Solving COVID
July 29, 2020

Some of the largest slums in Mumbai, India, may be nearing herd coronavirus immunity, a new serological survey found, Bloomberg reports.

The study tested 6,936 people across three suburbs in Mumbai — Dahisar, Chembur, and Matunga — and discovered that 57 percent of the subjects had coronavirus antibodies, a figure far higher than the 21 percent found in New York City in April and 14 percent in Stockholm, Sweden, in May. Per Bloomberg, epidemiologists generally believe a population must reach infection levels of 60 percent to achieve herd immunity, so the study indicates the neighborhoods are pretty much there. The survey appears to go hand-in-hand with a steep decline in cases in the slums in recent weeks, despite India having the world's fastest growth in infections overall.

Social distancing is a challenge in the crowded Mumbai neighborhoods, which seemingly makes them well-suited for the virus' spread, and the study suggests that it did so widely. Fortunately, the population in the slums is young and more likely to avoid severe cases of COVID-19. That, coupled with successful government containment measures that helped catch cases early and ensure high quality care, have kept the fatality low in the slums, even if many infections went undetected, Bloomberg notes.

It's encouraging that some of Mumbai's slums may be closing in on herd immunity without experiencing a high death rate, but the jury is still out on how long immunity lasts. It's also worth noting antibody rates were not nearly as high in other parts of Mumbai, where social distancing is more feasible. Read more at Bloomberg. Tim O'Donnell

August 12, 2020

The effects of the coronavirus do not end when patients "leave the hospital," Wes Ely, a pulmonologist and critical care physician at Vanderbilt University Medical Center, told Stat News. And one of the ways COVID-19 appears to linger in recovered hospitalized patients is its effect on neurological and psychological well-being — Stat reports as many as 1 in 3 recovering patients could experience after-effects in those areas.

This "COVID fog" makes patients feel like they "can't think," writes Stat. Since the early days of the pandemic in China and Europe, clinicians have described patients who continue to suffer from things like nerve damage, cognitive impairment, depression, and anxiety after their release. It's unclear if and when those folks will see their conditions improve, but experts are using their experience treating other pathogens and delirium after Intensive Care Unit stays, using results from brain autopsies and interviews with patients to get a sense of what's really going on.

"We would say that perhaps between 30 percent and 50 percent of people with an infection that has clinical manifestations are going to have some form of mental health issues," said Teodor Postolache, professor of psychiatry at the University of Maryland School of Medicine. "That could be anxiety or depression, but also nonspecific symptoms that include fatigue, sleep, and waking abnormalities, a general sense of not being at your best, not being fully recovered in terms of the abilities of performing academically, occupationally, potentially physically." Read more at Stat News. Tim O'Donnell

August 11, 2020

Since the early days of the coronavirus pandemic, the United States has emphasized ratcheting up vaccine production even before federal approval so that, if and when the time comes, the stockpile is ready to go. The same can't be said about a potential treatment known as monoclonal antibodies, however, Stat News reports.

Monoclonal antibodies are pretty much what they sound like — antibodies that have been genetically engineered into new medicines. Immunologists and virologists are reportedly optimistic they could play a role in fighting COVID-19, and data from two separate clinical trials run by Regeneron Pharmaceuticals and Eli Lilly are expected to be released in the fall, possibly indicating whether the therapies are safe and effective.

But even if they are, it may be too late. Former Food and Drug Administration Commissioner Scott Gottlieb said the U.S. "may have a missed a window" to scale up production of the treatments, which otherwise "could have been an important bridge to a vaccine." Perhaps more importantly, he added, they could also serve as a "hedge in the event vaccines are delayed or don't work." Ultimately, despite the antibodies' potential to change the tides of the pandemic, Gottlieb said, "we just don't have enough doses to realize that goal." Read more at Stat News. Tim O'Donnell

August 11, 2020

Russian President Vladimir Putin announced Tuesday that Russia has become the first country to approve a coronavirus vaccine, claiming victory in a global race to conquer COVID-19. The vaccine was developed by Moscow's Gamaleya Institute, and Putin said one of his two daughters is among the Russians already inoculated with the vaccine, joining a small group that includes the researchers who developed it and about 50 members of Russia's military.

Medical experts expressed concerns that the Kremlin aggressively and dangerously rushed the vaccine approval process, putting global prestige over public health. Putin said the Gamaleya vaccine had proven effective in two months of early-stage human trials and offered lasting immunity. Russian officials said Phase III trial of the vaccine will be conducted in Russia, Saudi Arabia, the United Arab Emirates, and maybe Brazil as thousands of Russian medical workers, teachers, and other groups are inoculated. The World Health Organization lists the Gamaleya vaccine trial as in Phase I.

Top U.S. infectious disease expert Dr. Anthony Fauci testified earlier this month that countries should only roll out vaccines after extensive testing. "I do hope that the Chinese and the Russians are actually testing the vaccine before they are administering the vaccine to anyone, because claims of having a vaccine ready to distribute before you do testing, I think, is problematic at best," Fauci told Congress. Peter Weber

August 9, 2020

The coronavirus is a serious, often-deadly pathogen, yet the Centers for Disease Control and Prevention estimates 40 percent of all cases are asymptomatic. In some isolated outbreaks in prisons and food processing plants where thousands of people contracted COVID-19, as many as 94 percent of infected individuals presented no symptoms. The Washington Post spoke to experts and suggested four possible reasons as to why, though it's important to note the research in all cases is in early stages.

T-Cells: T-cells, a type of white blood cell that generally provides longer-lasting immunity than antibodies, may be the key to understanding resistance. One research group found that, among uninfected blood samples donated to a blood bank between 2015 and 2018, a "remarkable" 40 to 60 percent recognized the coronavirus, suggesting some people may have an immune response based on memory of other, less potent coronaviruses.

Vaccines: The Mayo Clinic is studying whether vaccines for other pathogens can protect against the virus, as has been proven in other situations. Seven types of vaccines given one, two, or five years in the past were found to be associated with a lower rate of coronavirus infection, particularly pneumonia and polio vaccines.

Allergies: Scientists have noted children with asthma and allergies surprisingly don't seem to be at high risk of developing serious cases of COVID-19. One theory is that those children have a reduced number of ACE2 receptors, the protein the virus latches onto before replicating inside the body. Without those receptors, the virus' chance of causing damage could decrease, meaning allergies may offer protection in this case.

Masks: Masks are discussed as a preventative measure, but they may contribute to more mild infections, as well. The most direct evidence of this theory is a comparison of two cruise ships. On the Diamond Princess, where masks weren't used, 47 percent of the positive cases were asymptomatic, whereas an Antarctic-bound Argentine cruise ship that had a similar outbreak, but provided masks to all passengers and crew, saw an 81 percent asymptomatic rate. Read more at The Washington Post. Tim O'Donnell

August 7, 2020

The Bill & Melinda Gates Foundation is trying to make sure an eventual coronavirus vaccine is affordable for everyone.

The foundation has donated $150 million to the Serum Institute of India, the world's largest vaccine maker, the Gavi vaccine alliance announced Friday. The money will help speed up the development and distribution of an eventual COVID-19 vaccine and make it available to 92 poorer countries for no more than $3 per dose.

"Too many times we've seen the most vulnerable countries left at the back of the queue when it comes to new treatments, new diagnostics and new vaccines," said Gavi CEO Dr. Seth Berkley. But the consequences of such inequities when distributing a COVID-19 vaccine would be devastating. "If only the wealthiest countries in the world are protected, then international trade, commerce and society as a whole will continue to be hit hard as the pandemic continues to rage across the globe," Berkley continued.

The Serum Institute of India is one of several manufacturers working with AstraZeneca to make its candidate vaccine. It's also the go-to supplier for the World Health Organization, The Wall Street Journal notes. A total of 92 countries will be eligible to receive the discount vaccine as Gavi seeks $2 billion total to further support vaccine access. Kathryn Krawczyk

August 7, 2020

Gilead Sciences' potential coronavirus treatment is getting a supply chain boost.

Pfizer has entered a multi-year agreement with Gilead to manufacture its antiviral drug remdesivir, which has been FDA approved for emergency use to fight coronavirus, the pharmaceutical company announced Friday. The partnership is intended to ramp up production of the intravenous drug.

While no drug has been approved for the treatment of coronavirus, remdesivir has been approved for emergency use. A study showed the drug, which was developed as a potential Ebola treatment, significantly reduced the risk of death in severely sick COVID-19 patients. At the beginning of July, the Trump administration bought up all the remdesivir Gilead was set to produce in July, August, and September. Pfizer will start ramping up that production even further through contract manufacturing services at its McPherson, Kansas, facility.

Concerns still remain over the price of remdesivir. At $520 per dose, it could cost a patient $3,000 over a typical coronavirus treatment. State attorneys general have sought to enforce a federal patent law that would force Gilead to increase the supply of the drug and lower its price; the partnership with Pfizer will hopefully provide Gilead the bandwidth to do that. Kathryn Krawczyk

August 6, 2020

Testing accessibility has always been a problem when it comes to fighting the coronavirus. And even as that has improved, a slow turnaround rate has often made test results useless.

That's why some researchers and public health experts are starting to emphasize rapid result coronavirus tests even if they're less accurate than the time-intensive PCR tests, The New York Times reports. Their logic? "Even if you miss somebody on Day 1, If you test them repeatedly, the argument is, you'll catch them the next time around," said Omai Garner, director of clinical microbiology in the UCLA Health System.

The experts who back an emphasis on quicker tests cite the failure of long-term tests to stem coronavirus spread throughout the U.S. "If you had asked me this a couple months ago, I would have said we just need to be doing the PCR tests," said Susan Butler-Wu, a clinical microbiologist at the University of Southern California. But, she added, it's now "kitchen sink time, even if the tests are imperfect."

Still, PCR coronavirus tests rely on laboratory procedures to generate their results, and even quick-result tests require "specialized machines that are neither cheap nor easy to produce in bulk," the Times writes. But antigen tests, which identify a protein in the coronavirus, could be performed at any doctor's office or even at home, and could be mass-produced to cost just a few dollars each. Some companies are focused on developing these low-cost tests and ramping up their production until a vaccine is found.

Read more about the testing transformation at The New York Times. Kathryn Krawczyk

August 5, 2020

Seven states are teaming up with the goal of expanding rapid COVID-19 testing.

The governors of Maryland, Louisiana, Massachusetts, Michigan, Ohio, Virginia, and North Carolina have announced an interstate compact "to expand the use of rapid point-of-care antigen tests" during the coronavirus pandemic. The bipartisan group of governors is in talks to buy 500,000 antigen tests for each state.

"By banding together, the states are demonstrating to private manufacturers that there is significant demand to scale up the production of these tests, which deliver results in 15-20 minutes," the announcement said, touting this as the first such interstate testing agreement during the pandemic.

The compact was negotiated by Maryland Gov. Larry Hogan (R), who on Tuesday thanked "my fellow governors for signing on to this groundbreaking bipartisan agreement" to "acquire millions of faster tests to help save lives and slow the spread of COVID-19," adding that "we will be working to bring additional states, cities, and local governments on board as this initiative moves forward." Brendan Morrow

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