Pandemic News Links / Current News Updates

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The Best COVID Warning System? Poop and Pooled Spit, Says One Colorado School

11/3/20 ... do-school/

Carol Wilusz’s mornings now often start at 4 a.m., scanning the contents of undergraduates’ feces. Specifically, scanning the data on how much coronavirus they flushed into the shadows, destined to be extracted from 17 manholes connected to dorm buildings on Colorado State University’s Fort Collins campus.

“There are quite extensive numbers of poop jokes,” said Wilusz, a CSU molecular biologist.

Emerging research suggests infected people start shedding the coronavirus in their poop early in their infection, and possibly days before they begin shedding it from their mouths and noses. “It means that we can catch them before they’re actually spreading the infection,” she said.

In normal times, Wilusz studies stem cells and muscular dystrophy. Now, her team is on the front lines of defense against the massive COVID-19 outbreaks that, for a campus with more than 23,000 undergraduates alone, always seem to be lurking around the corner. The sewage review is part of a multipronged attack that includes the usual weapon of contact tracing plus a specialized “paired pooling” form of testing saliva samples. So far, the school has had about 500 cases since the semester started, about half that of the only somewhat bigger University of Colorado-Boulder.

Amid fluctuating scientific recommendations and a virus that still holds uncertainties, colleges across the country are taking a choose-your-own-adventure approach to COVID-19. For those holding in-person classes, the adventure includes an extra puzzle: how to concentrate a lot of people into one place without an outbreak tearing through the student body and spilling into the community, all without safety precautions that would break the bank. Testing is at the core of those plans.

“A lot of these institutions started testing just symptomatic students. And that is really not good, to put it bluntly, because as we’ve seen over the past couple of months, students tend to be asymptomatic,” said Chris Marsicano, an assistant professor at Davidson College in North Carolina who is leading an initiative tracking how universities are responding to the pandemic. “The institutions that have been the most successful are ones that are testing every student at least once a week.”

According to data collected in mid-September, only about 6% of large universities with in-person classes are routinely testing all students, according to an NPR analysis of his group’s data. The University of Illinois at Urbana-Champaign has been leading the pack, testing about 10,000 students each day using a streamlined spit-testing method. But it’s pricey. Despite driving down the cost of an individual test to about $10, Paul Hergenrother, a chemist leading the effort, said the school is still spending about $1 million a week.

At Colorado State University, Lori Lynn, co-chair of the school’s pandemic response team, said initially the school was paying $93 a pop to test students using the usual nose swab method.

“We quickly spent several million dollars on testing,” said Lynn, who added that cost is just one limiting factor. “We can’t test everybody in the community, you know, weekly or twice a week.”

Instead, Mark Zabel, a CSU molecular biologist and immunologist who typically studies neurodegenerative diseases, said his group recently figured out how to screen saliva for less than $20 a person. It involves pooling drool samples in a strategic way reminiscent of the children’s game Battleship.

Traditionally, pooling involves mixing samples from multiple people and testing them all in one go, to save time and materials. If the pool comes back negative for the virus, everyone in the pool can be considered negative. If it’s positive, samples from each person in that pool must be retested. If there are high rates of infection, that means a lot of retesting.

Instead of pooling samples willy-nilly, Zabel and his colleagues are doing something he calls paired pooling: They start with an eight-by-eight grid of saliva from 64 people, arrayed almost like a Battleship board. Each person’s spit sample gets divided up and analyzed in two pools, one pool for the row it sits in and one for the column it sits in, for a grand total of 16 pools per grid.

If the test containing samples in Row A and the test containing samples from Column One appear positive, that would indicate that the person whose spit is in the A-1 slot is a positive case.

“So, it’s super easy if we’ve got one positive among 64,” said Zabel. In that case, they’ve screened 64 people with just 16 tests. No retesting necessary.

Limited retesting is needed only if at least four pools come back positive.

They’re also using a different kind of PCR test than usual, in an effort to avoid competing for limited reagents, whose shortages have hampered labs nationwide.

Zabel said it takes between eight and 24 hours for results. However, some drawbacks exist. If retesting is necessary, total turnaround time could extend to three days. And if the outbreak were to grow beyond a certain point, in which at least 5% of people tested are positive, the process would become more cumbersome because they’d have to add more layers of testing.

It’s a shifting target and the university is continually reevaluating its testing strategy, but Zabel expects his lab could test up to 3,000 people a day, which would enable testing the entire student body every other week.

According to other researchers, that might not be enough.

Daniel Larremore and others writing in the New England Journal of Medicine said it’s time to ditch any approach that relies on highly accurate tests, and instead embrace antigen tests, which are cheap and quick — albeit less accurate — and can be administered frequently.

“You have the science of testing, which says if you’re testing everybody twice a week, you should basically have zero cases,” said Larremore, a computational biologist at the University of Colorado-Boulder, referring to modeling studies from his lab and others.

But then, there’s reality. And no testing system alone will solve the problem, Larremore said, “because there are humans involved.”

Wilusz, the CSU professor, knows how difficult this is. Often people continue shedding virus in their poop long after they’ve recovered, so over the course of the semester more and more dorms have started to yield virus-positive sewage.

“And then there’s also, we can’t stop students pooping in the wrong dorm. So one could poop in this dorm one day and then next door on the other day,” she said, making it hard to know which dorm to screen with saliva tests.

Also, only about 5,000 of the school’s 28,000 enrolled students live in dorms, though Wilusz said those close quarters create a high risk for spreading the disease because “they’re essentially like nursing homes for young people.”

She wonders how long students will remain game to spit into tubes before they get bored. Michigan State University researchers experimenting with paired pooling and saliva have made a habit of double-checking that students have submitted spit instead of something else. (Chewing tobacco and something the color of blue Gatorade have sullied a few CSU samples so far.)

But the shifting, multifaceted approach does seem to be helping at Colorado State. Back in September, Wilusz noticed a concerning spike in the amount of virus in the sewage connected to two dorms that collectively housed about 900 students. The university put the dorms on lockdown and tested everyone inside, revealing nine positive cases that hadn’t been found using other methods.

Now, with pooled-spit screening, Zabel said the team has been able to identify positives without locking down entire dorms, and can then use subsiding levels in sewage to confirm no infections slipped through the cracks.

The goal is to make it to Thanksgiving, when students return home. But then comes 2021. “We’ll see if we can keep on top of it,” Zabel said, knocking on his desk for luck.
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It's getting harder to tell how Americans are catching the coronavirus

November 5, 2020 ... rus-spread

Amid a surge in novel coronavirus cases nationwide, it's getting harder for public health officials to get an accurate count of how many Americans have been infected with the virus—and to pinpoint how Americans contracted the pathogen, the New York Times reports.

4 actions to take before the next Covid-19 surge (and resources to help)
It's getting harder to track how many Americans have been infected, experts say

Currently, the two most commonly used types of coronavirus tests in America are polymerase chain reaction (PCR) tests and antigen tests. Antigen tests produce results faster than PCR tests, but they're less likely to detect lower levels of the novel coronavirus.

Because the antigen tests may miss people with lower levels of the virus, some states do not include positive antigen tests in their official coronavirus case counts—though that conflicts with current CDC guidance on case reporting, the Times reports. According to the Times, seven states and Washington, D.C., don't include positive antigen tests in their official case counts, and six states separate positive antigen tests from positive PCR tests in their total reported case counts.

As it stands, the portion of Americans who test positive with antigen tests is relatively small, the Times reports. In Florida, for example, positive antigen tests make up about 4% of all cases the state has reported since March, according to the Times.

However, antigen testing for the novel coronavirus is likely to become more common, as the federal government has purchased antigen tests intended for use in schools and nursing homes this fall. In addition, some companies are hoping to get federal approval to make their tests available over the counter for Americans to use on their own at home.

Some experts say states' decisions not to report positive antigen tests in their total case counts can provide a false sense that coronavirus cases infection rates are lower than they actually are.

For instance, Annie Drachenberg, medical director for Abilene-Taylor County Health District in Texas, said that positive antigen tests account for more than half of all coronavirus cases reported in Taylor County.

Lisa Dick, administrator of the Brownwood-Brown County Health Department in Texas, said, "If we just posted PCR tests we would just be giving the community the idea that things were improving. … And people are making decisions based on that information, from leaders to individuals."

And many public health officials say that, even if states do report positive antigen tests results for the novel coronavirus, they can't be sure providers always are reporting the test results. They explained that the tests can be used at various point-of-care centers, including nursing homes and urgent care centers, and some of those centers may be unaware that they need to report the results.

"We don't know for sure what we don't know," Edward Lifshitz, medical director for the Communicable Disease Service at the New Jersey Department of Health, said.

Further, experts have estimated that, as antigen tests become more available and potentially are approved for at-home use, the true number of coronavirus cases in America may become almost impossible to track, the Times reports.

"We may eventually get these tests over the counter," Lifshitz said. "From a public health perspective that's a good thing. From a surveillance perspective, that becomes a nightmare."
It's also getting harder to pinpoint how Americans contracted the coronavirus, experts say

Another key to tracking coronavirus cases is contact tracing—an effort through which public health officials try to trace the virus's transmission from person-to-person, in hopes of encouraging testing and measures to mitigate the virus's further spread. But as new cases of the coronavirus have surged throughout the United States in recent weeks, Americans have become less sure of where they may have contracted the coronavirus, the Times reports.

For example, Denny Taylor, 45, told the Times that even though he had taken precautions including wearing a mask and having his groceries delivered, he became the first person among his family and co-workers to test positive for the virus. "I was so careful," Taylor said, adding that he had no idea of how he contracted the virus.

Likewise, Heidi Stevens, a columnist at the Chicago Tribune, recently tested positive for the novel coronavirus, despite the fact that she works from home, her children attend school online, and she wears a mask while she's out. Stevens also has said she has no idea how she caught the virus.

"I would drive myself crazy if I tried to really nail it down," she said. "It's just out there."

Crystal Watson, a senior scholar at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, expressed a similar sentiment. The coronavirus is "just kind of everywhere," she said.

As a result, some health officials have said contact tracing won't be enough to slow the rise in new cases, and some states have announced that they'll no longer be performing contact tracing to the extent they were earlier this year.

For example, in North Dakota, officials have announced they won't have one-on-one conversations with every person that officials identify who may have been exposed to the virus. And in Philadelphia, officials have acknowledged that some coronavirus cases won't be tracked.

"We weren't supposed to get to this point," Arnold Monto, a professor of epidemiology at the University of Michigan, said. He said that although tracking cases and notifying those who may have been exposed to the virus is a best practice to mitigate further transmission, it's not practical after a certain number of cases. "If you have five clusters going on at the same time, it's hard to say where it came from."

Watson said that tracing coronavirus cases becomes harder once more than 10 in 100,000 people have the virus—and, according to the Times, the novel coronavirus is "spreading at 10 to 20 times that rate" in some areas of the country.

Ultimately, at this point, "[c]ontact tracing is not going to save us," Ogechika Alozie, CMO at Del Sol Medical Center, said (Mervosh/Tompkins, New York Times, 10/31; Walker/Patel, New York Times, 11/1).
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The colleges with virtually no coronavirus cases

A handful of institutes of higher learning are keeping COVID-19 at bay. Here’s how they do it.

11/5/20 ... ronavirus/

Ava McDonald strode across her college’s campus on the way to the library, happy to spend the fall back in idyllic Bronxville, New York, after what has been a tumultuous year. The sophomore’s classmates lounged on blankets. Some talked at a distance. Others pored over books. Except for their masks, everything at Sarah Lawrence College appeared to be just as it was before the coronavirus pandemic swept the globe.

For the venerable liberal arts college’s 1,400 or so students, the campus has felt like a safe haven where they could live without fear of catching or spreading COVID-19. As of this writing, Sarah Lawrence has had only three cases of the virus, a minuscule number compared to other colleges and universities across the United States, several of which exceed 1,000 cases on their campuses.

In contrast to the pandemic drama playing out at colleges and universities across the country, a handful of schools, including Sarah Lawrence, have kept the disease at bay. Some of these schools are public, others private. All have created their own small public health infrastructures, sharing cohesive public health messaging and implementing COVID-19 testing regimens to stop the virus from spreading on their campuses.

At Sarah Lawrence, a seemingly carefree atmosphere belies months of planning. This past summer, college president Cristle Collins Judd started thinking about what the fall would look like on her campus. When fall arrived, the college had received a makeover that was nearly invisible from the outside, except for posted signs reminding students to wear masks and circles painted on the lawn to indicate the best places to sit for proper social distancing.

Only about 35 percent of the undergraduate student body now lives on campus, down from 84 percent last year. Most of these students are freshmen. They had to provide their COVID-19 test results within two weeks of arrival, and they have continued to undergo what Judd calls “surveillance testing” at monthly intervals throughout the semester.

Every dorm room houses a single student instead of the usual double or triple occupancy, and the school has kept several rooms empty to be used for quarantines. The school also reworked the pedestrian traffic flow, adjusting the entrances and exits of buildings to make social distancing easier. All the buildings are locked, too: only people with key cards can enter, as McDonald does almost every day.

Even though her classes as a writing major are all online, McDonald hasn’t been cooped up in her room. She picks up grab-and-go meals at the campus center, and when the weather is good, she studies at a desk outside. Life on campus has felt far from lonely. As a resident advisor, McDonald helps keep her residents on track with pandemic safety protocols even while making sure they haven’t become isolated from the rest of campus.

“The activities council does an event almost every day either in person or online,” McDonald says. “I would end my night by going to the open mic, for example, where a bunch of students just get on a Zoom call, and everyone performs whatever they want to share.”

The school attributes its success at keeping coronavirus at bay not to the students’ strict adherence to the rules, but to the campus’s camaraderie. “A key part for us was active communication with our students about caring for each other as a community,” says Judd.

Three degrees of separation

The coronavirus saga played out differently on James Madison University’s bucolic Shenandoah Valley campus in Virginia. When junior Joseph Dwyer arrived to help the football team as a trainer this summer, he felt confident the school had the situation under control. He lived in a dorm with the team. They wore masks and followed the guidelines from the U.S. Centers for Disease Control and Prevention.

When the rest of the students arrived in September, everything changed. The university’s plan quickly went off the rails for its 22,000 person student body, of which 30 percent live on campus in a typical year.

“There was no testing. They didn’t take temperatures anywhere,” Dwyer says. “They tried to space the desks six feet apart, but there wasn’t enough room for that.”

One week-long stretch in early September brought about 80 coronavirus cases a day as more than one of every two COVID-19 tests came back positive. As numbers mounted, Dwyer stayed in his room. By the time the school sent everyone home on September 7, less than three weeks after residence halls opened, the campus had recorded more than 1,060 total cases.

While Dwyer has seen pictures of his classmates at parties on Instagram, the kinesiology major says that most people he knows were staying in their apartments at the time. “I haven’t seen more than maybe five other people that I don’t live with,” he says. Dwyer has since dropped his classes for the semester. He is one of thousands who have done so, as enrollment is down across the country. (James Madison University declined requests for comment.)

Still, Dwyer is indignant toward the widespread blame laid on college students for outbreaks at their schools. Superspreader events, like fraternity parties, might include only a few dozen students, but they can have an outsized domino effect. In society at large, superspreader events can spark infections in communities. As few as 10 percent of infected people are responsible for spreading 80 percent of cases. In colleges, that effect is amplified by a formerly positive trait: the interconnectedness of campus life.

Almost all students are connected by a shared classmate, says Kim Weeden, a social science professor at Cornell University. At a mid-size school like Cornell, 92 percent of the student body is connected by three degrees of separation or fewer, according to a study by Weeden and Benjamin Cornwell, the chair of sociology at Cornell.

“A lot of colleges and universities spend an enormous effort trying to connect students to each other across interests, across class lines, across all sorts of lines,” Weeden says.

People at a university are so interconnected that, without any preventative measures in place, it is likely that every student and staff member at a mid-size university of 20,000 students would catch coronavirus within a single semester, even if the school had no cases when the semester began. We know that because Philip Gressman, a mathematics professor at the University of Pennsylvania, and Jennifer Peck, a professor of economics at Swarthmore University, put various campus coronavirus scenarios to the test in a new mathematical model.

“If everything goes right,” Gressman explains, “if there’s a low level of transmission in the surrounding community, if all the students are wearing masks basically all the time, if you’re cutting large classes to limit crowd size, if you’re doing a robust testing and contact tracing program—the combination of all of these things and a little bit of luck works, even if students are still taking classes in person.”

In the real world, though, everything seldom goes right. Students can only control their own actions, and even the university can’t regulate transmission in the community that surrounds them. Of the colleges that haven’t experienced major coronavirus outbreaks, “many of those places have had the advantage of being relatively isolated,” explains Sarah Fortune, a professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health.

By isolation, Fortune doesn’t mean a school has to be in a rural area. Rather risk can vary based on how freely people from the community move on campus. Schools situated in what Fortune calls porous communities, where there is more movement between the school and the surrounding area, have faced the threat of more serious outbreaks. If a college is less porous and it has established a solid testing program to help keep it COVID-free, then the student body could, in theory, be more relaxed, says Fortune. “The places that are more porous, where there is definitely transmission into the campuses from the outside community, these are the places that have to attend much more behavioral risk mitigation strategies.”

Both Cornell’s mathematical model and Fortune’s research suggest a testing scheme that rapidly reacts to the presence of COVID-19 is the best strategy for controlling the spread of coronavirus on campus and in the world at large. Those kinds of decisions come from the top.

Solving problems before they happen

College officials can help prevent coronavirus cases among their student body—even when no one is on campus. In North Carolina, sophomore Ashleigh Fields continues with her studies online, far from the nation’s capital and Howard University, where she is enrolled. Other than track practice, during which she leaps borrowed hurdles in a nearby field, the journalism major has stayed focused on her academics and freelance writing. She’s eager to return to her school and the District of Columbia in the spring.

“Howard is very lively,” says Fields. “You never truly have to go looking for an opportunity because one will approach you. You could be talking to your friends and meet someone creative who’s making a movie, and then they want you as an actor.”

Even with her excitement to rejoin campus life, Fields knows that it might not be possible with the pandemic going on. As a historically Black university situated in a metropolis of about 700,000 people, nearly half of whom are people of color as well, Howard University has a unique risk profile. Black Americans who contract COVID-19 are more than twice as likely to die than their white counterparts. The school’s administration has taken that into account for every aspect of its pandemic strategy.

“Given our student and faculty population, we would have to be very careful,” says Howard University’s president, Wayne A. I. Frederick, about the potential for on-campus activities. “If we don't feel we could do that safely, we will not bring them back to campus until there’s widespread distribution of a vaccine, which would be the ultimate way to decrease the spread of the virus.”

Howard’s decision to go fully online came with a great deal of planning as well. The school made sure students with economic insecurity could stay in the apartment complex near campus, and they have kept the campus food pantry open through the crisis given most Howard students hail from the surrounding area. Securing these necessities helps the students focus on their studies and reduces their exposure to the coronavirus by lowering their need to travel outside the home for public resources, such as WiFi access at a cafe. As of now, only 20 of Howard’s roughly 10,000 students have tested positive for coronavirus.

Although the school’s strategy differs from Sarah Lawrence’s in several major ways, one factor is the same: their thorough organization. Both schools researched their student populations, relied on science, and shared clear public health messages that told their students exactly how to guard themselves and their classmates against the virus.

“A college administration’s actions are hugely important,” Fortune says. Despite appearances, the number of coronavirus cases at most colleges remains low. At schools that have successfully stifled transmission, like her own Harvard University, she says, they “have a whole public health infrastructure. You just cannot believe the commitments that they have made to public health and the health of their communities.”
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Covid-19: How a 'warm vaccine' could help India tackle coronavirus


In India's boiling summers, temperatures can easily rise to 50C (122F).

Nearly all vaccines need to be transported and distributed between 2C and 8C in what comprises the so-called cold chain. And most of the Covid-19 vaccines under development, according to the World Health Organisation (WHO), will need to be refrigerated at temperatures well below 0C, the freezing point of water.

Imagine a Covid-19 vaccine that is heat tolerant and can be transported to remote towns and villages for tens of millions of jabs without depending on the cold chain.

A group of Indian scientists are working on such a vaccine. The "warm" or a heat-stable vaccine, they claim, can be stored at 100C for 90 minutes, at 70C for about 16 hours, and at 37C for more than a month and more.

Raghavan Varadarajan, a biophysicist and professor at the Indian Institute of Science, and his team have tested this vaccine on animals. "We got good results," Prof Varadarajan told me. Now they are waiting for funding to begin safety and toxicity tests on humans. Their paper has been accepted for publication in Journal of Biological Chemistry, a peer-reviewed scientific journal, published by the American Society for Biochemistry and Molecular Biology.

"I am hopeful that after this study, newer avenues would open up with regards to having cold-chain independent vaccines," said Dr Renu Swarup, secretary of India's Department of Biotechnology.

Vaccines that can withstand high temperatures are rare.

Only three - offering protection against meningitis, human papillomavirus (HPV) and cholera - are licensed and approved by WHO for use at temperatures up to 40C. These vaccines can be deployed quickly in hard- to-reach communities, and reduce pressures on healthcare workers. They have proved to be useful during large-scale emergency responses like distributing oral cholera vaccine in Mozambique last year following Cyclone Idai, according to WHO.

"The possibility to transport vaccines outside the cold chain for the very last mile to reach the most remote populations in resource-limited settings is very helpful. It can be particularly helpful for mass vaccination campaigns when hundreds of thousands of vaccine doses need to be transported to several vaccination points within a short period of time," said Julien Potet, policy adviser (vaccines) of Médecins Sans Frontières' Access Campaign.

India expects to receive and utilise 400-500 million doses of Covid-19 vaccines and plans to inoculate some 250 million people between January and July next year. They will be mainly distributed through the country's 42-year-old immunisation programme, one of the world's largest health programmes. It targets 55 million people, mainly newborns and pregnant women, with 390 million free doses of vaccines against a dozen diseases every year.

To service this massive programme, India already has a robust network of state-owned cold storages for vaccines that can provide doses to more than eight million locations.

Storing and keeping vaccines cool requires walk in freezers, ice-lined refrigerators, refrigerated trucks, coolant packs such as dry ice and cold boxes, which help in last-mile delivery. Nearly four million doctors and nurses are involved in the immunisation campaign.

"India has largely managed vaccines and immunisation drives well," says B Thiagarajan, managing director of Blue Star, which has a major share of pharmaceutical cold chain products. "When it comes to vaccines which have to be stored at temperatures between 2 to 8C, we are well equipped. If the vaccine has to be kept at -40C, there will be a problem."

The WHO says Covid-19 vaccines under development can be categorised in three storage temperature requirements: 2-8C, -20C and -70C. A number of candidates, say experts, will require an "ultra cold chain" at temperatures which will "definitely prove a challenge to many countries."

Ensuring a consistent cold chain for a mass immunisation programme will be a big challenge.

At nearly 40 million tonnes, India's cold storage capacity is one of the world's largest, but it mainly stores fresh food, healthcare products, flowers and chemicals. Much of the capacity is not internationally hygiene compliant for storing vaccines. Vaccines can easily lose potency when exposed to higher temperatures, and have to be protected against accidental freezing during transport, as well as breaks in the cold chain due to exposure to high heat.

Even if the vaccine could be stored at 2C to 8C, the storage capacity in most cold chains has been designed to enable immunisation of mainly infants. This capacity, according to WHO, "risks being vastly insufficient as we try to rapidly vaccinate the entire population for Covid-19".

"There are significant challenges and they can be overcome," says Andrea Taylor of the US-based Duke Global Health Institute. "But without knowing if they will have access to vaccines or the number of doses or type of cold storage needed for vaccines they may get, it is difficult for countries to move aggressively to prepare".

That is where a "warm vaccine" could truly be a game changer.
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Trailers Sent To El Paso To Handle Possible Coronavirus Death Surge

11/5/20 ... ath-surge/

EL PASO, Texas (CBSDFW.COM/AP) – Five trailers from the Federal Emergency Management Administration have been brought to El Paso to help accommodate the surge of COVID-19 fatalities in the border city, officials said Thursday.

Three of the trailers were staged at the El Paso County Medical Examiner’s Office while two were being held in reserve, said Jorge Rodriguez, the city’s emergency management coordinator.

The Texas Funeral Service Commission also has been asked to send representatives to make an assessment of the needs of the area’s funeral homes and mortuaries, he said.

Twenty-two more COVID-19 deaths were reported Thursday in El Paso County, bringing the county’s death toll for the eight-month pandemic to 639.

Meanwhile, 1,920 new cases of the coronavirus that causes the disease were reported in the county Thursday, a significant increase from the 1,537 new cases reported Wednesday, Mayor Dee Margo said.

Margo also walked back the figure of 3,100 new cases he reported Wednesday, blaming the error on “a multiple-day data dump.”

El Paso restaurant patrons are circumventing an order closing kitchens at 9 p.m. by leaving and gathering again at homes and other places, fueling a recent wave of COVID-19 cases in the border city and defeating the purposes of the curfew to disperse restaurant gatherings, Margo said.

That mirrors the experience in the Lower Rio Grande Valley that occurred earlier in the pandemic for about 2 1/2 months, Margo said.

“It is imperative that we stop doing this,” he said.

He said other factors in the spread have been fanned by people shopping as a group at crowded retail stores and by activities across the border in Ciudad Juárez, Mexico.

“We’ve got to understand that our behavior, our actions, are what will curtail the spread. They will not end the pandemic of this virus, but they will curtail the spread,” Margo said.

COVID-19 hospitalizations for the county totaled 1,003 on Thursday, down by 38 from the day before, and 292 of those were under intensive care, down 19 from the day before. “But it’s still not good,” Margo said at an afternoon briefing.

The El Paso-area coronavirus surge has formed a significant part of the statewide COVID-19 trend. State health officials reported 8,332 new cases Thursday, down from 9,048 Wednesday but otherwise higher than any figure since Aug. 11, bringing the total for the outbreak to 934,994.

Of those, an estimated 116,225 cases were active, the most since Aug. 23, with 5,954 COVID-19 cases requiring hospitalization, the most since Aug. 19.

The true number of infections is likely higher because many people haven’t been tested, and studies suggest people can be infected and not feel sick.

Meanwhile, 133 more people died of COVID-19, the Texas Department of State Health Services reported Thursday, bringing the state’s pandemic death toll to 18,453.

For most people, the coronavirus causes mild or moderate symptoms, such as fever and a cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.
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Woman sheds coronavirus for 70 days without symptoms

The woman was immunocompromised but never developed symptoms of COVID-19.

11/5/20 ... -days.html

A woman with COVID-19 in Washington state shed infectious virus particles for 70 days, meaning she was contagious during that entire time, despite never showing symptoms of the disease, according to a new report.

The 71-year-old woman had a type of leukemia, or cancer of the white blood cells, and so her immune system was weakened and less able to clear her body of the new coronavirus, known as SARS-CoV-2. Although researchers have suspected that people with weakened immune systems may shed the virus for longer than typical, there was little evidence of this happening, until now.

The findings contradict guidelines from the Centers for Disease Control and Prevention (CDC), which say that immunocompromised people with COVID-19 are likely not infectious after 20 days.

The new findings suggest "long-term shedding of infectious virus may be a concern in certain immunocompromised patients," the authors wrote in their paper, published Wednesday (Nov. 4) in the journal Cell.

"As this virus continues to spread, more people with a range of immunosuppressing disorders will become infected, and it's important to understand how SARS-CoV-2 behaves in these populations," study senior author Vincent Munster, a virologist at the National Institute of Allergy and Infectious Diseases, said in a statement.

Unusual case

The woman was infected in late February during the country's first reported COVID-19 outbreak, which occurred at the Life Care Center rehabilitation facility in Kirkland, Washington, where she was a patient.

She was hospitalized for anemia related to her cancer on Feb. 25, and doctors screened her for COVID-19 because she came from the center with the outbreak. She tested positive on March 2.

Over the next 15 weeks, the woman would be tested for COVID-19 more than a dozen times. The virus was detected in her upper respiratory tract for 105 days; and infectious virus particles — meaning they were capable of spreading the disease — were detected for at least 70 days. Specifically, the researchers were able to isolate the virus from the patient's samples, and grow it in a lab. They were even able to capture images of the virus using scanning and transmission electron microscopy.

Typically, people with COVID-19 are contagious for about eight days after infection, according to the report. Previously, the longest duration of infectious virus shedding in a COVID-19 patient was reported to be 20 days.

The woman was likely contagious for so long because her body didn't mount a proper immune response. Indeed, the woman's blood samples did not appear to contain antibodies against the virus.

The woman was treated with two rounds of convalescent plasma, or blood from recovered COVID-19 patients that contains antibodies against the disease. She cleared the infection after her second treatment, though there's no way to know if the convalescent plasma helped, as the woman still had low concentrations of antibodies after the transfusion.

The authors also performed genetic sequencing of SARS-CoV-2 over the course of the woman's infection, and saw that the virus developed several mutations over time. However, the mutations did not affect how fast the virus replicated. In addition, the authors did not see evidence that any of these mutations gave the virus a survival advantage, because none of the mutated variants became dominant over the course of the infection.

Unsolved mysteries

Exactly how the woman cleared the virus is unknown and is something that should be examined in future research involving patients with weakened immune systems, the authors said.

In addition, the researchers don't know why the woman never experienced symptoms of COVID-19 despite being immunocompromised, which puts her at higher risk of severe disease, according to the CDC.

"You would indeed think that the immunocompromised status would allow the virus to spread from the upper (more common cold scenario) to the lower respiratory tract (pneumonia)," Munster told Live Science in an email. "Even though the patient was at least infected for 105 days, this clearly didn’t happen, and this remains a mystery to us."

The authors note that their study involved only a single case, and so the findings may not necessarily apply to all patients with conditions that suppress the immune system.

An estimated 3 million people in the U.S. have an immunocompromising condition, including people with HIV, as well as those who have received stem-cell transplants, organ transplants and chemotherapy, the authors said.

"Understanding the mechanism of virus persistence and eventual clearance [in immunocompromised patients] will be essential to providing appropriate treatment and preventing transmission of SARS-CoV-2," the authors concluded.
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World Health Assembly to discuss plan for addressing COVID-19 response and critical health goals

11/5/20 ... goals.aspx

As health leaders prepare to gather for a virtual session of the resumed 73rd World Health Assembly (WHA), WHO has three messages to share.

First, we can beat COVID-19 with science, solutions and solidarity.

More than 47 million COVID-19 cases have now been reported to WHO, and more than 1.2 million people have lost their lives.

Although this is a global crisis, many countries and cities have successfully prevented or controlled transmission with a comprehensive, evidence-based approach.

For the first time, the world has rallied behind a plan to accelerate the development of the vaccines, diagnostics and therapeutics we need, and to ensure they are available to all countries on the basis of equity. The Access to COVID-19 Tools (ACT) Accelerator is delivering real results.

Second, we must not backslide on our critical health goals.

The COVID-19 pandemic is a sobering reminder that health is the foundation of social, economic and political stability.

It reminds us why WHO's 'triple billion' targets are so important, and why countries must pursue them with even more determination, collaboration and innovation.

Since May, Member States have adopted a number of decisions – the Immunization Agenda 2030, the Decade of Healthy Ageing 2020-2030, as well as initiatives to tackle cervical cancer, tuberculosis, eye care, food safety, intellectual property and influenza preparedness.

The resumed session will discuss a 10-year-plan for addressing neglected tropical diseases, as well as efforts to address meningitis, epilepsy and other neurological disorders, maternal infant and young child nutrition, digital health, and the WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010.

Third, we must prepare for the next pandemic now.

We've seen this past year that countries with robust health emergency preparedness infrastructure have been able to act quickly to contain and control the spread of the SARS-CoV-2 virus.

The WHA will consider a draft resolution (EB146.R10) that strengthens Member States' preparedness for health emergencies, such as COVID-19, through more robust compliance with the International Health Regulations (2005).

This resolution calls on the global health community to ensure that all countries are better equipped to detect and respond to cases of COVID-19 and other dangerous infectious diseases.


The World Health Organization
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VA Joins Pentagon in Recruiting Volunteers for COVID Vaccine Trials

11/6/20 ... ne-trials/

The Department of Veterans Affairs is recruiting 8,000 volunteers for the Phase 3 clinical trials of at least four COVID-19 vaccine candidates at 20 federal medical facilities across the U.S., according to officials with the VA and Operation Warp Speed, the Trump administration’s initiative to fast-track a coronavirus vaccine.

The largely unpublicized effort follows a Department of Defense announcement in September that it has partnered with AstraZeneca to recruit volunteers at five of its medical facilities, which are separate from the VA system.

DOD is also is in talks with developers of other vaccine candidates, although officials won’t say which ones.

Both federal departments have long experience in medical research and diverse populations — a crucial component of effective clinical trials, said J. Stephen Morrison, senior vice president and director of global health policy at the Center for Strategic and International Studies, a bipartisan think tank in Washington, D.C.

Since active troops are essential to national security, and veterans are extremely vulnerable to COVID-19, both departments have a vested interest in supporting the development of safe, effective vaccines, Morrison said.

“On the DOD active servicemen and -women side, it’s a question of making sure they’re ready, they are protected,” Morrison said. “With VA, their population, all elderly and infirm with underlying conditions, they could really be suffering if we don’t get a vaccine.”

According to a VA website, of its 20 medical centers involved, 17 would be part of the Johnson & Johnson vaccine trial, while the three others are recruiting — or have completed recruitment — for advanced-stage trials for Moderna, AstraZeneca and Pfizer vaccines.

Dr. Matthew Hepburn, head of vaccine development at Operation Warp Speed, said the VA effort lets veterans contribute to the overall well-being of the country.

“This is another way they can continue to serve in this way, fighting the pandemic as a volunteer,” Hepburn said during a discussion of vaccine and therapeutics development hosted by the Heritage Foundation on Oct. 27.

It’s not unusual for the military to participate in multicenter trials for treatments of ailments as diverse as cancer and trauma. Historically, many vaccines have been tested first by the military.

In the general population, clinicians often have difficulty recruiting African Americans and other minorities for medical research, and “the military provides a rich opportunity to find volunteers for those groups,” said retired Rear Adm. Thomas Cullison, a doctor and former deputy surgeon general for the Navy.

Military health facilities are held to the same standards as private research facilities, he said.

No service members will be required to participate in the COVID vaccine trials. All volunteers will be paid by the developer.

Support for routine vaccinations runs high in the military, but some have expressed concerns about new vaccines and mandatory inoculations, especially for anthrax. In a 2002 federal study, 85% of those who received that vaccine reported an adverse reaction, with just under half noticing minor redness at the injection site. But nearly a quarter of the side effects reported were more systemic, including fevers, chills, fatigue and joint pain.

That survey of a small group of National Guard and Reserve members found that, while 73% said they believe immunizations are effective, two-thirds said they did not support the mandatory anthrax program and 6 in 10 said they were not satisfied with the information they were given on the vaccines.

To quell concerns over the military’s role in supporting COVID vaccine development, the Pentagon has reiterated that troops or their dependents interested in participating in the research must provide voluntary written consent, and they will be allowed to take part only if they will be in the same location for the length of the research, expected to last at least two years.

In addition, active-duty members such as new recruits and boot camp participants will not be allowed to volunteer because they are “considered vulnerable from an ethical and regulatory standpoint,” an official said.

At the VA, officials are seeking to recruit healthy veterans from 18 to 65 years old who are not pregnant and may be at risk for exposure. As with trials conducted in civilian facilities, participants will be paid by the developer, VA spokesperson Christina Noel said.

Also, VA nurses and caseworkers also are being asked to identify their sickest, highest-risk patients to determine who should be at the top of the list once a vaccine is approved, according to a VA nurse and other health officials who asked not to be identified because they were not authorized to speak with the press.

The U.S. military has a long history of contributing to research on vaccines, including a key role in developing inoculations against yellow fever and adenovirus, and the Walter Reed Army Institute of Research is developing its own vaccine against the coronavirus.

Some segments of the population remain skeptical of federal medical experiments. A survey by AP-NORC in May found that Black people are particularly reluctant to get the coronavirus vaccine. Many have concerns about federal research in part because of associations with the infamous Tuskegee Institute syphilis experiments, in which U.S. Public Health Service officials intentionally withheld a cure from Black men infected with the disease.

But Morrison, of the Center for Strategic and International Studies, said the Defense Department and VA are a “natural fit” for the COVID vaccine trials.

“DOD has lots of expertise. They know how to vaccinate; they know how to reach communities. They have a whole science infrastructure and research-and-development infrastructure. And when you are thinking what the mission of VA is, [VA] sees this is part of their mission,” Morrison said.

The Defense Department announced its agreement with AstraZeneca in September, shortly before the drugmaker’s vaccine trial was put on hold to study a serious medical condition that one participant reported. That research was approved by the Food and Drug Administration to begin again Oct. 23. The military plans to restart its efforts to recruit 3,000 volunteers.

The Pentagon has also signed an agreement with another vaccine developer, the head of the Defense Health Agency, Army Lt. Gen. Ronald Place, told reporters Oct. 8. He wouldn’t provide the company’s name.

Democratic Sens. Elizabeth Warren of Massachusetts and Mazie Hirono of Hawaii have called, unsuccessfully, for the Senate Armed Services Committee to investigate what they say is a lack of Pentagon transparency on its role in vaccine development and distribution.

The Defense Department has awarded more than $6 billion in Operation Warp Speed contracts through an intermediary, Advanced Technology International, and the two senators want more information about those contracts.

“There may well be a valuable role for DoD officials in [Operation Warp Speed] — particularly given the department’s logistical capacity,” they wrote to the committee chair and ranking member. “But it is important that Congress conduct appropriate oversight of, and understand, DoD’s activities in this area.”

Neither department has disclosed the financial arrangements they have made with developers to support the vaccine research.
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First COVID-19 Vaccine Doses To Go To Health Workers, Say CDC Advisers

Thursday, November 5, 2020 ... to-health/

Health care workers will almost certainly get the first doses of COVID-19 vaccine in the U.S. when one is approved, according to Dr. José Romero, head of the committee that develops evidence-based immunization guidelines for the Centers for Disease Control and Prevention.

That's a decision based on the science of what will quell the pandemic fastest. "It's not just the doctors and nurses that are interacting with patients, but also the support personnel that help," Romero said in an interview Thursday with NPR. "It could include those persons that are delivering food, or maintenance people that could come in contact with them," so they can protect themselves and patients from the virus, and stay healthy to keep the U.S. health care system running.

Romero chairs the Advisory Committee on Immunization Practices, or ACIP, a longstanding CDC advisory group that includes 15 voting members, plus other vaccination experts who weigh in.

Once the Food and Drug Administration judges a COVID-19 vaccine to be safe, effective and authorized for use, ACIP will make rapid recommendations to the CDC on how a COVID-19 vaccine should be used and who should get the first shots.

"We anticipate having some vaccine for the high-risk individuals — health care providers — sometime in December or early January," Romero told NPR's Mary Louise Kelly on All Things Considered. "And then more and more vaccine will be rolled out."

The committee's goals for deploying a COVID-19 vaccine are to "decrease death and serious disease as much as possible" to keep society functioning and to reduce the burden of health disparities, according to the CDC website.

Beyond health care workers, three additional groups are considered by ACIP to be especially vulnerable to COVID-19, based on their exposure or susceptibility to the virus: essential workers, people age 65 and older, and anyone with underlying medical conditions associated with getting seriously ill from COVID-19.

The order of which of those groups would get their first doses — and when — may depend on the particular characteristics of whichever vaccine or vaccines are ultimately approved by the FDA. Such characteristics might include whether a particular vaccine has been demonstrated to be effective in older people, safe in people with conditions such as cancer or heart disease, or safe during a pregnancy. It's too soon to say which of the possible vaccines might be most suitable for which groups of people, he said.

"We haven't seen the data yet," Romero said, because vaccine clinical trials are still underway.

While they wait for that data, the committee members have been reviewing possible scenarios, using tools such as CDC computer models that project the number of lives that would be saved, based on assumptions about how effective a vaccine is and how many people get immunized.

By reviewing these potential outcomes now, the committee hopes to be able to move quickly once a vaccine is authorized. "There will be an emergency meeting of ACIP within 24 to 48 hours after the FDA has made [its] recommendations on the approval," Romero said.

At that meeting, ACIP members will vote on recommendations on dosage and a list of priority groups, which will become part of public health guidance issued by the CDC to states and territories, on how to vaccinate populations effectively against disease. Those guidelines will also signal the federal government to start shipping vaccine vials out to hospitals and vaccination sites across the country.

"We want shots in arms within 24 hours [of ACIP's recommendations]," Paul Mango, a top official with the U.S. Department of Health and Human Services, told reporters in a call last month.

The urgency with which the committee intends to move is motivated by the intention to save lives, Romero said — and is free from political influence.

"I've had no contact with the [Trump] administration or with pharmaceutical companies influencing my decision," he said. "No shortcuts should be taken for this vaccine, and it should be scrutinized the same way we would advise any other vaccine for prevention of infectious diseases."

State health officials are responsible for determining where vaccines should be distributed within their borders. Romero plays a key role regarding that distribution in Arkansas, where he also is health secretary.

"We've identified the top 10 hospitals to receive the initial allotment of vaccine," he said. "And as the vaccine becomes more available, we'll add more and more hospitals to that list."
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Coronavirus News: Workers at Brooklyn hospital get 5,500 pairs of new Nike sneakers

11/5/20 ... s/7671948/

BROOKLYN, New York City (WABC) -- Frontline healthcare workers battling the coronavirus pandemic at Maimonides Medical Center in Brooklyn received 5,500 pairs of new Nike sneakers and 20,000 high performance socks Thursday.

The donation came thanks to a partnership with local New York-based nonprofit World of Giving and Good360, global leaders in product philanthropy and purposeful giving.

Maimonides was inundated with COVID patients during the surge, and last month, there was another influx of patients after a spike in the virus in south Brooklyn. But for a few minutes Thursday, the talk wasn't about saving lives -- it was all about the sneakers.

"A pair of shoes can go a long way to filling the heart," cardiology fellow Dr. Sara Rosanel said.

Also Read: Walmart raising hourly wages for thousands of employees

And Maimonidies isn't the only recipient. Organizers say 16,000 pairs of these sneakers are being given out to workers at four other hospitals in New York City, offering a bit of a pick-me-up at a time when coronavirus cases are spiking around the country.

"As we head into a little growth in the virus, as the weather gets colder, there is a sense of, 'Wow, I've got to do this again," Maimonides CEO Kenneth Gibbs said. "So the notion that the generosity is ongoing is very important."

The donated items are designed specifically for healthcare professionals and were donated as a significant demonstration of community appreciation for the extraordinary efforts of Maimonides' frontline employees.

Also Read: Target to pay $200 bonuses to thousands of frontline workers

World of Giving distributes goods to those in need through a network of volunteers and partner charities, empowering them to lead healthy and productive lives.

"These sneakers were specifically designed for health care workers, for people who need to stay on their feet for many hours and will make their work easier and more enjoyable," founder Mark Roizman said.

Good360 partners with socially responsible companies to source highly needed goods and distribute them through their network of diverse nonprofits.

"Whenever we've had a chance to help people with COVID, love to step in and give them what they need," said Melissa Skabich, with PCE Communication, which represents Good360.
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