Coronavirus disease 2019

respiratory syndrome and infectious disease in humans, caused by SARS coronavirus 2
(Redirected from COVID–19)

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province, and has since spread globally, resulting in the ongoing 2019–20 coronavirus pandemic.

QuotesEdit

Disease characteristicsEdit

  • "It's a very complicated receptor binding process compared to most virus spike proteins," Benton said. "Flu and HIV have a more simple activation process." The coronavirus is covered in spike proteins, and it's likely only a small fraction of them go through these conformational changes, bind to human cells and infect them, Benton said.
    We know that the spike can adopt all these states that we were talking about," said co-lead author Antoni Wrobel, who is also a postdoctoral research fellow at the Francis Crick Institute's Structural Biology of Disease Processes Laboratory. "But whether each of the spikes adopts all of them we can't say because we can see only kind of snapshots."
    The spike protein is very quick to change. In the lab, the spike can morph into all of these different conformations in less than 60 seconds, Wrobel told Live Science. But "this will be very different in a real infection; everything will be slower because the receptor will be stuck on the surface of a cell so you have to allow time for the virus to diffuse to this receptor," Benton said.
    Why does the spike protein go through this many conformational changes to infect a cell? It "may be a way of the virus protecting itself from recognition by antibodies," Benton said. When the spike protein is in its closed states, it hides the site that binds with the receptor, maybe to avoid antibodies coming in and binding to that site instead, he said.
  • This study was the first study to examine the individual and synergistic effects of AT and RH on coronavirus survival on surfaces. The results show that when high numbers of the surrogates TGEV and MHV are deposited, these viruses may survive for days on surfaces at the ambient AT and wide range of RH levels (20 to 60% RH) typical of health care environments. TGEV and MHV may be more resistant to inactivation on surfaces than previously studied human coronaviruses, such as 229E (28). SARS-CoV has been reported to survive for 36 h on stainless steel, but the reductions in the levels observed were greater than those seen for either TGEV or MHV at 20°C at any RH in this study. However, the AT and RH conditions for the previous experiment were not reported, making comparisons difficult. Rabenau et al. reported much slower inactivation of SARS-CoV on a polystyrene surface (4 log10 reduction after 9 days; AT and RH conditions not reported), consistent with some observations for TGEV and MHV in the present study. There are some similarities with studies of another enveloped virus, human influenza virus, on surfaces in that at higher RH (50 to 60%), the inactivation kinetics are closer to those of TGEV and MHV.
  • The survival data for TGEV and MHV suggest that enveloped viruses can remain infectious on surfaces long enough for people to come in contact with them, posing a risk for exposure that leads to infection and possible disease transmission. This risk may also occur for other enveloped viruses, such as influenza virus (3, 4). The potential reemergence of SARS or the emergence of new strains of pandemic influenza virus, including avian and swine influenza viruses, could pose serious risks for nosocomial disease spread via contaminated surfaces. However, this risk is still poorly understood, and more work is needed to quantify the risk of exposure and possible transmission associated with surfaces. Statistical analysis showed that TGEV and MHV do not differ significantly in their inactivation kinetics on surfaces, and both viruses may be suitable models for survival and inactivation of SARS-CoV on surfaces. However, more data on the survival rates and inactivation kinetics of SARS-CoV itself are needed before these relationships with other coronaviruses can be definitively established. However, the findings of this study suggest that TGEV and MHV could serve as conservative surrogates for modeling exposure, transmission risk, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza viruses, on health care surfaces.
  • For months, scientists have observed trends showing older people and men tend to be more vulnerable. Scientists know something about why children tend to have less serious infections from coronavirus -- they have fewer ACE2 receptors in their noses, and these receptors are how coronavirus gets into our cells. But they can't really explain why older people have such a high death rate from coronavirus -- much higher than from the common flu.
    "What is it about age that makes you so much more susceptible to having disease?" Collignon questioned. "We've got the data and we know it's true ... but I don't think we've got all the answers for that."
  • The problem, says Collignon, is that not enough money is spent on answering the basics.
    "We spend billions of dollars on vaccines and drugs, but you can't get funding to do research on basics like how effective is this mask versus that mask," he said, adding that was partly because answers to those questions didn't make the problem go away -- they just decreased the risk.
  • Thomas Gilbert, an associate professor of chemistry and chemical biology at Northeastern University in Boston, Massachusetts, says coronavirus’s chemical make-up can be disrupted by nothing more specialised than cheap soap and warm water.
    “These viruses have membranes that surround the genetic particles that are called lipid membranes, because they have an oily, greasy structure,” he says. “It’s this kind of structure than be neutralised by soap and water.” Dissolving this outer “envelope” breaks the virus cell up, and the genetic material – the RNA which hijacks human cells to make copies of the virus – is swept away and destroyed.
    “I’ve heard of nothing yet to make the handwashing time shorter,” says Gilbert. “What you want to be doing is wetting your hands, getting the soap and working up a proper lather and then rubbing your hands for a good 20 seconds and get into all the nooks and crannies.” This gives enough time, Gilbert says, for the chemical reaction to take place between the lipid membrane and the soap. “There are other benefits – it also allows the soap to do a good job getting rid of the material.” And with warm water, Gilbert adds, all that virus fighting “happens a little quicker”.
  • The SARS-CoV-2 virus is genetically closely related to severe acute respiratory syndrome coronavirus (SARS-CoV), the first pandemic threat of a novel and deadly coronavirus that emerged in late 2002 and caused an outbreak of severe acute respiratory syndrome (SARS). SARS-CoV was highly lethal but faded out after intense public health mitigation measures. By contrast, the novel SARS-CoV-2 that emerged in December, 2019, rapidly caused a global pandemic. The SARS 2003 outbreak ceased in June, 2003, with a global total of 8098 reported cases and 774 deaths, and a case fatality rate of 9•7%, with most cases being acquired nosocomially. In comparison, the Middle East respiratory syndrome coronavirus (MERS-CoV)—another deadly coronavirus, but which is currently not presenting a pandemic threat—emerged in 2012, and has caused 2494 reported cases and 858 deaths in 27 countries and has a very high case fatality rate of 34%. Because MERS-CoV is widespread in dromedary camels, zoonotic cases continue to occur, unlike SARS-CoV, which emerged from wildlife and was eliminated from the intermediate host reservoir.
    The new coronavirus SARS-CoV-2 is less deadly but far more transmissible than MERS-CoV or SARS-CoV. The virus emerged in December, 2019, and as of June 29, 2020, 6 months into the first pandemic wave, the global count is rapidly approaching 10 million known cases and has passed 500 000 deaths. Because of its broad clinical spectrum and high transmissibility, eradicating SARS-CoV-2, as was done with SARS-CoV in 2003, does not seem a realistic goal in the short term.
  • There is nothing in recent history that compares to a contagious crisis of this magnitude, according to historians who study infectious diseases and disasters. The H1N1 flu pandemic in 2009 infected an estimated 60.8 million people in its first year, but the virus wasn’t nearly as severe as Covid-19, killing between 151,700 and 575,400 worldwide, according to the Centers for Disease Control and Prevention. MERS, another coronavirus that emerged in 2012, was much deadlier than Covid but significantly less infectious with only 2,494 reported cases.
  • China must have realized the epidemic did not originate in that Wuhan Huanan seafood market. The presumed rapid spread of the (COVID-19) virus apparently for the first time from the Huanan seafood market in December (2019) did not occur. Instead, the virus was already silently spreading in Wuhan, hidden amid many other patients with pneumonia at this time of year. The virus came into that marketplace before it came out of that marketplace.
  • Martin Michaelis, a professor of molecular science at the University of Kent in the UK, says water on its own is not enough to disable the virus. “When you have olive oil on your fingers when you’re cooking, it’ very hard to get rid of it with just water,” he says. “You need soap.” When it comes to the coronavirus, soap is needed in the same way “to remove that lipid envelope so that all the virus is deactivated”.
  • If a person infected with the coronavirus sneezes, coughs or talks loudly, droplets containing particles of the virus can travel through the air and eventually land on nearby surfaces. But the risk of getting infected from touching a surface contaminated by the virus is low, says Emanuel Goldman, a microbiologist at Rutgers University.
    "In hospitals, surfaces have been tested near COVID-19 patients, and no infectious virus can be identified," Goldman says.
    What's found is viral RNA, which is like "the corpse of the virus," he says. That's what's left over after the virus dies.
    "They don't find infectious virus, and that's because the virus is very fragile in the environment — it decays very quickly," Goldman says.
    Back in January and February, scientists and public health officials thought surface contamination was a problem. In fact, early studies suggested the virus could live on surfaces for days.
    It was assumed transmission occurred when an infected person sneezed or coughed on a nearby surface and "you would get the disease by touching those surfaces and then transferring the virus into your eyes, nose or mouth," says Linsey Marr, an engineering professor at Virginia Tech who studies airborne transmission of infectious disease.
  • Scientists now know that the early surface studies were done in pristine lab conditions using much larger amounts of virus than would be found in a real-life scenario.
    Even so, many of us continue to attack door handles, packages and groceries with disinfectant wipes, and workers across the U.S. spend hours disinfecting surfaces in public areas like airports, buildings and subways.
    There's no scientific data to justify this, says Dr. Kevin Fennelly, a respiratory infection specialist with the National Institutes of Health.
    "When you see people doing spray disinfection of streets and sidewalks and walls and subways, I just don't know of any data that supports the fact that we're getting infected from viruses that are jumping up from the sidewalk."
  • It's still unclear whether that takes place (that COVID-19 can spread before people show signs of being infected). But if it does, that might explain why the disease is spreading so quickly.
  • Dr. Susan Rehm, vice chair at the Cleveland Clinic’s department of infectious diseases, said another reason flu incidences are low is because most people have some innate immunity from prior vaccinations and infections.
    “COVID is a novel infection caused by the SARS coronavirus, and no one has any innate immunity to it,” she said. “So the population is probably overall more susceptible to it than maybe to influenza.”
  • The first seropositive samples in our study were already detected during the week of 23 February, one week before the first confirmed case of SARS-CoV-2 in NYC was identified, which suggests that SARS-CoV-2 was probably introduced to the NYC area several weeks earlier than has previously been assumed. This would not be unexpected given the unique diversity and connectivity of NYC and the large numbers of travellers that were arriving from SARS-CoV-2-affected regions of the world in January and February 2020. The antibody titres of initial positive individuals were low, which is consistent with slower seroconversion of perhaps mild cases. Of course, we cannot exclude with absolute certainty that some of the lower positive titres are false positives as the initially low seroprevalence falls within the confidence intervals of the positive predictive value.
    Of note, the seroprevalence in the routine care group (as well as the urgent care group at the end of May, after the peak) falls significantly below the threshold for potential community immunity, which has been estimated by one study to require at least a seropositivity rate of 67% for SARS-CoV-24. On the basis of the population of NYC (8.4 million), we estimate that by the week ending 24 May, approximately 1.7 million individuals had been infected with SARS-CoV-2. Taking into account the cumulative number of deaths in the city by 19 May (16,674—this number includes only officially confirmed, not suspected, COVID-19-related deaths), this suggests a preliminary infection fatality rate of 0.97% (with the assumption that both seroconversion and death occur with similar delays). This is in stark contrast to the infection fatality rate of the 2009 H1N1 pandemic, which was estimated to be 0.01–0.001%.
    • Daniel Stadlbauer, Jessica Tan, Kaijun Jiang, Matthew M. Hernandez, Shelcie Fabre, Fatima Amanat, Catherine Teo, Guha Asthagiri Arunkumar, Meagan McMahon, Christina Capuano, Kathryn Twyman, Jeffrey Jhang, Michael D. Nowak, Viviana Simon, Emilia Mia Sordillo, Harm van Bakel & Florian Krammer; “Repeated cross-sectional sero-monitoring of SARS-CoV-2 in New York City”, Nature, (03 November 2020)
  • Both influenza and coronaviruses cause respiratory tract infection that can lead to morbidity and mortality, especially in those who are immunocompromised or who have no existing immunity to the viruses. Indeed, while the COVID-19 should not be taken lightly, influenza is a much bigger problem, but because it is relatively common and has been around for a long time, it does not receive the attention that new viral outbreaks do. The COVID-19 is scary because it is new and we do not know a lot about it yet. New viruses are always scary because we have little to no protective immunity against them and we do not have vaccines. There is work going on to understand and develop preventive strategies to deal with this COVID-19 threat. However, universal precautions to limit its spread are very important right now until a new vaccine or another strategy is available.
  • I say "possibly" (for the SARS-CoV-2 to more dangerous to humans than the other coronaviruses) because so far, not only do we not know how dangerous it is, we can't know. Outbreaks of new viral diseases are like the steel balls in a pinball machine: You can slap your flippers at them, rock the machine on its legs and bonk the balls to the jittery rings, but where they end up dropping depends on 11 levels of chance as well as on anything you do. This is true with coronaviruses in particular: They mutate often while they replicate, and can evolve as quickly as a nightmare ghoul.

“Similarities and Differences between Flu and COVID-19”Edit

CDC, “Similarities and Differences between Flu and COVID-19”====

  • COVID-19 seems to spread more easily than flu and causes more serious illnesses in some people. It can also take longer before people show symptoms and people can be contagious for longer.
  • Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis.
  • COVID-19 seems to cause more serious illnesses in some people. Other signs and symptoms of COVID-19, different from flu, may include change in or loss of taste or smell.
  • While COVID-19 and flu viruses are thought to spread in similar ways, COVID-19 is more contagious among certain populations and age groups than flu. Also, COVID-19 has been observed to have more superspreading events than flu.

“U.K. variant puts spotlight on immunocompromised patients’ role in the COVID-19 pandemic” (Dec. 23, 2020)Edit

Kai Kupferschmidt, “U.K. variant puts spotlight on immunocompromised patients’ role in the COVID-19 pandemic” Science, (Dec. 23, 2020)

  • Now, his analysis, reported in a preprint on medRxiv earlier this month, has become a crucial puzzle piece for researchers trying to understand the importance of B.1.1.7, the new SARS-CoV-2 variant first found in the United Kingdom. That strain, which appears to spread faster than others, contains one of the mutations that Gupta found, and researchers believe B.1.1.7, too, may have originated in an immune compromised patient who had a long-running infection. “It’s a perfectly logical and rational hypothesis,” says infectious disease scientist Jeremy Farrar, director of the Wellcome Trust.
    Scientists are still trying to figure out the effects of the mutations in B.1.1.7, whose emergence led the U.K. government to tighten coronavirus control measures and other countries in Europe to impose U.K. travel bans. But the new variant, along with research by Gupta and others, has also drawn attention to the potential role in COVID-19 of people with weakened immune systems. If they provide the virus with an opportunity to evolve lineages that spread faster, are more pathogenic, or elude vaccines, these chronic infections are not just dangerous for the patients, but might have the potential to alter the course of the pandemic.
  • So far, SARS-CoV-2 typically acquires only one to two mutations per month. And B.1.1.7 is back to this pace now, suggesting it doesn’t mutate faster normally than other lineages. That’s why scientists believe it may have gone through a lengthy bout of evolution in a chronically infected patient who then transmitted the virus late in their infection. “We know this is rare but it can happen,” says World Health Organization epidemiologist Maria Van Kerkhove. Stephen Goldstein, a virologist at the University of Utah, agrees. “It’s simply too many mutations to have accumulated under normal evolutionary circumstances. It suggests an extended period of within-host evolution,” he says.
    People with a weakened immune system may give the virus this opportunity, as Gupta’s data show. More evidence comes from a paper published in The New England Journal of Medicine on 3 December that described an immunocompromised patient in Boston infected with SARS-CoV-2 for 154 days before he died. Again, the researchers found several mutations, including N501Y. “It suggests that you can get relatively large numbers of mutations happening over a relatively short period of time within an individual patient,” says William Hanage of the Harvard T.H. Chan School of Public Health, one of the authors. (In patients who are infected for a few days and then clear the virus, there simply is not enough time for this, he says.) When such patients are given antibody treatments for COVID-19 late in their disease course, there may already be so many variants present that one of them is resistant, Goldstein says.
  • U.K. scientists and others were initially cautious about concluding that B.1.1.7’s mutations made the virus better at spreading from person to person. But the new variant is rapidly replacing others, says Müge Çevik, an infectious disease specialist at the University of St. Andrews. “We can’t really rule out the possibility that seasonality and human behavior explain some of the increase,” she says. “But it certainly seems like there is something to do with this variant.” Drosten says he was initially skeptical, but has become more convinced as well.
    But exactly what impact each mutation has is much more difficult to assess than spotting them or showing they’re on the rise, says Seema Lakdawala, a biologist at the University of Pittsburgh. Animal experiments can help show an effect, but they have limitations. Hamsters already transmit SARS-CoV-2 virus rapidly, for instance, which could obscure any effect of the new variant. Ferrets transmit it less efficiently, so a difference may be more easily detectable, Lakdawala says. “But does that really translate to humans? I doubt it.” A definitive answer may be months off, she predicts.
    One hypothesis that scientists are discussing is that the virus has increased how strongly it binds to the ACE2 receptor on human cells, and that this allows it to better infect children than before, expanding its playing field. But the evidence for that is very thin so far, Çevik says. Even if children turn out to make up a higher proportion of people infected with the new variant, that could be because the variant spread at a time when there was a lockdown but schools were open. Another hypothesis is that P681H helps the virus better infect cells higher up in the respiratory tract, from where it can spread more easily than from deep in the lungs, Drosten says.

“Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics” (September 01, 2020)Edit

Eskild Petersen, Marion Koopmans, Unyeong Go, Davidson H Hamer, Nicola Petrosillo, Francesco Castelli, Merete Storgaard, Sulien Al Khalili, Lone Simonsen; “Comparing SARS-CoV-2 with SARS-CoV and influenza pandemics”, The Lancet, Volume 20, ISSUE 9, e238-e244, (September 01, 2020)

  • The new coronavirus SARS-CoV-2 is less deadly but far more transmissible than MERS-CoV or SARS-CoV. The virus emerged in December, 2019, and as of June 29, 2020, 6 months into the first pandemic wave, the global count is rapidly approaching 10 million known cases and has passed 500 000 deaths. Because of its broad clinical spectrum and high transmissibility, eradicating SARS-CoV-2, as was done with SARS-CoV in 2003, does not seem a realistic goal in the short term.
  • The R0 for the SARS outbreak in 2003 was estimated to be between 2•0 and 3•0 in the early months (until the end of April), before public health control measures were introduced. Various control measures soon reduced the transmissibility to 1•1, with a wide IQR of 0•4–2•4. For MERS-CoV, the R0 (unmitigated) was estimated to be 0•69 (95% CI 0•50–0•92), consistent with MERS-CoV never having caused sustained epidemics. For SARS-CoV-2, a recent China joint mission by WHO concluded that “transmission of SARS-CoV-2 is mostly driven by clusters in close contacts, particularly family clusters, and less so by community transmission”. Since the statement was released, this conclusion has been challenged, although superspreading events continue to occur in the pandemic. Studies have estimated the R0 at 2•2 (95% CI 1•4–3•9) and 2•7 (2•5–2•9); therefore, an average R0 of 2•5 seems a reasonable estimate. By comparison, the initial R0 estimate for the 2009 influenza A H1N1 pandemic was 1•7, later estimated between 0•17 and 1•3 after mitigation was initiated. R0 for the 1918 influenza pandemic was estimated at around 2•0 in the first wave in July, 1918.
  • A notable difference between SARS-CoV, SARS-CoV-2, and MERS-CoV are the kinetics of virus shedding. Whereas SARS-CoV and MERS-CoV have tropism for lower airways, with less virus present in the upper respiratory tract, this tropism is different in SARS-CoV-2. For SARS-CoV-2, the average viral load in a family cluster was 6•8 × 105 copies per upper respiratory tract swab during the first 5 days, and live virus isolates were obtained from swabs during the first week of illness. In a study from Hong Kong, high viral loads were found in the first samples obtained after admission to hospital. This finding was confirmed in a study from China, which found a high viral load at the onset of symptoms that declined in the following 5–6 days. This quick decline in the viral load makes isolation and quarantine of patients with SARS-CoV-2 and their contacts much more challenging and less effective, as it has to be done as soon as possible after illness onset in order to reduce transmission. By contrast, for SARS-CoV viral loads peaked at 6–11 days after symptom onset, allowing a full extra week to identify and isolate cases before transmission occurred. This difference would in part explain why SARS could be eradicated in 2003 compared with the trajectory seen in the SARS-CoV-2 pandemic.

Virus-infected patientsEdit

  • Danny Altmann, professor of immunology at Imperial faculty in London, guesses that those that recuperate from Covid-19 can have maybe 90% safety for a “fair while”. But how lengthy is that? “I would bet my house on you being safe for possibly a year but not much longer,” he mentioned. “The problem is that whenever an immunologist says anything about Covid immunity to a journalist, it’s right for about two weeks and then it’s completely wrong.”
  • Fatality rate of the 2019-CoV infection is relatively low, at slightly more than three percent, suggesting the possibility that those who died could have other predispositions. Most (of the patients) would fully recover.
  • Monoclonal antibodies are lab-made drugs meant to mimic natural antibodies to SARS-CoV-2, the virus that causes Covid-19. They're recommended for people who are at high risk of getting very sick from the virus, including anyone over age 65 and people with underlying health conditions.
    At least one study showed that the therapy can lower the amount of virus in a person's system. But no gold standard research proves that monoclonal antibodies do, indeed, provide this benefit. Most reports are anecdotal.
  • Monoclonal antibodies must be given soon after a person has tested positive. "These medications work best when given early," Surgeon General Jerome Adams said during Thursday's briefing.
    The two monoclonal antibody products that have been authorized for emergency use by the FDA, from the drugmakers Eli Lilly and Regeneron, must be given within the first week of illness.
  • According to the United Nations, about 1 billion persons live in so-called slums. Numerous studies have shown that this population is particularly vulnerable to infectious diseases. The current COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, emphatically underlines this problem. The often high-density living quarters coupled with a large number of persons per dwelling and the lack of adequate sanitation are reasons why measures to contain the pandemic only work to a limited extent in slums. Furthermore, assignment to risk groups for severe courses of COVID-19 caused by noncommunicable diseases (eg, cardiovascular diseases) is not possible due to inadequate data availability. Information on people living in slums and their health status is either unavailable or only exists for specific regions (eg, Nairobi). We argue that one of the greatest problems with regard to the COVID-19 pandemic in the context of slums in the Global South is the lack of data on the number of people, their living conditions, and their health status.
  • Our findings raise the possibility that the nature of an individual’s antibody response to prior endemic CoV infection may affect the course of COVID-19. They also indicate that analysis of S2 reactivity is crucial for a complete assessment of the humoral response to SARS-CoV-2, consistent with the observation that S2-only assays provide an equally strong correlate of neutralization compared to RBD-only assays (J. Nikolich and D. Bhattacharya, personal communication). The HR2 and FP cross-reactivities characterized here represent a possible source of background signal for SARS-CoV-2 serological assays that include the S2 subunit of Spike, which would be absent in those targeting only the RBD, for which sequence conservation is lower across CoV species. However, our findings also indicate that the incorporation of related endemic CoV antigens may improve the sensitivity of SARS-CoV-2 serological analyses, and in particular, that a differential analysis of SARS-CoV-2 and endemic CoV Spike S2 reactivity may provide an important measure of the efficiency with which preexisting cross-reactive responses can be redirected.
    The identification of broadly immunogenic epitopes in conserved functional domains of the SARS-CoV-2 Spike S2 subunit, including cross-reactivity with endemic HCoVs, also has implications for the design of therapeutic antibodies and vaccines. SARS-CoV-2 vaccines under development predominantly use two forms of the S antigen—whole protein or the RBD—and in each case are designed primarily to elicit neutralizing antibodies. Relative to RBD-focused vaccines, we hypothesize that vaccines that include the Spike HR2 and FP sites (1) will be able to induce a broader array of neutralizing reactivities, (2) may be more capable of rapidly recruiting preexisting memory B cells that are prevalent in the population, and (3) may be less prone to viral escape due to a lower tolerance for amino acid substitutions. In particular, the identification of HR2 and FP as conserved, functionally important and broadly immunogenic sites capable of eliciting cross-reacting antibodies, makes these regions candidates for the development of broadly neutralizing responses against CoVs. Future work should resolve the functional consequences of these cross-reactive antibody responses, and how an individual’s exposure history to endemic CoVs may affect their course of COVID-19.
  • We need to get a better idea of how many people are discharged from hospital and a better understanding of how many mild cases have been missed (from this COVID-19), while we focused on more severe disease (until this moment (3 February 2020)). When we find that out will depend on China giving us more details, because that's where most cases are, and so far, a decent number of cases outside of China have not seemed as severe.
  • "Imbalance in the microbiome contributes to the severity of COVID-19, and if it persists after viral clearance, could contribute to persistent symptoms and multi-system inflammation syndromes like long COVID syndrome," said lead researcher Dr. Siew Ng, a professor from the Institute of Digestive Dis-ease at the Chinese University of Hong Kong.
    "Restoration of the missing beneficial bacteria might boost our immunity against SARS-CoV2 virus and hasten recovery from the disease," she said. "Managing COVID-19 should not only aim at clearing the virus, but also restoring the gut microbiota."
  • RESULTS In 405 hospitals in 30 countries 11,266 adults were randomized, with 2750 allocated Remdesivir, 954 Hydroxychloroquine, 1411 Lopinavir, 651 Interferon plus Lopinavir, 1412 only Interferon, and 4088 no study drug. Compliance was 94-96% midway through treatment, with 2-6% crossover. 1253 deaths were reported (at median day 8, IQR 4-14). Kaplan-Meier 28-day mortality was 12% (39% if already ventilated at randomization, 10% otherwise). Death rate ratios (with 95% CIs and numbers dead/randomized, each drug vs its control) were: Remdesivir RR=0.95 (0.81-1.11, p=0.50; 301/2743 active vs 303/2708 control), Hydroxychloroquine RR=1.19 (0.89-1.59, p=0.23; 104/947 vs 84/906), Lopinavir RR=1.00 (0.79-1.25, p=0.97; 148/1399 vs 146/1372) and Interferon RR=1.16 (0.96-1.39, p=0.11; 243/2050 vs 216/2050). No study drug definitely reduced mortality (in unventilated patients or any other subgroup of entry characteristics), initiation of ventilation or hospitalisation duration.
    CONCLUSIONS These Remdesivir, Hydroxychloroquine, Lopinavir and Interferon regimens appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay. The mortality findings contain most of the randomized evidence on Remdesivir and Interferon, and are consistent with meta-analyses of mortality in all major trials.
    • H. Pan et al. Repurposed antiviral drugs for COVID-19; interim WHO SOLIDARITY trial results. medRxiv.org. October 15, 2020. doi: 10.1101/2020.10.15.20209817
  • The primary hypothesized mechanism of benefit from convalescent plasma is through direct antiviral action of neutralizing antibodies on SARS-CoV-2 RNA.1 In the PLACID Trial, a statistically significant 20% higher rate of conversion to a negative result for SARS-CoV-2 RNA occurred on day 7 among patients in the intervention arm.
    In plain English, this means that convalescent plasma did exactly what the investigators hoped it would do, yet there was no net clinical benefit to patients. Why might this be the case?
    The most common use of therapeutic plasma, which contains more than 1000 different proteins, is for the management of acute bleeding and complex coagulopathies. Despite the presence in plasma of anticoagulation factors such as antithrombin and protein C, the net effect of plasma is prothrombotic. Immunoglobulin therapy, which is derived from whole plasma, is subject to a US Food and Drug Administration warning about the risks of thrombosis, particularly in older patients, those with cardiovascular risk factors, and those with hypercoagulable conditions.
    It is now widely recognized that covid-19 is a life threatening thrombotic disorder. An excellent recent pathophysiology synthesis concluded that “SARS-CoV-2 not only produces an inflammatory and hypercoagulable state, but also a hypofibrinolytic state not seen with most other types of coagulopathy.” Most recently, plasma from convalescent covid-19 patients has been shown to directly cause endothelial cell damage in vitro.
  • To affirm a reinfection, scientists should study the genetic code of the virus from every spherical of sickness and show they’re distinct. That means gaining access to each units of swabs and the wherewithal to do entire genome sequencing. Even in hospitals the place the capability exists, such checks are not often accomplished. Reinfected sufferers merely go unnoticed or unreported. “There is probably a lot more than we are seeing,” mentioned Iwasaki.
    The immune system’s battle towards coronavirus is unleashed in a number of waves. The first line of defence, the innate immune system, is imprecise however quick. Invading pathogens immediate cells to churn out signalling proteins known as cytokines which name in a military of white blood cells that engulf and disrupt the virus.
    Next to gear up is the adaptive immune system, a extra specialised attacking drive. This unleashes T-cells, which destroy contaminated cells, and prompts B-cells to make antibodies that stick with viruses and cease them spreading additional. If and when the an infection is crushed, the T- and B-cells stand down, however some needs to be saved within the physique for years, an immune reminiscence that may be recommissioned ought to the virus attempt once more.
    Given the complexity of the immune response, it’s no shock that scientists are struggling to unravel why reinfections happen. Blood checks on sufferers reveal that virus-disabling antibodies can wane after a number of months, notably in these with gentle or no signs. But even with wholesome ranges of antibodies, reinfection cannot solely occur, however trigger extra severe illness.
  • Despite the lack of accurate data on how physical activity improves the immune response against the new coronavirus, there is evidence of lower rates of ARI incidence, duration and intensity of symptoms and risk of mortality from infectious respiratory diseases in individuals who exercise at high levels appropriate.
  • There are still gaps in the knowledge regarding the pathogenic mechanisms involved in SARS-CoV-2 infection. However, there is consensus in the scientific literature about the important involvement of the immune system in the susceptibility, progression and outcome of COVID-19. The imbalance in innate and adaptive immune responses, characterized mainly by changes such as cytokine storm and lymphopenia, in addition to the disorders in coagulation- and host-related conditions, including obesity, metabolic syndrome and aging (immunosenescence), is among the factors notoriously associated with a worse prognosis of infection.
    The benefits of exercise—regular and at appropriate intensity levels—for the immune system in respiratory infections such as COVID-19 include increased immunovigilance and improved immune competence, which help in the control of pathogens, a fact that becomes more important considering the immunosenescence and susceptibility of the elderly population to severe infection. Other favorable effects in relation to host factors, such as prevention or reduction of overweight, increased physical and cardiopulmonary conditioning, attenuation of the systemic pro-inflammatory and pro-thrombotic states, decrease in oxidative stress, improvements in glycemic, insulinic and lipidic metabolisms, besides the enhancement of the vaccination response, also indicate how adequately physical activity can help the organism’s immune response against COVID-19.
  • SARS-CoV-2 causes mild or asymptomatic disease in most cases; however, severe to critical illness occurs in a small proportion of infected individuals, with the highest rate seen in people older than 70 years. The measured case fatality rate varies between countries, probably because of differences in testing strategies. Population-based mortality estimates vary widely across Europe, ranging from zero to high. Numbers from the first affected region in Italy, Lombardy, show an all age mortality rate of 154 per 100 000 population. Differences are most likely due to varying demographic structures, among other factors. However, this new virus has a focal dissemination; therefore, some areas have a higher disease burden and are affected more than others for reasons that are still not understood. Nevertheless, early introduction of strict physical distancing and hygiene measures have proven effective in sharply reducing R0 and associated mortality and could in part explain the geographical differences.
  • Clinical case fatality, for which the case definition was fever and respiratory symptoms (including pneumonia), was around 5% in Hubei province and only around 1% in the rest of China and South Korea. In the USA, case fatality rates among patients with COVID-19 were less than 1% for people aged 20–54 years, 1–5% in those aged 55–64 years, 3–11% in those aged 65–84 years, and 10–27% in people aged 85 years and older. Early in the outbreak there have been few deaths in children and young adults younger than 20 years. Although most patients (90%) with COVID-19 have mild clinical illness, there is considerable demand for intensive care because of the subset of patients who develop acute respiratory distress syndrome. This requirement for respiratory support is higher for SARS-CoV-2 cases than for the influenza pandemic in 2009. In a study of patients who were admitted to hospital in New York, NY, USA, 14% required intensive care (median age 68 years).
  • The first WHO “disease X” scenario has become a reality. The SARS-CoV-2 pandemic has already caused severe morbidity and mortality in older adults, much higher than in the pandemic influenza. Although children are clearly less affected, their role in the transmission of the virus still needs to be studied.
  • To affirm a reinfection, scientists should study the genetic code of the virus from every spherical of sickness and show they’re distinct. That means gaining access to each units of swabs and the wherewithal to do entire genome sequencing. Even in hospitals the place the capability exists, such checks are not often accomplished. Reinfected sufferers merely go unnoticed or unreported. “There is probably a lot more than we are seeing,” mentioned Iwasaki.
    The immune system’s battle towards coronavirus is unleashed in a number of waves. The first line of defence, the innate immune system, is imprecise however quick. Invading pathogens immediate cells to churn out signalling proteins known as cytokines which name in a military of white blood cells that engulf and disrupt the virus.
    Next to gear up is the adaptive immune system, a extra specialised attacking drive. This unleashes T-cells, which destroy contaminated cells, and prompts B-cells to make antibodies that stick with viruses and cease them spreading additional. If and when the an infection is crushed, the T- and B-cells stand down, however some needs to be saved within the physique for years, an immune reminiscence that may be recommissioned ought to the virus attempt once more.
    Given the complexity of the immune response, it’s no shock that scientists are struggling to unravel why reinfections happen. Blood checks on sufferers reveal that virus-disabling antibodies can wane after a number of months, notably in these with gentle or no signs. But even with wholesome ranges of antibodies, reinfection cannot solely occur, however trigger extra severe illness.
  • The absence of a vaccine and effective treatment for COVID-19 has created public panic and burdened the health systems in most countries. Along with health workers’, sanitation personnel are also working at the frontlines in the war against the disease by keeping cities clean. Sanitation workers are engaged in Drudgery, Dangerous, Dirty and Dehumanising work that makes them vulnerable for developing the chronic respiratory diseases due to the exposure of various hazardous materials and toxic gases that are emitted from the solid waste. The sanitation workers working on a contractual basis are excluded from the labour policies and welfare programs who are playing a vital role in fighting the pandemic. Women sanitation workers are even more vulnerable because most of them are non-literate, poor in financial management and under-represented in the sanitation employee’s union. The local and state governments should protect and safeguard sanitation workers by providing them with adequate protective equipment, ensure payme¬¬¬nt of paying adequate salaries and provide them with health insurance.
  • Take a look at the death toll now (as of 5 February 2020 due to the COVID-19 outbreak), there are almost no children. A nine-month-old baby is the youngest known patient, and the baby's still alive. The youngest patients who died are about 30 years old. Most of them have congenital diseases, such as brain disorders, heart diseases, lung diseases, diabetes or cancer. There are patients who are over 80 years old. At first, more than half of them were over 80 years old. Many cases are 89. If you ask me, some 89-year-old people happen to fall and die. So, don't panic about the number of fatalities. A majority of them have congenital diseases, pneumonia or influenza. Their depth of breathing is lower than normal, and there's a possibility that they want to eliminate excess phlegm. This can pose a life-threatening risk. Most fatalities are not young people. There's not much difference from the common influenza. If people who are 89 or 90 years old have influenza, that's not good.
  • One thing about this (COVID-19) that's somewhat unprecedented is the speed at which new data is coming out and becoming available for mass consumption. In that article, there's not a lot of detail about when the initial patient returning to China became symptomatic. It's really hard to tell. People don't always accurately report. That's not on purpose or anything, but people aren't so self-aware that they're going to notice a single sneeze, or every little cough, or clearing their throat, or their nose is running and they think it's allergies. There are a lot of reasons why people might not necessarily recognize that they are symptomatic when they actually are.
  • The COVIDSurg Collaborative's study of surgical outcomes in patients with COVID-19 is commendable, as most existing publications around perioperative practice are commentaries or recommendations with extrapolated knowledge.
    The study findings suggest a grievous prognosis for patients having surgery during the COVID-19 pandemic, in that nearly one in four (23•8% [268 of 1128]) patients die within 30 days, and about half (51•2% [577]) of them will have major pulmonary complications. Factors associated with these outcomes were non-modifiable, except for the decision of elective surgery. Even among elective surgeries, delaying cancer surgery might have its own consequences. Hence, it becomes crucial to look for modifiable risk factors, such as the anaesthetic type.
    Although unproven in people with COVID-19, preference for regional anaesthetic over general anaesthesia has advantages such as minimal effect on the respiratory system, avoidance of intubation-related seeding of pathogens to the lower respiratory tract, decreasing thromboembolic complications, and a reduced surgical stress response.
    Using regional anaesthetic techniques, aerosol-generating procedures can be avoided with decreased risk to health personnel; additionally, there is potential to conserve protective equipment and essential drugs during shortages.
  • The implications of COVID-19 infection during pregnancy remain unclear at this moment. Pregnancy is considered high risk as this population remains vulnerable to coronavirus infection. Till date, data regarding SARS-CoV-2 infection amongst pregnant women, their manifestations and outcomes remain limited. Most pregnancies had good outcomes, and transmission of SARS-CoV-2 to infant was uncommon. However, the relationship between SARS-CoV-2 infection and risk of miscarriage remains unclear.
  • From observations, the (COVID-19) virus is capable of transmission even during incubation period. Some patients have normal temperatures and there are many milder cases. There are hidden carriers. There are signs showing the virus is becoming more transmissible. These walking "contagious agents" (hidden carriers) make controlling the outbreak a lot more difficult.

Accountability related to the virus outbreakEdit

  • "If you were to create a petri dish and say, how can we spread this the most? It would be cruise ships, jails and prisons, factories, and it would be bars," Alozie says. He was a member of the Texas Medical Association committee that created a COVID-19 risk scale for common activities such as shopping at the grocery store.
  • Back in February, at what has been dubbed “Game Zero,” nearly 2,500 Spanish soccer fans of the club Valencia CF traveled to Milan, Italy, to attend a Champions League match, joining a crowd of 40,000 in San Siro Stadium. No masking, distancing or screening protocols were in place at the time. The result was described as a “biological bomb”—a superspreading event that led to infection both locally and in Spain. According to a Wall Street Journal report, “The military drove the dead away by the truckload” from hospitals in Bergamo, Italy.
  • With some exceptions, governments have made great efforts to put the well-being of their people first, acting decisively to protect health and to save lives. The exceptions have been some governments that shrugged off the painful evidence of mounting deaths, with inevitable, grievous consequences. But most governments acted responsibly, imposing strict measures to contain the outbreak.
    Yet some groups protested, refusing to keep their distance, marching against travel restrictions — as if measures that governments must impose for the good of their people constitute some kind of political assault on autonomy or personal freedom! Looking to the common good is much more than the sum of what is good for individuals. It means having a regard for all citizens and seeking to respond effectively to the needs of the least fortunate.
    It is all too easy for some to take an idea — in this case, for example, personal freedom — and turn it into an ideology, creating a prism through which they judge everything.
  • The pandemic has exposed the paradox that while we are more connected, we are also more divided. Feverish consumerism breaks the bonds of belonging. It causes us to focus on our self-preservation and makes us anxious. Our fears are exacerbated and exploited by a certain kind of populist politics that seeks power over society. It is hard to build a culture of encounter, in which we meet as people with a shared dignity, within a throwaway culture that regards the well-being of the elderly, the unemployed, the disabled and the unborn as peripheral to our own well-being.
    To come out of this crisis better, we have to recover the knowledge that as a people we have a shared destination. The pandemic has reminded us that no one is saved alone. What ties us to one another is what we commonly call solidarity. Solidarity is more than acts of generosity, important as they are; it is the call to embrace the reality that we are bound by bonds of reciprocity. On this solid foundation we can build a better, different, human future.
  • The COVID-19 pandemic has disproportionately affected nursing home residents. According to a New York Times database, nursing homes account for 8 percent of cases and 41 percent of COVID-19-related deaths nationwide. While the clinical status of these patients is the major determinant of risk, debate continues on the relative importance of locale, the race and socioeconomic status of patients, facility size state regulations, payer mix, and ownership status. Nonetheless, there is agreement that, in general, America’s nursing homes are not designed, operated, or funded to deal effectively with infectious disease epidemics, and their staff are often too few in number and inadequately paid, protected, and trained.
  • “Current recommendations worldwide are not to have large crowds mingle,” says Monica Gandhi, an infectious disease expert at the University of California, San Francisco. In an e-mail exchange, Gandhi tells me she could envision fans returning to stadiums under strict safety protocols (masking, distancing, employing good hand hygiene) and at perhaps 10 percent to 20 percent of capacity. “COVID-19 is not radioactive,” Gandhi said, “and there are ways to keep fans and the college community safe.”
  • Part of the reason Gershon and Morse feel more confident about the subway: Transit agencies around the world are taking impressive efforts to get squeaky clean.
    Gershon gives the example of New York's MTA: "They started a very extensive and exhaustive program of deep cleaning — those subways have been more clean than, like, forever," she says. "They shut them down every day from 2 to 5 a.m. to clean."
    In addition, the New York subway system uses HVAC systems in each individual car, which turn over air quickly and filter out viral particles, Gershon says. That may aid in mitigating some of the risk associated with a respiratory disease.
    These protective efforts are going on around the world. In Ethiopia, authorities have begun disinfecting public buses to reinstill confidence in transit. Hong Kong has successfully used a disinfection robot to spray bleach in train waiting areas. In Prague, authorities disinfect 10 to 12 trams a day with a deep cleaning. And Seoul has set up isolation rooms in case transit workers develop symptoms.
  • There are several ways to improve air flow and quality, but many virus-fighting technologies are relatively new and difficult to research, experts say.
    Costly changes to HVAC systems also can create a false sense of security, said Raj Gupta, executive chairman of ESD, a Chicago-based engineering firm.
    Gupta said companies first should focus on three primary goals before addressing air quality: keeping sick people out of their space; enforcing distancing and mask-wearing; and emphasizing cleaning and hygiene.
    “It’s important to realize that if we want to throw money at filters and everything, it’s not going to matter if we don’t do those first three things,” Gupta said. “People should not rely on it as a quick fix.”
  • Outdoor workouts are a safer option than exercising inside a gym during the COVID-19 pandemic, according to I-Min Lee, professor in the Department of Epidemiology at Harvard T.H. Chan School of Public Health.
    Outside, it’s more likely that any potential virus in the air will disperse, she said in an August 20, 2020 story on the website Popsugar. But Lee said that those exercising outdoors should still heed safety guidelines such as wearing a mask, distancing from others, and frequently washing their hands.
  • Preliminary findings also suggest that around one-third of restaurant customers and around 40% of the hotel customers are willing to pay more for increased safety precautions. While customers expect hospitality businesses to implement more rigorous safety/cleaning procedures, a portion of them are willing to pay for those added safety measures (Gursoy et al., 2020). Further research is needed to determine the importance of each of these safety precautions, how such measures will influence customers’ attitudes and behaviors and whether customers are indeed willing to pay for them and by how much more.
    Preliminary findings also indicate that a large proportion of restaurant customers (64.71%) and the majority of hotel customers (70.42%) believe that the use of various technologies in service delivery will be necessary in the COVID-19 environment in order to minimize human-to-human contact (examples: service robots, contactless payment such as Apply pay or contactless bank cards, digital menus that can be viewed on personal mobile devices via QR codes, contactless digital payments, keyless entry, touchless elevators, etc.) (Gursoy et al., 2020). These findings strongly suggest that technology integration and adoption into hospitality operations will likely be integral in the near future.
  • The movement of cruise ships has the potential to be a major trigger of coronavirus disease (COVID-19) outbreaks. In Australia, the cruise ship Ruby Princess became the largest COVID-19 epicenter. When the Ruby Princess arrived at the Port of Sydney in New South Wales on March 19, 2020, approximately 2700 passengers disembarked. By March 24, about 130 had tested positive for COVID-19, and by March 27, the number had increased to 162. The purpose of this study is to analyze the relationship between the cruise industry and the COVID-19 outbreak. We take two perspectives: the first analysis focuses on the relationship between the estimated number of cruise passengers landing and the number of COVID-19 cases. We tracked the movement of all ocean cruise ships around the world using automatic identification system data from January to March 2020. We found that countries with arrival and departure ports and with ports that continued to accept cruise ships until March have a higher COVID-19 infection rate than countries that did not.
  • At one time, said Muller, the cruise industry treated onboard diseases as if they didn’t exist. “They just pretended it didn’t happen. Then in 2013, to their credit, they got smart and at first indication of a disease like norovirus, they’d pull up at the nearest harbor, get everybody off and do a deep clean.” (Norovirus, a contagious virus, causes vomiting and diarrhea.)
    But the ships infected with the coronavirus earlier this year were not allowed to dock; they were forced to sail aimlessly as they sought an open port that would accept them. Meanwhile, the disease spread onboard. “That was the worst thing that could have happened,” Muller said.
  • One much-publicized study on flying, conducted by the Defense Department, found that “overall exposure risk from aerosolized pathogens, like coronavirus, is very low” and concluded that a person would have to be sitting next to an infectious passenger for at least 54 hours to get an infectious dose of the virus through the air. But the “54-hour” number has since been removed from the report at the request of the authors, who worried it was being misinterpreted.
  • “Up-to-date information is crucial for the nation to effectively respond to this pandemic,” said Jean Ross, RN and a president of NNU. “Nurses know that we need detailed, consistent data to understand how and where the virus is spreading, who is most vulnerable to infection, and whether interventions are effective. We can use this information to learn how to prevent the spread of future pandemics. Unfortunately, instead of tracking and reporting Covid-19 data, federal and state governments have ignored, hidden, and manipulated Covid-19 data.”
    There is widespread resistance on the part of health care employers to transparently provide information on nurse and other health care worker Covid-19 infection rates and fatalities. Meanwhile, federal, state, and local governments have failed to compel health care facilities to provide this data. If hospitals are not widely required to publicly disclose their deaths and infection rates, they have no incentive to avoid becoming zones of infection.
  • Most states report only a limited subset of Covid-19 data. But comprehensive reporting is necessary to fully grasp the scope of the Covid-19 pandemic and respond effectively. Only 15 states are providing infection numbers for all health care workers on a daily, semiweekly, or weekly basis. In May, the Centers for Medicare & Medicaid Services (CMS) began requiring nursing homes to provide Covid-related health care worker infection and mortality data, which is publicly available from CMS. For the hospital industry, however, data collection on health care worker infections and deaths has been woefully inadequate.
    At the federal level, the U.S. Centers for Disease Control and Prevention (CDC) has been primarily responsible for tracking and reporting Covid-19 data, including information on testing, cases, hospitalizations, and deaths. But the Trump administration has moved hospital Covid-19 data reporting from the CDC to the U.S. Department of Health and Human Services (HHS), which has hired private companies under nondisclosure agreements, keeping the majority of the data collected hidden from public view. Trump appointees within HHS’ communications staff have reviewed and edited the CDC’s weekly scientific reports to downplay risks.
  • Benjamin, an internal medicine specialist and Maryland’s former secretary of health, said, “Just like in a restaurant, you take a mask off to eat popcorn or drink, etc. And of course, when you do that, if you’re infected, you will expel virus.” Especially, he noted, if you laugh or scream at the movie.
    De St. Maurice, a physician who specializes in pediatrics and infectious disease and is the co-chief infection prevention officer for UCLA Health, agreed: “How often are they going to pull the mask back up? And movies make you laugh and shout.”
    The health experts expressed concern that even proper social distancing might not be enough protection for a long period of exposure (say an average visit of two hours) to people who are not wearing masks.
  • Mandates for beauty services, especially hair and nails, are going to continue to change. But be sure to reach out to your hairstylists before you go to ensure they're wearing a mask — at the very least. "Clients should be asking if the hairstylists always wear protective gear including gloves and masks, and if everything used in the salon is scrubbed and sanitized after each client," dermatologist, Sapna Palep, founder of Spring Street Dermatology in New York City, tells Allure. "The chairs should also be wiped down thoroughly with antiseptic cloths." She notes that getting your hair done outside is safer, but either way, salons should be taking the temperatures of all staff and clients on a daily basis, and staff and clients should be screened for possible COVID-19 exposure.
  • We asked Scott Pauley, a representative for the CDC, if it’s better to send laundry out to a wash-and-fold service than use a laundromat, and he told us, “[It] would really boil down to social distancing, and whether you could limit close contact with other individuals.” If you choose to use a laundering service, protect the laundry workers handling your dirty stuff: If anyone in your household is sick, don’t send your dirty laundry out immediately. “Bundle it up, let it sit for a few days, and then send it out,” Roberts said. “Viruses don’t survive that long,” she noted. “Certainly not over two days or three days.” An article in the Journal of Hospital Infection agrees, finding that coronaviruses survive a max of two days on hospital gowns at room temperature. Similarly, be careful with the clean bundles of laundry you get back. “If you’re immunocompromised, if you’ve got lung issues, and you’re worried about it, then put them in a closet or something that’s not used, and don’t open them for a few days,” Roberts said. “That should pretty much get rid of the virus.”
  • Whether you do your laundry at home, in a laundromat, or in a shared laundry room in your building, public health experts say there are some general safety guidelines everyone can follow. If you’ve purchased or made cloth masks, the CDC recommends cleaning them frequently in a washing machine—they don’t currently offer any guidance for handwashing them. If anyone in your household is sick, or if you’re worried someone has been exposed to COVID-19, the CDC says not to shake your dirty laundry—this could spread the virus. The CDC also recommends wearing disposable gloves while handling laundry and washing your hands thoroughly when you take the gloves off (if you don’t have disposable gloves, wash your hands as often as you can). New York City’s Department of Health recommendations for businesses (PDF) say to avoid “hugging” dirty laundry to your body to reduce contact with possibly contaminated items. And Roberts says you can also leave your dirty laundry untouched and out of the way for a couple of days before washing to allow any pathogens to die off the surface.
  • “It’s an ideal setting for transmission,” said Carlos del Rio, an infectious-disease expert at Emory University, referring to church gatherings. “You have a lot of people in a closed space. And they’re speaking loudly, they’re singing. All those things are exactly what you don’t want.”
  • “The idea of just opening a stadium and letting the crowds come back to capacity is clearly really foolish,” says Mark Rupp, chief of infectious disease at the University of Nebraska Medical Center. In an interview, Rupp tells me that while there could be ways of limiting crowds and enforcing safety measures, “I don’t think there is any way of taking the risk out of it completely, quite frankly.”
  • The absence of a vaccine and effective treatment for COVID-19 has created public panic and burdened the health systems in most countries. Along with health workers’, sanitation personnel are also working at the frontlines in the war against the disease by keeping cities clean. Sanitation workers are engaged in Drudgery, Dangerous, Dirty and Dehumanising work that makes them vulnerable for developing the chronic respiratory diseases due to the exposure of various hazardous materials and toxic gases that are emitted from the solid waste. The sanitation workers working on a contractual basis are excluded from the labour policies and welfare programs who are playing a vital role in fighting the pandemic. Women sanitation workers are even more vulnerable because most of them are non-literate, poor in financial management and under-represented in the sanitation employee’s union. The local and state governments should protect and safeguard sanitation workers by providing them with adequate protective equipment, ensure payment of paying adequate salaries and provide them with health insurance.
  • Outbreaks of the coronavirus in meat processing plants appear to play an outsized role in a handful of states with new infection rates far higher than the rest of the country. Or, as economist Ian Shepherdson put its: "The U.S. meat industry is the source of most new COVID hotspots."
  • More than 200 scientists earlier this month signed an open letter warning that public health agencies such as the WHO and U.S. Centers for Disease Control were ignoring the potential risk of the virus spreading through air circulating indoors.
    The WHO responded by updating its guidance to acknowledge the possibility of airborne transmission of COVID-19.
    “I think improving ventilation and improving air cleaning is one of the few lines of defense that we have,” said Brent Stephens, an engineering professor and chair of Illinois Institute of Technology’s Department of Civil Engineering, who signed the open letter.
    “I don’t think we really have a good sense of how important it is,” said Stephens, who specializes in air quality in buildings. “We’re still learning.”
  • From the early days of the U.S. coronavirus outbreak, states have wrestled with the best course of action for the nation's imperiled bars and nightclubs. Many of these businesses find their economic prospects tied to a virus that preys on their industry's lifeblood — social gatherings in tight quarters.
    Public health experts and top health officials, including the Dr. Tony Fauci, say the evidence is abundantly clear: When bars open, infections tend to follow.
  • Characteristics that might have led to transmission from the instructors in Cheonan include large class sizes, small spaces, and intensity of the workouts. The moist, warm atmosphere in a sports facility coupled with turbulent air flow generated by intense physical exercise can cause more dense transmission of isolated droplets (6,7). Classes from which secondary COVID-19 cases were identified included 5–22 students in a room ≈60 m2 during 50 minutes of intense exercise. We did not identify cases among classes with <5 participants in the same space. Of note, instructor C taught Pilates and yoga for classes of 7–8 students in the same facility at the same time as instructor B (Figure; Appendix Table 2), but none of her students tested positive for the virus. We hypothesize that the lower intensity of Pilates and yoga did not cause the same transmission effects as those of the more intense fitness dance classes.
  • The call from the U.S. came as Australia's Federal Agriculture Minister David Littleproud urged an international scientific investigation into the health risks associated with the wet markets.
    "It only makes sense that we go and investigate these wildlife wet markets, to understand the risks that they pose to human health and also to biosecurity," Littleproud told reporters in Toowoomba, a town about 50 miles west of Brisbane, on Thursday, according to The Canberra Times.
    "It is the responsibility of all global nations to undertake this work in a scientific manner, in a calm and methodical way, to understand the risks and whether they can be mitigated," he said.
    In January, China closed the Huanan Seafood Wholesale Market in Wuhan where the SARS-CoV-2 virus that causes COVID-19 is thought to have emerged. But this month, the stalls at the market began reopening, though as Reuters notes, "their future looks uncertain with few customers as the virus stigma persists."
  • “Seafood involves water and frozen products – the low temperature and high humidity is suitable for the virus to survive,” Wu Zunyou, chief epidemiologist at the Chinese Centre for Disease Control and Prevention, said at the time.
    But while temperature, humidity and a few other factors are similar, most experts said the comparisons with the two Hong Kong markets ended there.
    Infectious disease expert Dr Leung Chi-chiu noted the two mainland hotspots were massive wholesale markets spanning more than 100 hectares each, boasting thousands of stalls with huge refrigerators and other frozen cabinets for seafood storage.
    “There are many more people going in and out of those places every day, enabling human-to-human transmission in places perfect for the survival of the virus,” he said.

Effects of the virus outbreakEdit

See also: 2020 stock market crash and Strikes during the 2020 coronavirus pandemic
  • CDC recognizes that wearing masks may not be possible in every situation or for some people such as children. Some older adults with cognitive, sensory, or behavioral issues might find wearing a mask difficult. Adaptations and alternatives should be considered whenever possible to increase the feasibility of wearing a mask or to reduce the risk of spreading COVID-19 if it is not possible to wear one. These adults need to take extra precautions when interacting with others. Additionally, some people may rely on reading lips or facial expressions during social interactions. This can be difficult when others are wearing masks that cover large portions of their face.
    Who should NOT use masks: Children under age 2 or anyone who has trouble breathing, is unconscious, or is incapacitated or otherwise unable to remove the mask without assistance.
  • This theme of helping others has stayed with me these past months. In lockdown I’ve often gone in prayer to those who sought all means to save the lives of others. So many of the nurses, doctors and caregivers paid that price of love, together with priests, and religious and ordinary people whose vocations were service. We return their love by grieving for them and honoring them.
    Whether or not they were conscious of it, their choice testified to a belief: that it is better to live a shorter life serving others than a longer one resisting that call. That’s why, in many countries, people stood at their windows or on their doorsteps to applaud them in gratitude and awe. They are the saints next door, who have awakened something important in our hearts, making credible once more what we desire to instill by our preaching.
    They are the antibodies to the virus of indifference. They remind us that our lives are a gift and we grow by giving of ourselves, not preserving ourselves but losing ourselves in service.
  • We (Government of Macau) don't know if this is the peak of the (COVID-19) disease. I think it could be only after Lunar New Year (CNY) because now people are moving a lot. If there is contagion it is now, during these travels, but maybe the most critical time could be registered after the CNY. That's why we took the hard decision to cancel CNY festivities, to prevent further aggravation of the disease.
  • Across the country, as millions open their doors and windows every night to cheer doctors and nurses battling a deadly pandemic, people like Padilla operate in the shadows. They work the same 12-hour shifts, using special training to ensure hospitals stay clean, but for considerably less pay and sometimes without the same protective gear given to doctors and nurses.
    Environmental service workers “are such an integral part of the whole health care team,” said Jane Hopkins, executive vice president of Service Employees International Union's Northwest chapter. “In a hospital, they’re just as important as a doctor – they’re just doing a completely different job.”
  • The impact on the (China's) economy (by this COVID-19 outbreak) is gaining weight, especially on transport, tourism, hotels, catering and entertainment. But, the impact will be temporary and will not change the positive foundation of China's economy. Many have tried to estimate the impact (of this COVID-19 outbreak) based on the impact of SARS in 2003, but China's economic power and ability to handle such an outbreak is significantly stronger than in those days.
  • COVID-19 has "brought home not only the realities of our vulnerabilities but the potential risk of this kind of a pandemic in man-made context, genetically modified, that is targeted in ways that are intended to undermine, attack our systems and our health," said Zarate, an NBC News contributor who oversaw the creation of infrastructure to combat terrorism financing in the wake of the terrorist attacks of Sept. 11, 2001. "Our homeland security posture and even our counterterrorism approach will be fundamentally altered by this crisis."

CrimonologyEdit

  • Like other viral pathogens, SARS-CoV-2 is closely dependent on the complexity of human behavior and human interactions. There are many documented outbreaks of respiratory pathogens in jails and prisons in many countries. Custodial institutions have been the epicenter of outbreaks of infections amongst prisoners amplifying infections at rates far exceeding those in nonincarcerated communities. Highly transmissible viral infections such as measles, mumps, and the novel coronavirus disseminates rapidly among inmates and staff and potentially into the larger community. Overcrowding, insufficient sanitation, poor ventilation, and inadequate healthcare in prisons contribute to enabling these institutions as breeding grounds of infectious disease outbreaks. Detention and incarceration of any kind involves large groups of people living in cohorts in confined spaces creating many challenges for curbing the spread of COVID-19. The number of single rooms in jails or prisons are insufficient to adhere to the recommended isolation and quarantine guidelines and limits the ability to implement strict infection prevention protocols.
  • COVID-19 provides the clearest illustration yet that prison health is public health. It is more important than ever for our governments and prison administrations to abide by the principle, enshrined in international law, that prisoners have an equal right to health and healthcare. Realistically, the only way that most countries could afford to meet this obligation is by first reducing their use of incarceration. This means ruling out custody for less serious, non-violent offending; and reversing the recent growth in the length of prison sentences.
“Has COVID-19 Changed Crime? Crime Rates in the United States during the Pandemic” (2020 Jul 8)Edit

John H. Boman, IV and Owen Gallupe; “Has COVID-19 Changed Crime? Crime Rates in the United States during the Pandemic”, Am J Crim Justice. 2020 Jul 8 : 1–9.

  • In response to the COVID-19 pandemic, state-level governments across the United States issued mandatory stay-at-home orders around the end of March 2020. Though intended to stop the spread of the COVID-19 virus, the lockdowns have had sweeping impacts on life in ways which were not originally planned. This study’s purpose is to investigate the extent to which governmental responses to COVID-19 have impacted crime rates in the U.S. Compared to the pre-pandemic year of 2019, crime – as measured by calls for service to law enforcement – has decreased markedly. However, there are multiple indications that the crime drop is being driven by decreases in minor offenses which are typically committed in peer groups. At the same time, serious crimes which are generally not committed with co-offenders (namely homicide and intimate partner violence) have either remained constant or increased. As such, the crime drop appears to be hiding a very disturbing trend where homicides remain unchanged and intimate partner batteries are increasing. Since many offenders would presumably be committing less serious crimes in a non-pandemic world, we raise attention to the possibility that mandatory lockdown orders may have taken minor offenders and placed them into situations where there is rampant opportunity for intimate partner violence, serious batteries, and homicides. While crime in the U.S. appears to be down overall, this good news should not blind us to a troubling co-occurring reality – a reality that paints a dim picture of unintended consequences to public health and criminal justice finances as a result of COVID-19 lockdowns.
  • Worldwide lockdowns and quarantines issued in response to the COVID-19 global pandemic have brought about a number of implications for everyday life. Unfortunately, most of the impacts of COVID-19 and the resulting lockdowns have been alarmingly negative – a gradually increasing death toll, job losses, unemployment, and a looming global financial crisis are among the most commonly reported issues worldwide. However, the pause to everyday life initiated by state governments in response to COVID-19 has resulted in scattered examples of positive changes as well. For instance, a notable drop in carbon-based emissions has reduced air pollution (Bauwens et al., 2020). Partially as a result of this, air quality across the globe has improved, resulting in a decline in the number of air-pollutant-instigated respiratory health problems (Dutheil, Baker, & Navel, 2020).
  • Nearly every major news source which has reported on this issue since COVID-19 lockdowns began have found a similar phenomenon: Crime is down across the United States. The most common metric of these reports is police calls for service (911 calls). Probably due to the fact that 911 calls are concrete events which are easily trackable over time, major news outlets like The Washington Post (Jackman, 2020), USA Today (Jacoby, Stucka, & Phillips, 2020), and CNN (Waldrop, 2020) have all used this as the metric for determining that crime is down across the U.S.
    In these major news sources, the extent to which crime has decreased since COVID-19 lockdowns began varies dramatically. For example, The Washington Post (Jackman, 2020) reported decreases in calls for service in 29 of 30 jurisdictions including a 25% decline in Chicago and ~ 20% in Washington and Baltimore between March 16 and April 22, 2020 compared to the same period in 2019. USA Today reported that weekly calls for service dropped “at least” 12% between February 2 and March 28, 2020 across 30 police agencies (Jacoby et al., 2020). Although not providing exact numbers, CNN reports that calls for police service are down in New York City. Regarding the crime drop, New York City Police Commissioner Dermot Shea told CNN that “Crime has dropped off – off the face of the map, really” (Waldrop, 2020).
  • Despite having a well-executed study that points to emerging evidence as to how COVID-19 is impacting crime rates, Ashby (2020) faced the same limitations all criminologists currently do about how crime is fluctuating in response to COVID-19: A lack of sufficient data. The most widely available data source right now on judging how COVID-19 has impacted crime comes from publicly available police data. The limitations of official police data are well documented. Due to police simply not knowing about offenses due to under/non-reporting of crime (MacDonald, 2002), police data do a very poor job at capturing one of Ashby’s variables – serious assaults which occur within the home. This variable is capturing something that is similar to, but not synonymous with, intimate partner violence (IPV; see Ashby’s discussion on p. 14). Evidence dating back over 20 years demonstrates that IPV is most frequently not reported to the police (e.g., Bachman & Saltzman, 1995). While estimates vary, only about half of IPV incidents result in a 911 call (Reaves, 2017). And due to the frequent ambiguity of 911 calls (see New Jersey Division of Criminal Justice, 2003) and the common situation where law enforcement officers cannot substantiate a domestic battery occurring (only about 40% of cases result in arrest; Reaves, 2017), IPV is certainly an underestimated variable with police data (cf. Bachman & Saltzman, 1995; Reaves, 2017; also see Gracia, 2004). Self-report data on perpetration or victimization data would be highly preferential to capture IPV (see Straus & Gelles, 1990).
  • During COVID-19 lockdowns, peer dynamics have clearly been altered due to stay-at-home orders and social distancing requirements. We argue that these disruptions to established social patterns are the driving force behind the reduction in offending over the course of the pandemic. Without access to peer groups, the context in which much criminal behavior occurs is removed (Osgood, Wilson, O’Malley, Bachman, & Johnston, 1996). With no school to attend, students cannot congregate afterwards. This is important since a typical day would see a ‘spike’ in crime after school lets out when youthful offenders have little to no supervision (see Gottfredson, Gottfredson, & Weisman, 2001). While the after-school crime spike is a time and context in which substantial amounts of minor offending typically occurs, it cannot occur if adolescents are not attending school.
    During the stay-at-home order, the opportunity for underage drinking with friends – and the minor offending that often accompanies it – also largely disappears without the option of attending parties. Since groupy offenses constitute the majority of criminal acts, it is likely that the NIBRS data will eventually show that they carried the bulk of the crime reduction following state government responses to COVID-19. Supporting this anecdotally, Chief Tullis noted that since the start of mandatory lockdowns in Ohio, his officers are seeing very few peer groups coming into conflict with the law. Underage drinking is nearly non-existent since nobody is going out in groups. In fact, nearly everyone getting arrested in his department’s jurisdiction are acting alone. Due to the commonality of arresting people who are committing crime with co-offenders, Chief Tullis stressed that the lockdowns issued in response to COVID-19 have represented a dramatic shift in policing.
”Prisons and custodial settings are part of a comprehensive response to COVID-19” (2020 Apr; 5)Edit

Stuart A Kinner, Jesse T Young, Kathryn Snow, Louise Southalan, Daniel Lopez-Acuña, Carina Ferreira-Borges, and Éamonn O'Moore; ”Prisons and custodial settings are part of a comprehensive response to COVID-19”, Lancet Public Health. 2020 Apr; 5(4): e188–e189.

  • Prisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to health-care services relative to that in community settings. Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19).
  • Prisons concentrate individuals who are susceptible to infection and those with a higher risk of complications. COVID-19 has an increased mortality in older people and in those with chronic diseases or immunosuppression. Notably, multimorbidity is normative among people in prison, often with earlier onset and greater severity than in the general population, and prison populations are ageing in many countries.7 Furthermore, inadequate investment in prison health, substantial overcrowding in some prison settings, and rigid security processess have the potential to delay diagnosis and treatment.
    As such, COVID-19 outbreaks in custodial settings are of importance for public health, for at least two reasons: first, that explosive outbreaks in these settings have the potential to overwhelm prison health-care services and place additional demands on overburdened specialist facilities in the community; and second, that, with an estimated 30 million people released from custody each year globally, prisons are a vector for community transmission that will disproportionately impact marginalised communities.
  • Prison health is public health by definition. Despite this and the very porous borders between prisons and communities, prisons are often excluded or treated as separate from public health efforts. The fast spread of COVID-19 will, like most epidemics, disproportionately affect the most disadvantaged people. Therefore, to mitigate the effects of prison outbreaks on tertiary health-care facilities and reduce morbidity and mortality among society's most marginalised, it is crucial that prisons, youth detention centres, and immigration detention centres are embedded within the broader public health response.

EducationEdit

  • "We're going to have a mental health epidemic among our children in this country. …The poorest kids, they know people who died, they know people who are sick. The very air you breathe, the people you pass on the street are suddenly dangerous to you. All of that trauma is going to come into our schools and into our classrooms, and we really need to prepare for this.
  • "As a pediatrician, I am really seeing the negative impacts of these school closures on children," Dr. Danielle Dooley, a medical director at Children's National Hospital in Washington, D.C., told NPR. She ticked off mental health problems, hunger, obesity due to inactivity, missing routine medical care and the risk of child abuse — on top of the loss of education. "Going to school is really vital for children. They get their meals in school, their physical activity, their health care, their education, of course."
  • A recent study from Yale University could potentially shed some light on these questions. It tracked 57,000 childcare workers, located in all 50 states, Washington, D.C., and Puerto Rico, for the first three months of the pandemic in the United States. About half continued caring for very young children, such as the children of essential workers, while the other half stayed home. The study found no difference in the rate of coronavirus infections between the two groups, after accounting for demographic factors.
    Walter Gilliam, lead author of the study and a professor of psychology at the Yale Child Study Center, cautioned that it's difficult to generalize this report to a K-12 schools setting, because the children were mostly under the age of 6 and kept in very small groups — and, he said, the childcare workers were trained in health and safety and reported following strict protocols around disinfection. However, he said, "I think it would be great to do this study with school teachers and see what we can find out."
  • When you add up what we know and even what we still don't know, some doctors and public health advocates said there are powerful arguments for in-person schooling wherever possible, particularly for younger students and those with special needs.
    "Children under the age of 10 generally are at quite low risk of acquiring symptomatic disease," from the coronavirus, said Dr. Rainu Kaushal of Weill Cornell Medicine. And they rarely transmit it either. It's a happy coincidence, Kaushal and others said, that the youngest children face lower risk and are also the ones who have the hardest time with virtual learning.
  • “It’s not reasonable to ask adolescents and young adults to take on additional risks for the enjoyment of spectators and the financial gain of their universities,” said Dr. Adam Ratner, the director of pediatric infectious diseases at New York University School of Medicine and Hassenfeld Children’s Hospital at N.Y.U. Langone Health.
    There are places where athletes have been exempt from campus shutdowns, he said: “Everyone is used to there being a different set of rules for athletic programs at universities,” and it’s particularly troubling to see that playing out in a pandemic.
  • “These schools have reached the conclusion, right or wrong, that because of the risks of the virus, students should be at home with their families, studying on Zoom,” Mr. Edelman said. “But they’re willing to take a small number of students, who are disproportionately minorities, and fly them back and forth across the country to compete in sporting events indoors because it’s revenue-generating. Ethically, that’s appalling, and logically it doesn’t make sense.”
  • Dr. Dean said that in his experience, the students involved in fall sports had been particularly careful to follow the rules about reducing possible Covid exposure. “The fall sport athletes have something to lose, they’re being safe, not going to parties,” he said. “They want to play,” and they know that if they test positive, they can’t.
    His colleague Dr. James Nataro, the chairman of pediatrics at the University of Virginia, who is a pediatric infectious diseases expert who studies emerging infections, said that the university, which had students on campus and held in-person classes in the fall, generally did well. “Against almost every prediction, the students complied, the students were just wonderful,” he said.
    The school is part of the Atlantic Coast Conference, which modified its schedule to include more in-conference games, Dr. Nataro said, and spectators were kept to a minimum. Still, he said, it was clear, watching football games, that “there were lots of opportunities for transmission,” and some of the good results may have been a matter of luck. And though he himself loves football, he said, he worries about “the lesson it sends if people turn on the TV and watch all these guys without masks standing next to each other — that image isn’t lost.”
  • On Oct. 14, the Infectious Diseases Society of America gave a briefing on safe school reopenings. Bottom line? "The data so far are not indicating that schools are a superspreader site," said Dr. Preeti Malani, an infectious disease specialist at the University of Michigan's medical school.
“The virus that shut down the world: Education in crisis” (28 December 2020)Edit
 
A learning crisis already existed before COVID-19 hit. We are now looking at an even more divisive and deepening education crisis.

Raphael Pouget, “The virus that shut down the world: Education in crisis”, UNICEF, (28 December 2020)

  • School closures as a result of health and other crises are not new, at least not in the developing world, and the potentially devastating consequences are well known; loss of learning and higher drop-out rates, increased violence against children, teen pregnancies and early marriages.
    What sets the COVID-19 pandemic apart from all other crises is that it has affected children everywhere and at the same time.
    It is the poorest, most vulnerable children who are hurt the most when schools close and so the UN was quick to advocate for continuity of learning, and the safe opening of schools, where possible, as countries began to put lockdown measures in place: “unfortunately, the global scale and speed of the current educational disruption is unparalleled and, if prolonged, could threaten the right to education”, Audrey Azoulay, the head of the UN education agency, UNESCO, warned in March.
  • [F]or millions of children, the idea of an online virtual classroom is an unattainable dream. In April, UNESCO revealed startling divides in digitally based distance learning, with data showing that some 830 million students do not have access to a computer.
    The picture is particularly bleak in low-income countries: nearly 90 per cent of students in sub-Saharan Africa do not have household computers while 82 per cent are unable to get online. “A learning crisis already existed before COVID-19 hit”, a UNICEF official said in June.” We are now looking at an even more divisive and deepening education crisis.”
    However, in many of the developing countries where online or computer learning are not an option for most students, radio still has the power to reach millions of people and is being used to keep some form of education going.
  • [T]he UN was warning in August that the long-term impact of disrupted education could create a “lost generation” of children in Africa. A World Health Organization (WHO) survey of 39 sub-Saharan African countries revealed that schools were open in only six nations and partially open in 19.
    By the end of the year, 320 million children were still locked out of schools worldwide, and UNICEF felt compelled to issue a call for governments to prioritize school reopening and make classrooms as safe as possible.
    “What we have learned about schooling during the time of COVID is clear: the benefits of keeping schools open, far outweigh the costs of closing them, and nationwide closures of schools should be avoided at all costs”, said Robert Jenkins, UNICEF Global Chief of Education.

ExerciseEdit

  • The global outbreak of COVID-19 has resulted in closure of gyms, stadiums, pools, dance and fitness studios, physiotherapy centres, parks and playgrounds. Many individuals are therefore not able to actively participate in their regular individual or group sporting or physical activities outside of their homes. Under such conditions, many tend to be less physically active, have longer screen time, irregular sleep patterns as well as worse diets, resulting in weight gain and loss of physical fitness. Low-income families are especially vulnerable to negative effects of stay at home rules as they tend to have sub-standard accommodations and more confined spaces, making it difficult to engage in physical exercise.
    The WHO recommends 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week. The benefits of such periodic exercise are proven very helpful, especially in times of anxiety, crisis and fear. There are concerns therefore that, in the context of the pandemic, lack of access to regular sporting or exercise routines may result in challenges to the immune system, physical health, including by leading to the commencement of or exacerbating existing diseases that have their roots in a sedentary lifestyle.
  • The laboratory study to investigate the physiological effect of wearing a facemask found that it significantly elevated heart rate and perceived exertion. Those participating in exercise need to be aware that facemasks increase the physiological burden of the body, especially in those with multiple underlying comorbidities. Elite athletes, especially those training for the upcoming Olympics, need to balance and reschedule their training regime to balance the risk of deconditioning versus the risk of infection. The multiple infection-control measures imposed by the Hong Kong national team training centre was highlighted to help strike this balance. Amidst a global pandemic affecting millions; staying active is good, but staying safe is paramount.
    • Ashley Ying-Ying Wong, Samuel Ka-Kin Ling, , Lobo Hung-Tak Louie, , George Ying-Kan Law, ,Raymond Chi-Hung So, Daniel Chi-Wo Lee, Forrest Chung-Fai Yau, Patrick Shu-Hang Yung; “Impact of the COVID-19 pandemic on sports and exercise”, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, Volume 22, (October 2020), pp. 39-44
  • Although moderate-levels of exercise can boost overall immunity. Intensive and prolonged physical exertion has been linked with an ‘open-window’ of impaired immunity up to 72 h after the exercise Common infections for athletes mostly comprises of dermatological related infections (especially in contact sports), upper respiratory tract infections, and gastrointestinal infections. The coronavirus is a respiratory pathogen and previous studies have shown that the risk of upper respiratory tract infections was almost six times more likely in endurance races. The underlying mechanism is not fully understood, although most studies suggest exercise significantly influences acquired immunity while evidence about the role of exercise on innate immunity is less conclusive. As the virus was also found in stool samples, contaminated environments, such as soil, may pose a threat to outdoor sporting events. There are still unknowns regarding the relationship of immunity and sports, therefore experts are still researching on the role of psychological factors (especially during competitions) as one of the large knowledge gaps.
    • Ashley Ying-Ying Wong, Samuel Ka-Kin Ling, , Lobo Hung-Tak Louie, , George Ying-Kan Law, ,Raymond Chi-Hung So, Daniel Chi-Wo Lee, Forrest Chung-Fai Yau, Patrick Shu-Hang Yung; “Impact of the COVID-19 pandemic on sports and exercise”, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, Volume 22, (October 2020), pp. 39-44.
  • The final impact of the COVID-19 pandemic on sports and exercise cannot be determined at this stage, however, the information that we gathered may provide valuable guidance to athletes and governing committees to move forward safely. COVID-19 is highly transmittable in sporting environments due to its viability, long incubation period, and milder symptoms; especially in contact sports. The essential preventive measures include minimizing human-to-human contact and practising proper personal hygiene. Athletes’ on-field own risky behaviours should be avoided to minimize unnecessary infection as close contact with others is unavoidable during contact sports. The decision to resume sporting events should correlate to the local number of cases and strict infection measures will need to be implemented at the early phases of resumption. Exercise with a facemask definitely has a toll on the human body and it is advised to adjust the exercise intensity when masked. Sports and exercise may be important, especially for competitive athletes, but safety is still paramount. Everyone should practice safe sports with the appropriate measures and prevent the further transmission of the COVID-19 pandemic.
    • Ashley Ying-Ying Wong, Samuel Ka-Kin Ling, , Lobo Hung-Tak Louie, , George Ying-Kan Law, ,Raymond Chi-Hung So, Daniel Chi-Wo Lee, Forrest Chung-Fai Yau, Patrick Shu-Hang Yung; “Impact of the COVID-19 pandemic on sports and exercise”, Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, Volume 22, (October 2020), pp.39-44.
  • It is safe to exercise during the coronavirus outbreak. One should not limit the multitude of health benefits that exercise provides us on a daily basis just because there is a new virus in our environment. However, there may be some additional precautions to reduce your risk of infection. If you are a “social exerciser”, you might want to limit your exposure to exercise partners who have exhibited signs and symptoms of illness. The problem, though, is that infected people may be infectious before they exhibit symptoms. In some instances, wearing a mask while exercising may be a way to reduce your exposure. It is very important to make sure that if you are exercising on equipment in fitness facilities or gymnasiums that you make sure to disinfect the equipment before and after you use it. When done exercising, the most effective way to clean hands is to wet them with clean water, then apply soap and scrub for at least 20 s, before rinsing and drying with a clean towel. Hand sanitizers with at least 60% alcohol content may also be used, but the U.S. Centers for Disease Control and Prevention warns they are not effective against all germs. This strategy should be used at all times, not just because there is an acute viral outbreak. Avoiding touching your face and neck with your hands is also advised if you cannot disinfect them until a later time.
  • The Coronavirus disease (COVID-19) crisis is now present in China. It started in December, 2019 and has, so far, led 213 individuals died and at least 9066 infected in China by local time 17:26, January 30, 2020. It has also spread to a number of Asian countries, as well as to Canada, France, Germany, and the United States. As a result, the Chinese government has put several major cities in Hubei Province on lockdown and has thrown plans for the Lunar New Year holiday into chaos for millions of people. On January 30, 2020, the World Health Organization also declared the COVID-19 outbreak a global health emergency because it could spread to countries that are not prepared.
    Furthermore, to prevent the spread of the new and deadly virus, all cities in China now have shut down most public places and facilities, including parks, leaving many people with no place to exercise. As a result, people may wonder if one should exercise at all during the outbreak and if so, how? These questions made Journal of Sport and Health Science remember some well-known studies done by my colleague, Dr. Jeffrey A. Woods and his team at the University of Illinois at Urbana-Champaign (UIUC), in which they found a protective effect of exercise on mortality due to influenza in mice.

Forestry and land managementEdit

  • Disinfection in a cave environment is very different compared to a home or business. Microbes, including many types of viruses, occur naturally in caves. They are harmless and part of the natural ecosystem and natural processes within the cave. These microbes, particularly in some deep and old caves, can be very unusual creatures. Some produce chemicals or may have genetics that can be of benefit to people for advances in medicine, agriculture and other fields. In our National Parks caves we want to kill the Covid-19, but not impact our natural, original microbe community.
    Disinfectant sprays are handy and effective since each spray disinfects a relatively large area. But, in caves that is opposite of what you want. Disinfecting a large area means killing natural cave microbes. Right now, Covid-19 comes from people and is spread to other people. So, the key is to only disinfect the areas where people travel through the cave and the facilities they use to do so.
  • The global COVID-19 pandemic will pose unique challenges to the management of wildland fire in 2020. Fire camps may provide an ideal setting for the transmission of SARS-CoV-2, the virus that causes COVID-19. However, intervention strategies can help minimize disease spread and reduce the risk to the firefighting community. We developed a COVID-19 epidemic model to highlight the risks posed by the disease during wildland fire incidents. Our model accounts for the transient nature of the population on a wildland fire incident, which poses unique risks to the management of communicable diseases in fire camps. We used the model to assess the impact of two types of interventions: the screening of a firefighter arriving on an incident, and social distancing measures. Our results suggest that both interventions are important to mitigate the risks posed by the SARS-CoV-2 virus. However, screening is relatively more effective on short incidents, whereas social distancing is relatively more effective during extended campaigns.

Mental healthEdit

  • Despite the need for distance, social interaction still represents an important part of mental health care for children, clinicians said. Facilities have come up with various ways to do so safely, including creating smaller pods for group therapy. Kids at Cincinnati Children's can play with toys, but only with ones that can be wiped clean afterward. No cards or board games, said Dr. Suzanne Sampang, clinical medical director for child and adolescent psychiatry at the hospital.
    "I think what's different about psychiatric treatment is that, really, interaction is the treatment," she said, "just as much as a medication."
    The added infection-control precautions pose challenges to forging therapeutic connections. Masks can complicate the ability to read a person's face. Online meetings make it difficult to build trust between a patient and a therapist.
    "There's something about the real relationship in person that the best technology can't give to you," said Robb.
“Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19” (2020 Nov)Edit

Maria Elizabeth Loades, Eleanor Chatburn, Nina Higson-Sweeney, Shirley Reynolds, Roz Shafran, Amberly Brigden, Catherine Linney, Megan Niamh McManus, Catherine Borwick, and Esther Crawley; “Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19”, J Am Acad Child Adolesc Psychiatry. 2020 Nov; 59(11): 1218–1239.e3.

  • The COVID-19 pandemic has resulted in governments implementing disease containment measures such as school closures, social distancing, and home quarantine. Children and adolescents are experiencing a prolonged state of physical isolation from their peers, teachers, extended families, and community networks. Quarantine in adults generally has negative psychological effects including confusion, anger, and posttraumatic distress. Duration of quarantine, fear of infection, boredom, frustration, lack of necessary supplies, lack of information, financial loss, and stigma appear to increase the risk of negative psychological outcomes. Social distancing and school closures may therefore increase mental health problems in children and adolescents, already at higher risk of developing mental health problems compared to adults at a time when they are also experiencing anxiety over a health threat and threats to family employment/income.
    Social distancing and school closures are likely to result in increased loneliness in children and adolescents whose usual social contacts are curtailed by the disease containment measures. Loneliness is the painful emotional experience of a discrepancy between actual and desired social contact. Although social isolation is not necessarily synonymous with loneliness, early indications in the COVID-19 context indicate that more than one-third of adolescents report high levels of loneliness and almost half of 18- to 24-year olds are lonely during lockdown.7 There are well established links between loneliness and mental health. The purpose of this review was to establish what is known about the relationship between loneliness and mental health problems in healthy children and adolescents, and to determine whether disease containment measures including quarantine and social isolation are predictive of future mental health problems.
  • This rapid systematic review of 63 studies of 51,576 participants found a clear association between loneliness and mental health problems in children and adolescents. Loneliness was associated with future mental health problems up to 9 years later. The strongest association was with depression. These findings were consistent across studies of children, adolescents, and young adults. There may also be sex differences, with some research indicating that loneliness was more strongly associated with elevated depression symptoms in girls and with elevated social anxiety in boys. The length of loneliness appears to be a predictor of future mental health problems. This is of particular relevance in the COVID-19 context, as politicians in different countries consider the length of time that schools should remain closed, and the implementation of social distancing within schools.
    Furthermore, in the one study that examined mental health problems after enforced isolation and quarantine in previous pandemics, children who had experienced enforced isolation or quarantine were five times more likely to require mental health service input and experienced higher levels of posttraumatic stress. This suggests that the current social distancing measures enforced on children because of COVID-19 could lead to an increase in mental health problems, as well as possible posttraumatic stress. These results are consistent with preliminary unpublished data emerging from China during the COVID-19 pandemic, where children and adolescents aged 3 to 18 years are commonly displaying behavioral manifestations of anxiety, including clinginess, distraction, fear of asking questions about the pandemic, and irritability. Furthermore, a large survey of young adult students in China has reported that around one in four are experiencing at least mild anxiety symptoms. In the United Kingdom, early results from the Co-SPACE (COVID-19 Supporting Parents, Adolescents and Children in Epidemics) online survey of more than 1,500 parents suggest high levels of COVID-19−related worries and fears, with younger children (aged 4−10 years) significantly more worried than older children and adolescents (aged 11−16 years).
  • It is difficult to predict the effect that COVID-19 will have on the mental health of children and young people. The subjective social isolation experienced by study participants did not mirror the current features of social isolation experienced by many children and adolescents worldwide. Social isolation was not enforced upon the participants, nor was social isolation almost ubiquitous across their peer groups and across the communities in which they lived. As loneliness involves social comparison,91 it is possible that the shared experience of social isolation imposed by disease containment measures may mitigate the negative effects. The studies were also not in the context of an uncertain but dangerous threat to health. These features limit the extent to which we can extrapolate from existing evidence to the current context. To make evidence-based decisions on how to mitigate the impact of a second wave, we need further research on the mental health impacts of social isolation in the disease containment context of a global pandemic.

Public healthEdit

  • According to the United Nations, about 1 billion persons live in so-called slums. Numerous studies have shown that this population is particularly vulnerable to infectious diseases. The current COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, emphatically underlines this problem. The often high-density living quarters coupled with a large number of persons per dwelling and the lack of adequate sanitation are reasons why measures to contain the pandemic only work to a limited extent in slums. Furthermore, assignment to risk groups for severe courses of COVID-19 caused by noncommunicable diseases (eg, cardiovascular diseases) is not possible due to inadequate data availability. Information on people living in slums and their health status is either unavailable or only exists for specific regions (eg, Nairobi). We argue that one of the greatest problems with regard to the COVID-19 pandemic in the context of slums in the Global South is the lack of data on the number of people, their living conditions, and their health status.
  • During the 2019 flu season from Sept. 29 to Dec. 28, the CDC reported more than 65,000 cases of influenza nationwide. During the same period this flu season, the agency reported 1,016 cases.
    Health experts said that high vaccination rates against the flu – combined with social distancing, mask-wearing and hand-washing employed to stop the spread of the coronavirus – played a huge role in preventing influenza transmission.
  • Rehm said Americans were especially motivated to get a flu vaccine last year as health experts warned hospitals could be overwhelmed by flu and COVID-19 patients in a “twindemic” scenario.
    “A lot of people in the past haven’t felt that flu was very severe and thus haven’t necessarily felt so motivated to get vaccinated,” she said. “Certainly, COVID has taught us that respiratory illnesses can be extremely severe.”
“In Ambulances, an Unseen, Unwelcome Passenger: COVID-19” (Jan 25, 2021)Edit

“In Ambulances, an Unseen, Unwelcome Passenger: COVID-19”, “Associated Press”, (Jan 25, 2021)

  • For EMTs Thomas Hoang and Joshua Hammond, the coronavirus is constantly close. COVID-19 has become their biggest fear during 24-hour shifts in California's Orange County, riding with them from 911 call to 911 call, from patient to patient.
    They and other EMTs, paramedics and 911 dispatch-ers in Southern California have been thrust into the front lines of the national epicenter of the pandem-ic. They are scrambling to help those in need as hospitals burst with a surge of patients after the holi-days, ambulances are stuck waiting outside hospitals for hours until beds become available, oxygen tanks are in alarmingly short supply and the vaccine rollout has been slow.
  • Statistics on COVID-19 cases and deaths among EMTs and paramedics — especially ones employed by private companies — are hard to find. They are considered essential health care workers but rarely receive the pay and protections given to doctors and nurses.
  • Unlike doctors and nurses, first responders must go inside homes. They walk into hot zones where everyone in a household is sick, where the virus is in the air. They lift immobile patients onto gurneys, their masked faces just inches apart.
    They race to hospitals already overwhelmed with sick people, sometimes only to wait hours outside before their patient can be admitted. And then they do it all again when the next 911 call comes in.
  • When an EMT reports a positive COVID-19 test, the dispatchers must find a way to cover the ambulance's calls if the whole crew must quarantine. When one household has multiple coronavirus patients requiring two ambulances, the dispatchers have to plug the hole.
    Their greatest fear is what's called a “level zero” — when there are no ambulances left to send to an emergency. In Los Angeles County, one of the nation's hardest-hit counties during the pandemic, the fear becomes a regular reality.

SexologyEdit

  • For the first time in years, rates of chlamydia, gonorrhea and syphilis, which had been on track in 2020 to hit record highs in the United States, have taken an abrupt downturn.
    This should be good news. The coronavirus pandemic has certainly kept more people away from bars, night clubs and large parties, reducing opportunities for unsafe sex, studies show.
    But the drop is more likely a harbinger of bad news, experts in reproductive and sexual health believe. They say the pandemic has seriously hindered efforts to mitigate sexually transmitted infections that can lead to pelvic inflammatory dis-ease, chronic pain, infertility and even blindness and death in newborns. Rather than showing sexually transmitted diseases are on the run, the upbeat numbers likely signal instead that they are now going largely undetected.
    In communities across the country, contact tracers for gonorrhea and syphilis, which had already been severely understaffed, have been diverted to Covid-19 cases. Eighty percent of sexual health screening clinics reported having to reduce hours or shut down altogether sometime during the pandemic, according to a survey by the National Coalition of STD Directors.
  • Social scientists are exploring how the coronavirus outbreaks have affected sexual behavior. Justin Lehmiller, a social psychologist at the Kinsey Institute, which has been issuing surveys during the pandemic to about 2,000 people, gay, straight and bisexual, said that even those in continuing relationships reported having less sex in the first months. “Higher levels of stress and anxiety are pushing down de-sire,” he said. “Singles have more challenges to hooking up.”
    But when doctors and nurse practitioners who work with teenagers were asked if the pandemic had slowed down their patients’ sexual activity, they replied that, anecdotally speaking, not at all. Dr. Bolan said that one New York pediatrician reported that she’d treated many teenagers for S.T.D.s.
  • Even if sex has declined, researchers question how long it can remain suppressed. Dr. Lehmiller noted that online dating apps report record business. Whether that translates into sexual activity rather than virtual meet-ups is unclear, he said. If people are returning to normal levels of encounters, they may not want to admit it.
    “There is shaming about traveling, social events and gatherings during the pan-demic, so sex and dating is seen as part of that,” he said.
  • Dating is a complicated and often clumsy dance even in the best of times. Add in mask-wearing directives, social distancing and fear of a highly contagious virus for which there is no cure, and you get… well, an awful lot of people going out and doing some version of it anyway. A survey conducted by Everlywell — a company that makes at-home health tests — found that nearly one in four Americans ages 20 to 31 broke quarantine to have sexual contact with someone in April, when stay-at-home orders were at their peak.
  • “My best advice is to tell the date beforehand that you intend to wear a mask and would like the date to do so as well,” Dr. Helweg-Larsen wrote. “You can also practice what to say if the date is resisting (something simple like, ‘please put on your mask’ or, ‘you are protecting me with your mask’) or you can use non-verbal communication like stepping or turning away from someone.”
“Why the coronavirus might change dating forever” (May 25 2020)Edit

MacKenzie Sigalos, “Why the coronavirus might change dating forever”, CNBC, (May 25 2020)

  • In New York, the epicenter of the COVID-19 outbreak in the U.S., the city’s health department put out a set of guidelines entitled, “Sex and coronavirus disease.” One piece of official advice: “You are your safest sex partner.”
    Dating is hard enough in the best of times. Throw in government directives like this, plus nationwide social distancing mandates, and a highly contagious virus for which there’s no cure or vaccine, and you would expect the search for love to be the last thing on everyone’s mind. But dating is thriving.
  • Before the pandemic, online dating fatigue was taking hold. Dating app downloads for the top 15 apps was shrinking globally, and research showed that all that swiping just made people lonelier.
    The pandemic, at least by some metrics, has been great for business. Dating.com reported that global online dating was up 82% during early March, for example.
    As states across the country began rolling out stay-at-home orders in March 2020, Bumble saw a 26% increase in the number of messages sent on its platform, a company spokesperson told CNBC. Tinder saw the length of conversations rise by 10-30%, and elite dating app Inner Circle saw messages rise 116% over that same time period.
  • Turns out, dating during a global pandemic and being a contestant on “Love is Blind” aren’t too dissimilar. Both scenarios beg the obvious question: Can you truly gauge physical chemistry in a virtual setting?
  • Fisher thinks COVID-19 has given way to a new stage in the courtship process.
    “You know, years ago, marriage used to be the beginning of a partnership. Now it’s the finale,” says Fisher. “All of my data show that the longer the courtship process is, the more likely people are to remain together and create a stable partnership.”
“Coronavirus has changed online dating. Here’s why some say that’s a good thing” (May 15, 2020)Edit

Courtney Vinopal, “Coronavirus has changed online dating. Here’s why some say that’s a good thing”, Nation, (May 15, 2020)

  • “It’s an excellent time for singles to date,” said Helen Fisher, the chief scientific adviser to Match.com and a senior research fellow at The Kinsey Institute. “People have time. They’re not getting dressed up to go to work. And most importantly, they have something to talk about.”
    Not everyone, though, is keen to get into online dating, even if spending more time than usual alone at home has made some otherwise happily single people reconsider their feelings about finding a long-term companion. Not to mention that the pandemic has ushered in mass unemployment, higher levels of stress, greater strain for single parents and worries about fatal risks from stepping outside your door — factors not necessarily conducive to romance.
  • Fifty years ago, a global pandemic might have hindered single people from connecting with prospects through their family, friends or faith communities. But these days, most people are connecting virtually to start anyway. “The influence of technology on our romantic and sexual lives has been so enormous,” said Justin Garcia, an evolutionary biologist and sex researcher at The Kinsey Institute. “From online dating, to texting, video chatting, sexting, etc., we have already been in the midst of a digital revolution for human courtship,” he added, so it’s not a huge surprise that singles would continue dating this way in the midst of a pandemic.
  • The stay-at-home orders issued across the country have been a boon for some of the major online dating apps. “As a city goes into lockdown, engagement on OKCupid goes up,” the app’s global chief marketing officer, Melissa Hobley, said. Since March, the company has seen a whopping 700 percent increase in the amount of OKCupid users going on a virtual date. The app Hornet, which caters to the gay male community, has seen a 30-percent increase in social feed engagement since social distancing measures began in mid-March, according to CEO Christ of Wittig. And the dating app Tinder reported that it saw more engagement on March 29 than on any other day in its history, with more than 3 billion users swiping to connect with people, according to an April 1 press release.
  • A study conducted by Match found that while only 6 percent of singles were using a video platform to meet a potential date before the COVID-19 outbreak, 69 percent of singles said they’d be open to chatting over video with someone they met on a dating app during quarantine as of mid-April. Twenty-two percent of these respondents even said they’d consider entering an exclusive relationship with someone they hadn’t met in person, indicating an openness to cultivating relationships mostly online. As of the end of April 23, 51 percent of users on the dating app Coffee Meets Bagel said they planned to video chat more, and 18 percent had had at least one video call with a match.
  • Before the novel coronavirus hit, U.S. couples were already getting married later in life than ever be-fore. Helen Fisher said what’s happening now is increasing the amount of time people spend in a “courtship” stage even more.
    “We’re seeing the emergence of a new phase in the courtship trajectory, which is meet online, talk online, then talk in person,” Fisher added. “Yes, we’re moving forward to the past. We’re getting to know somebody before the sex.”
  • “When your daily habits change, it’s novel. And novelty drives up dopamine in the brain,” the biological anthropologist said. “The novelty is setting up the brain, priming the brain for love. It’s a very good time for romance.”
    “I truly believe this is how you need to get to know people, anyway,” Price said. “This kind of slowed us both down and made us calculate how and when we wanted to do things. It’s been fun.”

Lockdowns/self-isolationEdit

  • Without the mitigation effects offered through quarantine and isolation, the actual progress of the disease in the rest of the world will certainly be much more devastating than the harrowing scenes witnessed to date in China, Europe, and the United States. Moreover, workers involved in informal and precarious labor often live in slums and overcrowded housing — ideal conditions for the explosive spread of the virus.
  • Radical containment measures have been used to curb the pandemic in some affected countries. The approach taken in South Korea was especially effective, done by rapidly applying extensive testing, quarantine, and contact tracing of individuals from a large church group in the early stages of the outbreak. Also, schools were closed, and all international arrivals were quarantined for 2 weeks. China, South Korea, and Singapore show that mitigation using a combination of contact tracing and rigorous social distancing measures is possible. However, new outbreaks have started to occur in each of these countries and renewed control measures have been implemented
    Countries such as Denmark, Italy, Spain, and Germany have relied mostly on social distancing and hygiene measures, in population lockdowns of various magnitudes of intensity. Such draconic measures were used when the epidemics were progressing too fast and capacity for effective case identification, contact tracing, and containment became impossible. The consensus is that rigorous mitigation measures are needed early to slow down SARS-CoV-2 transmission. Drastic measures of quarantine and mobility restrictions put in place by China, Europe, and the USA are no different than those used for plague in the 14th century. The COVID-19 pandemic so far has shown that such measures could possibly halt the pandemic if individuals follow the specific country guidelines.

“Inferring the effectiveness of government interventions against COVID-19” (15 Dec 2020)Edit

Jan M. Brauner, Sören Mindermann, Mrinank Sharma, David Johnston, John Salvatier, Tomáš Gavenčiak, Anna B. Stephenson, Gavin Leech, George Altman, Vladimir Mikulik, Alexander John Norman, Joshua Teperowski Monrad, Tamay Besiroglu, Hong Ge, Meghan A. Hartwick, Yee Whye Teh, Leonid Chindelevitch, Yarin Gal, Jan Kulveit; “Inferring the effectiveness of government interventions against COVID-19”, Science, (15 Dec 2020)

  • Worldwide, governments have mobilized resources to fight the COVID-19 pandemic. A wide range of nonpharmaceutical interventions (NPIs) has been deployed, including stay-at-home orders and the closure of all nonessential businesses. Recent analyses show that these large-scale NPIs were jointly effective at reducing the virus’ effective reproduction numbe, but it is still largely unknown how effective individual NPIs were. As more data become available, we can move beyond estimating the combined effect of a bundle of NPIs and begin to understand the effects of individual interventions. This can help governments efficiently control the epidemic, by focusing on the most effective NPIs to ease the burden put on the population.
  • Our model enabled us to estimate the individual effectiveness of each NPI, expressed as a percentage reduction in Rt. We quantified uncertainty with Bayesian prediction intervals, which are wider than standard credible intervals. These reflect differences in NPI effectiveness across countries among several other sources of uncertainty. Bayesian prediction intervals are analogous to the standard deviation of the effectiveness across countries, rather than the standard error of the mean effectiveness. Under the default model settings, the percentage reduction in Rt (with 95% prediction interval) associated with each NPI was: limiting gatherings to 1000 people or less: 23% (0 to 40%); to 100 people or less: 34% (12 to 52%); to 10 people or less: 42% (17 to 60%); closing some high-risk face-to-face businesses: 18% (−8 to 40%); closing most nonessential face-to-face businesses: 27% (−3 to 49%); closing both schools and universities in conjunction: 38% (16 to 54%); and issuing stay-at-home orders (additional effect on top of all other NPIs): 13% (−5 to 31%). Note that we were not able to robustly disentangle the individual effects of closing schools and closing universities since these NPIs were implemented on the same day or in close succession in most countries [except Iceland and Sweden, where only universities were closed]. We thus reported “schools and universities closed in conjunction” as one NPI.
  • We categorized NPI effects into small, moderate, and large, which we define as a posterior median reduction in Rt of less than 17.5%, between 17.5 and 35%, and more than 35% (vertical lines in Fig. 4). Four of the NPIs fell into the same category across a large fraction of experimental conditions: closing both schools and universities was associated with a large effect in 96% of experimental conditions, and limiting gatherings to 10 people or less had a large effect in 99% of conditions. Closing most nonessential businesses had a moderate effect in 98% of conditions. Issuing stay-at-home orders (i.e., in addition to the other NPIs) fell into the “small effect” category in 96% of experimental conditions. Three NPIs fell less clearly into one category: Limiting gatherings to 1000 people or less had a moderate-to-small effect (moderate in 81% of conditions) while limiting gatherings to 100 people or less had a moderate-to-large effect (moderate in 66% of conditions). Finally, closing some high-risk businesses, including bars, restaurants, and nightclubs had a moderate-to-small effect (moderate in 58% of conditions). Limiting gatherings to 1000 people or less was the NPI with the highest variation in median effectiveness across the experimental conditions, which may reflect the NPI’s partial collinearity with limiting gatherings to 100 people or less.
  • Business closures and gathering bans both seem to have been effective at reducing COVID-19 transmission. Closing most nonessential face-to-face businesses was only somewhat more effective than targeted closures, which only affected businesses with high infection risk, such as bars, restaurants, and nightclubs. Therefore, targeted business closures can be a promising policy option in some circumstances. Limiting gatherings to 10 people or less was more effective than limits of up to 100 or 1000 people and had a more robust effect estimate. Note that our estimates are derived from data between January and May 2020, a period when most gatherings were likely indoors due to weather.
    Whenever countries in our dataset introduced stay-at-home orders, they essentially always also implemented, or already had in place, all other NPIs in this study. We accounted for these other NPIs separately and isolated the effect of ordering the population to stay at home, in addition to the effect of all other NPIs. In accordance with other studies that took this approach, we found that issuing a stay-at-home order had a small effect when a country had already closed educational institutions, closed nonessential businesses, and banned gatherings. In contrast, Flaxman et al. and Hsiang et al. included the effect of several NPIs in the effectiveness of their stay-at-home order (or “lockdown”) NPIs and accordingly found a large effect for this NPI. Our finding suggests that some countries may have been able to reduce Rt to below 1 without a stay-at-home order by issuing other NPIs.
  • We found a large effect for closing schools and universities in conjunction, which was remarkably robust across different model structures, variations in the data, and epidemiological assumptions. It remained robust when controlling for NPIs excluded from our study. Our approach cannot distinguish direct effects on transmission in schools and universities from indirect effects, such as the general population behaving more cautiously after school closures signaled the gravity of the pandemic. Additionally, since school and university closures were implemented on the same day, or in close succession in most of the countries we study, our approach cannot distinguish their individual effects. This limitation likely also holds for other observational studies that do not include data on university closures and estimate only the effect of school closures. Furthermore, our study does not provide evidence on the effect of closing preschools and nurseries.
    Previous evidence on the role of pupils and students in transmission is mixed. Although infected young people (aged ca. 12 to 25) are often asymptomatic, they appear to shed similar amounts of virus as older people, and might therefore infect higher-risk individuals. Early data suggested that children and young adults had a notably lower observed incidence rate than older adults—whether this was due to school and university closures remains unknown. In contrast, the recent resurgence of cases in European countries has been concentrated in the age group corresponding to secondary school and higher education (especially the latter), and is now spreading to older age groups as well as primary-school-aged children. Primary schools may be generally less affected than secondary schools, perhaps partly because children under the age of 12 are less susceptible to SARS-CoV-2.
  • [C]losing schools and universities in conjunction seems to have greatly reduced transmission, but this does not mean that reopening them will necessarily cause infections to soar. Educational institutions can implement safety measures such as reduced class sizes as they reopen. However, the nearly 40,000 confirmed cases associated with universities in the UK since they reopened in September 2020 show that educational institutions may still play a large role in transmission, despite safety measures.

See alsoEdit

External linksEdit

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