Right about now, there may not be a more eagerly awaited announcement than a legitimate vaccine for Covid-19. Unfortunately, these things dont happen overnight, and the earliest estimates have a new vaccine becoming widely available in about a year.
At this point we would all benefit from a coronavirus vaccine, but who among us is willing to participate in a test trial for a potential cure? Its a noble deed, but also a scary thought. Now, a new study from the University of York is illustrating just how difficult a task it can be to find willing volunteers for vaccine and medication trials.
The research came to one, overarching conclusion: people are afraid of participating in these tests, and its that fear that causes many trials to fail in achieving an adequate number of volunteers.
These findings just go to show the enormous task facing scientists as they work tirelessly to perfect a Covid-19 vaccine, and the selflessness of the participants who already have, and will, come forward and put themselves at risk for the greater good.
The first U.S. test trial for a coronavirus vaccine just went underway, but there will assuredly be many more trials before a vaccine is approved. More volunteers will be needed.
In the United Kingdom, up to two-thirds of medical trials fail to recruit their targeted number of volunteers. Most study participants said they avoid taking part in medical trials due to fears about the new treatment and any possible side effects.
In all, over 400 prior studies that had investigated why people opt out of health and medical trials were analyzed for this project.
Besides concerns about possible side effects, many people also said they worry about compromising their privacy and confidentiality by participating in a medicinal trial. Additionally, various black and minority ethnic (BAME) patients told researchers that they just generally distrust medical professionals, and wouldnt join a trial for that reason.
Clinical trials are an essential part of developing new medicines and improving healthcare, but recruiting patients to take part is one of the biggest challenges researchers face, comments lead study author Dr. Peter Knapp, from the Department of Health Sciences at the University of York and the Hull York Medical School, in a press release. Our review highlights how people are held back from taking part in research by their fears surrounding losing control of the treatments they receive and worries about possible side effects.
Lack of trust was also identified as a common barrier for minority ethic patients around the world perhaps a legacy of major historical violations of ethical standards in cases like the Tuskegee syphilis experiment, he adds, citing a particularly dark corner of US medical history.
Still, countless vaccines and medications are eventually approved via successful trials, so some people must be willing to volunteer. Among willing participants, researchers found that most were motivated by a desire to help others. Other factors included the possibility of improving their health and an inherent trust in the doctors involved.
These findings may not be particularly shocking, but they are especially poignant given the ongoing Covid-19 situation. We all want a vaccine sooner rather than later, but its important to remember the sacrifices and risks that trial participants will be putting themselves through for the worlds benefit.
We live in a time of superhero worship. From Spiderman to The Joker everyone has their comic book character of choice these days, but if youre searching for a real-life hero look no further than the selfless individuals volunteering for Covid-19 vaccine trials.
The full study can be found here, published in Trials.
COVID-19 is caused by a new strain of coronavirus, which means no-one has any immunity when they are first exposed to it.
"With flus they're all derived from very similar types of viruses, whereas this is a new virus where everyone is naive to [it]," said evolutionary biologist Jemma Geoghegan of the University of Otago, who studies the emergence and evolution of viruses.
This means when it comes to cures for COVID-19, while scientists can draw on what we know about other viruses, in many ways they're starting from scratch.
Viral infections are often harder to cure than bacterial infections because you can't treat them with antibiotics, although antiviral medications are available for some infections.
Treatments might be used to alleviate the symptoms of your infection while your immune system is fighting the virus.
Conversely, vaccines are designed to prevent people getting infected in the first place.
They do this by imitating the infection, so that the body's immune system knows how to fight that particular infection and protect you against getting it in the future.
Here's what we know about how our bodies deal with COVID-19, and what's in the pipeline to cure it so far.
Australian researchers have found that our immune systems respond to this coronavirus in the same way as to influenza.
The immune cells that emerge in the blood before patients recover from COVID-19, are the same cells we see in people before they recover from the flu.
Researchers at the Peter Doherty Institute for Infection and Immunity were able to work this out by looking at multiple blood samples from one of Australia's first patients diagnosed with COVID-19.
Importantly, the research published in Nature Medicine is "the first paper that shows the body can give immunity and fight back and recover", researcher Carolien van de Sandt said.
Based on their experience with influenza patients, it also allowed the researchers to accurately predict how long the patient would take to recover from COVID-19.
But it's still too early to tell whether contracting coronavirus once would give you immunity to prevent you catching it again.
However the research could also help in the development of a vaccine and other treatments to tackle COVID-19.
Early signs are promising, after Australian researchers this week revealed they are ready to begin clinical trials of a potential treatment for COVID-19 using two existing drugs.
The drugs in question are an older HIV drug and an anti-malaria drug called chloroquine, which is rarely used now as the malaria pathogen has become resistant to it.
"There's certainly positive signals either this HIV drug or this anti-malaria drug actually work really well against COVID-19," David Paterson, director of the Centre for Clinical Research at the University of Queensland, told The Project.
"We know that in the test tube and in the patients that have been studied so far they've been able to recover and there's no more evidence of virus in [their] system," Professor Patterson said.
The next step for this research is to compare the HIV, the malaria drug, and a combination of the two, to see what treatment is most effective.
This phase of the trial could be as short as three months, Professor Paterson said, but it would take longer to roll the treatment out in the community, if it did prove effective.
Worldwide, Chinese doctors are completing clinical trials looking at the effectiveness of a combination of two HIV drugs, lopinavir and ritonavir, at treating COVID-19, New Scientist reported.
They are also soon to start testing a drug called remdesivir which was originally developed for Ebola.
Lots of different groups around the world are working on possible COVID-19 vaccines.
"There are now 15 potential vaccine candidates in the pipeline globally using a wide range of technolog[ies]: mRNA, DNA, nanoparticle, synthetic and modified virus-like particles," said microbiologist Ian Henderson of the University of Queensland.
The US National Institutes of Health announced that they have funded phase 1 clinical trials of a potential COVID-19 vaccine, called mRNA-1273, which began this week.
The vaccine was able to be brought to clinical trials so quickly because researchers had already been working on a vaccine to protect against another coronavirus, which causes Middle East respiratory syndrome (MERS).
While results from this first trial may be available within three months, it will still take at least a year and likely longer for a resulting vaccine to be widely available to the public.
Closer to home, last month Queensland researchers were ready to begin testing another potential COVID-19 vaccine on animals, and hope to then start human trials of it by the middle of the year.
But getting to clinical trials, and proving your vaccine is both safe and effective, isn't the only challenge scientists developing these vaccines face.
"The next challenge will be finding enough production capacity globally to produce these competing vaccines, at a scale that millions or even billions of people can be vaccinated," Professor Henderson said.
Which is why we're still hearing it will take at least 12 to 18 months, for a COVID-19 vaccine to be widely available.
Note: The map shows the known locations of coronavirus cases by county. Circles are sized by the number of people there who have tested positive, which may differ from where they contracted the illness. Some people who traveled overseas were taken for treatment in California, Nebraska and Texas. Puerto Rico and the other U.S. territories are not shown. Sources: State and local health agencies, hospitals and C.D.C. Data as of 11:45 p.m. on Friday, March 20.
It started two months ago, just north of Seattle. A young man who had returned from China tested positive for the coronavirus, the first known case in the United States.
At first, the virus was detected only in a handful of cases, and mostly in those who had traveled outside the United States.
There were lone patients in Arizona, in Massachusetts, in Wisconsin. Married couples in Illinois and California were infected. Groups of Americans evacuated from overseas received treatment in California, Nebraska and Texas.
But in the past three weeks, everything has changed. As testing expanded and the virus spread, cases have been confirmed by the dozens, then by the hundreds and thousands.
By Friday night, more than 17,000 cases of the coronavirus had been detected across all 50 states and Washington, D.C., and more than 200 people had died. New York, California and Washington State have been the hardest hit.
The climb in the number of cases has been rapid, in part because of more testing. This week saw five times more cases than the previous one, more than 6,000 of which were in New York, which has the most cases in the country.
See our maps tracking the coronavirus outbreak around the world.
Vice President Mike Pence on Saturday said he and his wife will be tested for the COVID-19 coronavirus task force. Patrick Semansky/AP hide caption
Vice President Mike Pence on Saturday said he and his wife will be tested for the COVID-19 coronavirus task force.
Updated at 3:40 p.m. ET
Vice President Pence on Saturday announced he and his wife will be tested for the COVID-19 coronavirus, following confirmation that an aide on his staff was diagnosed with the respiratory disease last week.
Pence made the remarks at a news conference following the coronavirus task force meeting at the White House. Earlier in the week the vice president,who leads the task force, told reporters that he has not been tested for the virus because the White House doctor had told him he didn't need to be.
"I'm pleased to report that he is doing well," Pence said of his aide, adding that "he had mild cold-like symptoms for a day and half."
Pence explained that all contact-tracing has been completed and neither he nor the president had direct contact with the aide. Regardless, he said, he would undergo testing later in the day.
He also offered the latest figures on the number of Americans who have been tested: More than 195,000 people have been tested, not including those who were tested in county hospitals or health care labs around the nation. Of those, roughly 19,350 have tested positive for the coronavirus, Pence said.
President Trump, who was first to speak at the news conference at the White House, ran through the list of steps the administration has taken to fight the spread of the virus, including an order for "hundreds of millions" of face masks and other supplies for health care professionals.
"We started with very few masks and now we're making tens of millions of masks," Trump said after blaming previous administrations for the stockpile shortages the country now faces.
He later specified the government has issued a contract for 500 million N95 masks, saying they are "now" available to hospitals and other health care centers.
Part of the demand for supplies is being met by the private sector in "sixth gear," he said, which is heeding the call to make masks, swabs and ventilators by pivoting from their primary industries to making the desperately needed supplies.
Trump praised Hanes, the cotton clothing maker, for retrofitting its manufacturing capabilities to produce masks for medical use. He also noted the shift by alcohol distilleries in Tennessee, Kentucky and West Virginia toward making hand sanitizer products that will be distributed throughout all 50 states.
He touted his work on legislation to bring economic relief to businesses and workers. He said his administration will give people extra time to file taxes, moving the deadline from April 15 to July 15. Additionally, he said students will not face interest penalties or fines for delaying student loan payments. Homeowners will also get help: Foreclosures and evictions on HUD loans are suspended for the next 60 days.
Trump talked about reaching agreements with Canada and Mexico to halt the entry of what he called the "Chinese virus," a term some have criticized as stigmatizing.
Adm. Brett Giroir, head of the U.S. Public Health Service, is leading the effort to expand testing. He said the agency is distributing equipment from the Strategic National Stockpile to "many states" on a daily basis.
But there's no clear answer to when states would have enough masks or other equipment.
Giroir said the outcry for more tests is not necessarily an issue of supply he said there are tens of thousands of tests out there but of making sure the right facilities are getting the right kind of tests and training.
This week, governors across the country warned that they were seeing shortages of supplies needed for testing, including testing reagents, used to create a chemical reaction to detect the virus, and swabs. On Friday, Health and Human Services Secretary Alex Azar said there had been "tremendous progress" in lab testing and dismissed complaints about shortages as "anecdotal."
But groups that represent public health labs, epidemiologists and state health officials said late Friday that there were "widespread shortages of laboratory supplies and reagents."
The Association of Public Health Laboratories said testing should be reserved for health care workers and first responders, older Americans with symptoms and other people at high risk of getting seriously ill from the virus.
The groups said mass testing would quickly deplete supplies, and it instead urged people with mild respiratory illness to stay at home and isolate themselves.
Hospitals have also said health care workers lack masks and other gear needed to protect themselves when treating patients with the virus. Pence said on Friday that there would be an announcement this weekend about what he called "a major acquisition" of masks.
A week ago, Trump and Pence had said there would be a website where people could find out whether they needed to be tested for the virus and direct them to nearby drive-though sites. While a division of Google's parent company has developed a pilot project in San Francisco, no website for national use has materialized.
After the president thanked Google for developing the website last week, the tech company put out a statement saying the life sciences division, Verily, was only in the "early stages" of such a rollout.
Amazon plans to hire 100,000 workers to assist with online deliveries in the U.S. and raise their minimum pay to at least $17 an hour through April. USA TODAY
With storesstripped bare of household essentials, retailers cutting back hoursand experts calling for social distancing amid the spread of coronavirus, many people may rely on delivery services to get what they need.
A study published in theNew England Journal of Medicine on Tuesdayfoundthat coronavirus could be detected up to three hours after aerosolizationin the air, up to four hours on copper, up to 24 hours on cardboard and up to two to three days on plastic and stainless steel.
This had led some to wonder whether thosepackages on their front porch could spread coronavirus. The answer seems to beno. The Centers for Disease Control and Prevention said that the virus isspread through respiratory droplets and there is currently no evidence to support the transmission of COVID-19 with imported goods.
"In general, because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from products or packaging that are shipped over a period of days or weeks at ambient temperatures," the CDC said on its website.
The World Health Organization offered similar guidance saying it is safe to receive packages from any area.
"The likelihood of an infected person contaminating commercial goods is low and the risk of catching the virus that causes COVID-19 from a package that has been moved, travelled, and exposed to different conditions and temperature is also low," the WHO said in a Q&A about the virus.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, saidduring a CNN coronavirus town hallthat if the disease were to transfer onto something like mail, it would likely be alow concentration.
Here's what you need to know about sending mail during the coronavirus pandemic:
Coronavirus myths, debunked: A cattle vaccine, bioweapons and a $3,000 test
Joseph Vinetz, a professor ofmedicine at Yale and infectious disease researcher, said that wiping down mail may help with some people's anxiety, but there's no evidence that doing so would be useful to protect against coronavirus.
"Thats just not a viable way of thinking about this epidemic nor am I taking any special precautions myself personally or for family or my friends based on packages," he said. "Whether its a package that comes in the mail delivered by Amazon or a letter from the USPS it's no different than going to the grocery store or going to get take out food."
AmeshAdalja,a senior scholar at the Johns Hopkins University Center for Health Security, agreed that the risk is theoretical and minimal.
"I will never disinfect my mail," he said. "And I dont even know how you would disinfect your mail."
Trying to order groceries online?: Here are some tips to do it successfully amid coronavirus
Adalja said there's minimal risk of the virus living on a package for several days, but if someone were to sneeze or cough on a letter before putting it into your mailbox "that's a different story."
Still, he said the same best practices that work during flu season like washing your hands and not touching your face after you open your mail would solve this problem.
How are postal services dealing with coronavirus?
A spokesperson for USPS, which employs more than 630,000 people, said 13 of its employees have tested positive for COVID-19. The company is closely monitoring the situation and is following strategies recommended by the CDC, according to the statement.
FedEx has advised employees who are have flulike symptoms to stay home, and is temporarily suspending signature requirements and regularly disinfecting the equipment used to make deliveries.
Amazon said it is offering flexibility for employees who need to stay home and paid time off for those who are diagnosed with coronavirus.Prime Now, Amazon Fresh, and Whole Foods Market delivery customers also have the option of "unattended delivery" if they want to limit into contact with others.
UPS said in a statement Monday that it istemporarily modifying the procedures its drivers use for residential and business deliveries. In order to minimize contact with recipients,UPS drivers will validate and record the name of the recipient of the package instead ofobtaining a signature. If an adult signature is requested by a shipper, recipients must present identification with proof of age to the driver.
Online shopping?: Amazon prioritizing shipments for medical supplies, household staples during coronavirus crisis
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What do we know about the virus now?
The Covid-19 virus is a member of the coronavirus family that made the jump from animals to humans late last year. Many of those initially infected either worked or frequently shopped in the Huanan seafood wholesale market in the centre of the Chinese city of Wuhan. Unusually for a virus that has made the jump from one species to another, it appears to transmit effectively in humans current estimates show that without strong containment measures the average person who catches Covid-19 will pass it on to two others. The virus also appears to have a higher mortality rate than common illnesses such as seasonal flu. The combination of coronaviruss ability to spread and cause serious illness has prompted many countries, including the UK, to introduce or plan extensive public health measures aimed at containing and limiting the impact of the epidemic.
Wash your hands with soap and water for at least 20 seconds and do this often, including when you get home or into work. Use hand sanitiser gel if soap and water are not available. Avoid touching your face. Cough or sneeze into a tissue or the crook of your elbow (not your hand) and put used tissues straight in the bin. Avoid close contact with people who are showing possible symptoms. Follow NHS guidance on self-isolation and travel.
The coronavirus outbreak hit amid flu season in the northern hemisphere and even doctors can struggle to distinguish between the two the overlap in symptoms probably contributed to slow detection of community infections in some countries, including Italy.
Typical flu symptoms, which normally come on quickly, include a high fever, sore throat, muscle aches, headaches, shivers, runny or stuffy nose, fatigue and, more occasionally, vomiting and diarrhoea. Doctors are still working to understand the full scope of symptoms and severity for Covid-19, but early studies of patients taken to hospital found nearly all of them developed a fever and dry cough, and many had fatigue and muscle aches. Pneumonia (lung infection) is common in coronavirus patients, even outside the most severe cases, and this can lead to breathing difficulties. A runny nose and sore throat are far less common, reported by just 5% of patients. The only real confirmation of having Covid-19 is taking a test though.
In the UK, the medical advice is now that the household of anyone who develops a new persistent cough or high temperature should all stay at home for 14 days, keeping away from other people. This applies to everyone, regardless of whether they have travelled abroad.
You should look on the dedicated coronavirus NHS 111 website for information. If you get worse or your symptoms last longer than seven days, you should call NHS 111. People will no longer be tested for the virus unless they are in hospital.
A large study in China found that about 80% of confirmed cases had fairly mild symptoms (defined as no significant infection in the lungs). About 15% had severe symptoms that caused significant shortness of breath, low blood oxygen or other lung problems, and fewer than 5% of cases were critical, featuring respiratory failure, septic shock or multiple organ problems. However, it is possible that a larger number of very mild cases are going under the radar, and so this breakdown in severity could change over time as wider screening takes place. Older people and those with respiratory problems, heart disease or diabetes are at greater risk.
It is probably about or a bit less than 1%. Much higher figures have been flying about, but the chief medical officer, Chris Whitty, is one of those who believes it will prove to be 1% or lower. The World Health Organizations director general, Dr Tedros Adhanom Ghebreyesus, talked of 3.4%, but his figure was calculated by dividing the number of deaths by the number of officially confirmed cases. We know there are many more mild cases that do not get to hospital and are not being counted, which would bring the mortality rate significantly down.
Deaths are highest in the elderly, with very low rates among younger people, although medical staff who treat patients and get exposed to a lot of virus are thought to be more at risk. But even among the over-80s, 90% will recover.
Most infections happen in families, where people live at close quarters. You need to be within one to two metres of somebody to be infected by viral-loaded water droplets from their coughs or when they are speaking. That is less likely on public transport. However, it would be possible to pick up the virus on your hands from a surface that somebody with the infection had touched. The virus can linger for 48 hours or even possibly 72 hours on a hard surface, such as the hand rail in the tube though less time on a soft surface. That is why the advice is to wash your hands regularly and avoid touching your face, to prevent the virus getting into your nose, mouth or eyes.
Not at the moment, but drugs that are known to work against some viruses are being trialled in China, where there are thousands of patients, and new trials are starting in the US and other countries. Large numbers are needed to find out whether they work in a few people or a lot of people or nobody at all. The most hopeful are Kaletra, which is a combination of two anti-HIV drugs, and remdesivir, which was tried but failed in Ebola patients in west Africa in 2013 and 2016. Some Chinese doctors are also trying chloroquine, an antimalarial drug, which is off-patent, therefore cheap and highly available, and would be very useful in low-income countries. The first results are expected in mid-March and should indicate if the drugs will at least help those who are most severely ill. A miracle cure is not expected.
Efforts to develop an effective vaccine for Covid-19 have been quick compared with historical epidemics, such as Ebola. A number of teams are already testing vaccine candidates in animals and preparing to carry out small trials in people. The US company, Moderna Therapeutics, is already recruiting and hopes to enrol 45 volunteers between 18 and 55 and will launch their trial imminently. Phase one trials like this look at whether the vaccine triggers an immune response and whether the given dose causes adverse effects and could be completed quite quickly. However, the subsequent phases, which will involve thousands of volunteers and will look more closely at efficacy, will take longer and obtaining a commercially available vaccine within a year would be extremely quick. The governments chief scientific adviser, Sir Patrick Vallance, said he did not think a working vaccine to protect people from the coronavirus would be produced in time for the current outbreak, but that a timeframe of a year or 18 months was not unreasonable to assume.
Read: The strongest evidence yet that American is botching coronavirus testing
This surge in testing capacity was slow in coming. In the 10 days after February 26when the Centers for Disease Control and Prevention confirmed that the coronavirus was being transmitted through community spread in the United Statesfederal and state labs tested 2,806 Americans. Another week elapsed before the country had tested 20,000 people. In the few days since, the country has expanded its testing capacity to cover at least that many people every day.
Yet the national numbers are still distorted by massive testing operations in just a few states. New York, California, and Washington have conducted nearly half of all tests nationwide, even though those states contain, combined, about a fifth of the countrys population. Florida and Texaseach home to more than 20 million peoplehave tested only about 3,000 patients each.
Some state public-health departments arent reporting as much information as others. Weve assigned every state a letter grade in the chart above to help readers understand how thorough each one is in its reporting. This grade is not assessing the quality of a states testing, but rather the transparency and regularity of its reporting.
All 50 states and Washington, D.C., regularly report their number of positive cases. Some states, such as Connecticut, disclose little additional information, so weve assigned them a grade of D. But others, such as Florida, publish not only their positive cases but also their negative cases and the results of tests conducted by private labs. Those states get an A grade. Having this full suite of figures at the state level allows for a far greater understanding of the size of both the outbreak and the response.
Read: The 4 key reasons the U.S. is so behind on coronavirus testing
In the chart above, each states number of positive cases includes people who are currently ill with the disease, people who have recovered from it, and people who have died. We have also broken out the number of deaths in its own column.
Some states have used strict criteria to determine who can and cannot be tested for the coronavirus. While we havent factored these into a states grade, we think these ruleswhile perhaps necessary, given the shortage of tests available from the CDChave led states to substantially undercount how many people had been infected in their communities, especially during the last week of February and the first two weeks of March. At least 18 states have enforced particularly stringent rules in some counties or hospitals: California, Hawaii, Indiana, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, Tennessee, Texas, Virginia, West Virginia, Wisconsin, and Wyoming. (Some of those states, such as Hawaii and Maryland, have since loosened their criteria.)
What became known as Covid-19, or the coronavirus, started in late 2019 as a cluster of pneumonia cases with an unknown cause. The cause of the pneumonia was found to be a new virus severe acute respiratory syndrome coronavirus 2, or Sars-CoV-2. The illness caused by the virus is Covid-19.
Now declared as a pandemic by the World Health Organisation (WHO), the majority of people who contract Covid-19 suffer only mild, cold-like symptoms.
WHO says about 80% of people with Covid-19 recover without needing any specialist treatment. Only about one person in six becomes seriously ill and develops difficulty breathing.
So how can Covid-19 develop into a more serious illness featuring pneumonia, and what does that do to our lungs and the rest of our body?
Guardian Australia spoke with Prof John Wilson, president-elect of the Royal Australasian College of Physicians and a respiratory physician.
He says almost all serious consequences of Covid-19 feature pneumonia.
Wilson says people who catch Covid-19 can be placed into four broad categories.
The least serious are those people who are sub-clinical and who have the virus but have no symptoms.
Next are those who get an infection in the upper respiratory tract, which, Wilson says, means a person has a fever and a cough and maybe milder symptoms like headache or conjunctivitis.
He says: Those people with minor symptoms are still able to transmit the virus but may not be aware of it.
The largest group of those who would be positive for Covid-19, and the people most likely to present to hospitals and surgeries, are those who develop the same flu-like symptoms that would usually keep them off work.
A fourth group, Wilson says, will develop severe illness that features pneumonia.
He says: In Wuhan, it worked out that from those who had tested positive and had sought medical help, roughly 6% had a severe illness.
The WHO says the elderly and people with underlying problems like high blood pressure, heart and lung problems or diabetes, are more likely to develop serious illness.
When people with Covid-19 develop a cough and fever, Wilson says this is a result of the infection reaching the respiratory tree the air passages that conduct air between the lungs and the outside.
He says: The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough.
But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages.
If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.
If the air sacs then become inflamed, Wilson says this causes an outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia.
He says lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the bodys ability to take on oxygen and get rid of carbon dioxide.
Thats the usual cause of death with severe pneumonia, he says.
Prof Christine Jenkins, chair of Lung Foundation Australia and a leading respiratory physician, told Guardian Australia: Unfortunately, so far we dont have anything that can stop people getting Covid-19 pneumonia.
People are already trialling all sorts of medications and were hopeful that we might discover that there are various combinations of viral and anti-viral medications that could be effective. At the moment there isnt any established treatment apart from supportive treatment, which is what we give people in intensive care.
We ventilate them and maintain high oxygen levels until their lungs are able to function in a normal way again as they recover.
Wilson says patients with viral pneumonia are also at risk of developing secondary infections, so they would also be treated with anti-viral medication and antibiotics.
In some situations that isnt enough, he says of the current outbreak. The pneumonia went unabated and the patients did not survive.
Jenkins says Covid-19 pneumonia is different from the most common cases that people are admitted to hospitals for.
Most types of pneumonia that we know of and that we admit people to hospital for are bacterial and they respond to an antibiotic.
Wilson says there is evidence that pneumonia caused by Covid-19 may be particularly severe. Wilson says cases of coronavirus pneumonia tend to affect all of the lungs, instead of just small parts.
He says: Once we have an infection in the lung and, if it involves the air sacs, then the bodys response is first to try and destroy [the virus] and limit its replication.
But Wilson says this first responder mechanism can be impaired in some groups, including people with underlying heart and lung conditions, diabetes and the elderly.
Jenkins says that, generally, people aged 65 and over are at risk of getting pneumonia, as well as people with medical conditions such as diabetes, cancer or a chronic disease affecting the lungs, heart, kidney or liver, smokers, Indigenous Australians, and infants aged 12 months and under.
Age is the major predictor of risk of death from pneumonia. Pneumonia is always serious for an older person and in fact it used to be one of the main causes of death in the elderly. Now we have very good treatments for pneumonia.
Its important to remember that no matter how healthy and active you are, your risk for getting pneumonia increases with age. This is because our immune system naturally weakens with age, making it harder for our bodies to fight off infections and diseases.
But from chaos comes heroes.
Despite so much uncertainty and with lives indefinitely upended, people and communities are still coming together to support one another. Here are some of the ways people are lending a hand through individual acts and large-scale efforts.
For millions of students, school closures mean no reliable access to meals.
Some districts have implemented plans to continue making food available to students who need it. But restaurants -- some dealing with business loss because of the outbreak -- have also risen to help meet the need.
Restaurant owners in Myrtle Beach, South Carolina, met to discuss what they were going to do to keep their businesses going as the pandemic restricted how they could serve customers, said Caf Gelato owner Doug Lammers. Then, he said, the conversation turned to how they could help.
So, until further notice, his shop is offering meals to children in need.
And other establishments are reaching out to their communities in their time of need as well.
"Our family welcomes your family in this time of need," said a post on Instagram signed by Laura and the White Duck Taco Shop family. "We can all get through this together."
Contributing to hourly workers' wages
Hourly workers, who don't have sick days and whose jobs are threatened because of orders to shut down or limit the hours of restaurants, bars and stores, are already experiencing financial strain.
Customers have been digging into their pockets to help their servers weather the times.
The check specified that the tip on the $29.75 bill was to be split equally between five staff members, each specified by name.
The receipt said to "hold tip to pay your guys over the next few weeks."
Split over 30 employees, that came out to about $300 each, Galvan said.
"They were amazed that a client would care enough about them to leave that amount to help them get through this tough time," Galvan said.
Providing resources to those most affected
Jayde Powell is a "shopping angel."
"As a pre-med student, I know that people who are older or people who have heart, lung or immune conditions are especially at risk for contracting the virus," Powell, a University of Nevada, Reno student, told CNN. "We're doing this to try and reach out to people who might feel that they are just completely alone in this situation."
The assistance goes beyond delivery. Powell has created a GoFundMe for older adults who can't afford to get the things they need.
In Minnesota, healthcare workers who are pressed to serve more and more patients as the virus spreads have gotten help at home from University of Minnesota Medical School students.
What started with two second-year medical students became an operation with more than 280 students in three days.
"I've never met a lot of the people on this team and am convinced they are superheroes in disguise," said Sara Lederman, one of the founding students. "Everyone's superpowers are coming out. We are realizing so many of our classmates have incredible skills and talents that we didn't know about until now."
Restoring faith in humanity
Some people are using music to bridge the distance the outbreak has imposed on their communities.
"It was one of those moments where you feel like you're a part of something incredible," Rebecca Tien, the children's mother, told CNN. "It was also a good way to remember the value of connection, especially at a time like this when everyone feels disconnected. Just to know we were a part of something so sweet, even just for a minute, meant a lot."
For Emmanuel Maira Mallen and his wife, mariachi was the way to give back.
He woke up Saturday morning to a slew of frightening posts about coronavirus on his Facebook feed, he said. Hoping to brighten someone else's day, the couple decided to hire a mariachi to play in a San Antonio area H-E-B grocery store.
The energy was tense when he (and the band) walked in, he said. The store didn't know they were coming, and employees struggled to meet customers' needs through an air of panic. No one was talking, he said. No one smiled.
But when the music began, he saw laughter and people began to dance. The whole atmosphere changed, he said. A video of the performance has been shared around Facebook, expanding the impact of his act beyond what he ever imagined.
"We wanted to do something small for our community and bring some laughter and now that it has reached millions of views, I'm pretty sure we put a lot of smiles on a lot of faces," Mallen said.
CNN's Alaa Elassar, David Williams and Lauren Lee contributed to this report.
The national mobilization against the coronavirus is now in full swing. Schools and workplaces nationwide have shuttered. The federal government has recommended that people not gather in groups of 10 or more. Social distancing and self-isolation are now becoming part of the fabric of daily American life.
This has all sparked a serious question among many people: Are we overreacting? Its not just a question being asked by partiers and bar-goers it has also been asked in the New York Times. A widely circulated article by Stanfords John Ioannidis suggests that the stepped-up US response is a fiasco in the making thats being made without enough data.
To someone who hasnt been following the pandemics spread closely, the drastic measures indeed might seem like an overreaction. After all, around 13,000 cases and 200 deaths as of Thursday in a country of 330 million doesnt seem that bad. Is it really worth shutting down the economy, a measure that will of course have horrific costs of its own, for such a small toll?
But the numbers mask whats really causing experts to worry: The coronaviruss trajectory is putting us on a course of many, many more cases and many, many more deaths unless we do something drastic.
In other words, theres a simple answer to the question: No, were not overreacting.
To explain why were not overreacting, we need to look to the experience of another country going through the coronavirus crisis: Italy. Heres a chart comparing the countrys cases to the USs.
A couple of weeks ago, Italy was much like us, with 107 deaths on March 4. But things were already rapidly getting worse; by March 10, more than 600 people were dead, and today more than 3,400 are. That makes Italy the epicenter of coronavirus fatalities in the world, with more deaths than even China, where the outbreak started. Hospitals have been pushed to the breaking point, with doctors and nurses without adequate protective equipment collapsing at work and other doctors reporting that patients wont all get lifesaving care because there isnt enough of it to go around.
Whats scary about Italys experience is that Italy wasnt exactly passive in its response to the virus. The country did act, quarantining a dozen towns in northern regions on February 23, urging the public to engage in social distancing, and ordering the closure of all schools nationwide on March 4.
But case numbers kept growing. On March 8, Italy locked down the north of the country, and on March 9 it extended the lockdown to the whole country. Now, it looks like these extreme efforts might have slowed the rate of growth of cases. On March 15, there were 3,590 new cases. On March 16, 3,233. On the 17th, 3,526. And on the 18th, 4,207. Thats not exponential growth, suggesting the lockdown really did help but those still arent good numbers, especially when Italys hospitals are already overwhelmed.
Italy has been devastated by the virus because the action it took was just a little too moderate, a little too restrained, and a little too slow. The country took measures that were substantial and costly but nonetheless insufficient to actually bring the epidemic to a halt. (This was the message hammered home in a recent project where Italians sent video messages to themselves 10 days ago.)
Theres some reason to think we wont be hit as hard as Italy. Italys population is older than ours, and older people are hit hardest by the virus. Smoking might affect death tolls, too, and smoking is more common in Europe than in the US. Because the United States is bigger, US reported cases per capita are a little further behind Italys than the raw confirmed case numbers are. And comparing confirmed cases across countries is difficult anyway, because most countries are undertesting and its hard to be sure who is undertesting more.
But the bottom line remains that theres no real reason to think measures that didnt suffice in Italy will suffice here.
The lesson from Italy isnt just that you have to act before your hospitals are overwhelmed. Its that you have to take steps that appear in the moment to be an exceptional overreaction because by the time it looks like the steps youre taking are appropriate, it will have been too late.
Now, when public health experts say the US is on Italys trajectory, what exactly does that mean?
It means that the US and most European countries are seeing early coronavirus growth numbers that look like the ones from Italy. Our confirmed cases are increasing at about the rate theirs did. That gives us every reason to think our health systems will eventually be overwhelmed like theirs were, unless we take strong measures sooner than they did.
So far, weve taken some strong measures which is good. But its not clear that were acting that much faster than Italy did and remember, Italy wasnt fast enough.
The frightening chart above compares the USs reactions to Italys. It shows confirmed case numbers in Italy and in the US, starting on the day when each country passed 100 confirmed cases. It shows the points at which Italy took various precautionary measures. To break away from Italys trajectory, we need to take measures that are stronger than the ones it took, or take measures sooner along the trajectory than it did.
The US passed the 13,000 confirmed case mark on Thursday. Italy locked down the northern half of the country on the day it reached 13,000 cases and extended the lockdown to the southern half one day later.
To be sure, there are a lot of problems with using confirmed case data for these trajectory estimates. Italy is likely substantially undertesting, as is the US. Confirmed cases are a poor reflection of overall cases. Sometimes, growth in confirmed cases is due to increases in testing capacity, not increases in the viruss spread.
But even with those caveats, confirmed case data isnt worthless. They lag behind reality, Caitlin Rivers, a senior associate at the Johns Hopkins Center for Health Security, told me on Monday, but theyre still our best window into what is going on.
And looking through that window, the picture looks bleak for the US. Taking the drastic steps some parts of the country are now taking, like the California stay-at-home order, gives us a chance not a guarantee, to be clear to veer from the Italian trajectory. (This online tool offers state-by-state projections of hospitalizations over time depending on which interventions a state takes.)
In a press conference on March 16, the National Institutes of Healths Dr. Anthony Fauci, who has played a major role in leading the US response, explained to Americans why the strong measures the government was taking were not an overreaction.
Some will look and say, well, maybe weve gone a little bit too far, he said. The thing that I want to reemphasize, and Ill say it over and over again, when youre dealing with an emerging infectious diseases outbreak, you are always behind where you think you are if you think that today reflects where you really are.
Lets say that today we found 1,000 new Covid-19 cases. Keep in mind that the virus has a two- to 10-day incubation period. In the past week or so, each of those people was exposed to the virus. Then they got sick. Then they got sick enough to seek medical attention, which can take a few more days. Then they got a test. Then the test took a day or more to return positive results (some people are reporting longer waits than that for results, while some newly designed tests might be able to get results faster).
Each of those positive tests, then, reflects an infection up to two weeks ago. The situation has already worsened for the two weeks or so since those new cases were infected. For much of that time, those 1,000 people have been out and about in the world, potentially infecting others. In a population not taking strong social distancing measures, it is estimated that on average they will have infected two or three others. Some of those newly infected will themselves have started infecting others.
Italy took strong measures. Its mistake was not that it didnt react at all its that it kept being a little bit behind the ball. Each measure was appropriate to the situation the Italians observed. But the real situation was always much worse. So things kept worsening until they pulled out all the stops with a countrywide lockdown.
It will always seem that the best way to address [the virus] would be to be doing something that looks like it might be an overreaction, Fauci said. It isnt an overreaction. Its reaction we feel is commensurate [with what] is actually going on in reality.
To break away from Italys trajectory, we have to respond with stronger measures than Italy. We have to respond in ways that feel like an overreaction. In the past few days, weve seen the first US steps that are stronger than Italys responses at a similar point in the outbreak steps like the Bay Areas shelter-in-place order, the follow-up extending it to all of California, New Yorks similar order Friday, and state orders shutting down restaurants and bars. Thats what it will take to give ourselves a chance at a different curve.
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