Amid the steady stream of stories on the lives lost to coronavirus are cases that stand out as remarkable. In the past month, at least two pairs of twins have died in Britain and two pairs of brothers, all within hours or days of each other. But do the deaths point to genetic factors that make some more likely than others to succumb to the disease?
Most scientists believe that genes play a role in how people respond to infections. A persons genetic makeup may influence the receptors that the coronavirus uses to invade human cells. How resilient the person is to the infection, their general health, and how the immune system reacts will also have some genetic component.
A team led by Prof Tim Spector, head of twin research and genetic epidemiology at Kings College London, has reported that Covid-19 symptoms appear to be 50% genetic. But Spector said more work is needed to understand which genes are involved and what difference they make to the course of the disease. We dont know if there are genes linked to the receptors or genes linked to how the infection presents, he said.
Identical twins Katy and Emma Davis, aged 37, died at Southampton general hospital last month. The sisters, who lived together, had underlying health problems and had been ill for some time before they contracted the virus. Another pair of twins, Eleanor Andrews and her sister Eileen, aged 66, died earlier this month. They too lived together and had underlying health conditions.
Two brothers from Newport, Ghulam Abbas, 59, and Raza Abbas, 54, died within hours of each other at Royal Gwent hospital. Another pair of brothers from Luton, Olume Ivowi, 46, and Isi Ivowi, 38, died within days of each other.
These deaths alert people to the fact that this could be genetic, but when people live together they share an environment as well, Spector said. The upshot is that twins who live together are more likely to have similar lifestyles and behaviours, from diet and exercise habits to how quickly they seek medical care. Twins are not generally less healthy than the wider population.
Twin deaths made headlines long before the coronavirus struck. When Julian and Adrian Riester died on the same day in Florida in 2011, a cousin of the twin Franciscan monks said it was confirmation that God favoured them. But Spector sees the hand of cold statistics at work. When you look formally at this, you see that twins rarely die at the same time, he said. There are billions of people on the planet. One in 70 is a twin and one in 200 is an identical twin.
Marcus Munafo, professor of biological psychiatry at Bristol University, said reports of twin deaths must be interpreted with caution. Twin deaths are unusual, which makes them newsworthy, but coverage can distort our perceptions. Salience bias refers to the fact that we tend to focus on information that stands out more, even if its not particularly relevant. So we need to be careful not to read too much into events that might stand out for reasons that are not actually related to the issue were interested in, he said.
When twins or siblings tragically die with Covid-19 that captures our attention, but that doesnt mean theres any particular reason to think twins or siblings are at greater risk.
Life during the coronavirus pandemic is full of questions.
And for many of those questions, people are turning to the internet and, by extension, to Google. Google is by far the worlds dominant search engine, fielding about 90 percent of the worlds online queries. So Google has more insight into our internet searches than any other company.
Fortunately for the data nerds among us, the company makes those search trends readily available with a website called Google Trends. This tool lets people compare how popular one search is over time or compared with another, offering insight into what people are curious about. Thats particularly helpful with the coronavirus, which has consistently dominated search queries in the past few months even beyond more quotidian standbys like weather, music, and video.
We spoke with Simon Rogers, data editor at Google, who has been putting out a fascinating daily newsletter and coronavirus page from Google Trends data about different trending searches and what they might mean.
This interview has been edited for clarity and brevity.
For those who arent familiar, can you explain what Google Trends is?
Google Trends is basically a public tool that anybody can use. It takes a sample of all search there are billions of searches every day, so it couldnt possibly measure every one and basically all of those searches go through this process where we try and work out what theyre really about, which topics theyre about. And then what we do is try and make that data easier for people to access.
So around something like coronavirus, say, thatll be where we would look at the top questions that somebody will be asking about the virus. Google Trends is, I would say, the worlds largest free-access, journalistic data set. And its ever-changing, and every day it gives you a sense of what people really care about.
What advantage does Google Trends have over other datasets?
Theres ubiquity in search. It takes you beyond that echo chamber of social media. Because youre not presenting yourself in a certain way, youre being honest. Youre never as honest as you are with your search engine. You get a sense of what people genuinely care about and genuinely want to know and not just how theyre presenting themselves to the rest of the world. And its immediate. As soon as something happens, it shows up in search.
Ive been paying attention to Google Trends a lot more during coronavirus. Thats because, as were spending more time at home and computers mediate our lives with the outside world even more, it seems like were getting a better window into what peoples thoughts and questions and fears are during the pandemic. Do you think thats the case?
I think partly its because suddenly youve got this giant shared experience, something were all going through, and its very easy in that environment to feel isolated. Whats happened to you isnt happening to anybody else. But you can get a real sense of how thats reflected in the way that we search. Looking at the searches, right now, I think they almost split into two different categories.
On one side, there are people searching for the big issues around the virus: Is there a vaccine yet? or Why does one drug work? or What are the symptoms? those kinds of big questions. And then the other side is the fallout from the virus, which are searches around things like loneliness and big emotional issues. And then there are also things like: How do I cut my own hair? or How do I bake bread? or How do I keep the kids entertained? things were all going through.
Those latter trends have been some of the most interesting to me. I saw the bread, obviously, banana bread I figure people are just buying way too many bananas and have to figure out how to deal with it how to cut your own hair. One of the things that really blew me away was that all of a sudden everyone and their mother was Googling how to make coffee and must have never had to figure that out before. What do you make of that?
Its funny, isnt it? Its all those things that we do during the day, not at home often. I think its partly because people want to expand their knowledge of something. So probably people know how to make instant coffee by now, right? But people will search for how to make Dalgona coffee, which is this kind of whipped thing with sugar in it that my daughters been doing tons of in the last five weeks. Its things like that which are out of the ordinary, so theyre not necessarily things you would do if you didnt have time at home and you werent thinking of how to just change things up a little bit.
What are some of the more surprising searches youve seen trending?
The fact that there were things Ive been thinking of personally to see them show up in search is always interesting. Like we have a 3D printer, and I was thinking, I wonder if other people search for how to 3D print face masks to donate to hospitals, which is a very specific thing. Searches for 3D printing are higher than ever before in history. And theres some things which are kind of reassuring, like searches for how to help, food donation, helping the community, how to volunteer all of those things are higher than ever before.
Its good to think that were thinking of others at this moment. But theres big spikes in searches around very specific DIY that goes across both search data and YouTube data. And theres a lot of big spikes in search for things that are homemade, weird stuff that I wouldnt even think about, like homemade eyebrow wax, that makes sense but also scares me a little bit.
I could use some homemade eyebrow wax right about now.
Ha! Then, theres more the how-to thing, like how to make a face mask at home or how to ripen avocados, how to divide fractions. We saw searches for shredded were spiking and we thought, Oh, this is people talking about weightlifting or bodybuilding, and actually its people searching for shredded chicken.
What about the weirdest search?
Theres things that would have seemed weird like six weeks ago that dont seem weird now. Drive-by birthday party spiked 5,000 percent, and thats not something I or anybody had ever heard of before six weeks ago. And if youd asked me this in March, Id say well, this is a weird thing, but now it just feels normal.
Its the new normal. What about concerning Google searches? For example, this morning I saw that one of the highest-trending US coronavirus questions was, Who created coronavirus? which is this conspiracy theory that keeps popping up and has no basis in fact.
There are things that are concerning for society like the spike in searches for loneliness, people searching for having trouble sleeping, depression. All of those things are concerning to me, and I worry for people that dont have people with them or are feeling it. Then the other misinformation thing is really interesting, because normally around any political thing, you always see spikes and searches where people are trying to find out if a misinfo story is true.
But now, I do get the sense that the highest spikes are things around searches for reliable information, like people searching for cdc.gov or wherever are really high at the moment. So I wonder whether thats because were looking for things we know are true. Occasionally, misinfo things do show up. But if you have politicians saying, Coronavirus was created somewhere, then people are going to search for that. And thats just a side effect of where we are right now. I think the fact that people are looking for it is actually a good thing because it means we want to know if its true or not. Theyre not necessarily just going to accept it.
Is there any real-world stuff that you could do with Google Trends, especially as it relates to public health. Like, could you see where there are new coronavirus hot spots or something like that?
The country-level datasets, which we update every day, shows the top 100 places searching for coronavirus as well as the top related queries, which are what people type in when they search for the virus. Governments have noticed different stages for different things that are popping up in search and then change their official information to reflect that. I think were really at the beginning of how useful this is.
One of the things weve been thinking about are these kind of patterns of search around the virus. What you see is when people dont really have many cases, lots of searches are very informational like, What is coronavirus? And then when cases start happening then there are things like, What are the symptoms of coronavirus? And then it gets to more sophisticated questions when youre living in lockdown.
Like in New York, for instance, youll see questions around things like, How long does coronavirus live on surfaces? or Whens the lockdown going to end? or How do I get my stimulus check? So you can really see how things change over time. I think you could probably build a really interesting model around that. This is a real-time reaction to the situation around people.
Are there any regional or country-specific differences in coronavirus that have stuck out to you?
There are some differences. For instance, in France right now they have these zones of infection, so people search for the red zone, and before that was people searching for a pass to leave Paris and things like that. You see these kinds of country differences, but really the way that the search evolves is common across countries.
So if you were to look at the searches in, say, Milan seven weeks ago, they are very similar to searches were seeing in New York now. Its almost like the big questions are common across all of us. Were all trying to find the same things. It comes out of the uncertainty of knowing there isnt a cure, there isnt a vaccine right now. That uncertainty leads to a lot of similar questions in different places.
What dont we see in Google Trends data?
We cant tell demographics. I dont know who somebody is. The data is anonymized so you dont get individual data. So, I cant tell you how different age groups search or anything like that. Also, unless youre extrapolating something from the data, what you can tell is what people care about, but you cant tell what their opinions are about it.
What should people not be Googling?
I wouldnt tell anybody not to Google anything, because thats such a personal thing. I think people need to think about information with the same care they think about any aspect of their lives. If youre consuming information, you want it to be reliable. Just thinking of information as this valuable resource that matters is really important.
I think Id rather have people Googling everything, searching for everything, rather than accepting something without searching for it. Id much rather you looked up stuff yourself than just believe things on face value, wherever theyre coming from.
Support Voxs explanatory journalism
Every day at Vox, we aim to answer your most important questions and provide you, and our audience around the world, with information that has the power to save lives. Our mission has never been more vital than it is in this moment: to empower you through understanding. Voxs work is reaching more people than ever, but our distinctive brand of explanatory journalism takes resources particularly during a pandemic and an economic downturn. Your financial contribution will not constitute a donation, but it will enable our staff to continue to offer free articles, videos, and podcasts at the quality and volume that this moment requires. Please consider making a contribution to Vox today.
Javier Saade serves on several boards, is venture partner at Fenway Summer and is a senior advisor at FS Vector, Fenway Summers advisory affiliate. Previously, he was associate administrator and chief of investment and innovation at SBA.
The last two decades have ushered in significant change and transformation. I believe the 2020s will be dispositive in redefining the pillars of our economy, and COVID-19 magnifies this greatly. As of this writing there are 3,611,394 confirmed cases, and the U.S. accounts for 33% of those. We are now dealing with a 4.8% Q1 GDP contraction and expectations for Q2s shrinking runs into the 25% range, more than 30 million unemployed and a $7 trillion federal intervention in a span of six weeks.
Eric Schmidt recently predicted that the coronavirus pandemic is strengthening big tech. It is hard to disagree with him; it almost feels obvious. Big tech and other digital companies are net beneficiaries of new habits and behaviors. Some of this shift will be permanent, and well-capitalized tech companies are likely to expand their power by grabbing talent and buying companies for their IP then dissolving them.
With power comes political backlash and public wariness. One flavor of that counter pressure is already in full effect. Sen. Elizabeth Warren and Rep. Alexandria Ocasio-Cortez have proposed new legislation that seeks to curtail acquisition activity via the Pandemic Anti-Monopoly Act. Ill reserve judgment on their effort, but the theme is familiar: the strong get stronger and the weak get weaker, which further widens gaps and calcifies disparity.
The COVID-19 shock is highlighting a chasm that has evolved over decades. The digital divide, lack of capital access, sporadic paths to education and microscopic levels of wealth accumulation in communities of color and the implicit/explicit bias against non-coastal elites are some contributing factors.
During the 2008 crisis, the combined value of the five biggest companies ExxonMobil, General Electric, Microsoft, AT&T and Procter & Gamble was $1.6 trillion. Microsoft is worth almost that today all by itself. No need to talk about FAANG, because since the pandemics economic halt, Peloton downloads went up five-fold in a month, Zoom grew to 200 million users from 10 million in December and Instacart users grew six times in that period.
Roelof Botha of Sequoia Capital was recently quoted as saying, Like the killing off of the dinosaurs, this reorders who gets to survive in the new era. It is the shock that accelerates the future that Silicon Valley has been building. It is hard to argue with his views.
To be clear, I am a beneficiary of and a big believer in technology. Throughout my career I have managed it, invested in it and made policy on it. For example, one of the multi-billion-dollar programs I oversaw, the Small Business Innovation Research (SBIR) program, has invested more than $50 billion in tens of thousands of startups, which have collectively issued 70,000 patents and raised hundreds of billions of capital and 700 of them have gone public, including tech titans such as Qualcomm, Biogen and Symantec.
My point: I think about technology a lot, and, lately, about its repercussions. There is a massive shift afoot where more power and influence will be consolidated by these remarkable companies and their technology. Besides the economic consequences of the strong crushing the weak, there are serious ethical issues to consider as a society. Chamath Palihapitiya has been pretty vocal about the moral hazard of what is essentially a massive transfer of wealth and income. On one side you have mismanaged and/or myopic corporations and on the other, the counterparty is the American people and the money we need to print to bankroll the lifeline. I am not talking about Main Street here, by the way.
It is not hard to imagine a world in which tech alone reigns supreme. The ethical dilemmas of this are vast. A recent documentary, Do You Trust this Computer, put a spotlight on a frantic Elon Musk ringing the alarm bell on machines potential to destroy humanity. Stephen Hawking argued that while artificial intelligence could provide society with outsized benefits, it also has the potential to spiral out of control and end the human race. Bill Gates has been less fatalistic, but is also in the camp of those concerned with synthetic intelligence. In an interesting parallel, Bill has for years been very vocal on the risks pandemics pose and our lack of preparedness for them indeed.
These three men have had a big impact on the world with and because of technology. Their deep concern is rooted in the fact that once the genie is out of the bottle, it will make and grant wishes to itself without regard to humanity. But, is this doomsday thinking? I dont know. What I do know is that I am not alone thinking about this. With COVID-19 as a backdrop, many people are.
Algorithmic sophistication and computer horsepower continue to evolve by leaps and bounds, and serious capital continues to be invested on these fronts. The number of transistors per chip has increased from thousands in the 1950s to over four billion today. A one-atom transistor is the physical boundary of Moores Law. Increasing the amount of information conveyed per unit, say with quantum computing, is the most realistic possibility of extending Moores Law, and with it the march toward intelligent machines and a tech first world. The march has been accelerated, even if peripherally, by the pandemic.
While the promise of technology-driven progress is massive, there are some serious societal costs to exponential discovery and unleashed capability acceleration. Dartmouths Dr. James Moor, a notable thinker at the intersection of ethics and technology, believes that the use and development of technologies are most important when technologies have transformative effects on societies. He stipulates that as the impact of technology grows, the volume and complexity of ethical issues surrounding it increases. This is not only because more people are touched by these innovations, they are. It is because transformative technology increases pathways of action that outstrip governance systems and ethical constructs to tame it.
So what? The twists and turns of technology application lead to consequences, sometimes unknowable and for that reason we should be increasingly vigilant. Did Zuckerberg ever imagine that his invention would have been so central to the outcome of the 2016 election? Unknowable consequences, exhibit one. Interconnected systems touch every aspect of society, from digital terrorism to bioengineering to brain hacking and neural cryonics to swarm warfare, digital assets, intelligent weapons, trillions of IoT connected devices the list goes on.
As a society, we should be open to innovation and the benefits it ushers in. At the same time, we must also remain committed to sustainable tech development and a deployment mechanism that does not fail to shine a light on human dignity, economic inequality and broad inclusiveness. These seem like esoteric issues, but they are not, and they are being put to the test by COVID-19.
A fresh example of this thematic happened recently: Tim Bray, a VP and engineer at Amazons AWS, resigned because of the companys treatment of employees, and was quoted as saying, in part, Amazon treats the humans in the warehouses as fungible units of pick-and-pack potential. Only thats not just Amazon, its how 21st-century capitalism is done If we dont like certain things Amazon is doing, we need to put legal guardrails in place to stop those things.
Eliminating human agency has been at the core of innovation during the last four decades. Less human intervention in a call center, a hedge fund trading desk, a factory, a checkout line or a motor vehicle seems fine but in cases of greater importance, humans should remain more active or we will, at best, make ourselves irrelevant. In the past, labor displacement has been temporary, but it seems to me that the next wave is likely to be different in terms of the permanence of labor allocation, and big tech getting bigger will likely hasten this.
Innovative capability has been at the center of progress and living standard improvements since we harnessed fire. The worlds technology portfolio is an exciting one, but potentially terrifying to those who could be more hampered by it, such as the front-line workers on Main Street shouldering the health and economic brunt of the coronavirus.
Years ago, Peter Drucker pointed out that technology has transformed from servant to master throughout our history. Regarding the assembly line, he noted that it does not use the strengths of the human being but, instead, subordinated human strengths to the requirements of the machine.
In my opinion, Druckers quote is at the very core of our point in time, happening on a scale and speed that is hard to fathom and changing the digital divide amongst us into a digital canyon between us and technology.
Hi, Poonam. Hi. Nice to meet you. My contractions are about 15 minutes apart. And Im about to get pulled into an O.R. at Cornell to have a C-section. Like any minute now, theyre going to come pull me through that door. And Im gloved-up and masked-up. And my husbands all suited-up. Hes literally in a hazmat suit. Doctor: Dad, do you want to grab those shoes and throw them? Theyre pulling me in. I have to go. Thank you. My name is Poonam Sharma Mathis. My husband is Kris Mathis. We have a 4-year-old, Pierce Mathis. I need some Monday motivation, Pierce. My first birth was pretty uneventful. The baby came out, we made eye contact and then I closed my eyes, and I woke up in the recovery room. Everybody was kissing him and hugging him. And I felt like the community and the village that hes so blessed to be a part of was there. I grew up with a lot of extended family and a lot of love. Wed been wanting a girl in this generation so badly. So when we found out we were having a girl, we were just grateful. I was 37 weeks pregnant when they started to issue stay-at-home orders. OK, so I am officially scared. Im having contractions this morning. I am not a hypochondriac. Im not somebody whos really prone to general mass hysteria. But we are Im breathless. We are dealing with something we dont understand. Kris: Only a couple of days prior to our birth, they had been saying no partners, no spouses. I was probably one of the first spouses that was allowed into the hospital. I was walking, and it was like, do not touch anything. Make sure your mask is on. Put the booties over your shoes. My husband could catch it right now. Right? He could bring it home, and give it to my son whos 4 and a half. And theres a thought about going home with my daughter, and then just immediately quarantining myself and my daughter. Doctor: All right, Mom, are you ready? Do you want to open your eyes for me? No? Her name is Asha: 7 pounds, 11 ounces. They put her skin on my chest. But I had a mask on, so I wasnt breathing on her. Daddy is cuddling with her. Its weird. She opened her eyes right when she was born really wide. And then I havent seen her eyes since. She didnt like what she saw or something. Our expectations were that I probably wasnt going to be there anyway. So just being there for the delivery and seeing the baby, meeting the baby, it was a really exciting thing for me. You realize you have to do a father-daughter dance, and give her away one day? But then immediately after the birth, I had to say goodbye. Say, good night. Sweet dreams. Its 11:30 at night. Im in my room. I just breastfed. [Asha crying] I wore a mask, and I threw up. The only good news is they let her stay in my room because babies are not being kept in the nursery right now. Theyre being kept with the mom. The next step is that we are waiting for news of my coronavirus status. Based on that result, theyll decide how much interaction Ill be having with her, for her own safety. So now we wait. I just want to kiss her. It was really exciting to find out that we tested negative, because that meant I could kiss her head. But its definitely different delivering and recovering in a hospital during coronavirus, and it hit me yesterday. Yesterday was the worst day of physical pain in my life. I genuinely thought I might die. This is one of the most intense surgeries you can have, is a C-section. But if you have any air bubbles that go into your stomach when they cut you open, which is normal, those air bubbles dont come out right away. Then they float around your body, I guess, and they feel like knives stabbing you from the inside until they come out. And they dont want to come out. It is so traumatic being here without somebody to advocate for you when things go wrong, because theres too much going on. They are overwhelmed. Im pushing the call button to get care, and they dont come right away. And last time I gave birth here, four and a half years ago, they did everything right away because they were able to. I was in so much pain for so long, and waiting for my medication for so long, that I was throwing up. I threw up eight times from pain. It feels like I was in a horror movie where they chopped somebody up, but then the person escapes and is running to safety. And thats a ridiculous thing to say. We have the best health care. Were in the best city. But thats how it feels. I just want to get her home as soon as possible. And hopefully then Im able to walk and stand, and do something to help my husband take care of these kids. Thursday at around 1:30, my husband and son came and picked us up. She was so excited to meet you she didnt know what to do. Asha. I havent left the upstairs from Thursday till now. Its Monday morning. Theres so much family thats just waiting, itching to rush in and be with us. And who knows if that will happen before shes 3 months old. One toe is kind of curving. Yeah. Will she wrap her finger around your finger if you put it in there? Poonam: Shes like a little animal, huh? Youre going to be such a good big brother. Poonam: Mm-hmm. Im just grateful that shes healthy. Im grateful that so far, my husband and myself and my son are healthy. I look at her eyes, and I do believe that the eyes show something even from birth. Whenever she does open her eyes, she just looks and shes just laser-focused. And its not a curious focus. Its like like she knows she needs to be calm right now or something. I had a great aunt who always said that if she could come back, shed come back as my daughter. So maybe thats her, I hope. If so, nothings going to keep her down.
While boredom has driven some people to cut their own bangs or maybe dye their hair that one color their mom begged them not to, one man has taken it to an entirely different level.
Chris Woodhead, a 33-year-old from East London, has been tattooing himself every day he's been in quarantine. As of Monday, the artist is on his 49th day of tattooing, and he has no intention of stopping.
"The idea of tattooing myself every day through the isolation came about in a way quite naturally," Woodhead told CNN. "I thought it would be a good way of implementing some structure into my day, now that I can't tattoo from the studio."
Woodhead is not unfamiliar with the process of tattooing his own body. The artist -- who works at a studio in London -- learned the art by giving himself 100 tattoos before ever tattooing another person.
Before his decision to turn his passion into a distraction, Woodhead's body was already covered in nearly 1,000 tattoos. While an additional 100 or so tattoos "won't make a difference," Woodhead said he plans to keep going until he is able to return to his studio, regardless of how long it takes.
After all, he has only so much skin
However, Woodhead has about one month before he runs out of easily available space on his body. When that happens, the artist plans to draw designs that fit in the tiny spaces that may overlap with existing pieces.
So far, Woodhead tattoos his body by contorting himself without even needing a mirror. While some spots were easier to tattoo than others, the back of his legs and elbows were the most difficult.
Coming up with ideas for new tattoos everyday has not been a challenge for Woodhead, who is constantly drawing and trying out new ideas. Some of his isolation tattoos included a virus, butterfly, tiger, clown and a mermaid -- and the ideas just keep flowing.
"It's definitely helped me get through the endless day-to-day. It's really boring being stuck at home, and without that creative process I would be pretty lost," Woodhead said. "Also, I've been able to play with different techniques that I would potentially not be able to try on other people, so I am progressing my skill, which is really nice."
Along with practicing how to tattoo tiny designs, which are more difficult, the artist is also learning more about the healing process. Woodhead said that he does not encourage anyone who is not a professional tattoo artist to try this at home on themselves.
While tattooing himself has helped him stay grounded as the pandemic upends life around him, Woodhead said the process is much more than a mere distraction.
"Tattooing isn't a hobby to me or any other tattoo artist. It's a huge part of me. The human body is an incredible canvas to play around with, and there is endless space."
In the early 1950s, psychiatrists began treating schizophrenia with a new drug called chlorpromazine. Seven decades later, the drug is still used as an anti-psychotic.
But now scientists have discovered that the drug, also known as Thorazine, can do something entirely different. It can stop the new coronavirus that causes Covid-19 from invading cells.
Driven by the pandemics spread, research teams have been screening thousands of drugs to see if they have this unexpected potential to fight the coronavirus. Theyve tested the drugs on dishes of cells, and a few dozen candidates have made the first cut.
Theyre startlingly diverse. Some, like chlorpromazine, have been used for years not for viral infections, but for conditions including cancer, allergies, arthritis, even irregular menstrual periods. Other drugs have not yet been approved by the Food and Drug Administration, but they have already proven safe in clinical trials. Their track records might help them get approved faster than a drug designed from scratch.
As researchers publish findings on these promising drugs, theyre starting tests on animals and people to see how well they perform. No one should try self-medicating with any of the drugs for Covid-19, the researchers warned, since they may have dangerous side effects and have yet to be proven effective in clinical trials.
Im going to be brutally honest with you: 95 to 98 percent of these are going to fail, said Sumit K. Chanda, a virologist at Sanford Burnham Prebys Medical Discovery Institute in La Jolla, Calif. But we only need one or two.
The strategy Dr. Chanda and other researchers are using is known as drug repurposing. It has a history that started decades before Covid-19 appeared. In 1987, for example, the cancer drug zidovudine became the first F.D.A.-approved drug against H.I.V.
The most obvious drugs to repurpose against the new coronavirus are those that work against other viruses. One high-profile antiviral being investigated is remdesivir, which Gilead Sciences previously tested unsuccessfully as an antiviral against Ebola.
But over the years, researchers have found some drugs that originally had nothing to do with viruses turn out to be good antivirals, too. Its just hard to tell in advance which ones have this hidden power.
We dont know a lot about why drugs do what they do, said Matthew Frieman, a virologist at the University of Maryland School of Medicine.
In 2012, another coronavirus disease known as MERS emerged in the Middle East. Dr. Frieman responded by starting a drug-repurposing study. He and his colleagues tested 290 F.D.A.-approved drugs and found that 27 of them blocked the MERS virus from infecting cells. They also proved effective against the related coronavirus that causes SARS.
Dr. Frieman and his colleagues have now tested those drugs against the new coronavirus, and made a preliminary report that 17 of them showed promise. Along with chlorpromazine, they include drugs for disorders as varied as Parkinsons disease and leukemia.
Recently, Dr. Chandas team in California began a mammoth search of their own for drugs to repurpose for Covid-19. They doused infected cells with 13,000 compounds and looked for ones that slowed down the virus. They then narrowed down these candidates by reducing their doses, in order to mimic the levels that would end up in a patients lungs.
On April 17, Dr. Chandas team reported in a preprint, which has not yet been peer-reviewed by a journal, that six drugs showed particular promise, including one for osteoporosis and one thats been investigated as treatment for arthritis.
Yet another team has been trying to find drugs that work against coronavirus and also to learn why they work.
The team, led by Nevan Krogan at the University of California, San Francisco, has focused on how the new coronavirus takes over our cells at the molecular level.
The researchers determined that the virus manipulates our cells by locking onto at least 332 of our own proteins. By manipulating those proteins, the virus gets our cells to make new viruses.
Dr. Krogans team found 69 drugs that target the same proteins in our cells the virus does. They published the list in a preprint last month, suggesting that some might prove effective against Covid-19.
The researchers shipped the compounds to the Icahn School of Medicine at Mount Sinai in New York and at the Pasteur Institute in Paris. Those labs tried them out on infected cells.
Brian Shoichet, a pharmaceutical chemist at U.C.S.F. who helped build the list, was keenly aware of how often drug repurposing fails.
I wasnt that hopeful at all, he said.
It turned out that most of the 69 candidates did fail. But both in Paris and New York, the researchers found that nine drugs drove the virus down.
The things were finding are 10 to a hundred times more potent than remdesivir, Dr. Krogan said. He and his colleagues published their findings Thursday in the journal Nature.
Strikingly, the drugs hit only two targets.
One group temporarily stops the creation of new proteins inside cells. This group includes molecules that are being tested as cancer drugs, such as ternatin-4 and Zotatifin.
Dr. Shoichet speculated that these compounds starve the virus of the proteins it needs to make new copies of itself. This attack may suddenly halt the viral production line.
Viruses are actually delicate beasts, he said.
The other compounds home in on a pair of proteins known as Sigma-1 and Sigma-2 receptors. These receptors are part of the cells communication network, helping the cell withstand stress in its environment.
Why does the new coronavirus need to manipulate Sigma receptors? We dont really know, Dr. Shoichet said.
One possibility is that the virus uses Sigma receptors to make a cell produce more of the oily molecules that form membranes for new viruses.
Among the substances that act on Sigma receptors and block the virus, the researchers found, are the hormone progesterone and the drugs clemastine and cloperastine, both used against allergies.
In addition, Dr. Krogan said that all of Dr. Friemans candidates, including chlorpromazine, target Sigma receptors. A third of Dr. Chandas candidates do too, he said.
The researchers also tested dextromethorphan, a Sigma-receptor-targeting drug in many brands of cough syrup. They were surprised to find that, at least in their cell samples, it actually made infections of this coronavirus worse.
In their paper, the researchers raised the possibility that Covid-19 patients may want to avoid dextromethorphan. Dr. Krogan emphasized that more study would be needed to see if it actually increases coronavirus infection in humans. But if it was me, he said, to be cautious, I would not be taking these cough syrups.
The anti-malaria drugs chloroquine and hydroxychloroquine act on the Sigma receptor. Dr. Krogans team found that they also fought the virus in cells. Those compounds were extolled by President Trump for weeks despite no firm evidence they actually helped cure Covid-19.
Dr. Frieman and Dr. Chanda also found that chloroquine-related drugs worked fairly well in slowing the virus in cell cultures. But Dr. Chanda found they didnt work as well as the six compounds at the top of his list.
Dr. Chanda expressed skepticism about the chloroquine drugs, noting their failure against other viruses.
Weve been down this road multiple times, he said. I would happy to be wrong about this.
Last week, the F.D.A. issued a warning against using hydroxychloroquine or chloroquine for Covid-19 outside the hospital setting or a clinical trial. Thats because the drug has a well-known risk for causing irregular heart rhythms.
In their new study, Dr. Krogan and his colleagues ran an experiment that might explain this risk at the molecular level.
They found that chloroquine and hydroxychloroquine bind not just to Sigma receptors, but to a heart protein called hERG, which helps control heartbeats.
I think its a rational argument, said Dr. Frieman, who was not involved in the Nature study. Chloroquine does a lot of things in the cell.
Dr. Krogan and his colleagues found that other compounds target Sigma proteins in a more promising way.
An experimental anticancer compound called PB28 is 20 times more potent than hydroxychloroquine against the coronavirus, for example. But its far less likely to grab onto the hERG protein.
Dr. Chanda said that PB28 in particular looks really fantastic.
Dr. Krogan said that studies are underway to test the drug in hamsters to see if that promise holds. Dr. Frieman and his colleagues are starting animal studies of their own, as well as testing drugs on a chip lined with human lung cells.
Timothy Sheahan, a virologist at the University of North Carolina who was not involved in the new studies cautioned that it will take more testing to make sure these promising drugs are safe to give to patients ravaged by Covid-19.
Cancer drugs, for example, can be like a sledgehammer to your body, he noted. Are you going to want to do that when someone is really sick?
In addition to animal tests and clinical trials, researchers are now planning to tweak the structure of these drugs to see if they can work even more effectively against the virus.
Physical and occupational therapists carry bags of personal protective equipment on their way to the room of a COVID-19 patient in a Stamford Hospital intensive care unit in Stamford, Conn., on April 24. This "prone team" turns over COVID-19 to help them breathe. John Moore/Getty Images hide caption
Physical and occupational therapists carry bags of personal protective equipment on their way to the room of a COVID-19 patient in a Stamford Hospital intensive care unit in Stamford, Conn., on April 24. This "prone team" turns over COVID-19 to help them breathe.
Intensive care teams inside hospitals are rapidly altering the way they care for patients with COVID-19.
The changes range from new protective gear to new treatment protocols aimed at preventing deadly blood clots.
"Things are moving so fast within this pandemic, it's hard to keep up" says Dr. Angela Hewlett, an infectious diseases physician at University of Nebraska Medical Center in Omaha and medical director of the Nebraska Biocontainment Unit. To stay current, she says, ICUs are updating their practices "on an hourly basis."
"We are learning at light speed about the disease," says Dr. Craig Coopersmith , interim director of the critical care center at Emory University. "Things that previously might have taken us years to learn, we're learning in a week or two. Things that might have taken us a month to learn beforehand, we're learning in a day or two."
The most obvious changes involve measures to protect ICU doctors, nurses and staff from the virus.
"There is a true and real probability of infection," says Dr. Tiffany Osborn a critical care specialist at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis. "You have to think about everything you touch as if it burned."
So ICUs are adapting measures used at special biocontainment units like the one at the University of Nebraska. These units were designed to care for patients affected by bioterrorism or infected with particularly hazardous communicable diseases like SARS and Ebola.
The Nebraska biocontainment unit "received several patients early on in the pandemic who were medically evacuated from the Diamond Princess cruise ship," Hewlett says. But it didn't have enough beds for the large numbers of local patients who began arriving at the University of Nebraska Medical Center.
So the nurses, respiratory therapists and physicians from the biocontainment team have "fanned out and are now working within those COVID units to make sure that all of our principles and protocols are followed there as well," Hewlett says.
Those protocols involve measures like monitoring ICU staff when they remove their protective gear to make sure the virus isn't transmitted, and placing infected patients in negative pressure rooms, which draw air inward, when possible to prevent the virus from escaping.
One of the riskiest ICU procedures is inserting a breathing tube in a COVID-19 patient's airway, which creates a direct path for virus to escape from a patient's lungs. "If you're intubating a patient, that's a much higher risk than, say, going in and doing routine patient care," Hewlett says.
So ICU teams are being advised to add several layers of protection beyond a surgical mask.
Extra personal protective equipment may include an N95 respirator, goggles, a full face shield, a head hood, an impermeable isolation gown and double gloves.
In many ICUs, teams are also placing a clear plastic box or sheet over the patient's head and upper body before inserting the tube. And as a final safety measure, the doctor may guide the tube using a video camera rather than looking directly down a patient's airway.
"It usually takes 30 minutes or so in order to get all of that equipment together, to get all of the right people there," says Dr. Kira Newman, a senior resident physician at UW Medical Center in Seattle. "and that would be a particularly fast intubation."
But most changes in the ICU are in response to an ongoing flood of new information about how COVID-19 affects the body.
There's a growing understanding, for example, that the infection can cause dangerous blood clots to form in many severely ill patients. These clots can kill if they block arteries supplying the lungs or brain. But they also can prevent blood from reaching the kidneys or even a patient's arms and legs.
Clots are a known risk for all ICU patients, Cooperman says, but the frequency and severity appears much greater with COVID-19. "So we're starting them on a higher level of medicine to prevent blood clots and if somebody actually develops blood clots, we have a plan B and a plan C and a plan D," he says.
ICU teams are also recalibrating their approach to ensuring that patients are getting enough oxygen. Early in the pandemic, the idea was to put patients on mechanical ventilator quickly to make sure their oxygen levels didn't fall too far.
But with experience, doctors have found that mechanical ventilators don't seem to work as well for COVID patients as they do for patients with other lung problems. They've also learned that that many COVID-19 patients remain lucid and relatively comfortable even when the oxygen levels in their blood are extremely low.
So many specialists are now recommending alternatives to mechanical ventilation, even for some of the sickest patients. "We're really trying now to not intubate," Osborn says.
Instead, ICU teams are relying on devices that deliver oxygen through the nasal passages, or through a mask that fits tightly over the face. And there's renewed interest in an old technique to help patients breathe. It's called proning.
"Instead of them being on their back, we're turning them on their front," Osborn says. The reason, she says is to open up a part of the lung that is collapsed when a patient is on their back.
Wondering when you can return to your normal activities after having COVID-19? It can be ... [+] complicated. (Photo: Getty)
You are not a Hot Pocket, at least in one way. When you get infected with the COVID-19 coronavirus, you cant just set a timer to then determine when exactly you will be ready. In this case, ready means fully recovered and ready to return to your normal activities, whatever normal activities happen to be these days with the pandemic.
As I have written previously for Forbes, COVID-19 can be a freaking confusing illness. Its still quite an enigma, wrapped with uncertainty, surrounded by some really bad bacon thats spoiled. There just havent been enough scientific studies to tell for sure how long you specifically may have symptoms and how long you specifically may be contagious when youve got a severe acute respiratory syndrome coronavirus-2 (SARSCoV-2) infection. While some possible ranges have been identified, these durations do seem to vary quite a lot from person to person.
World Health Organization (WHO) Director-General Tedros Adhanom Ghebreyesus had mentioned that recovery times tend to be about two weeks for those with mild disease and about three to six weeks for those with severe or critical disease. However, these seem to be only rough guidelines as studies have already shown a number of exceptions. For example, the symptoms of mild illness could easily extend into a third week, perhaps even longer.
Another issue is how much COVID-19 symptoms can fluctuate from day to day. Since your immune system has never seen this virus before, it can be like a guy on Tinder for the first time, just launching random things and seeing if anything will stick. You can feel better one day, only to feel worse the next, and vice-versa. Basically, your symptoms can hop around in type and severity, sort of like a really indecisive kangaroo that happens to be on Tinder for the first time.
This disease is a lot less predictable than the seasonal flu, which is more akin to momentarily hooking up with an ex whom you know is not right for you. You can do something to reduce the potential impact of flu (i.e., get vaccinated) and you know what to expect. By contrast, the trajectory for COVID-19 can be a lot less clear. Add this fact to the growing list of why COVID-19 is bleeping not the flu.
So if youve got relatively mild COVID-19, you may want to give yourself at least a two-to-three week window for recovery. At the same time, continue to closely monitor your symptoms and be ready to quickly seek medical attention if they do get much worse. Of course, having more severe disease extends your expected recovery time, perhaps into or beyond the three to six week range, perhaps even longer. Damage to your lungs or other organs could stretch out recovery much, much further, months further.
The timelines for recovery for those hospitalized for COVID-19 can be a lot longer. US Postal Worker ... [+] Robert Johnson, 40, is greeted by his relatives, wife Nicole, son Joseph and health care workers as he is released from Spaulding Hospital after spending more then 30 days in the ICU, many on a ventilator, after recovering from the COVID-19 virus in Cambridge, Massachusetts on May 4, 2020. (Photo by Joseph Prezioso / AFP) (Photo by JOSEPH PREZIOSO/AFP via Getty Images)
So how can you tell if youve recovered enough to return to your normal activities? Its not as if a microwave bell goes ding and someone sings, Hot Pocket, when you are ready. Instead, the timing of your return depends on how your illness progresses and what those normal activities happen to be. If normal means going back to Zoom meetings with just the top half of you dressed then the bar may not be super high. If it means doing something more strenuous or potentially interacting more directly with people as an essential worker, the bar should be higher.
The Centers for Disease Control and Prevention (CDC) offers guidelines on when health care professionals can return to work. They offer two possibilities for someone who has COVID-19 with symptoms: a test-based strategy and a symptom-based strategy.
The test-based strategy requires, guess what, access to testing. Otherwise it would have been called something else. In this strategy, you need to get to a point where you no longer have a fever without taking fever-reducing medications and have had improvement in your respiratory symptoms such as cough or shortness of breath. But thats not all. You also have to have negative results on a test that identifies the presence of SARS-CoV2 RNA test. This is the test where they stick a cotton swab way up your nose and another one to the back of your throat. Note that other more comfortable ways of testing are currently being developed and evaluated because no one really says, gee, what Id really like is a cotton swab to be stuck so far up my nose that it feels like my brain is being touched. As always, make sure that the test that you are getting is legit, one that has received authorization from the U.S. Food and Drug Administration (FDA). After all, surprise, surprise, there are people out there trying to scam you with bogus tests.
For this strategy, having one negative test is not enough to return to work. Thats because these tests can give you false negatives. Youve got to have at least two negative tests over a period of greater than 24 hours. This may sound straightforward, except for the swab up the nose deal. But for many, finding a way to get this test can be more difficult than finding flour in the supermarket these days. Plus, there can be delays in receiving test results. Being told two weeks later that you had a negative test may not really help your current decision of whether to return to work unless youve somehow mastered time travel.
If you dont have ready access to timely testing, the only other option offered by the CDC is the symptom-based strategy. Here you have to fulfill two criteria. One is that at least 10 days have passed since your symptoms first appeared. Ten days happens to be a little longer than the 9.5 days that was the median time from patients first having symptoms to finally testing negative for the virus RNA in a study published in theChinese Medical Journal.The other criterion is that at least 3 days (72 hours) have passed since recovery, defined as resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath). Thus, dont rush back to work the very first day that you dont have any symptoms. That can be like going directly from sitting on the toilet to a full sprint without even pulling up your pants. Plus, as the saying goes, one can be an accident, two can be a coincidence, and three times is a pattern. Waiting can help make sure that youve finally, actually, really recovered.
Although the above recommendations are for health care professionals, they could potentially apply to you even if you arent in health care. The CDCs guidelines for Discontinuation of Isolation for Persons with COVID -19 Not in Healthcare Settings has similar specifications and timelines. Keep in mind, though, that these are minimal criteria, as evidenced by the fact that the words at least appear in each criterion. At least means at least and not that should be plenty. When your significant other says at least remember when my birthday is, simply writing an email that says Happy Birthday! See I remembered along with a thumbs up emoji is probably not enough. The response could be a not so nice emoji that involves another finger being raised. Similarly, if you can give yourself even more time to rest before returning to work, try to do so. Four days after your symptoms are completely gone is better than just three days. Five days is better four days. You can probably figure out what six days is.
Don't try to push yourself too hard such as resuming full exercise, the first few days back after ... [+] COVID-19. (Photo: Getty)
Also, ease yourself back into your daily routine. The first day back is probably not the time to resume power lifting. Instead, gradually test what you can handle and give yourself some slack. There have been reports of people not feeling quite right or having trouble thinking or sleeping for extended periods of time after the infection. In an article for NBC News, Erika Edwards described how some recovering patients were feeling a range of hard-to-pin-down symptoms, including a "weird forgetfulness," fear, and nervousness. Weird forgetfulness is not a great thing to have when you are on a Zoom business call and not wearing any pants.
In fact, consider consulting others like family, friends, or health care professionals when deciding whether and when to return to work and other daily routines. Note that this list didnt include random strangers on Facebook. The problem with not thinking straight is that you may not even realize that you are not thinking straight. So rely on trusted people to help steer you right.
Of course, not everyone has the luxury to take time to return to normal activities. Little kids dont tend to tell parents, I got this. You just rest there while I make everyone dinner, take out the trash, and finish caulking the ceiling. Also, your employer may have the sympathy and empathy of a toilet brush and push you to return to full working capacity immediately. Not everyone may really truly understand how new and how different this nasty COVID-19 coronavirus is. Once again, it is very different from the flu or anything that your immune system is used to seeing.
While you may know exactly what to expect when microwaving and eating a Hot Pocket, you dont quite know what you are getting with the COVID-19 coronavirus. You may want to keep reminding yourself and others that you are not a Hot Pocket. You are not a Hot Pocket.
ST. LOUIS More than half ofGratiot County's knownCOVID-19 cases have been tied to a single home for the elderly, where 12 residents and three staff members have tested positive for the disease, according to a Tuesday news release from the local health department.
A resident ofRiverside Healthcare Center, a woman in her 70s, died from the disease on May 2,Leslie Kinnee, a health department spokeswoman said Tuesday.
The facility, located in St. Louis, Michigan north of Ithaca, offers nursing home, assisted living and independent living accommodations, according to its website. Its first positive COVID-19 case was reported April 25, Kinnee said.
Greater Lansing schools continue classes remotely. But what will school look like next fall?
In all, 26Gratiot County residents have tested positive for the novel coronavirus and two have died, health officials reported.
Riverside Healthcare Center of St. Louishas canceled group activities and closed communal spaces. Residents who test positive for COVID-19must self-isolate in their rooms, according to the news release.
Employees who test positive are not allowed to return to work until all symptoms have improved and they've been released from monitoring by the Mid-Michigan District Health Department.Staff have access to "enhanced" personal protective equipment, including N95 masks and gowns, officials said.
The need for groceries is great, yet Lansing residents aren't going to food pantries as much as they used to
Riverside Healthcare Center took extensive measures to protect its residents and staff from COVID-19, but the virus still managed to infiltrate the building, Sarah Doak, community health and education division director for the MMDHD, said in statement.COVID-19 is very contagious and can spread easily among a vulnerable population, such as those residing in long-term care centers.
All staff and residents of the facility have been tested for COVID-19, temperatures are taken twice a day andnon-essential visitors are banned, according to the news release.
Angel: Journalists are on front lines of coronavirus pandemic, subscribe to show support
"Mid-Michigan District Health Department is in communication with our team on a daily basis and making every effort to rid Riverside of COVID-19," Al Raza, the facility's administrator, said in a statement. "The Riverside Healthcare Center team is deeply saddened by the loss of our resident and we will miss her dearly."
Across Michigan, at least43,950 people have tested positive for the disease and4,135 have died, according to data submitted Monday morning to the state health department.
Contact reporter Sarah Lehr at slehr@lsj.com. Follow her on Twitter @SarahGLehr.
Read or Share this story: https://www.lansingstatejournal.com/story/news/2020/05/05/more-than-half-gratiot-countys-covid-19-cases-one-nursing-home/3085793001/
With false information linking the coronavirus to 5G telecoms or Chinese labs being widely shared on social media, Ian Sample speaks to social psychologist Dr Daniel Jolley about why the pandemic is such fertile ground for conspiracy theories
How to listen to podcasts: everything you need to know
