Three days after announcing plans to reduce theater attendance by 50%, Regal Cinemas announced that it will be closing all theater locations, effective March 17. The company announced the news via social media, noting that All theatres will remain closed until further notice.
The dramatic shift comes amid declining attendance over fears of the rapid spread of COVID-19. It also follows moves by a number of cities and states that have blocked large gatherings and all non-essential travel in order to encourage social distancing. The move was no doubt as much an attempt to protect public health as it is recognition that staying open simple isnt feasible at the moment.
Regal currently operates 549 theaters, comprising 7,211 screens spread out over 42 States, American Samoa, the District of Columbia, Guam and Saipan, according to its site. The company has not announced whether it has any plans to help compensate employees, nor how it will handle users with an Unlimited Pass.
AMC last week announced its own reduced operations. We reached out to the company to see if it had any plans for a full shutdown amid all of the recent news. Well update when we hear something back.
Movie studios, meanwhile, are reconsidering their approach for films set for a theatrical release. Notably, NBCUniversal announced that it would be releasing films like The Hunt, The Invisible Man and Emma through on-demand services, in addition to theaters.
In late February, Julie Eaker, a physician assistant and supervisor at a small, rural, tribal community health clinic in Siskiyou County, California, had a patient who had a possible exposure to Covid-19. It wasnt direct: They had been exposed to a person, and that person had been in direct contact with a confirmed Covid-19 case. Eakers patient was developing an upper respiratory infection too, and she wanted to ease their peace of mind and protect the community by getting them tested for Covid-19.
To this day, the patient still hasnt been tested for the illness. And its not because Eaker didnt try. The story she describes is Kafkaesque.
First, Eaker called her local health department and was told her patient didnt qualify for testing since they hadnt traveled to China, per the guidelines from the Centers for Disease Control and Prevention at the time. After the CDC relaxed its testing criteria, the patient was still sick, so Eaker called again. I didnt receive a phone call back, she says.
The patient thought they had pneumonia and asked to be tested for peace of mind. Finally, last week, after Eaker ordered some test kits herself from a private lab, she got a call back. The health department told me I was not allowed to use those test kits that I ordered without their permission!
Eaker was horrified. So she called the CDC to confirm if the local health department was correct. I did not get through, she says. I spent hours and hours and hours on hold. So I thought I would just call the White House and talk to Vice President Pence, who is in charge of the coronavirus task force.
She didnt get Pence, but a White House switchboard operator told her to call the CDC.
Somebody has got to help us, she says, exasperated. Were out here on the front lines trying to take care of people.
Meanwhile, the commercial tests the clinic ordered still havent arrived. And Eaker wonders if Covid-19 has been spreading in her community of 3,000 people. Siskiyou County might not have big sports arenas or universities where disease can infect masses. But it has multigenerational family homes where viruses can quickly infect a whole family, and a health clinic thats already at capacity due to the flu.
Accurate testing is critical to stopping an outbreak: When one person gets a confirmed diagnosis, they can be put in isolation where they wont spread the disease further. Then their contacts can be identified and put into quarantine so they dont spread the virus if theyve become infected, too. Thats particularly important for a virus like this one, which seems able to spread before people show symptoms, or when their symptoms are mild.
Ever since the first case of Covid-19 was detected in the US on January 20, the governments blunders in creating and distributing diagnostic testing have greatly handicapped our response to the growing pandemic. Eakers story is not unique: Reports suggest providers everywhere are struggling to help their patients, while receiving frustrating guidance from authorities.
Dr. Anthony Fauci, the federal governments top infectious disease scientist, called the testing situation a failing at a congressional hearing on Thursday.
The idea of anybody getting it easily the way people in other countries are doing it were not set up for that, he said. Do I think we should be? Yes. But were not.
While the testing situation in America is getting better private industry has stepped up to fill in the slow rollout of tests from the CDC, and the Cleveland Clinic announced it has developed a new rapid test that gives results in eight hours, rather than taking days problems remain. The number of tests that can be performed per day is still limited and varies by testing facility. Part of that is due to a shortage of key chemicals needed to run the tests. Its becoming increasingly clear that too-stringent testing guidelines early in the outbreak stymied researchers in knowing if Covid-19 was spreading in the US.
There was clear lack of foresight, Nathan Grubaugh, an epidemiologist at the Yale School of Public Health, says. We were very slow to roll out testing capacity to individual places wherever that came from, it was a very bad strategy.
Part of the confusion here is that there are different figures floating around for the number of tests that have been done. As private labs take up the slack from public health facilities, theres no centralized database of numbers.
I think that we could have probably controlled this, if we had effective testing, Angela Rasmussen, a Columbia University virologist, says.
We havent. In an investigation led by the Atlantic, a research team reported that a little more than 7,000 Covid-19 tests were performed as of March 11 putting the US far behind other developed countries. (The Atlantics investigation is in partnership with independent researchers, and US testing counts are now being updated daily by the Covid Tracking Project.)
South Korea, for example, has tested more than 140,000 people and has even set up drive-though testing stations for people to access. So far, the Trump administrations promises to increase testing have fallen flat.
Test kits have been in short supply though thats changing.
The numbers here are a bit confusing, too. As of March 7, Food and Drug Administration Commissioner Stephen Hahn said the CDC has sent out enough test kits to test 75,000 people (far fewer than the million promised by the Trump administration). But those are just the tests sent to public health labs. An additional 1.1 million tests (produced by private industry) have been sent out to non-public commercial and academic labs, according to Hahn. In all, he estimated 850,000 Americans are able to be tested.
But capacity to test is still lagging. Part of that is due to a shortage of key chemicals needed to run the tests. Currently, according to the American Enterprise Institute, 16,030 Covid-19 tests can be processed in the US a day, up from 7,840 a few days ago. (South Korea has been able to run 10,000 tests per day since February.)
Some labs have much higher capacity than others. Even the corporate diagnostic companies like Quest and LabCorp only have the capacity to run 1,000 and 1,500 tests a day, respectively. Your ability to get tested may depend on where you live, the lab your physician uses, and the judgment of your doctor.
Theres no one reason the testing effort has been so slow. There seem to be bureaucratic, scientific, and economic drivers for the debacle.
Heres where the trouble started. The CDC started sending out test kits to laboratories the first week of February, a month after China announced the outbreak. But the health agency quickly encountered a problem.
Some labs reported to the CDC that some of the test kits were delivering inconclusive results during verification. Its believed that one of the chemicals used to conduct the test was not working properly and needed to be remanufactured.
Im very puzzled by whats happened. The CDC did a really good job with H1N1 and Zika in exactly this thing: sending out huge quantities of test kits very rapidly to every state in the US and more than 100 countries around the world, Tom Frieden, who led the CDC under President Barack Obama, told Vox. The world came to rely on the CDC.
The tests are conducted via mouth or throat swabs, through the testing of mucus that has been coughed up or fluid from a patients trachea. Theyre designed to identify the viruss specific genetic signature, and results have to be shipped to labs, where they take a day to process.
Also, at first, the testing was bottlenecked. Most states had to send their samples to the CDC until March 2, and so, to the frustration of state health officials, precious time was lost shipping materials to Atlanta in those critical first few weeks. Whats more, each test required lengthy phone calls with the CDC, Rachel Levine, who leads the Pennsylvania health department, told Vox.
As of February 25, only 12 labs across the country in just five states had the ability to test. The first case of Covid-19 detected in the US originally did not meet the criteria for testing, as the New York Times explains. Perhaps that had deadly consequences: The outbreak in Washington state appears to be part of a transmission chain related to that first discovered case. When the CDC refused testing for that case, the Seattle Flu Study, a research group, performed one on its own.
Now that states can perform their own tests, they are able to turn them around in a matter of hours. Its a much more efficient mechanism, Levine said, but it took a long time for that to happen.
In Seattle, currently the US city with the most Covid-19 cases, local researchers were so exasperated by the CDCs initial faulty test that they came up with their own, as Stats Helen Branswell reported:
Frustrated by the lack of testing resulting from the problem with the CDC-developed kit, the Seattle Flu Study began using an in-house developed test to look for Covid-19 in samples from people who had flu-like symptoms but who had tested negative for flu.
That testing was vital for Washington, as it led to more clues about how the disease was spreading there. Genetic detective work from Washington suggests the virus has been circulating there for at least six weeks. Modeling suggests there could be 1,110 cases of Covid-19 in the Seattle area.
So theres been human error. But its also important to know that the work of setting up testing for a new virus can be difficult. Laurie Garrett, the science journalist who won a Pulitzer Prize for her reporting on the 1995 Ebola outbreak, said Chinas most-used tests have had false negatives nearly half the time.
Everybody is having trouble with the sensitivity/specificity issues with the coronavirus, Garrett said. But the slow start to testing in America, compounded by the problematic test kits that were first sent out into the field, has set back the US response.
I have no criticisms for the scientists at the CDC who developed the test because sometimes tests just dont work, Rasmussen says. But she does mention its problematic that the CDC has removed data about the number of people tested in the United States from its website, saying it didnt want there to be discrepancies with state testing numbers. In my view, the biggest scandal is that sort of response.
Vice President Mike Pence and other top Trump administration officials have been promising to ramp up the countrys capacity to test for coronavirus, but they have failed to meet their goals.
As Bloomberg reported on March 5, senators were told in a CDC briefing that the Trump administration would not be ready to roll out the 1.5 million kits it had promised by the end of this week. The number would be fewer than 500,000, it appeared.
The Atlantic has provided the best accounting of how many tests have actually been conducted in the United States so far: around 7,000, according to its survey of state health officials and other sources. That puts the US far behind some of its economic peers with much smaller populations:
In South Korea, more than 66,650 people were tested within a week of its first case of community transmission, and it quickly became able to test 10,000 people a day. The United Kingdom, which has only 115 positive cases, has so far tested 18,083 people for the virus.
Making matters worse, some people who have sought tests in the past few weeks, like Eakers patient, have been turned away. And these shortcomings make it harder for the public health community to react to a virus that spreads quickly and easily.
Many people dont really show symptoms of Covid-19, or their symptoms are very mild, but you want them to be tested anyway if there is an opportunity. To do that, doctors need to be able to order the test, which the CDC is only now permitting them to do. Commercial labs only recently started processing the coronavirus test, too, a step health care providers had been urging the administration to take.
The issue is with asymptomatic transmission. You dont know who is infected, and symptoms arent going to help if the patient doesnt have any, Abraar Karan, a Harvard physician, said. A rapid test would help because you can then do mass testing at scale.
Another is the criteria for who qualified to be tested. Originally, that was limited only to people who traveled to China or who had been in close contact with someone known to have Covid-19.
Then the tests expanded to include anyone who traveled to any affected country, as well as people with unexplained flu-like symptoms. Now, anyone with a physicians authorization can be tested for Covid-19 that is, if they can access a test.
Meanwhile, the federal government has decreased some regulatory roadblocks for more testing labs to come online. Labs can now start testing if they are pursuing an emergency authorization to test, and they dont have to wait for the FDA to give them final approval. But some of the materials to run the tests are growing scarce for some labs, according to Stat.
We dont need testing just to diagnose sick people coming into doctors offices and hospitals. We also need testing to do surveillance out in communities. You actually have to go out now in many places in the US and start taking samples from people, Grubaugh says.
Those surveillance studies will help us understand how prevalent milder cases are in populations. And adding those milder cases to data sets will help researchers determine more accurately how deadly this virus is, whom it tends to infect, and how often people spread it before showing symptoms. As testing ramps up, be prepared to hear about a lot more cases of Covid-19 in the US.
As former FDA Commissioner Scott Gottlieb tweeted Thursday, the private labs also need to step up. Only big national clinical labs like LabCorp and Quest can fill the void. A lot rides on them now. ... Only these big national chains have throughput, scale, and ordering systems to fill the void that was created. We look to them now. We need them.
All that information can then be used to better halt the spread of the illness.
Again, without testing, were in the dark. And while were in the dark, the virus can spread. As Rasmussen says, we dont know what the prevalence actually is.
We want to know what your experience has been when it comes to testing for the virus, figuring out travel plans, and staying healthy. Let us know by filling out the survey below (you can also access the Google form here).
Global crises often bring surprises for schools. The first world war flagged up the high number of young soldiers who couldnt read or write. In the second world war, middle-class country families despaired when evacuated children showed up malnourished and riven with lice. In the aftermath of both, politicians determined to make life better: focusing schools more on literacy and introducing daily milk and school nurses.
Pandemics, like wars, temporarily change our way of life. Change happens fast. Schools may even have closed by the time you read this. This will be difficult, and if its for a long time and in isolation there are real concerns about safeguarding and loss of learning, but lets not forget schools shut for a six-week period each year and families do cope. What is of long-term concern is what happens even when schools are open.
Official guidance is that everyone should be regularly washing their hands with soap and water while singing Happy Birthday twice. The song may not be official, but it helps children wash for the recommended 20 seconds. But this week the realisation has emerged that one in three schools dont usually have soap and hot water in their bathrooms.
When the news broke that Covid-19 was in the UK and infected numbers were rising, Teacher Tapp, the daily survey app that I co-founded, asked over 6,000 teachers about precautions in their school. An alarming 37% said they did not have hot water and soap available for pupils. Soap is not a legal requirement in washrooms and given schools are struggling for cash, its an easy thing to cut. Hot water access is legally required, but speaking to teachers, it is clear that old plumbing systems are not providing hot water or at least not fast enough to get to the tap before the child has disappeared.
Plus, regulations state that schools need to have just one sink per 30 pupils. Line up every one of those kids, ruthlessly enforce a quick changeover at 20 seconds, and you need at least 10 minutes to get everyones hands clean. Given the average school break is only 20 minutes, that doesnt leave much time for eating, playing, or going to the toilet. Which might explain why almost no secondary schools were actively teaching handwashing even 10 days ago.
On top of that, only one in five teachers said tissues were available for children. Less than a third said their school was offering hand-sanitising facilities: Everyone has run out of sanitiser. We cant source it from anywhere, and we probably couldnt afford it anyway, one senior leader said.
Thankfully, primary children are increasingly washing hands on entry and before leaving school a job thats easier for infant classrooms with their own sink. One friend noted how nice it was to hold her young sons hand on the walk home from school now that his palms were no longer sweaty and grimy.
The coming months will be challenging and the focus will be on the extent to which schools can keep going at all. But once the pandemic has cleared, its worth us remembering that nearly 22 million school days are lost every year to colds. About 40% of children get threadworm, a parasitic infection that causes a distractingly itchy bottom. Both problems are reduced by hand-washing, along with more serious respiratory viruses and tummy bugs.
Other countries, already know this. In Japan, schools are equipped with long wash basins where pupils and teachers wash their hands several times a day. In Nigeria, after the Ebola crisis, handwashing in schools rose by over 60%, with children more likely to take part if their friends were also washing their hands.
The next few months are going to be a hard lesson in patience and acceptance. But, as with the two world wars, it may be that a better future sits on the other side. At the very least it should be one where every child is expected and, crucially, is able, to wash their hands regularly.
As one of the worlds leading institutions in the health sciences, UCSF is deeply committed to providing the most accurate and up-to-date medical information to our patients and to the public at large. To allay some confusion about a document on the COVID-19 pandemic that was attributed to UCSF last week on social media and in the press in many cases carrying our official university logo wed like to provide some background.
The document in question contained notes taken at a private panel discussion on COVID-19 held on March 10, which featured a group of expert speakers from UCSF and the Chan Zuckerberg Biohub. However, UCSF was not a sponsor of this event, and these notes were not reviewed, either for accuracy or for potentially important context, by the participating scientists.
If you are seeking information on the scope of the COVID-19 pandemic, including the best measures to minimize transmission of the novel coronavirus, please consult the many COVID-19 resources available from the Centers for Disease Control and Prevention, the California Department of Public Health, and UCSF.
WATERBURY The first positive case of COVID-19 in Waterbury was confirmed Monday.
Mayor Neil M. OLeary also declared an emergency Monday, a move that was not motivated by the first confirmation.
The declaration gives OLeary broad powers over employee work assignments and schedules as needed to respond to a particular threat. OLeary said he doesnt foresee the need to exercise that authority in the short term. The declaration is primarily intended to make Waterbury eligible for federal disaster relief funds, as they become available, he said.
Waterbury began preparing for the anticipated arrival of COVID-19 since mid-January. The city formed a broad task force enlisting representatives from police, fire, health, schools and other departments, as well as leaders from the citys two hospitals. The task force has kept the city abreast of the latest developments and advice, as well as established protocols for quarantines, treatment of patients and various scenarios.
It certainly brings it home, OLeary said of the confirmed case. We were expecting it. I am not surprised.
Adam Rinko, the citys emergency management coordinator, said Monday night the citys health department informed him of an infection in the city. He had no details about the individuals age, gender or occupation.
Rinko said the city has been acting on the presumption there were multiple local undetected infections already. And more are expected.
We were ramping up for this, Rinko said. It was kind of inevitable. We were under the impression there were cases here all along.
Related
Government official: First dose to be delivered Monday in clinical trial for potential COVID-19 vaccine Associated Press
Borders across Europe closing to limit the spread of COVID-19 as the first human trial of a vaccine gets underway in the US.
This undated handout picture courtesy of the British Health Protection Agency shows the coronavirus seen under an electron microscope. Picture: AFP.
JOHANNESBURG - More countries are being placed on lockdown on Tuesday morning with borders across Europe closing to limit the spread of COVID-19 while the first human trial of a vaccine gets under way in the US.
More than 7,000 people have died globally from the coronavirus out of over 182,000 cases.
However, almost 80,000 people have made full recoveries.
In South Africa, President Cyril Ramaphosa said the ANC was confident government's COVID-19 preventative measures would work.
Ramaphosa said the party was focused on coming up with a plan to minimise the effects of the spread of the virus.
South Africa has 62 confirmed cases with more expected to be announced in the coming days.
The president declared a state of disaster on Sunday night announcing travel restrictions, school closures and cancelling mass events.
WATCH: South Africas coronavirus interventions
PANIC BUYING
Many grocery shops were overrun on Monday by consumers panic buying and stock-piling items.
Videos on social media show long snaking queues with scores of people standing in close quarters.
South Africans have been urged to be rational when shopping for supplies as so-called panic-buying spikes.
The dean of the Gordon Institute of Business Science Nicola Kleyn said this could also be referred to as rational disaster buying.
Its entirely rationale if people think they wont have access to those things for a period. People want to go home and have a feeling of Ive done what I need to do so I dont need to go out anymore.
To track the latest developments around the coronavirus both in South Africa and abroad, click on this live status report from Strategix.
There is no FDA-approved Covid-19 vaccines or drugs on the market currently. Nicol Campo/LightRocket via Getty Images
The unstoppable coronavirus Covid-19 is now officially a global pandemic. And we still havent found a cure or vaccine for it. The good news, though, is that a number of biotechnology and pharmaceutical companies, some with the support of government funding, are working around the clock to develop vaccines and treatment.
SEE ALSO: Severe Covid-19 Patients in US Are Testing Out a Last-Resort Coronavirus Drug
Here are five promising preventive and antiviral therapies in the works that may survive clinical trials and reach the market.
British pharmaceutical giant GSK is working with two outside organizations for preclinical studies on Covid-19 vaccines using its pandemic vaccine adjuvant platform, a technology used to develop HPV and flu vaccines in the past.
GSK has provided the technology to University of Queensland program funded by the Coalition for Epidemic Preparedness Innovations (CEPI), an international organization based in Oslo, Clover Biopharmaceuticals, a Chinese biotech company thats making a vaccine called Covid-19 S-Trimer.
In collaboration with the Biomedical Advanced Research and Development Authority (BARDA), a division under the Department of Health and Human Services (HHS), Johnson & Johnson is exploring candidates for both vaccines and antiviral drugs.
Similar to GSK, the American pharma giant is using its vaccine platform technology, which was used for the developing an experimental Ebola vaccine in 2009.
We are also in discussions with other partners, that if we have a vaccine candidate with potential, we aim to make it accessible to China and other parts of the world, Paul Stoffels, Johnson & Johnsons chief scientific officer, said in a statement last month.
The company aims to start a Phase 1 clinical trial by the end of 2020, Stoffel said last week.
Inovio recently completed the preclinical testing of a DNA-based vaccine called INO-4800. And clinical trials are expected to begin in April with patients in the U.S., as well as China and South Korea.
The company expects to have first trial results in the fall and have one million vaccines doses ready by the end of the year.
Biotech startup Moderna is developing an RNA-based vaccine candidate called mRNA-1273 through a program funded by CEPI. Last month, the company shipped a batch of the vaccine to the National Institute of Allergy and Infectious Diseases (NIAID), a division under the National Institutes of Health. Clinical trials are expected to start next week and conclude on June 1 next year.
A frontrunner among existing Covid-19 therapy projects, Gileads antiviral drug, Remdesivir, is currently used in a phase 3 trial on over 1,000 patients around the world.
The experimental drug was first tested on Covid-19 patients in Wuhan, China, the epicenter of the coronavirus outbreak. Last month, the NIAID allowed the company to expand phase 3 trials to other countries hit by the virus.
Trial results from China can be expected as soon as April.
Commentary Commentary
Achieving herd immunity to COVID-19 in the UK could result in the deaths of more than 1 million people with a further 8 million severe infections requiring critical care, says an observer.
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CANTERBURY: The UK government recently enacted its second phase of response to the COVID-19 pandemic: Delay.
According to ITV journalist Robert Peston, the governments strategy to minimise the impact of COVID-19 is to allow the virus to pass through the entire population so that people acquire herd immunity, but at a much delayed speed. This is so that those who suffer the most acute symptoms are able to receive the necessary medical support without overwhelming the National Health Service (NHS) with cases.
At face value, this seems like a sound strategy, but what exactly is herd immunity and can it be used to combat COVID-19?
HOW HERD IMMUNITY WORKS
Our bodies fight infectious diseases through the actions of our immune systems. When we recover, we often retain an immunological memory of the disease that enables us to fight off that same disease in the future.
This is how vaccines work, creating this immune memory without requiring getting sick with the disease.
If you have a new disease, such as COVID-19, that we dont have a vaccine for and no one in the country has ever been infected with, the disease will spread through the population.
But if enough people develop an immune memory, then the disease will stop spreading, even if some of the population is not immune. This is herd immunity, and it is a very effective way to protect the whole of a population against an infectious disease.
But herd immunity is typically only viewed as a preventive strategy in vaccination programmes. If we dont have a vaccine as we dont for COVID-19 achieving herd immunity would require a significant proportion of the population to be infected and recover from COVID-19.
So what would this mean for the spread of the disease in the UK?
The percentage of the population that needs to be immune to enable herd immunity depends on how transmissible a disease is. This is measured by the term R0, which is how many new infections each case will generate.
For COVID-19, the R0 is estimated to be 3.28, though studies are still ongoing and this number will probably change. This means that for herd immunity, about 70 per cent of the UK population would need to be immune to COVID-19.
Achieving herd immunity would require well over 47 million people to be infected in the UK. Current estimates are that COVID-19 has a 2.3 per cent case-fatality rate and a 19 per cent rate of severe disease.
This means that achieving herd immunity to COVID-19 in the UK could result in the deaths of more a million people with a further 8 million severe infections requiring critical care.
DELAY AS A PUBLIC HEALTH STRATEGY
However, it is not clear how much of this discussion of herd immunity reportedly proposed by David Halpern, chief executive of the Behavioural Insights Team, and later blogged about by Robert Peston shapesgovernment policy.
Also, the concept as discussed is not simply to let the disease run its course through the population, but to slow its spread and protect those most vulnerable from severe disease.
Slowing the spread of COVID-19 is a promising strategy, especially when combined with enhanced measures to protect the elderly and those with underlying health conditions
By slowing the spread of the disease, the NHS might have more time to prepare, we might be able to develop treatments or vaccines and we will be closer to the summer when we have lower incidences of other diseases that burden the NHS, such as the flu.
A delay strategy when combined with surveillance and containment, as recommended by the WHO, could be effective in combating the spread of COVID-19.
Yet if the UKslows the spread of the virus but relieson herd immunity to protect the most vulnerable people, itwould still need 47 million people to be infected.
Even if the UKmanages to protect the most vulnerable people (though no discussion is provided on how this will be done or for how long) the fatality rate for the otherwise healthy portion of the population may still be 0.5 per cent or higher. This means that even in this unlikely best case scenario we would still be looking at more than 236,000 deaths.
We can and we must do better than that. China is rapidly controlling the spread of COVID-19 without requiring herd immunity (only 0.0056 per cent of its population has been infected).
Waiting for herd immunity to COVID-19 to develop in the UK by letting the virus pass through the community is not a good public health strategy.
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Jeremy Rossman is Honorary Senior Lecturer in Virology at the University of Kent, and President of Research-Aid Networks. This commentary first appeared on The Conversation.
