An effective vaccine is seen as the world’s greatest hope for achieving some kind of return to normal, and the timeline for developing one has been sped up dramatically. But as hard as it’s going to be to make a vaccine quickly, once we do, we’ll have a new problem: Getting it to billions of people. Brendan Murray explains how difficult it will be for the global supply chain to distribute and administer the drug.
4 Min Audio at the link – Two potential coronavirus vaccines started their final phase of testing Monday. Each trial will include up to 30,000 volunteers.
One of the many still unanswered questions regarding COVID-19 is the duration of protective immunity following infection. A recent report from China indicated that individuals with asymptomatic COVID-19 had a less robust immune response to SARS-CoV-2 (NEJM JW Infect Dis Sep 2020 and Nat Med 2020 Jun 18; [e-pub]). California investigators now report further longitudinal data on antibody levels after mild COVID-19.
The Swedish government chose to pursue herd immunity during the spring when COVID-19 overwhelmed many European nations, favoring voluntary control measures over strict lockdown procedures. This week, 21 Swedish infectious diseases experts denounced the policy, writing, “In Sweden, the strategy has led to death, grief, and suffering, and on top of that there are no indications that the Swedish economy has fared better than in many other countries. At the moment, we have set an example for the rest of the world on how not to deal with a deadly infectious disease.”
Much of the study on the immune response to SARS-CoV-2, the novel coronavirus that causes COVID-19, has focused on the production of antibodies. But, in fact, immune cells known as memory T cells also play an important role in the ability of our immune systems to protect us against many viral infections, including—it now appears—COVID-19.
So much hope is riding on a breakthrough, but a vaccine is only the beginning of the end. Biologically, a vaccine against the COVID-19 virus is unlikely to offer complete protection. Logistically, manufacturers will have to make hundreds of millions of doses while relying, perhaps, on technology never before used in vaccines and competing for basic supplies such as glass vials. Then the federal government will have to allocate doses, perhaps through a patchwork of state and local health departments with no existing infrastructure for vaccinating adults at scale. The Centers for Disease Control and Prevention, which has led vaccine distribution efforts in the past, has been strikingly absent in discussions so far—a worrying sign that the leadership failures that have characterized the American pandemic could also hamper this process. To complicate it all, 20 percent of Americans already say they will refuse to get a COVID-19 vaccine, and with another 31 percent unsure, reaching herd immunity could be that much more difficult.
At the beginning of July, PolicyLab at Children’s Hospital of Philadelphia (CHOP) released COVID-19 case projections that strongly suggested that the novel coronavirus was spreading along the nation’s interstate highways.
Multiple data sets now confirm the increased risk for morbid and mortal complications due to coronavirus disease 2019 (COVID-19) in individuals with preexisting cardiovascular diseases including hypertension, coronary artery disease, and heart failure.1,2 These salient observations have strengthened preventive strategies and undoubtedly have resulted in lives saved. Although episodes of clinical myocarditis have been suspected and a few cases have been reported in the literature,3 direct cardiac involvement due to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been difficult to confirm. [Related JAMA Study]
COVID-19 includes a wide spectrum of illness that ranges from asymptomatic or mild infection to critical illness with acute respiratory distress syndrome (ARDS). It is estimated that 20% of patients who develop symptomatic COVID-19 may go on to develop ARDS. In patients with COVID-19-associated ARDS, the mortality rate is high, and recovery can be complicated by arrhythmia, cardiac injury, shock, or superinfections.
We describe 2 children with persistent fever and profuse diarrhea who abstract developed signs of mucocutaneous involvement (conjunctivitis, fissured lips, skin rash, erythema, and edema of the hands and feet). Blood tests revealed elevated markers of inflammation, lymphopenia, thrombocytopenia, and complement consumption. Afterward, diffuse edema with hypoalbuminemia appeared in the context of a capillary leak syndrome. In both patients, repeated nasal swabs were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but each patient had high titers of immunoglobulin G and immunoglobulin M against the SARS-CoV-2 virus. The negative PCR results in the presence of immunoglobulin M and immunoglobulin G suggested that the inflammatory response developed in the late phase of viral infection, when SARS-CoV-2 was not detectable in the upper airway. In this report, we describe patients with what we propose to name as SARS-CoV-2–induced Kawasaki-like hyperinflammatory syndrome. SARS-CoV-2–induced Kawasaki-like hyperinflammatory syndrome seems to be caused by a delayed response to SARS-CoV-2. It resembles Kawasaki disease complicated by macrophage activation syndrome, although it has peculiar features, such as prodromal diarrhea, capillary leak syndrome, and myocardial dysfunction. Intravenous corticosteroid treatment appears to be helpful.
Hair loss has become another emergent consequence of the novel coronavirus as COVID-19 patients battle symptoms for months at a time. While the Centers for Disease Control and Prevention doesn’t recognize hair loss as a symptom of COVID-19, more than 27% of at least 1,100 poll respondents in the Survivor Corps Facebook group reported hair loss.
Asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a major public health concern.1 Health care workers (HCWs) are at higher risk of infection and can become inadvertent vehicles of transmission.2 Therefore, Houston Methodist initiated a coronavirus disease 2019 (COVID-19) surveillance program among asymptomatic HCWs and expanded to asymptomatic community residents. We report prevalence of SARS-CoV-2 among the first group tested.
Official Reporting for July 28, 2020
World Health Organization
Confirmed Cases: 16,341,920
Confirmed Cases: 16,465,707
Confirmed Cases: 16,575,647
Total deaths: 147,672
Midwest: Could See Surge In COVID-19 Cases Unless States Are More Careful, Fauci Warns – NPR
California: California’s COVID-19 epicenter shifts to the Central Valley – Mercury News
Texas: COVID-19 vaccine trials begin in hard-hit South Texas border communities – Border Report
Florida: Coronavirus Crisis May Have Peaked – Forbes
Baltimore, Maryland: Baltimore doctor who worked pandemic ‘front lines’ dies of COVID-19 – WTOP
Europe faces down a second coronavirus pandemic wave – NBC
Germany: German officials ‘very concerned’ by rising cases – BBC
Spain: Covid-19 Cases Surge in Spain, Threatening Tourism Recovery – Wall Street Journal
China: China’s Northeast Cluster Spreads to Beijing as Resurgence Grows – Bloomberg
Vietnam: Vietnam Confirms 11 New Coronavirus Cases, Imposes Quarantines And Evacuations – NPR
Science and Tech
The antiviral interferon might help early but exacerbate disease in later stages. Several new studies of immune response to SARS-CoV-2, the virus that causes the disease, suggest timing could be critical for a class of proteins known as interferons, which are being researched as potential treatments. These immune proteins suppress viral replication early in disease. Yet if they are active later, some scientists think they can exacerbate the harmful inflammation that forces some COVID-19 patients onto life support. Interferons are “a double-edged sword,” says immunologist Eui-Cheol Shin of the Korea Advanced Institute of Science and Technology.
While SARS-CoV2 is new, coronaviruses have been studied for decades. A good deal is known about the structure and function of individual genes and protein products encoded by these genes in different viruses (e.g., [1, 2, 3, 4, 5, 6]), and comparison between homologous residues is the “go-to” technique for annotation. For example, what may be the significance of a mutation/polymorphism at amino-acid 921 of the SARS-CoV-2 Spike protein? We can use a straightforward but tedious alignment procedure to determine that the corresponding residue in SARS-CoV-1 is 903. A literature review reveals that this residue in SARS-CoV-1, is involved in a Salt bridge, and is highly conserved in Beta Coronaviruses. These annotations could indicate that amino-acid mutations at position 921 could have a high impact on the Spike protein function (see [7 1]). Correspondence between homologous residues in different viral genomes is established by straightforward and tedious procedures that are performed on a per-study basis and are rarely described in enough detail to be reused.
By reconstructing the evolutionary history of SARS-CoV-2, the virus that is responsible for the COVID-19 pandemic, an international research team of Chinese, European and U.S. scientists has discovered that the lineage that gave rise to the virus has been circulating in bats for decades and likely includes other viruses with the ability to infect humans. The findings have implications for the prevention of future pandemics stemming from this lineage.
Inside SF’s New Biosafety Lab, Where Scientists Wrangle Live Coronavirus – KQED
There’s so much scientists still don’t know about the novel coronavirus: basic stuff, like how exactly it invades a host’s healthy cells, the molecular interactions that enable it to spread through the body and why it affects some people more than others.
The U.S. Department of Health and Human Services today reserved the available advanced manufacturing capability and capacities of the Center for Innovation in Advanced Development and Manufacturing (CIADM) at the Texas A&M University System for use in manufacturing COVID-19 vaccines. The task order to the CIADM includes accelerating expansion of that manufacturing capacity for potential COVID-19 vaccines.
Oxford vaccine enters final phase of COVID-19 trials. Here’s what happens now. – National Geographic
Phases one and two of the clinical trial took place simultaneously in April in southern England, when safety and immune responses were checked in more than a thousand healthy volunteers ages 18 to 55. The vaccine is now in the third and final development phase: testing volunteers in Brazil at the Federal University of São Paulo’s Reference Center for Special Immunobiologicals, as well as at two locations run by the D’Or Institute for Research and Education.
A Stanford Medicine test for the coronavirus has been validated for pooled testing. This method greatly increases testing capacity and conserves testing resources, which continue to be in short supply.
Businesses from Bangor to Barstow have begun reopening. As they do, the safety of their employees and customers — from both real and perceived risks — have become paramount concerns. Concerns over catching and spreading the coronavirus mean that the roughly 40% of workers able to work from home likely will continue to do so. But for the majority of workers, a physical return looms in at least some capacity.
“A handful of airlines led the way in making it easier for passengers to get refunds or use credits way out into the future. Others have been much more greedy in their approach, trying to hold onto as much cash as possible,” says Scott Mayerowitz, executive editorial director for The Points Guy. “Our staff at The Points Guy has been monitoring the situation ever since the start of the pandemic. This report summarizes months of our experiences, highlighting which airlines have been the most customer friendly.”
Social and Psychological Impact
The brain naturally gravitates toward negative thoughts. Here are ways to steel yourself in rocky patches, from deep breathing to caring for others.
With Covid-19 cases rising in the U.S. and the economic outlook uncertain—just when many had hoped things would improve—it can be tough at times not to slide into despair. Rick Hanson, a clinical psychologist and author of the 2018 book, “Resilient,” spoke with The Wall Street Journal about how we can build our resilience in challenging times. Dr. Hanson, a senior fellow at the Greater Good Science Center at the University of California, Berkeley draws on neuroscience, psychology and mindfulness training in his work.
Invasive Aspergillosis as an Underrecognized Superinfection in COVID-19 – Open Forum Infectious Diseases
Risk Factors Associated With Mortality Among Residents With Coronavirus Disease 2019 (COVID-19) in Long-term Care Facilities in Ontario, Canada – JAMA
Lung Ultrasound Findings in Patients With Coronavirus Disease (COVID-19) – American Journal of Roentgenology
Presence of Genetic Variants Among Young Men With Severe COVID-19 – JAMA
COVID-19: Complement, Coagulation, and Collateral Damage – Journal of Immunology
Early IL-1 receptor blockade in severe inflammatory respiratory failure complicating COVID-19 – PNAS
Pre-Pub (not yet peer reviewed, should not be regarded as conclusive)
Molecular mechanisms of Cardiac Injury associated with myocardial SARS-CoV-2 infection – BioRXiv
Coping in Quarantine
The story behind the fungus in your dough