Category: Covid-19

Large numbers of people working close together in a cold environment may make meatpacking plants fertile ground for the novel coronavirus.

By Kai KupferschmidtMay. 19, 2020 , 5:25 PM

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

When 61 people met for a choir practice in a church in Mount Vernon, Washington, on 10 March, everything seemed normal. For2.5 hours the chorists sang, snacked on cookies and oranges, and sang some more. But one of them had been suffering for 3 days from what felt like a coldand turned out to be COVID-19. In the following weeks, 53 choir members got sick, three were hospitalized, and two died, according to a12 May report by the U.S. Centers for Disease Control and Prevention(CDC) that meticulously reconstructed the tragedy.

Many similar superspreading events have occurred in the COVID-19 pandemic. Adatabase by Gwenan Knightand colleagues at the London School of Hygiene & Tropical Medicine (LSHTM) lists an outbreak in a dormitory for migrant workers in Singapore linked to almost 800 cases; 80 infections tied to live music venues in Osaka, Japan; and a cluster of 65 cases resulting from Zumba classes in South Korea. Clusters have also occurred aboard ships and at nursing homes, meatpacking plants, ski resorts, churches, restaurants, hospitals, and prisons. Sometimes a single person infects dozens of people, whereas other clusters unfold across several generations of spread, in multiple venues.

Other infectious diseases also spread in clusters, and with close to 5 million reported COVID-19 cases worldwide, some big outbreaks were to be expected. But SARS-CoV-2, like two of its cousins, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), seems especially prone to attacking groups of tightly connected people while sparing others. Its an encouraging finding, scientists say, because it suggests that restricting gatherings where superspreading is likely to occur will have a major impact on transmission, and that other restrictionson outdoor activity, for examplemight be eased.

If you can predict what circumstances are giving rise to these events, the math shows you can really, very quickly curtail the ability of the disease to spread, says Jamie Lloyd-Smith of the University of California, Los Angeles, who has studied the spread of many pathogens. But superspreading events are ill-understood and difficult to study, and the findings can lead to heartbreak and fear of stigma in patients who touch them off.

Most of the discussion around the spread of SARS-CoV-2 has concentrated on the average number of new infections caused by each patient. Without social distancing, this reproduction number (R) is about three. But in real life, some people infect many others and others dont spread the disease at all. In fact, the latter is the norm, Lloyd-Smith says: The consistent pattern is that the most common number is zero. Most people do not transmit.

Thats why in addition to R, scientists use a value called the dispersion factor (k), which describes how much a disease clusters. The lower k is, the more transmission comes from a small number of people. In a seminal 2005 Nature paper, Lloyd-Smith and co-authors estimated that SARSin which superspreading played a major rolehad a k of 0.16. The estimated k for MERS, which emerged in 2012, is about 0.25. In the flu pandemic of 1918, in contrast, the value was about one, indicating that clusters played less of a role.

Estimates of k for SARS-CoV-2 vary. In January, Julien Riou and Christian Althaus at the University of Bern simulated the epidemic in China for different combinations of R and k and compared the outcomes with what had actually taken place. They concluded that k for COVID-19 is somewhat higher than for SARS and MERS. That seems about right, says Gabriel Leung, a modeler at the University of Hong Kong. I dont think this is quite like SARS or MERS, where we observed very large superspreading clusters, Leung says. But we are certainly seeing a lot of concentrated clusters where a small proportion of people are responsible for a large proportion of infections.But in a recent preprint, Adam Kucharski of LSHTM estimated that k for COVID-19 is as low as 0.1. Probably about 10% of cases lead to 80% of the spread, Kucharski says.

That could explain some puzzling aspects of this pandemic, including why the virus did not take off around the world sooner after it emerged in China, and why some very early cases elsewheresuch as one in France in late December 2019, reported on 3 Mayapparently failed to ignite a wider outbreak. If k is really 0.1, then most chains of infection die out by themselves and SARS-CoV-2 needs to be introduced undetected into a new country at least four times to have an even chance of establishing itself, Kucharski says. If the Chinese epidemic was a big fire that sent sparks flying around the world, most of the sparks simply fizzled out.

Why coronaviruses cluster so much more than other pathogens is a really interesting open scientific question, says Christophe Fraser of the University of Oxford, who has studied superspreading in Ebola and HIV. Their mode of transmission may be one factor. SARS-CoV-2 appears to transmit mostly through droplets, but it does occasionally spread through finer aerosols that can stay suspended in the air, enabling one person to infect many. Most published large transmission clusters seem to implicate aerosol transmission, Fraser says.

Individual patients characteristics play a role as well. Some people shed far more virus, and for a longer period of time, than others, perhaps because of differences in their immune system or the distribution of virus receptors in their body. A 2019 study of healthy people showed some breathe out many more particles than others when they talk. (The volume at which they spoke explained some of the variation.) Singing may release more virus than speaking, which could help explain the choir outbreaks. Peoples behavior also plays a role. Having many social contacts or not washing your hands makes you more likely to pass on the virus.

The factor scientists are closest to understanding is where COVID-19 clusters are likely to occur. Clearly there is a much higher risk in enclosed spaces than outside,Althaus says. Researchers in China studying the spread of the coronavirus outside Hubei provinceground zero for the pandemicidentified 318 clusters of three or more cases between 4 January and 11 February, only one of which originated outdoors. A study in Japan found that the risk of infection indoors is almost 19 times higher than outdoors. (Japan, which was hit early but has kept the epidemic under control, has built its COVID-19 strategy explicitly around avoiding clusters, advising citizens to avoid closed spaces and crowded conditions.)

Some situations may be particularly risky. Meatpacking plants are likely vulnerable because many people work closely together in spaces where low temperature helps the virus survive. But it may also be relevant that they tend to be loud places, Knight says. The report about the choir in Washington made her realize that one thing links numerous clusters: They happened in places where people shout or sing. And although Zumba classes have been connected to outbreaks, Pilates classes, which are not as intense, have not, Knight notes. Maybe slow, gentle breathing is not a risk factor, but heavy, deep, or rapid breathing and shouting is.

Probably about 10% of cases lead to 80%of the spread.

Timing also plays a role. Emerging evidence suggests COVID-19 patients are most infectious for a short period of time. Entering a high-risk setting in that period may touch off a superspreading event,Kucharski says; Two days later, that person could behave in the same way and you wouldnt see the same outcome.

Countries that have beaten back the virus to low levels need to be especially vigilant for superspreading events, because they can easily undo hard-won gains. After South Korea relaxed social distancing rules in early May, a man who later tested positive for COVID-19 visited several clubs in Seoul; public health officials scrambled to identify thousands of potential contacts and have already found 170 new cases.

If public health workers knew where clusters are likely to happen, they could try to prevent them and avoid shutting down broad swaths of society, Kucharski says. Shutdowns are an incredibly blunt tool, he says. Youre basically saying: We dont know enough about where transmission is happening to be able to target it, so were just going to target all of it.

But studying large COVID-19 clusters is harder than it seems. Many countries have not collected the kind of detailed contact tracing data needed. And the shutdowns have been so effective that they also robbed researchers of a chance to study superspreading events. (Before the shutdowns, there was probably a 2-week window of opportunity when a lot of these data could have been collected, Fraser says.)

The research is also prone to bias, Knight says. People are more likely to remember attending a basketball game than, say, getting a haircut, a phenomenon called recall bias that may make clusters seem bigger than they are. Clusters that have an interesting social anglesuch as prison outbreaksmay get more media coverage and thus jump out to researchers, while others remain hidden. Clusters of mostly asymptomatic infections may be missed altogether.

Privacy is another concern. Untangling the links between patients can reveal who was at the origin of a cluster or expose information about peoples private lives. In its report about the chorus, CDC left out a seating map that could show who brought the virus to the practice. Some clubs involved in the new South Korean cluster were gay venues, which resulted in an antigay backlash and made contact tracing harder.

Fraser, who istracking HIV transmission in Africa by sequencing virus isolates, says it is a difficult trade-off, but one that can be managed through good oversight and engagement with communities. Epidemiologists have a duty to study clusters, he says: Understanding these processes is going to improve infection control, and thats going to improve all of our lives.

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Why do some COVID-19 patients infect many others, whereas most don't spread the virus at all? - Science Magazine

A new strain of Coronavirus, COVID 19, is spreading around the world, causing deaths and major disruption to the global economy.

Responding to this crisis requires global cooperation among governments, international organizations and the business community, which is at the centre of the World Economic Forums mission as the International Organization for Public-Private Cooperation.

The Forum has created the COVID Action Platform, a global platform to convene the business community for collective action, protect peoples livelihoods and facilitate business continuity, and mobilize support for the COVID-19 response. The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.

As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.

1. How COVID-19 is impacting the globe

An economic model shaped like a doughnut is being embraced by Amsterdam as a way to help both people and the planet thrive.

The model, developed by Kate Raworth, a senior research associate at Oxford Universitys Environmental Change Institute, is a way of achieving societal goals and thinking about economics based on the priorities set out by the United Nations Sustainable Development Goals.

Those in the middle of the doughnut fall short of life's essentials while those in the ring around that centre occupy a sweet spot where the Earth's resources aren't exploited. Everything outside the doughnut overburdens the planet.

Such sustainable models have never been more important, said Raworth. "As we all start thinking about how we will emerge from this crisis, let us seek to be holistic in how we reimagine and recreate the local-to-global futures of the places we live, she says.

A new antibody test has been approved by the UK after an independent evaluation showed it had a high degree of accuracy and specificity. The test can pinpoint COVID-19 antibodies thanks to a "specificity greater than 99.8% and sensitivity of 100%. The test, developed by Roche, is one of a number approved for use around the globe.

Antibody tests check blood for certain proteins produced by our bodies immune systems. These tests have been identified by a number of countries as a way to tackle the spread of the virus and loosen lockdowns since they can show who has been exposed to the disease.

The game was designed by university psychology professor, Richard Wiseman, and involves players navigating a busy street to avoid pedestrians, cyclists and people sneezing. "There's quite a lot of research showing that if you get people - kids in particular - to behave in certain ways in video games it really does transfer to real life," Wiseman said.

License and Republishing

World Economic Forum articles may be republished in accordance with our Terms of Use.

Written by

Linda Lacina, Digital Editor, World Economic Forum

The views expressed in this article are those of the author alone and not the World Economic Forum.

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What you need to know about the COVID-19 pandemic on 20 May - World Economic Forum

A few weeks ago, Perry, who lives in Chicagos northwest suburbs, started feeling symptoms of what he thought was COVID-19. The 64-year-old and his wife drove from their house to Waukegan to get tested.

But instead of the invasive and unpleasant nasal test hed heard about, they were handed swabs that looked like large Q-tips and told to collect their own samples.

They instructed us to take the swab and place it halfway up our nostril, twirl it to the right a few times and twirl it to the left a few times, and let it sit in the nasal cavity for 15 seconds, said Perry, who asked that his last name not be used for privacy reasons.

Then they handed Perry a small vial with liquid to put the swab inside.

When Perry told his doctor about how he took the test, his physician said he was surprised he collected the sample himself.

[He said] that my results were worthless based on his experience and knowledge of how the test should be done, he said.

Perry and his wife tested negative, but they didnt know if they could trust the results, so they decided to self-quarantine for 14 days.

As COVID-19 testing becomes more available crucial to reopening society many sites in Illinois are starting to offer tests where patients collect the sample themselves. Recently, Chicago Mayor Lori Lightfoot announced six new sites in the city where patients will administer an oral swab sample themselves.

Its a method that may become more common as federal guidelines expand to eventually allow at-home tests. But its raising questions for people who worry about whether they did they tests correctly and if the rush to expand testing has pushed through methods that might not be entirely sound.

Health care experts say if done correctly, self-swabbing is acceptable. Testing sites often have a health care provider watching the patient administer the swab and kits include directions on how to do it properly.

Emily Landon, an infectious disease specialist at the University of Chicago, said she and her team had conducted previous studies that show people can reliably test themselves. She said she expects self-swabbing to become more widespread. Its not only more efficient, but it could be safer for health care workers.

The holy grail of testing is really something where people can test themselves on a regular basis, Landon said. You dont need staff or people to wear [personal protective equipment] to do the collecting. You dont need them to be there if you just hand people a sample and they can pick up a kit and take it home.

Landon envisions a time when essential workers can test themselves daily before heading to work as we wait for a vaccine or cure.

Read more: All of WBEZs coverage of the COVID-19 outbreak in Chicago and the region

As for why self-testing is allowed now, when it was done only by healthcare professionals at the start of the pandemic, Landon said this is a routine evolution in how scientists approach new diseases. When theres a new virus, Landon said guidelines always start out especially conservative. For example, doctors testing for COVID-19 used to collect multiple nose and throat swabs, but also blood and urine samples. As doctors learned more, that changed. Theyve since dropped the blood and urine samples. Now, federal guidelines allow for self-sampling and even at-home tests, which is why different testing sites administer different tests.

Its an acknowledgement that there are practicalities, Landon said. We may not need the redundancy we were having before, because now were confident this one method is good enough.

As the federal government has adjusted who can administer a COVID-19 test, theyve also changed how the test can be conducted. Previously, the preferred test was the nasopharyngeal test, which goes all the way to the back of the nose and is extremely uncomfortable. Doctors and researchers are finding that its not always necessary to go back that far.

An early study by UnitedHealth out of Washington state found self-collected nasal swabs, even those that dont feel like a brain scrape, can be just as reliable as those particularly uncomfortable tests administered by health care workers. Another study by Rutgers University found testing saliva was also extremely reliable.

Information is changing quickly and neither study has been peer reviewed yet, key for acceptance in the scientific community. While these early studies show promise, there still isnt enough data or information to say with certainty the best test or testing method.

But, then again, doctors say no test is ever 100% accurate. Its not just how far back you test within the nasal cavity, but when an individual gets tested compared to when their symptoms began.

Regardless of what kind of nasal swab test is conducted, Landon said the sample needs to be collected correctly.

If you skimp and you do just stick the cotton in as far as comfortable youre not going to be as good of a sample, she said. Its going to have to be a little bit uncomfortable, thats what it comes down to.

If people doubt their results or are worried they didnt collect a good sample, experts advise patients to reach out to the testing site or a specialist who can advise whether to retake the test.

Kate McGeecovers higher education for the WBEZ Education Desk. You can follow her @McGeeReports.

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COVID-19 Self Tests Are Increasing, And Apparently Work - WBEZ

It had all started innocuously enough -- a cough and fever. After that, however, his illness took off. Within a week, he was on a breathing machine in the ICU because of a life-threatening lung infection from Covid-19.

His wife Heidi and two daughters painfully remember the next six days when Herbert was unconscious -- wondering if and how they could be at his bedside during a strict no-visitor hospital policy, just to hold his hand in what might be his last days.

Herbert's rapid worsening was even jarring for his medical team caring for him. "It was certainly unusual how quickly he went from a period of apparent stability to requiring ventilatory support," said Dr. Neal Greenfield, a critical care physician who helped care for Michael at Northwestern Medicine Delnor Hospital in Geneva, Illinois.

But as quickly as Herbert got worse, he then recovered. His doctors reduced his sedation, and with his regained consciousness, Herbert video-called his family every day. Unable to speak with a breathing tube, he would sign, "I love you."

He was taken off of his ventilator on his mother's birthday -- a week earlier than expected -- and he gave his mom the best birthday gift a son could give.

"I was able to call her and just say, "Hi," and then I was able to FaceTime my girls and wife, which was wonderful," he said.

Herbert was released from the hospital a few days later. His cough and fever improved. On paper, he would be listed as recovered, but as we are learning, the aftermath of Covid-19 is not nearly as straightforward as once believed.

Tracking for a disease with little information

"Two months ago, recovery wasn't on anyone's mind. We were dealing with the crisis," said Dr. Reynold Panettieri, vice chancellor of clinical and translational science and a pulmonary critical care physician at the Robert Wood Johnson Medical Center at Rutgers University in New Jersey.

While most patients with Covid-19 will fully recover, data from China suggest that some patients, especially those who had more severe infections, may face lasting -- even permanent -- damage to their bodies.

To better understand these effects, Panettieri is leading a six-month study of recovered Covid-19 patients. So far, his research group has enrolled more than 800 participants.

"Now, we'll start to see what the long-term consequences are," Panettieri said. "And that is an issue that will really need to be addressed."

Unlike most viral diseases, which may result in a nagging cough for weeks, Panettieri has observed that some patients recovering from Covid-19 have other serious symptoms that won't go away.

"They had an illness for about two weeks, and three months later, they're still not feeling 'quite right,'" he said. "They were aggressive athletes or were exercising and...they still haven't gotten back to that prowess that they were pre-illness."

He said this could be related to a number of factors, including how the virus affects the lungs, heart and muscles.

For Michael Herbert, his doctors believe his lingering cough and shortness of breath are likely remnants of his serious bout of pneumonia. Despite leaving the hospital a month ago, Herbert still struggles to recover back to how he felt before getting sick.

Dangerous lung scarring reminiscent of SARS and MERS

While a longer recovery course might be expected for someone such as Herbert who faced a more severe illness, there's also concern for more permanent lung damage, according to Dr. Ronald DePinho, professor and past president of MD Anderson Cancer Center and co-founder of Tvardi Therapeutics. DePinho is particularly worried that the immune response to Covid-19 may cause irreversible scarring known as pulmonary fibrosis.

Pulmonary fibrosis can be a "relentlessly progressive" disease of the lungs in which patients can become dependent on oxygen or even ultimately require lung transplants, he said. Again, this is after a patient is thought to have "recovered."

Though it's too early to know whether patients with the novel coronavirus will develop this sort of lung scarring, studies in other related coronaviruses, such as SARS and MERS, suggests certain Covid-19 patients may have lasting fibrosis. One study following 36 MERS patients found a third still had lung fibrosis on chest x-rays after a median follow-up of 43 days.

And up to two-thirds of patients with SARS who were sick enough to require hospitalization also developed pulmonary fibrosis, according to DePinho. If the same pattern holds true for Covid-19, that could mean many thousands of people will have long-term lung scarring, he said.

The data from China thus far is still thin, but the early results follow the same pattern DePinho is describing. In a study of 63 Covid-19 patients from Wuhan, China, about 18% had "fibrous stripes" on CT scans. And in another study, it took more than 6 weeks for one patient's chest CT to return to normal, even though his symptoms had already improved.

This might explain why some patients have significant drops in their lung function even after recovering from the novel coronavirus. Losses in lung function could be as high as 20 to 30 percent, the medical director of infectious diseases at Princess Margaret Hospital in Hong Kong told a media briefing in March.

More on Covid-19 and the lungs

There is another factor that may be driving long-term issues with the lungs, unrelated to scarring or fibrosis. We are learning those with Covid-19 also can form blood clots at an abnormally high rate. In rare situations, a clot that has formed in the deep veins of the legs may travel to the lungs -- known as a pulmonary embolism. This is what happened to Warnell Vega, a healthy 33-year-old I interviewed with Covid-19 who survived a life-threatening pulmonary embolism and is now home in recovery.

As is often the case, Vega developed a pulmonary embolism with little or no warning. He only had a mild cough when he passed out in his bathroom. He woke up in an ICU at Mount Sinai hospital. He was subsequently diagnosed with Covid-19, after which a scan revealed a pulmonary embolism. His doctors told me that Vega became critically ill and developed signs of pulmonary hypertension, which happens 2-4% of the time in patients with a PE (pulmonary embolism). So far Vega told me he feels close to normal, but recent clinical studies have shown that close to half of patients who suffered a pulmonary embolism will still experience exercise limitations at one year.

Given his history of a blood clot and pulmonary embolism, Vega is at risk of developing a blood clot again, and may need to be on blood thinners for some time as he continues to recover.

The heart

Another significant risk factor for a successful recovery is the impact of this virus on the heart. The virus' impact on the lungs may eventually lead to less oxygenated blood reaching the heart. Ot the virus may attack the heart itself, leading to myocarditis -- inflammation of the heart muscle. Both can lead to chronic heart damage, even in the previously healthy.

"There have been a number of reported cardiac complications associated with the Covid virus and they're so varied," said Dr. Joseph Brennan, the director of the coronary intensive care unit at Yale University School of Medicine.

He said there are a couple ways to look at how Covid-19 could cause long-term effects on the heart. One way is the direct impact of the virus on the heart, and the other is how clotting from Covid could lead to heart attacks.

"We are all aware that heart attacks may have long-term consequences because of a potential and permanent decline in heart function," he said. "Those that have had...heart attacks associated with the Covid virus will more than likely have long-term consequences."

A study published in the medical journal JAMA Cardiology found 19.7% of hospitalized Covid-19 patients suffered from some type of cardiac injury. Such patients might not be able to exercise as much, feel breathless or feel like their heart is beating faster than usual for an indefinite period of time. In general, a faster heart rate will likely be a common side effect in the long run for Covid-19 patients, especially if patients have underlying lung issues from Covid-19, he said.

Though Michael Herbert did not have heart-related complications from Covid-19, he did suffer from diabetes, high blood pressure and obesity -- conditions that affect heart health and put him at risk for a more severe infection, according to the US Centers for Disease Control and Prevention.

The brain

Another important organ at risk for damage from blood clots? The brain. Large clots would more likely cause obvious symptoms, but smaller ones may lead to a type of dementia known as vascular dementia. Both can cause permanent damage that might not present itself until years down the line.

"We know that if someone has a stroke, it approximately doubles their risk of getting dementia later in life," said Dr. Marion Buckwalter, associate professor of neurology and neurosurgery at Stanford University. "[Our research group] discovered that people who had a more vigorous immune response by day two after stroke were more likely to have cognitive decline in the first year after stroke."

Michael Herbert feels lucky that he hasn't experienced these types of symptoms during his recovery, especially given how severe his infection was.

"I'm feeling good," Michael said. "My strength has come back. It's not perfect, but I feel better."

Though his progress has been incremental, he remains encouraged that each day has been a step in the right direction. He remembers how weak he felt trying to move from his ICU bed to a wheelchair. Now, he is working towards walking two miles a day without stopping.

The entire ordeal has been a huge wake up call for him -- he now takes his health much more seriously, and he is grateful that his doctors have provided him a second chance.

"I mean, I have bonus time here in life," he said. "I was supposed to be dead, and I didn't die. I'm not going to waste any days I have left."

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Why overcoming Covid-19 is just the first hurdle of a much longer journey - CNN

Officials said underlying medical conditions are common in San Diego County's population.

SAN DIEGO Every day the death toll climbs from COVID-19, and statistics showing how many of those patients had underlying medical conditions, but those numbers represent people - victims of COVID-19 with families who loved them.

Bob Fria loved his family, his wife, his daughter, and his three grandchildren.

He also had a passion for cars.

He was 77. He stayed very active. He was a car collector. Worked on his cars daily, said his daughter, Nicole Wendell. He wrote a book on mustangs. He was personal friends with Lee Iacocca, and he was a historian worldwide.

Fria died in last month from COVID-19 while hospitalized in the ICU. His daughter wants people to know her father was much more than a statistic.

We were totally in shock that this could happen to my dad. He was as healthy as you could imagine a 77-year-old man to be. He acted like he was maybe 60 and it just struck him quick, she said.

Fria had high blood pressure, but it was under control.

Hypertension is the most common underlying condition associated with COVID-19 deaths, according to San Diego County health officials. Other common underlying conditions include dementia, Alzheimer's disease, heart disease, asthma, diabetes, obesity and a compromised immune system.

But make no mistake, COVID-19 killed Bob Fria, not his high blood pressure.

Well over 50 percent of our population has at least one type of underlying medical condition. Hypertension alone is an underlying medical condition, said Dr. Wilma Wooten, the countys public health officer.

Their life is no less valuable than someone's life who does not have underlying medical conditions, Dr. Wooten said.

So, when we hear the COVID-19 death statistics each day, don't be fooled into thinking it only happens to people with underlying medical conditions.

It happens to people, who are loved.

Its no joke. It's out there. It takes healthy people, whether they're young or old. And, my dad was a victim of that, said Wendell.

Bob Frias wife, Joyce, who also has high blood pressure, contracted COVID-19 and recovered. His daughter and one granddaughter also are COVID-19 survivors.

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COVID-19 is killing people, with and without underlying medical conditions - CBS News 8

People with type 1 diabetes are more likely to die of Covid-19 than those with type 2, according to NHS research confirming that diabetes significantly increases coronavirus sufferers risk of dying.

Almost one in three of all deaths from coronavirus among people in hospital in England during the pandemic have been associated with diabetes, according to the study.

People with type 1 diabetes the autoimmune form of the disease are three-and-a-half times more likely to die if they catch Covid-19 than non-diabetics, while type 2 diabetics those with the form closely linked to being overweight are twice as likely to die as non-diabetics. Nine out of 10 diabetics have type 2, and many are obese.

Age, however, is the biggest determining risk factor for death among those with either form of diabetes who get Covid-19. Under-40s have a very low risk compared with those over 40, and especially compared with older people, according to new findings collated by NHS England. People with type 1 diabetes, which is usually diagnosed in childhood, tend to be younger than those with type 2.

Last week, separate findings suggested that a quarter of coronavirus-related deaths were among people with diabetes. The findings have not yet been subjected to peer review but will soon be published in a leading medical journal.

So far during the pandemic, 7,466 people who died in hospital in England had type 2 diabetes and 365 had type 1.

Prof Jonathan Valabhji, NHS Englands national clinical director for diabetes and obesity and the studys lead author, said: This research shows the extent of the risk of coronavirus for people with diabetes and the different risks for those with type 1 and type 2 diabetes. Importantly, it also shows that higher blood glucose levels and obesity further increase the risk in both types of diabetes.

Jon Cohen, emeritus professor of infectious diseases at Brighton and Sussex medical school, said: Bacterial infections are more common and more severe in diabetes. This has generally not been thought to be such a problem with viral infections such as coronavirus, but any severe infection can cause problems with insulin control so this too will likely contribute to the increased mortality rate in type 1 patients.

So diabetic patients are probably not at greater risk of catching coronavirus, but do have a greater risk of becoming seriously ill if they do catch it.

The study also found that the overall death rate for people with diabetes doubled in the early stages of the pandemic. Among both type 1 and type 2 patients, men, BAME people and those living in more deprived communities were at higher risk. In both types of sufferer, those with underlying kidney disease or heart failure and/or who previously had a stroke, were also at higher risk.

This article was amended on 20 May 2020 to amend references to diabetes that did not adhere to house style guidelines.

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Covid-19: people with type 1 diabetes more likely to die than those with type 2 - study - The Guardian

At todays meeting of the 73rd World Health Assemblyits first-ever to be held virtuallydelegates adopted a landmark resolution to bring the world together to fight the COVID-19 pandemic.

The resolution, co-sponsored by more than 130 countries, was adopted by consensus.

It calls for the intensification of efforts to control the pandemic, and for equitable access to and fair distribution of all essential health technologies and products to combat the virus. It also calls for an independent and comprehensive evaluation of the global response, including, but not limited to, WHOs performance.

As WHO convened ministers of health from almost every country in the world, the consistent message throughout the two-day meetingincluding from the 14 heads of state participating in the opening and closing sessions was that global unity is the most powerful tool to combat the outbreak. The resolution is a concrete manifestation of this call, and a roadmap for controlling the outbreak.

In his closing remarks, WHO Director-General Dr Tedros Adhanom Ghebreyesus said COVID-19 has robbed us of people we love. Its robbed us of lives and livelihoods; its shaken the foundations of our world; it threatens to tear at the fabric of international cooperation. But its also reminded us that for all our differences, we are one human race, and we are stronger together.

The World Health Assembly will reconvene later in the year.

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Historic health assembly ends with global commitment to COVID-19 response - World Health Organization

Ford temporarily halted production in Chicago plant because of COVID-19 cases  MarketWatch

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Ford temporarily halted production in Chicago plant because of COVID-19 cases - MarketWatch

Donald Trump has reignited a controversy over the antimalarial drugs chloroquine and hydroxychloroquine after telling reporters he was taking the latter to protect himself against coronavirus. What do we know about these drugs?

Hydroxychloroquine, which Trump says he has been taking for about two weeks, was developed as an antimalarial but it is also used to treat conditions like lupus, an anti-immune disease, and arthritis, where it can help combat inflammation. It has been licensed for use in the US since the mid 1950s and is listed by the World Health Organization as an essential medicine.

Researchers have been interested in chloroquines as an anti-viral agent for some time. A study in Virology Journal in 2005 found that chloroquine inhibited the closely related Sars virus in primate cells in lab conditions.

However, evidence for the effectiveness of hydroxychloroquine in recent human trials during the coronavirus pandemic has been at best inconclusive, with some suggestions that it could worsen the outcome of severe cases.

The WHO is looking at whether hydroxychloroquine could be an effective Covid-19 treatment, while the US National Institutes for Health is also running a clinical trial to establish whether the drug, administered together with the antibiotic azithromycin, can prevent hospitalisation and death from Covid-19.

In recent days, enthusiasm about hydroxychloroquine has been boosted by a study, which has yet to be peer-reviewed, that looked at the combination of hydroxychloroquine, the antibiotic azithromycin and zinc supplements.

It showed that patients who received the three-drug combination vs the two-drug combination of hydroxychloroquine and azithromycin were 44% less likely to die than the second group. Joseph Rahimian, a co-author of the study, pointed out that the studys findings were limited to the possible promise of zinc, not of hydroxychloroquine.

In May, the British Medical Journal reported on a randomised (although still problematic) clinical trial in China that found little evidence hydroxychloroquine worked, with serious adverse events noted in two patients.

A second study reported in the BMJ last week on a French trial also concluded that hydroxychloroquine does not significantly reduce admission to intensive care or improve survival rates in patients hospitalised with pneumonia owing to Covid-19. Overall, 89% of those who received hydroxychloroquine survived after 21 days, compared with 91% in the control group.

The US Food and Drug Administration in a safety alert issued on 24 April warned that it had received reports that hydroxychloroquine and chloroquine could have serious side-effects and that the drugs should be taken only under the close supervision of a doctor in a hospital setting or a clinical trial.

There are a number of side-effects. The most serious is that it can interfere with the rhythm of the heart. Other side-effects include headache, dizziness, nausea, vomiting, stomach pain, skin rash or itching or hair loss. Research published by the Mayo Clinic has suggested that off-label repurposing of drugs such as hydroxychloroquine could lead to drug-induced sudden cardiac death.

Although Trumps official physician has said he was in very good health at his last official checkup, the president is 73 and his recorded weight would put him in a BMI category of clinically obese.

Despite there being no conclusive body of evidence that it can be effective when used to prevent contracting coronavirus, the president apparently decided in conversation with the White House physician Sean P Conley that it was worth the risks.

After numerous discussions he and I had for and against the use of hydroxychloroquine we concluded the potential benefit from treatment outweighed the relative risks, Conley wrote.

It is probably worth pointing out that Conley, a naval doctor, trained initially as an osteopath and then in emergency medicine, serving as research director at Portsmouth Navy Department of Emergency Medicine prior to his assignment to the White House medical unit.

For his part, Trump, despite the FDA and other warnings, said: I think its good. Ive heard a lot of good stories. And if its not good, Ill tell you right. Im not going to get hurt by it. Its been around for 40 years.

Yes. Trump has a history of personally advocating for the use hydroxychloroquine, which he has described as a potential game-changer. Although it has been reported that Trump has a small stake in a French company that makes hydroxychloroquine via an investment fund, this seems to be about Trumps own hunches and his desire to be both proved right and protected against the disease.

On Monday, he also claimed lots of doctors were using the drug prophylactically and cited letters he had received from members of the public. As Paul Waldman, a columnist in the Washington Post, has suggested, this is more about Trumps psychology than anything else.

Trump compensates for his own insecurity by working to convince himself and everyone else that the experts dont know what theyre talking about, and he knows more than them about everything, Waldman has written.

Excerpt from:

Hydroxychloroquine, Trump and Covid-19: what you need to know - The Guardian

The construction industry has 19 confirmed clusters of COVID-19, which is more than any other local industry, according to data released by Austin Public Health.

AUSTIN, Texas COVID-19 is tearing through the construction industry in Austin, with 19 confirmed clusters of the virus reported by Austin Public Health.

Austin Public Health officials provided a detailed list of the local industries with confirmed coronavirus clusters during the city council work session on Tuesday, May 19.

COVID-19 has overwhelmingly impacted the construction industry, according to the data.

Austin's Interim Health Authority Dr. Mark Escott said Tuesday that 127 construction workers were tested for coronavirus last week. On May 7 and May 8, about 8% of workers at two different construction sites tested positive for the virus, according to data about targeted testing from Austin Public Health.

Dr. Escott also said we need more testing at construction sites in the city.

The new numbers from Dr. Escott identify 36 non-institutional clusters total. Clusters have been identified in construction, manufacturing, retail trade, services and financial, insurance and real estate industries.

One COVID-19 cluster has been identified in the dental industry, three clusters in medical labs and one in specialty outpatient services, according to the data.

Austin Public Health also notes six clusters in retail trade, which include food service, general merchandising and grocery.

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These Austin industries have the most COVID-19 clusters - KVUE.com