Category: Covid-19

The Covid-19 coronavirus meets its most formidable foe the moment it enters the human body.

The immune system is waiting, ready for action, and it determines who dies and who survives. It is why the vast majority of the infected have recovered from the disease.

Yet one of the most important unknowns is why some peoples immune systems are up to the task of clearing out the virus while others are sluggish or overreact, leading to death. Just as vexing:

Its helpful in thinking through these unanswered questions to understand how the immune system works (collectively and in individuals), how immunity testing works, and how immunity to similar viruses changes over time. Its also comforting to know that if you get Covid-19, your body will try very, very hard to save you. And if it doesnt, it could be because it tried too hard.

So here is a guide to the immune system: antibodies, serological tests, reinfection, and immunological memory, explained.

The first thing to know about the immune system is that it is not simple. At all.

A huge array of cells and chemicals your body produces work in concert to clear a foreign invader from your body. Theres a lot of elegance to this whole system, Akiko Iwasaki, an immunologist at the Yale School of Medicine, says. Its like an orchestra. All these cells and chemicals have to work in concert each with a different part to play to defeat the virus.

A viral infection begins when a virus enters a cell of your body. In the case of Covid-19, which is transmitted mostly by respiratory droplets, maybe that takes place somewhere in the lining of your nose or in the area of your lungs directly in contact with the air you inhale.

The virus then attaches to a cell via a protein on the cells surface called ACE-2 and lets itself in.

There, it begins to wreak havoc. The virus hijacks the cells machinery to make copies of itself. Those copies break out of the cell and then spread around your body. The copies enter more of your cells, make more copies, and so on. This is going viral, in the literal sense, and its a process your body works furiously to stop.

If the immune system is an orchestra in concert, its music can be broken down into two movements.

First, the opening: the innate immune response. This is the base-level protection you have to defend against infections even those your body has never seen before.

Iwasaki explains that every cell of your body has something of its own immune system in miniature. Your cells have a mechanism to detect virus infection, she says. Every cell is looking out for telltale genetic signs of viral replication. Once thats found, your cells start secreting these cytokines [signaling molecules] to tell the neighboring cells that theres a viral infection, she says. It will signal that cell to make a lot of antiviral proteins. Every part of the viral life cycle is targeted by hundreds of genes that are induced by this.

The innate immune response will then try to stop the virus in its tracks there, but it can fail, as we know. Viruses those sneaky bastards have evolved ways to counter this initial response. The viruses might encode proteins that degrade some of these signaling molecules, Iwasaki says. Even though we have this amazing system, viruses try to circumvent it.

If the innate immune system cant get rid of the infection, the second movement in this orchestration begins: the adaptive immune system. It has a vast array of instruments, each tuned to a specific task.

There are dendritic cells, which act as messengers from the innate immune system and tell the adaptive immune system which viral proteins it should seek out and destroy. There are killer T-cells, which hunt down and kill cells that have been infected. There are helper T-cells, which stimulate killer T-cells and recruit yet another class of cells called macrophages to gobble up infected cells, and they also stimulate B-cells, which bring this whole concert to a crescendo.

B-cells are critically important because they produce antibodies. These are little proteins that bind, specifically, to a single distinct part of a virus or pathogen and make it unable to hijack your cells. Antibodies can also identify invaders for other immune cells to destroy, and they can mark infected cells for destruction before a virus can burst out. And after an infection fades, the antibodies that linger can prevent the same virus from rising again.

But this process takes time.

When you first get infected with SARS-Cov-2, it usually takes anywhere from 10 to 14 days to make antibodies that are effective, says Vineet Menachery, an immunologist who studies coronaviruses at the University of Texas Medical Branch. That immunity actually peaks between four and eight weeks after youve been infected. The antibodies are really powerful at that point.

It takes a long time because an antibody has to be unique for the virus its trying to protect against. It takes a while and some trial and error to both build an antibody that can perfectly bind to the contours of the virus and to produce millions of copies of that antibody. The magnitude of potential antibodies is somewhere in the neighborhood of quadrillions or quintillions, Angela Rasmussen, a Columbia University virologist, says. But your immune system can narrow the choices down to the right formulation to clear the virus from your body.

The process isnt simple, but you can be in awe of it, like you can be in awe of a timepiece constructed from hundreds of delicately selected parts. I teach an entire semester course on this, Iwasaki says. This is the delicate process that a vaccine is trying to replicate artificially.

This antibody construction process can backfire, however. In some cases, antibodies bind to the virus, Iwasaki explains, and instead of blocking the virus, theyre taken up by white blood cells. Those white blood cells then go haywire, producing molecules called cytokines. Ordinarily, these chemicals promote inflammation throughout the body.

Inflammation is something that makes us feel sick, but it also helps us survive. People often think of swelling when they think of inflammation, Rasmussen says. Swelling occurs because cells from your immune system are rushing into the site of the infection. These immune cells have to get out of your blood vessels, she says, in order to corral the infection. Its a lovely process called rolling extravasation, she says. Your tissue gets inflamed because the balance of fluid is being changed.

But sometimes, so many cytokines are released that they trigger white blood cells to turn against healthy cells. That can then lead to organ failure and death. And that ultimately makes the disease as bad as it is, Iwasaki says.

Its unclear why a cytokine storm, as this reaction is called, might impact some people severely and not others, though there are indications that aging is a factor, as are underlying conditions like high blood pressure and diabetes. Researchers are also now looking for genetic clues to see who is most at risk. Thankfully, though, doctors do have some insights into how to treat this overreaction.

This whole orchestra ends when the immune system neutralizes all the virus in the body. That doesnt always mean the virus is purged; many viruses can linger in a latent state in the body without reproducing or causing symptoms. These latent viruses can flare up when the immune system is weakened, causing opportunistic infections. At the same time, youll be left with antibodies circulating in your blood.

But for reasons scientists dont quite understand, for some infections and notably, in other types of coronavirus infections antibody levels can wane over a period of years.

So how do doctors and scientists know if this process has been successful? How can they know if someone is now immune to the virus that causes Covid-19?

They test for it.

In particular, blood tests, also known as immunity tests or serological tests, can reveal who possesses antibodies to the virus. Deploying these tests will help answer a lot of questions. Most basically, it can help a person know if they have had Covid-19.

On a larger scale if deployed in well-designed studies serological tests could reveal the complete picture of the pandemic. They can also help scientists answer basic questions like:

Serological tests could also potentially allow people who have immunity to return to work. That could be a huge boost to front-line health workers who may have been exposed to the virus but are desperately needed back in action.

Just finding the antibodies isnt always enough, though. Scientists also need to do additional tests to make sure those antibodies are potent.

There are two main types of antibody tests, Menachery explains. The first just looks for antibodies and can be completed in a few hours. This is called an ELISA test (short for Enzyme Linked Immunosorbent Assay). And it doesnt provide the most complete picture of immunity.

The second test is more involved, and rarer. Its called a serum neutralization test, and it takes a few days to process. It not only looks for antibodies, it then exposes those antibodies to a virus in a cell culture to see how effective the antibodies are in stopping the virus.

Ideally, scientists will correlate the two tests and figure out which concentrations of antibodies confer the highest level of immunity. This work is ongoing, Menachery says. Its still not known what levels of antibodies are needed to have lasting, protective immunity. (What also remains to be shown: that the presence of antibodies also means you cant give the virus to someone else.)

These tests are useful, but they dont answer everything. As noted earlier, it takes days, if not weeks, for the body to produce antibodies. So a negative antibody test doesnt mean the virus isnt present. And since antibodies are produced during an infection and linger after its cleared, a positive antibody test doesnt mean that the virus is no longer active.

Confirming whether someone can still spread Covid-19 requires a separate genetic test like an RT-PCR test that detects the active virus.

Even if people do become immune, one thing we dont know about still is how long that immunity would last, Rasmussen says. And thats unfortunately not something we can determine until we wait months or years in the future, and test again and see if those antibodies are still there.

For reasons scientists dont quite understand, for some infections, your immunity never wanes. People who are immune to smallpox, for example, are immune for life: Antibodies that protect against smallpox have been found as long as 88 years after a vaccination.

Less reassuring here is that scientists have observed antibody levels to other coronaviruses (there are four coronavirus strains that infect people as the common cold) can wane over a period of years. A few weeks after an infection, antibody levels will be at their highest. But a year from now, that number is likely going to be a little bit lower, and five years from now its likely to be potentially a lot lower or a little bit lower, and we dont know the factors that change that, Menachery says.

However, even if you lose the antibodies, it doesnt mean you are again completely susceptible to the virus. Yes, none of this is simple.

There have been a few experiments where volunteers were willingly exposed to a coronavirus strain that produces a common cold. These studies show its common for the antibodies to these other coronavirus strains to decline after a year or so.

The majority of people that dont have serum neutralizing antibodies [i.e., antibodies that take out the virus], they get infected again, but they didnt get that sick, Menachery says. You couldnt do this type of test for Covid-19, he adds; its too dangerous.

There have been reports of a few patients out of China who had mild symptoms of Covid-19 who did not have detectable neutralizing antibodies after recovery, though they did have another form of antibody that binds to the virus. Its unclear whether they have protective immunity, Nature reports. Yes, there is more than one type of antibody, and they do different things, because none of this is simple.

Luckily, even if your antibodies against a coronavirus decline, your body has a backup plan.

Certain types of B-cells recall, these are the ones that make antibodies become memory B-cells. These save the instructions for producing a particular antibody, but they arent active. Instead, they hide out in your spleen, in your lymph nodes, perhaps at the original site of your infection waiting for a signal to start producing antibodies again.

With the memory B-cells in reserve, instead of waiting two weeks or more to get antibody production going, youll only have to wait maybe two or three days, Menachery says. So that means, yes, you can get infected again, but you may not even know youre sick. If you do get sick, maybe its a very minor infection.

Generally, he says, the more severe your infection, the more antibodies your immune system will produce, and the longer theyll stay in your bloodstream post-infection. So, he says, there is some concern that if you had a mild infection that your level of protection may not last long.

You may have seen some reports of people testing positive a second time for Covid-19 after recovering. The experts we spoke to say these reports are likely due to flaws in testing. I think the risk of being infected more than once from SARS-CoV-2 is nil, says Gregory Gray, an infectious disease epidemiologist at Duke University, in an email.

That may be because as you progress in the illness, the testing for Covid-19 becomes more inconsistent.

Often at the time that virus diseases present themselves, its fairly far into the replication of that virus in that person, says Diane Griffin, a professor of microbiology and immunology at the Bloomberg School of Public Health at Johns Hopkins University. Many symptoms of virus disease are actually manifestations of the immune response to the disease. Often things are starting to get better at the time youre starting to figure out someone even has a virus infection.

At least in the short term, its probably more the case that the people who have tested positive after recovering havent completely cleared the virus from their system or that a prior negative test was inaccurate.

Over the long term, the immune system itself becomes less effective with advancing age. And as people get older, they can acquire more chronic illnesses that can hamper the response to a virus, even if its one the immune system recognizes. It will be years, though, before scientists can understand what aging means for immunity to Covid-19.

The Centers for Disease Control and Prevention is now conducting serological surveys for Covid-19 antibodies in several places across the US.

Its an attempt to figure out who was previously infected with the virus, particularly if they never exhibited symptoms. A survey like this can show the actual background rate of infection and answer critical questions like what proportion of people have been infected without showing symptoms and where the virus has spread in a population, and quantify the overall rates of severe complications. Knowing these variables can help health officials better target interventions.

Many people who may have been infected also want to know if they are immune so they can safely leave lockdowns. Countries like Germany are even considering granting immunity passports so individuals can return to work.

Such testing could make a difference in a handful of cases, like for doctors and nurses who were infected or may have been exposed but are desperately needed back in action. But serological testing is unlikely to be a wholesale solution to reopening the economy.

Again, scientists are still uncertain about the robustness and duration of immunity that a Covid-19 infection confers, so a positive antibody test at this point doesnt guarantee that one can safely end social distancing measures. If immunity does fade after a year or two, the same person could be vulnerable to reinfection.

Meanwhile, to reopen schools, shops, and offices across the board, large numbers of people would have to have immunity. Without a vaccine, that would mean that the virus would have to infect vast swaths of the population, in the process sending thousands to the hospital and to their graves. That is exactly what measures like lockdowns and social distancing are trying to avoid.

While this outbreak has been ghastly, it has not been so bad as to bring about herd immunity in any quick time frame. There have been some imperfect serological studies that suggest the virus has infected more people than previously estimated. But even if true, the studies dont mean were anywhere close to achieving herd immunity.

So its unlikely that immunity can be a benchmark for when its okay to go back to normal across the population, and even in individual cases, it requires careful consideration of risks and benefits.

For those who have not yet contracted the virus, the main form of protection from Covid-19 right now is prevention. But there are several options scientists are studying that could help those who were never infected fend off the illness.

Chief among them is a vaccine. A vaccine can take various forms, including a weakened version of the virus itself, a small piece of the virus, or genetic material that prompts the immune system to manufacture antibodies to the virus.

Developing a vaccine for SARS-CoV-2 would be the ideal solution to the Covid-19 pandemic since its a form of prevention that would also hasten the end of costly measures like lockdowns, quarantines, and social distancing.

But its a time-consuming approach. Many experts estimate that it will take at least a year to develop a vaccine for the new coronavirus.

Vaccines can also pose risks. A small number of people can have dangerous adverse reactions to a vaccine, like severe allergies. In rare cases, vaccines can cause a phenomenon called immune enhancement, where the vaccine makes the recipients immune system overreact to the virus target, leading to a more severe disease than in those who were unvaccinated.

Though these risks are small, vaccines have to be delivered to millions of people. Thats why vaccine development focuses so much on safety and reducing the risks of complications as much as possible. Researchers are looking into various ways to speed up development, including human challenge trials where volunteers are deliberately exposed to the virus to test their immunity with and without a vaccine.

Another tactic under investigation is using convalescent plasma. The idea is to harvest the liquid part of blood, including proteins used for clotting, from people who have survived Covid-19. This plasma contains antibodies to the virus, so scientists are seeing whether it can help people with active infections get better. Researchers are also studying whether convalescent plasma can be used as a prophylactic to prevent Covid-19 in the first place.

Companies are also developing antibodies to SARS-CoV-2 using mice genetically engineered to have human immune systems. These antibodies can also be used to treat or prevent the disease.

But antibody transfusions, whether they come from Covid-19 survivors or were created in a lab, only confer protection against the virus for a few months.

The long-term strategy is to get enough people in a population immune to the virus so that it no longer spreads easily. This is known as herd immunity. It usually requires between 70 and 90 percent of a group of people to be immune in order to be effective, depending on the contagiousness of the virus.

With a large enough share of immunity in the population, even the remaining people who are not immune face a much lower likelihood of being infected. With few susceptible hosts in close proximity, pockets of infection quickly fade out. The question is whether this herd immunity is attained through vaccination or through infection.

The latter would not be ideal since it would involve millions getting sick from Covid-19. The United Kingdom was pursuing this approach back in early March but backed off its herd immunity strategy of limiting restrictions on movement and allowing people to be exposed. The country changed course when forecasters revealed that millions would likely contract the virus, overwhelming the UKs health system. Sweden has adopted a similar approach and is now facing vastly more Covid-19 cases than its neighbors.

Its also hard to gauge how close any country is to herd immunity since many people have likely been infected with the virus without knowing it. Figuring this out would require extensive testing for antibodies. And not everyone develops the same level of immunity from an infection. So vaccinating people against Covid-19 is the safer strategy.

Until then, widespread testing to identify the infected, isolating them, and tracing their contacts could help ease some of the pandemic control measures in place now.

How about what we can do as individuals?

Short of drugs like interferons, there isnt much a person can do to boost their immune system or their response to Covid-19, despite what various supplements promise.

The best Covid-19 approach for individuals is healthy habits maintain good hygiene, exercise, eat a balanced diet, get plenty of sleep, stay hydrated, manage any chronic health conditions like diabetes, and limit exposure to pollution.

Though the Covid-19 pandemic has been raging for several months, a lack of key information from how many people were infected to the origins of the disease continues to hamper the response.

More science on almost every aspect of this new virus is needed, but in this pandemic, as with previous ones, decisions with great consequences must be made before definitive data are in, wrote Harvard epidemiologist Marc Lipsitch in a column in the New York Times.

But the unknowns around immunity to the disease may be the most critical because they stand between the untenable present and a return to normal. Meanwhile, pressure is mounting to relax restrictions on movement to allow life to continue. With incomplete information, policymakers still have to make decisions that depend on immunity, but this can be done in ways that reduce risk.

The best approach is to construct a conceptual model a set of assumptions about how immunity might work based on current knowledge of the immune system and information about related viruses, and then identify how each aspect of that model might be wrong, how one would know and what the implications would be, Lipsitch wrote.

This is no easy task. It still might be the case that what we learn about immunity may not be enough for everything to go back to normal. We may need to wait, patiently, for a vaccine.

One advantage scientists have in the Covid-19 pandemic that they didnt have in prior outbreaks is an unparalleled level of information-sharing among researchers around the world. Researchers are posting their preliminary findings online for the world to scrutinize and working across borders, collaborating on an unprecedented scale.

That has led to unknowns becoming known faster than ever. But the disease is continuing to spread, and the drastic pandemic response measures cant continue forever, so some difficult choices lie ahead.

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Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. Voxs work is reaching more people than ever, but our distinctive brand of explanatory journalism takes resources particularly during a pandemic and an economic downturn. Your financial contribution will not constitute a donation, but it will enable our staff to continue to offer free articles, videos, and podcasts at the quality and volume that this moment requires. Please consider making a contribution to Vox today.

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Covid-19 immunity and testing, explained - Vox.com

Dr. Tommy Alquist administering COVID-19 antibody test last week in Treasure Valley. | Courtesy Camille Blaylock

IDAHO FALLS Since the onset of COVID-19, there have been many questions surrounding testing requirements for the virus and who is able to get a test.

RELATED | COVID-19 related deaths up to 54 in Idaho; 767 people presumed recovered

Beginning Monday, Crush The Curve Idaho, a statewide initiative aimed at reducing the spread of coronavirus, is partnering with Mountain View Hospital in Idaho Falls to offer a COVID-19 antibody serology test to anyone who would like it.

This is a blood draw to fill a little tube, which will be sent to the University of Washington to get results back, Tina Upson, Executive Director of Crush the Curve, tells EastIdahoNews.com.

It takes about two to three minutes and results are available two days later, Upson says.

The test specifically determines whether someone had COVID-19, not just a generic form of coronavirus. Though this test is not FDA-approved, Upson says it is authorized for use under the emergency act.

RELATED | Local clinic offering drive-thru test for coronavirus antibodies

Crush The Curve Idaho tested over 5,000 people for COVID-19 antibodies in the Treasure Valley last week, Ball Ventures CEO and CrushTheCurve Board Member Cortney Liddiard says in a news release. It is obvious there is a need for this important data and we are thrilled to have found such a great testing partner to help meet the demand.

People who had been sick for the first three months of the year werent eligible to get tested previously because of limited testing supplies, Upson says.

Weve been able to move over 1,000 people a day through (the Treasure Valley) testing siteand get answers to (their) questions, she says.

Testing will be available Monday through Friday between 8 a.m. and 4 p.m. at The Waterfront in Snake River Landing. All social distancing rules will be followed and nearly 50 volunteers will be on-hand to help administer the test.

Those who show up will be given a packet to fill out in their car, which Upson says will take about 10 minutes. Once the paperwork is complete, you put it on your dashboard and wait for your name to be called. Once your paperwork is reviewed, youll be directed to the blood draw line.

What were finding in Meridian and in the Treasure Valley istheyre in and out in 30 minutes, she says. Day one may be a bit slowerbut the team of volunteers will make it a good experience. Even if wait times are a bit higher because of demand, I am cautiously optimistic that that will be just fine with everybody.

Sanitation volunteers will be wiping everything down constantly. If you feel you currently have COVID-19, Upson says active virus testing is available by calling (208) 542-7032 Ext. 0.

The test costs $95 and is covered by insurance. You can also pay with cash. Upson says there will be funding set aside for those unable to pay and no one will be turned away.

RELATED | Idaho must meet these criteria to begin reopening process. Heres where we stand.

RELATED | Eastern Idaho residents ask Gov. Little to re-open the state during rally Saturday

Upson says all test results are reported to the state.

Testing will be available in Chubbuck beginning Thursday at Idaho Central Credit Union at 4400 Central Way.

By opening testing to everyone, we will help Idaho return to work with a pathway going forward, Dr. Tommy Ahlquist, CEO of BVA Development says in a news release. We now have the capacity to quickly test anyone and provide repeat antibody testing at recommended intervals. These baseline tests will be important as we establish who has been exposed to COVID-19. Repeat testing will be critical as we move forward.

Appointments are not required but you can streamline the process if one is set up. To schedule an appointment, click here.

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New COVID-19 antibody test available to everyone in eastern Idaho beginning Monday - East Idaho News

PORTLAND, Ore. The Oregon Health Authority announced four more deaths and 58 new cases of COVID-19 in Oregon on Sunday.

The four additional deaths bring the death toll to 91 and the total number of positive cases is now at 2,311. A total of48,964 people have been tested for the virus in the state.

OHA released the following information about the four people who died. All had underlying health conditions:

The 58 new COVID-19 cases reported Sunday are in the following counties:

RELATED: Coronavirus in Oregon: By the numbers

RELATED: Shuttered by coronavirus, Oregon small businesses face rent crisis

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4 more deaths, 58 new cases of COVID-19 in Oregon - KGW.com

BRYAN, Tex. (KBTX)- Gabriel Menchaca has always believed in God but his recent brush with death and the loss of his father to COVID-19 has only strengthened his faith.

The Bryan native who now resides in College Station was Brazos County's first community spread patient of COVID-19. He spent nearly a month in a coma at Baylor Scott and White Health and when he woke up he learned his father was in the same hospital dying from the virus.

"My dad was an amazing man and I'm not just saying that because he's my dad. He was an amazing man and greeted everyone with a smile," said Menchaca.

Gabriel says he was very close to his father, Emilio Amos Menchaca , who passed away on April 13.

The 67-year-old's death followed his son's diagnosis of COVID-19 in mid-March.

"The first day it felt like the flu. My body was sore and I had chills. I could barely walk. It just felt like the flu," said Menchaca.

The 37-year old says the first hospital he visited sent him home with no test and his condition quickly got worse so he went to another hospital in the area.

"I got to Baylor Scott and White and tell them my medical history, what I've been through. I've had cancer and I have diabetes and they took me right in. They took me right in," said Menchaca.

At the hospital, he was given the COVID-19 test, medicine for his symptoms, and then he sent home to self-isolate while waiting for the test results.

A few days later the Brazos County Health District announced a male in his 30s with no history of travel had tested positive for the virus.

Menchaca says watching the news conference on KBTX is how he learned of his test results.

"Nobody called me," he said. "My mom and my girlfriend both asked 'Gabriel, is that you?' and I said no, no. Just to get closure and be on the safe side I called the health department. They asked me my name and I told them Emilio Menchaca and they said yes sir, you're the one."

He was told to continue self-isolating in his apartment but two days later his condition got to a point he needed emergency care.

"Two days later I'm waking up and I'm coughing. I'm struggling hard. I'm coughing, I can't breathe. My chest is so tight and it hurt," he said.

That's when he was rushed back to the emergency room at Baylor Scott and White and Menchaca says that's the last thing he remembered.

"I walked in and I told the nurse I'm the one who tested positive. Non-travel. And they were like oh, okay. They were ready for me. They didn't even take me through the hospital. They took me through the back and put me in an isolated room," he said.

"I remember I was tired because I haven't had much rest. So I laid down and that was the last thing I remember. Next thing I know it's a month later," said Menchaca.

Nearly four weeks later, he woke up in a hospital bed. There were doctors and nurses but his family wasn't here. He called them from the phone in his hospital room but his own family didn't believe it was really him.

"I called my mom and she's crying and her response was "whoever this is you better stop playing." She's crying. I kept saying this is me, mom. It's me. And she's crying hysterically. Then my brother gets on and he's like "who is this?" and I kept saying it's my bro, it's really me."

Menchaca was told since he went into a coma the hospital barred all visitors and the virus had spread throughout the community. What they didn't tell him immediately was that his father also contracted the virus and was in critical condition in the same hospital.

Fearing a relapse, his family and doctors felt it was best to keep the news from Gabriel until the day his father passed.

"I do remember the phone call. I'm laying in bed. It's my brother. I could tell something was wrong. I could feel it. He said dad has been in the hospital and I said I figured. What's going on. He said yeah, they're fixing to pull the, you know. I said "he's not going to make it?" and he was like "no."

Gabriel says right before he woke up from his coma he remembers a dream or vision of his father appearing before him and asking if he was ready. In his heart, he believes that was his dad trading places with him.

"I remember in my dream he thumped me on the forehead and that's when I woke up. That's when I woke up. And he was down the hallway taking a turn for the worst. I do believe I'm here because of my dad. He made the ultimate sacrifice as a father for me. He was a righteous man and he walked with the Lord. My dad had a plan and the Lord let him work it out," said Menchaca.

Gabriel should have had months of physical and speech therapy but to everyone's surprise, he's made a miraculous and fast recovery and is now at home but still keeping a distance from others.

He credits his fast recovery to his father, his faith, and the staff at Baylor Scott and White who were by his bedside when no one else could visit.

"They held my hand, hugged me, consoled me, cried with me. The staff there was just amazing," he said.

Menchaca doesn't know how he got the virus or who he got it from and he's at peace with that. He says he's been blessed with so many friends and family who have offered to help with anything he needs but his response is always the same:

"I have everything I need. My lungs are breathing on their own now. My heart is pumping on its own. I'm seeing through my own eyes. I can stand on my feet. I'm not without. I'm beyond rich and it's all thanks to the Lord."

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Local man shares his own story of surviving COVID-19 after losing his father to it - KBTX

As the global race for a Covid-19 vaccine intensifies, theres a question Jane Halton and her team come back to time and again: if and when successful vaccines emerge, what can be done to ensure they dont simply go to those with the deepest pockets?

If market power is allowed to dictate access, how can those most vulnerable to Covid-19 be assured of protection?

We are acutely aware of this and it is literally a topic that is being discussed on a daily basis, she tells the Guardian. Because to us it is just unacceptable that there is not fair access to a successful vaccine across the worlds population.

The notion that this would be a question of going to the highest bidder, to us is just totally unacceptable.

Halton, a former secretary of Australias health and finance departments, is chair of the coalition for epidemic preparedness innovations, a global body playing a critical role in financing and coordinating Covid-19 vaccine development.

One of its founding aims is to ensure that vaccines, once developed, are distributed fairly.

The world has witnessed what happens when the market is left to dictate vaccine distribution. During the H1N1 pandemic in 2009, wealthy nations negotiated large advance orders of the vaccine, effectively crowding out poorer countries.

The West African ebola crisis an outbreak that killed 11,325 people exposed its own galling market failure.

Even as the death toll in West Africa grew and grew, big pharmaceuticals could not see a way to recoup the considerable losses they would face attempting to find a vaccine.

The leader of Britains ebola response, Adrian Hill, said there was simply no big market to make it worthwhile for massive corporations.

There was no business case to make an ebola vaccine for the people who needed it most, he said.

It was out of that failure that the coalition for epidemic preparedness innovations emerged.

The worlds response to this crisis fell tragically short, it says in explaining its background. A vaccine that had been under development for more than a decade was not deployed until over a year into the epidemic.

That vaccine was shown to be 100% effective, suggesting that much of the epidemic could have been prevented. It was evident that we needed a better system to speed the development of vaccines against known epidemic threats.

But Covid-19 presents it with a test like no other. A paper published in the Lancet last month warned of the significant prospect that wealthy countries would monopolise global supply of Covid-19 vaccines.

This risk is real, the paper warned. Such an outcome would result in a suboptimal allocation of an initially scarce resource.

There should not be a divide between the haves and the have-nots

Halton predicts the pressure to secure access to successful vaccines will be astronomical.

One of the things Im worried about is vaccine nationalism and Ive started to use that terminology when I talk to people, she says.

Weve been worrying about this issue now for months and months ... What is a mechanism to ensure equitable access?

An estimated minimum of 1 billion people across the globe are vulnerable to Covid-19. They fall into a number of categories: the immunocompromised, those with co-morbidities, the ageing, and frontline medical staff.

So that says to you you need a lot of vaccine to protect even the most vulnerable in our society, Halton says.

Its a problem the World Health Organisation is also working urgently to solve. This week it announced it planned to design mechanisms to ensure equitable distribution.

While were looking for vaccines, unless we break the barriers to equitable distribution of the products, whether its vaccines or therapeutics, we will have a problem, so we need to address the problem ahead of time, WHOs director general, Tedros Adhanom Ghebreyesus, said.

There should not be a divide between the haves and the have-nots.

For private companies, vaccine development is considered risky, protracted and hugely expensive.

Companies are faced with the prospect of spending extraordinary amounts to develop vaccines, with a low likelihood of success.

As a company, you are not going to spend the hundreds of millions and sometimes billions of dollars that are needed to develop a vaccine, Halton says. One, because you think your chances of being successful are about 5%. [Second], because you dont even think theres going to be a market for it.

So this part of market failure is completely understandable. And thats why [the coalition for epidemic preparedness innovations] was set up.

It believes it needs $US2bn to develop three vaccine candidates in the next 12 to 18 months. It has raised almost half of that.

The $2bn does not include the costs of manufacture or delivery.

The coalitions work emphasises speed. Each stage of the vaccine development process is compressed. Halton says the speed at which Covid-19 vaccines are being developed is unprecedented.

One of the projects the coalition is funding is at the University of Queensland, where researchers are testing a molecular clamp technology they hope can help neutralise the virus.

The coalition asked UQ researchers to begin working on a Covid-19 vaccine in January. Within three weeks it had produced the candidate now being tested.

Like every researcher whos looking at their baby, they are optimistic, she says. All I can say is I hope theyre right. I genuinely hope theyre right. Its very hard for me to form a judgment about the likelihood of success.

More broadly, she remains optimistic.

I think when we look across all the work thats going on globally on vaccines, I do have some hope that we will end up with not just one successful candidate ideally we would have three, she says.

Ive said this now publicly several times: hope for the best but prepare for the worst. And if you hope for the best what you would do is hope to get three successful candidates.

Read more from the original source:

Covid-19 vaccines: pressure is on to ensure they go to the most needy, not the highest bidder - The Guardian

When eventually the coronavirus crisis begins to recede and we return to an approximation of normality no matter how socially distanced or how much handwashing it involves we can expect some kind of international initiative to prevent, or at least limit, the spread of future lethal viruses. As a species we are pretty good at learning from recent experience. Its whats known as the availability heuristic the tendency to estimate the likelihood of an event based on our ability to recall examples.

But as the moral philosopher Toby Ord argues in his new book, The Precipice, we are much less adept at anticipating potential catastrophes that have no precedent in living memory. Even when experts estimate a significant probability for an unprecedented event, he writes, we have great difficulty believing it until we see it.

This was precisely the problem with the coronavirus. Many informed scientists predicted that a global epidemic was almost certain to break out at some point in the near future. Aside from the warnings of legions of virologists and epidemiologists, the Microsoft founder, Bill Gates, gave a widely disseminated Ted Talk in 2015 in which he detailed the threat of a killer virus. For a while now, a pandemic has been one of the two most prominent catastrophic threats in the governments risk register (the other is a massive cyberattack).

But if something hasnt yet happened, there is a deep-seated temptation to act as if its not going to happen. If that is true of an event, like this pandemic, that will kill only a tiny fraction of the worlds population, its even more the case for what are known as existential threats. There are two definitions of existential threat, though they often amount to the same thing. One is something that will bring a total end to humanity, remove us as a species from this planet or any other. The other, only slightly less troubling, is something that leads to an irrevocable collapse of civilisation, reducing surviving humanity to a prehistoric state of existence.

An Australian based at Oxfords Future of Humanity Institute, Ord is one of a tiny number of academics working in the field of existential risk assessment. Its a discipline that takes in everything from stellar explosions right down to rogue microbes, from supervolcanoes to artificial superintelligence.

Ord works through each potential threat and examines the likelihood of it occurring in the next century. For example, the probability of a supernova causing a catastrophe on Earth he estimates to be less than one in 50m. Even adding all the naturally occurring risks together (which includes naturally occurring viruses), Ord contends that they do not amount to the existential risk presented individually by nuclear war or global heating.

Most of the time, the general public, governments and other academics are largely content to neglect most of these risks. Few of us, after all, enjoy contemplating the apocalypse.

In any case, governments, as former Conservative minister Oliver Letwin reminds us in his recent book Apocalypse How?, are usually preoccupied with more pressing issues than humanitys demise. Everyday problems like trade agreements demand urgent attention, whereas hypothetical future ones such as being taken over by machines can always be left for tomorrow.

But given that were living through a global pandemic, now is perhaps an opportune moment to think about what can be done to avoid a future cataclysm. According to Ord, the period we inhabit is a critical moment in the history of humanity. Not only are there the potentially disastrous effects of global heating but in the nuclear age we also possess the power to destroy ourselves in a flash or to at least leave the question of civilisations survival in the balance.

Thus Ord believes the next century will be a dangerously precarious one. If we make the right decisions, he foresees a future of unimaginable flourishing. If we make the wrong ones, he maintains that we could well go the way of the dodo and the dinosaurs, exiting the planet for good.

When I speak to Ord over Skype I remind him of the unsettling odds he awards humanity in this life-and-death struggle between our power and our wisdom. Given everything I know, he writes, I put the existential risk this century at around one in six.

In other words, the 21st century is effectively one giant game of Russian roulette. Many people will recoil from such a grim prediction, while for others it will fuel the anxiety that is already rife in society.

He agrees but says that he has tried to present his modelling in as calm and rational a fashion as possible, making sure to take into account all the evidence that suggests the risks are not large. One in six is his best estimate, factoring in that we make a decent stab at dealing with the threat of our destruction.

If we really put our minds to it and mount a response equal to the threat, the odds, he says, come down to something more like 100-1 for our extinction. But, equally, if we carry on ignoring the threat represented by advances in areas like biotech and artificial intelligence, then the risk, he says, would be more like one in three.

Martin Rees, the cosmologist and former president of the Royal Society, co-founded the Centre for the Study of Existential Risk in Cambridge. He has long been involved in raising awareness of looming disasters and he echoes Ords concern.

Im worried, he says, simply because our world is so interconnected, that the magnitude of the worst potential catastrophes has grown unprecedentedly large, and too many have been in denial about them. We ignore the wise maxim the unfamiliar is not the same as the improbable.

Letwin warns of an overdependence on the internet and satellite systems, allied with limited stocks of goods and long supply chains. These are ideal conditions for sabotage and global breakdown. As he writes, ominously: The time has come to recognise that more and more parts of our lives of society itself depend on fewer and fewer, more integrated networks.

Complex global networks certainly increase our vulnerability to viral pandemics and cyberattacks, but neither of those outcomes qualify as a serious existential risk in Ords book. The pandemics he is concerned about are not of the kind that break out in the wet markets of Wuhan, but rather those engineered in biological laboratories.

Although Ord draws a distinction between natural and anthropogenic (human-made) risks, he argues that this line is rather blurry when it comes to pathogens, because their proliferation has been significantly increased by human activity such as farming, transport, complex trade links and our congregation in dense cities.

Yet like so many aspects of existential threat, the idea of an engineered pathogen seems too sci-fi, too far-fetched, to grab our attention for long. The international body charged with policing bioweapons is the Biological Weapons Convention. Its annual budget is just 1.4m (1.2m). As Ord points out with due derision, that sum is less than the turnover of the average McDonalds restaurant.

If thats food for thought, Ord has another gastronomic comparison thats even harder to swallow. While hes not sure exactly how much the world invests in measuring existential risk, hes confident, he writes, that we spend more on ice-cream every year than on ensuring that the technologies we develop dont destroy us.

Ord insists that he is not a pessimist. There are constructive measures to be taken. Humanity, he says, is in its adolescence, and like a teenager that has the physical strength of an adult but lacks foresight and patience, we are a danger to ourselves until we mature. He recommends that, in the meantime, we slow the pace of technological development so as to allow our understanding of its implications to catch up and to build a more advanced moral appreciation of our plight.

He is, after all, a moral philosopher. This is why he argues that its vital that, if humanity is to survive, we need a much larger frame of reference for what is right and good. At the moment we hugely undervalue the future, and have little moral grasp of how our actions may affect the thousands of generations that could or alternatively, might not come after us.

Our descendants, he says, are in the position of colonised peoples: theyre politically disenfranchised, with no say in the decisions being made that will directly affect them or stop them from existing.

Given everything I know, I put the existential risk this century at around one in six

Just because they cant vote, he says, doesnt mean they cant be represented.

Of course, there are also concrete issues to address such as global heating and environmental depredation. Ord acknowledges that climate change may lead to a global calamity of unprecedented scale, but hes not convinced that it represents an actual existential risk to humanity (or civilisation). Thats not to say that it isnt an urgent concern: only that our survival isnt yet on the line.

Perhaps the biggest immediate threat is the continued abundance of nuclear weapons. Since the end of the cold war, the arms race has been reversed and the number of active warheads cut from more than 70,000 in the 1980s to about 3,750 today. Start (the Strategic Arms Reduction Treaty), which was instrumental in bringing about the decrease, is due to lapse next year. From what I hear at the moment, says Ord, the Russians and Americans have no plan to renew it, which is insane.

Sooner or later all questions of existential risk come down to a global understanding and agreements. Thats problematic, because while our economic systems are international, our political systems remain almost entirely national or federal. Problems that affect everyone are consequently owned by no one in particular. If humanity is to step back from the precipice, it will have to learn how to recognise its common bonds as greater than its differences.

There are many predictions currently being made about how the world might be changed by the coronavirus. The philosopher John Gray recently declared that it spelt the end of hyperglobalisation and the reassertion of the importance of the nation state.

Contrary to the progressive mantra, Gray wrote in an essay, global problems do not always have global solutions the belief that this crisis can be solved by an unprecedented outbreak of international cooperation is magical thinking in its purest form.

But nor can individual countries afford to turn their backs on the world, at least not for long. The pandemic may not engender deeper international cooperation and a keener appreciation of the fact that we are, so to speak, all in it together. Ultimately, though, we will have to arrive at that kind of unity if were to avoid far greater afflictions in the future.

Link:

What if Covid-19 isn't our biggest threat? - The Guardian

WRIGHT COUNTY, Mo. -- All nine patients who tested positive for COVID-19 in Wright County have recovered as of Sunday night, according to the Wright County Health Department.

Wright County is the first in the Ozarks to announce all of its COVID-19 patients have recovered.

Other nearby counties have reported new recoveries as well. The Springfield-Greene County Health Department reports 67 recoveries from 93 positive cases, as of Sunday. Christian County health leaders report at least 12 of 18 patients who tested positive from COVID-19 have been medically cleared.

Missouri has reported 274 deaths and nearly 7,000 cases of COVID-19 as of Sunday, but the Department of Health & Senior Services has not yet released statewide or county-by-county recovery numbers.

For the latest look at COVID-19 cases around the Ozarks, click here.

Link:

All nine COVID-19 patients in Wright County have recovered - KY3

If the African American community is going to beat this virus -- and create a pandemic-resistant black community -- we are going to have to make big changes in both our public systems and our personal lives.

This virus is especially lethal to African Americans because it is -- in effect -- a pandemic jumping on top of multiple, pre-existing epidemics that were already ravaging the black community. Diseases like hypertension, diabetes, asthma and obesity make the virus far more deadly. And African American communities have those illnesses in numbers that are way out of proportion.

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Van Jones: I'm someone Covid-19 could easily kill. Here is what I'm doing about it - CNN

Diana Hu is a pediatrician at Tuba City Regional Health Care Corporation and a member of the Navajo epidemiology response team. Aurelia Yazzie/Courtesy Tuba City Regional Health Care Corporation hide caption

Diana Hu is a pediatrician at Tuba City Regional Health Care Corporation and a member of the Navajo epidemiology response team.

After New York and New Jersey, the place with the highest coronavirus infection rate in the U.S. is the Navajo Nation. Dr. Deborah Birx of the national coronavirus task force told the White House press corps the tribe is using strike teams to address the issue.

"They're really doing amazing work at their public health institutions with their governors and their mayors," Birx says. "They are in full contact tracing."

But contact tracing or tracking all the people that COVID-positive patients may have infected has been a challenge on the Navajo Nation.

"We are doing the best we can," says Shawnell Damon, the Navajo epidemiology chief for the COVID-19 strike force. "There are some cases where a number of people have been exposed to some people, and so we're trying to find those people and yeah, that's where the shortcomings come from."

Damon says the tribe has about 80 contact tracers. And they are working hard to do their job. But some realities of life on the reservation make such tracing difficult. Not everybody has a phone, and it takes hours to drive to one home. Damon is trying to train more contact tracers to cover the vast geography and lack of telecommunication infrastructure.

Other long-standing problems have contributed to the rapid spread of the disease on the Navajo Nation. Many households lack clean, running water, which makes frequent hand-washing difficult. Some homes do not have reliable electricity. And hospitals are few and far apart for a reservation the size of West Virginia.

'Forgotten by our own government'

All these issues, the tribe says, can be traced to broken promises.

"We are United States citizens but we're not treated like that," says Navajo Nation President Jonathan Nez. "You can hear the frustration, the tone of my voice. We once again have been forgotten by our own government."

More than 150 years ago, the Navajo and many other tribes signed treaties with the federal government giving up their land in exchange for funding of things like housing, infrastructure and health care. But for decades that hasn't happened.

Now, the Navajo Nation is suing the federal government for what it calls its fair share of federal COVID relief money. On March 25, Congress passed the $2 trillion Coronavirus Aid, Relief, and Economic Security Act, or CARES Act, which includes $8 billion to help tribes fight the coronavirus. The Navajo Nation and 10 other tribes are suing the federal government, arguing they shouldn't have to share these relief funds with for-profit Alaska Native corporations.

The Indian Health Service, or IHS, is responsible for providing medical and other health-related services to enrolled Native American tribal members. But tribes and watchdog groups often point out the money allocated to the IHS is insufficient for the size of the population it serves and the scope of health conditions, such as obesity, diabetes and asthma, prevalent in that population.

"Native American communities are often invisible in terms of their health inequities. When you look at IHS per capita spending, it is much lower than we see for veterans medical spending or Medicare spending," says Dr. Laura Hammitt, the director of Infectious Disease Programs at the Johns Hopkins Center for American Indian Health. "IHS is chronically underfunded."

The federal government spends $2,834 per person on health care in Indian Country, while it spends $9,404 per person on veterans health and $12,744 per person on Medicare, according to the most recent data.

Limited scope for 'strike teams'

The IHS works off the motto: Make the best of what you've got, even in a crisis. That's meant converting offices to patient rooms and relying on the National Guard to staff facilities in some cases. But there's still an acute nursing shortage on the Navajo Nation, and the tribe is desperately lacking in equipment. IHS Chief Medical Officer Dr. Loretta Christensen says they're forced to fly COVID-19 patients to hospitals in Albuquerque, N.M.; Flagstaff, Ariz., and Phoenix, which comes at an extremely high cost.

"Our goal is to get our patients to a higher level of care as quickly as possible so that we can get them stabilized," Christensen says. "We do realize there's finite capacity, and that's why we've made plans that we may have to manage many of these patients here on Navajo and we have ramped up that service."

Christensen says the tribe is putting together a critical care strike team. But up until now strike teams have only been used to deliver food and supplies to people who have been exposed to the virus.

"We need this administration to consult with tribes, to listen with tribes, to work in understanding them far more than they do," says Rep. Deb Haaland, D-N.M. The congresswoman is a member of the Laguna Pueblo Tribe, which has also seen deficiencies in federal health care funding.

As sovereign nations, tribes do have the ability to work government to government. For example, the Navajo president is working with New York's governor to get some of that state's unused equipment.

Diana Hu, a Tuba City, Ariz., pediatrician, says that's a huge advantage.

"The big disadvantage, of course, is they don't have a big public health infrastructure themselves," says Hu. "And they've had to learn real quickly. Their learning curve has been quite steep."

And Hu, also a member of the tribe's epidemiology response team, says there are not enough strike teams or contact tracers to get a complete picture of how far COVID-19 has spread on the Navajo Nation.

Read more:

Navajo Nation Sees High Rate Of COVID-19 And Contact Tracing Is A Challenge - NPR

WHO has published guidance on adjusting public health and social measures for the next phase of the COVID-19 response.1 Some governments have suggested that the detection of antibodies to the SARS-CoV-2, the virus that causes COVID-19, could serve as the basis for an immunity passport or risk-free certificate that would enable individuals to travel or to return to work assuming that they are protected against re-infection. There is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection.

The measurement of antibodies specific to COVID-19

The development of immunity to a pathogen through natural infection is a multi-step process that typically takes place over 1-2 weeks. The body responds to a viral infection immediately with a non-specific innate response in which macrophages, neutrophils, and dendritic cells slow the progress of virus and may even prevent it from causing symptoms. This non-specific response is followed by an adaptive response where the body makes antibodies that specifically bind to the virus. These antibodies are proteins called immunoglobulins. The body also makes T-cells that recognize and eliminate other cells infected with the virus. This is called cellular immunity. This combined adaptive response may clear the virus from the body, and if the response is strong enough, may prevent progression to severe illness or re-infection by the same virus. This process is often measured by the presence of antibodies in blood.

WHO continues to review the evidence on antibody responses to SARS-CoV-2 infection.2-17 Most of these studies show that people who have recovered from infection have antibodies to the virus. However, some of these people have very low levels of neutralizing antibodies in their blood,4 suggesting that cellular immunity may also be critical for recovery. As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans.

Laboratory tests that detect antibodies to SARS-CoV-2 in people, including rapid immunodiagnostic tests, need further validation to determine their accuracy and reliability. Inaccurate immunodiagnostic tests may falsely categorize people in two ways. The first is that they may falsely label people who have been infected as negative, and the second is that people who have not been infected are falsely labelled as positive. Both errors have serious consequences and will affect control efforts. These tests also need to accurately distinguish between past infections from SARS-CoV-2 and those caused by the known set of six human coronaviruses. Four of these viruses cause the common cold and circulate widely. The remaining two are the viruses that cause Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. People infected by any one of these viruses may produce antibodies that cross-react with antibodies produced in response to infection with SARS-CoV-2.

Many countries are now testing for SARS-CoV-2 antibodies at the population level or in specific groups, such as health workers, close contacts of known cases, or within households.21 WHO supports these studies, as they are critical for understanding the extent of and risk factors associated with infection. These studies will provide data on the percentage of people with detectable COVID-19 antibodies, but most are not designed to determine whether those people are immune to secondary infections.

Other considerations

At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an immunity passport or risk-free certificate. People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission. As new evidence becomes available, WHO will update this scientific brief.

References

WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue an update. Otherwise, this scientific brief will expire 1 year after the date of publication.

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"Immunity passports" in the context of COVID-19 - World Health Organization