Currently Displaying: clinical public health27 Posts. 3 Pages.












ngq, you sexy beast! Here is a sanity check for that clean meta. ;)

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  • Rapid and non-invasive antibody diagnostics remain a holy grail in scaling up testing for COVID-19. Preliminary results are currently under peer review for the rapid finger prick antibody test, AbC-19 Lateral Flow, that claims to be 98.6% accurate. While these claims seem promising, the results have not been made public, with questions remaining on the sets of samples the study used or what the researchers mean by ‘accuracy’. Diagnostic tests are typically assessed by sensitivity (false negative) and specificity (false positive). The other outstanding issue with these types of tests, however, relate to uncertainties in the period of time after infection that IgG antibodies disappear from the blood. Since acuity of COVID-19 infection appears to be correlated with the intensity of the antibody response, it is plausible that the test could come back negative for those with low antibody levels in as little as three months (for reference, antibody levels for SARS were detectable for up to two years). A rapid antibody test would nonetheless be a valuable diagnostic tool for detecting positive cases, even if negative test results would require further investigation. It is also important to note that other human coronaviruses don’t confer lifelong immunity, while ongoing research is also examining the role of T-cell immunity.

 

[post_title] => High Accuracy Shows Promise of Rapid Fingerprick Antibody Testing [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => high-accuracy-shows-promise-of-rapid-fingerprick-antibody-testing [to_ping] => [pinged] => [post_modified] => 2020-08-13 22:23:02 [post_modified_gmt] => 2020-08-14 02:23:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/high-accuracy-shows-promise-of-rapid-fingerprick-antibody-testing/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [1] => WP_Post Object ( [ID] => 2385 [post_author] => 3 [post_date] => 2020-07-21 11:25:55 [post_date_gmt] => 2020-07-21 15:25:55 [post_content] =>
  • During Monday’s media briefing, the WHO Technical Lead for COVID-19 suggested that while those who are infected with the novel Coronavirus did mount some level of immunity, there are persistent uncertainties how strong that protection is and for long it lasts. This came a day after a study by King’s College London found that immunity appeared to peak three weeks after the first symptoms, waning rapidly thereafter. The study, which is currently under peer review, shows that 60% of people had a “potent” antibody response at the height of their infection, but that only 17% retained the same potency three months later, while others had undetectable antibody levels. This is corroborated by other studies that suggest loss of immunity within a couple months after infection, which if true could challenge the notion of herd immunity to COVID-19.
  • A paper in Nature Medicine this week meanwhile provides a detailed survey of the immune response in a cohort of COVID-19 patients to the Spike antigen by memory B cells and T cells. In addition to coordinating and controlling antibody responses, T cells can also detect fragments of a virus (peptides) which makes it harder to dodge immune defences. Although the study only included a small number of adults with mild infections, both could be detected in the blood one month after COVID-19 infection, suggesting key protective immune responses could be generated in natural infection and may be potentially boosted.
  • These results could have important implications for vaccine development, as certified antibody diagnostic tests are currently designed to detect one single antibody response, and not to quantify it. Consistent and sustained levels of antibody response, however, may require annual booster immunization, similar to the seasonal flu vaccine. According to the Nature Medicine paper, the most effective vaccine against COVID-19 is likely to elicit both neutralizing antibodies, as well as a high total antibody titre and strong T cell response. While immunological questions persist, the WHO warned that it remains possible that people may be re-infected, urging safe public health measures.
[post_title] => Questions Persist on Immunity to COVID-19 [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => questions-persist-on-immunity-to-covid-19 [to_ping] => [pinged] => [post_modified] => 2020-08-13 22:23:02 [post_modified_gmt] => 2020-08-14 02:23:02 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/questions-persist-on-immunity-to-covid-19/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [2] => WP_Post Object ( [ID] => 1999 [post_author] => 1 [post_date] => 2020-06-10 22:13:09 [post_date_gmt] => 2020-06-22 02:13:09 [post_content] =>

Chronology of events

On May 1, the NEJM published a study that suggested that two types of blood pressure medications (angiotensin-converting–enzyme inhibitors and angiotensin-receptor blockers) were not associated with worse outcomes in patients with COVID-19, while noting ACE inhibitors in particular had significantly protective effects on mortality.

On May 22, the Lancet published an article by the same authors that found that chloroquine and hydroxychloroquine, explored as potential therapies for COVID-19, did not correspond with improved outcomes and may be associated with higher mortality by up to 30%.

Over the following week, a number of high-profile clinical trials were halted or suspended as a result of the Lancet paper. That included the multi-country Solidarity Trial that was being coordinated by the WHO.

On May 28, more than 180 scientists submitted an open letter to the Lancet editor and study authors outlining questions about the statistical analysis and a lack of transparency in the underlying data, including contributing countries or hospitals.

On June 2, the editors of the NEJM and Lancet issued respective “Expressions of Concern” over methodological and data integrity questions related to the two publications, while the WHO resumed the relevant arm of the Solidarity Trial. Two days later, the co-authors retracted both papers from the NEJM and Lancet, as the journal editors indicated that they would undertake an internal audit of their procedures.

What are the issues?

Data Integrity

Much of the controversy has been around the quality and nature of the large proprietary collection of electronic health records analysed and provided by Surgisphere, a private medical data provider based in the U.S. The primary author of both papers claimed that an independent audit of the data was requested by Medical Technology and Practice Patterns Institute, but were told by the medical data research institute that Surgisphere would not share the underlying data due to “agreements with its clients and the fact that the documents contain confidential information,” It should be noted that Surgisphere Chief Executive was a co-author on the papers. According to a statement on the Surgisphere company website, its data registry was based on electronic health records from customers of its machine learning program and data analytics platform producing data that allows researchers to study “real-world, real-time patient encounters.”

Methodological integrity

The high-profile retractions and pulled pre-print raise broader questions about working with large datasets that researchers are not able to validate, and particularly about how such work could pass peer review at prestigious medical journals.While it is not uncommon for studies to use large datasets without external scrutiny of the raw data, but it is far more uncommon for high-impact journals like the Lancet. While its editor and the NEJM claim the review process was confidential, both journals claim the papers had “external peer review, statistical review, as well as scientific and manuscript editing.” How such a comprehensive dataset could have been gathered from hospitals around the world in the middle of a pandemic is a question that researchers, journals and peer reviewers should have raised.

Adverse Impacts

Although the retrospective analysis was not a randomized control trial, it received a lot of attention given its publication in a high-impact journal and purported scale of almost 100,000 patient records from 671 hospitals around the world between December 2019 and April 2020. Even if the results were correct, however, experts suggest such observational data, with its inherent weaknesses, should not be used to stop trials that could provide definitive and actionable answers. Among the major adverse impacts of the published Lancet study has been suspension of several well-designed clinical trials. One of the major concerns is that the publicity around the Lancet findings have made it harder to conduct trials or recruit patients, as the retraction won’t receive as much attention as the original study. In retrospect, researchers and decision makers may have placed too much reliance on the study, particularly as there had been prior queries about the methods of analysis and some of the results did not fit with what is known about other risk factors. The Annals of Internal Medicine, for example, maintained an ongoing and regularly updated review that summarised data from randomised trials and from observational studies. The journal did not include the Lancet study in their review or conclusion that “at this time, there is insufficient and often conflicting evidence on the benefits and harms of using chloroquine  or hydroxychloroquine to treat COVID-19” that currently make it “impossible to determine the balance of benefits to harms.”

Ensuring research integrity during a pandemic

Scientific publication must above all be rigorous and honest. The retractions raise larger issues of reproducibility and scientific integrity, particularly when using big databases to draw conclusions, an approach that has been gaining rigor in the era of big data. While big databases have opened new lines of inquiry, there are also major issues as experts warn conducting studies properly is far more difficult and require a thorough understanding of underlying data to ensure the methods are rigorous and outcomes reasonable. There have been calls from scientists for independent auditing of data by journals and possibly regulatory bodies like the FDA which has extensive experience of auditing clinical data.

Part of the challenge has been pace. Unlike prior pandemics like SARS and Ebola, the COVID-19 pandemic has led to substantially more scientific publications, most notably pre-prints that are often not peer-reviewed. The rapidly increasing number of publications and urgency to quickly understand the virus present significant challenges in ensuring that research is conducted according to methods and standards of research integrity. This includes, for example, underlying models used to plan pandemic response and predict future outbreak trajectories that are often “poorly reported, at high risk of bias, and reported performance that are optimistic.” Serological tests that have received accelerated approval raise similar concerns, as claims by manufacturers around specificity and sensitivity often lack published data, presenting challenges as countries use testing to determine how to ease lockdowns.

Related papers

  • Top journals raise concerns about data in two studies related to COVID-19 (STAT)
  • High-profile coronavirus retractions raise concerns about data oversight (Nature)
  • Jeffrey Aronson: When I Use a Word . . . Retraction (BMJ Opinion)
  • After retractions of two Covid-19 papers, scientists ask what went wrong (STAT)
  • Will the pandemic permanently alter scientific publishing? (Nature)
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A study in Physics of Fluids reporting on the mechanisms of coughing and airborne transmission of viruses. While cough droplets in typical environmental conditions will travel less than the widely mandated 2 meters for social distancing, the authors note that changes in air flow and other environmental properties (e.g. wind, temperature, humidity) can cause that figure to rise quite dramatically. For example, even modest winds (i.e. 4 to 15km/h) could result in saliva droplets dispersing and traveling up to 6 meters. Although the study provides guidelines on the mechanical aspects of droplet transmission, experts suggest the computer simulation may not capture the process of dilution, while the relationship to viral transmission also remains unclear.

A non-peer reviewed pre-print of a study on bioRxiv examining mutations of the novel Coronavirus did not find any variants that had increased transmissibility. While this suggests none of the known mutations are cause for immediate concern, the findings do not rule out the possibility of emerging future variants with different properties. The Director of the Francis Crick Institute has also suggested testing the study conclusions in functional assays of frequently occurring variants in order to examine their proposed mechanisms.

The U.S. Centers for Disease Control and Prevention issued a new guidance with five COVID-19 planning scenarios to public health authorities based on lower and upper bounds across three parameters: virus transmissibility and disease severity, transmission prior to onset of symptoms, and infections that don’t develop symptoms. One of the scenarios, representing the CDC’s “current best estimate about viral transmission and disease severity in the U.S.” (assuming a R0 of 2.5), approximates 35% of COVID-19 infections may be asymptomatic, and that 0.4% of symptomatic positive cases result in mortality. Epidemiologists, however, question the estimates of symptomatic case fatality rate in the scenarios – from 0.2% (least severe) to 1% (most severe) – which is lower than the reported range in the literature.

[post_title] => The latest on COVID-19 transmission dynamics: good and bad news [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => the-latest-on-covid-19-transmission-dynamics-good-and-bad-news [to_ping] => [pinged] => [post_modified] => 2020-08-13 22:29:04 [post_modified_gmt] => 2020-08-14 02:29:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/the-latest-on-covid-19-transmission-dynamics-good-and-bad-news/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 2471 [post_author] => 3 [post_date] => 2020-05-28 08:04:20 [post_date_gmt] => 2020-05-28 12:04:20 [post_content] =>

An alarming new study of more than 200 million Twitter posts since January that mention COVID-19, estimates that 45% were sent by accounts that behave more like bots than humans. Although the researchers from Carnegie Mellon University are not able to conclusively identify the individuals or groups behind the accounts, the bot activity is two- to three-times higher than projections based on prior disasters, crises and elections. The study also identifies at least 100 false narratives about the Coronavirus pandemic that bot accounts have disseminated, including theories about hospitals being filled with mannequins or tweets that link disease transmission to 5G technology. In addition to inciting fear and social disorder (in the U.K., for example, dozens of wireless towers have been destroyed), misinformation on social media poses significant public health risks.

The twin issues of increasing access to the internet and fighting misinformation have been core priorities of the UN Secretary General, who last week announced the launch of a new ‘Verified’ The program will aim to recruit millions of ‘digital first responders’ around the world to counter misinformation about the COVID-19 pandemic. This network of ‘information volunteers’ would also share a daily fact-based UN feed that either fill an information void or that actively counter false narratives about the pandemic.

The Smithsonian Science Education Center also released a rapid response guide for young people on the science and social science of the novel Coronavirus based on the UN SDGs. COVID-19: How Can I Protect Myself and Others? was developed in collaboration with the WHO and the InterAcademy Partnership, a global network of over 140 national academies of science, engineering, and medicine. The guide is currently available in 16 languages (particularly African and Asian languages) and for various age groups (ranging from 8 to 17), providing learning activities, tasks as well as tools for young people to keep themselves, their families and communities safe.

[post_title] => Recruiting Digital First Responders to counter pandemic misinformation [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => recruiting-digital-first-responders-to-counter-pandemic-misinformation [to_ping] => [pinged] => [post_modified] => 2020-08-13 22:29:04 [post_modified_gmt] => 2020-08-14 02:29:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/recruiting-digital-first-responders-to-counter-pandemic-misinformation/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [5] => WP_Post Object ( [ID] => 2470 [post_author] => 3 [post_date] => 2020-05-28 08:03:20 [post_date_gmt] => 2020-05-28 12:03:20 [post_content] =>

Global demand for face masks has far outpaced supply, impacting health care workers but also the public, as governments are increasingly mandating face coverings as a precondition for lifting lockdowns. According to the latest guidance from the WHO and the S. CDC, however, face masks are only recommended for healthy people that are not able to socially distance or if they are taking care of someone with COVID-19.

Limited access and soaring prices have disproportionately affected vulnerable populations, particularly as more than 50 countries have made mask-wearing in public mandatory. In March, the WHO estimated that 89 million medical masks would be required each month. Although companies around the world have repurposed their manufacturing capacity to develop face masks, quality control has been a significant issue with millions of masks rejected for failing to meet international standards. Many of these masks were made in China, which increased production 12-fold since January, and is projected to account for 85% of all masks globally by the end of the year (compared to just over half in 2019).

A pre-print study from the University of Edinburgh provided two conclusions when analyzing aerosol dispersion from a variety of different face coverings. First, while medical respirator masks provide protection against inhaling germs, they may not protect others from exhaled germs, which suggests greater caution by the public in maintaining a distance from someone wearing respirator masks. The second relevant conclusion is that even home-made cloth masks and face shields are effective at blocking upwards of 50% of exhaled germs (granted they fit closely all around the face)

[post_title] => Face masks: latest guidance, demand and supply challenges [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => face-masks-latest-guidance-demand-and-supply-challenges [to_ping] => [pinged] => [post_modified] => 2020-08-13 22:29:04 [post_modified_gmt] => 2020-08-14 02:29:04 [post_content_filtered] => [post_parent] => 0 [guid] => https://covid19.dighr.org/developments/face-masks-latest-guidance-demand-and-supply-challenges/ [menu_order] => 0 [post_type] => development [post_mime_type] => [comment_count] => 0 [filter] => raw ) [6] => WP_Post Object ( [ID] => 2009 [post_author] => 1 [post_date] => 2020-05-24 09:03:54 [post_date_gmt] => 2020-05-20 13:02:54 [post_content] =>

Social Distancing Works

An article in Health Affairs examines the role of social distancing measures in reducing the growth rate of the pandemic in the U.S. The authors conclude that jurisdictions with no physical distancing policies had 35 times more cases of COVID-19, and that the rate of new infections dropped the longer a physical distancing policy was in place.

COVID-19 can cause severe illness in children

A cross-sectional study in JAMA Pediatrics confirms earlier reports that COVID-19 can cause severe illness in children (CFR of 4.2), but considerably less than in adults. Similar to adult COVID-19 patients, severe cases in children are strongly associated with pre-existing comorbidities (including developmental delays, genetic anomalies, and immune suppression). A separate retrospective review in the Journal of Pediatrics, authors examined associations between underlying epidemiologic and clinical conditions with rates of hospitalization, finding positive correlations with neurological disorders (19%), cardiac conditions (9%), hematologic conditions (9%) and oncologic conditions (5%).

COVID-19 may  increase frequency of Children’s Kawasaki Syndrome

Emergent reports from around the world suggest an association between a Kawaski-like syndrome and COVID infection in children. An observational cohort study in the Lancet hypothesizes that COVID-19 may be responsible for the 30-fold increase in the incidence of hyper-inflammatory syndrome Kawasaki-like disease among older children in Italy.

RCTs pending on the benefits and safety of convalescent plasma for people with COVID-19

A Cochrane Rapid Review shows that only 32 patients in seven case-series studies have been studied systematically, and there is at this time limited evidence on the benefits and safety of convalescent plasma for people with COVID-19. The review noted that 47 studies are currently underway, and 22 of these are Randomized Control Trials. Cochrane will update this clinical review on a monthly basis as trial results emerge. It notes that its review and conclusions are likely be different from its current assessment of “limited evidence.”

80% of secondary transmissions may have been caused by a small fraction of infectious individuals

A pre-print publication on Wellcome Open Research examines outbreak size outside China, and highlights the high variability across countries in the overdispersion of COVID-19 transmission.  Findings suggest that 80% of secondary transmissions may have been caused by a small fraction of infectious individuals, and that the effective reproduction number could be drastically reduced by preventing relatively rare superspreading events.

Voluntary collective isolation and contact-tracing for vulnerable Indigenous Communities

The Lancet published a paper this week on a case study and potential protocols for indigenous populations in the Bolivian Amazon. The interdisciplinary study proposes a multiphase COVID-19 prevention and containment plan focused on voluntary collective isolation and contact-tracing that could be exported and adapted to local circumstances elsewhere to prevent widespread mortality in indigenous communities.

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“Impartial, independent, and comprehensive evaluation”

For the first time in the WHO’s history, its annual World Health Assembly (WHA) was entirely virtual. With a focus almost entirely on the Coronavirus pandemic, the condensed two-day meeting was preceded by three weeks of intense negotiations.

The most significant outcome this year was the adoption of a COVID-19 resolution that was proposed by the European Union and supported by 120 countries that contained three major elements (A73/CONF/1), including an “impartial, independent, and comprehensive evaluation (of the) international health response to COVID-19.” In the closing remarks, the WHO Director General affirmed that the review would take place “as soon as possible.”

Rising geopolitical tensions shape emergent Global Health institutions and practices

The WHA opened with a failed motion to grant Taiwan Observer status, underscoring growing tensions in part arising from accusations by the U.S. (and shared by other Western and Pacific Asian countries) that China was not transparent in the early days of the pandemic.

In a letter, the U.S. President threatened to permanently eliminate the funding that was temporarily withdrawn from the WHO, suggesting the U.S. would pursue bilateral aid channels including US$500 million to 40 ‘at risk’ countries. The President of China addressed the Assembly directly pledging US$2 billion over the next two years to support COVID-19 response efforts in developing countries, and an ambition to establish China as a “global humanitarian response capital and hub.” Focusing on African countries in particular, President Xi referenced debt suspension initiatives, building “green corridors” to accelerate delivery of essential goods as well as partnering with 30 major hospitals in Africa to build a China Centres for Disease Control headquarters on the continent.

‘No monopolies on access’ to COVID treatments and vaccines in a pandemic

The negotiations on access to treatments and future vaccines were far more divisive. Led by Costa Rica, developing countries and civil society organizations expressed particular concern about ensuring equitable access, including to COVID-related knowledge, lessons learned, experience, and best practices. The WHO Secretariat will have until May 29 to develop a framework for a voluntary COIVD-19 Intellectual Property Pool for patents and clinical trial data, while the EU-led resolution also references WTO TRIPS flexibilities allowing countries to override patents to ensure access.

COVID is a ‘wake-up call to our global fragility’

In his address to the World Health Assembly, the UN Secretary General called for greater unity and solidarity along three dimensions: a coordinated and comprehensive health response guided by the WHO and focusing on developing countries; policies to address the social and economic dimensions of the COVID crisis; and a response and recovery plan based on equity, inclusion and sustainability centred on human rights. Given the unprecedented nature of the pandemic, some civil society organizations such as South Centre expressed disappointment in the lack of ambition of the COVID-19 resolution. Knowledge Ecology International (KEI) likewise referred to the “typical watered down, lawyered ambiguity” of the final draft that fails to limit legal monopolies that could affect access (they noted that other proposals like Canada’s would have called for “universal and non-exclusive and open-licensing” that referenced data sharing and more expansive mandate beyond existing mechanisms).

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  • Two papers suggest that the Infection Fatality Rate (IFR) for COVID-19 may be “significantly higher” than previously thought. In Health Affairs, authors estimates an IFR of 1.3% among symptomatic cases in the U.S., while a paper in the Journal of Econometrics cautions against comparison due to variability across countries in testing strategies and testing accuracies.
  • WHO Europe issued a new guidance document that recommends expanding nurse-led models of care to improve access to care to during the pandemic
  • In collaboration with the WHO, the U.S. CDC is launching a new weekly webinar series for Infection Prevention & Control in healthcare settings. The first webinar on ‘Triage of COVID-19 Patients: Operational Considerations and Practical Examples’ will be Thursday, May 14
    • Johns Hopkins offers a free online course on Contact Tracing (Coursera)
  • A paper in the Journal of Virology and a commentary in GUT point to gastrointestinal symptoms like diarrhoea, nausea and vomiting in a quarter of patients in China
  • A new study suggests that patients with mild cases cleared the Coronavirus in five less days on a combination of interferon beta-1b, lopinavir-ritonavir and ribavirin (Lancet)
  • Patients that have recovered from COVID-19 are selling their blood plasma at significant prices to healthy patients that believe it will confer immunity (KHN, WSJ)
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The Journal for Clinical Medicine Research published a systemic review that provides a comprehensive clinical summary of available data as well as preventive measures (Modern Pandemic: A Systematic Review from Front-Line Health Care Providers’ Perspective)

An article in JAMA (Choices for the ‘New Normal’) outline six lessons for clinical care. These include the changing pace of learning, the value of updated clinical guidelines, protecting the workforce, enabling virtual care, increasing preparedness for novel threats, and addressing issues of inequity.

Virus Mutations Reveal How COVID-19 Really Spread (Scientific American)

A new study by the U.S. Los Alamos National Laboratory found that a mutated strain of Coronavirus strain detected in Europe three months ago may be spreading faster than earlier versions, urging vaccine and drug developers to consider this new strain in produce solutions (Spike mutation pipeline reveals the emergence of a more transmissible form of SARS-CoV-2)

A new paper in the Journal for Clinical Medicine (Estimation of Unreported Coronavirus Infections from Reported Deaths) estimates that almost 92% total daily new infections were unreported based on the early outbreak of COVID-19 in China.

In the International Journal of Public Health, authors suggest three additional ways that the COVID-19 pandemic will affect health outcomes: increase in mortality due to the diversion of health resources, impact of the ensuing recession on health systems, and the consequence of potential austerity measures

Undiagnosed and untreated TB cases is expected to cause 1.4 million deaths, as global focus is on COVID-19 according to the Stop TB Partnership (Guardian)

Widespread population serological testing can be important in determining immunity (‘sero-protection’) as well as mitigation strategies among vulnerable populations (‘social sero-epidemiology’). At present, most tests have been limited in scope, as the quality of serologic tests also remains a challenge (Washington Post)

Immunity passports and vaccine certificates: scientific, equitable & legal challenges (Lancet)

WHO claims that prior reports of COVID-19 ‘reinfections’ were false positives (Guardian)

 

COVID-19 Riddle: why does the virus affect some countries and regions more than others? (NYT)

WHO urges public health basics and community surveillance strategies (WEF)

‘Risk-based’ social distancing key to reopening (WSJ)

Mass screening may have helped South Africa stem coronavirus tide (Financial Times)

 

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Preliminary estimates of the prevalence of selected underlying health conditions among patients with COVID-19 — United States, February 12–March 28, 2020

US CDC, WMWR Early Release, 3 April 2020

https://www.cdc.gov/mmwr/volumes/69/wr/mm6913e2.htm?s_cid=mm6913e2_w

Findings

Of the 7,162 patients with reported data on underlying factors, 37.6% had at least one underlying condition or risk factor, including diabetes mellitus (11%), chronic lung disease (9%), cardiovascular disease (9%). Underlying conditions and risk factors were significantly higher among ICU admissions (78%), while at least one underlying condition was reported in 94% of patients that died.

Interpretation

Preliminary estimates suggest that underlying risk factors and co-morbidities can play a significant role, particularly among severe cases that require ICU admission. It remains unknown, however, whether severity or level of control of underlying health conditions affects the risk for severe disease with COVID-19.

Loss of smell and taste in combination with other symptoms is a strong predictor of COVID-19 infection

Menni et al, 7 April 2020, NOT YET PEER REVIEWED

https://www.medrxiv.org/content/10.1101/2020.04.05.20048421v1

Findings

This paper in pre-press shows preliminary evidence that anosmia (loss of smell) and ageusia (loss of taste) may be early symptoms of COVID-19. The study suggests that loss of taste and smell is a strong predictor of having been infected by the COVID-19 virus. Also, the combination of symptoms that could be used to identify and isolate individuals includes anosmia, fever, persistent cough, diarrhoea, fatigue, abdominal pain and loss of appetite. This is particularly relevant to healthcare and other key workers in constant contact with the public who have not yet been tested for COVID-19.

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Some say there is a trade-off: save lives or save jobs – this is a false dilemma (Heads of the IMF & WHO, Telegraph, 3 April 2020)

Commentary by the IMF Managing Director and the WHO Director General about the false dichotomy of save lives or save livelihoods. The argue that getting the virus under control is a prerequisite to saving livelihoods. Their joint appeal to policymakers, particularly in low- and middle-income countries, is to recognize that “protecting public health and putting people back to work go hand-in-hand.” In addition to the WHO, which is actively providing technical assistance to its Member States, at least 85 countries have requested emergency financing from the IMF. As financing reaches the countries in need, the authors furthermore extend a joint plea “to place health expenditures at the top of the priority list,” including paying salaries to healthcare workers, supporting hospitals, establishing field clinics, investing in medical and protective equipment, as well as carrying out public awareness campaigns such as hand washing.”

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  • Rapid and non-invasive antibody diagnostics remain a holy grail in scaling up testing for COVID-19. Preliminary results are currently under peer review for the rapid finger prick antibody test, AbC-19 Lateral Flow, that claims to be 98.6% accurate. While these claims seem promising, the results have not been made public, with questions remaining on the sets of samples the study used or what the researchers mean by ‘accuracy’. Diagnostic tests are typically assessed by sensitivity (false negative) and specificity (false positive). The other outstanding issue with these types of tests, however, relate to uncertainties in the period of time after infection that IgG antibodies disappear from the blood. Since acuity of COVID-19 infection appears to be correlated with the intensity of the antibody response, it is plausible that the test could come back negative for those with low antibody levels in as little as three months (for reference, antibody levels for SARS were detectable for up to two years). A rapid antibody test would nonetheless be a valuable diagnostic tool for detecting positive cases, even if negative test results would require further investigation. It is also important to note that other human coronaviruses don’t confer lifelong immunity, while ongoing research is also examining the role of T-cell immunity.

 

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