Written by Steven Hansen

The U.S. new cases 7-day rolling average is 25.0 % HIGHER than the 7-day rolling average one week ago. U.S. deaths due to coronavirus are now 11.7 % HIGHER than the rolling average one week ago. U.S. hospitalizations due to COVID-19 are now 12.7 % HIGHER than the rolling average one week ago. Today’s headlines include:

• U.S. Sets Coronavirus Record With Daily New Cases Pushing Past 130,000
• Coronavirus Mutation Concern Verified by Largest COVID-19 Viral Sequence Analysis in U.S.
• WHO is hunting for the coronavirus’s origins. Here are the new details
• What Is In The Future For COVID-19 Therapies
• COVID-19 Shortages Prompt Tough Decisions at Bedside
• Indoor concerts may be made safe from coronavirus spread
• China’s propaganda machine rolls out praise for Wuhan
• The colleges with virtually no coronavirus cases

The recent worsening of the trendlines for new cases should be attributed to going back to college/university, cooler weather causing more indoor activities, possible mutation of the virus, fatigue from wearing masks / social distancing, holiday activities, and continued loosening of regulations designed to slow the coronavirus spread.

My continuing advice is to continue to wash your hands, 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.

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Hospitalizations (grey line) and Mortality (green line) For Week ending 24OCT2020

source: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html

Coronavirus News You May Have Missed

The WHO is hunting for the coronavirus’s origins. Here are the new details. – National Geographic

Disease detectives who have worked on similar hunts say the investigation is business as usual—but now with advanced tools and techniques that should aid the process.

… The months-long delay in starting this investigation has raised criticism from public health researchers and world leaders, such as U.S. President Donald Trump, who have accused the WHO of being too deferential to China’s wishes. During the first phase of the search, a WHO team won’t be present for the on-the-ground surveys and will only review and discuss data collected by Chinese researchers. Some reports have described this arrangement as the WHO ceding responsibility, given the organization is sponsored by individual nations and China is its second-biggest funder after the United States.

But disease detectives who have worked on similar hunts say this is business as usual. The WHO lacks the staffing—with 7,000 employees spread across 150 countries—to conduct a full-scale investigation on its own and always relies on national teams or international volunteers for field work.

… For COVID-19, the most crucial piece of this enterprise would involve testing biological samples—such as blood—that are routinely collected and stored at hospitals. Researchers would study samples from both before and after the coronavirus outbreak was publicly declared in late December 2019. Ideally, this retrospective survey would extend throughout China and into neighboring countries.

… Of the 336 animals sampled at the Wuhan market, none tested positive for SARS-CoV-2. By contrast, 8 percent of the environmental swabs—many involving drains and sewage—carried the virus.

… Raina MacIntyre, an infectious diseases expert and professor at the University of New South Wales in Australia, says Chinese scientists have already done significant research on the potential animal origins of the SARS-CoV-2 virus. China and other countries have contributed genetic sequences of the coronavirus collected from humans to a database for tracking the germ’s evolution. By comparing entries, multiple research groups have reached the conclusion that the novel coronavirus “has probably come from bats, perhaps through an intermediary animal host,” MacIntyre says.

The multitude of SARS-esque viruses that horseshoe bats retain make them a prime suspect in the current pandemic’s origins. And those nocturnal cave dwellers are not only found in China but in the bordering countries of Myanmar, Laos, and Vietnam. “We need a WHO-sponsored international collaborative network, like the one we had in 2003, and we need to seriously consider investigations beyond China,” Wang says.

[editor’s note: this post deserves a full read]

Indoor concerts may be made safe from coronavirus spread – The Hill

There’s a lot of things to miss about the Before Times, and most of them include crowds of people. For music lovers, it’s that unique experience of bonding with complete strangers over art and a little bit of sweat. But will it ever be safe to have them again?

A new preprint by German researchers suggests it will, as long as organizers take all of the recommended safety precautions — and attendees follow them. And if you’ve ever been to a concert, you know the caveat is not insignificant.

A disclaimer: The preprint has not yet been peer reviewed, meaning that the results haven’t been replicated or reviewed, nor the model used in the experiment. But these sorts of studies can help guide future research — and give concertgoers just a touch of hope.

To learn more about the risks, researchers held a concert of their own, a test event in Leipzig, Germany, where the coronavirus pandemic has rebounded and the government has ordered a second lockdown

All the participants and staff tested negative for the coronavirus within two days of the event and wore N95 masks. The arena was divided into three different scenarios, one with no restrictions, one with moderate social distancing restrictions and one with strict restrictions. The results were promising, suggesting “low to very low” impact on the spread of coronavirus under specific conditions: adequate ventilation, strict hygiene protocols, social distancing and limited capacity.

“There is no argument for not having such a concert,” Michael Gekle, part of the team at Martin Luther University Halle-Wittenberg who conducted the study, said in an interview. “The risk of getting infected is very low.”

Coronavirus Mutation Concern Verified by Largest COVID-19 Viral Sequence Analysis in U.S. – SciTechDaily

Before COVID-19 first entered the United States in March, Houston Methodist Hospital had already begun preparations to test for and sequence the virus on a large scale, given the news coming out of Wuhan, China.

Between March 5, when the first case turned up in metropolitan Houston, and July 7, physician/researchers at Houston Methodist sequenced the genome of over 5,085 strains of the virus. These accounted for nearly 10 percent of the COVID-19 cases that came through the 2,400-bed Houston Methodist health system, during two distinct waves that occurred in that time frame.

“99 percent isn’t 100 percent. If there is a mutation that accounts for just one percent of the population, and you suppress or eradicate the majority, you can drive up some trait of that one percent, whether it’s virulence or transmissibility, and then it’s a different ballgame.” — James Davis, Argonne staff scientist

During the earliest parts of the pandemic, March through April, Gly614 was just one variant among many others. But during the second wave in May, Davis recalls, all of the cases they were sequencing at Houston Methodist showed that Gly614 had proliferated to the point of becoming the dominant amino acid in the spike protein.

In fact, it was found in over 99 percent of the sequenced variants.

“The SARS-CoV-2 virus is remarkably conserved, so whenever you see changes like this it’s more remarkable because you don’t tend to see that many mutations,” he said. ​”I’m not sure if it makes the virus more virulent or easier to transmit, but the study does show some data suggesting that patients with the Gly614 mutation have a larger viral load, though they aren’t necessarily sicker.”

Coincident with the Gly614 takeover in the second wave, patients tended to be younger, showed less severe symptoms, were more likely to be Hispanic/Latino, and lived in areas of lower median incomes. Still, the reasons were unclear and they’d hoped that Argonne’s computational resources would open a door on the causes.

… This research appears in the article ​”Molecular Architecture of Early Dissemination and Massive Second Wave of the SARS-CoV-2 Virus in a Major Metropolitan Area,” in mBio, October 30, 2020. Maulik Shukla, of both Argonne and the University of Chicago, was among the co-authors.

Read Coronavirus Genetic Mutation May Have Made COVID-19 More Contagious for more on this research.

Biden Victory: What It Means for COVID, Healthcare – Medscape

Joe Biden’s victory sets the stage for healthcare to become a high-profile priority of his presidency.

The former vice president has sketched out a big health agenda: ramping up the federal response to COVID-19, boosting the Affordable Care Act, creating a new “public option” to cover uninsured Americans, and expanding Medicare and Medicaid.

But the president-elect’s long to-do list on health is likely to face significant roadblocks in Congress and the courts, experts say.

For instance, Biden’s ambitious proposals on COVID-19 — including his recent call for a national mask mandate — could be waylaid by legal challenges and run into political hurdles on Capitol Hill, where he may face a divided Congress.

Here’s a closer look at what we can expect from a Biden presidency:

… Biden will move to federalize the response to COVID-19. He has said he will take back major responsibilities from the states — such as setting national policies on mask wearing, social distancing, and the reopening of schools and businesses, based on CDC guidance. In the days leading up to the election, Biden called for a national mask mandate, after waffling on the issue throughout the summer.

… national mandates on masks and social distancing will be challenging to enforce, experts say. They are also likely to face pushback from business interests, opposition from public officials in GOP-led states, and even legal challenges.

Biden’s ability to work with Congress — or not — may determine whether he is able to implement some of the key components of his coronavirus action plan, which includes:

• Providing free COVID-19 testing for all Americans
• Hiring 100,000 contact tracers
• Eliminating out-of-pocket expenses for coronavirus treatment
• Delivering “sufficient” PPE for essential workers
• Supporting science-backed vaccines and medical treatments being developed
• Requiring the reopening of businesses, workplaces, and schools only after “sufficient” reductions in community transmission — under evidence-based protocols put forward by the CDC
• Giving emergency paid leave for workers dislocated by the pandemic and more financial aid for workers, families, and small businesses
• Shoring up safeguards to protect at-risk Americans, including older people
• Boosting pay for healthcare workers on the front lines

China’s propaganda machine rolls out praise for Wuhan, ignoring officials’ mistakes. – New York Times

Wuhan, once synonymous with the devastation that the coronavirus could wreak, has become the subject of glowing paeans across Chinese media, lauded by officials as a symbol of the country’s resilience in the outbreak’s aftermath.

Propaganda agencies have churned out the television tributes to the city, where the outbreak first emerged, while the national Ministry of Culture and Tourism sponsored a new opera about its doctors.

Wuhan is getting such attention as a city of heroes in part because it has truly made a remarkable recovery. The city, with its packed pool parties and crowded amusement parks, is now proof of the country’s broader recovery. Cases there and nationwide now hover near zero.

But the acclamation is also part of a campaign by the Chinese government to position Wuhan — and by extension China — as a global emblem of superior governance. It’s a propaganda push designed to help sand away any lingering public anger over the government’s costly missteps in the early weeks of the pandemic.

Fauci, NIAID Look to Past to Inform Future of COVID-19 Therapies – MedPage

n developing therapeutic agents for COVID-19, researchers learned from the lessons of past viruses, from HIV to Ebola to even flu, experts at an NIH webinar said.

Clinical agents in development for SARS-CoV-2 include antivirals and host targeted/immunomodulators, as well as neutralizing monoclonal antibodies. And randomized trials are still the best way to determine whether they work, experts said.

The Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) series of trials are public-private partnerships. ACTIV-1 studies host-targeted immune modulators, ACTIV-2 and ACTIV-3 concentrates on neutralizing antibodies and oral antivirals, ACTIV-4 targets anticoagulants and antiplatelet drugs, and ACTIV-5 (the “Big Effect Trial”), a phase II proof of concept study looks at “multiple promising treatments.”

But antivirals are still desperately needed, as only remdesivir (Veklury) has been approved by the FDA to treat COVID-19.

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), discussed prior experience in studying the replication cycle for the HIV virus. He added that discovering “all vulnerable points of intervention” eventually led to a host of antiretroviral therapies against the disease, including nucleoside/nucleotide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitors.

While acknowledging that chronic HIV infection was different from acute infection with SARS-CoV-2, he said the replication cycle was comparable and each virus can “provide vulnerable targets in the replication cycle” for which to develop drugs.

The colleges with virtually no coronavirus cases – National Geographic

In contrast to the pandemic drama playing out at colleges and universities across the country, a handful of schools, including Sarah Lawrence, have kept the disease at bay. Some of these schools are public, others private. All have created their own small public health infrastructures, sharing cohesive public health messaging and implementing COVID-19 testing regimens to stop the virus from spreading on their campuses.

At Sarah Lawrence, a seemingly carefree atmosphere belies months of planning. This past summer, college president Cristle Collins Judd started thinking about what the fall would look like on her campus. When fall arrived, the college had received a makeover that was nearly invisible from the outside, except for posted signs reminding students to wear masks and circles painted on the lawn to indicate the best places to sit for proper social distancing.

Only about 35 percent of the undergraduate student body now lives on campus, down from 84 percent last year. Most of these students are freshmen. They had to provide their COVID-19 test results within two weeks of arrival, and they have continued to undergo what Judd calls “surveillance testing” at monthly intervals throughout the semester.

[editor’s note: this post is hard to summarize and deserves a full read]

COVID-19 Shortages Prompt Tough Decisions at Bedside – Medscape

Choosing which hospitalized COVID-19 patients receive potentially lifesaving care, making urgent calls for ventilators and other equipment, and triaging care based on patient age and comorbidities were among the challenges revealed in new feedback from healthcare leaders and frontline workers.

Even though many hospitals have contingency plans for how to allocate resources and triage patient care during crisis capacity, for many providers during the real-world COVID-19 trial of these protocols, they fell short.

Many hospital crisis capacity plans, for example, were too general to address all the specific challenges arising during the pandemic, investigators report in a study published online today in JAMA Network Open.

“Our research shows that the types of challenges and approach to resource limitation in real-world clinical settings during the pandemic differed in practice from how we had prepared in theory,” lead author Catherine Butler, MD, told Medscape Medical News. Insufficient dialysis treatment time, staff shortages, and routine supply scarcity are examples “for which there was not an established plan or approach for appropriate allocation.”

“This left frontline clinicians to determine what constituted an acceptable standard of care and to make difficult allocation decisions at the bedside,” added Butler, acting instructor in the Division of Nephrology at the University of Washington in Seattle and a research fellow at the VA Health Services Research and Development Seattle-Denver Center of Innovation.

The qualitative study included comments from respondents on three major themes that emerged: planning for crisis capacity, adapting to resource limitation, and the multiple unprecedented barriers to care delivery.

Overall, planning and support from institutional leaders varied. One provider said, “Talking to administration, and they just seemed really disengaged with the problem. We asked multiple times if there was a triage command center or a plan for what would occur if we got to the point where we had to triage resources. They said there was, but they wouldn’t provide it to us.”

… Multiple providers said they faced difficult care decisions because of limited dialysis or supply shortages. “They felt that this patient had the greatest likelihood of benefitting from most aggressive therapy…I think there was probably like 5 or 6 patients in the ICU…and then you had this 35-year-old with no comorbidities,” one respondent said. “That’s who the ICU dialyzed, and I couldn’t really disagree.”

… Another respondent understood the focus on ventilators and ICU beds throughout the crisis, but said, “no one has acknowledged that dialysis has been one of the most, if not the most, limited resources.”

… COVID-19 has naturally changed how clinicians speak with families. One respondent recalled looking at the ICU physician and being like, ‘Have you talked to the son this week?’ And she’s like, ‘Oh my God, no…Did you talk to the son?’ I’m like, ‘Oh my God, no.’ ” They realized, the respondent added, “that none of us had called the family because it’s just not in your workflow. You’re so used to the family being there.”

… The study was partially funded by grants from the National Institute of Diabetes and Digestive and Kidney Diseases and a COVID-19 Research Award from the University of Washington Institute of Translational Health Sciences given to Butler.

JAMA Network Open. Published online November 6, 2020. Full text

The following are foreign headlines with hyperlinks to the posts

Britain records 24,957 new coronavirus cases – just 14% up on last week – and 413 new deaths bringing total to 48,888

Austria reports new daily record of 8,241 COVID-19 cases

Iran sets new daily record for COVID-19 cases

Bosnian Prime Minister Tegeltija tests positive for COVID-19

2 Real Madrid players test positive for COVID-19

UK bans Denmark visitors over mink Covid-19 fears

The following are additional national and state headlines with hyperlinks to the posts

White House chief of staff Mark Meadows tests positive for coronavirus

One State Forced to Change Its Masking Strategy

Oregon Gov. Orders 2-Week ‘Pause’ of Counties with Rising COVID-19 Cases

Here’s how President-elect Biden’s transition team is preparing to tackle the virus, which is raging as never before.

Driven by surges in the U.S. and Europe, global infections approach 50 million, with a daily death toll averaging 7,500.

Matt Gaetz, a congressman with close ties to the White House, said he tested positive for antibodies this week.

Six White House aides, including Trump’s chief of staff, have the coronavirus.

A California city says the police can remove maskless customers from stores. The police aren’t so sure.

Hundreds of infections can be traced to the Sturgis motorcycle rally, but its full impact may never be clear.

Biden will get a surprisingly strong jobs market when taking over as president

Illinois Gov. Pritzker self-isolating after possible coronavirus exposure

Trader Joe’s discloses coronavirus infection rates after report highlights grocer risk

Today’s Posts On Econintersect Showing Impact Of The Pandemic With Hyperlinks

Shutdown Or Not Leads To The Same Road

Millions Still Haven’t Gotten Stimulus Checks, Including Many Who Need Them Most

US Unilateralism, China Multilateralism, And The Real COVID-19

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