WASHINGTON (Reuters) - The U.S. House of Representatives on Thursday approved a $2.2 trillion Democratic plan to provide more economic relief from the coronavirus pandemic, as a bipartisan deal continued to elude House Speaker Nancy Pelosi and the White House.
Objections from top Republicans are likely to doom the House Democrats plan in the Senate. Senate Majority Leader Mitch McConnell has called the $2.2 trillion price tag outlandish, although Democrats have reduced the cost of their proposal by over a trillion dollars since May. The House vote was 214-207.
No Republican voted for the Democratic plan, although 18 Democrats voted no, many of them moderates from swing districts who have been urging Pelosi to bring a bipartisan proposal to the House floor.
Todays package is another partisan exercise that will never become law, Representative Abigail Spanberger, one of the Democrats who voted no, said.
Republican President Donald Trumps negotiating team has suggested a $1.6 trillion response, and the White House on Thursday dismissed Democrats $2.2 trillion plan as not serious.
Pelosi and Treasury Secretary Steven Mnuchin have talked every day this week, including a 50-minute phone call Thursday, in an effort to negotiate a bipartisan aid package to respond to the economic fallout from a pandemic that has killed more than 207,000 Americans and thrown millions out of work.
Congress and the White House approved more than $3 trillion worth of coronavirus relief measures earlier this year, but Mnuchin, as well as members of Congress from both parties, have argued more stimulus is needed.
Asked if there would be a resolution to her negotiations with the administration on Thursday evening, Pelosi told reporters, No. She gave no details of their talks but said: Even if we came to some agreement, nothing is agreed to until everything is agreed to. Its the language.
In the absence of a deal with the White House, and with lawmakers preparing to leave Washington for the remaining weeks of the 2020 presidential and congressional campaign, the Democratic-majority House went ahead and passed the Democrats proposal.
Frankly if we had reached a bipartisan agreement...we wouldnt have this bill on the floor, House Majority Leader Steny Hoyer said. But we also want to let the American people know where we stand.
Pelosi and Mnuchin differed over aid to state and local governments, Democratic demands for a child tax credit and stronger worker safety protections, healthcare provisions and help for small businesses.
After Pelosi and Mnuchins phone call Thursday afternoon, Pelosis deputy chief of staff Drew Hammill wrote on Twitter: The two discussed further clarifications on amounts and language, but distance on key areas remain.
White House spokeswoman Kayleigh McEnany dismissed the Democratic proposal as not a serious offer.
Pelosi said of the White House proposal on Bloomberg TV: This isnt half a loaf. What theyre offering is the heel of the loaf.
Republican Senator Mike Braun told CNBC on Thursday that a deal worth over $1.6 trillion could be rejected by one-third to one-half of Senate Republicans. That would still allow a bill to pass with support from Democrats.
Lawmakers and securities analysts viewed talks as a last-gasp effort to secure relief ahead of the Nov. 3 election for tens of millions of Americans and business including U.S. airlines, which have begun furloughing over 32,000 workers.
Reporting by Susan Cornwell and David Morgan; additional reporting by Susan Heavey, Doina Chicacu, Daphne Psaledakis and Lisa Lambert; Editing by Cynthia Oserman
U.S. Surgeon General Jerome Adams said during a stop in Texas Monday that a vaccine against COVID-19 could be ready as soon as the end of this year or early 2021. But he isn't saying when Americans might be able to get it. (Sept. 28) AP Domestic
Moderna's coronavirus vaccine appears to create as strong an immune responsein older people as it does in younger adults. That'sa positive sign as many vaccines don't work as well in the elderly.
A small study published Tuesday in the New England Journal of Medicine foundthe Moderna COVID-19 vaccine elicited animmune systemresponse almost as strong in people over 56 as in adults between the ages of 18 and 55.
"This is very promising but it's also somewhat surprising," said David Dowling, an immunologist and professor at Harvard Medical School, who studies vaccines.
Older people are at higher risk for severe illness from COVID-19, according to the Centers for Disease Control and Prevention. People 50 to 64 years old are four times more likely to be hospitalized and30 times more likely to die from COVID-19 than people between the ages of 18 and 29. Those aged 65 to 74 are five times more likely to be hospitalized and 90 times more likely to die. The older the person, the higher the risk.
The Moderna study was conducted by researchers at Emory University in Atlanta and included two groups of 20 people each, one made up of people aged 56 to 70 and one of people 71 and over. Participants were enrolled in Atlanta, Seattle and Bethesda, Maryland. Thefindings were compared to findings previously reported among vaccine recipients between 18 and 55.
"The immune responses were very comparable to that of the young adults,"said Dr. Evan Anderson, a professor of infectious disease at Emory University Medical School and lead author on the paper.
Moderna's mRNA-1273 experimental vaccine is now in Phase 3 clinical trials in the United States. It isconsidered a front runner among the four candidate vaccines currently in end-stage trials. There is no data available yet on how well it protects people from getting COVID-19.
Having a vaccine that works well for older people could make a big difference in COVID-19 vaccine distribution. There have been fears any vaccineapproved might not work as well in the elderly.
Feds: COVID-19 vaccine will begin moving 24 hours after the first one is approved
More: When will children get a COVID-19 vaccine? It's going to be a while
It's long been known a person's immune system weakens as theyget older.
"With increasing age, our immune responses generally decline and a number of different vaccines tend to not work as well as we get older. That's why we have the high dose influenza vaccine for people 65 and above," Andersonsaid. "The fact that that 100 microgram dose (of Moderna's COVID vaccine) seemed to be sufficient to generate a similar immune response in older peopleis a very pleasantfinding."
If a higher dosage were to berequired for COVID-19, as it is for some influenza vaccines,fewer doses would beavailable.
There also have beenconcerns that some vaccines might not work at all for seniors, limiting their options orrequiring they wait until newer vaccines become available. Another approach,so-called "ring immunization" where the at-risk person doesn't get vaccinated but everyone around them does, would require more vaccine, too.
Thefindings don't show whether the experimental vaccine will give people immunity to the SARS-CoV-2 virus, but are "heartening," said Anderson.
The study only included 40 people and almost all were white, so the researchers acknowledged a broader study population was needed to confirmthe results.COVID-19 has disproportionately impacted communities of color.
Raymond Grosswirth, a participant in a Phase 3 clinical trial for a COVID-19 vaccine.(Photo: Jeff Blackman, Senior Visual Communications Specialist at Rochester Regional Health)
Read or Share this story: https://www.usatoday.com/story/news/health/2020/09/29/modernas-covid-19-vaccine-may-work-equally-well-older-adults/3575377001/
Dr. Anthony Fauci downplayed concerns about the safety of a COVID-19 vaccine during a conversation on Tuesday at the 2020 Texas Tribune Festival.
Fauci, the director of the National Institute of Allergy and Infectious Diseases and a leader in the U.S. response to the novel coronavirus, said Americans should feel confident in the development and efficacy of a vaccine. This comes as a growing majority of people say they are not likely to be immunized as soon as a vaccine is available.
It's "disturbing" that so many people are reticent to get a vaccine, he said, blaming mixed messages that have come out of Washington for waning public trust.
Some public officials, including President Donald Trump, have questioned the credibility of agencies such as the Centers for Disease Control and Prevention and the Food and Drug Administration during the pandemic.
Others have viewed Trumps forecast that a vaccine could be ready by Election Day as politically motivated and expressed fears that the president might sidestep the regulatory process.
Fauci stressed that officials must reach out to their communities to regain the confidence ... that this is being done to protect them as individuals and to protect our society.
To reach herd immunity the point at which enough people are immune to a disease that it doesnt spread the community must meet a certain threshold either through vaccination or from previously contracting the virus. Experts worry that if enough people refuse a vaccine, the coronavirus will continue to spread.
Fauci said five companies have vaccines that are currently in advanced clinical trials, nearing the final step before seeking FDA approval.
Two companies, Moderna and Pfizer, are the furthest ahead and have shown early promising results. Moderna appears set to deliver a report to regulators by November. Pfizer, which has already begun to manufacture its vaccine so doses will be ready should it win FDA approval, could deliver its report by the end of October.
The data from each trial and at each stage is closely guarded and shared only with an independent board of scientists, statisticians and clinicians. The board decides whether a potential vaccine shows promise and should advance to the next stage.
I feel cautiously optimistic, as a scientist, that we will have a safe and effective vaccine," Fauci said. "I believe it will happen, and it will happen likely by this end of the calendar year."
Even if a vaccine is ready by the years end, it likely will not be widely available until late 2021, experts say, because of the massive logistical challenges that come with distributing hundreds of millions of doses to every corner of the country. The first people likely to receive a vaccine are health care workers and those most at risk of contracting the virus, such as the elderly and people with preexisting conditions.
Three players and five staffers with the Tennessee Titans tested positive for coronavirus, forcing two NFL teams off the practice field on Tuesday, the league and players union announced.
Both the Titans and Minnesota Vikings, who played host this past Sunday in Minneapolis, "will suspend in-person club activities starting today," according to the joint statement.
The Vikings said that, as of Tuesday morning, it had received no positive tests results for anyone with their club.
The Titans are next scheduled to host to the Pittsburgh Steelers and the Vikings are supposed to take on the Houston Texas. Both games are set for 1 p.m. ET on Sunday.
The statement did not make mention if those upcoming contests will be played.
"All decisions will be made with health and safety as our primary consideration," according to the union and league. "We will continue to share updates as more information becomes available."
The league's Covid-19 protocols do not spell out exactly how many players would need to test positive for a game to be postponed.
"There is no algorithm for postponing a game," NFL spokesman Brian McCarthy said in a statement to NBC News. "We will monitor and evaluate the situation on a day-by-day basis."
In a memo to all teams, NFL Commissioner Roger Goodell said the positive tests on the Titans should be a stark reminder to follow all health rules.
These results confirm the need to remain diligent in implementing all of our health and safety protocols to the fullest extent, Goodell wrote. This includes not only our testing program, but facility maintenance, wearing of PPE by players and staff, and carefully regulating behavior and contracts outside of the club facility."
The commissioner continued: "It is also critical to remind everyone in your organization players and non-players immediately to report any symptoms that they have, or that family members or others with whom they are in close contact have, to your club physician or Infection Control Officer.
And as of Tuesday evening, the Steelers still expect to be playing at Nissan Stadium in Nashville.
"We dont have a lot of definitive answers long term as to what the prognosis looks like," Steelers Coach Mike Tomlin told reporters. "We have been given a mandate to prepare as if the game is going to be played, and played on time. So that is our mentality. "
The NFL has completed three weeks of games, which have been played largely inside empty stadiums.
The Titans are among the few teams that will allow a handful of spectators. While their first home game on Sept. 20 against Jacksonville was a closed-door contest, this Sunday's Steelers game if played will have about 7,000 people watching in person.
If the Titans-Steelers game has to be postponed, the NFL would have a viable option to reschedule. Tennessee is off on Sunday, Oct. 25, which is the same day as Steelers are set to play the Baltimore Ravens.
Both the Steelers and Ravens have bye weeks on the following Nov. 1, so the NFL could move this Sunday's Titans-Steelers game to Oct. 25 and push Pittsburgh-Baltimore to the following weekend.
David K. Li is a breaking news reporter for NBC News.
NASHVILLE, Tenn. (AP) The Tennessee Titans wont be back inside their building until Saturday at the earliest because of eight positive tests for the coronavirus, the first outbreak to hit the NFL as it tries to play a full schedule amid the pandemic.
Tennessee is scheduled to host Pittsburgh in a matchup of two of the leagues seven remaining undefeated teams on Sunday, and Steelers coach Mike Tomlin said his team has been given a mandate to prepare as if the game will be played on time even if the Titans are unable to practice.
Were going to trust the medical experts, Tomlin said. If they deem it safe for us to proceed, were going to go down there with the intention of playing and playing to win.
Tennessee suspended in-person activities through Friday after the NFL said three Titans players and five personnel tested positive for the coronavirus. The NFL had played three weeks without a COVID-19 outbreak. Now, the Titans will become the first significant in-season test of the leagues virus protocols.
The Minnesota Vikings also suspended in-person activities Tuesday following the Titans test results. The Titans beat the Vikings 31-30 in Minneapolis last weekend.
Both clubs are working closely with the NFL and the NFLPA, including our infectious disease experts, to evaluate close contacts, perform additional testing and monitor developments, the league said in a statement.
The Titans placed a pair of key players, defensive captain and lineman DaQuan Jones and long snapper Beau Brinkley, on the reserve/COVID-19 list later Tuesday.
The Vikings released a statement saying they had not received any positive results from their testing after Sundays game and they followed NFL protocol by closing their facility immediately. The Minnesota complex will remain closed at least through Wednesday.
Minnesota is scheduled to visit Houston (0-3) on Sunday.
All decisions will be made with health and safety as our primary consideration, the NFL said. We will continue to share updates as more information becomes available.
If they kick off Sunday, the Titans will have spent three days in virtual, video meetings with possibly only a walk-through Saturday. The prospect of a team facing a competitive disadvantage because of the virus was not a surprise to Tomlin.
Once we left the station and we got all teams into a training camp-like setting, we as a collective, meaning the National Football League, acknowledged that this COVID environment could be challenging to that, Tomlin said. So we all proceeded with that understanding.
Titans coach Mike Vrabel is scheduled to talk to reporters Wednesday morning.
I just wanna play, Titans starting left guard Rodger Saffold tweeted.
Commissioner Roger Goodell sent a memo to teams Tuesday noting the protocols set up by the league and the NFLPA are being followed. Those who tested positive will be isolated, monitored and offered medical care, and family members also are offered testing. Officials and others who worked the game will be tested.
This is not unexpected; as Dr. Sills and others have emphasized, there will be players and staff who will test positive during the season, Goodell wrote in the memo obtained by The Associated Press, referencing the NFLs chief medical officer, Dr. Allen Sills. We are exploring in more detail the nature of the close contacts to determine where they occurred (locker room, flights, etc.), and identify any additional learnings that can be shared with all clubs.
Goodell asked teams to look at what theyve done to limit contact, especially when traveling and within position groups, and to review how they bring in players for tryouts. He noted the test results affirm the need to follow health and safety protocols to the fullest extent.
The NFL has been fining coaches and teams when coaches have violated league rules requiring face coverings during games.
Steelers defensive tackle Cam Heyward posted on Twitter that if the game were postponed, players would be compromised in their preparation for the following week.
This is wild but this is the world we live in now, Heyward wrote.
The Titans beat the Vikings in Minneapolis without outside linebackers coach Shane Bowen, who did not travel with the team following a virus test result Saturday. Vrabel said Monday that Bowen was not with the team.
Rookie offensive lineman Isaiah Wilson, the Titans top draft pick out of Georgia, also has been on the reserve/COVID-19 list since Sept. 6.
The Titans, like other NFL teams, use devices that detect whenever someone is within 6 feet of another device and records how long they are that close together. That means the league has data on everyones interactions from inside the team headquarters to the practice field, an airplane, inside a hotel and at a stadium.
That information should help the Titans and the infectious disease experts know which players and coaches were at risk. The closure of Tennessees facility should also help limit further spread of the virus.
The Titans are due to have about 7,000 fans in Nissan Stadium on Sunday as local restrictions on large gatherings have been eased. That number is set to expand to about 8,500 on Oct. 11 for a game against Buffalo and up to 10,000 on Oct. 18, when Houston is scheduled to visit.
___
AP Pro Football Writer Dave Campbell in Minneapolis and AP Sports Writer Will Graves in Pittsburgh contributed to this report.
___
Follow Teresa M. Walker at https://twitter.com/TeresaMWalker
___
More AP NFL: https://apnews.com/NFL and https://twitter.com/AP_NFL
COVID-19 positivity rates increase ahead of NYCs return to indoor dining
Positive COVID-19 test rates rose to 1.93 percent on Monday, the New York Times reports, heightening concerns about a possible second shutdown in NYC. Gov. Andrew Cuomo attributed the rise primarily to new clusters that have been identified in Brooklyn. He also noted upticks in positive cases in Rockland and Orange Counties in the Hudson Valley, according to the Times.
Mayor Bill de Blasio previously said that if the rate of positive cases went above 2 percent in the city, he would reconsider allowing restaurants to return to indoor dining. Currently, restaurants are slated to reopen their dining rooms tomorrow at 25 percent capacity.
Earlier in the month, Gov. Cuomo said that hed be nervous at reaching a 2 percent positivity rate, while a 3 percent positivity rate would be cause for alarm, according to the Times. On Tuesday, he reiterated that, for now, NYC wasnt at the point of rolling back anything.
In a separate press conference on Tuesday, de Blasio confirmed that indoor dining will go ahead tomorrow, and clarified that the city may reevaluate the decision if positive test rates go above three percent on a rolling seven-day average.
Update, 12:45 p.m.: This post has been updated with comments from the mayors and governors press conferences on Tuesday.
Donations have poured in to support historic Neirs Tavern in Queens after it was burglarized last Friday. A GoFundMe set up to raise money for repairs and lost revenue met its $2,500 goal within 24 hours, QNS.com reports.
The Bronx Brewery has teamed up with its first-ever food partner, Empanology, to start collaborating on a food and beer menu that will feature items like the restaurants chopped cheese empanada paired with the brewerys World Gone Hazy IPA. Empanology will be open for outdoor dining and takeout daily from the brewery, with delivery options to follow, according to a restaurant spokesperson.
The Post details the lengths that some NYC restaurants are going to in order to prepare for the return of indoor dining.
Gramercy restaurant Laut Singapura is hosting a cocktail event from October 2 through October 4 featuring drinks based off of five of the Worlds 50 Best Bars in Singapore. Tickets to the event are $75 apiece and include five cocktails paired with savory bites.
Williamsburg restaurant and wine bar the Four Horsemen now has a Daymoves coffee cart stationed in front of the restaurant, serving coffee and La Bicyclette pastries Monday through Thursday from 8 a.m. to 3 p.m. and Friday through Sunday from 11 a.m. to 4 p.m.
A welcome addition to NYCs outdoor dining lineup:
Sign up for our newsletter.
PORTSMOUTH, Va. (WAVY) Why are Black people in America three times more likely to die from COVID-19? Studies show a patients zip code plays a role in health disparities but new research shows DNA is also a factor.
Black people make up about 13 percent of the population, but 22 percent of the people killed by COVID-19.
Dr. Robert Winn, director of the Massey Cancer Center at Virginia Commonwealth University, recently partnered with researchers at Oxford University to investigate whether something in the DNA that causes high blood pressure in Black Americans is also leading to a staggering COVID-19 death rate.
Just like in high blood pressure, the ACE receptors are active and highly active and they seem to be really hyperactive in African Americans, said Winn.
That hyperactivity could go biologically ballistic when the body is exposed to the novel coronavirus. Winn says there is a subgroup that quickly falls victim to the dreaded cytokine storm.
This is the concept of too much of a good thing aint good, said Winn.
The cytokine storm can occur within a week of infection from the coronavirus. During the so-called storm, the immune system goes overboard in responding to the virus by creating inflammation that destroys organs. Many persons of African descent are familiar with keloids that form following a cut or trauma to the skin. Winn says the immune systems overreaction that causes keloids is akin to the overreaction that triggers the deadly cytokine storm.
Winns research shows cytokine storms can be brought under control when certain patients are given ACE D inhibitors to clam hyperactive ACE receptors.
And when we used the ACE D inhibitor, that was the polymorph that we saw, we could see that there was a potentially better outcome, said Winn.
Winn says the DNA of African Americans often gets another assault from how patients live.
Lets not play that its only about our genetic basis. The truth of the matter is when you live in high-stress areas poor access to food, when youre in a house where you cannot separate remember those things are impacting your genes in real-time.
Several studies are being used to promote the use of certain ACE inhibitors to block the formation of cytokine storms. While the science on COVID-19 and DNA is still under review, Winn says the best thing you can do now is to wear a mask, practice social distancing and get a flu shot.
View the study done by Winn and others.
As students return to college campuses, the surrounding communities are seeing an increase in coronavirus infections. Michael Conroy/AP hide caption
As students return to college campuses, the surrounding communities are seeing an increase in coronavirus infections.
Young adults are driving coronavirus infections in the U.S. and are likely spreading the virus to older, more vulnerable populations, according to a recent report from the Centers for Disease Control and Prevention.
Early in the COVID-19 pandemic, older adults were more likely to get infected, but when researchers analyzed cases from June to August, they found that people in their 20s accounted for the largest share of confirmed cases compared to other age groups. And public health experts say this is a worrying trend.
"This group is going to continue to transmit a lot of virus," says Mike Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
The CDC report confirmed what many public health experts have long warned: Infections in young adults lead to infections in older people who are much more likely to be hospitalized and die from COVID-19 than people in their 20s and 30s.
In Southern states over the summer, rising infections among young adults preceded increases in COVID-19 by four to 15 days among people over the age of 60.
"They are mobile, they have contact with those who are older, and we're going to see that spillover occur more and more as we get into the fall," Osterholm says.
The spread among young adults is partly a reflection of how states reopened at the end of the spring, says Dr. Kirsten Bibbins-Domingo, chair of the department of epidemiology and biostatistics at the University of California, San Francisco.
"We asked older people to stay at home because they were more at risk, and we opened the economies and asked younger people to go out and work," Bibbins-Domingo says. "We also know it was summertime, people wanted to be out and socializing again," she adds.
Young people are more likely to hang out in groups, go to bars and restaurants behavior that keeps this virus circulating.
U.S. cases dropped off significantly at the end of the summer, but many communities with colleges and universities are now seeing a rebound in infections as students return to campus.
North Dakota has the highest rate of new cases per capita in the country, with many cases concentrated around colleges and universities.
And last week, Wisconsin Gov. Tony Evers declared a public health emergency because of "near-exponential growth" of cases, much of it linked to a steep rise in 18- to 24-year-olds getting infected.
"We were heading in a good direction, but that changed in early September," says Katarina Grande, who oversees the data team at the public health department for the city of Madison, Wis., and Dane County, Wis.
Cases in her county more than tripled during the first half of this month, compared to the end of August. Most of those new infections are tied to the University of Wisconsin-Madison. Grande says her agency is now tracking an increase in cases in the broader community, which could be an early sign that the campus outbreak is seeding new infections throughout the area.
In California, people under 35 years old made up half of all new cases by late July, says George Lemp, an infectious disease epidemiologist and former director of the University of California's HIV/AIDS Research Program.
"That did decline somewhat over time, but still remains fairly high," Lemp says.
Lemp, who has tracked this trend for months, says infections were already popping up around universities in the summer because students were in session or living near campus.
The question plaguing campuses and college towns is what to do about it.
"We know it's not effective to yell at college students and tell them what their behavior should look like, the decisions to gather and have parties," says Grande. "But that's the population that we're seeing transmission occur in."
As more students returned this month, many colleges and universities adopted new measures to prevent the spread of the coronavirus and test students to head off outbreaks.
Public health experts generally agree that shaming young adults is not the best strategy for getting them to follow COVID-19 guidelines.
In the San Francisco Bay area, one local public health department has tapped a group of young adults who are popular on social media to act as COVID-19 "influencers," in hopes of reaching a younger, more receptive audience.
"These young people are our football stars, they are makeup artists, they're on YouTube, they're fashionistas," says Ryyn Schumacher, a program manager at Contra Costa Health Services, which recently launched the new COVID-19 Youth Ambassador Program.
Schumacher says the idea to target this demographic came directly from looking at county data that showed 1 out of every 4 people testing positive was between the ages of 14 and 24.
"We don't spoon-feed the message to our young people," Schumacher says of the social media initiative. "It's up to them to craft their messages. We ask how are you protecting your grandma from COVID? And they may want to talk about their grandma and how she makes the best menudo."
Schumacher says they hope to expand the pilot program and build a relatable outreach campaign that resonates with tens of thousands of young adults.
"It talks about their voice, their story, their brand and the message then becomes a lot more authentic and genuine," Schumacher says.
Remarks by President Trump in an Update on the Nation's Coronavirus Testing Strategy Whitehouse.gov
About 9% of people nationwide have been infected with the coronavirus, according to a new study led by Stanford School of Medicine investigators.
This is the largest study to date to confirm that we are nowhere near herd immunity, said Julie Parsonnet, MD, professor of medicine and of epidemiology and population health, referring to the point at which alarge part of the population becomes immune to a specific disease. Scientists estimate that 60%-70% of the population must have antibodies to the coronavirus before COVID-19, the disease the virus causes, fades, said Parsonnet, a co-author of the study.
The findings were based on antibody levels from a cross section of patients on dialysis in July.The study also foundsignificantly higher rates of infection among Black and Hispanic people and among people living in densely populated areas.
With this survey, we were able to provide a very rich picture of the first wave of the COVID-19 outbreak in the U.S. that can hopefully help inform strategies to curb the epidemic moving forward by targeting vulnerable populations, said Shuchi Anand, MD, lead author of the study, which was published Sept. 25 inThe Lancet. Glenn Chertow, MD, professor of medicine and chief of the division of nephrology, is the senior author.
The research was conducted by analyzing blood samples from more than 28,000 patients on dialysis across 46 states. The results indicate that population density may be the largest contributing factor to infection rates, Anand said.
Antibodies are produced by the bodys immune system in response to an infection and can be measured in the blood for months and even years after someone is no longer infected.
Antibody testing is essential for monitoring the pandemic, Parsonnet said. The advantage over swab testing is that it gives you more of a historical view. Its still uncertain how long antibodies remain in the blood of individuals after theyve had COVID-19, but estimates range from at least two months to much longer period of time, she said.
Serology testing, which measures antibody levels in the blood, is commonly used to test for the occurrence of widespread illness, Parsonnet said. Stanford researchers chose to conduct this testing on dialysis patients for multiple reasons, among them the ready availability of leftover blood plasma samples from the large population of these patients who get monthly laboratory blood tests.
Not only is this patient population representative of the U.S. population, but they are one of thefew groups of people who can be repeatedly tested, Anand said. This is a potential strategy for ongoing SARS-CoV-2antibody testing and surveillance.
Since end-stage kidney disease is a Medicare-qualifying condition, these patients dont face many of the financialbarriers to care that limit testing among the general population, Anand said.
Unlike other studies that have aimed to determine the presence of antibodies to SARS-CoV-2, the virus that causes COVID-19, these estimates are unaffected by whether people feel well or unwell, worried or not worried, or have access to testing or not, Chertow said.Testing 28,503 blood samples from patients on dialysis, the researchers found that 2,292 hadantibodies to COVID-19, a prevalence of 8 percent in the sampling population, and 9.3 percent when standardized to the U.S. adult population.
This study also showed a higher prevalence of undiagnosed cases consistent with other studies, Anand said.Other serologic surveys of SARS-CoV-2 antibodies in the United States have been restricted to hotspots or underrepresented high-risk, vulnerable populations, and faced challenges to timely repetition and longitudinal follow-up, limiting their utility for surveillance, the study said.
The Stanford study showed a wide variation in prevalence by neighborhood, ethnicity, income level and population density. Results showed disproportionally high antibody levelsin Hispanic and Black populations (16.3%) compared with the white population (4.8%).And living in densely populated areas translated to a 10-fold higher risk of getting the disease than living in low-density areas.
The study also showed a remarkable variation by state, with early pandemic hotspots showing significantly higher rates than their neighboring states. The study determined that 33.6% of the population of New York had antibodies, whereas that figure was 17.5% in Illinois. In Pennsylvania, it was 6.4%, and in California, it was only 3.8%
There are limitations to relying on the dialysis population as a representative sampling for the nation, such as a higher proportion of those at increased risk of COVID-19 due to comorbidities. On the other hand, these patients are more often unemployed with less exposure to large groups. With repeated testing, these variations will become clearer, Anand said.
This is a practical approach, Anand said. It may not be completely precise, but it is internally consistent. This could greatly help health agencies plan for how best to distribute resources and plan for vaccine distribution.
Other Stanford authors are Maria Montez-Rath, PhD, biostatistician and senior research engineer; biostatistician Jialin Han.
Paul Beyer, CEO of Ascend Clinical, co-conceived the project with Chertow. Other members of the Ascend clinical leadership also contributed to the work, carrying out the rapid and high-throughput testing of plasma.
The study was funded by Ascend Clinical Laboratories. The Stanford researchers were funded by grants from the National Institutes of Health (grants5K23DK101826 and NIDDK K24 DK085446)and by the Stanford Department of Medicine.
