Swedish Red Cross volunteers deliver goods to elderly residents in Nacka, near Stockholm on April 29, 2020, to protect them from exposure to the new coronavirus.
Jonathan Nackstrand | AFP | Getty Images
CNBC is looking at how places around the world have tackled Covid-19. By talking to a wide range of experts, as well as everyday citizens, we're taking stock of what's gone well and what hasn't.
Sweden, the fifth subject of our series, has confirmed more than 76,000 cases and more than 5,500 deaths in a population of 10 million. The country did not go into lockdown, instead issuing recommendations about social distancing and working from home while allowing many schools and businesses to stay open. Sweden's mortality rate per 100,000 ishigher than the United States, but it has fared better than the United Kingdom.
Mental health
Sweden kept its country open relative to its neighbors. Some citizens worked from home, and many bicycled rather than taking public transit. Schools, particularly for younger children, remained open, as did many businesses. Because of the lack of enforcement and feeling of normalcy, some citizens say they didn't feel as stressed and anxious as they might have otherwise.
"There's a mental health aspect to lockdown," said Nils Mattisson, founder of Minut, a home monitoring start-up based in London andMalmo, Sweden. "All the fear can have adverse effects on people's health."
Ramping up ICU beds
Back in the spring, Sweden needed far more intensive care beds to care for a potential flood of Covid-19 patients. According to Dr. Jonathan Ilicki, head of medical operations at health start-up Doktor24, the situation did improve somewhat.
"In a short period of time, we did see a huge increase in ICU beds per capita, particularly in Stockholm," he said. Swedish officials quickly ordered the construction of a field hospital in a convention complex just south of the city centerin early April. That hospital closed in June as demand for care eased in the region.
However, there has been some controversy about whether vulnerable elderly patients were provided with these beds when they needed them. Some health-care workers have pointed to a reluctance to admit elderly patients who came down with the virus in their nursing homes.
People play chess at a park in Stockholm on May 29, 2020, amid the coronavirus Covid-19 pandemic.
JONATHAN NACKSTRAND
Daily briefings ... for a while
Sweden's top health authorities provided a daily briefing in the hardest months of the pandemic, which some residents appreciated. But that all changed in late June, when state epidemiologist Anders Tegnell shared that some of the responses were flawed. Updates are now provided just two days a week on Tuesdays and Thursdays. As Bloomberg reports, the briefings had turned into "daily grillings" where Tegnell had to justify his decisions.
Still, citizens say they appreciated the information, particularly when it came from a high-ranking scientist. "It was a source of comfort, and it was helpful and relatively straightforward," said Mattisson.
An engaged and compliant public
Many in Sweden say that public health officials didn't mandate certain behaviors, in part because they didn't need to. Restaurants, bars and salons might have remained open, but they were relatively empty compared with the months before the pandemic. Moreover, many people avoided gathering in large groups, particularly indoors.
"There's a strong trust in Sweden between the government and the people," said Dr. Arvin Yarollahi, the head of the orthopedic department ata hospital group in the country calledNU-sjukvarden.Yarollahi said people took the recommendations seriously, even if they weren't enforced.
"I think we had a response that suited our culture," said Fredrik Soder, CEO of a Swedish health-tech company called Health Integrator. "We take the authorities seriously." Soder said that many people chose to work from home if they could feasibly do so, and they took pains to socially distance. Swedish people were also encouraged to refrain from seeing their elderly relatives, who were at high risk for Covid-19.
That said, public health experts feel that the health officials in Sweden could have pushed for more behaviors to suppress infection. That includes wearing masks, or avoiding discretionary travel.
The economy
Sweden's economy hasn't been unscathed but its contraction seems to be less dramatic than what other countries are facing. A Capital Economics report from mid-June noted that Sweden's GDP would likely shrink 8%, compared with the harder-hit countries with late lockdowns like the U.K., where the contraction would be closer to 25%. That said, other reports have found that Sweden's economy didn't perform all that differently than its neighbors, including Denmark. Despite less stringent lockdowns, unemployment still rose and consumer spending fell.
That's probably because people did take precautions, despite the relatively mild government-imposed restrictions. "We were told to use our common sense," said Soder. "And that meant a lot less shopping at stores, and a lot more staying at home.
State epidemiologist Anders Tegnell of the Public Health Agency of Sweden gives a news conference on a daily update on the coronavirus Covid-19 situation, in Stockholm, Sweden, on June 3, 2020.
ANDERS WIKLUND
PPE and availability of tests
At the onset of the pandemic, some medical staff have noted that there wasn't sufficient personal protective equipment available to keep them safe. There were also urgent calls, and investigations from local journalists, for more PPE to be provided to those who care for the elderly in nursing homes and other facilities.
Similarly, Sweden struggled to ramp up tests and some residents with symptoms have shared with publications like Business Insider as late as June that they couldn't get tested. Some even went to hospitals, only to be asked to wait hours for a test -- and then be told that they weren't available.
"The speed and scale of distribution of PCR-based testing and screening of health-care workers could have been managed better, faster and more efficiently, especially in elderly care," acknowledged Johannes Schildt, CEO of a Sweden-based health-care start-up called Kry.
Policy around masks
Dr. Cheng Xu, a gastroenterologist in Sweden who treated many elderly patients, recalls honeymooning in Asia in late January and spotting many people wearing masks.
Back in Sweden, Xu hasn't seen most citizens sport a face covering in crowded public spaces. And although he stocked up in the early months, anticipating a potential pandemic, he fears that there's less value in him wearing one if others are neglecting to do so.
People enjoy the warm evening at Sundspromenaden in Malmo, Sweden, on May 26, 2020, amid the coronavirus pandemic.
Johan Nilsson | AFP | Getty Images
"There's an aggregated net positive effect," he said. "We need a more significant percentage wearing them, especially those who have symptoms."
The vulnerable elderly population
Care home deaths have accounted for nearly half of all fatalitiesin Sweden, even though the country recommended for people to avoid seeing their elderly relatives. One of the problems is that some staff were not provided adequate protective equipment, and may have gone to work despite having symptoms of the virus.
Prime Minister StefanLofven admitted in June that the country did not go far enough to protect its most vulnerable, and many public health experts agree.
"Sweden kept many of its schools open and the restrictions were mild, but there were a lot of elderly deaths," said Dr. Andrew Azman,a research associate in infectious disease epidemiology at Johns Hopkins Bloomberg School of Public Health, who is based in Switzerland. "It wasn't one of the better responses overall."
Others say that the outcome has brought to light a deeper need for new policies when it comes to caring for nursing home residents. "The lack of nursing staff has been a problem, and there's also poor wages and poor working conditions," said Yarollahi. "Many things have come to the surface and I'm hoping they can get better."
Lack of tracking and data collection in schools
A woman walks through the Kungstradgarden in Stockholm on May 8, 2020, amid the new coronavirus COVID-19 pandemic.
Jonathan NACKSTRAND | AFP
Sweden made a relatively unique decision in keeping schools open, particularly for younger children. Many countries, including the United States, are weighing opening up schools after the summer holiday -- and are eager to learn from countries like Sweden.
But epidemiologists say there wasn't sufficient data collected about infections among school-age children.
"It's really frustrating that we haven't been able to answer some relatively basic questions on transmission and the role of different interventions," Carina King, an infectious disease epidemiologist at the Karolinska Institute told Science Magazine. King shared that her team had been hampered by "the lack of funding, time, and previous experience of conducting this sort of research."
Achieving herd immunity
With its relatively open strategy, some public health experts have wondered whether it resulted in greater immunity. The vision of so-called herd immunity might be a ways off, recent studies suggest.
"We know that large parts of the population are unprotected, as they haven't been infected," Karin Tegmark Wisell, head of the Public Health Agency's microbiology department, sharedwith reporters earlier this week. That means there remains a "large susceptibility in the population," she said.
We asked every expert we spoke to for their score out of 10. (1 is the extremely poor and 10 is ideal.) It's an extremely subjective measurement, but the average across all of them was 5.5.
Sweden was one of the most polarizing countries from our series with some rating it as a 10/10 and others giving it as low as a 2/10. Those who have treated Covid-19 patients tended to dole out the lower scores.
"I think Sweden's health officials missed an opportunity to communicate suggested recommendations more clearly," saidAzman, who gave Sweden a lower score. "They didn't suggest face mask use, for instance."
"I'd give it good marks for transparency, reassuring communications and finding a mix of restrictions that were sustainable in the long term yet effective in slowing the spread of the virus," said Mattisson, who gave Sweden a 7 overall. "But bad marks for not protecting the care homes, not isolating people who arrived from places like Italy sooner and not being smarter about masks."
SEE ALSO:
How the UK fought the coronavirus
How Canada is fighting Covid-19: ramping up PPE production, travel ban from the U.S., and Bonnie Henry.
Why Israel's "second wave" of Covid-19 is worse than its first
How Taiwan beat the coronavirus
Correction:Dr. Arvin Yarollahi is head of the orthopedic department at NU-sjukvarden. An earlier version misspelled his name.
Ive lost two family members to COVID, my cousin and my great uncle, so Im frustrated by those who are taking this situation very lightly, because they just dont understand the risks, Marquez said. I have asthma, and one of my sons, whos also a teacher, has diabetes. If were back in the classroom, Ill be exposed to 1,800 students, and could bring COVID home to my own family. This is not time to be getting students back together, as having their lives at risk is just not an option.
Texas is now dealing with surges in Covid-19 coronavirus cases in many different parts of the state. ... [+] Pictured here is Texas Governor Greg Abbott. (Photo by Lynda M. Gonzalez-Pool/Getty Images)
The Covid-19 coronavirus is not a great way to welcome someone to the world.
Nonetheless, as the following CBS DFW news segment shows, 85 infants in Nueces County have tested positive for the Covid-19 coronavirus so far:
Welcome to 2020, infants, a year in which adults, you know the big versions of you, have not done a great job of controlling the spread of the Covid-19 coronavirus in the U.S. The virus has been surging of recent in Texas, home of Nueces County which includes the city of Corpus Christi.
Its not clear how most of these infants are now doing health-wise. According to Alexandria Rodriguez and Ashlee Burns reporting for the Corpus Christi Caller Times, a six-week-old boy, who had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) ending up dying of sudden infant death syndrome (SIDS). However, it has yet to be determined what specific role the Covid-19 coronavirus may have played in the infants death.
These are real infants and not adults acting like infants. So you cant blame them for catching the virus. Infants arent the ones ignoring public health recommendations, claiming that masks are suppressing their freedoms, and posting on social media conspiracy theories such as claiming that the pandemic is a hoax. Infants arent the ones who have failed to take enough action to contain the virus and looked for others to blame. Correction, infants who are less than one year of age, arent the ones. Instead, real infants kind of lie around, cry, and burp.
Nonetheless, add infants to the rapidly growing list of people directly affected by the U.S.s failure to contain the virus. Infants are of particular concern not just because they are cute and supposed to have their whole lives ahead of them but also because they have weaker immune systems. Weaker immune systems may make them more susceptible to worse outcomes from Covid-19 coronavirus infections. Their immune systems are like Ryan Gosling in the movie Remember the Titans. They havent quite figured things out yet, needing time to fully develop and learn from the world around them.
Umm, about this Covid-19 coronavirus thing, why isn't it being controlled better? (Photo: Getty)
Plus, a study published in Nature suggests that infants may have weaker immune systems for another reason. Weaker immune systems may allow good bacteria, such as the kind that makes poop smell bad, to move in and colonize their bodies. Of course, if this is the case, then leaving the door open in this way, could allow some bad visitors as well.
Since the Covid-19 coronavirus is still so new, there havent been too many studies on what happens to different infants when they get infected. A new publication in the Journal of the Pediatric Infectious Diseases Society does detail four cases of newborns hospitalized with fevers and found to have SARS-CoV-2 infections. Two of these infants had such difficulty breathing that they had to be admitted to the intensive care unit. One of the newborns ended up receiving remdesivir. Although all four newborns ended up surviving, this case series showed that Covid-19 can be much more than a mild illness for infants.
Infants probably wont be raising their little fists and saying, darn you 2020, because they cant quite talk yet and have no other year as a point of reference. However, adults should know that this year infants may face even more risks and tougher times than in previous years. Many adult decisions will affect infants even when infants do not seem directly involved. For example, most infants dont go to school yet, unless they are incredibly advanced. Nevertheless, opening schools prematurely would not only put the students, teachers, and school staff at risk but also could result in students bringing the virus home with them and subsequently infecting any infants who may be in the same household.
Therefore, whether you follow recommended public health measures could end up affecting infants, even if you are not an infant yourself, at least age-wise.
The West Virginia Department of Health andHuman Resources (DHHR)reports as of 5:00 p.m., on July 18, 2020, there have been 226,616 totalconfirmatorylaboratory results received for COVID-19, with 4,922 totalcases and 100 deaths.
Inalignment with updated definitions from the Centers for Disease Control andPrevention, the dashboard includes probable cases which are individuals that havesymptoms and either serologic (antibody) or epidemiologic (e.g., a link to aconfirmed case) evidence of disease, but no confirmatory test.
CASESPER COUNTY (Case confirmed by lab test/Probable case):Barbour (25/0), Berkeley (545/19), Boone(57/0), Braxton (7/0), Brooke (37/1), Cabell (224/7), Calhoun (5/0), Clay(15/0), Fayette (102/0), Gilmer (13/0), Grant (21/1), Greenbrier (76/0),Hampshire (48/0), Hancock (51/3), Hardy (48/1), Harrison (135/1), Jackson(149/0), Jefferson (264/5), Kanawha (489/12), Lewis (24/1), Lincoln (21/0),Logan (43/0), Marion (130/3), Marshall (80/1), Mason (27/0), McDowell (12/0),Mercer (69/0), Mineral (71/2), Mingo (50/2), Monongalia (693/15), Monroe(16/1), Morgan (20/1), Nicholas (20/1), Ohio (174/0), Pendleton (19/1),Pleasants (4/1), Pocahontas (37/1), Preston (89/25), Putnam (108/1), Raleigh(92/3), Randolph (196/2), Ritchie (3/0), Roane (12/0), Summers (3/0), Taylor(29/1), Tucker (7/0), Tyler (10/0), Upshur (31/2), Wayne (147/2), Webster(2/0), Wetzel (40/0), Wirt (6/0), Wood (193/10), Wyoming (7/0).
Ascase surveillance continues at the local health department level, it may revealthat those tested in a certain county may not be a resident of that county, oreven the state as an individual in question may have crossed the state borderto be tested. Such is the case of Cabell County in thisreport.
Please note that delays may be experiencedwith the reporting of information from the local health department to DHHR.
Please visit the dashboard at www.coronavirus.wv.gov for more detailed information.
Additional report:
Toincrease COVID-19 testing opportunities, the Governor's Office, the HerbertHenderson Office of Minority Affairs, WV Department of Health and HumanResources, WV National Guard, local health departments, and community partners todayprovided free COVID-19 testing for residents in counties with high minoritypopulations and evidence of COVID-19 transmission.
The testing resulted in 2,300 individuals tested: 559 inBerkeley County (two-day testing event); 717 in Jefferson County (two-daytesting event); and 1,024 Monongalia County (one-day testing event).Please note these are considered preliminary numbers.
SEDRO-WOOLLEY, Wash. Every day when I walk into work as a public-school teacher, I am prepared to take a bullet to save a child. In the age of school shootings, thats what the job requires. But asking me to return to the classroom amid a pandemic and expose myself and my family to Covid-19 is like asking me to take that bullet home to my own family.
I wont do it, and you shouldnt want me to.
I became an educator after a career as a nurse. I teach medical science and introduction to nursing to 11th and 12th graders at a regional skills center that serves students from 22 different high schools in 13 different school districts.
My school district and school havent ruled out asking us return to in-person teaching in the fall. As careful and proactive as the administration has been when it comes to exploring plans to return to the classroom, nothing I have heard reassures me that I can safely teach in person.
More than 75 New York Department of Education employees have died of Covid-19. CDC guidelines say a return to traditional schooling with in-person classes would involve the highest risk for Covid-19 spread. But even in-person classes with students spaced apart and prevented from sharing materials are categorized as leading to more risk. The lowest risk for spread, according to the CDC, is virtual learning. I cant understand why we would choose more risk than is necessary.
Its impossible to hear about the way parties, day camps and church services have led to outbreaks this summer without worrying about what will happen if kids and adults gather in the fall. It scares me to think of how many more lives will be lost. It terrifies me that I could be among those who lose their lives.
I completely understand why parents and administrators want kids to return to school. When we first started online learning in March, it was miserable pointless, even. Eventually, we established parameters, and I figured out how to teach kids across the northwest corner of Washington State virtually. During summer school, Ive live-streamed my lectures into campgrounds, living rooms and bedrooms decorated with twinkly lights or festooned with posters. My virtual classroom includes pets and younger siblings.
Yes, it has been hard. Yesterday, as several really adorable teenage faces laughed through the computer screen at my use of a Tyrannosaurus Rex to explain the sympathetic nervous system and the feeling of impending doom it can cause, I thought, I miss them. I wished I was standing in my favorite place in the world, my classroom because, frankly, that T-Rex analogy is much better when accompanied by my dino walk.
But it amazes me how fast students adapted to remote learning. I teach a particularly hands-on class. This summer, Ive managed to teach them to type blood, to suture wounds and how the sensory system works. Ive taught them all about infection control and epidemiology they can not only tell you that you should wear a mask, but they can show you how to do it correctly. I used to put my hand over students hands to guide them through certain lessons. Now I use a GoPro camera. Its hard, but they are learning.
Most important, we students and teacher are safe.
If Im asked to return to the classroom as the pandemic rages, I will have to walk away. As deeply as I love teaching, I will not risk spreading this virus in a way that could hurt a child or a family member of a child. While children make up a small proportion of U.S. coronavirus cases and they are less likely to become seriously ill than adults, the virus might be linked to multisystem inflammatory syndrome in children. Plus, many of my students struggle with poverty or are from multigenerational households. I will not risk passing a virus to them that they might pass to their vulnerable loved ones. I wont do it.
It isnt fair to ask teachers to buy school supplies; we arent the government. But we do it anyway. It isnt fair to ask us to stop a bullet; we arent soldiers. But we go to work every day knowing that if theres a school shooting, well die protecting our students.
But this is where I draw the line: It isnt fair to ask me to be part of a massive, unnecessary science experiment. I am not a human research subject. I will not do it.
Rebecca Martinson is a teacher at Northwest Career & Technical Academy in Mount Vernon, Wash.
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Sweden's controversial "herd immunity" strategy depends heavily on the hope that infection with the ... [+] Covid-19 coronavirus will confer long lasting immunity. Here people stand in line and interact without social distancing outside a restaurant on July 17, 2020 in Gotland, Sweden. Sweden largely avoided imposing strict lockdown rules on its citizens as the coronavirus (COVID-19) arrived earlier this year. Consequently, it has recorded thousands more deaths than other Scandinavian countries, putting its per capita death rate higher than that of the United States. (Photo by Martin von Krogh/Getty Images)
Can you or cant you? That is the big, big question.
Researchers have been trying to figure out whether you can get infected by the Covid-19 coronavirus more than once. After all, who wants a sequel to a bad experience, like watching Grown Ups 2 after the movie Grown Ups? Plus, the answer to this question can help address so many other things such as whether its safe to return to regular activities, how effective a vaccine may be, and how long this stinking pandemic may last.
So whats the answer now? Well, as with Kanye Wests run for the Presidency, things are not yet completely clear. In fact, they can seem downright confusing. However, some recently published scientific studies have offered some more pieces of evidence.
For example, there are the Rhesus pieces from a study published in the journalScience. This study involved deliberately infecting a set of Rhesus macaques with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) and then seeing if they could get deliberately infected again. Macaque rhymes with hacky sack, Monterrey Jack, and Nordic Track and is a species of monkey. This species has a lot of similarities with humans, except for perhaps the whole eating-termites-and-beetles thing and the expose-your-genitals-when-threatened thing. Well, the latter two at least arent similarities with most humans.
Rhesus macaque monkeys have many similarities to humans physiologically. (Photo by Frank ... [+] Bienewald/LightRocket via Getty Images)
For the study, a research team from Peking Union Medical College in Beijing, China, led by Chuan Qin, intratracheally challengedsix macaques with the SARS-CoV-2. Now if anyone tells you that they want to intratracheally challengeyou with a virus (or anything else like doughnuts for that matter), keep in mind what this would mean. This basically entails sticking a tube down your throat into your trachea and then placing the virus there. Its a way of making sure that you get infected.
The research team then confirmed that the macaques got sick from the virus. This included testing them up the wazoo, literally. They regularly checked the macaques rectal temperatures and their rectums, throats, and nasal cavities for the virus. Additionally, the research team followed the macaques symptoms and took chest X-rays that revealed signs of pneumonia.
Testing of the macaques blood showed that during the course of the infection the macaques developed antibodies against the protein spikes on the surface of the SARS-CoV2. If you recall, the Covid-19 coronavirus looks like a little spiky massage ball and uses the spikes to attach to and enter your cells. This was evidence that the macaques immune systems were responding against the virus.
Eventually, the six macaques survived the infections and recovered from their symptoms. However, the challenges didnt end there for four of the macaques. Twenty-eight days after their first intratracheal challenge, they got, guess what, another such challenge. The other two macaques were spared this second infection and remained as controls to be used for comparison.
After being re-challenged, the four macaques did develop fevers for short periods of time but otherwise showed no other signs of re-infection in the ensuing two weeks, based on chest X-rays and testing, again up the wazoo. In fact, the four re-exposed macaques mustered even higher levels of antibodies against the spike proteins than they had during the first infection.
So it looked like 28 days after the initial infection, the macaques still had some type of immunity against the virus. Good news if you happen to be a macaque and reading this. But what if you arent a macaque? What if you are human? Are you similar enough to macaques whether or not you raise your tail when intimidated? Do these results apply to you?
View of the Peking Union Medical College Hospital in Beijing, China (Photo: MARK RALSTON/AFP via ... [+] Getty Images)
Alas, there havent been similar challenge studies in humans yet. A World Health Organization (WHO) document from May 6 laid out a bunch of the risks and ethical challenges about doing human challenge studies in which volunteers would be deliberately exposed to the SARS-CoV2. As you can imagine, being exposed to a potentially deadly virus is not the same as being exposed to something like doughnuts. There are real immediate risks involved. Plus, if you havent figured it out yet, humans have a long history of doing very bad things to each other. This includes discriminating against different races and taking advantage of those perceived to be of lower status. For example, who exactly will be the volunteers for such challenge studies? Will it be wealthy people who can jump on to private yachts when it is time to social distance? Or will it be people more in disadvantaged situations?
A group of scientists did start a petition to Frances Collins, MD, the Director of the National Institute of Health (NIH), to undertake immediate preparations for human challenge trials, arguing that this will help develop and test a Covid-19 vaccine. From a scientific standpoint, human challenge studies would certainly help answer many questions about immunity a lot more directly and quickly. But as alluded to earlier, conducting such human challenge studies in a safe and ethical manner is not that easy. Like the title of a 2009 film, its complicated.
In the meantime, everyone will have to rely on more indirect human studies, such as the study published on June 18 inNature Medicine. For this study,a research team from Chongqing Medical University in Chongqing, China, led by Ai-Long Huang, followed what happened to 74 people who were infected with the SARS-CoV2, half of whom never developed any symptoms. Thus, 37 were considered asymptomatic infections and 37 were symptomatic infections.
When you first get infected with a virus, it takes time for your immune system to develop an antibody response, thats assuming that your immune system can even generate such a response. Not all viruses may elicit an immune response. The first type of antibody that your immune system may produce in your blood is immunoglobulin M, or IgM if you dont have time to say immunoglobulin. This antibody doesnt hang around for long, with production increasing momentarily and then decreasing. To remember this, use the mnemonic M for momentary.
Before IgM disappears, production of a second type of antibody, immunoglobulin G or IgG, ramps up and stays up for an extended period of time. IgG is the antibody that can help with persistent immunity. Just think, gee, is IgG still around?
Heres a Beckman Coulter Diagnostics video on IgM and IgG with very dramatic piano music in the background:
For the Nature Medicine study, the research team measured the levels of these types of antibodies three to four weeks after the patients had been first exposed to the virus. For IgM, 81.1% of those who had asymptomatic infections and 83.8% of those who had symptomatic infection ended up testing positive. Similarly, for IgG, a greater percentage of the symptomatic patients (78.4% versus 62.2%) tested positive. In fact, those who had had symptoms tended to have significantly higher levels of IgG (medians of 20.5 versus 3.4) than those who didnt.
About eight weeks after they had recovered from their infections, most patients already had declines in IgG levels, 93.3% of the asymptomatic patients and 96.8% of the symptomatic patients. These werent just itty-bitty declines but fairly large ones, medians of a 71.1% decline among the asymptomatic patients and a 76.2% decline among the symptomatic patients. Of note, 81.1% of the asymptomatic group and 62.2% of the symptomatic group had declines in the levels of neutralizing serum antibodies. In fact, 40.0% of asymptomatic patients and 12.9% of the symptomatic patients no longer had any measurable IgG.
Certainly, antibodies are only one component of your immune response to a virus, albeit an important one. They are like pants. Just because you no longer have them doesnt necessarily mean that you are left completely exposed, especially if your happen to have been wearing Spanx underneath. Some kind of immunity against a virus may remain even if you dont have detectable antibodies in your blood. But checking for antibodies in your blood serum is currently the easiest way to measure the level of protection that you may have.
So how does all of this fit in with the case reports of people getting re-infected with the virus? For example, the following NBC 9 news segment covered the case of a woman who apparently got infected again:
Is this case and similar cases actually cases of re-infection? Or do they represent situations in which false negative test results occurred between positive test results? In such cases, what seems like two separate infections could have instead simply been one really long infection. Also, there is the chance that a person could have a positive test and no longer be infected. The test for viral genetic material (i.e., RNA) could be detecting fragments of the virus rather than whole live version.
Either way, case reports are case reports and not scientific studies. There are exceptions to every rule, except for the rule that macaroni and cheese is always yummy and always appropriate. If such case reports do in fact represent real re-infections, then a major question is how common are such occurrences? Are they rare or common enough to be very worried about them?
It could be that your immune response and your subsequent immunity depend heavily on the type and severity of infection that you had in the first place. Not having symptoms may be great for the present time but could potentially elicit a weaker immune response. As youve seen, rather than being a single type of illness, Covid-19 can come in many different flavors.
Then theres the question of how long immunity may last. As I covered previously for Forbes, a study of those who got the original SARS during the 2002-2003 outbreak suggested that immunity may last about two years. But as a recently released book about a family whose last name rhymes with speed bump or suction pump suggested, just because you are from the same family doesnt mean that you will behave in exactly the same way. Its still not clear all the ways that the SARS-CoV2 may differ from the SARS virus.
So there is some evidence that your immune response to the SARS-CoV2 may differ depending on factors such as how severe your infection was and how strong your immune system may be. Random chance may play a role too because nothing in life is 100%. If your immune response was not very strong in the first place, then perhaps the door is left wide open for re-infection. Would a subsequent infection then be more or less severe? The other issue is duration of immunity and protection. Is it only a few weeks? A couple months? A year? Longer?
So many questions.
Ultimately, immunity to the SARS-CoV2 may be much more complex than yes you are immune because you had the infection situation. Immunity is not like a toupee. Its not either on or off. Different types of infection could lead to different degrees of immunity that could last for different lengths of time. Different can be really good when it comes to leadership, creativity, clothing, and a salad bar but not necessarily with immune responses to a virus. Such complexity could further complicate the heck out of the pandemic and its response. It would make simplistic approaches such as oh, lets get everyone exposed to the virus and sacrifice a bunch of lives so that the pandemic can end, less likely to work.
Thus, the answer to the question of whether you can get infected by the Covid-19 coronavirus more than once may be it depends. Stay tuned for more.
COVID-19 in people with diabetes: understanding the reasons for worse outcomes The Lancet
Orange County reported 25 more deaths connected to the novel coronavirus on Saturday, the third-highest day on record as the number of confirmed cases continues to surge.
Health officials said that 109 deaths have been reported in the last two weeks, and 494 since the pandemic began. The deaths reported Saturday included seven people who lived in institutional settings such as nursing homes.
The number of confirmed COVID-19 cases countywide climbed to 29,011, with 702 new cases reported Saturday. The number of infections in Orange County has grown dramatically over the last month, and is now second only to Los Angeles County.
Across California, transmission rates for coronavirus continued to rise. The total number of confirmed COVID-19 cases topped 375,000 Friday, and the number of deaths exceeded 7,600.
Gov. Gavin Newsom added Orange County to his coronavirus watchlist because the share of COVID-19 tests that have come back positive, and the number of people infected per 100,000 residents, are too high to meet state benchmarks.
Over a seven-day period, 13.9% of COVID-19 tests came back positive. Over the last two weeks, officials have confirmed 12,531 new cases, an average of 396 positive tests per 100,000 Orange County residents a rate equivalent to that of L.A. County.
Orange and Riverside counties have seen the number of hospitalized patients with confirmed COVID-19 infections nearly triple in the last two months. In San Bernardino County, that number has more than quadrupled. All three counties allowed many businesses to reopen a week before Los Angeles County.
California has mandated face coverings in public settings since June 18. But Orange County has become a hotbed of opposition to that rule, sparking concern from public health officials who say the coverings are among the most effective tools to slow the spread of the virus.
Orange Countys former health officer resigned after receiving weeks of verbal abuse, including a death threat, over her mandatory mask order.
Last week, education officials approved recommendations that would allow public schools to reopen in the fall without requiring social distancing or mandatory mask policies, prompting immediate backlash.
19 July 2020, Cairo, Egypt More than one million patients in countries of the Eastern Mediterranean Region have successfully recovered from COVID-19 since the first case was reported on 29 January 2020.
This is a welcome and significantly positive milestone, and reflects the efforts made by countries to protect their populations during these very challenging times, said Dr Ahmed Al-Mandhari, WHO Regional Director for the Eastern Mediterranean. Individuals also play a key role by being properly informed, taking appropriate measures to protect themselves and their families, recognizing symptoms when they occur, and seeking medical support immediately before their condition becomes critical. All of this contributes to effective containment and unnecessary loss of life.
While the number of cases, including recovered cases, is not comprehensively reported to WHO, countries currently reporting the highest number of recovered cases are Islamic Republic of Iran, Pakistan, Saudi Arabia and Qatar. The same countries are also reporting the highest numbers of infected cases.
Successful treatment of patients requires timely diagnosis and health system capacity to provide treatment, and also protect health care workers and provide sufficient medical supplies. From its regional logistics hub in Dubai, WHO has so far delivered personal protective equipment, including almost 7.5 million surgical masks and 125 000 respirators for health care workers, to all countries in the Region.
Efforts are also under way to identify effective treatments and develop vaccines for COVID-19 in order to save more lives. WHO is currently tracking more than 1700 clinical trials globally that are investigating nearly 200 therapeutic options or their combinations. There are also 23 candidate vaccines undergoing clinical evaluation, while another 140 candidate vaccines are in pre-clinical evaluation.
In the Eastern Mediterranean Region, Egypt, Islamic Republic of Iran, Kuwait, Lebanon, Pakistan and Saudi Arabia are participating in the Solidarity Trial to test the effectiveness of Remdesivir and Interferon beta-1a in the treatment of hospitalized patients. Additionally, Afghanistan, Jordan, Lebanon, Libya, Morocco, Pakistan, Somalia, Sudan, Syrian Arab Republic, United Arab Emirates and Yemen are participating or planning to participate in the Unity Studies that aim to analyse COVID-19 transmission patterns, severity, clinical features and risk factors for infection, as well as levels of infection and antibody response. The United Arab Emirates has also launched a clinical trial of a COVID-19 vaccine candidate under development by China.
Countries in the Region are fully committed to containing transmission and saving lives. Despite the increasing numbers of cases reported, there are proven measures that work: strong government leadership and informed communities are essential to controlling disease spread, and also promoting recovery of patients. By now, we all know what needs to be done to turn around the course of this pandemic. As research for vaccines and treatment continues, this landmark milestone of one million recovered cases in our Region should give us all even more determination and drive to succeed, said Dr Al-Mandhari.
As many hospitals and doctor's offices limited patient appointments and surgeries during the coronavirus pandemic, a concerning side effect of the shutdown began to emerge. With fewer screening exams, patient visits and surgical procedures, breast cancer care took a frightening hit.
Regular breast cancer screenings save lives, but early in the pandemic, the American Cancer Society recommended that doctors postpone any routine breast cancer screenings or intervention to protect at-risk patients from potential exposures or illness.
"No one should go to a health care facility for routine cancer screening at this time," Dr. Richard Wender, chief cancer control officer for the ACS, said in a statement on April 29.
But delaying those appointments didn't just mean delaying regular breast exams. For some, it meant delaying preventative treatments, such as chemotherapy, designed to keep cancer from coming back. And as weeks turned into months, ACS eventually shifted its policy, encouraging women to talk to their doctor before potentially resuming their regular appointments.
The most recent statement, released on July 2, encouraged women to resume their usual screening mammograms, but suggested that some women can choose to wait for two years for their next screening mammogram based on their individual history and breast cancer risk factors.
Though the earlier advice has now changed, we don't know the effect these delays might have on breast cancer patients in the future.
Dr. Paulomi Shroff, a board-certified breast surgeon in Marietta, Georgia, has experienced the impact of the shutdown on her patients firsthand.
"Originally, an issue was that we couldn't get mammograms for about six weeks in Georgia," she said. Many other places around the country had even longer delays meaning that "women who had breast lumps would get pushed back in terms of getting them investigated."
In this July 31, 2012, file photo, a radiologist compares an image from earlier, 2-D technology mammogram to the new 3-D Digital Breast Tomosynthesis mammography.
Stopping mammograms did not just affect the women with breast lumps. Shroff said that it also affected women scheduling their yearly mammograms to screen for breast cancer.
"Really the problem with not having mammography in that time period is that women are skipping their mammograms," Shroff said. Because many women make a habit of getting their mammograms at a certain time of year, "if they were supposed to have their mammogram in May and didn't get it, they may just wait until next May," she added.
Altogether, the delays in mammograms could mean even more trouble for women down the road.
For patients diagnosed with breast cancer before the pandemic, the shutdown impacted their access to physicians, medications and surgeries. "A lot of different centers de-prioritized breast surgery," Shroff said.
This is a concern, she said, because by performing surgery "as early as possible, we are reducing the metastasis risk."
While patients waited for surgery, some who had certain types of cancer could be prescribed medications that would help keep their cancer from worsening.
Once elective surgeries were resumed, the pandemic had an impact on the decisions women made for having their breast cancers removed. In an effort to conserve hospital beds and to avoid overnight hospital stays, many patients and surgeons opted for less-invasive surgeries.
"In patients who might have otherwise wanted a mastectomy, if we could get away with a lumpectomy, we got away with a lumpectomy," Shroff said.
For those considering having a plastic surgeon reconstruct their breasts after having their breast cancers removed, Shroff said, "If they needed reconstruction we tried to do the minimum possible" to avoid an overnight hospital stay.
Even for patients without cancer, but with a high-risk change in their breast tissue called atypia, the pandemic caused problems. Shroff told ABC News that she had one patient with atypia who had to wait three months for surgery. By the time she had her surgery, it had progressed into cancer.
"I effectively sat on it without treatment for three months, which is not something I would have done in a non-COVID era," Shroff said.
In this May 6, 2010 file photo, a radiologist checks mammograms in Los Angeles.
Fortunately, multiple national societies are providing guidance to doctors making decisions about breast cancer care.
"Our society, along with four other societies ... wrote really literature-based guidelines about what to do with breast cancer patients during the pandemic," said Dr. Jill Dietz, president of the American Society of Breast Surgeons.
In addition to recommendations for virtual visits, streamlined in-person visits, masks, screening and preoperative testing, the guidelines prioritize patients' cancer care based on their individual risk of breast cancer progression or of serious illness should they contract COVID-19. Dietz said, "All of those factors are playing a role."
In terms of resuming mammograms, Dr. Lynn Baxter, director of breast imaging for Northside Radiology Associates at Northside Hospital in Atlanta, said that even though mammograms are back up and running at her facility, not everyone should be rushing to be seen.
"Let's say someone is older and has COPD -- if it's just a regular screening, it might be in the best interest of her health to wait. ... Let's say that same lady felt a lump, I would say, no, she really needs to come in and get that taken care of."
Most importantly, Baxter recommended that women "think about their individual risk and talk with their providers."
Along with these prioritization strategies, Shroff wants women across the country to know: "You don't need to be scared to go the doctor's in the pandemic, as long as you practice good personal hygiene, wear a mask, wash your hands. Don't not seek medical care because of this."
Stephanie E. Farber, M.D., is a plastic surgeon in Atlanta and is an ABC News Medical contributor.
