As COVID-19 hospitalizations continue to surge around the world, another dangerous infection may also be sickening patients: a drug-resistant superbug called Candida auris, National Geographic reported.
The superbug is a yeast that can infect the ears and open wounds, and it can also enter the bloodstream to trigger severe infection throughout the body, according to the U.S. Centers for Disease Control and Prevention (CDC). The yeast clings to surfaces and spreads easily in health care settings, especially among patients with catheters or other tubes that enter their bodies.
Now, early data hints that the influx of COVID-19 patients in hospitals may also be driving a surge of C. auris cases, according to the National Geographic report. Notably, the United States has already reported 1,272 cases of the fungal infection this year, according to the CDC that's about a 400% increase over the number of cases reported in all of 2018, the most recent year with available data. The number of cases in 2020 may be even higher than reported, given that the ongoing pandemic has disrupted surveillance systems used to track the fungus's spread. Other kinds of fungi in the Candida genus closely resemble C. auris, so doctors can identify the yeast only by using a specialized laboratory test.
Related: 20 of the worst epidemics and pandemics in history
"Unfortunately, there have been places where we've seen a resurgence of C. auris," Dr. Tom Chiller, head of the mycotic diseases branch at the CDC, told National Geographic. "We've also seen it get into some of the acute care hospitals and also into some COVID-19 units the concern there is that once it sets up shop in a place, it's hard to get rid of."
According to the CDC, "patients can remain colonized with C. auris for a long time," meaning the fungus can remain on their skin without necessarily causing overt symptoms, "and C. auris can persist on surfaces in healthcare environments." The superbug can also be notoriously difficult to treat. The C. auris yeast comes in several variants that show resistance to different classes of antibiotic drugs; in particular, many variants studied show resistance to the common antifungal fluconazole, and several show resistance to amphotericin B, a second-line antifungal drug that can be given if an initial antibiotic fails, National Geographic reported. Due to drug-resistance, doctors must sometimes resort to treating patients with third-line drugs if a second-line treatment also fails.
Most known variants of C. auris can be treated with third-line antifungals called echinocandins, but these treatments aren't readily available in all countries and some variants of the yeast show resistance to all three classes of antifungals, the CDC notes. Since the yeast was identified in 2009, a few thousand cases have been reported around the world; about 30% to 60% of people infected with the fungus worldwide have died, although many of these people had other serious illnesses, simultaneously, according to the agency.
Dr. Anuradha Chowdhary, a professor of medical mycology at Vallabhbhai Patel Chest Institute at the University of Delhi, told National Geographic that COVID-19 patients should be regularly screened for C. auris, in order to accurately track rates of infection and identify which antibiotic treatments, if any, might help affected patients recover.
"If we don't identify it, then we don't know if a patient is dying of COVID-19 or another infection," Chowdhary said. But "if it's resistant to drugs, how will we treat it?" she added.
If a given variant of C. auris resists all three classes of antifungal medication, "multiple classes of antifungals at high doses may be required to treat the infection," but this treatment would be a last resort, the CDC notes. Research suggests that using several classes of antifungal at the same time may have an additive effect and help overpower the yeast's resistance to individual drugs, although this still needs to be confirmed with more data.
You can learn more about C. auris at National Geographic.
Originally published on Live Science.
It's time to gather the family together for the talk. Not that talk the talk about what to do for Thanksgiving this year as the pandemic rolls on.
It has been months since many of us have seen extended family we're longing to check in on aging parents, to see old friends from back home, etc. But even though Thanksgiving often conjures up pictures of big happy reunions, how safe is it to make them a reality?
"Right now, in many areas of the country, COVID-19 rates are starting to surge again," says Dr. Tina Tan, pediatric infectious disease specialist at the Ann and Robert H. Lurie Children's Hospital of Chicago and professor of pediatrics at Northwestern University's Feinberg School of Medicine. Tan fears that the lure of holiday parties as well as more indoor activity because of the colder weather may result in more illnesses.
But if your heart is set on having a get-together, there are some things you can do to protect yourself, Tan says.
First, make sure you know who is attending and if you are traveling, how you'll get there. You need to know what coronavirus transmission rates are in the area you live and where you're going, Tan says. You can use NPR's coronavirus tracker to check this.
"Unfortunately, you're not really going to know that until fairly close to when you want to travel because these [transmission rates] are changing really rapidly," she says.
Family trip road trip
The safest way to travel is to drive, Tan says. The main risks in a road trip are the stops along the way, such as at restaurants, gas stations, or public restrooms.
"I would recommend you do anything you can to limit your exposure," says Dr. Ravina Kullar, an epidemiologist and spokesperson for the Infectious Diseases Society of America. "If you have to fill up the gas tank, put gloves on and use hand sanitizer" and wear a mask, she says.
That's what Clay Alling is planning to do take a family road trip to the coast. Alling is a chef and general manager for a group of British pubs called Baker St. Pub & Grill, all located in Texas.
He often makes Thanksgiving dinners and delivers them to customers in the Houston area, where he lives.
"Not this past Thanksgiving, the one before that, I did 55 turkeys, I did 300 pounds of mashed potatoes, 100 pounds of green beans ... 42 dozen eggs, 12 dozen yeast rolls ... 12 cherry pies, 15 pecan pies, 28 pumpkin pies. It was crazy."
But he's not doing that this year. The pandemic has hit his business hard and has forced adaptations like expanding the food menu at many locations and implementing extensive safety protocols to reopen. He has been working harder than ever this year.
"I'm gonna take a break," he says. "We're going to get some kind of relaxation into everybody's lives."
This year, Alling will take his wife, their three children and his elderly father-in-law (who lives next door and whom the family has been caring for) to the beach for a Thanksgiving escape. They're going to rent a house, which is pretty safe, Tan says.
"You just have to make sure the cabin or whatever you're renting has been cleaned thoroughly so there's not the risk of someone having COVID that was just there ... and it's still on the surfaces or in the air."
But what about flying?
Thanksgiving is traditionally one of the busiest times of the year for air travel. The Transportation Security Administration screened a record-breaking 26 million passengers over the holiday in 2018.
The airlines are enforcing mask-wearing more consistently than they were at the beginning of the pandemic, Tan says, and they are seating people farther apart. Same with trains.
"The planes themselves are actually very safe. I mean, their air circulation system is better than the air circulation system in many homes," she says.
A recent report in the Journal of Travel Medicine suggests that strict mask-wearing policies on planes is particularly effective. Scientists studied all Emirates airline flights from Dubai to Hong Kong between June 16 and July 5 and found that although Emirates had 58 coronavirus-positive passengers flying on eight-hour trips, nobody else on those flights got sick.
"I think your biggest risk is at the airport," says Tan, where the situation is less predictable. There are more people and fewer controls.
Precautions before you gather
Even if there's no travel involved, gathering indoors with extended family and friends can be risky, especially if there's an older or high-risk person in your group.
The Centers for Disease Control and Prevention says people 65 years and older are at higher risk for getting a severe case of COVID-19. About 80% of deaths in the U.S. from COVID-19 have been of people in this age group.
You'll need to agree on some ground rules in the weeks leading up to your feast. To be really on the safe side, you would try to quarantine for two weeks before the day, or take as many precautions as practical.
Holly Provan, a cardiac rehab nurse at Huntington Hospital in Pasadena, Calif., plans to spend Thanksgiving weekend with her family and friends in a shared cabin in the woods in the tiny town of Lake Arrowhead, a few hours drive away. To do that as safely as possible, Provan says she will stop working for a week before the trip, keep everyone in the house socially distant from others, shop exclusively online and take a COVID-19 test.
"We're making some sacrifices for that week before just to make sure we're all extra careful and that they feel safe," she says.
Sharing a cabin with another family or extended family can be relatively low-risk, says Tan, if everyone attending has been following good hygiene practices hand-washing, social distancing as much as possible and mask-wearing in the days or weeks leading up to the event.
And when you're not eating, ideally you should be wearing a mask. "I know it's very awkward, but that's going to be the way you can keep your family and the other family safe," Tan says.
Tan suggests one other precaution before the event: Make sure everybody has a flu shot. "You don't want to bring something else into the mix."
As for COVID-19 tests, Tan says they are not a guarantee.
"Basically what we know about these tests is it only tells you at that particular point in time what your status is," she says. The tests often fail to show when someone is carrying COVID if their exposure has been very recent. They are more accurate five to seven days from exposure, and often, you just don't know when you were exposed, she says. Plus, many people are asymptomatic.
Safer at home sweet home
The safest thing to do is stay home with the people in your own household. That's what Leigh Anne Pineda plans to do. Pineda lives in a garden apartment building with her husband and two children in Burbank, Calif. She works in a credit union, and her youngest child is asthmatic, which puts him at a higher risk for complications from COVID-19.
Although her family is nearby and has been helping with the kids from time to time, Pineda has decided to make this Thanksgiving the one holiday where it's just the four of them.
"I think it's really easy to get engulfed in all the bustle of the holiday and not really enjoy it because there's so many people and there's so much going on and you've got to say 'hi' to these people and clean up all the mess," Pineda says. This year, they're going to ignore the laundry and the dishes and just enjoy one another's company.
And they might even cook something completely untraditional. Her husband is a chef of Filipino descent and might just put some pancit and pork belly on the table. "I'm not going to lie. I'm not the biggest fan of turkey," she says.
And, she's actually looking forward to avoiding the sometimes-exhausting extended family gathering. "Now I have an excuse to stay home!" she says.
"I'm going to continue to trust South Dakotans to make wise and well-informed decisions for themselves and their families. I'm also asking that we all show respect and understanding to those who make choices we may not agree with. Our trust in the data and in each other has been rewarded. This is a testament to the people of South Dakota -- our greatest weapon against this common enemy."
If there is an epicenter for the resurgent coronavirus in America, then, South Dakota may well be it.
And yet, Noem seems oblivious to all of these data points. Instead, her op-ed largely defends her mostly hands-off approach to the virus in the state to date -- she never issued a stay-at-home order, for example -- while also arguing that there is no need for a mask mandate at this point.
Here's Noem on masks:
"There are many others who question the effectiveness of masks, and South Dakotans should take the time to read this information so they can make informed decisions for themselves and their families. As I've said before, if folks want to wear a mask, they should be free to do so. Similarly, those who don't want to wear a mask shouldn't be shamed into wearing one. And government should not mandate it. We need to respect each other's decisions -- in South Dakota, we know a little common courtesy can go a long way.
"Recently, a South Dakota doctor wrote me, thanking me 'for treating your fellow citizens of South Dakota like adults...' I tell you this because there are also some South Dakota medical professionals who have written to tell me of their fears about voicing their thoughts on the situation."
That's positively Trumpian!
Many people suggest masks may not work! Masks are about personal freedom, not public health! Some doctor thanked Noem for taking such a laissez-faire stance on masks!
Masks work to drastically slow the spread of the virus. They remain -- until a vaccine is widely available -- our best tool to fight Covid-19. This is not a political or a partisan statement. It is a fact.
Aligning herself so closely with Trump in her response to Covid-19 could well be a smart strategic move for Noem as the party turns in 2024 to its future national candidates. But for the residents of her state, Noem's actions in regard to the virus have been downright deplorable.
TheWest Virginia Department of Health and Human Resources (DHHR) reportsas of 10:00 a.m., October 21, 2020, there have been 695,527 total confirmatory laboratory results receivedfor COVID-19, with 20,734 total cases and 413 deaths.
DHHRhas confirmed the deaths of a 62-year old male from Wetzel County, an 87-yearold female from Cabell County, a 76-year old male from Upshur County, an 85-yearold female from Harrison County, and an 89-year old female from Cabell County. Im sorry to report that we have lost another five WestVirginians, said Bill J. Crouch, DHHR Cabinet Secretary. Each loss is aheartbreak to a family and to our state. I urge you to remember your actionsfor safety result in saving the lives of your family, neighbors and friends.
CASESPER COUNTY: Barbour(164), Berkeley (1,461), Boone (307), Braxton (47), Brooke (197), Cabell(1,237), Calhoun (33), Clay (55), Doddridge (67), Fayette (727), Gilmer (64),Grant (179), Greenbrier (162), Hampshire (122), Hancock (195), Hardy (102),Harrison (624), Jackson (362), Jefferson (538), Kanawha (3,394), Lewis (68),Lincoln (221), Logan (719), Marion (362), Marshall (262), Mason (167), McDowell(106), Mercer (606), Mineral (206), Mingo (528), Monongalia (2,239), Monroe (206),Morgan (109), Nicholas (177), Ohio (467), Pendleton (73), Pleasants (23),Pocahontas (64), Preston (181), Putnam (804), Raleigh (681), Randolph (389),Ritchie (31), Roane (92), Summers (82), Taylor (165), Tucker (58), Tyler (25),Upshur (228), Wayne (513), Webster (26), Wetzel (95), Wirt (32), Wood (505),Wyoming (187).
Please note that delaysmay be experienced with the reporting of information from the local healthdepartment to DHHR. As case surveillance continues at the local healthdepartment level, it may reveal that those tested in a certain county may notbe a resident of that county, or even the state as an individual in questionmay have crossed the state border to be tested. Such is the case of Barbour, Brooke, Harrison, andRitchie counties in this report.
Please visit the dashboard located at www.coronavirus.wv.gov for more information.
Free COVID-19 testing isavailable today in Berkeley, Cabell, Doddridge,Harrison, Logan, Mingo, Monongalia, Monroe, Morgan, Pendleton, Randolph, Roane,Taylor, Wayne, Wirt, and Wyoming counties.
Berkeley County,October 21, 8:30 AM 12:30 PM, Hedgesville High School, 109 Ridge Road North, Hedgesville,WV
Cabell County,October 21, 9:00 AM 2:00 PM, Cabell County Health Department, 703 SeventhAvenue, Huntington, WV (flu shots offered)
DoddridgeCounty, October 21, 1:00 PM 4:00 PM, Doddridge County High School, 79 BulldogDrive, West Union, WV
HarrisonCounty, October 21, 9:00 AM 12:00 PM, Jackson Square (back door of the HealthDepartment), Traders Alley, Clarksburg, WV
Logan County,October 21, 10:00 AM 2:00 PM, Old 84 Lumber Building, 100 Recovery Road, PeachCreek, WV
Mingo County,October 21, 8:00 AM 12:00 PM, Williamson Health and Wellness Center, 183 East2nd Street, Williamson, WV
MonongaliaCounty, October 21, 9:00 AM 4:00 PM, West Virginia University, StudentRecreation Center, 2001 Rec Center Drive, Morgantown, WV
Monroe County,October 21, 3:00 PM 7:00 PM, Monroe County Health Department, 200 HealthCenter Drive, Union, WV
Morgan County,October 21, 2:00 PM 6:00 PM, Warm Springs Middle School, 271 Warm Springs Way,Berkeley Springs, WV
PendletonCounty, October 21, 2:00 PM 6:00 PM, Pendleton County Health Department, 273Mill Road, Franklin, WV
RandolphCounty, October 21, 2:00 PM 6:00 PM, 22 Buffalo Street, Elkins, WV
Roane County,October 21, 1:00 5:00 PM, Roane County High School, 1 Raider Way, Spencer, WV
Taylor County,October 21, 12:00 PM 2:00 PM, First Baptist Church of Grafton, 2034 WebsterPike (US Rt. 119 South), Grafton, WV
Wayne County,October 21, 10:00 AM 2:00 PM, Wayne County Health Department, 217 Kenova Avenue,Wayne, WV 25570
Wirt County, October21, 12:00 PM 4:00 PM, Coplin Clinic, 483 Court Street, Elizabeth, WV, Pre-registrationat www.ipsumcovidresults.com
WyomingCounty, October 21, 1:00 PM 5:00 PM, Old Board of Education, 19 Park Street, Pineville,WV
Testing is available toeveryone, including asymptomatic individuals. Additional testing will be held Thursday,October 22 in Berkeley, Boone, Braxton, Brooke, Cabell, Doddridge, Lincoln,Marion, Marshall, Mingo, Monroe, Morgan, Pendleton, Putnam, Ritchie, Taylor,Wayne, Wirt, and Wyoming counties.
PIERRE, S.D. (KELO) Ten new COVID-19 deaths were reported on Saturday as South Dakota surpassed more than 10,000 active COVID-19 cases in the state, according to the South Dakota Department of Healths update.
The death toll increased to 366. There have been 143 deaths in October, the deadliest month of the pandemic in South Dakota. The new deaths were six women and four men with three in the 60-69 age range, two in the 70-79 age range and five in the 80+ age range. The new deaths were listed in the following counties: four in Jerauld (11), one in Lincoln (18), one in Meade (10), three in Minnehaha (105) and one in Todd (6).
On Saturday, 939 new coronavirus cases were reported, bringing the states total case count to 38,141, up from Friday (37,202).
On Tuesday, the DOH changed its website to not list new total cases on the SD overview tab of its dashboard. KELOLAND News has been counting the number of new total cases since the beginning of the pandemic and will continue to report on the new total cases. There were 852 new PCR cases and 87 new antigen cases announced for 939 new cases Saturday.
Total recovered cases are now at 27,557, up 573 from Friday (26,984).
Active cases are now at 10,218, up from Friday (9,862).
Current hospitalizations are at 356, up from Friday (349). Total hospitalizations are at 2,378, up from Friday (2,336).
Total persons tested negative is now at 205,539, up from Friday (203,800).
There were 2,678 new persons tested reported on Saturday.
Keep reading
Your Guide To Coronavirus
KELOLAND News is covering the COVID-19 pandemic. This is your guide to everything you need to know to prepare. We also have the latest stories from across the globe feeding into this page.
Worshippers came to Redding's Sundial Bridge on July 22, 2020. The crowd put the community 'at risk' for COVID-19, Shasta County health officials say. Redding Record Searchlight
At least two Shasta County supervisors are losing their patience with the leadership at Bethel Church over its messaging amid the recent COVID-19 outbreak at its School of Supernatural Ministry.
At Thursdays special board meeting, Supervisors Les Baugh and Leonard Moty said the tipping point for them came this week, when they learned Kris Vallotton, a church leader who co-founded the evangelical school, hosted a large family outdoor wedding last weekend in Shingletown.
The wedding also came up at Tuesdays regular board meeting.
Im not convinced theyre really hearing (us), said Baugh, a pastor at Anderson Community Church in Anderson.
Supervisor Moty, you mentioned the wedding (Tuesday) and I didnt know at the time the wedding actually had been a personal wedding of one of the leaders of the Bethel community, and I do say, as a community, thats wrong. That should not have happened, Baugh said on Thursday.
Supervisor Les Baugh(Photo: Mike Chapman/Record Searchlight)
Moty on Thursday said he was happy to see the School of Supernatural Ministry worked with health officials to help stop the outbreak among its students and staff.
And then, quite frankly, I was very dismayed by this event, and one of their leaders of their church, (who is) very familiar with the (COVID-19) situation, has a very large wedding event there, Moty said. From what I understand, size-wise, (it) could have maybe have been legal if they would have social distanced and wore masks ... but they did nothing of the sort.
Moty said it clearly sent the wrong message.
Supervisor Leonard Moty(Photo: Andreas Fuhrmann)
During Thursdays meeting to consider opting out of the states COVID-19 color-coded tier system, many of the public speakers blamed Bethel and the county for its failure to hold the church accountable for the surge in cases.
Purple tier in Shasta County:Nearly 200 people plead with supervisors on COVID restrictions
Supervisor Joe Chimenti pointed out the megachurch, with its 11,000 members, is hugely influential in the community and the leadership's actions matter. Combined, the church and its subsidiaries, like Bethel Music, Bethel Media and the School of Supernatural Ministry, are one of the largest employers in Shasta County.
I think theyre a large influencer in so many positive ways in the community, that this is a real opportunity for them to step up and show some leadership in terms of how they can help us as a community come together because as we know, this can become very divisive, Chimenti said.
The number of COVID-19 cases associated with theSchool of Supernatural Ministry and a Redding nursing home is on the decline, Shasta County Health Officer Dr. KarenRamstromsaid during a media briefing Wednesday.
Bethel officials have said in written statements they continue to work with public health.
As of last Tuesday, the school had reported 321 positive cases since the outbreak started in September. Bethel spokesman Aaron Tesauro said Friday public health officials confirmed less than 12 active coronavirus cases in the school.
For the actions that Bethel has made as a church and school since March, we recommend the public view our history of adjustments and statements at www.bethel.com/coronavirus, Tesauro said in an email.
Bethel School of Supernatural Ministry co-founder Kris Vallotton posted a video Tuesday night, Oct. 20, 2020 on Facebook in which he defended the occurrence of a large wedding in Shingletown last weekend.(Photo: Facebook)
Tesauro directed questions about the wedding to Vallotton.
Vallotton addressed his grandson'swedding in avideo he posted Tuesday on Instagram and Facebook. He did not respond to an email from the Record Searchlight seeking comment at the time.
In the video, he said about 100 people attended the wedding, down from an original guest list of 300, and the family and attendees knew the risk.
He said few people wore masks, but they knew all the guests and "we had them seated at family tables."
"I live a fully lockdown life with some exceptions and I think ... we have to measure the risk to reward," he said.
On Friday, Vallotton said in an email to the Record Searchlight that he has reached out to supervisors and will work out my relationship with them personally. He declined to comment further.
RELATED STORY:Amid surge in COVID cases at its school, Bethel hosted in-person worship conference
Meanwhile, in another Instagram video this month, church leader Beni Johnson disparaged the importance of wearing masks to help prevent spread of the virus. If you'll do the scientific research, these masks are worthless and they're people's security blankets," she said in the video.
Johnson later apologized but she also said she still questions the importance of the public health measure.
Sean Feucht sings on stage with his family, Ezra, 5, Keturah, 9, and Malachi, 7, in front of the west steps of the state Capitol as protesters gathered at Liberty Fest to protest Gov. Gavin Newsom's stay-at-home order in Sacramento, Calif., on May 23. Hundreds of protesters rallied outside the Capitol on Saturday to protest against California's stay-at-home orders even as residents entered the Memorial Day weekend with newly expanded options for going to the beach, barbecuing and shopping. (Jason Pierce/The Sacramento Bee via AP)(Photo: Jason Pierce, AP)
Christian recording artist Sean Feucht, aBethel volunteer worship leader, has held large open-air concerts in California and in other parts of the country, including the National Mall in Washington D.C., Kenosha, Wis. and Chicago and Nashville, in defiance of physical distancing and other health guidelines during the pandemic. A rally organized in July at the Sundial Bridge drew thousands.
Moty said its important for the county to keep pressuring Bethel to do the right thing and follow health guidelines.
Baugh said at the start of the outbreak at the School of Supernatural Ministry, health officials danced around it when they could have been more forthright with the public.
We cant be afraid to talk about things in a very transparent way if were going to salvage our community and be healthy as a community. We have to talk about these things, he said.
Health and Human Services Agency Director Donnell Ewert told supervisors during his last conversation with Vallotton, the BSSM director told him Bethels leadership is not of one mind.
Ewert said he asked Vallotton if the churchs leadership could come up with a united message about the importance of wearing masks and social distancing because it would help the community.
And he told me he couldnt do it because they are not of one mind, Ewert said.
Moty told Ewert he found that unsettling.
That disturbs me very much to hear that they cant control different aspects of their organization for the good of public health in Shasta County. Thats really bad, Moty said.
David Benda coversbusiness, developmentand anything else that comes up for the USA TODAY Network in Redding. He also writes the weekly "Buzz on the Street"column.Hes part of a team of dedicated reporters that investigate wrongdoing, coverbreaking news and tell other stories about your community. Reach him on Twitter @DavidBenda_RS or by phone at 1-530-225-8219. To support and sustain this work, please subscribetoday.
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CHEEKTOWAGA, N.Y. (WIVB)A person has tested positive for coronavirus at Cleveland Hill Elementary School.
The district says that person was in the building today and that contact tracing is getting underway.
The school is going to be thoroughly cleaned and disinfected.
The district says students, parents, and staff should monitor their health for COVID-19 symptoms.
A Martinsville resident is the latest person in the West Piedmont Health District to have died of COVID-19. That death emerged this morning in the report from the Virginia Department of Health, but deaths lag in reporting because cause is verified by the death certificate. This is the 24th death in in the city and the 87th in the district. The cases continue to mount, as well, with 44 more this morning. And has been the case all month, Franklin County had the most, with 27. Henry County reported 9 new cases, Martinsville had 5, and Patrick County had 3. There was a new hospitalization in Franklin and Patrick Counties. That's now 2,852 cases and 290 hospitalizations in the district since the pandemic began. The woman from Patrick County who died recently of COVID-19 was the first in the county in several weeks. But Franklin County's case numbers continue to soar. Even with the pandemic, two traditional fund-raising events in the area will go on Saturday: Wine By the River at Smith-River Sports Complex and the MLC Foundation event at the NCI parking lot have adjusted to allow for social distancing and safety. Friday was a record for the most cases of the novel coronavirus, with more than 80,000 reported. Many are in rural areas. President Trump continues to downplay the surge.The 7-day rolling average for new daily COVID-19 cases in the U.S. surpassed 61,140 Thursday, compared with 44,647 two weeks ago. As of today, the total cases will reach 8.5 million. There were nearly 500,000 new cases worldwide since Friday morning. The Virginia Department of Health reportsthis morning there have been 172,372 cases and 3,578 deaths statewide -- up by 39 from Friday. Some 12,198 people have been hospitalized. Henry County has had 1,283 cases, with 134 hospitalizations and 31 deaths. Martinsville has had 477 cases, with 64 hospitalizations and 24 deaths. Patrick County has had 317 cases including 58 hospitalizations and 27 deaths. Franklin County has had 775 cases, 34 hospitalizations and 5 deaths. Danville has reported 1,167 cases (42 deaths), and Pittsylvania County has had 1,255 (17 deaths).Johns Hopkins University's real-time mapshowed 42,288,341 cases worldwide and 1,145,557 deaths. In the U.S. there have been 8,494,415 cases and 223,998 deaths because of COVID-19.
(220) updates to this series since Updated 9 hrs ago
Bellin doctor says current average 'wait time' is less than what it was before COVID-19 Fox11online.com
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented changes in all aspects of our lives and has placed biomedical research at the forefront. One of the many pressing questions surrounding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections is identifying the determinants of the clinical spectrum, from people with asymptomatic disease to patients with severe COVID-19. Up to 40% of infections may be asymptomatic, suggesting that a large proportion of people may be protected from disease (1). On the other end of the spectrum is severe disease, with an overall estimated fatality rate near 1% (2). On pages 422 and 424 of this issue, Zhang et al. (3) and Bastard et al. (4), respectively, report analyses of >1600 patients infected with SARS-CoV-2 from >15 countries to identify endogenous factors that determine susceptibility to severe COVID-19.
Many studies have focused on characterizing the heterogeneity of COVID-19 in terms of demographics, with clear evidence of higher mortality in men and older individuals. The adaptive immune system, including both B and T cells, has recently been recognized to play a critical role in providing preexisting immunity to SARS-CoV-2 (57). These studies have highlighted mechanisms that protect against severe symptoms but have not revealed factors that predispose to mortality. Consequently, acquired immune responses to prior infections may account for a large percentage of the variability in disease presentation, although questions remain about additional determinants of disease, such as preexisting comorbidities. Host genetic risk factors have also emerged as a potential explanation for clinical heterogeneity and additionally offer the potential for understanding molecular pathways for tailored therapeutic intervention.
Small-scale studies have implicated the type I interferon (IFN) pathway as protective against SARS-CoV-2 (8, 9). The type I IFN pathway plays a crucial role in mediating innate immune responses to viral infections. This family of cytokines is comprised of 13 IFN- subtypes, IFN-, IFN-, IFN-, and IFN-, which all signal through the heterodimeric IFN I receptor, composed of IFN-/ receptor 1 (IFNAR1) and IFNAR2 (see the figure). In host cells, type I IFNs are expressed at low amounts, poised to combat infections. Upon infection, they are rapidly produced by immune cells, such as macrophages and dendritic cells, to limit the spread of pathogens. In addition, type I IFNs induce the expression of several hundred interferon stimulated genes that can further limit pathogen replication through various mechanisms. However, this typically protective immune response can, when overactivated, lead to autoimmune diseases. Conversely, loss-of-function variants in genes encoding members of the type I IFN pathway lead to severe immunodeficiencies characterized by life-threatening viral infections. Recently, multiple studies demonstrated that impaired type 1 IFN responses may be a hallmark of severe COVID-19 (1012), but why this pathway was suppressed remained unclear.
Zhang et al. report a large genetic sequencing effort to define host risk factors to SARS-CoV-2 infection, analyzing exome or genome sequences from 659 patients with severe COVID-19 for rare pathogenic variants that could be associated with life-threatening disease. The authors focused on the type I IFN pathway and analyzed 13 candidate genes that have previously been linked with susceptibility to other viral infections. Deleterious variants that can impair gene function were identified in 3.5% (23/659) of cases. Defects in type I IFN gene expression and protein levels were recapitulated in patient cells harboring these variants, demonstrating recurrent diminished activity of this pathway in severe disease. SARS-CoV-2 viral loads were higher in patients' immune cells than in cells from healthy donors (who were infection-negative and seronegative for SARS-CoV-2), demonstrating an inability to properly clear the virus. Together, these data implicate the importance of type I IFN signaling in defense against SARS-CoV-2 infection and suggest that inherited deleterious variants explain a subset of severe COVID-19.
Bastard et al. identified neutralizing autoantibodies as another potential cause of severe COVID-19. Autoantibodies recognize and thereby may inhibit host proteins; they are a hallmark of many autoimmune diseases and are thought to be a contributor to autoimmune pathophysiology. Neutralizing autoantibodies against type I IFNs, mostly IFN-2 and IFN-, were found in up to 13.7% (135/987) of patients with life-threatening COVID-19 and were shown to neutralize activation of the pathway in vitro. By contrast, these autoantibodies were not present in 663 patients with asymptomatic or mild COVID-19 and were only found in 0.33% (4/1227) healthy individuals not exposed to SARS-CoV-2. The presence of neutralizing autoantibodies correlated with low serum IFN- concentrations. Autoantibodies against type I IFNs were also detected in blood samples of some patients obtained before SARS-CoV-2 infection, indicating that their production was not triggered by the virus in those patients. Notably, inactivating autoantibodies were identified primarily in males (94%) and may be a cause of the higher male-specific disease mortalities.
Viral particles are sensed by various PRRs, including cytosolic sensors. Type I IFNs are potent antiviral cytokines produced by innate immune cells. They bind a specific cell-surface receptor and signal through the JAK-STAT pathway to induce expression of ISGs that encode other antiviral proteins and various transcription factors. Subsets of patients with severe COVID-19 have loss-of-function genetic variants in several members of the type 1 IFN pathway (red) or neutralizing autoantibodies against type I IFNs, specifically IFN-2 and IFN-.
By analyzing patients with severe COVID-19, these two studies provide evidence that type I IFNs are protective against COVID-19 and that limiting this response through either gene mutations or autoantibodies leads to severe disease. Autoantibodies against other proinflammatory cytokinesincluding type II IFN (IFN-), interleukin-6 (IL-6), IL-17A, and IL-17Fhave been reported in healthy individuals, patients with autoimmune diseases, and other opportunistic infections, although the function of these autoantibodies is not always understood (13). Studying the mechanisms of acquired immunodeficiency, perhaps related to sex and aging, could help reduce infectious disease morbidity and mortality.
Type I IFN concentrations are tightly regulated, with several rare monogenic autoinflammatory and immunodeficiency disorders caused by either too much or too little interferon production, respectively. Healthy people may have impaired type I IFN responses owing to inherited loss-of-function variants in genes encoding components of the type I IFN signaling cascade but remain clinically silent until they encounter particular viruses or other microbes (8). This may be the case in severe COVID-19 patients who have no prior history of clinical immunodeficiency.
Collectively, this work has important therapeutic implications. Inhaled IFN- and systemic antiviral therapies are being studied for COVID-19 in clinical trials (14). The studies of Zhang et al. and Bastard et al. offer a potential avenue for identifying people who are at risk of developing life-threatening SARS-CoV-2 infection, primarily older men, by a presymptomatic screening of their blood samples for type I IFN autoantibodies. Identification of such patients may also be important to avoid potential therapeutic use of their convalescent plasma (which will contain the cytokine-neutralizing autoantibodies) in ongoing clinical trials. Furthermore, recombinant IFN- treatment may not benefit patients with neutralizing autoantibodies, whereas it may work well for patients who carry loss-of-function variants in type I IFN genes, other than IFNAR1 or IFNAR2. In patients with autoantibodies, treatment with IFN- may be beneficial because neutralizing autoantibodies against this cytokine appear to be less common (4, 14). Findings from these studies have paved the way for precision medicine and personalized treatment strategies for COVID-19.
What remains unknown are the contributions of genetic variation outside of the type I IFN pathway for defense against SARS-CoV-2 infection. Additionally, although Zhang et al. focused on rare germline variation, the roles of common single-nucleotide polymorphisms (SNPs) and acquired somatic mutations in immune cells, which accumulate with age, need to be investigated. Further comprehensive genetic studies could also help provide insights into the potential contribution of deleterious variation in the severe SARS-CoV-2associated multisystem inflammatory syndrome in children (15). Although the studies of Zhang et al. and Bastard et al. illuminate the importance of pathways responsible for clearing infections, it is also possible that proinflammatory variants may either reduce or enhance disease severity. Why some patients who carry pathogenic variants in innate immune genes, such as IFN-related genes, remain asymptomatic until their exposure to a specific pathogen is likely explained by the presence of other genetic modifying alleles or epigenetic factors. Unbiased genomic studies can answer some of these questions; however, they need to be expanded to larger and more diverse populations (beyond mostly European descent) to meaningfully address the susceptibility to SARS-CoV-2 and other potentially pandemic viral infections. Ultimately, through collaborative efforts, biomedical research should and will help combat spread of the virus by identifying people at risk with rapid diagnostic tests and facilitating new targeted therapies.
Acknowledgments: We thank D. Kastner and E. Beck for helpful discussions.
