Facebook is just trying to keep the lights on as traffic continues to soar amid the coronavirus outbreak. The challenge is compounded by the company struggling to transition to a fully work from home culture. (Mike Isaac and Sheera Frenkel / The New York Times)
Also: Heres what Facebook said about dealing with the spike in traffic.
The World Health Organization plans to reach at least 50 million people with a WhatsApp chat service that delivers information about the novel coronavirus. The service garnered 10 million users within three days of launching. (Antony Sguazzin / Bloomberg)
Twitter temporarily locked the account of The Federalist after the conservative opinion site published a piece proposing the deliberate spread of the coronavirus in order to boost immunity to the disease. Fast, decisive, positive action from Twitter here. (Zachary Petrizzo / Mediaite)
Apples Screen Time feature has become a horrifying reminder of how much were using our devices now that were all stuck at home. Im up to 16 hours a day across my devices, how about you? (Travis M. Andrews / The Washington Post)
Pinterest launched a new Today tab to bring people curated boards and coronavirus information. The company plans to include expert information from the World Health Organization and Centers for Disease Control. (Nathan Ingraham / Engadget)
Foxconn and Wistron, two iPhone makers, have suspended production at their Indian plants to comply with a nationwide lockdown ordered. Prime Minister Narendra Modi has ordered the population to stay at home for three weeks. (Debby Wu / Bloomberg)
The coronavirus pandemic isnt (yet?) hurting TikTok stars at The Hype House in Los Angeles. Some say theyve seen enormous growth since the virus started to spread. (EJ Dickson / Rolling Stone)
Hundreds of tech employees are getting laid off amid the coronavirus outbreak and now its all happening over Zoom. Heres how it went down at TripActions. (Biz Carson / Protocol)
Theres a conflict playing out in the more orthodox factions of the Jewish community about whether or not to allow Zoom for virtual Seders. (Arutz Sheva)
Why youre getting coronavirus emails from every brand youve ever interacted with. Theyre all making decisions out of an abundance of caution. Abundance OCaution is going to be a great drag name for someone when this is all over. Or now! (Rebecca Jennings / Vox)
The internet was designed to adapt to huge spikes in traffic just like the one were living through. But the platforms and apps that make the internet useful are less tested. (Adam Clark Estes / Recode)
Americans who primarily get their news through social media are less likely to closely follow coronavirus news coverage. Theyre also the most likely to report seeing misinformation about the pandemic. (Pew Research Center)
Total cases in the US: 54,453
Total deaths in the US: 737
Cases reported in California: 2,853
Cases reported in New York: 26,358
Cases reported in Washington: 2,469
Information from the CDC. California data from the Los Angeles Times.
Stuff to occupy you online during the quarantine.
Crunch is now offering free online workout classes for 45 days.
The Verge launched a newsletter called Home Screen about life on the internet during the pandemic. Its designed to show you fun distractions from the disaster highly recommended.
A new app called Find My Pasta tells you the availably of products at nearby stores.
The popular game Heads Up is now free to download.
Send us tips, comments, questions, and backlash against this newsletter: casey@theverge.com and zoe@theverge.com.
The study, published in the medical journal JAMA Cardiology on Wednesday, found that among a group of Covid-19 patients hospitalized in Wuhan China, 19.7% suffered cardiac injury, which was found to be a risk factor for dying in the hospital.
Cardiac injury, also referred to as myocardial injury, occurs when there is damage to the heart muscle, and such damage can occur when blood flow to the heart is reduced -- which is what causes a heart attack.
The new study, conducted from January to February, included data on 416 adults who were confirmed to have Covid-19 and were hospitalized at Renmin Hospital of Wuhan University in China.
The data also revealed that the death rate was higher among patients with cardiac injury versus those without: 42 of the patients with cardiac injury, or 51.2%, died versus 15 of those without, or 4.5%.
"We know that cardiac damage is a marker for more mortality," Michos said. "This study clearly showed that even after you account for age and pre-existing cardiovascular disease, there was a still four-fold increased risk of dying. That's really important."
The new study had some limitations, including that the findings are based on observational data, and more research is needed to determine whether similar findings would emerge among a larger and more diverse group of Covid-19 patients.
Though the study showed cardiac injury is a common condition among patients hospitalized with Covid-19, it did not indicate whether Covid-19 directly causes cardiac injury. The mechanism of cardiac injury, or the process in which it occurs, among the patients with Covid-19 remains uncertain, and more evidence is needed to demonstrate whether Covid-19 directly injures the heart, the authors said.
"We need to figure out the mechanism of why do people with evidence of cardiac injury have higher morbidity or mortality? Is it related to the fact that they have underlying conditions that make them more susceptible to dying? Is it a marker of individuals that have a more robust immune response that is leading to heart damage?" said Michos of Johns Hopkins.
This and other studies suggest that those with elevated troponin, which measures cardiac injury, seem to be at a greater risk than when the elevation of other types of markers are present, such as inflammatory markers, Michos said.
The researchers also offered some ideas, writing in the study that people with preexisting cardiovascular diseases might be more susceptible to heart injury induced by Covid-19.
"Approximately 30% and 60% of patients with cardiac injury in the present study had a history of coronary heart disease and hypertension, respectively, which were significantly more prevalent than in those without cardiac injury," the researchers wrote in the study.
Also, acute inflammatory responses due to an infection can lead to reduced blood flow in patients with preexisting cardiovascular diseases, the researchers noted. They wrote that "based on these lines of evidence, we hypothesize that an intense inflammatory response superimposed on preexisting cardiovascular disease may precipitate cardiac injury."
A 'potentially important long-term issue'
When it comes to the public health impacts of Covid-19 and cardiac injury, the study suggests that "two key take-aways are that it's an important marker of those at high-risk for mortality as a consequence of Covid-19 infection and it may be an indicator of future risks associated with the cardiovascular injury from this infection, even if you recover," Gump said.
"Even though they're not dying from that cardiac injury, something about that biomarker is providing some prognostic value beyond other risk factors that were controlled, so it could still be important in terms of identifying high-risk patients that enter the hospital with Covid-19," Gump said.
"The other key here is the potentially important long-term issue," he said. "Many patients who pull through may still have cardiac injury and associated long-term cardiovascular issues as a consequence of Covid-19 infection."
They noted in the editorial that so far there have been only scarce data with respect to cardiovascular complications of Covid-19.
"To date, many patients with COVID-19 are still hospitalized in China and other countries, such as Italy and Iran. Therefore, continued observations of the cardiovascular complications of the disease are needed. In addition, further assessment is needed to identify risk factors for poor prognosis," Yang and Jin wrote. "Emerging as an acute infectious disease, COVID-19 may become a chronic epidemic similar to influenza because of genetic recombination. Therefore, we should be ready for the reemergence of COVID-19 or other coronaviruses."
CNN's Gina Yu contributed to this report.
Nearly a week and a half after Googles sister company Verily launched its COVID-19 screening and testing website, the company has published a video of its in-person drive-through testing process.
As the video explains, anyone looking to be tested first has to take an online screening questionnaire, the details of which were revealed last week when the website launched. The screener is designed to help prioritize testing. The criteria include exposure to existing cases of the virus, current symptoms, age, previous health conditions, and at-risk locations or occupations. Those criteria determine whether you qualify.
If you qualify for testing, youll get a reference ID number and appointment details, including the time and location. Then, youll head to the testing site, which consists of three stations. At the first station, youll get your ID and reference ID checked through the closed window of your vehicle to prevent possible infection. Once confirmed, youll drive to the second station, which will match your ID to a lab kit. Then youll head to the final station, where youll receive a nasal swab. That sample will get sent to a lab, with results delivered between two to four days later.
Right now, Verilys Project Baseline testing is still limited to just Santa Clara and San Mateo counties. As the video notes, Verilys website and testing process is part of the larger, California-based COVID-19 testing program, which is a state-directed program with federal input. Despite muddled statements from the White House regarding a Google-built screening website earlier in March, its not clear that Verily has plans to expand the program beyond California, or even whether the Verily Project Baseline site was the Google website that President Trump had been referring to at the time.
Webster Countys first positive case of novel coronavirus, COVID-19, was confirmed on Thursday, according to the Webster County Public Health.
The individual has recovered from the virus, the Health Department reported.
The Webster County resident is in the 18-40 age group, according to Kelli Bloomquist, public information officer for the Emergency Operations Center for Webster County.
Test results typically take between four and seven days to be returned from the date of the testing, Bloomquist reported.
A specific date for when this individual was tested cannot be released, according to Bloomquist. Other identifying information such as what city the patient lives in can also not be released as it violates the Health Insurance Portability and Accountability Act and other guidelines set forth by the Iowa Department of Public Health.
Bloomquist said Webster County Public Health was informed of the test results Thursday morning, which was the same time the Iowa Department of Public Health was informed.
In terms of people who may have had contact with the ill patient, Bloomquist said, The people who met the criteria for notification were notified by Webster County Public Health.
Meanwhile, Wright County also confirmed its first case of COVID-19 on Thursday. That individual, who is aged 41-60, is self-isolating at home, according to Wright County Supervisor Karl Helgevold. Helgevold is serving as the public information officer for that county.
Webster County Public Health Director Kari Prescott continues to urge caution and responsibility in regards to slowing the spread of the virus.
While this is Webster Countys first case, it may not be the last, and thats why we encourage all residents to continue to make prevention a priority, Prescott said.
According to Prescott, these actions include: washing hands frequently with soap and water for at least 20 seconds each time, covering coughs and sneezes with a tissue or elbow/upper arm and staying home when ill.
Approximately 80% of Iowans infected with COVID-19, will experience only a mild to moderate illness, Prescott said. Most mildly ill Iowans do not need to go to their health care provider or be tested to confirm they have COVID-19.
Sick Iowans must stay home and isolate themselves from others in their house, according to the Health Department.
The Health Department advises people to stay home and isolate from others in the house until: you have had no fever for at least 72 hours (that is three full days of no fever without the use of medicine that reduces fevers) and other symptoms have improved (for example, when your cough or shortness of breath have improved) and at least seven days have passed since your symptoms first appeared.
People who believe they need health care are asked to call first. Providers can assess whether patients need to be seen in the office or if they can recover at home. There may also be options for patients to talk to a medical provider from home using technology.
For additional questions, contact Webster County Health Department at 515-573-4107 or after hours call 515-227-7153.
For up-to-date information on COVID-19, visit the IDPH webpage at https://idph.iowa.gov/Emerging-Health-IssuWebster Countys first positive case of novel coronavirus, COVID-19, has been confirmed, according to the Webster County Health Department.
Fort Dodge and Webster County community leaders share in these videos how the emergency operations team is responding to the COVID-19 emergency.
The videos can be viewed online at https://www.youtube.com/playlist?list=PLh_vw3k5iFZFWBJu9PUbk19l6Cm4PWypr
Webster County Public Health has videos on their Facebook page to help answer questions the public might have.
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