WHO says it has no evidence to support ‘speculative’ Covid-19 lab theory – The Guardian

Jacksonville: Single mother beats COVID-19 with home health care treatment  ActionNewsJax.com

When the Krewe of Zulu parade rolled out onto Jackson Avenue to kick off Mardi Gras festivities on Feb. 25, the party started for black New Orleans. Tens of thousands of people lined the four-and-a-half-mile route, reveling in the animated succession of jazz musicians, high-stepping marching bands from historically black colleges and universities and loose-limbed dancers dressed in Zulu costumes, complete with grass skirts and blackface makeup, an homage to the Zulu people of South Africa and, for some, a satirical spit in the eye to the past, when Mardi Gras was put on by clubs of white men who barred black people from taking part.

Though some black critics have chided the Zulus for continuing to black up, their costumes and traditions are a way of reclaiming and redeploying the most toxic stereotypes of black Americans. Founded in 1909, the Zulu Social Aid and Pleasure Club is a brotherhood of some 800 men, nearly all of them black, known for community service, civic pride, black excellence and that Mardi Gras parade. And so on that late February day, as people stood shoulder to shoulder and several feet deep, hoping to catch a painted coconut, the throw that is the Zulu parades signature and coveted prize, no one had any idea that this joyous gathering would turn out to be a coronavirus hothouse.

For the Zulu club, the Carnival season involves a series of meticulously planned and eagerly awaited ceremonies, balls and festivals, almost every day in January and February. The Zulu Ball, one of the groups three grand-scale, marquee events, fell on Friday, Feb. 21, this year. Some 20,000 people, floor-length ball gowns and tuxedos required, packed into the New Orleans Ernest N. Morial Convention Center one of the few venues large enough to hold the crowd that came to eat and drink and dance and witness the crowning of the Zulu King and Queen of Mardi Gras. At the parade, the king, elected by club members, wears a golden crown and an elaborate festoon of feathers. He rides on a float, waving a glittery scepter at the crowd, flanked by two hand-painted leopards rearing up on their hind legs.

As Mardi Gras festivities began, bringing over a million visitors from around the world streaming into the warm, welcoming city to celebrate face to face and elbow to elbow with local residents in a progression of street parties and parades, dozens of coronavirus cases had already been documented in China, which reported its first death on Jan. 11. On Jan. 20, the first known case was confirmed in the United States: a Washington State resident who had recently returned from Wuhan, China. Behind the scenes, Louisiana health administrators had begun discussing the growing situation, seeing it as low-risk, according to emails obtained by Columbia Universitys Brown Institute for Media Innovation.

On Feb. 5, four days after Surgeon General Jerome Adams tweeted, Roses are red/Violets are blue/Risk is low for #coronavirus/But high for the flu, New Orleans officials held a multiagency coronavirus planning meeting. The same day, a statement posted on the citys website read: Our publichealth and health caresystems are ready for Mardi Gras,and the coronavirus poses a verylow risk to the Carnival celebrations. At the time, just 12 cases had been reported in the United States and none in Louisiana.

On Sunday, Feb. 23, two days after the Zulu Ball, President Trump set the tone for the country, the state of Louisiana and the city of New Orleans when he said at a news conference: We have it very much under control in the country. On Monday, Feb. 24, when an estimated 200,000 people spent the day at Lundi Gras, sponsored by the Zulu club, enjoying a smorgasbord of New Orleans food and music on three stages at Woldenberg Park along the Mississippi River, he reiterated on Twitter that the disease was under control. According to an internal memo, however, Trump had already been warned by his own trade adviser about the potential of half a million deaths and an economic hemorrhage of trillions of dollars as a result of the pandemic. According to reports, his health and human services director had alerted him twice about the possibility of a pandemic; the president accused him of being alarmist.

The day after Lundi Gras, the Zulu club member Cornell Charles everybody called him Dickey, a childhood nickname rose early and put on a honey yellow jacket, part of the groups signature uniform. As part of the Zulu Krewe parade organizing committee, he spent the next 10 hours fussing over the logistics of the exuberant, chaotic parade. Larry A. Hammond, 70, a former Zulu king and a club member, waved to the crowd from one of the many floats. On that same day, officials from the C.D.C. issued a far bleaker warning than any before about the spread of the virus in the United States, recommending social-distancing measures. Yet the president himself was still playing down the risk; that same day, while traveling in India, Trump said, We have very few people with it. The people who did have it, he said, are getting better, theyre all getting better. The following day, he reassured the country that the number of confirmed cases within a couple of days is going to be down close to zero.

Mayor LaToya Cantrell of New Orleans stood on St. Charles Avenue during the Feb. 25 parade next to Jay H. Banks, chairman of the Zulu clubs board, raising a glass and joyfully shouting, Hail Zulu! as the king passed by on his float. She would later defend not canceling the festivities. When its not taken seriously at the federal level, its very difficult to transcend down to the local level in making these decisions, Cantrell told CNN on March 26.

On March 9, the same day Louisiana reported its first presumptive case of Covid-19, Trump compared the virus to the flu on Twitter, and also tweeted: The Fake News Media and their partner, the Democrat Party, is doing everything within its semi-considerable power (it used to be greater!) to inflame the CoronaVirus situation, far beyond what the facts would warrant.

Banks, a city councilman who first became involved with the Zulu club as a boy, remembers the rush of panic he felt on March 16, when he saw a Facebook post about the first of his Zulu brothers to get sick, Dickey Charles, who was just 51. Written by the chaplain of the Zulu club, Jefferson Reese Sr., it read, Zulu Brother Cornell Dickey Charles is very ill and in need of prayer. Amen followed by three brown praying-hands emojis. When I saw the post, I thought, Oh, man, Banks says. I knew we were going to have a problem. Eight weeks after Mardi Gras, at least 30 members of the club had been found to have Covid-19. Eight would be dead.

Banks, who believes he knows at least 16 people who have died of the disease, says if he and the Zulu leadership had had the slightest clue that the pandemic was a direct danger, they would have canceled their events. The president was saying that this was not a big deal, and nobody in the federal government raised a red flag, Banks says. Gov. John Bel Edwards of Louisiana could have canceled the parade. But like Mayor Cantrell, he said he had little useful guidance from Washington. There was not one person at the state or its federal government, not at the C.D.C. or otherwise, who recommended canceling any event, not just Mardi Gras, but I dont think anywhere across the country, he told Face the Nation on March 29.

Zulu is 800 men, predominantly black, Banks says. Like all black communities, we have a large contingent of people who have pre-existing conditions. Our members come from all walks of life, and many of them dont have jobs with sick days and dont have the luxury of working at home. When you add these factors to a disease that capitalizes on these kind of circumstances, you get a perfect storm.

On April 6, Louisiana became one of the first states to release Covid-19 data by race: While making up 33 percent of the population, African-Americans accounted for 70 percent of the dead at that point. Around the same time, other cities and states began to release racial data in the absence of even a whisper from the federal government where health data of all kinds is routinely categorized by race. Areas with large populations of black people were revealed to have disproportionate, devastating death rates. In Michigan, black people make up 14 percent of the population but 40 percent of the deaths. (All data was current as of press time.) In Wisconsin, black people are 7 percent of the population but 33 percent of the deaths. In Mississippi, black people are 38 percent of the population but 61 percent of the deaths. In Milwaukee, black people are 39 percent of the population but 71 percent of the deaths. In Chicago, black people are 30 percent of the population but 56 percent of the deaths. In New York, which has the countrys highest numbers of confirmed cases and deaths, black people are twice as likely to die as white people. In Orleans Parish, black people make up 60 percent of the population but 70 percent of the dead. Data from the Louisiana Department of Health shows that neighborhoods in the parish with large numbers of black residents have been hit hardest.

The coronavirus pandemic has stripped bare the racial divide in the health of our nation. A complex and longstanding constellation of factors explains these higher death rates. On April 8, a C.D.C. study suggested that about 90 percent of the most serious Covid-19 cases involve underlying health conditions hypertension and cardiovascular disease, obesity, diabetes, chronic lung disease that are more common and more deadly in black Americans and strike at younger ages. According to the C.D.C., the rate of diabetes is 66 percent higher in black Americans than in white Americans; the rate of hypertension is 49 percent higher. The average black life expectancy, from birth, is about 3.5 years lower than white life expectancy. In fact, the health outcomes of black Americans are by several measures on par with those of people in poorer countries with much less sophisticated medical systems and technology. And though these health disparities are certainly worsened by poverty, they are not erased by increased income and education. The elevated rates of these serious illnesses have weaponized the coronavirus to catastrophic effect in black America.

Earl Benjamin-Robinson is deputy director of the Louisiana Department of Healths Office of Community Partnerships and Health Equity, created in 2019 to identify and target health disparities in vulnerable populations. When we first started hearing about Covid in China, he says, and learned that those who got severely ill and who subsequently died dealt with underlying conditions like hypertension, diabetes, lung disease and so on, I became concerned and kept in the forefront knowing that African-Americans in the U.S. and in our state are overrepresented when it comes to those conditions. Benjamin-Robinson, who lives in New Orleans, says he also had begun hearing rumors in the local community and on social media that black people were immune to the coronavirus, supposedly because melanin protected against it. These false theories became so rampant that on March 17, the day after the actor Idris Elba announced that he had tested positive for the disease, he posted a Twitter live video to denounce the rumors. There are so many stupid, ridiculous conspiracy theories about black people not being able to get it, he said. Thats dumb, stupid.

As public-health officials, we knew about the clear, distinct racial health disparities, as it relates to chronic illnesses in our state, in the early months, Benjamin-Robinson says. But in the absence of racial data and with no real sense of urgency coming from the federal government, we werent able to put a plan in action to create targeted messaging and get information directly to African-Americans. After the release of racial data for Louisiana in early April, Benjamin-Robinsons office helped develop public-health promotional materials about Covid-19 specifically for black Louisianans, which were distributed via email and social media.

On March 27, Senators Kamala Harris of California, Elizabeth Warren of Massachusetts and Cory Booker of New Jersey, and Representatives Ayanna Pressley of Massachusetts and Robin Kelly of Illinois, all Democrats, sent a letter to Alex Azar, secretary of the Department of Health and Human Services, urging the agency to reveal racial data on testing and treatment for the virus. Although Covid-19 does not discriminate along racial or ethnic lines, existing racial disparities and inequities in health outcomes and health care access may mean that the nations response to preventing and mitigating its harms will not be felt equally in every community, the lawmakers wrote. Lack of information will exacerbate existing health disparities and result in the loss of lives in vulnerable communities.

On April 3, the American Medical Association, the professional organization that represents some 250,000 physicians, residents and medical students, also implored the Department of Health and Human Services to release coronavirus data by race. It is well documented that social and health inequities are longstanding and systemic disturbances to the wellness of marginalized, minoritized and medically underserved communities, read its letter, co-signed by organizations including the American Academy of Pediatrics, the American Academy of Family Physicians and the National Medical Association. While Covid-19 has not created the circumstances that have brought about health inequities, it has and will continue to severely exacerbate existing and alarming social inequities along racial and ethnic lines.

Amid this pressure from lawmakers, physicians, scientists and advocacy groups to release national Covid-19 statistics by race, on Wednesday, April 8, the C.D.C. put out a limited data set of 1,482 coronavirus patients hospitalized in 14 states. It indicated that despite making up 18 percent of those studied, black people accounted for a third of all severe cases.

At the daily White House press briefing the day before, President Trump, apparently aware of the C.D.C. numbers that were about to be released, asked Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who has served under six American presidents and is the most visible member of the White House coronavirus-response team, to address Covid-19 among black Americans. Dr. Fauci highlighted the underlying health conditions that are more common among black Americans and that raise the risk of death from Covid-19. Were very concerned about that, he said. Its very sad. Theres nothing we can do about it right now, except to try and give them the best possible care to avoid those complications.

Trump then referred to the racial statistics as very nasty numbers. Terrible numbers. As the news conference went on, the president expressed confusion about the disproportionate rates of infection. Why is it that the African-American community is so much, you know, numerous times more than everybody else? he asked.

Fifty years after the legislative and societal advances of the civil rights movement, America remains deeply segregated. Black people are more likely than white people to live in communities with high rates of poverty, where physical and social structures are crumbling, where opportunity is low and unemployment high. Even educated, affluent black people live in poorer neighborhoods, on average, than white people with working-class incomes.

The conditions in the social and physical environment where people live, work, attend school, play and pray have an outsize influence on health outcomes. Those in the public-health field call these conditions social determinants of health. Living in safe communities with adequate education and health care services, outdoor space, clean air and water, public transportation and affordable healthful food all contribute to lower rates of disease and longer, healthier lives. Living where the streets are unsafe and the air and water are polluted, where adequate health care facilities and outdoor space are lacking and where a dearth of healthful and affordable food creates a desert all leads to poorer health outcomes.

As scientists and policymakers have known since the 1980s, black and poor communities shoulder a disproportionate burden of the nations pollution. Covid-19 typically attacks the lungs and is especially dangerous to those with existing respiratory conditions, and a paper released on April 5 by researchers at the Harvard T.H. Chan School of Public Health found that a majority of the conditions that increase the risk of death from Covid-19 are also affected by long-term exposure to air pollution. After analyzing over 3,000 U.S. counties, the researchers concluded that even a small increase in exposure to fine particulate matter tiny particles in the air leads to a significant increase in the Covid-19 death rate. Less than two weeks after the report was released, the Trump administration declined to impose stricter controls on the lung-corroding industrial matter that the Harvard researchers underlined as hazardous.

New Orleans is at the southeastern end of what has been called Cancer Alley, the 85-mile stretch of the Mississippi known for its concentration of polluting petrochemical manufacturers. As soon as I heard about Covid, I started getting nervous about the relationship between PM 2.5 and this virus, says Beverly Wright, the founder and executive director of the Deep South Center for Environmental Justice in New Orleans. PM 2.5 refers to the width of the airborne particles: 2.5 micrometers or less, a small fraction of the width of a human hair. We have long known that emissions coming from these facilities are very dangerous to the health of people who live nearby, and it is black people who live the closest. So Im getting tired of being told our Covid death rates are only because were obese or have diabetes or are eating badly, without any regard to the systematic harm pollution has caused us.

The accumulated effects of environmental inequality are compounded by the physiological ramifications of an atmosphere of bias and discrimination, which have been documented to lead to higher rates of poor health outcomes for black Americans. Dr. Arline Geronimus, a professor at the University of Michigan School of Public Health, termed this phenomenon weathering. The landmark research she and her colleagues published in 2006 pointed to early health deterioration, caused by stress that required high-effort coping, evident across multiple biological systems even when adjusted for poverty. The authors concluded that the lived experience of being black exacted a physical price on the bodies of African-Americans. Dr. Camara Phyllis Jones, a physician and epidemiologist and a former president of the American Public Health Association, describes this effect as accelerated aging. We have evidence that the wear and tear of racism, the stress of it, is responsible for the differences in health outcomes in the black population compared to the white population, Dr. Jones says. In a 2019 study comparing 71 individuals, 48 of them black, a team of U.C.L.A. scientists found evidence that racist experiences may lead to increased inflammation in black Americans, heightening the risk of serious illness including heart disease. In the study, published in the journal Psychoneuroendocrinology, the scientists compared participants with similar socioeconomic backgrounds to rule out poverty as a determining factor in the changes in inflammation.

The societal discrimination that harms the bodies of those on the receiving end is also present in the health care system itself. In 2003, the National Academy of Sciences documented the effects of bias in the medical system in a report that laid out the facts in damning detail. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care examined 480 previous studies and found that in every medical intervention, black people and other people of color received poorer-quality care than white people, even when income and insurance were equal. This unequal treatment in the health care system persists today in numerous studies showing that black patients receive inadequate pain management for a variety of illnesses, surgeries and other medical procedures, both in the emergency room and in other settings, compared with people of other races. New York Citys health department is among a number of health departments and medical facilities around the country that have acknowledged the problem by mandating anti-racism training for their employees. During the current pandemic, health care providers are putting themselves in the line of fire to save lives, but they are working within a flawed system. Research on implicit bias shows its more likely to operate when people are working under time pressure, explains Dr. David Williams, chairman of the department of social and behavioral sciences at Harvards T.H. Chan School. Dr. Williams suggests that this kind of pressure could be worsened by long shifts, fatigue, the need to make quick judgments and even a shortage of protective gear and ventilators. All of those are factors that are more likely to make health care providers go into autopilot, he says. And when they do, they are more likely to rely on the shorthand social categorization to navigate their decisions. So I worry about what it means in terms of the life-or-death decisions in the context of coronavirus.

Dr. Clyde W. Yancy, chief of cardiology in the department of medicine at Northwesterns Feinberg School of Medicine, has studied racial health inequities for most of his career. As a black man and a native of the Baton Rouge area who grew up during segregation, he also understands them on a personal level. These disparities are real, they are deep and they are exacting a terrible price, says Dr. Yancy, who wrote an article pulling together research about the connection between black Americans and Covid-19, published online in The Journal of the American Medical Association on April 15. If there ever was a moment to have a rallying cry, to have a call to action, to have a wake-up call, there should be a moment of epiphany right now. And that epiphany should be: This is not the way a civil society allows its population to exist.

About 10 days after the end of Mardi Gras, Dickey Charles told his wife, Nicole, that he wasnt feeling well. Charles, a courier for GE Healthcare, rose most days around 2 a.m. to work an early route driving a van to deliver medical supplies to hospitals and clinics. His second shift, as a supervisor at the New Orleans Recreation Development Commission and the baseball, football and girls basketball coach at Lusher Charter School, left him little time for rest. Adding the annual whirlwind of Zulu Carnival activities was taxing for Charles, though he rarely let on. He was an easygoing, humble mountain of a man and father of two grown daughters. At six feet and 260 pounds, he carried his weight well. But he also had a number of health conditions: hypertension, diabetes and kidney disease. His wife, who worked as a medical administrator, kept a watchful eye on him but also says he tried to take good care of himself. He had been fighting those things for 20 years, says Nicole Charles, who added that her husband took three different blood-pressure medications, two kinds of insulin and another medication for his kidneys. He was very good with taking his medications. I didnt have to fight him, never had to fuss.

Burnell Scales Sr., Nicoles father, who goes by Slim, knew something was wrong on Sunday, March 8, when he showed up at the Charleses home in Uptown Carrollton, expecting to see his son-in-law stirring a giant pot of gumbo or red beans or heaping shrimp, crawfish and crabs onto plates for the procession of friends, family and Zulu members who came by every week after church for an open-door hangout and to watch Saints games during football season. I came in thinking hed be handing me a plate of something he was cooking up, but he wasnt in the kitchen like usual, says Scales, who joined the Zulus decades ago and introduced his son-in-law to the group in 2004. He was in bed. Thats when I started to worry a little.

On March 12, it was clear to Nicole that Charles still didnt feel well. His fever had been up and down, spiking close to 102. She stayed close to him, administering fluids and Tylenol, assuming he had the flu. That day, after it proved difficult to get a fast appointment with his primary-care doctor, she insisted that he go to urgent care, where he was tested for the flu. When the test was negative, he was sent home with no mention of Covid-19.

Nicoles anxiety rose the following day when he completely lost his appetite. My husband is a big man, and food was definitely something he loved, she says. She also worried that he needed to eat something because he couldnt take medications to control his blood pressure, diabetes and kidney problems on an empty stomach. Even if he was sick, he would still eat, but I couldnt even get him to eat soup.

That Friday, Nicole says, she told him, Baby, were going to the hospital. Of course, that was an argument, she says, because hes a man. They agreed to go the next day. I said to him, Youre going, because you dont have a choice.

The next day, Saturday, March 14, her husband told her he felt weaker, and Nicole took him to the emergency room. Security was high at the hospital as the growing coronavirus cases had begun to grip the city: That day, the Louisiana Department of Health reported 77 cases of the virus, 53 of them in Orleans Parish, and the first death. It was like Fort Knox, Nicole recalls. They directed me to one area so I could register him and took him off to another where I couldnt go. And of course you had to put on a mask; they gave everybody one.

In the E.R., Charles was again tested for the flu, and again the test was negative. But Nicole says no one suggested a Covid-19 test at that time. By that evening, Charles was lying in a hospital bed, attached to IV fluids. It just all happened so fast, says Nicole, her voice catching. It was like zero to 100.

In the late 19th century, W.E.B. Du Bois, the eminent black sociologist and author, conducted research to better understand the diseases that contributed to high rates of mortality in black communities. Du Bois and his team did extensive shoe-leather fieldwork that he would turn into his 1899 opus, The Philadelphia Negro, canvassing neighborhoods and interviewing residents in 2,500 households. He also used census data to document the distribution of health status. Unlike most experts at the time, who blamed racial inferiority and genetic flaws for health inequities, Du Bois highlighted the social conditions they studiously ignored. In a later work, The Health and Physique of the Negro American, Du Bois wrote: With the improved sanitary condition, improved education and better economic opportunities, the mortality of the race may and probably will steadily decrease until it becomes normal. Du Bois was unsparing on the lack of empathy for the health and well-being of black Americans, who were still reeling and recovering from 250 years of enslavement and struggling through the reactionary years of Jim Crow. The most difficult social problem in the matter of Negro health is the peculiar attitude of the nation toward the well-being of the race, Du Bois wrote in The Philadelphia Negro. There were, he continued, few other cases in the history of civilized peoples where human suffering has been viewed with such peculiar indifference.

This peculiar indifference was infamously sanctioned by the federal government between 1932 and 1972, when the United States Public Health Service conducted a study on hundreds of black day laborers and sharecroppers in Alabama. The Tuskegee Study of Untreated Syphilis in the Negro Male examined the progression of untreated syphilis, under the assumption that the infection manifested differently in black people. The subjects were told they would receive treatment for what was described as bad blood, but they never did. Instead, they were poked and prodded while the illness was allowed to progress. Once the men died, doctors autopsied their bodies to compile data on the ravages of the disease. The effects of the Tuskegee syphilis study still reverberate in the form of distrust and sometimes avoidance of the health care system among black Americans. In our current moment, this medical distrust has shown up in the form of those conspiracy theories and low-information rumors about Covid-19 akin to the false theories and rumors that were also prevalent during the AIDS era that Dr. Benjamin-Robinson of the Louisiana Department of Health warned against and Idris Elba tried to dispel.

In 1985, nearly a century after Du Bois made his observations about racial health disparities, the U.S. Department of Health and Human Services released the Report of the Secretarys Task Force on Black and Minority Health, better known as the Heckler Report. This 239-page study marked the first time the federal government had comprehensively examined the health status of black people and other people of color and elevated the issue of health inequality into the national arena. Named for Secretary Margaret Heckler of H.H.S., the report estimated more than 18,000 excess deaths each year among black people because of heart disease and stroke, compared with the number of deaths that would occur if their health were on par with that of non-Hispanic white people. It also cited 8,100 excess deaths from cancer, 6,200 from infant mortality and 1,850 from diabetes. Heckler called this shameful inequality an affront both to our ideals and to the ongoing genius of American medicine.

But the Heckler Report recommended no new government funding to address the crisis. Instead, the report essentially advised black Americans to save themselves by improving their health through education, self-help and self-care. Dr. Edith Irby Jones, president of the National Medical Association, a black medical society, was one of many critics of the reports emphasis on merely health education and lifestyle changes. If black people would only behave, their health problems would be solved, she wrote in 1986 in the associations journal. The insidious conclusion was that black people, individually and collectively, were poor, irresponsible, careless, uneducated and making thoughtless choices that led to the health crisis in the first place. There was and remains little focus on the societal conditions that erode the health of black Americans, and little mention of discrimination and bias either inside or outside the health care system.

Surgeon General Jerome Adams echoed this trope when he recently implied that individual behavior was leading to higher deaths from Covid-19 among African-Americans. At a White House press briefing on Friday, April 10, he told communities of color to step up and help stop the spread so that we can protect those who are most vulnerable. Adams, who is black and has spoken openly of his own struggles with high blood pressure, asthma and pre-diabetes, nonetheless added that African-Americans and Latinos should avoid alcohol, tobacco and drugs. He went on: We need you to do this, if not for yourself, then for your abuela. Do it for your granddaddy. Do it for your big mama. Do it for your pop-pop.

Dr. Williams of Harvard cautions against such suggestions. Its important to recognize and to acknowledge that the higher death rates of African-Americans from the coronavirus are not linked to the individual decisions black people have made or their communities have made, he says. We are looking at societal policies, driven by institutional racism, that are producing the results that they were intended to produce.

Many of the same experts who had pushed to release coronavirus data by race also worried that racial disparities in infections, hospitalizations and deaths would be used against black people. And like clockwork, after cities with sizable populations of black people began to report large numbers of Covid-19 infections at the beginning of April and statistics showed disproportionate death rates for African-Americans, a counternarrative began to arise: The national, state and municipal shutdowns were too draconian; the coronavirus pandemic was not as much of a threat at least, not to all Americans as had been argued. A smattering of demonstrations broke out the week of April 13, as protesters gathered in a handful of states to push back against stay-at-home orders.

President Trump fanned the extremist flames on April 17 in a series of tweets that encouraged his supporters to flout state policies put in place to keep residents safe during the pandemic. LIBERATE MINNESOTA! Trump wrote. LIBERATE MICHIGAN! LIBERATE VIRGINIA, and save your great 2nd Amendment. It is under siege! The next day in Austin, Tex., at a You Cant Close America rally, hundreds of demonstrators, nearly all white, defied social-distancing guidelines by gathering on the steps of the Capitol. The protesters many without masks but outfitted with Trump hats and flags shouted Let us work and Fire Fauci. A woman wearing a Keep America Great cap waved a sign reading, My Life, My Death, My Choice, Personal Responsibility, and another protester held a hand-drawn poster that read, My Life! Not Yours!

Dr. Jones notes that even before the coronavirus struck, the country had veered toward an ominous distrust of legitimate science that spread down from the White House and into the streets. But the pandemic has intensified the peril of such thinking. These protesters dont understand that nobody is immune to this infectious disease that doesnt respect state borders, city borders, neighborhood borders, she says. We are not the land of the free and the home of the brave individually, but their individual actions have profound impacts on the collective. Were in a dangerous situation by letting ideology take priority over the health interest and well-being of the nation.

On Sunday, March 15, the day after he was admitted to the hospital, Dickey Charless oxygen levels had become unstable, with his fever spiking and breaking. Late that evening, a chest X-ray showed potential signs of pneumonia. Nicole, who had been sleeping on a pullout chair next to her husband in his room, said one of the doctors told her it was time for an honest conversation. They said, Your husband is much sicker than he looks,. she remembers. .His lungs will not be functioning much longer. We need to vent him. That day, her husband was finally tested for Covid-19.

Nicole was able to stay with Charles for the next three days, locked to his side. Attached to the ventilator, unable to speak, he looked surprisingly peaceful to her, even vital. She kept up a vigil of prayer, whispering I love you over and over. She streamed gospel music on Pandora on her phone, taking comfort in the song The Blood Still Works. Its still healing, she sang to him. There is power in the blood of Jesus, the blood still works. She had Charless phone with her and did her best to field an avalanche of calls from worried family members and Zulu brothers. I told them, Please keep him in prayer,. she says.

On Wednesday, March 18, while Nicole was in the midst of praying, Charles opened his eyes. I said to him: Baby, you opened your eyes for me! I love you so much,. she recalls. That was the last time I saw my husband with his eyes open. The next day, Nicole says, hospital administrators told her she could no longer visit her husband because of a shortage of personal protective equipment. Louisianas caseload had increased to 392 cases from 280 the day before. At a news conference, Governor Edwards announced that the states health care system could be overwhelmed in seven to 10 days on its current trajectory.

Five days later, on Tuesday, March 24, a team of hospital medical providers called Nicole. Charless blood pressure had dropped, and his kidneys had failed. They told her that he wasnt going to make it. They asked if she would like to see him in person or use FaceTime. She wanted to see him and asked if his two daughters could come too. The hospital ran through a series of questions to assess the daughters own exposure to the coronavirus, and then administrators allowed Bethaney, 24; LeTreion, 32; and Nicole to come to his room. Wearing gowns, gloves and masks, they prayed over his body and said goodbye. At 1:30, when Charles took his last breath, Nicole, his wife of nearly 30 years, was by his side. I told God, I love him; Im leaving him in your hands,. she says. I said, Please let him rest, let him go in peace.'

The following day, as Nicole was subsumed by staggering grief, she received a call that Charless Covid-19 test had come back positive. Since his death, she and LeTreion have tested negative for the virus. Bethaney and Nicoles father, Burnell Scales, have tested positive; Bethaney has remained asymptomatic, while Scales had mild symptoms and has since recovered.

The afternoon Charles died, Jay Banks was crushed to learn that two other friends had died as well. The same day, at a White House briefing, President Trump stated, There is tremendous hope as we look forward and we begin to see the light at the end of the tunnel. At a Fox News town hall, he said: I would love to have the country opened up and just raring to go by Easter. Since then, Reese, the Zulu clubs chaplain, has posted a heart-wrenching scroll of deaths on his Facebook page: the Zulu warriors who have received, he wrote, their wings. On March 26, Earl Henry Jr., 63, died. He was a Zulu member for nearly half his life. Three days later, Terry Sharpe Sr., 49, died. He drove a truck for a living and was a loyal member of Pilgrim Baptist Church. On March 31, Larry A. Hammond died. A retired postal worker, he was a member of the Omega Psi Phi fraternity and a veteran of the Air Force; he died in the local V.A. hospital. On the day of his death, Mayor Cantrell tweeted that he had been a vital part of our citys rebirth after Katrina, and a culture bearer in the truest sense. She included a picture of them smiling together. Hammond was wearing his Zulu jacket.

The Zulu Social Aid and Pleasure Club had its origins at the intersection of discrimination and death. After Emancipation, formerly enslaved Africans often could not afford to bury their dead. So they pooled their money by forming social-aid clubs to provide dignified, respectful funerals. But the coronavirus has broken the Zulu clubs 111-year tradition of sending off passing members with respect and grace. On April 3, fewer than a dozen people came to Zion Travelers First Baptist Church to say goodbye to Dickey Charles. They sat scattered throughout the pews in the chapel in observance of the guidelines Mayor Cantrell put into place on March 16 prohibiting gatherings of more than a few people. Nicole and her family managed to live-stream the service, and another 600 people watched from home. Elroy A. James, an assistant attorney general for Louisiana and the president of the Zulu club, tuned in, saddened that the organization wasnt able to celebrate its fallen brother in style. He deserved a second-line funeral, James says, referring to the New Orleans tradition of commemorating life with a spirited procession of pageantry, jazz and dance. Man, it would have been great.

As a boy and later a student at Southern University and the Tulane University School of Medicine, Dr. Clyde W. Yancy, the cardiologist at Northwestern, remembers being fascinated with the decorated coconuts, the sought-after prize of the Krewe of Zulu parade. Everybody, including me, wanted a gold Zulu coconut, he says. There was no status, no privilege, we were all just standing on the sidewalk, hoping we got lucky enough to catch the gold coconut.

He says this precious memory has been marred by the racial health disparities he has spent much of his career studying, the disparities that have come to define the American outbreak of Covid-19 and the harm this lethal combination has inflicted on the Zulu club. These men were doing something as seemingly harmless as socializing, as networking, and just because of that moment of fellowship to celebrate their heritage, theyre now dead? he says. That just made me pause. It makes you understand the pain, the hurt of this gap in health care outcomes as a function of race that have been with us for decades. Covid-19 has basically taken off the Band-Aid that was covering the wound, pointed out how deep it is and left us no other choice but to finally say: We get it, we see it.

Experts say the only way to defeat the current coronavirus pandemic is with comprehensive testing and tracing to identify infected persons and ensure they dont come into contact with others. To achieve this, the Army wants to fast-track development of wearable detection technologies that can predict infection and alert the wearer and others around them.

On Monday, the Army issued a request for project proposals through the Medical Technology Enterprise Consortium to develop a wearable diagnostic capability for the pre/very earlysymptomatic detection of COVID19 infection.

Using its other transaction authorityan iterative, fast-paced funding mechanism outside the Federal Acquisition Regulationthe Defense Department set aside $25 million for this effort, with plans to make up to 10 awards.

Physiologic surveillance for COVID19 positive individuals that do not yet show clear medical symptoms is an ultimate goal, the solicitation states, citing the need for advanced algorithms to predict infection. Physiological signatures therefore must produce predictive algorithms that can be tied into validated and relevant antibody/molecular measurements.

The perfect solution will be designed so the devices outputa determination on whether the person poses an infection riskcan be easily decipherable by non-medical or -technical personnel and to be minimally-invasive for the wearer.

Device(s) should be designed to be worn for continuous physiological monitoring in a non-obtrusive manner and should not affect the daily activity of the wearer, the solicitation states.

Physiological indicators should include, but are not limited to, physiological markers of early COVID symptomologyelevated temperature/fever, respiratory difficulty/cough, etc.antibodies against COVID-19, and molecular biomarkers indicative of COVID-19 exposure.

The data generate and transmitted by the device must also be secured at the highest level, per regulations under the Health Insurance Portability and Accountability Act, or HIPAA.

Army contracting officials said the military would prefer a single device that meets all needs but will accept pitches for a combination of technologies and sensors.

The winning bidders should also be prepared to work through any necessary FDA approvals required, including obtaining an Emergency Use Authorization within the first 45 days of the contract.

The Army is not looking for the latest, undeveloped tech. Instead, the requirement calls for all submissions to be at least at Technology Readiness Level 3 or 4working proof-of-concept or tested in a laboratory environmentor above. More specifically, proposed technologies should currently be in development or commercially available, according to the solicitation.

MTEC said the contract will be awarded on an accelerated timeline through its Enhanced White Paper method, with awards expected within four weeks from the white paper deadline: 12 p.m. May 13.

Due to the urgent need to deploy this technology mid-crisis, MTEC is also suspending its members-only submission requirement. As with other OTA consortia, MTEC usually restricts access to the requirements and submissions to its membership.

Due to the critical and urgent nature of the technical topic area, MTEC membership is NOT required for the submission of an Enhanced White Paper in response to this MTEC RPP, the solicitation states. However, vendors will be required to join the consortium if their white paper is chosen to move forward to award.

The contract is set to run for nine months.

Tracing infection from mobility data

What sort of measures are required to contain the spread of severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19)? The rich data from the Open COVID-19 Data Working Group include the dates when people first reported symptoms, not just a positive test date. Using these data and real-time travel data from the internet services company Baidu, Kraemer et al. found that mobility statistics offered a precise record of the spread of SARS-CoV-2 among the cities of China at the start of 2020. The frequency of introductions from Wuhan were predictive of the size of the epidemic sparked in other provinces. However, once the virus had escaped Wuhan, strict local control measures such as social isolation and hygiene, rather than long-distance travel restrictions, played the largest part in controlling SARS-CoV-2 spread.

Science, this issue p. 493

The ongoing coronavirus disease 2019 (COVID-19) outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions were undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We used real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation in transmission in cities across China and to ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. After the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside of Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19.

The outbreak of coronavirus disease 2019 (COVID-19) spread rapidly from its origin in Wuhan, Hubei Province, China (1). A range of interventions were implemented after the detection in late December 2019 of a cluster of pneumonia cases of unknown etiology and identification of the causative virus, severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2), in early January 2020 (2). Interventions include improved rates of diagnostic testing; clinical management; rapid isolation of suspected cases, confirmed cases, and contacts; and, most notably, restrictions on mobility (hereafter called cordon sanitaire) imposed on Wuhan city on 23 January 2020. Travel restrictions were subsequently imposed on 14 other cities across Hubei Province, and partial movement restrictions were enacted in many cities across China. Initial analysis suggests that the Wuhan cordon sanitaire resulted in an average 3-day delay of COVID-19 spread to other cities (3), but the full extent of the effect of the mobility restrictions and other types of interventions on transmission has not been examined quantitatively (46). Questions remain over how these interventions affected the spread of SARS-CoV-2 to locations outside of Wuhan. Here, we used real-time mobility data, crowdsourced line list data of cases with reported travel history, and timelines of reporting changes to identify early shifts in the epidemiological dynamics of the COVID-19 epidemic in China, from an epidemic driven by frequent importations to local transmission.

As of 1 March 2020, 79,986 cases of COVID-19 were confirmed in China (Fig. 1A) (7). Reports of cases in China were mostly restricted to Hubei until 23 January 2020 (81% of all cases), after which most provinces reported rapid increases in cases (Fig. 1A). We built a line list dataset from reported cases in China with information on travel history and demographic characteristics (8). We note that the majority of early cases (before 23 January 2020; see the materials and methods) reported outside of Wuhan had known travel history to Wuhan (57%) and were distributed across China (Fig. 1B), highlighting the importance of Wuhan as a major source of early cases. However, initial testing was focused mainly on travelers from Wuhan, potentially biasing estimates of travel-related infections upward (see the materials and methods). Among cases known to have traveled from Wuhan before 23 January 2020, the time from symptom onset to confirmation was 6.5 days (SD = 4.2 days; fig. S2), providing opportunity for onward transmission at the destination. More active surveillance reduced this interval to 4.8 days (SD = 3.03 days; fig. S2) for those who traveled after 23 January 2020.

(A) Epidemic curve of the COVID-19 outbreak in provinces in China. Bars indicate key dates: implementation of the cordon sanitaire of Wuhan (gray) and the end of the first incubation period after the travel restrictions (red). The black line represents the closure of the Wuhan seafood market on 1 January 2020. The width of each horizontal tube represents the number of reported cases in that province. (B) Map of COVID-19 confirmed cases (n = 554) that had reported travel history from Wuhan before travel restrictions were implemented on 23 January 2020. Colors of the lines indicate date of travel relative to the date of travel restrictions.

To identify accurately a time frame for evaluating early shifts in SARS-CoV-2 transmission in China, we first estimated from case data the average incubation period of COVID-19 infection [i.e., the duration between time of infection and symptom onset (9, 10)]. Because infection events are typically not observed directly, we estimated the incubation period from the span of exposure during which infection likely occurred. Using detailed information on 38 cases for whom both the dates of entry to and exit from Wuhan were known, we estimated the mean incubation period to be 5.1 days (SD = 3.0 days; fig. S1), similar to previous estimates from other data (11, 12). In subsequent analyses, we added an upper estimate of one incubation period (mean + 1 SD = 8 days) to the date of Wuhan shutdown to delineate the date before which cases recorded in other provinces might represent infections acquired in Hubei (i.e., 1 February 2020; Fig. 1A).

To understand whether the volume of travel within China could predict the epidemic outside of Wuhan, we analyzed real-time human mobility data from Baidu Inc., together with epidemiological data from each province (see the materials and methods). We investigated spatiotemporal disease spread to elucidate the relative contribution of Wuhan to transmission elsewhere and to evaluate how the cordon sanitaire may have affected it.

Among cases reported outside of Hubei province in our dataset, we observed 515 cases with known travel history to Wuhan and a symptom onset date before 31 January 2020, compared with only 39 cases after 31 January 2020, illustrating the effect of travel restrictions (Figs. 1B and 2A and fig. S3). We confirmed the expected decline of importation with real-time human mobility data from Baidu Inc. Movements of individuals out of Wuhan increased in the days before the Lunar New Year and the establishment of the cordon sanitaire, before rapidly decreasing to almost no movement (Fig. 2, A and B). The travel ban appears to have prevented travel into and out of Wuhan around the time of the Lunar New Year celebration (Fig. 2A) and likely reduced further dissemination of SARS-CoV-2 from Wuhan.

(A) Human mobility data extracted in real time from Baidu Inc. Travel restrictions from Wuhan and large-scale control measures started on 23 January 2020. Gray and red lines represent fluxes of human movements for 2019 and 2020, respectively. (B) Relative movements from Wuhan to other provinces in China. (C) Timeline of the correlation between daily incidence in Wuhan and incidence in all other provinces, weighted by human mobility.

To test the contribution of the epidemic in Wuhan to seeding epidemics elsewhere in China, we built a nave COVID-19 generalized linear model [GLM (13)] of daily case counts (see the materials and methods). We estimated the epidemic doubling time outside of Hubei to be 4.0 days (range across provinces, 3.6 to 5.0 days) and estimated the epidemic doubling time within Hubei to be 7.2 days, consistent with previous reports (5, 12, 14, 15). Our model predicted daily case counts across all provinces with relatively high accuracy (as measured with a pseudo-R2 from a negative binomial GLM) throughout early February 2020 and when accounting for human mobility (Fig. 2C and tables S1 and S2), consistent with an exploratory analysis (6).

We found that the magnitude of the early epidemic (total number of cases until 10 February 2020) outside of Wuhan was very well predicted by the volume of human movement out of Wuhan alone (R2 = 0.89 from a log-linear regression using cumulative cases; fig. S8). Therefore, cases exported from Wuhan before the cordon sanitaire appear to have contributed to initiating local chains of transmission, both in neighboring provinces (e.g., Henan) and in more distant provinces (e.g., Guangdong and Zhejiang) (Figs. 1A and 2B). Further, the frequency of introductions from Wuhan were also predictive of the size of the early epidemic in other provinces (controlling for population size) and thus the probability of large outbreaks (fig. S8).

After 1 February 2020 (corresponding to one mean + one SD incubation period after the cordon sanitaire and other interventions were implemented), the correlation of daily case counts and human mobility from Wuhan decreased (Fig. 2C), indicating that variability among locations in daily case counts was better explained by factors unrelated to human mobility, such as local public health response. This suggests that whereas travel restrictions may have reduced the flow of case importations from Wuhan, other local mitigation strategies aimed at halting local transmission increased in importance later.

We also estimated the growth rates of the epidemic in all other provinces (see the materials and methods). We found that all provinces outside of Hubei experienced faster growth rates between 9 January and 22 January 2020 (Fig. 3, A and B, and fig. S4b), which was the time before travel restrictions and substantial control measures were implemented (Fig. 3C and fig. S6); this was also apparent from the case counts by province (fig. S6). In the same period, variation in the growth rates is almost entirely explained by human movements from Wuhan (Fig. 3C and fig. S9), consistent with the theory of infectious disease spread in highly coupled metapopulations (16, 17). After the implementation of drastic control measures across the country, growth rates became negative (Fig. 3B), indicating that transmission was successfully mitigated. The correlation of growth rates and human mobility from Wuhan became negative; that is, provinces with larger mobility from Wuhan before the cordon sanitaire (but also larger number of cases overall) had more rapidly declining growth rates of daily case counts. This could be due partly to travel restrictions but also to the fact that control measures may have been more drastic in locations with larger outbreaks driven by local transmission (for more details, see Current role of imported cases in Chinese provinces section).

(A) Daily counts of cases in China. (B) Time series of province-level growth rates of the COVID-19 epidemic in China. Estimates of the growth rate were obtained by performing a time-series analysis using a mixed-effects model of lagged, log linear daily case counts in each province (see the materials and methods). Above the red line are positive growth rates and below are negative rates. Blue indicates dates before the implementation of the cordon sanitaire and green after. (C) Relationship between growth rate and human mobility at different times of the epidemic. Blue indicates before the implementation of the cordon sanitaire and green after.

The travel ban coincided with increased testing capacity across provinces in China. Therefore, an alternative hypothesis is that the observed epidemiological patterns outside of Wuhan were the result of increased testing capacity. We tested this hypothesis by including differences in testing capacity before and after the rollout of large-scale testing in China on 20 January 2020 [the date that COVID-19 became a class B notifiable disease (18, 19)] and determined the impact of this binary variable on the predictability of daily cases (see the materials and methods). We plotted the relative improvement in the prediction of our model (on the basis of normalized residual error) of (i) a model that includes daily mobility from Wuhan and (ii) a model that includes testing availability (for more details, see the materials and methods). Overall, the inclusion of mobility data from Wuhan produced an improvement in the models prediction [delta-Bayesian information criterion > 250 (20)] over a nave model that considers only autochthonous transmission with a doubling time of 2 to 8 days (Fig. 3B). Of the 27 provinces in China reporting cases through 6 February 2020, we found that the largest improvements in prediction for 12 provinces could be achieved using mobility only (fig. S5). In 10 provinces, both testing and mobility improved the models prediction, and in only one province (Hunan) was testing the most important factor improving model prediction (fig. S5). We conclude that laboratory testing during the early phase of the epidemic was critical; however, mobility out of Wuhan remained the main driver of spread before the cordon sanitaire. Large-scale molecular and serological data will be important to investigate further the exact magnitude of the impact of human mobility compared with other factors.

Because case counts outside of Wuhan have decreased (Fig. 3B), we can further investigate the current contribution of imported cases to local epidemics outside of Wuhan by investigating case characteristics. Age and sex distributions can reflect heterogeneities in the risk of infection within affected populations. To investigate meaningful shifts in the epidemiology of the COVID-19 outbreak through time, we examined age and sex data for cases from different periods of the outbreak and from individuals with and without travel from Wuhan. However, details of travel history exist for only a fraction of confirmed cases, and this information was particularly scant for some provinces (e.g., Zhejiang and Guangdong). Therefore, we grouped confirmed cases into four categories: (I) early cases (i.e., reported before 1 February 2020) with travel history, (II) early cases without travel history, (III) later cases (i.e., reported between 1 February and 10 February 2020) with travel history, and (IV) later cases without travel history.

Using crowdsourced case data, we found that cases with travel history (categories I and III) had similar median ages and sex ratios in both the early and later phases of the outbreak (age 41 versus 42 years; 50% interquartile interval: 32.75 versus 30.75 and 54.25 versus 53.5 years, respectively; P value > 0.1, 1.47 versus 1.45 males per female, respectively; Fig. 4D and fig. S7). Early cases with no information on travel history (category II) had a median age and sex ratio similar to those with known travel history (age 42 years; 50% interquartile interval: 30.5 to 49.5, P value > 0.1; 1.80 males per female; Fig. 4D). However, the sex ratio of later cases without reported travel history (category IV) shifted to ~1:1 (57 male versus 62 female, 2 test, P value < 0.01), as expected under a null hypothesis of equal transmission risk [Fig. 4, A, B, and D; see also (21, 22) and the materials and methods], and the median age in this group increased to 46 (50% interquartile interval: 34.25 to 58, t test: P value < 0.01; Fig. 4, A to C, and fig. S7). We hypothesize that many of the cases with no known travel history in the early phase were indeed travelers who contributed to disseminating SARS-CoV-2 outside of Wuhan. The shift toward more equal sex ratios and older ages in nontravelers after 31 January 2020 confirms the finding that epidemics outside of Wuhan were then driven by local transmission dynamics. The case definition changed to include cases without travel history to Wuhan after 23 January 2020 (see the materials and methods).

(A) Age and sex distributions of confirmed cases with known travel history to Wuhan. (B) Age and sex distributions of confirmed cases that had no travel history to Wuhan. (C) Median age for cases reported early (before 1 February) and those reported later (between 1 and 10 February). Full distributions are shown in fig. S7. (D) Change through time in the sex ratio of (i) all reported cases in China with no reported travel history, (ii) cases reported in Beijing without travel history, and (iii) cases known to have traveled from Wuhan.

Containment of respiratory infections is particularly difficult if they are characterized by relatively mild symptoms or transmission before the onset of symptoms (23, 24). Intensive control measures, including travel restrictions, have been implemented to limit the spread of COVID-19 in China. Here, we show that travel restrictions are particularly useful in the early stage of an outbreak when it is confined to a certain area that acts as a major source. However, travel restrictions may be less effective once the outbreak is more widespread. The combination of interventions implemented in China was clearly successful in mitigating spread and reducing local transmission of COVID-19, although in this work it was not possible to definitively determine the impact of each intervention. Much further work is required to determine how to balance optimally the expected positive effect on public health with the negative impact on freedom of movement, the economy, and society at large.

T. J. Hastie, D. Pregibon, Generalized linear models in Statistical Models in S, J. M. Chambers, T. J. Hastie, Eds. (Wadsworth & Brooks/Cole, 1992), pp. 195246.

M. J. Keeling, O. N. Bjrnstad, B. T. Grenfell, Metapopulation dynamics of infectious diseases in Ecology, Genetics and Evolution of Metapopulations, I. Hanski, O. E. Gaggiotti, Eds. (Elsevier, 2004), pp. 415445.

J. H. McDonald, Handbook of Biological Statistics (Sparky House, ed. 3, 2014).

Hopes are rapidly rising for a COVID-19 vaccine. The World Health Organization recently announced that as many as 102 potential candidates are currently under developmenteight of them already in clinical trials. President Donald Trump has called for his own ambitious vaccine research program, dubbed Operation Warp Speed, with the goal of finding a cure by year-end. If all goes well, a vaccine could be available en masse by January, according to Dr. Anthony Fauci, the nations top epidemiologist and a key member of the White House coronavirus task force.

These developments are good news. As United Nations Secretary-General Antonio Guterres said this week, only a vaccine can return the world to normalcy, while all other measures, such as universal testing, will only mitigate the spread of the infectious disease.

But if and when a vaccine is available, will Americans actually give it their trust?

Under any circumstances, there would be some skepticism. Even reasonable citizens might show some caution in embracing new and relatively unproven therapies. This skepticism, however, could take on epic proportions under Trumps leadership. The presidents near-constant stream of lies, misinformation, obfuscations, and half-truths has systematically destroyed Americans last reserves of trust in government. A logical consequence of this behavior is that many Americans will end up wary of a cure produced by the administration, even with rock-solid proof of its efficacy.

This could be catastrophic. Public reluctance to accept a vaccine will mean continued suffering, despite a treatment in hand, and an even slower road back toregular life. As much as Trump would like to believe that a vaccine would be gratefully embraced by all Americansno doubt a catalyst for his urgency in pursuing oneTrump himself has made that outcome less likely.

Even in the best of situations, persuading Americans to get their shots isnt easy. Fewer than half of Americans get their flu shots every year, according to the Centers for Disease Control and Prevention. During the H1N1 pandemic of 2009-2010, only 27 percent of Americans were ever vaccinated, despite relatively high-profile public health campaigns and the availability of free vaccinations to anyone who wanted one. As a result, H1N1 continues to sicken and kill Americans every yearalbeit at rates far, far below that of COVID-19.

Scholarly analyses of the publics response to the H1N1 vaccine find a correlationeven if its a relatively small onebetween general levels of public trust in government and vaccination rates. Much more significant in influencing vaccination ratesis the quality and consistency of official communications from government officials. More than anything, thats what enables citizens to accept official advice and trust in a treatments safety. Individuals and institutions are trusted when the public perceives that they are knowledgeable and expert, they are open and honest, and concerned and caring, as one study found. All of these are standards that the president and his administration have repeatedly failed to clear.

Trump himself has been a font of misinformation and conflicting advice. He boosted the anti-malaria drug chloroquine (now shown to be both ineffective and deadly) and made utterly unsupported claims that the virus will go away with the summer heat. Then, he suggested that injecting oneself with disinfectants could be a treatment for COVID-19, a proposal met with horror from public health expertsand a stern warning from the makers of Lysol.

The president has also failed to be open and honest. He has undermined the credibility of public health officials and governors in whom Americans put more faith. More than once, his false statements have forced his top public health officials to issue clarifications that contradict his own baseless claims. At the same time, Trump has encouraged resistance against the restrictions imposed by his own administration, such as through his pointed refusal to wear a face mask in defiance of CDC guidance.

Trump has also failed to convey any sense of empathy for the people hardest-hitby the ravages of the viruss outbreak. According to an analysis by the Washington Post, Trump has spent just four and a half minutes expressing condolences for the pandemics victims while spending 45 minutes praising himself over more than 13 hours of airtime during a three-week period.

Even Operation Warp Speed, Trumps push for a vaccine, smacks of political expediency more than a genuine concern to save lives. According to the New York Times, Trump has repeatedly urged a faster timetable, despite consistent warnings from public health experts of the risks of rushing through the process.

These fears are certainly justified, given the administrations record of missteps in its pandemic response. For instance, flawed coronavirus test kits ordered by the CDC set back the nations testing capacity by weeks in the early onset of the crisis. The FDAs rush to approve antibody test kits has now led to a flood of inaccurate or outright fraudulent tests on the market.

Its no surprise, then, that Americans feel awash in misinformation and conflicting guidance. A new survey from the Pew Research Center finds that about half of respondents say they find it difficult to sort fact from fiction in their daily news consumption. Nearly two-thirds of Americans say theyve seen some news that seemed completely made up.

This confusion makes the public a ripe target for anti-vaccine misinformation campaigns, which the Associated Press recently reported are already in high gear. I dont want the government forcing it on my community or my family, activist Rita Palma told the AP. In addition to sowing doubts about the effectiveness of a potential vaccine, these groups are organizing resistance against the possibility of mandating its usage, a headache that governments will be forced to confront.

The consequence of all of these failures is a public that is rightfully suspicious of the Trump administrations motives and competence as it joins the race for a cure. Recent polls find that only 23 percent say they trust Trumps information a great deal. Fewer than half would follow his recommendations. Even most Republicans now say they dont put much stock in Trumps pronouncements. All told, these circumstances are hardly a recipe for a successful vaccination campaign, even if government scientists were to beat the odds and meet the administrations ambitious year-end deadline.

In the meantime, the damage Trump has done to public trust has weakened efforts to mitigate the virus. Public officials still need Americans to maintain the discipline of social distancing, reject deadly misinformation, and comply with guidance on wearing masks, especially as quarantine fatigue sets in and hardens. They will need people to get themselves tested regularly and adhere to quarantines if contact tracing shows theyve been exposed to someone infected. But as images of crowded beaches and mask-less protesters show, rebellion is already brewing and may only get worse.

Granted, public trust in government has long been in decline. But Trumps appalling pandemic response could be the ultimate deathblow. As much as Trump wants to reap the political rewards of unleashing a cure this election year, he is sabotaging his prospects by destroying the public trust needed to bring the pandemic under control. What hell leave behind instead is one more disaster for his eventual successor to repair.

Vaccine development plays other roles than curing the disease at hand.

The sector also helps with general disease surveillance, helping catch pandemics early.

The history of Ebola shows the link between vaccine development and epidemic management.

With more than 100 vaccines for COVID-19 now in development, its fair to say that never before has a vaccine been so widely anticipated or needed. Because it is now accepted that the only way to end this coronavirus pandemic, minimize loss of life and return to some semblance of normality is through vaccination.

This pandemic has made it brutally clear that vaccines dont just prevent infectious disease and save lives, they are also essential in helping to maintain global security, social cohesion and economic stability. But with the global spotlight now on the race to develop COVID-19 vaccines as we will almost certainly need more than one the fact that this is expected to take 12-18 months begs the question, could vaccines play a more immediate role during a pandemic?

We already know that as a public-health intervention, vaccination is one of the most impactful and cost-effective. It has eradicated smallpox, nearly eradicated polio and, in recent decades, reduced the incidence of infectious diseases that once killed millions every year, such as measles, helping to halve child mortality.

But when new threats emerge, or when something changes in the way that known but neglected infectious diseases spread, it can catch us off-guard with sudden widespread epidemics or pandemics of diseases for which no vaccines exist. This is what happened with SARS, MERS, swine flu, Ebola and Zika.

In each case, this has triggered a race to develop a vaccine, and in each case where a vaccine was successfully developed it wasnt available in time to have a meaningful impact in ending the immediate crisis. That doesnt mean we dont need them. The Ebola vaccine may not have played a part in ending the West Africa epidemic, which infected more than 28,000 people, killing more than 11,000, but it has since played an essential role in preventing subsequent epidemics in the Democratic Republic of the Congo from spiralling out of control.

So, given that we already knew about some of these diseases before the crises, with Ebola first identified in 1976 and Zika as far back as 1947, why did we not have vaccines for some of them already? There are a multitude of reasons why, but in essence it comes down to the fact that the world tends to wait until infectious disease becomes a global health security threat before treating it like one.

With Ebola, prior to the West Africa epidemic, it was a disease that tended to kill a couple of hundred people every few years, mainly in extremely poor rural communities in Africa. This, and the fact that it is such an aggressive disease that in rural settings usually burned itself out immobilizing or killing people before they had much chance to spread it meant it was not viewed as a disease with epidemic potential. Given the huge cost and time necessary for developing a vaccine, and that it can take half a billion dollars to build a manufacturing facility, there was no market to stimulate the development of an Ebola vaccine, because those most at risk were few in number and could never afford it.

When the inevitable happened and Ebola eventually found its way to more densely populated areas, where it was able to spread faster, the perception of the risk it posed changed dramatically. However, even then, with the huge number of deaths and the epidemic costing more than $2.8 billion in cumulative GDP losses, there was still no obvious market for a vaccine.

The fact that we have a vaccine today was only made possible when my organisation, Gavi, the Vaccine Alliance, provided a $300 million incentive to manufacturers to go through the lengthy and costly processes involved in bringing a candidate vaccine to market. And because of this we are now building a stockpile of 500,000 doses of the licensed Ebola vaccine to tackle future outbreaks. We can only do this because of the support of generous donors like the Spanish government and La Caixa. When I met Prime Minister Snchez earlier this year, I was reassured of his continuing interest and support.

But from this Ebola experience, some lessons were learned. The World Health Organization (WHO) came up with a list of 11 infectious diseases of epidemic potential, for which no vaccines or treatments existed. The Coalition for Epidemic Preparedness and Innovation (CEPI), whose mandate is to accelerate development of vaccines for these diseases was created. And, CEPI is now backing the development of eight COVID-19 vaccines including with some financing provided through the Gavi-affiliated International Finance Facility for Immunisation.

But while this goes a long way to cover some of our blind spots for known diseases, what about unknown ones or new strains? In many ways, this is by far a much bigger threat, because in evolutionary terms they are inevitable. Viruses are mutating all the time, and human activity is increasingly bringing us into contact with them.

Since 1940, more than 335 new emerging infectious diseases have been identified, and around 60% of these can be traced back to human interactions with animals. Viruses like the SARS-CoV-2 virus that causes COVID-19 can exist in wild animals, like bats, who often harbour viruses that can jump to humans because their physiology and immune systems create ideal environments for viruses to flourish without harming the host.

New EIDs (emerging infectious diseases) in the postwar period

Image: Nature

Human activities, such as deforestation, farming and the sale of live wild animals or bushmeat run the risk of exposing humanity to such viruses often through contact with not just bats, but other wild animals like exotic canine species and monkeys, or vectors like mosquitoes that may have lived for years with no human contact. Similarly, existing viruses like influenza, which already kills between 290,000 and 650,000 people globally every year, are well known to mutate, creating the risk of new, deadlier strains emerging.

All this increases the risk of outbreaks of both new and existing diseases. Infectious disease experts across the globe have warned for years that it was just a matter of time before we experienced a pandemic on the scale we are currently seeing.

As we have seen, its not just the emergence of viruses we need to worry about, but also their ability to spread. Population growth, urbanization, climate change and human migration make the spread of pathogens easier than ever before. Meanwhile climate change is also altering the range of disease-carrying vectors, like mosquitoes, which is shifting the geographic spread of some diseases. With more people living in closer proximity to each other, and over a billion people crossing international borders each year, the transmission of disease is not only easier, its harder to stop.

In the absence of a vaccine, our best chance of doing so is to catch outbreaks as early on as possible. That means better disease surveillance. Infectious disease surveillance networks already exist across the globe, but they can be highly porous and of varying effectiveness. One cost-effective way of widening the net is through improved access to primary healthcare, particularly in lower-income countries, where often these infectious diseases emerge undetected.

Primary healthcare is usually the first point of contact people have with medical or health services when they get sick, and so realistically the first chance wed have of detecting an outbreak early on. But in many parts of the world primary healthcare is still very limited or non-existent. Gavi is helping to change that through the expansion of national childhood immunization programmes.

With 90% of the worlds children now receiving at least one routine vaccination, no other public health intervention has such a large reach. Expanding this reach doesnt just protect more children from infectious disease, it can also improve our infectious disease surveillance, because immunization programmes are a gateway to primary healthcare.

When a child gets access to vaccination, they, their parents and their community also get access to a range of vital components to health services, including supply chains, trained health workers, data systems and, crucially, disease surveillance. So, through the expansion of routine immunization, we are also helping to improve our ability to catch outbreaks earlier on by putting in place the basics of a healthcare warning system.

In the context of a pandemic, these immunization programmes are also important because they will form the backbone of a global vaccine distribution network when vaccines are available, enabling us to roll out a vaccine to everyone as quickly as possible, even in the poorest countries with the weakest health systems.

But what then of vaccines against unknown threats or new strains? How can we get those faster? The delay we face now during this pandemic is not due to the time it took to create the first vaccine. The first was actually developed within days of the genomic sequence of SARS-CoV-2 being published. Instead, it comes down to the clinical trials that are necessary to ensure that any vaccine being developed is both safe and effective. This can normally take between five and 10 years and involves testing the vaccine on small groups of people initially and then eventually on much larger groups of thousands of people including those with other illnesses, ages and risk over a period of time. This is essential to ensure that the vaccine is safe and to fully understand the degree of protection it offers, if any. Because of this, clinical trials cannot and must not be avoided.

In the current crisis, however, it may be possible to carry out these trials in an adaptive and simultaneous fashion, rather than one after the other, which could potentially speed up the process. One possible silver lining to this pandemic is that it may usher in a range of new vaccine technologies that help us be better prepared for the next one. While it is not possible to develop a vaccine for a threat before you know what that threat is, some of the vaccine technologies now being investigated as part of the COVID-19 response could potentially make it possible to prepare in other ways.

For example, a number of groups working on a COVID-19 vaccine are looking at vaccine platform approaches. This involves creating a molecular delivery system, capable of carrying a range of different antigens for a given class of disease. One advantage to vaccine platforms is that they make it possible to carry out the majority of the safety trials, and fully understand and optimize manufacturing on the platform, before an outbreak, and then add the antigen once you know what youre dealing with. Similarly, mRNA and DNA vaccines can radically speed up the time it takes to develop such payloads, as we have seen with the first COVID-19 vaccine to be created. While further tests would still need to be carried out on these payloads, the time it takes to develop a vaccine in an emergency would be rapidly accelerated.

Vaccines can, and in many ways already do, have a critical role to play in preventing outbreaks from escalating into pandemics. For the current crisis, however, we will just have to wait and do everything we can to protect people until COVID-19 vaccines are shown to be effective, produced in unprecedented quantities and make sure that everyone has equal access to them once they are. We are not safe unless everyone is safe. Otherwise, this virus will keep coming back.

A new strain of Coronavirus, COVID 19, is spreading around the world, causing deaths and major disruption to the global economy.

Responding to this crisis requires global cooperation among governments, international organizations and the business community, which is at the centre of the World Economic Forums mission as the International Organization for Public-Private Cooperation.

The Forum has created the COVID Action Platform, a global platform to convene the business community for collective action, protect peoples livelihoods and facilitate business continuity, and mobilize support for the COVID-19 response. The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.

As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.

But if we want vaccines to play a more immediate role with future threats like COVID-19 and it is an evolutionary certainty that there will be more and if we want to avoid a repeat of this pandemic, then we need to start recognizing the critical role vaccines play before outbreaks occur. Not just in terms of protecting people during pandemics, but also in their early detection to prevent them from spiralling out of control in the first place.

(Reuters) - Britains AstraZeneca (AZN.L) joined forces with the University of Oxford on Thursday to help develop, produce and distribute a potential COVID-19 vaccine, as drugmakers around the world race to find a solution to the deadly disease.

FILE PHOTO: The company logo for pharmaceutical company AstraZeneca is displayed on a screen on the floor at the New York Stock Exchange (NYSE) in New York, U.S., April 8, 2019. REUTERS/Brendan McDermid/File Photo

UK Business Secretary Alok Sharma welcomed the tie-up as a vital step to making the Oxford vaccine available as soon as possible if it succeeds in clinical trials.

A team of British scientists last week dosed the first volunteers, and earlier this month said large-scale production capacity was being put in place to make millions of doses even before trials show whether it is effective.

Only a handful of the vaccines in development have advanced to human trials, an indicator of safety and efficacy - and the stage where most vaccines fail.

Our hope is that, by joining forces, we can accelerate the globalisation of a vaccine to combat the virus and protect people from the deadliest pandemic in a generation, AstraZeneca Chief Executive Pascal Soriot said.

The drugmaker did not give details on when it plans to start producing the vaccine ChAdOx1 nCoV-19, being developed by the Jenner Institute and Oxford Vaccine Group.

Though the firm is not a major player in vaccine development unlike European peers GSK (GSK.L) and Sanofi (SASY.PA), who are working on their own vaccine, it has deep pockets and a $6-billion-strong R&D budget.

The AstraZeneca-Oxford partnership is looking to produce 100 million doses by the end of the year and prioritise supply in the UK, Soriot told here the Financial Times.

Cambridge-based AstraZeneca is also testing two of its approved treatments as a therapy to help in the outbreak that has so far infected over 3 million people and killed more than 215,000.

Its shares rose 2% on London's FTSE 100 .FTSE by 0923 GMT as the main index fell, outpacing rival GSK.

Governments, drugmakers and researchers are working on around 100 vaccines for the virus. Industry experts say a successful vaccine will likely take more than a year to be developed but that is much faster than the average development time of 5-7 years.

There are currently no treatments or vaccines approved for the highly-contagious respiratory illness caused by the coronavirus, but healthcare workers have been trying many approaches to treat patients.

India's Serum Institute, the world's largest maker of vaccines by volume, has already said here it would produce millions of doses of the Oxford University shot.

The vaccine, a type known as a recombinant viral vector vaccine, uses a weakened version of the common-cold virus spiked with proteins from the novel coronavirus to generate a response from the bodys immune system.

Other drugmakers testing possible COVID-19 vaccines include Pfizer (PFE.N), Moderna (MRNA.O), Johnson & Johnson (JNJ.N) and Novavax (NVAX.O).

Reporting by Pushkala Aripaka in Bengaluru; Editing by Aditya Soni and Elaine Hardcastle

The common MMR vaccine could be critical to protecting patients over 50 and other vulnerable populations from COVID-19 according to Dr. Larry P. Tilley

ATLANTA, May 03, 2020 (GLOBE NEWSWIRE) -- The report MMR Vaccine Link to COVID-19: Fewer Deaths and Milder Cases from SARS-CoV-2 in Measles-Rubella Vaccinated Populations reveals that the MMR vaccine launched in 1971 (49 years ago) could explain why those 49 and under are much less likely to have bad outcomes from COVID-19 compared to those 50 and over, according to report co-contributor Dr. Larry P. Tilley, an Advisory Board Member of World Organization.

Dr. Larry P. Tilley:COVID-19 / MMR Vaccine Researcher

It is critical that COVID-19 doctors and researchers quickly review the epidemiological data presented in our paper demonstrating what appears to be a clear link between patient outcome and MMR vaccination history, said Tilley.

The first draft of World Organizations research was provided to the COVID-19 Research Team at the National Institute of Health on March 29, 2020. Biological evidence corroborating World Organizations investigation was then published just two weeks later by neuroscientists at the University of Cambridge in England.

The epidemiological data in our study when considered alongside the biological evidence from the University of Cambridge makes it clear: commonly available MMR Vaccinations could be the key to preventing a second wave of the COVID-19 pandemic this fall, continued Tilley.

COVID-19 survivors, regardless of how severe their cases were, are encouraged to apply online to join World Organizations COVID-19 MMR Titer Study. Anyone who has tested positive for COVID-19 can apply to join the study, even if asymptomatic. Tests will be administered at Quest Diagnostics laboratories across the United States.

About Dr. Larry P. TilleyDr. Larry P. Tilley is a board-certified internist and medical consultant who currently assists over two dozen pharmaceutical companies in the development of new medications and protocols.

About World OrganizationWorld Organization is a 501c3 nonprofit charity based in Atlanta, Georgia.

ContactDr. Larry P. Tilley, 505-570-2025, drlarrytilley@gmail.com

HOUSTON: Researchers in the US' Texas A&M University are asking hundreds of frontline medical workers to participate in a late-stage, phase 4, clinical trial of a widely-used tuberculosis vaccine that could help boost the immune system and blunt the devastating effects of COVID-19 .

Texas A&M is the first US institution in the clinical trial to have federal clearance for testing on humans. Researchers hope to demonstrate that Bacillus Calmette-Guerin or BCG mitigates the effects of the novel coronavirus, allowing fewer people to be hospitalised or to die from COVID-19.

The researchers are seeking to repurpose the vaccine, which is also used to treat bladder cancer. BCG could be widely available for use against COVID-19 in just six months because it has already been proven safe for other uses, the university said.

"This could make a huge difference in the next two to three years while the development of a specific vaccine is developed for COVID-19," said Dr Jeffrey D Cirillo, a Regent's Professor of Microbial Pathogenesis and Immunology at the Texas A&M Health Science Center.

"BCG is not meant to cure coronavirus but bridge the gap until a vaccine is developed, thus allowing us to buy time until something can be developed," said Dr Cirillo.

Healthcare workers will be the first people eligible for the clinical trial, which is set to begin this week. Efforts are underway to recruit 1,800 volunteers to take part in Texas A&M's nationwide test of BCG's application for coronavirus.

"It's not going to prevent people from getting infected. This vaccine has the very broad ability to strengthen your immune response. We call it 'trained immunity," said Dr Cirillo.

Because the human body fights a COVID-19 infection in a manner that is similar to how it would attack bladder cancer, the researchers are hopeful that his work could lead to an effective - and quickly developed - treatment for COVID-19.

Additionally, evidence shows that the coronavirus can cause damage to a patient's central nervous system, and it even might cause long-term effects that could lead to dementia, Alzheimer's or Parkinson 's disease. Dr Cirillo said the potential for lasting effects from COVID-19 is another reason to get the vaccine to the public as quickly as possible.

Texas A&M University Chancellor John Sharp has offered USD 2.5 million to ensure research can proceed as quickly as possible.

The Texas A&M Health Science Center is leading a group of scientists and medical doctors with Harvard's School of Public Health, the University of Texas MD Anderson Cancer Center in Houston, Cedars Sinai Medical Center in Los Angeles, and the Baylor College of Medicine in Houston.

Dr Cirillo said repurposing the existing bladder cancer vaccine called TICE(R) BCG could result in bringing a COVID-19 treatment to the US public in the fastest possible way.

Because the drug is already approved by the FDA, the researchers can skip the first three phases of clinical trials usually required before testing on people, since this vaccine has already passed those phases.

As the coronavirus has spread around the world, researchers have noticed that the morbidity and mortality rates were lower in some developing countries, including India, where the BCG vaccine is widely used.

How to Fund the Search for a COVID-19 Vaccine and Boost the Recovery  Bloomberg