How has COVID-19 affected extreme income poverty across the world? We may never know the full answer. Poverty data is typically drawn from household surveys, and for obvious reasons it is nigh impossible to conduct proper surveys under current conditions in many countries. But we do know that the strongest driver of poverty is economic growth and for this indicator, the International Monetary Fund has just produced new estimates for 2020 and beyond from which inferences can be made as to the impact on poverty. Interested readers can access poverty estimates for every country in the world on the World Poverty Clock, a tool with which I am associated.
The results are sobering. Table 1 shows topline figures, built up from an analysis of 183 countries for which data is reported.
The first row of Table 1 shows a baseline of poverty estimates made in late 2019. A total of 650 million people were thought to be in extreme poverty in 2019 and, given likely growth trajectories, poverty was on a path of a steady reduction in most countries, as well as in the aggregate.
Today, the pattern is quite different. Some small data updates affect the historical record2019 may have been a better year than previously believed, with slightly fewer poor people in the world. But in 2020, the impact of collapsing growth will be substantial.
Compared to 2019, poverty in 2020 could rise by 120 million people. Compared to the baseline path for poverty, the 2020 figure is 144 million people higher. Some of this will be offset as economies start to recover in 2021, but the longer-term scenario suggests that half of the rise in poverty could be permanent. By 2030, the poverty numbers could still be higher than the baseline by 60 million people.
Figure 1 shows the top 10 countries where extreme poverty is likely to rise the most. Far and away the biggest impact is likely to be felt in India. India is a particular case in having a large number of highly vulnerable people, only recently escaped from poverty, coupled with a very significant expected fall in economic growth. Indias per capita growth rate for 2020 has been revised downwards to about -11 percent this year, one of the deepest recessions in the world. This has sharply altered its poverty trajectory that had been trending downwards. India recently gave up its title as the country with the largest number of extreme poor to Nigeria but will reclaim its title this year, adding 85 million people to its poverty rolls in 2020.
COVID-19 is widely viewed as a temporary shock to economic growth, and indeed the experience of China, which has had a sharp V-shaped recession and recovery, shows this could be the case. For the majority of countries, however, the economic damage could be more long-lasting, and this is the real risk to families that have been pushed below the poverty line. The experience of living with poverty for short periods of time is harsh, but some families have coping mechanismsassets they can sell, assistance from governments, relatives, and neighbors. But over longer periods of time, poverty leaves permanent scarsmalnutrition, susceptibility to disease, missed schooling. For this reason, it is useful to look at the longer-term impact of COVID-19 on poverty, despite all the caveats associated with any decadelong economic forecasts.
Figure 2 provides an estimate of the countries that could have the deepest, long-lasting impact of COVID-19 on poverty. With the exception of Venezuela, they are all in Africa. The Asian countries that appear in Figure 1Bangladesh, India, and the Philippinesdisappear from Figure 2 because trend growth rates in Asia are higher, so the impact of recession on poverty is quickly reversed. By contrast, in the African countries that are listed in Figure 2, trend economic growth is slow, so the impact of COVID-19 could set back development for several years. Indeed, for some of the countries with high levels of poverty, like Nigeria and the Democratic Republic of Congo, poverty numbers in 2030 could exceed those in 2020.
The countries listed in Figure 2 are those where the largest effort is needed to offset COVID-19s impact on the poorest families, by international and domestic, official, and philanthropic actors.
While the trajectories summarized above look grim, they are not set in stone. An important lesson from the response to COVID-19 is that cash transfers to poor households can be quickly and effectively deployed. Several countries now have digitized rolls of families eligible for social assistance, along with a capability of making cash payments directly into bank accounts or into mobile wallets from which cash can be extracted at registered dealers. For example, Pakistan introduced the Ehsaas Emergency Relief program in April 2020, designed to provide 12 million families with a cash equivalent of $75. Thanks to a national registration scheme, families could simply send an SMS message to a designated number with their ID number to find out if they were eligible to receive support or not. Simple criteria such as foreign travel, vehicle registration, and monthly phone bill were cross-checked against broader socioeconomic data to determine eligibility. Once eligibility was confirmed, a family member could use a previously issued biometric ID card to receive cash at any one of 18,000+ branches of two local banks.
Not all countries have such systems in place. But they could. The largest digital ID system in the world is Indias Aadhar unique identification, with over 1.2 billion people registered. A similar approach could be used for a digital moonshot that would register all Africans within a decade at modest cost.
If such systems could be put in place, extreme poverty could be eradicated at a global cost of around $100 billion. This is the size of the poverty gap, post-COVID-19. Figure 3 shows that the number had already stabilized at around $90 billion before COVID-19, and has now been pushed higher.
The poverty gap can be filled by a combination of domestic and international resources. It can be compared to official aid of $105 billion in 2018 (net disbursements to developing countries). It is less than the $130 billion in debt service owed by developing countries in 2020, of which about half will go to private lenders. It is well under 1 percent of the $11 trillion being spent by advanced economies to protect their own citizens and businesses from the impact of COVID-19. It is a fraction of the $2.5 trillion that the IMF has indicated that developing countries should spend to respond appropriately to COVID-19.
There is no technological or financial reason to accept the reversals in global poverty being wrought by COVID-19. The damage is due to a lack of political will and international leadership on the issue.
The family of seven known human coronaviruses are known for their impact on the respiratory tract, not the heart. However, the most recent coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has marked tropism for the heart and can lead to myocarditis (inflammation of the heart), necrosis of its cells, mimicking of a heart attack, arrhythmias, and acute or protracted heart failure (muscle dysfunction). These complications, which at times are the only features of coronavirus disease 2019 (COVID-19) clinical presentation, have occurred even in cases with mild symptoms and in people who did not experience any symptoms. Recent findings of heart involvement in young athletes, including sudden death, have raised concerns about the current limits of our knowledge and potentially high risk and occult prevalence of COVID-19 heart manifestations.
The four common cold human coronavirusesHCoV-229E, HCoV-NL63, HCoV-OC43, and HCoV-HKU1have not been associated with heart abnormalities. There were isolated reports of patients with Middle East respiratory syndrome (MERS; caused by MERS-CoV) with myocarditis and a limited number of case series of cardiac disease in patients with SARS (caused by SARS-CoV) (1). Therefore, a distinct feature of SARS-CoV-2 is its more extensive cardiac involvement, which may also be a consequence of the pandemic and the exposure of tens of millions of people to the virus.
What appears to structurally differentiate SARS-CoV-2 from SARS is a furin polybasic site that, when cleaved, broadens the types of cells (tropism) that the virus can infect (2). The virus targets the angiotensin-converting enzyme 2 (ACE2) receptor throughout the body, facilitating cell entry by way of its spike protein, along with the cooperation of the cellular serine protease transmembrane protease serine 2 (TMPRSS2), heparan sulfate, and other proteases (3). The heart is one of the many organs with high expression of ACE2. Moreover, the affinity of SARS-CoV-2 to ACE2 is significantly greater than that of SARS (4). The tropism to other organs beyond the lungs has been studied from autopsy specimens: SARS-CoV-2 genomic RNA was highest in the lungs, but the heart, kidney, and liver also showed substantial amounts, and copies of the virus were detected in the heart from 16 of 22 patients who died (5). In an autopsy series of 39 patients dying from COVID-19, the virus was not detectable in the myocardium in 38% of patients, whereas 31% had a high viral load above 1000 copies in the heart (6).
Accordingly, SARS-CoV-2 infection can damage the heart both directly and indirectly (see the figure). SARS-CoV-2 exhibited a striking ability to infect cardiomyocytes derived from induced pluripotent stem cells (iPSCs) in vitro, leading to a distinctive pattern of heart muscle cell fragmentation, with complete dissolution of the contractile machinery (7). Some of these findings were verified from patient autopsy specimens. In another iPSC study, SARS-CoV-2 infection led to apoptosis and cessation of beating within 72 hours of exposure (8). Besides directly infecting heart muscle cells, viral entry has been documented in the endothelial cells that line the blood vessels to the heart and multiple vascular beds. A secondary immune response to the infected heart and endothelial cells (endothelitis) is just one dimension of many potential indirect effects. These include dysregulation of the renin-angiotensin-aldosterone system that modulates blood pressure, and activation of a proinflammatory response involving platelets, neutrophils, macrophages, and lymphocytes, with release of cytokines and a prothrombotic state. A propensity for clotting, both in the microvasculature and large vessels, has been reported in multiple autopsy series and in young COVID-19 patients with strokes.
There is a diverse spectrum of cardiovascular manifestations, ranging from limited necrosis of heart cells (causing injury), to myocarditis, to cardiogenic shock (an often fatal inability to pump sufficient blood). Cardiac injury, as reflected by concentrations of troponin (a cardiac musclespecific enzyme) in the blood, is common with COVID-19, occurring in at least one in five hospitalized patients and more than half of those with preexisting heart conditions. Such myocardial injury is a risk factor for in-hospital mortality, and troponin concentration correlates with risk of mortality. Furthermore, patients with higher troponin amounts have markers of increased inflammation [including C-reactive protein, interleukin-6 (IL-6), ferritin, lactate dehydrogenase (LDH), and high neutrophil count] and heart dysfunction (amino-terminal pro-Btype natriuretic peptide) (9).
More worrisome than the pattern of limited injury is myocarditis: diffuse inflammation of the heart, usually representing a variable admixture of injury and the inflammatory response to the injury that can extend throughout the three layers of the human heart to the pericardium (which surrounds the heart). Unlike SARS-associated myocarditis, which did not exhibit lymphocyte infiltration, this immune and inflammatory response is a typical finding at autopsy after SARS-CoV-2 infections. Involvement of myocytes, which orchestrate electrical conduction, can result in conduction block and malignant ventricular arrhythmias, both of which can lead to cardiac arrest.
Along with such in-hospital arrythmias, there have been reports of increased out-of-hospital cardiac arrest and sudden death in multiple geographic regions of high COVID-19 spread, such as the 77% increase in Lombardy, Italy, compared with the prior year (10). There have been many reports of myocarditis simulating a heart attack, owing to the cluster of chest pain symptoms, an abnormal electrocardiogram, and increased cardiac-specific enzymes in the blood, even in patients as young as a 16-year-old boy. When there is extensive and diffuse heart muscle damage, heart failure, acute cor pulmonale (right heart failure and possible pulmonary emboli), and cardiogenic shock can occur.
COVID-19associated heart dysfunction can also be attributed to other pathways, including Takotsubo syndrome (also called stress cardiomyopathy), ischemia from endothelitis and related atherosclerotic plaque rupture with thrombosis, and the multisystem inflammatory syndrome of children (MIS-C). The underlying mechanism of stress cardiomyopathy is poorly understood but has markedly increased during the pandemic. MIS-C is thought to be immune-mediated and manifests with a spectrum of cardiovascular features, including vasculitis, coronary artery aneurysms, and cardiogenic shock. This syndrome is not exclusive to children because the same clinical features have been the subject of case reports in adults, such as in a 45-year-old man (11).
Recent series of COVID-19 patients undergoing magnetic resonance imaging (MRI) or echocardiography of the heart have provided some new insights about cardiac involvement (1214). In a cohort of 100 patients recovered from COVID-19, 78 had cardiac abnormalities, including 12 of 18 patients without any symptoms, and 60 had ongoing myocardial inflammation, which is consistent with myocarditis (12). The majority of more than 1200 patients in a large prospective cohort with COVID-19 had echocardiographic abnormalities (13). This raises concerns about whether there is far more prevalent heart involvement than has been anticipated, especially because at least 30 to 40% of SARS-CoV-2 infections occur without symptoms. Such individuals may have underlying cardiac pathology.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has the potential to directly and indirectly induce cardiac damage.
To date, there have been four small series of asymptomatic individuals with bona fide infections who underwent chest computed tomography (CT) scans to determine whether there were lung abnormalities consistent with COVID-19. Indeed, half of the asymptomatic people showed lung CT features that were seen in patients with symptoms. But so far, there have been minimal cardiac imaging studies in people who test positive for SARS-CoV-2 or are seropositive but without symptoms. Furthermore, the time course of resolution or persistence of any organ abnormalities after SARS-CoV-2 infection has not yet been reported. With a high proportion of silent infections despite concurrent evidence of internal organ damage, there is a fundamental and large hole in our knowledge base.
In contrast to people without symptoms, there is a substantial proportion of people who suffer a long-standing, often debilitating illness, called long-COVID. Typical symptoms include fatigue, difficulty in breathing, chest pain, and abnormal heart rhythm. An immunologic basis is likely but has yet to be determined. Nor have such patients undergone systematic cardiovascular assessment for possible myocarditis or other heart abnormalities, such as fibrosis, which could account for some of the enduring symptoms. It would not be surprising in the future for patients to present with cardiomyopathy of unknown etiology and test positive for SARS-CoV-2 antibodies. However, attributing such cardiomyopathy to the virus may be difficult given the high prevalence of infections, and ultimately a biopsy might be necessary to identify virus particles to support causality.
Cardiac involvement in athletes has further elevated the concerns. A 27-year-old professional basketball player, recovered from COVID-19, experienced sudden death during training. Several college athletes have been found to have myocarditis (14), including 4 of 26 (15%) in a prospective study from Ohio State University (15), along with one of major league baseball's top pitchers. Collectively, these young, healthy individuals had mild COVID-19 but were subsequently found to have unsuspected cardiac pathology. This same demographic groupyoung and healthyare the most common to lack symptoms after SARS-CoV-2 infections, which raises the question of how many athletes have occult cardiac disease? Systematic assessment of athletes who test positive for SARS-CoV-2, irrespective of symptoms, with suitable controls through some form of cardiac imaging and arrhythmia screening seems prudent until more is understood.
The most intriguing question that arises is why do certain individuals have a propensity for heart involvement after SARS-CoV-2 infection? Once recognized a few months into the pandemic, the expectation was that cardiac involvement would chiefly occur in patients with severe COVID-19. Clearly, it is more common than anticipated, but the true incidence is unknown. It is vital to determine what drives this pathogenesis. Whether it represents an individual's inflammatory response, an autoimmune phenomenon, or some other explanation needs to be clarified. Beyond preventing SARS-CoV-2 infections, the goal of averting cardiovascular involvement is paramount. The marked heterogeneity of COVID-19, ranging from lack of symptoms to fatality, is poorly understood. A newly emerged virus, widely circulating throughout the human population, with a panoply of disease manifestations, all too often occult, has made this especially daunting to unravel.
Acknowledgments: E.J.T. is supported by National Institutes of Health grant UL1 TR001114.
NORTH TEXAS (CBSDFW.COM) Doctors are testing a drug in North Texas, which will help with one of the most dangerous complications induced by COVID-19 called the cytokine storm.
Mortality in COVID-19 patients has been linked to its presence where excessive production of proinflammatory cytokines leads to ARDS aggravation and widespread tissue damage resulting in multi-organ failure and death. This means the body starts to attack its own cells and tissues rather than just fighting off the virus.
Targeting cytokines during the management of COVID-19 patients could improve survival rates and reduce mortality.
Unfortunately with some patients, when they get infected with the virus, its as if their foot is on the gas pedal and it stays on the gas pedal and it keeps pushing hard on the gas pedal, said Dr. Cameron Durrant, CEO of Humanigen. What Lenzilumab does, and it has a dual action, is it alleviates the pressure by taking the foot off the gas pedal and putting a foot on the brake pedal.
A Mayo Clinic study looking at 12 patients found 92% of them saw improvement with the drug staying five days in the hospital instead of 11.
As for immunity, no one knows how long it lasts in patients who had the coronavirus. On the plus side, the disease mutates more slowly than flu viruses, whose viral-protein targets change so fast that annual flu shots are needed.
(credit: Humanigen)
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Women over 50 are most likely to share pandemic-related stories on Twitter from websites that share fake news, and Republicans are many times more likely to share questionable material than Democrats, according to a new study by researchers from Northeastern, Harvard, Northwestern, and Rutgers.
The study looked at age and demographics to pinpoint who is sharing false pandemic content via Twittercross referencing shares on the social media platform this year with URLs from five websites identified with fake news.
Photo by Adam Glanzman/Northeastern University
80 to 90 percent of fake news comes from a few tenths of one percent of all accounts, says David Lazer, University Distinguished Professor of political science and computer and information sciences at Northeastern, and one of the researchers who conducted the study.
Researchers defined fake news as information that mirrors legitimate news in form, but lacks the news medias editorial norms and processes for ensuring the accuracy and credibility of information.
The fake news domain with the most shares is Gateway Pundit, the study found. Since March, the website has received an order of magnitude more shares than the second most shared fake news domain, Info Wars.
The popularity of Gateway Pundit is even more striking when compared with all other web domainsincluding mainstream news mediathat share news about the pandemic. In August and September respectively, Gateway Pundit was ranked the 4th and 6th most shared domain for URLs about COVID-19. In August, the only domains with more COVID-19-related shares were the New York Times, the Washington Post and CNN, the study found.
It is notable that, during 2020, registered Republicans and older people are more likely to share URLs from fake news domains. The same demographics were also more likely to do so during the 2016 presidential election, researchers wrote in the study released today.
But researchers note that while older people are more likely to share fake news, younger people are more likely to believe it. In a study released earlier this year, researchers found that minorities and younger people are more susceptible to fake news and misinformation about COVID-19, and younger generations are also more likely to believe false claims they receive on closed messaging platforms such as WhatsApp and Facebook Messenger.
Source: Lazer Lab at the Network Science Institute, covidstates.org
According to that report, 22 percent of participants said they believed the rumor that COVID-19 originated as a weapon in a Chinese lab, and 7 percent trusted the claim that the flu vaccine increases the risk of contracting COVID-19.
This time around, researchers were curious about who was behind the sharing of bad information, not who was believing it. The average age of these so-called super sharers is 59, considerably older than the average Twitter user, Lazer says.
In terms of the data, its disproportionately older women, he says.
In October, Twitter started labelingtweets that contain misleading information about COVID-19, flagging the posts in a way that de-amplifies them in the platforms algorithm, regardless of how viral they go. In some cases, misleading tweets are simply deleted.
Since the global respiratory disease took hold, killing more than 1 million people worldwide so far, there has been a great deal of confusion and misinformation surrounding COVID-19much of it occurring online, in the so-called Infodemic.
To conduct the study, researchers collected COVID-19-related tweets from registered voters in America between January and September 2020, and examined the content posted by a list of accounts matched to demographic information such as age, race, gender and political party affiliation. The number of COVID-19-related tweets was almost 30 million.
The study found that despite older people sharing more misinformation, they are actually more informed, likely because older users are more interested in COVID-19 generally. The seeming paradox warrants further research, Lazer says.
It begs the question that maybe older people [overall] are less misinformed, but older people on Twitter are more misinformed. Alternatively, sharing may not be predicated on believing. We dont know. This is a question that we will address with additional data.
For media inquiries, please contact media@northeastern.edu.
All told, roughly 40% of respondents mentioned something related to coronavirus, which has raged throughout the US for nearly eight months, when asked what they had heard about the President recently. That was a decline compared with last week, but about on par with the share of mentions the topic received in the week Trump received his diagnosis, and well above most prior weeks in the project.
The results show the net sentiment associated with news about Trump shifted this week, rising into positive territory for the first time since July.
That shift appears to be mostly due to changes in how people talk about coronavirus when it comes to Trump. Since Trump's diagnosis, more people are using positive words to talk about Trump and coronavirus than did so before the news shifted to the President's health.
In the three weeks before Trump's diagnosis, Americans frequently used words like "lie," "downplay" and "vaccine" to talk about Trump and coronavirus, words which largely related to Trump's handling of the pandemic. Since his diagnosis, frequently used words around coronavirus and Trump have been more focused on his health: "Hospital," "recover," "sick" and "positive," for example.
At the same time, the change in topic within coronavirus mentions means more of the words used in responses related to coronavirus and Trump have a positive tone to them. That change accounts for much of the positive movement in Trump's net sentiment in this week's data.
For the final stretch in the campaign, it's possible this shift could benefit Trump if attention remains off of his handling of the pandemic. But as cases rise, Americans' focus may return to Trump's role in managing the US response more than his own health.
For Biden this week, his three most frequently mentioned topics were each mentioned by roughly one in 10 respondents. Two of those topics have landed near the top frequently for Biden: coronavirus and general references to his media appearances.
But the third is new for the Democratic nominee; there has been a sharp increase in words related to controversies around Biden. This week, those words primarily relate to recently published emails that purport to detail the business dealings of Biden's son in Ukraine and in China. The emails have been seized upon by President Donald Trump, Republican allies in Congress and conservative media in the closing weeks of the election to attack the Democratic nominee. CNN has not determined the authenticity of the emails. The FBI is investigating whether the emails are connected to an ongoing Russian disinformation effort targeting the former vice president's campaign, according to a US official and a congressional source briefed on the matter.
The top word for Biden in this week's data is "son," while "Ukraine" lands in the top 20.
The President and his staffers promoted articles about this information, even as Facebook and Twitter stopped users from freely sharing them.
Other words landing near the top for Biden this week are "good," "coronavirus," "town hall" and "campaign."
"Coronavirus" was the dominant word for Trump, with the rest of his frequently mentioned words trailing far behind. Other words for Trump mostly related to his return to the campaign trail, including mentions of rallies, the campaign and his town hall on NBC.
The word "debate" landed near the top for both candidates. It's the fourth word on Biden's list and the fifth for Trump. The two candidates will meet Thursday in Nashville for the final presidential debate before the election.
With no statewide mask mandate, some mayors are resorting to options they had long resisted. On Monday, the mayor of Fargo used his emergency powers to issue a mandatory mask order, the first of its kind in the state. Hours later, the City Council of Minot, the fourth-largest city in North Dakota, issued a similar order.
We were hoping we had escaped the Covid-19, Mayor Tim Mahoney of Fargo, a practicing surgeon, said in an interview. Now were just like everybody else in the country. It has hit us with a vengeance.
We kind of thought wed outsmart it, and you cant outsmart this virus.
In other parts of the country, officials are also returning to another tried-and-true method of containing the virus: stay-at-home orders. On Tuesday, local health officials ordered students at the University of Michigan in Ann Arbor to stay in their residences except for essential activities effective immediately, in an effort to control an escalating community outbreak.
Since Oct. 12, cases associated with the university have made up about 61 percent of confirmed and probable local infections, said Jimena Loveluck, the health officer for Washtenaw County, who warned that many cases have been tied to parties and other big gatherings.
During the day, on campus, everyones fine and following the rules, said Emma Stein, a senior news editor at The Michigan Daily, the student paper, who is now confined at home with her eight roommates. But at night, on weekends, they dont.
The order could leave the campus unusually quiet ahead of Oct. 31, when the university is expected to play its first home football game of the season against its biggest in-state rival, Michigan State. For added deterrence, health officials are considering an extra kick: Within the week, officials said, the health department may start fining people who violate the order to stay at home.
In a sign of how quickly the virus is spreading in many parts of the Midwest and the Great Plains, infections recently overtook a private nursing home in northern Kansas.
LONDON Scientists at Imperial College London plan to deliberately infect volunteers with the coronavirus early next year, launching the worlds first effort to study how vaccinated people respond to being intentionally exposed to the virus and opening up a new, uncertain path to identifying an effective vaccine.
The hotly contested strategy, known as a human challenge trial, could potentially shave crucial time in the race to winnow a number of vaccine candidates. Rather than conducting the sort of trials now underway around the world, in which scientists wait for vaccinated people to encounter the virus in their homes and communities, researchers would purposely infect them in a hospital isolation unit.
Scientists have used this method for decades to test vaccines for typhoid, cholera and other diseases, even asking volunteers in the case of malaria to expose their arms to boxes full of mosquitoes to be bitten and infected. But whereas the infected could be cured of those diseases, Covid-19 has few widely used treatments and no known cure, putting the scientists in charge of Britains study in largely uncharted ethical territory.
Starting with tiny doses, the scientists will first administer the virus to small groups of volunteers who have not been vaccinated at all, in order to determine the lowest dose of the virus that will reliably infect them. That process, scheduled to begin in January at a hospital in north London, will be followed by tests in which volunteers are given a vaccine and then intentionally exposed to this carefully calibrated dose of the virus.
The study will be led by scientists with Imperial College London and hVivo, a company specializing in human challenge trials. It still requires approval from Britains drug regulation agency, but the government said on Tuesday that it would allot 34 million pounds, or $44 million, in public funding.
The first round of volunteers, up to 90 healthy adults aged 18 to 30, will have the virus dripped into their noses without having been vaccinated. If not enough participants become infected, the scientists will try to expose these early-stage volunteers to a higher dose, repeating the process until they have identified the necessary exposure level of the virus.
Only once the scientists decide on a dose, which they intend to do by late spring, will they begin the process of comparing vaccine candidates by immunizing the next group of volunteers and then exposing them to the virus.
Some vaccine candidates now undergoing trials may already have received approval by then, but researchers hope a challenge trial will add direct evidence of efficacy and help them compare the performance of different vaccines.
Deliberately infecting volunteers with a known human pathogen is never undertaken lightly, said Professor Peter Openshaw, an immunologist and co-investigator on the study. However, such studies are enormously informative about a disease, even one so well studied as Covid-19.
Many important questions about the study remain unanswered. The British governments vaccine task force, which will select the first vaccine candidates to include in the human challenge trial, has not yet announced its plans.
The idea of human challenge trials has already been met with a lukewarm reception by several leading vaccine makers, including Johnson & Johnson and Moderna, leaving analysts uncertain as to which companies vaccines will end up being included.
And it is not yet clear how regulators in Europe or the United States will evaluate results from human challenge trials, or whether such studies will accelerate the vaccine approval process.
For proponents of the strategy, saving lives by potentially speeding the development of a vaccine and advancing the understanding of the virus is a moral imperative. Those scientists and bioethicists say that the risk of the coronavirus seriously sickening or killing young, healthy volunteers the sort of people who would be infected is low enough as to be outweighed by the possibility of saving tens of thousands of lives.
Im surprised they havent been used earlier, Professor Julian Savulescu, the director of the Oxford Uehiro Center for Practical Ethics, said of human challenge trials on coronavirus vaccines. Every day that you delay developing a vaccine and effective treatment, another 5,000 people die. Itd be useful for screening out less effective vaccines and for understanding the immune response.
Skeptics have urged scientists to wait, or to forgo the approach entirely. There have been unexpected and unexplained cases of severe illness in young patients, and the long-term consequences of an infection are unknown, with the pandemic having started only months ago. It is also difficult to extrapolate widely from a human challenge trial. It is unclear, for example, whether studies in healthy young adults could reliably predict the efficacy of a vaccine in older adults or people with pre-existing conditions.
Scientists have also warned about the challenges of mimicking real-world transmission in a laboratory. That could make it difficult for the researchers to know whether a vaccine that may protect volunteers from deliberate exposure in a hospital would do the same for people encountering the virus at work or at home.
Is it breathed out, sneezed out, do you sniff it all in one fell chunk of virus coming at you? said John Moore, a professor of microbiology and immunology at Weill Cornell Medical College. No one really knows. Its so hard to model. Squirting a bolus of virus into the nose is an imperfect model of natural transmission.
The debate has split an advisory panel to the World Health Organization, which published guidelines about the safest way to conduct challenge trials in June. In the United States, the National Institutes of Health said that it was not planning to support such trials and that randomized clinical trials were sufficient.
But Britain took a different view.
Prime Minister Boris Johnson, facing a barrage of criticism for his handling of a pandemic that has left Britain with the highest death toll in Europe, has tried to cast the country as being at the forefront of scientific progress on the coronavirus. Researchers at the University of Oxford have developed one of the leading vaccine candidates, as well as one of the most promising treatments, the steroid called dexamethasone.
Some scientists questioned whether the fierce competition to be the first to develop an effective vaccine had unduly influenced plans for a human challenge trial.
Theres unquestionably vaccine nationalism involved, Prof. Moore said. Its a race for money and glory. Thats the reality of it.
The scientists overseeing the trial said they would use the antiviral medicine remdesivir to treat volunteers as soon as they began detecting viral infection, even before the onset of symptoms. But that drug has been found to have only modest benefit. And some analysts said the treatment, while necessary, would limit researchers ability to determine whether the vaccine candidates being evaluated reduced the severity of illness.
The volunteers in London will be paid roughly Britains minimum wage, which is about 9, or $11, per hour, for their time in taking part in the trial and their two to three weeks in mandatory quarantine. The researchers said they were wary of offering additional incentives that could cloud the judgment of volunteers.
Thousands of people in Britain have already expressed interest in taking part in challenge trials for the coronavirus through an American group, 1Day Sooner, that advocates for such studies.
But with the virus now surging again across Europe and parts of the United States, some scientists have argued there is no shortage of people enrolled in ordinary vaccine trials being exposed to the virus under natural conditions.
This is not a rare disease, said Dr. Paul Offit, a professor at the University of Pennsylvania and a member of the Food and Drug Administrations vaccine advisory panel. You can probably find a hot spot to do a vaccine trial.
A study suggested that mouthwashes can inactivate coronaviruses in a laboratory. But what does this ... [+] mean for the Covid-19 coronavirus. (Photo by Igor Golovniov/SOPA Images/LightRocket via Getty Images)
Theres a difference between a laboratory and your mouth. One of them is a controlled environment. The other is your mouth.
A study published in Journal of Medical Virology showed that in a laboratory, different types of nasal rinses and mouthwashes seemed to inactivate human coronaviruses. For example, a 1% baby shampoo nasal rinse solution appeared to inactivate 99.9% of human coronaviruses after about two minutes. Listerine and Listerinelike products apparently could inactivate similar amounts of virus even faster, after just 30 seconds.
This revelation prompted some reactions on social media such as:
And some additional speculation:
However, before you turn your mouth into a mouthwash jacuzzi with the hopes of ridding your body of the Covid-19 coronavirus, keep in mind several things about the study. First of all, the study tested the solutions on more common types of coronavirus and not the severe acute respiratory syndrome coronavirus 2 (SARSCoV2). They may have similar structures but are not necessarily exactly the same in all regards. In some ways, comparing the SARS-CoV2 with other coronaviruses can be like comparing a cheese rolling team with a football team. Sure they are both sports teams. Sure they both involve people. But having a wheel of Double Gloucester cheese roll over you is not the same as a 250-plus pound middle linebacker.
Nonetheless, solutions that disrupt the membrane surrounding one type of coronavirus may do so with the membranes around other types. In fact, this isnt the first study to suggest that mouthwashes can affect the SARS-CoV2 membrane. A study published in a June issue of theJournal of Infectious Diseases found that different oral rinses inactivated SARS-CoV-2 in a laboratory, findings that Dr. Judy Stone covered previously for Forbes
Speaking of laboratory, for the Journal of Medical Virology study, the researchers from the Pennsylvania State College of Medicine (Craig Meyers PhD, Janice Milici, Samina Alam, PhD, David Quillen, MD, David Goldenberg, MD, FACS, and Rena Kass, MD) and Brigham Young University (Richard Robison PhD) applied the various nasal rinse and mouthwash solutions to the human coronaviruses in what were basically culture dishes in a laboratory. Now people may have told you that your mouth is a culture dish. But thats because your mouth has lots of different microbes in it. Your mouth isnt actually a glass or plastic culture dish. At least, it shouldnt be. If it is, then see a doctor as soon as possible.
What works in a culture dish in a laboratory may not necessarily apply to your mouth. Your mouth isnt smooth like a real culture dish. Its more like the Grand Canyon with various places for microbes to hide away.
Plus your mouth is not the only place the Covid-19 coronavirus may be. The SARS-CoV2 is considered a respiratory virus and will typically infect cells in your respiratory tract. So unless you are snorting Listerine (which you shouldnt do), it is not going to reach your respiratory tract. By the way, be careful about putting anything besides baked lasagna vapors up your nose. For example, using Neti pots with tap water is a bad idea as I have covered previously for Forbes. So it is highly unlikely that mouthwash or a nasal rinse will be able to rid your body of the Covid-19 coronavirus.
Actress Stacy Keibler gargles with mouthwash during an attempt to set a new Guinness World Record ... [+] for the most people using mouthwash simultaneously at Times Square on June 25, 2013 in New York City. (Photo by Slaven Vlasic/Getty Images)
Mouthwash is not going to allow you to freely kiss someone either. Well, not from a Covid-19 coronavirus standpoint at least. It may not prevent the SARS-CoV2 coming out out of one persons nose and mouth from getting into the other persons nose and mouth. Gargling with mouth wash while kissing is highly impractical, will make very strange motorboat noises, and isnt going to be failsafe either.
Similarly, dont treat mouthwash or nasal rinses as a way to forego social distancing and face mask wearing. If someone tries to get within one Denzel of you (which is within six feet since Denzel Washington is around six feet tall) and tells you, dont worry I used mouthwash, say WTH and back away quickly. You can replace WTH with oh, no you dont too.
Of course, it probably wont hurt to use mouthwash, assuming that you do it properly. For example, dont bathe in it or pour it into your ear. One way mouthwash, baby shampoo, and nasal rinse solutions could be helpful against coronaviruses and maybe the Covid-19 coronavirus is to clean things when using a disinfectant or another cleaning methods is not safe or practical. Examples include your toothbrush, a mouth guard, a set of vampire teeth, or anything that you may put into your mouth, nose, or other opening in your body. Keeping such things virus free can ultimately protect you against the Covid-19 coronavirus.
So the results from this study do have some practical applications. Nonetheless, unless you happen to be a gigantic toothbrush, do not expect mouthwash, baby shampoo, or nasal wash solutions to rid 99.9% of the Covid-19 coronavirus from you. Remember just because something happens in a lab doesnt mean that it will work in all aspects real life. Lots of things can inactivate or kill viruses and other pathogens in the lab but either dont work or are impractical on or in human beings. Take disinfectants such as Lysol for example. They may kill the Covid-19 coronavirus on a table or a Justin Bieber shrine for example. But no one in his or her right mind should recommend that Lysol be ingested or injected into the body, right?
By: KDKA-TV News Staff
HARRISBURG (KDKA) The Pennsylvania Department of Health is reporting 2,063 new cases of Coronavirus and 30 additional deaths.
The number of cases today is one of the highest numbers since the beginning of the pandemic, but there was a faulty data file which prevented some lab results from being properly reported. Some of the cases should have been part of Oct. 21s report.
The statewide total number of cases has risen to 188,360 since Wednesdays report, according to the states data.
The number of tests administered within the last seven days, between Oct. 15-21, is 231,482 with 10,375 positive cases, the Health Department says. There were 37,114 test results reported to the department through 10 p.m.
The Health Department says all 67 counties in Pennsylvania have had cases of COVID-19. Current patients are either in isolation at home or being treated at the hospital.
The statewide death toll has risen to 8,592.
There are 2,185,079 patients across the state who have tested negative for the virus to date.
The state Health Department numbers show there are 24,990 resident cases of COVID-19 in nursing and personal care homes across Pennsylvania. Among employees, there are 5,436 diagnosed cases. That brings the entire total to 30,426 cases. Out of the total deaths across Pennsylvania, state officials say 5,670 have occurred in residents from nursing or personal care facilities.
Approximately 11,846 of the states total cases are in healthcare workers.
Currently, all 67 counties are in the green phase of reopening. However, restrictions are in place for bars, restaurants and large gatherings.
If you have concerns about the virus, you can check out the states COVID-19 Early Warning Monitoring System Dashboard.
More information on the Coronavirus pandemic:
There is one graph that has to do with the coronavirus that blows my mind. It looks like this. This graph shows coronavirus cases in the United States versus the European Union. Do you see what happens here? Everyone has a surge around the same time, but while the European Union dramatically drops, the United States plateaus for a little bit and then skyrockets. This is shocking to me because the United States is perhaps the most prepared country on earth for a pandemic. The U.S. government has an actual playbook that tells us what we need to do in the case of a pandemic. Not to mention, its like the richest country in the world, with the best health institution on earth, the C.D.C., which literally fights pandemics in other countries and teaches even our peers how to do epidemiology. And yet, you look at this graph and you wonder, what happened? I want to piece together a timeline to find out how this happened. How does the country with the most money and experts and the C.D.C. and a literal pandemic playbook end up with so many deaths, and end up with a graph that looks like this? [MUSIC PLAYING] The countries best and worst prepared for an epidemic, were rated No. 1 at being prepared. Europe has largely contained the virus. Nearly 200,000 Americans dead from Covid. Were doing great. Our country is doing so great. [MUSIC PLAYING] As I piece together this timeline, Im going to need some help. And for that, I turned to Nick Kristof. Hes a Pulitzer Prize-winning journalist. He speaks Mandarin. Hes been all around the world, reporting on and explaining public health crises for decades. Ive always felt that I come from the country that helped invent public health. And now, my own country, arguably the most powerful country in the history of the world, has taken a challenge that we kind of knew what to do with, and just blowing it in ways that cost so many lives so needlessly. So if I want to understand how this all played out and how we got a graph that looks like this, where do we start? Lets go way back, before we were paying any attention to this. I figured our timeline would start somewhere in January of 2020, but Nick told me to go back even further, way back to 2005. That summer, President George Bush was on vacation at his ranch in Texas when he got ahold of this book. It was about the Spanish flu that killed tens of millions of people back in 1918. This book freaked George Bush out. He got back to Washington, and immediately got to work putting together a plan, a step-by-step guide of what the U.S. should do if a pandemic came to our country. He called it a playbook for pandemic response. President Obama developed a playbook of his own that had very specific plans in place on what the government should do in the case of a disease outbreak, including specifically citing coronaviruses. This pandemic playbook was then passed on to the Trump administration. We left them the detailed playbook, which specifically cited novel coronaviruses. Short of leaving a flashing neon sign in the Situation Room saying. Watch out for a pandemic, Im not sure what more we could have done. No one knew when the big pandemic would come, what it would look like. But even still, the previous two administrations were obsessed with making sure we were ready. But if we wait for a pandemic to appear, it will be too late to prepare. So now lets fast forward to when the big one did hit. And that part of the story happens on the last day of 2019. On Dec. 31, 2019, a report of 44 people with pneumonia comes in from a fish market in China. So at this point, it seems like this is a fairly small deal. Its 40 people with pneumonia in China. So who in the U.S. would even care or have this on their radar in the first place? `Epidemiologists were on top of this immediately in early January, about the risk this might be something serious. The World Health Organization was communicating with the C.D.C., the C.D.C. was communicating with the administration. And indeed, it appears to have entered the presidents daily brief in early January. Were going to begin here with the outbreak of a mystery virus in China that now has the World Health Organization on edge. I heard that China was concealing information. And didnt that stop American experts from getting a full picture on what was happening? Yes, absolutely. China behaved irresponsibly and was concealing information. But we had channels into China, into the World Health Organization. We were getting feedback about what was really happening. Its the middle of January, and coronavirus is potentially a thing of concern. Didnt President Trump get on a call with President Xi Jinping? Yeah, they did. They had an important phone conversation then. But what they talked about was trade. But it just doesnt get any bigger than this, not only in terms of a deal. Tell President Xi, I said, President, go out, have a round of golf. This was a huge, huge missed opportunity. OK, so we miss these first two opportunities of taking those early reports really seriously and that call with Xi Jinping, which potentially could have been a health collaboration to stop the virus. But it was still early on. The coronavirus hadnt even been detected in the United States yet. Gwen Stefani and Blake Shelton not quite yet engaged, right? Definitely not married. So while the United States was preparing for the Grammys and the Super Bowl, the coronavirus quietly came into our country. The first case is reported around Seattle on Jan. 21. At this point, Trump has been hearing more and more warnings from his intelligence briefings, as well as from the C.D.C. And as the news breaks of the first case in the U.S., Trump is on his way to Switzerland to speak at the World Economic Forum, where he talks a lot about China, but just not about the virus. Our relationship with China right now has probably never been better. Man, just like imagine what could have happened at this moment. End of January, the president reads his briefing. Hes like, oh, whoa, this is real. This is spreading globally. We need to get serious about this. He calls Xi Jinping back, and hes like, hey, Xi Jinping, I know weve been talking a lot about trade, but why dont we talk about this virus thats coming from your country to mine? What do we need to do to solve it? And Xi Jinping is like, yeah, youre right, lets do it. Trump gets up to tell the nation a pandemic is coming and that weve got to be ready for it, but dont worry because were super prepared. We have all the plans. We have a literal pandemic playbook. We have money. We have experts. We can squash this. Have you been briefed by the C.D.C.? I have. Are there words about a pandemic at this point? No, not at all, and we have it totally under control. Its one person coming in from China, and we have it under control. Its going to be just fine. There was some hope that we could have actually eliminated it in early January and avoided this catastrophe for the world. Instead, our leaders, and our citizens, were completely focused on other things. The Grammy Awards are finally here. CNN breaking news. Kobe Bryant Has been killed in a helicopter crash. Special coverage of the impeachment trial. Did nothing wrong. Did nothing wrong. [CHEERING AND APPLAUSE] So by the end of January, the virus has now arrived to the United States. There are reported cases here. We are now aware that it is a problem. I guess Im wondering, like, what is the response? What should the U.S. have done in that moment? The first step in response to a disease like this is to find out where it is, which means you develop a test. We have 12 cases 11 cases. And many of them are in good shape now, so. The United States and South Korea had their first reported case of Covid-19 on the same day. A month later, South Korea, who, by the way, has like a fifth the number of people that the United States has, had tested 13,000 people. Here in the U.S., we had tested 3,000. Im not afraid of the coronavirus, and no one else should be that afraid, either. A reminder that all of these steps, the testing was not a new idea. This was in the old playbooks. Testing and surveillance of where the virus is is like a fundamental step in responding to a pandemic. Its mind-blowing that because you cant get the federal government to improve the testing because they just want to say how great it is. And the testing is not going to be a problem at all. So this struggle to develop a test, wasnt this more of like an issue with the F.D.A. and the C.D.C. and H.H.S. sort of feuding with each other about who was going to do the test? At one level, the way we fumbled the development of testing in the United States was a result of bureaucratic infighting. But if President Trump had shown the same passion for getting a test that he showed for building a wall or for backing hydroxychloroquine to treat the coronavirus, we would have had a test all ready to go and all around the country by the end of January or beginning of February. Hydroxychloroquine, were just hearing really positive stories. I happen to be taking it. I think its good. Ive heard a lot of good stories. Sierra Leone in West Africa had an effective test before the United States did. And so as a result, we didnt know where the virus was. We were blind. Theyre working hard. Looks like, by April, you know, in theory, when it gets a little warmer, it miraculously goes away. Hope thats true. And then, Americans started to die. [MUSIC PLAYING] It started with just one in February. But soon one became 10 became 100, and soon it was 100 per day, and then 200 per day, and 500 per day. And now, were in the thousands. And then the month of April was here. And in one month, 57,000 Americans died from Covid-19. So was there a moment for you when you realized that this was spiraling out of control? I visited a couple of emergency rooms and I.C.U.s early in the crisis. And this was when people are still talking about how the coronavirus is like the flu. And meanwhile, these emergency rooms are just swamped. The doctors and nurses are traumatized. I need a vent. I need a vent. I need a ventilator. And the strength of those doctors contrasted with just the fecklessness of our political leadership. And again, I said last night, we did an interview on Fox last night You have to be calm. Itll go away. [BEEPING] Many of the places are really in great shape. They really have done a fantastic job. We have to open our country. We cannot let the cure be worse than the problem itself. Were not going to let the cure be worse than the problem. We have to be calm. Itll go away. Ive seen a lot of grim diseases, but the combination in Covid of such large numbers dying, all alone because their loved ones cant go with them, saddens me, but it also just enrages me because this was so unnecessary. OK, so lets realize where we are. Its April, and we really didnt get the early response down. We didnt get testing figured out. But now, were in the thick of a crisis. People are dying. There is a crisis in the United States. So the big question here is, what do you do once youre actually in the thick of this crisis? And in my conversations with Nick, and in all of these playbooks, theres this one theme that just keeps coming up, which is health communications. Which sort of just sounds like a boring P.S.A. from the government. Larry, you know this simple exercise can help you stay healthy. I didnt even know what that meant to begin with. But as I looked into it, I started to realize that there was something there. In fact, the Bush playbook says that the need for timely, accurate, credible and consistent information that is tailored to specific audiences cannot be overstated. So it turns out that, when a country is devolving into pandemic chaos, one of the most important things, if not the most important thing, a government can do is communicate to its citizens how important and risky this is. And the 15, within a couple of days, is going to be down to close to zero. Staying at home leads to death also. Are you telling the Americans not to change any of their behaviors? No, I think you have to always look, I do it a lot anyway, as you probably heard, wash your hands, stay clean. You dont have to necessarily grab every handrail, unless you have to. You know, you do certain things that you do when you have the flu. I mean, view this the same as the flu. The C.D.C. is recommending that Americans wear a basic cloth or fabric mask. This is voluntary. Its easy to focus just on the failures of President Trump, but look, there is plenty of failure to go around, and it involves blue states as well as red ones. New York was particularly hard hit, in part because New York leaders initially did not take this seriously enough. Mayor Bill de Blasio tweeted that people should get on with their lives and go out on the town. It would be difficult to think of any signal that a leader could possibly send that was more wrong and more lethal than that one. Tonight, FEMA is bringing in hundreds of ambulances to help with record-breaking 911 calls in New York. This morning, as an emergency field hospital is being built in iconic Central Park All of those beds, all 20,000, will have to be turned into intensive care beds to focus on Covid-19 patients who are really, really sick. We simply blew it. And the result was that Americans did not take the virus as seriously as they did in other countries. OK, so the U.S. blew it when it came to health communications, whereas Europe and many countries around the world got it right. I want to know what the actual proof is that thats the key to fixing it. Is it just because the playbook said it or because Nick said it? Well, I got my hands on some data that really helped me understand this. Google collected data from a bunch of peoples phones to track before the pandemic and during the pandemic how peoples movement changed. If you assemble that data onto a map, you see something really interesting. If you look over here, you can see these dark blue areas, which represent countries that shut down by up to 80 to 100 percent. This means they werent going out, they werent shopping, they werent going to cinemas. They were staying home like the government implored them to. Austria shut down by 64 percent, France by 80 percent, Ireland by 83 percent. All of this movement shut down in the name of beating the virus. Meanwhile, over here in the United States, were at about 39 percent on this same day in late April. We never really shut down. One of the basic things about this pandemic is that, if people really do take it seriously, and for four weeks or six weeks do adhere to stay-at-home orders in the way Europe did, with 90 percent of the travel shut down, then the virus is stopped in its tracks. Other countries did it, one after the other. The U.S. was never able to do that. We fought the virus, and the virus won. Again, I cant help but think of what could have happened if our president got up and said My fellow Americans This is going to be very difficult. We have to shut down our entire country. Not just the urban spots, the entire country. Its going to be painful, but it will help us reopen our economy quicker and it will help save American lives. But that didnt happen. I remember looking at the graphs in April and watching daily deaths climb so rapidly, just skyrocketing. The natural response wouldve been to say, whoa, slow down, we need to really tighten things up and learn from other countries that have done better. But instead, the very next day The president, remarkably, attacks stay-at-home orders in states around the country and encouraged supporters to liberate states like Michigan. This was an obliviousness to science and public health advice, a lack of empathy for those who were dying. I dont know what to call that failure except an example of extraordinary incompetence. I find that truly heartbreaking. This is where the graph starts to blow my mind, and really starts to get to the heart of my big question of why these lines look so different. Watch how the Covid cases sort of plateau in the U.S., but in Europe, cases start to look like this. Our peers buckled down and did the hard work to get ahead of the virus by following basic pandemic measures articulated in all of the plans, including our own playbooks. They saw the results of that. The U.S., on the other hand, plateaus for a bit, and by mid-June, starts to skyrocket again. In the nations three most populous states, things are going from bad to worse. California, Texas and Florida are in crisis. Today, reporting more than 5,000 Covid-related hospitalizations. And even though Europe is having an uptick now, you need to look at this gap. This gap represents a lot of unnecessary suffering, and the death of tens of thousands of Americans. I understand that were going to make mistakes. This is hard stuff. Lots of countries made mistakes. But what has troubled me is that we just didnt learn from them. We werent self-correcting. Instead, we doubled down on mistakes. And then, we just gave up. OK, so I now feel like I have a much better understanding of why our graph looks like this compared to other countries. It has a little bit to do with those early mistakes and whatever, but those are sort of forgivable. Instead, its what happened once the pandemic was here and raging and killing Americans. Instead of having leaders who told us what we needed to do to make it through this risky and uncertain time, we had leaders that denied that this was even a big deal, and then who eventually just gave up on the whole thing. The death certificates of more than 150,000 Americans will say something like Covid-19. In a larger sense, what should be written on those death certificates as the cause of death is incompetence.
