Written by Steven Hansen
The U.S. new cases 7-day rolling average are 6.3 % LOWER than the 7-day rolling average one week ago. U.S. hospitalizations due to COVID-19 are now 13.5 % LOWER than the rolling average one week ago. U.S. deaths due to coronavirus are now 19.1 % LOWER than the rolling average one week ago. Today’s posts include:
- U.S. Coronavirus New Cases are 74,502
- U.S. Coronavirus hospitalizations are at 54,118
- U.S. Coronavirus deaths are at 3,230
- U.S. Coronavirus immunizations have been administered to 19.4 % of the population
- The 7-day rolling average rate of growth of the pandemic shows new cases worsened, hospitalizations worsened, and deaths worsened [note: this is an early sign of trend reversal – could the new variants be impacting COVID case growth?>
- Another New Coronavirus Variant Is Spreading Rapidly In New York, Researchers Report
- What Do We Really Know About Adenovirus Vectors for Vaccines Like Johnson & Johnson?
- Hydrating the respiratory tract: an alternative explanation why masks lower severity of COVID-19
- Johnson & Johnson Vaccine a Key Player in Achieving Herd Immunity by Early Fall
- Pfizer director Dr. Scott Gottlieb explains how a third Covid shot may protect against variants
- Age groups that sustain resurging COVID-19 epidemics in the United States
- Does Pfizer’s COVID Vaccine Protect Against Asymptomatic Infection?
- A UCSF infectious disease doctor is convinced this pandemic is ending, and sooner than you think…here’s why
The recent worsening of the trendlines for new cases is behind us which was attributed to going back to college/university, cooler weather causing more indoor activities, mutation of the virus, fatigue from wearing masks / social distancing, holiday activities, and some loosening of regulations designed to slow the coronavirus spread.
My continuing advice is to continue to wash your hands (especially after using the toilet as COVID first sheds in your stool), putting down the toilet seat (as flushing the toilet releases a plume), wear masks, avoid crowds, and maintain social distancing. No handwashing, mask, or social distancing will guarantee you do not get infected – but it sure as hell lowers the risk in all situations – and the evidence to-date shows a lower severity of COVID-19. In addition, certain activities are believed to carry higher risk – like being inside in air conditioning and removing your mask (such as restaurants, around your children/grandchildren, bars, and gyms). It is all about viral load – and outdoor activities are generally safe if you can maintain social distance. Finally, studies show eating right (making sure you are supporting your immune system) and adequate sleep increase your ability to fight off COVID.
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Hospitalizations Are The Only Accurate Gauge As Reporting Is Not Affected By Holidays
The 4 day Thanksgiving holiday period put the first wobble in the trends. Over weekends and holidays, the number of new cases and deaths decline. Over weekends, this is not a problem for week-over-week rolling averages as weekends are compared against the previous weekend. But when a holiday falls within a working week, a non-working day is compared to a working day which causes havok in the trends.
However, hospitalizations historically appear to be little affected by weekends or holidays – the daily counts do not vary significantly from day-to-day.
The hospitalization growth rate trend is improving.
For the Thanksgiving and the end of the year holiday period – roughly, it seems each appears to have added around 5 % to the rate of growth of new cases, hospitalizations, and deaths.
Historically, hospitalization growth follows new case growth by one to two weeks.
As an analyst, I use the rate of growth to determine the trend. But, the size of the pandemic is growing in terms of real numbers – and if the rate of growth does not become negative – the pandemic will overwhelm all resources.
The graph below shows the rate of growth relative to the growth a week earlier updated through today [note that negative numbers mean the rolling averages are LOWER than the rolling averages one week ago]. As one can see, the rate of growth for new cases peaked in early December 2020 for Thanksgiving, and early January 2021 for end of year holidays – and the rate of growth is now contracting.
In the scheme of things, new cases decline first, followed by hospitalizations, and then deaths.
It is up to each of our readers to protect themselves and others by washing hands, wearing a mask, avoiding crowds, and maintaining social distancing.
Will The New Variants Cause The Next Spike?
Maybe and maybe not. It all depends on vaccinations:
- the more people that are vaccinated reduces the pool of people that can be infected. Today we have removed over 19 % of the population from being infected which theoretically should reduce the infection rate by 19 % [it is unstudied whether the vaccines prevent a vaccinated person from being a carrier of the virus even though showing no signs]. If the vaccines are shown to stop transmission, then in theory it would reduce the infection rate by double the percent vaccinated [in this case you prevent your own infection and do not pass it along to another].
- it is also unknown what the effective rate of the current vaccines is against mutations that seem to appear almost daily. As an example, if the effective rate drops to 60%, it means the 19 % reduction in the infection rate discussed above is almost cut in half. The South African and Brazilian variant is somewhat immune to the current vaccines.
- The pandemic should be over immediately if everyone could be vaccinated today. The problem is that every day brings a new mutation (which would not appear if the pandemic was stopped). The longer the immunization process takes – the more ineffective the vaccine will become.
- It is not clear whether the vaccine prevents those vaccinated from spreading the virus. It seems to be well documented that it normally stops the virus from taking hold and when it does not – the infection is mild.
Coronavirus News You May Have Missed
Age groups that sustain resurging COVID-19 epidemics in the United States – Science
Following initial declines, in mid 2020 a resurgence in transmission of novel coronavirus disease (COVID-19) occurred in the US and Europe. As COVID19 disease control efforts are re-intensified, understanding the age demographics driving transmission and how these affect the loosening of interventions is crucial. We analyze aggregated, age-specific mobility trends from more than 10 million individuals in the US and link these mechanistically to age-specific COVID-19 mortality data. We estimate that as of October 2020, individuals aged 20-49 are the only age groups sustaining resurgent SARS-CoV-2 transmission with reproduction numbers well above one, and that at least 65 of 100 COVID-19 infections originate from individuals aged 20-49 in the US. Targeting interventions – including transmission-blocking vaccines – to adults aged 20-49 is an important consideration in halting resurgent epidemics and preventing COVID-19-attributable deaths.
Hydrating the respiratory tract: an alternative explanation why masks lower severity of COVID-19 – Cell
The seasonality of respiratory diseases has been linked, among other factors, to low outdoor absolute humidity and low indoor relative humidity, which increase evaporation of water in the mucosal lining of the respiratory tract. We demonstrate that normal breathing results in an absorption-desorption cycle inside facemasks, in which supersaturated air is absorbed by the mask fibers during expiration, followed by evaporation during inspiration of dry environmental air. For double-layered cotton masks, which have considerable heat capacity, the temperature of inspired air rises above room temperature, and the effective increase in relative humidity can exceed 100%. We propose that the recently reported, disease-attenuating effect of generic facemasks is dominated by the strong humidity increase of inspired air. This elevated humidity promotes mucociliary clearance of pathogens from the lungs, both before and after an infection of the upper respiratory tract has occurred. Effective mucociliary clearance can delay and reduce infection of the lower respiratory tract, thus mitigating disease severity. This mode of action suggests that masks can benefit the wearer even after an infection in the upper respiratory tract has occurred, complementing the traditional function of masks to limit person-to-person disease transmission. This potential therapeutical use should be studied further.
A New Coronavirus Variant Is Spreading in New York, Researchers Report – New York Times
The variant contains a mutation thought to help the virus dodge the immune system, scientists said.
A new form of the coronavirus is spreading rapidly in New York City, and it carries a worrisome mutation that may weaken the effectiveness of vaccines, two teams of researchers have found.
The new variant, called B.1.526, first appeared in samples collected in the city in November. By the middle of this month, it accounted for about one in four viral sequences appearing in a database shared by scientists.
One study of the new variant, led by a group at Caltech, was posted online on Tuesday. The other, by researchers at Columbia University, was published on Thursday morning.
Neither study has been vetted by peer review nor published in a scientific journal. But the consistent results suggest that the variant’s spread is real, experts said.
… Dr. Nussenzweig said he was more worried about the variant in New York than the one quickly spreading in California. Yet another contagious new variant, discovered in Britain, now accounts for about 2,000 cases in 45 states. It is expected to become the most prevalent form of the coronavirus in the United States by the end of March.
[editor’s note: according to Newsweek – “The Caltech researchers found that the variant contains spike mutations such as E484K, which has been associated with vaccine resistance, and S477N, which has been implicated to increase viral infectivity”]
Does Pfizer’s COVID Vaccine Protect Against Asymptomatic Infection? – MedPage
Pfizer/BioNTech’s COVID-19 vaccine appeared to prevent not only symptomatic disease, but asymptomatic infection as well, a real-world review of Israeli health records showed.
A large case-control study comprising over one million people found that the estimated vaccine effectiveness for “documented infection” was 46% (95% CI 40-51%) at days 14-20 following one dose of vaccine, and was 92% (95% CI 88-95%) at least 7 days following the second dose, reported Ran Balicer, MD, PhD, of Clalit Health Services in Tel Aviv, and colleagues.
Using a proxy for asymptomatic infection, they estimated 29% vaccine efficacy (95% CI 17-39%) at days 14-20 following the first dose and 90% (95% CI 83-94%) at 7 or more days after the second dose, as noted in the New England Journal of Medicine.
Study authors defined asymptomatic infection as “a PCR-confirmed infection with no report of symptoms during referral and initial physician questioning.” They included these data in a supplemental appendix, with a caveat: “In the absence of systematic periodic testing of SARS-CoV-2 among asymptomatic people in Israel, documented asymptomatic infections do not account for all asymptomatic infections, and likely cannot capture vaccine effectiveness for this outcome,” Balicer and colleagues wrote.
The Pfizer vaccine is authorized in the U.S. to prevent symptomatic COVID-19 illness, which was the primary endpoint in the product’s phase III trial. Prevention of overall coronavirus infection was not addressed directly in the trial, though Pfizer promised to examine it later through antibody testing.
What Do We Really Know About Adenovirus Vectors for Vaccines? – Google Podcasts
As the U.S. hits the half-million death mark from COVID-19 — a grim milestone that is equal to roughly the entire population of Atlanta and more than that of Miami — a new weapon is being added to the COVID-19 vaccine arsenal.
Johnson & Johnson is seeking emergency use authorization for what would become the U.S.’s first one-dose and non-mRNA COVID vaccine. It employs adenovirus vectors, a technology that has been used in labs for decades and was approved for the Ebola vaccine by the FDA in December 2019. It’s the same technology that AstraZeneca/Oxford and Sputnik V use.
Still, questions remain on how these vaccines may be different than mRNA or similar enough to other existing shots to encourage vaccine uptake. To explain how adenovirus vectors work and what to expect from the new products, Daniel Griffin, MD, PhD, chief of infectious disease at ProHEALTH Care, an Optum unit, joins us on this week’s episode.
[editor’s note: please click through to the podcast]
Johnson & Johnson Vaccine a Key Player in Achieving Herd Immunity by Early Fall – Newsweek
The Food and Drug Administration (FDA) could authorize the distribution of Johnson & Johnson’s COVID-19 vaccine this week. With this new vaccine, combined with increased supplies and access to the shots, America’s on track to return to a more normal life by early fall.
Without the one-dose shot, America would need to significantly ramp up its vaccination efforts to reach herd immunity before next winter. Vaccines from Pfizer and Moderna require two shots, and at America’s current rate of administering doses, it could take nearly a year to fully inoculate up to 85 percent of the population. The benefit of the Johnson & Johnson vaccine is that full vaccination is completed with one shot.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, estimates that between 70 and 85 percent of the population needs to be vaccinated against COVID-19 to reach herd immunity. That goal is achievable by the end of the summer or early fall, according to Fauci, who told Newsweek his prediction was based on people getting both doses of either the Moderna or Pfizer vaccine or the single-dose vaccine from Johnson & Johnson.
… “Herd immunity is a population concept, so whatever limits transmission of the virus in the population is what matters. Right now, there is little evidence that one vaccine dose can limit virus transmission in the population,” Vincent Racaniello a professor of microbiology and immunology at Columbia University, told Newsweek. “There is some evidence that two doses can limit transmission, and so right now we should think in terms of two doses.”
Only 6 percent of the population has received both doses of a vaccine, and at the current rate, about 25 percent of the population will be fully vaccinated by April 30, according to the Brown University tracker. If nothing were to change, that timeline puts America achieving herd immunity at the end of November or early December.
[editor’s note: Post-vaccination observation period may not be necessary for Johnson & Johnson Covid-19 vaccine ]
Pfizer director Dr. Scott Gottlieb explains how a third Covid shot may protect against variants – CNBC
- Pfizer is exploring two paths to boost vaccine protection against Covid variants, according to board member Dr. Scott Gottlieb.
- The first is a study involving a booster shot using the existing vaccine formulation.
- Gottlieb said the second is a modified version designed to provide broad defense against a range of mutations, including the one first found in South Africa.
US likely to see surge in Covid-19 cases by mid-March due to variant, epidemiologist says – CNN
[editor’s note: I place high probability on a surge. We are currently seeing a reversal of trends in new cases, hospitalizations and deaths]
Epidemiologist Michael Osterholm says that while the United States is in a downward trend with coronavirus cases, he expects an increase in cases to occur in the next few weeks due to a highly contagious variant first detected in the United Kingdom.
“We’re seeing the B.1.1.7, or the UK variant, double about every 10 days in this country,” Osterholm said on CNN’s “New Day.”
“It often takes four, six, even eight weeks of this virus circulating before it really takes off, going from kind of the small little brush pile fire to a large forest fire,” said Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.Osterholm said he is concerned once we get to around the third week of March.
He also said he is worried that millions of people age 65 and older may not have had their first shot of vaccine by the end of March, and he suggested that health authorities target that population for at least a single dose.
“We have the compelling data that they have remarkable responses after a single dose … So to me, it’s a no brainer, but we’ve got to act on it soon because this variant isn’t waiting for us to get our act together,” Osterholm said.
The following are foreign headlines with hyperlinks to the posts
German Chancellor Angela Merkel warned of a potential third wave in the country due to COVID-19 variants.
Britain’s national medical director criticized Gwyneth Paltrow’s high-priced treatment for long COVID, stating that “serious science” should be applied.
‘No Cheering’: Tokyo Olympic Organizers Release Guidelines For Torch Relay
China’s Bid to Stop Wuhan COVID-19 Spread Cut Deaths From Other Causes: Study
New infections in Europe have fallen to half their winter peak, W.H.O. says.
The Pfizer vaccine’s initial success holds up in wider use, a study finds.
A debate over a ‘vaccine passport’ to allow travel in the E.U. grows.
To blunt surge in cases, Poland tightens rules on what counts as a mask.
France may impose regional restrictions as infections rise sharply.
Hungary facing “most difficult two weeks” of the pandemic so far, prime minister says
European Health Commissioner says EU’s goal is to vaccinate 70% of adults by summer
UK Covid-19 cases fall nearly 80% in 6 weeks of lockdown
Guatemala authorizes emergency use of Russia’s Sputnik V vaccine
Finland to enter a 3 week lockdown on March 8
The following additional national and state headlines with hyperlinks to the posts
Government Borrowing Jumps by Most on Record in Covid Pandemic
Macroeconomics: shipping enjoys a higher trade multiplier as 2021 promises a slow recovery
Fry’s Electronics is no more, permanently closing all stores
Traveling without quarantine? It may soon be possible with new airline industry app
Vaccine Ad Campaign: A new public service ad campaign aims to convince Americans to get vaccinated, telling them “It’s Up to You.”
California’s Death Toll; Los Angeles County has reported more than 800 deaths during the winter coronavirus surge, updating its count using backlogged records, pushing California’s toll above 50,000, or about one-tenth of the U.S. total from the pandemic.
Federal Relief Package: Republicans rallied solidly against Democrats’ proposed $1.9 trillion COVID-19 relief bill. Lawmakers are also awaiting a decision by the Senate’s parliamentarian that could bolster or potentially kill a pivotal provision hiking the federal minimum wage.
‘Long-haulers’ to be subjects of nationwide initiative
Moderna said it sent a new COVID-19 vaccine targeting variant B.1.351 to the NIH for clinical testing.
Pfizer/BioNTech will test a third dose of its injection to provide better protection against emerging variants.
The FDA warned against compounding remdesivir for COVID-19 because of “complexities related to the quality and sourcing” of the active ingredient; and pharmacies shouldn’t produce thymosin alpha-1 for COVID, either, because it’s not approved at all.
During the pandemic more teens have gone to the hospital for mental health care, with rates of suicidal thinking and behavior up 25% from last year in this age group.
Scammers posing as Pfizer and Moderna have created sham websites to trick people into buying COVID shots online.
Pentagon, FEMA open mass vaccination sites in Texas and New York
CDC urges masks, better ventilation in gyms
Vaccine distribution to jump 40 percent next week, UPS executive says
Los Angeles County orders extra $5 an hour in ‘hero pay’ for grocery workers
Jobless claims fall sharply to 730K as weather, fraud distort data
Most Severe COVID Tied to Four Cardiometabolic Conditions
Pet Cats Highly Susceptible to SARS-CoV-2
California has passed the 50,000-death mark, the most of any state.
After months of despair, a big drop in virus deaths at nursing homes.
More than 120,000 virus cases have been linked to American colleges since the start of 2021.
Jimmy and Rosalynn Carter, newly vaccinated, return to church in Georgia.
A study, published in the CDC’s Morbidity and Mortality Weekly Report, studied two separate outbreaks that occurred three months apart at a facility in Kentucky. Five residents tested positive during both outbreaks while testing negative multiple times in between, suggesting they were reinfected with the virus. Those residents experienced worse symptoms the second time around compared with the first, researchers found, suggesting “the possibility that disease can be more severe during a second infection.” Though Covid-19 reinfections are expected, they are generally rare, the CDC says.
A CNBC + Acorns Invest in You survey found that 40% of Americans have taken an emergency financial action during the pandemic, including tapping into emergency savings, borrowing money from family or friends, and visiting a food bank.
Covid-19 vaccine shots administered as second doses outpace first doses in US, CDC data shows
US health leaders are preparing for all scenarios — including another wave of Covid-19 cases
New evidence that Covid-19 antibodies lower risk of re-infection
Today’s Posts On Econintersect Showing Impact Of The Pandemic With Hyperlinks
January 2021 Headline Pending Home Sales Significantly Decline
February 2021 Kansas City Fed Manufacturing Expands At A Faster Pace
20 February 2021 New York Fed Weekly Economic Index (WEI): Index Modest Decline Continues
Headline Durable Goods New Orders Improved Again In January 2021
Second Estimate 4Q2020 GDP Growth Marginally Improves But Remains Deep In Contraction Year-over-Year
20 February 2021 Initial Unemployment Claims Rolling Average Improves
February 2021 Chemical Activity Barometer Index Improves
Infographic Of The Day: How Global Health And Wealth Has Changed Over Two Centuries
Vaccine Inequality Would Create Added Misery For All And Trillions Additional Costs
Warning to Readers
The amount of politically biased articles on the internet continues to increase. And studies and opinions of the experts continue to contradict other studies and expert opinions. Honestly, it is difficult to believe anything anymore.
I assemble this coronavirus update daily – sifting through the posts on the internet. I try to avoid politically slanted posts (mostly from CNN, New York Times, and the Washington Post) and can usually find unslanted posts on that subject from other sources on the internet. I wait to publish posts on subjects that I cannot validate across several sources. But after all this extra work, I do not know if I have conveyed the REAL facts. It is my job to provide information so that you have the facts necessary – and then it is up to readers to draw conclusions.
Analyst Opinion of Coronavirus Data
There are several takeaways that need to be understood when viewing coronavirus statistical data:
- The global counts are suspect for a variety of reasons including political. Even the U.S. count has issues as it is possible that as much as half the population has had coronavirus and was asymptomatic. It would be a far better metric using a random sampling of the population weekly. In short, we do not understand the size of the error in the tracking numbers.
- Just because some of the methodology used in aggregating the data in the U.S. is flawed – as long as the flaw is uniformly applied – you establish a baseline. This is why it is dangerous to compare two countries as they likely use different methodologies to determine who has (and who died) from coronavirus.
- COVID-19 and the flu are different but can have similar symptoms. For sure, COVID-19 so far is much more deadly than the flu. [click here to compare symptoms]
- From an industrial engineering point of view, one can argue that it is best to flatten the curve only to the point that the health care system is barely able to cope. This solution only works if-and-only-if one can catch this coronavirus once and develops immunity. In the case of COVID-19, herd immunity may need to be in the 80% to 85% range. WHO warns that few have developed antibodies to COVID-19 when recovering from COVID-19. Herd immunity does not look like an option without immunization although there is now a discussion of whether T-Cells play a part in immunity [which means one might have immunity without antibodies]
- Older population countries will have a significantly higher death rate as there is relatively few hospitalizations and deaths in younger age groups..
- There are at least 8 strains of the coronavirus. New York may have a deadlier strain imported from Europe, compared to less deadly viruses elsewhere in the United States.
- Each publication uses different cutoff times for its coronavirus statistics. Our data uses 11:00 am London time. Also, there is an unexplained variation in the total numbers both globally and in the U.S.
What we do or do not know about the coronavirus [actually there is little scientifically proven information]. Most of our knowledge is anecdotal, from studies with limited subjects, or from studies without peer review.
- How many people have been infected as many do not show symptoms?
- Masks do work. Unfortunately, early in the pandemic, many health experts — in the U.S. and around the world — decided that the public could not be trusted to hear the truth about masks. Instead, the experts spread a misleading message, discouraging the use of masks.
- Current thinking is that we develop 5 months of immunity from further COVID infection.
- The Moderna and Pfizer vaccines have an effectiveness rate of about 95 percent after two doses. That is on par with the vaccines for chickenpox and measles. The 95 percent number understates the effectivenessas it counts anyone who came down with a mild case of Covid-19 as a failure. But turning Covid into a typical flu — as the vaccines evidently did for most of the remaining 5 percent — is actually a success. Of the 32,000 people who received the Moderna or Pfizer vaccine in a research trial, only one contracted a severe Covid case.
- To what degree do people who never develop symptoms contribute to transmission? Research early in the pandemic suggested that the rate of asymptomatic infections could be as high as 81%. But a meta-analysis, which included 13 studies involving 21,708 people, calculated the rate of asymptomatic presentation to be 17%.
- The accuracy of rapid testing is questioned – and the more accurate test results are not being given in a timely manner.
- Can children widely spread coronavirus? [current thinking is that they are a minor source of the pandemic spread]
- Why have some places avoided big coronavirus outbreaks – and others hit hard?
- Air conditioning contributes to the pandemic spread.
- It appears that there is increased risk of infection and mortality for those living in larger occupancy households.
- Male patients have almost three times the odds of requiring intensive treatment unit (ITU) admission compared to females.
- Outdoor activities seem to be a lower risk than indoor activities.
- Will other medical treatments for Covid-19 ease symptoms and reduce deaths? So far only remdesivir, Bamlanivimab,
and Regeneron) are approved for treatment. What drugs work?
Arthritis drugs tocilizumab and sarilumab could cut relative risk of death of those in intensive care by 24%
- A current scientific understanding of the way the coronavirus works can be found [here].
There is now a vaccine available – the questions remain:
- how effective it will be in the general population,
- will there be any permanent side effects that will appear months from now,
- how long immunity will last [we can currently say we do not know if it will last more than 4 months],
- there is no evidence the vaccine will block transmission
Heavy breakouts of coronavirus have hit farmworkers. Farmworkers are essential to the food supply. They cannot shelter at home. Consider:
- they have high rates of respiratory disease [occupational hazard]
- they travel on crowded buses chartered by their employers
- few have health insurance
- they cannot social distance and live two to four to a room – and they eat together
- some reports say half are undocumented
- they are low paid and cannot afford not to work – so they will go to work sick
- they do not have access to sanitation when working
- a coronavirus outbreak among farmworkers can potentially shutter entire farm
The bottom line is that COVID-19 so far has been shown to be much more deadly than the data on the flu. Using CDC data, the flu has a mortality rate between 0.06 % and 0.11 % Vs. the coronavirus which to date has a mortality rate of 4 % [the 4% is the average of overall statistics – however in the last few months it has been hovering around 1.0%] – which makes it between 10 and 80 times more deadly. The reason for ranges:
Because influenza surveillance does not capture all cases of flu that occur in the U.S., CDC provides these estimated ranges to better reflect the larger burden of influenza.
There will be a commission set up after this pandemic ends to find fault [it is easy to find fault when a once-in-a-lifetime event occurs] and to produce recommendations for the next time a pandemic happens. Those that hate President Trump will conclude the virus is his fault.
Resources:
- Get the latest public health information from CDC: https://www.coronavirus.gov .
- Get the latest research from NIH: https://www.nih.gov/coronavirus.
- Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/.
- List of studies: https://icite.od.nih.gov/covid19/search/#search:searchId=5ee124ed70bb967c49672dad
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