coronavirus research
July 2, 2020

School will start up again in August or September, and plans are in flux — in most school districts but also in families. The American Association of Pediatrics offered its advice this week, and it was a little unexpected. Children should be "physically present in school" as much as possible, AAP "strongly" urged. One of their rationales: Unlike with the flu, it seems "children may be less likely to become infected and to spread infection" of the COVID-19 coronavirus.

"What we have seen so far in the literature — and anecdotally, as well — is that kids really do seem to be both less likely to catch the infection and less likely to spread the infection," pediatric infectious disease specialist Sean O'Leary, who helped write the AAP's guidelines, tells The New York Times. "It seems to be even more true for younger kids, under 10 or under 12." There are very few reports of the virus spreading in U.S. day care centers, he said. "And it seems like in countries where they have reopened schools, it plays a much smaller role in driving spread of disease than we would expect."

"Austria, Denmark, Germany, and Norway have reopened schools without major outbreaks," though they opened slowly, limited class size, and used aggressive mitigation strategies, epidemiologist Jennifer Nuzzo and pediatrician Joshua Sharfstein elaborate in a New York Times op-ed. "Israel experienced outbreaks in schools, but only after loosening limitations on class sizes." They ran through some other data points:

Early in the COVID-19 epidemic, Australia identified 18 infected youth in 15 schools; health officials traced 863 contacts of the students, only two of whom were found to have been infected. The Pasteur Institute in France found just three probable cases of COVID-19 in school-age children among 510 students in a town that experienced a major outbreak; the children did not pass the infection to teachers or other students. [Nuzzo and Sharfstein, The New York Times]

"Accumulating evidence and collective experience argue that children, particularly school-aged children, are far less important drivers of SARSCoV-2 transmission than adults," but it's not clear why, Dr. Benjamin Lee and Dr. William Raszka write in the journal Pediatrics. Maybe because infected children "are so frequently mildly symptomatic, they may have weaker and less frequent cough, releasing fewer infectious particles into the surrounding environment." But it could also be that kids have been staying more socially distant. It would be nice to know more before classes start. Peter Weber

May 27, 2020

"People think that, with COVID-19, 1 percent die and the rest just have flu," virologist Peter Piot, a giant of AIDS and Ebola research, tells The New York Times. "It's not that simple — there's this whole thing in the middle." Piot, 71, should know: The coronavirus "hit me like a bus" in March, he said, and he's only now able to move about for more than 10 minutes at a time. Researchers are still learning about the new coronavirus, but some people fortunate enough to recover still face lung scarring, heart damage, persistent fatigue, blood clots, strokes, neurological problems, and other long-term damage.

People in their 70s or older, like Piot, "are most likely to die from the virus, while younger people generally have a milder form of COVID," Renuka Rayasam writes at Politico. "Survivors in their 40s, 50s, and 60s will likely suffer the longest," experiencing serious aftereffects following more severe infections. The exhaustion and shortness of breath can make it impossible to return to work for a year or more, which can also lead to deteriorating mental health. COVID-19 survivors aren't allowed to join the U.S. military, Rayasam notes.

Middle-aged survivors are "the group that we're concerned about when we discharge," Shari Brosnahan, a pulmonary and critical care doctor at NYU's Langone Health, tells Politico. "If you were an active person with this disease and were in the ICU, your transition away from either being a primary breadwinner or taking care of kids or taking a trip in your retirement, those are things that have been taken away from you."

The 99,000 recorded U.S. COVID-19 deaths grab most of the attention, but it's worth remembering — and keeping in mind — that life hasn't returned to normal for many of the 1.68 million Americans infected with the coronavirus, and it may not feel normal for quite a while. Peter Weber

May 22, 2020

The Centers for Disease Control and Prevention prominently warns on its "How COVID-19 Spreads" page that "the virus spreads easily between people." But it also says, in new language, that "the virus does not spread easily in other ways," including "from touching surfaces or objects," The Washington Post noticed Thursday.

"It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes," the CDC says. "This is not thought to be the main way the virus spreads, but we are still learning more about this virus." CDC spokesman Kristen Nordlund told the Post the quietly updated guidance came from an internal review and "usability testing," but did not represent a change in how the CDC describes transmission. Previous versions of the site did have similar language, the Post reports.

The coronavirus can remain potentially viable on cardboard for up to 24 hours and up to three days on plastic and metal, virologist Vincent Munster and his colleagues at the National Institute of Allergy and Infectious Diseases lab in Hamilton, Montana, found. But it usually breaks down within hours of leaving its host. "Direct contact with people has the highest likelihood of getting infected — being close to an infected person, rather than accepting a newspaper or a FedEx guy dropping off a box," Munster told the Post.

If not living in fear of Amazon deliveries is the good news, the bad news is people are starting to venture into public spaces again, not always observing social distancing. The U.S. is on the cusp of 100,000 COVID-19 deaths, and if just 30 percent of people return to pre-COVID life, that number will easily surpass 200,000 by the end of summer, Nina Fefferman, who models diseases at the University of Tennessee, Knoxville, tells Politico. Peter Weber

May 14, 2020

Dozens of children have been diagnosed with a rare inflammatory disease, similar to Kawasaki disease, in the U.S. and Europe in recent weeks, and Italian doctors definitively linked the mysterious new malady to COVID-19 in an article published Wednesday in the British medical journal The Lancet.

"In the past month we found a 30-fold increased incidence of Kawasaki-like disease," report the doctors, from the Papa Giovanni XXIII Hospital in hard-hit Bergamo. The 10 children diagnosed with the disease, called pediatric multisystem inflammatory syndrome, since the COVID-19 epidemic began were older than the toddlers usually afflicted by Kawasaki disease — the average age was 7 1/2 — and were more likely to have severe inflammation, heart complication, shock, and need for treatment with steroids along with the usual immunoglobulin therapy.

Eight of the 10 children tested positive for COVID-19, and doctors said they suspect tests missed the coronavirus in the other two. In the previous five years, the hospital treated a total of 19 Kawasaki-like patients.

"Our study provides the first clear evidence of a link between SARS-CoV-2 infection and this inflammatory condition, and we hope it will help doctors around the world as we try to get to grips with this unknown virus," said Dr Lorenzo D'Antiga, the hospital's director of child health. "I have no doubt that Kawasaki disease in these patients is caused by SARS-CoV-2."

The Italian doctors stressed that the disease is still very rare in children — no more than one child in 1,000 exposed to the virus are affected, and only a fraction of those kids need intensive care. Britain, France, Spain, Switzerland, and Italy have collectively reported about 50 cases, New York has seen about 100, and there have been infections in Louisiana, Mississippi, and California, among other states. Three kids have died from the disease in New York and Britain announced its first death on Tuesday. Peter Weber

May 4, 2020

At Sunday night's Fox News virtual town hall, President Trump said he still talks a lot about the malaria drug hydroxychloroquine as a COVID-19 treatment and complained that some Democrats "would rather see people — I'm going to be very nice, I'm not going to say die — I'm going to say would rather see people not get well because they think I'm going to get credit if, you know, hydroxychloroquine works." He dismissed a Veterans Affairs study suggesting the drug increased the risk of death and a subsequent FDA warning.

In his quest for a "silver bullet" to slay the coronavirus, Trump became obsessed with hydroxychloroquine after hearing frequent praise for the drug from Fox News and friends, The Washington Post reported Saturday night. "Although Trump stopped touting the drug publicly, privately he maintained his support for hydroxychloroquine and got upset with government officials presenting studies or bringing him evidence of its risks or failings, encouraging them to have a more positive outlook." Fox News host Laura Ingraham brought two doctors to the Oval Office on April 3 to talk up the malaria drug, the Post reports, adding this anecdote:

Keith Frankel, a vitamins executive who occasionally socializes with Trump at his Mar-a-Lago Club in Palm Beach, Fla., said the president asked him to call California Gov. Gavin Newsom (D) on his cellphone and try to make a deal for the nation's largest state to buy millions of tablets of hydroxychloroquine from an Indian manufacturer. Frankel said he got Newsom's phone number from Trump. ... "A guy I know sells products to these guys in India who are making the drug," Frankel said. He said he learned of the Indian manufacturer through a connection in Turkey. Several million of the pills could have been supplied, he said, but "there ended up being no deal." [The Washington Post]

Top U.S. medical officials are more excited about Remdesivir, and Trump also touted that experimental antiviral drug in the Fox News town hall. "We are putting the full power and might behind this drug," he said, without elaborating. Peter Weber

May 1, 2020

The U.S. now has more than 63,000 confirmed COVID-19 deaths, and most experts say that's almost certainly an undercount. Still, if you compare that number to the 2017-18 flu season, which the Centers for Disease Control and Prevention (CDC) estimates killed 61,000 people, it looks like COVID-19 might be similar to a bad flu — President Trump has made this point, as have many conservative media personalities. But the data so far show that this new coronavirus is much more lethal than the flu, and Dr. Jeremy Samuel Faust has an explanation.

Faust, a Harvard Medical School instructor and emergency physician at Brigham & Women's Hospital in Boston, wrote in Scientific American that he started wondering about the flu-to-COVID comparisons when it occurred to him that in nearly eight years of hospital work, "I had almost never seen anyone die of the flu." Neither had any of the colleagues he called around the country. So he did some research, and this is what he found:

The 25,000 to 69,000 numbers that Trump cited do not represent counted flu deaths per year; they are estimates that the CDC produces by multiplying the number of flu death counts reported by various coefficients produced through complicated algorithms. These coefficients are based on assumptions of how many cases, hospitalizations, and deaths they believe went unreported. In the last six flu seasons, the CDC's reported number of actual confirmed flu deaths — that is, counting flu deaths the way we are currently counting deaths from the coronavirus — has ranged from 3,448 to 15,620. [Jeremy Faust, Scientific American]

So in an apples-to-apples comparison, matching the second week of April's COVID-19 deaths to the worst week of the past seven flu seasons, "the novel coronavirus killed between 9.5 and 44 times more people than seasonal flu," Faust writes. Read his entire essay at Scientific American. Peter Weber

April 29, 2020

Researchers are still learning a lot about the COVID-19 coronavirus: what it does to the body, what other animals it infects — dogs, for example — how to treat the disease, and, of course, how contagious and lethal the new virus is for humans. Antibody tests, designed to determine how many people have been infected with the coronavirus, suggest the coronavirus is less fatal for the average individual, and far more contagious, than originally believed.

Some people, largely conservative opinion journalists, cite the serology data to argue the coronavirus outbreak is no more deadly than the seasonal flu and the U.S. has overreacted. Infectious disease experts come to the opposite conclusion. "I think it is the worst pandemic since 1918," Cecile Viboud, an epidemiologist at the National Institutes of Health's Fogarty International Center, tells The Washington Post.

There are two fatality rates: the case fatality rate, measuring symptomatic COVID-19 patients who die, and the infection fatality rate, which covers everyone infected with the coronavirus. The case fatality rates "have been about 6 percent globally as well as in the United States," the Post reports, while the infection fatality rate is now believed — based on antibody tests — to be anywhere from 0.5 percent to 0.8 percent. You may have read that the seasonal flu has a fatality rate of 0.1 percent, but that's the case fatality rate. So even if the coronavirus infection fatality rate is 0.2 percent, as a controversial study of California's Santa Clara County suggested, "it would still be deadlier than the flu," the Post notes.

As of Wednesday morning, the U.S. has reported more than a million COVID-19 infections and 58,355 deaths, according to Johns Hopkins. But that's almost certainly undercounting both numbers. New Centers for Disease Control and Prevention (CDC) data analyzed by The New York Times show that total deaths in seven states were 50 percent higher than usual from March 8 to April 11.

The CDC will eventually count and sort these thousands of "excess deaths," the Times reports, but "right now, they are the most useful tool, several epidemiologists said, for measuring the impact of coronavirus in the United States" and around the world — and the deaths are clearly "far more than during a typical bad flu season." Peter Weber

April 20, 2020

Life will not return to normal anytime soon, even if states lift COVID-19 lockdowns in an attempt to revive hard-hit economies. Face masks will be de rigueur, people may be "trapped indoors for months," and crowded public events are out, science reporter Donald McNeil Jr. writes at The New York Times, citing more than 20 health and science experts. Until there's a vaccine, "if Americans pour back out in force, all will appear quiet for perhaps three weeks. Then the emergency rooms will get busy again."

Among the many things we don't yet understand about this new coronavirus is how deadly it is or how many people have been infected. "Fatality rates depend heavily on how overwhelmed hospitals get and what percentage of cases are tested," and those numbers keep getting revised in hard-hit areas, McNeil reports. People who die of the disease at home or in overwhelmed hospitals are not counted, but people with few or no symptoms are never tested, so "if you don't know how many people are infected, you don't know how deadly a virus is."

The changing fatality rate is one reason the models keep fluctuating, McNeil says, but "there may be good news buried in this inconsistency: The virus may also be mutating to cause fewer symptoms. In the movies, viruses become more deadly. In reality, they usually become less so, because asymptomatic strains reach more hosts. Even the 1918 Spanish flu virus eventually faded into the seasonal H1N1 flu."

While we don't know the fatality rate or level of contagion, the "refrigerated trucks parked outside hospitals tell us all we need to know: It is far worse than a bad flu season," McNeil writes. How the pandemic ends depends on the virus' lethality, medical advances, and how individuals behave, he adds. "If we scrupulously protect ourselves and our loved ones, more of us will live. If we underestimate the virus, it will find us." Peter Weber

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