11/27/20 - smart, useful, science stuff about COVID-19
SOLUTIONS AND SUCCESSES:
1) I'm highlighting today a few inspirational stories of success in addressing the SARS-CoV-2 pandemic. For starters, this 11/19/20 piece at Vox reveals how Vermont has curbed the spread of SARS-CoV-2 — the state has "consistently had one of the lowest infection rates in the continental U.S.,” writes Julia Belluz. Measures include providing motel rooms that allowed homeless shelters to reduce crowding and other efforts to target people at high-risk for getting infected — bus drivers, health care workers, factory workers, people in low-income neighborhoods, and people living in shelters, prisons and retirement homes. More measures taken by Vermont officials include "hazard pay, meal deliveries, and free, pop-up testing in at-risk communities,” the story states. “Instead of just talking about how ‘social distancing is a privilege,’ leaders in the state designed programs and policy to overcome barriers to social distancing,” the story describes a program director at Dartmouth College’s Center for Global Health Equity as saying: https://www.vox.com/2020/11/19/21541810/vermont-covid-19-coronavirus-social-distancing.
2) Here are some of the ways that the Cherokee Nation has curtailed outbreaks of the new coronavirus: a mask mandate indoors and outdoors, efforts to protect older people including monthly stipends to help with virus-related expenses, a strong data-collection online dashboard for case tracking, a Cherokee language Covid hotline, "free drive-through testing, hospitals well-stocked with PPE, and a small army of public health officers fully supported by their chief,” reports Usha Lee McFarling for STAT (11/17/20). Other measures included making sure people had enough food to eat, devising and implement contact tracing system, and “educating residents [about the new coronavirus] in both English and Cherokee language.” Outcomes include no cases of workplace transmission, a high school that reopened this fall for in-person classes, and a resumption of elective medical and dental care: https://www.statnews.com/2020/11/17/how-covid19-has-been-curtailed-in-cherokee-nation/.
3) Here’s yet another success story, for the most part — Iceland has used testing, contact-tracing, isolation, and mask-wearing to control the spread of the new coronavirus in its population. Some of what they did: they converted a large research center, long used to study the genetics of people in Iceland, into a testing center for the virus. People who test positive are “enrolled in a tele-health monitoring service at a COVID outpatient clinic for a 14-day isolation period. They will receive frequent phone calls from a nurse or physician who documents their medical and social history, and runs through a standardized checklist of 19 symptoms,” writes Megan Scudellari at Nature (11/25/20). Individuals' samples of the virus are sequenced to determine their strain and origin. The country has been re-opened to tourists for months: https://www.nature.com/articles/d41586-020-03284-3.
4) Or draw inspiration from filmmaker Alice Wu's 11/21/20 Twitter thread about her recent visit to Taiwan and the measures taken there to prevent the spread of the new coronavirus. Measures she notes include a government-approved, "Covid-safe" car that takes airport arrivals to a 14-day quarantine hotel. Meals are left outside your door 3 times a day. Wu writes: “not an expert. But again: EVERYONE IN TAIWAN HAS BEEN LIVING THEIR LIVES FREELY SINCE FEBRUARY! I mean yes, people voluntarily wear masks in public places, but otherwise, restaurants, subways, etc are packed. So…”:
PUBLIC HEALTH:
5) Some public health experts would really like more people in the U.S. to enable anonymous smartphone technology that can alert us if we’ve been exposed to SARS-CoV-2, according to this 11/24/20 story by Geoffrey A. Fowler at The Washington Post. (Several science writers I know have installed or enabled these alerts on their phones. I did too, a couple months ago.) The story includes a list of links to information on how to enable these alerts if you live in one of 16 U.S. states or territories, plus Washington, D.C., that currently have systems in place. Six additional states plan to test or launch similar systems, Fowler reports, saying he’ll keep updating these lists. The alerts reportedly rely on software built into iPhones and Android devices to “detect when people (or the phones they’re holding) get into close contact with each other,” the story states: https://www.washingtonpost.com/technology/2020/11/18/coronavirus-app-exposure-alerts/.
6) Masks are hardly the whole answer, but nearly all public-health experts now endorse universal mask mandates to reduce the spread of SARS-CoV-2, reports Apoorva Mandavilli at The New York Times (11/24/20). “Increasing evidence” suggests that cloth face coverings “stop virus expelled by an infected person when breathing, talking, singing or shouting,” Mandavilli writes. While no randomized experiments establishes whether cloth face-mask wearing is effective at preventing infections with SARS-CoV-2, case studies strongly support that it is. And a randomized experiment on mask-wearing makes about as much ethical sense as a randomized study of the effectiveness of hand-washing or of the harms from cigarette-smoking: https://www.nytimes.com/article/coronavirus-masks.html.
7) A rapid SARS-CoV-2 test for home use received approval on 11/17/20 from the U.S. Food and Drug Administration, reports Matthew Perrone at the Associated Press (11/18/20). It’s the first test for the virus that gives results at home (within 30 minutes of collecting a sample), Perrone reports. “The company’s test allows users to swab themselves to collect a nasal sample. The sample is then swirled in a vial of laboratory solution that plugs into a portable device. Results are displayed as lights labeled positive or negative,” Perrone writes. Initially, people will need a prescription for the test, made by California-based Lucira Health, the story states. The FDA “did not disclose the tests’s accuracy or the study results that regulators used to make the decision,” Perrone writes: https://www.statnews.com/2020/11/18/fda-allows-first-rapid-coronavirus-test-that-gives-results-at-home/.
8) School staffers and parents of kids attending school in-person, in particular, might find this 11/18/20 story in Science helpful. It describes what is currently known about the risk of SARS-CoV-2 transmission in schools (it’s murky) and how schools worldwide are managing risks. “Early evidence, often gathered by researchers with children in school or a teacher spouse, suggests schools can stay open even in the face of significant community spread, given strong safety measures and political will,” write Gretchen Vogel and Jennifer Couzin-Frankel. “School outbreaks appear less common than initially feared, but data are sparse,” they continue. Testing at some schools is performed to monitor the overall spread of the virus, the story suggests, but it can drain resources and doesn’t catch early-stage infections. “Families look to schools to communicate what’s OK,” says a Harvard University researcher who studies the psychology of decision-making and is quoted in the story. The writers add: “The mere act of opening can send an unintended message that mixing together is benign—and provide more opportunities to do so,” such as sports. “It’s hard to make [sports] safe,” a Duke University pediatrician and epidemiologist is quoted as saying: https://www.sciencemag.org/news/2020/11/covid-19-soars-many-communities-schools-attempt-find-ways-through-crisis.
9) An 11/16/20 Q&A at Scientific American with Andrew Huberman, a Stanford University neuroscientist who studies the visual system, details how our vision and our breathing can “offer us easy and accessible releases from stress,” particularly in the context of the pandemic challenges and overall intensity of 2020. For instance, emerging research suggests that altering our breathing can alter brain regions responsible for arousal and panic, writes freelance science journalist Jessica Wapner in the introduction to the Q&A. And when we see stressful or exciting news, it increases our heart rate and breathing, Huberman says. You don’t want to miss this section: Our eyes are “not connected to the brain; they are the brain,” Huberman says. “During development, the eyes are part of the embryonic forebrain. Your eyes get extruded from the skull during the first trimester, and then they reconnect to the rest of the brain.” One of the tips Huberman mentions: one can turn off their brain's stress response by changing the way we are viewing our environment, specifically by taking on a panoramic view that allows you to see “far into the periphery.” Also, “every time you exhale, you’re slowing down the heart rate,” he says: https://www.scientificamerican.com/article/vision-and-breathing-may-be-the-secrets-to-surviving-2020/.
10) Evidence now is only circumstantial and some dentists remain skeptical, but some COVID-19 survivors with enduring symptoms like brain fog, muscle aches, and nerve pain are also reporting problems with their teeth and gums, some as severe as teeth falling out, reports freelance journalist Wudan Yan for The New York Times (11/26/20). COVID-19 is, in some respects, a vascular disease that damages blood vessels. That could include damage to blood vessels that keep our teeth alive, according to the medical director of a non-profit that studies blood vessel disease who is quoted in the story: https://www.nytimes.com/2020/11/26/health/covid-teeth-falling-out.html.
11) Check out my new acquaintance Betsy Ladyzhets's weekly “COVID-19 Data Dispatch, a newsletter written to help people make sense of myriad unstandardized (and often untrustworthy) pandemic data sources. The publication provides news on public health agencies, resources for understanding and communicating about the pandemic, context on how COVID-19 data experts are thinking about major issues, and occasional interviews or original analysis. Ladyzhets is a data journalist and science writer who’s been managing her publication’s pandemic coverage and volunteering at the COVID Tracking Project since the spring. All data sources featured in the newsletter since its July inception are compiled in a public Google spreadsheet, and Ladyzhets is working on other supplemental resources that may be useful for journalists, community leaders, and data nerds alike. Thanks to Betsy for drafting this entry for me.
VACCINES:
12) Here’s coverage of AstraZeneca’s 11/23/20 announcement that its relatively low-cost vaccine to protect against the new coronavirus is about 70% effective, by Helen Branswell and Adam Feuerstein at STAT (11/23/20). (Hm, is Monday always the day that groups announce that their vaccine candidate is highly effective?) The announcement came by a press release issued partway through the company's large-scale Phase 3 studies conducted in the UK and Brazil. Again, full data was not released and the results have not been submitted to a journal yet, so for this and other reasons, we should view these results with caution. Astra Zeneca’s vaccine, made in partnership with the University of Oxford, relies on technology that differs from the messenger-RNA approach of vaccines by Pfizer/BioNTech and by Moderna that are also now deep into Phase 3 studies. Called “viral-factored,” the approach adopted by Astra Zeneca delivers a genetic bit of SARS-CoV-2 within the genome of a weakened version of another common type of viruses, called adenoviruses. Inside our bodies, the modified adenovirus delivers the coronavirus genetic material too, which carries instructions for making the complex molecule that SARS-CoV-2 uses to hijack our cells — the “spike protein." This exposure to the spike protein trains the immune system to respond to SARS-CoV-2, which theoretically will protect us from a natural infection out in the world. The AstraZeneca vaccine only requires normal refrigeration temperatures, whereas the Moderna vaccine and the Pfizer vaccine must be stored at -4 F and -94 F, respectively. One of the big questions among the many remaining for all 3 of these vaccines — can people who get the vaccine still transmit SARS-CoV2 if they become infected? https://www.statnews.com/2020/11/23/astrazeneca-covid-19-vaccine-is-70-effective-on-average-early-data-show/.
13) Some particularly unexpected numbers appeared in AstraZeneca’s press release about the vaccine’s effectiveness — why was a full, two-dose immunization reportedly 62% effective while a two-dose combination in which the first-dose was only at half strength said to be more protective, 90%? AstraZeneca is not sure (although see Dr. Anthony Fauci’s thought about that up in the STAT story above), report Rebecca Robbins and Benjamin Mueller at The New York Times (11/25/20). The fact that the weakened-first-dose data is available at all is the result of a dosing error, which persisted “over a matter of weeks," Robbins and Mueller report. Once the dosing error was discovered, it was decided to continue the study to test the vaccine in the different doses, the story cites an AstraZeneca executive as saying. Other “irregularities and omissions in the way AstraZeneca initially disclosed the data have eroded [some outside scientists' and industry experts’] confidence in the reliability of their results,” the story states. But the different dosing results “could end up being quite a useful mistake,” the AstraZeneca executive is quoted as saying. This way, researchers can obtain safety and effectiveness results for both doses: https://www.nytimes.com/2020/11/25/business/coronavirus-vaccine-astrazeneca-oxford.html.
14) This piece by Carl Zimmer and Rebecca Robbins, organized in a question-and-answer format, nicely addresses the top issues currently surrounding the AstraZeneca vaccine. For instance, how soon might the vaccine be available in the U.S.? Well, AstraZeneca has more data collection to complete in the U.S., including a new test of the half-strength initial dose, Zimmer and Robbins report. Some of the U.S. results might not be available until next year, the story states, so “there’s still a long way to go” before the vaccine would be available (11/27/20). In English: https://www.nytimes.com/2020/11/24/health/astrazeneca-covid-vaccine.html; in Spanish: https://www.nytimes.com/es/2020/11/27/espanol/ciencia-y-tecnologia/vacuna-coronavirus-astrazeneca.html.
15) November has been chock-a-block with positive vaccine news, as you probably noticed. Seven days after Pfizer/BioNTech announced that early data showed its vaccine candidate had more than 90% effectiveness against the new coronavirus, competitor Moderna announced that its vaccine, using similar messenger-RNA technology in its own large, late-stage study in humans, was 94.5% effective. Then on 11/18/20, Pfizer/BioNTech announced that the effectiveness portion of its Phase 3 study was complete, showing 95% effectiveness. (See a pattern here over time?) Both groups report that their vaccine protects against severe and mild cases of COVID-19, report Damian Garde and Matthew Herper at STAT (11/18/20): https://www.statnews.com/2020/11/18/pfizer-biontech-covid19-vaccine-fda-data/.
16) Right after the Pfizer announcement of more 90% effectiveness, longtime infectious diseases reporter Donald G. McNeil Jr. at The New York Times said “a little rejoicing is in order." “This is pretty great,” he added in an interview with Adriana Balsamo at the Times published on 11/13/20. Yes, Pfizer did not release its data and the findings did not undergo formal scrutiny by outside experts. “But I’ve read previous news releases from Big Pharma companies and compared them to the data issued later, and they’ve been honest,” McNeil reportedly said. In the interview, McNeil also criticizes the spring lockdown in the U.S. as “a joke," because there was no coordinated and rapid accurate testing, contact tracing and isolation of infected people. As a result of that wasted opportunity, “we’re basically stuck with masks and not eating or meeting indoors until the vaccines arrive,” McNeil is quoted as saying: https://www.nytimes.com/2020/11/13/insider/virus-donald-mcneil.html.
17) On 11/20/20, Pfizer and BioNTech submitted their vaccine candidate to the U.S. Food and Drug Administration for emergency-use authorization, which would likely lead to it becoming available to health-care workers and others at high-risk for COVID-19, various outlets reported. Here’s Helen Branswell’s story about this development, for STAT: https://www.statnews.com/2020/11/20/pfizer-biontech-submit-formal-application-to-fda-to-authorize-covid-19-vaccine/. The New York Times piece above on the AstraZeneca irregularities, states that both the Pfizer/BioNTech vaccine and the Moderna vaccine “seem nearly certain to win emergency authorization from the FDA in the coming weeks."
SCIENCE:
18) Some deep history of how messenger-RNA vaccines were developed appears after the introductory material in this story by Arthur Allen for Kaiser Health News (11/18/20). A scientist in Hungary did pioneering work decades ago on the problem of preventing the body's innate immune system from destroying raw RNA that could be used to carry vaccines and drugs into the body. The innate immune system includes our inflammatory response, processes that remove foreign material, many kinds of recruitment activity and processes to identify and prepare for a fight against a dangerous microbe, and defense mechanisms like digestive acids, sweat, mucus, saliva, and tears. Over time, researchers found ways to slip RNA past the body's innate immune system so the genetic material could train a response from the adaptive immune system (antibodies, B cells, T cells) that yields immunological memory: https://khn.org/news/vaccine-pioneers-basic-research-scientists-laid-groundwork-for-billion-dollar-pharma-products/.
19) Can you catch the new coronavirus twice or are you immune once you recover from an initial infection? There’s little consensus on this yet. Reinfections are “still rare but on the rise,” reports Jop de Vrieze for Science (11/18/20). At research journals, editors seek strong evidence for re-infection claims to rule out residual genetic material from an original infection. Most journals require that scientists provide the full sequence of the virus from each illness to make sure that the viruses are “sufficiently different,” de Vrieze writes, attributing this statement to a University of Birmingham hematologist. Many labs don’t have the time or money to get that data, the story states: https://www.sciencemag.org/news/2020/11/more-people-are-getting-covid-19-twice-suggesting-immunity-wanes-quickly-some.
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Love/In friendship, Robin