Tulane Outbreak Daily – July 14, 2020

Why We’re Losing the Battle With Covid-19 – New York Times

Editor’s Note: Just listened to this excellent article while working on this edition. Highly recommend.

The escalating crisis in Texas shows how the chronic underfunding of public health has put America on track for the worst coronavirus response in the developed world. [If link above does not work, try this]

Immune Response Varied Among COVID-19 Patients – Med Page Today

Small study finds wide range, with implications for vaccine development [Related Study in Nature]

Study in Primates Finds Acquired Immunity Prevents COVID-19 Reinfections – NIH Director’s Blog

There have been rare reports of people recovering from infection with SARS-CoV-2, the novel coronavirus that causes COVID-19, only to test positive a second time. Such results might be explained by reports that the virus can linger in our systems. Yet some important questions remain: Is it possible that people could beat this virus only to get reinfected a short time later? How long does immunity last after infection? And what can we expect about the duration of protection from a vaccine? [Related Study]

We could have more coronavirus outbreaks in tower blocks. Here’s how lockdown should work

The recent lockdown of nine social housing towers in Melbourne’s north to contain the spread of COVID-19 led to widespread concerns for residents’ welfare. Among the concerns was that implementation of these lockdowns was less than perfect in terms of infection control. In housing commission towers, many people live in close quarters and share facilities, making them a high-risk setting for outbreaks of infectious disease.

This Tennessee doctor caught coronavirus at a meeting about coronavirus. He nearly died – USA Today

It was mid-March when Dr. Daniel Lewis, the chief medical officer at a Tennessee hospital, attended a small meeting about how to keep the coronavirus from spreading within the medical center.

Winter wave of coronavirus ‘could be worse than first’ – BBC

Asked to model a “reasonable” worst-case scenario, they suggest a range between 24,500 and 251,000 of virus-related deaths in hospitals alone, peaking in January and February.

Clinical Considerations

Babies’ Mysterious Resilience to Coronavirus Intrigues Scientists – Scientific American

COVID-19 is often mild in infants. Learning why could help scientists better understand the disease—and point the way toward possible treatments [CDC Study] [another study]

SARS-CoV-2 Linked to Brain Lesions in Non-Survivors of COVID-19 – Neurology Advisor

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may induce hemorrhagic and encephalopathy-related brain lesions in patients who died from the coronavirus disease 2019 (COVID-19), according to findings from a postmortem brain magnetic resonance imaging (MRI) study published in Neurology.

Study Shows SARS-CoV-2 Can Directly Attack Heart Cells and Change Their Function – BioMedAdvances

Infection with SARS-CoV-2, the virus that causes COVID-19, can produce a wide range of symptoms. Some patients experience heart complications with COVID-19 such as a change in heart rhythm. Some patients have suffered damage to the heart cells which has led to heart attacks, while others have experienced circulatory system changes which have led to blood clots forming.

New study shows SARS-CoV-2 viral load peaks in the early stages of disease – Medical Express

In a retrospective study, investigators from New York University Langone Health found that the quantity of SARS-CoV-2 (viral load) collected from patients in the emergency department is significantly higher in patients with fewer or milder symptoms who did not require hospitalization—the opposite of what might be expected. Reporting in The American Journal of Pathology, published by Elsevier, they also found that a patient’s history of cancer and cardiovascular disease is associated with higher viral loads even after adjusting for age. [Related pre-proof]

D-dimer as an indicator of prognosis in SARS-CoV-2 infection: a systematic review – ERJ Publications

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) stimulates pro-thrombotic changes. This, combined with its tropism for endothelium and lung structures, may explain its association with thrombotic events, reduction of pulmonary gas exchange, acute respiratory distress syndrome (ARDS) and a composite end-point (intensive care unit, invasive ventilation, death). This study aims to highlight the correlation between elevated D-dimer (an indirect thrombosis marker) and the increased rate of poor prognosis-associated conditions, and to introduce D-dimer-labelled anticoagulant administration as a potentially useful tool to prevent complications and positively influence coronavirus disease 2019 (COVID-19) course.

Silent hypoxia in patients with SARS CoV-2 infection before hospital discharge – MDLinx

This study was intended to evaluate the degree of hypoxia and subjective dyspnoea elicited by a 6-minute walking test (6 MWT) in COVID-19 patients prior to discharge. Researchers conducted a 6 MWT in 26 discharge-ready COVID-19 patients without chronic pulmonary disease or cardiac failure. They tested heart rate, oxyhaemoglobin saturation (SpO2), respiratory rate, and subjective dyspnoea measured on the Borg CR-10 scale, before and immediately after the 6 MWT with continuous monitoring of SpO2 and heart rate during the 6 MWT. The findings revealed that in the diagnosis of asymptomatic exercise-induced hypoxia, the 6 MWT is a potential tool in hospitalized COVID-19 individuals prior to discharge. Due to important methodological limitations, further research is required to validate the data and to evaluate their clinical consequences. [Related Study]

Official Reporting for July 14, 2020

World Health Organization


Confirmed Cases: 12,964,809

Deaths: 570,288


Confirmed Cases: 13,079,218

Deaths: 572,662

Johns Hopkins

Confirmed Cases: 13,177,855

Deaths: 574,793

Centers for Disease Control and Prevention (CDC)

Total cases: 3,355,457
Total deaths: 135,235

Surveillance Headlines


Texas: Thousands of Texas prisoners still have the coronavirus. More than 25% of inmates at four units are infected. – Texas Tribune

California: Gov. Newsom orders statewide closures of indoor activities – Mercury News

Alabamba: Alabama coronavirus spread continues, hospitalizations accelerate – Montgomery Advertiser

Arizona: Beloved Arizona teacher dies of coronavirus, two others sharing classroom also infected – NBC


Australia Grapples With New Surge In Coronavirus Cases – NPR


UK: England is mandating face coverings in shops and supermarkets, the government announced. – NYT


Hong Kong – Hong Kong Adopts Its Strictest-Ever Virus Measures as City Reels – Bloomberg

Science and Tech


COVID-19 treatments, vaccines could be ready by early 2021, Fauci tells Stanford Medicine – PaloAlto Online

The prognosis for getting a handle on the deadly COVID-19 disease currently escalating in the United States could be good if the public is responsible for its actions and if scientific breakthroughs continue this year, Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, said during a half-hour virtual interview with Stanford Medicine on Monday.

Top ethicist makes the case for COVID-19 vaccine challenge trials – AMA Assn

Human challenge trials intentionally place human subjects in harm’s way, so it is imperative that care be taken about when and how they are conducted. One prominent medical ethicist says challenge trials for COVID-19 vaccines might be the way to go, given the enormous morbidity and mortality associated with the infectious disease caused by SARS-CoV-2.


Remdesivir may work even better against COVID-19 than we thought – Science

Remdesivir can not only speed recovery, but may cut the chance of dying of COVID-19, preliminary data released by the drug’s maker suggest.


An Update and Behind the Scenes: FDA’s Coronavirus Treatment Acceleration Program – FDA.gov

When the U.S. Food and Drug Administration learned of the novel coronavirus (COVID-19) and its potentially devastating effects, we acted swiftly to set the regulatory stage for drug and biologics manufacturers to develop products to treat this serious disease. To meet this urgent need, the FDA created the Coronavirus Treatment Acceleration Program (CTAP) to enable the FDA’s Center for Drug Evaluation and Research (CDER) and Center for Biologics Evaluation and Research (CBER) to leverage cross-agency scientific resources and expertise to bear on COVID-19 therapeutic development and review. We’re excited to say that there are now more than 510 drug development programs in planning stages, and as of today, the agency has reviewed more than 230 trials of potential therapies for COVID-19.



Published Research

Primary exposure to SARS-CoV-2 protects against reinfection in rhesus macaques – Science

Pre-Pub (not yet peer reviewed, should not be regarded as conclusive)

Association of initial viral load in SARS-CoV-2 Patients with Outcome and Symptoms – American Journal of Pathology

SARS-CoV-2 Nucleocapsid Assembly Inhibitors: Repurposing Antiviral and Antimicrobial Drugs Targeting Nucleocapsid-RNA Interaction – Chemical Biology

Coping in Quarantine

Confusing CDC Advice Explained by Conan O’Brian

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