COVID-19 Research Roundup 2: 9/12/20–9/18/20

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Greenlight

25 min readNov 10, 2020

Summaries from new articles and research papers exploring COVID-19, disparities, schools, novel treatments, and prevention strategies for 9/12/20–9/18/20.

Greenlight’s weekly deep dives our brought to you through our partnership with the Pandemic Response Network.

Overview

Executive Summary
Important Statistics/Quotes
COVID-19 & the Education System
Disparities Among Race, Ethnicity, & Geography
Infection Prevention and Treatment Strategies
The Race for a Vaccine
Infection Rates and Disease Course in Children
Live Trackers/Important Links

Executive Summary

Pfizer and Moderna released their clinical trial protocols under pressure by researchers for increased transparency. Astrazeneca resumed their COVID-19 vaccine trial after one participant developed a serious inflammatory condition. U.S. hospitals are turning down the full supplies of remdesivir allocated to them, while only administering the drug in severe and critically ill COVID-19 patients and stocking up on supplies for a potential pandemic acceleration during the winter months. Eli Lilly stated that its monoclonal antibody reduced hospitalization in COVID-19 patients who initially experienced mild to moderate symptoms. Centers for Disease Control and Prevention (CDC) director Robert Redfield stated that the majority of the American public will likely not have access to a COVID-19 vaccine until late spring or summer of 2021. Europe is disseminating a message of learning “how to live with the virus,” after acknowledging an inability to completely eliminate transmission or quickly develop a vaccine. Researchers are examining the design of studies of mononucleosis in college students for potential for robust prospective analysis of the so-called “long-COVID”, in which symptoms persist for weeks to months after an individual was infected. One study found significantly different clinical symptoms in COVID-19 as compared with influenza A and B, including increased rates of presentation with fever, diarrhea or vomiting, headache, body ache or myalgia, and chest pain.

Children attending school are increasingly a cause for concern in regards to transmitting COVID-19, with many kids showing no symptoms. School districts are also facing a whirlwind of challenges aside from the health concerns brought by COVID-19, including adherence to building safety standards, balancing on-screen time, and bolstered teacher staffing to meet new classroom requirements.

Guidance and recommendations were drafted for the process of COVID-19 vaccine allocation in an attempt to properly address inequity and vulnerability among populations. Developing countries, including South Africa, Ghana, Senegal, and Pakistan, are pushing to limit patent protections for Covid-19 vaccines so that lower-cost, generic alternatives to the vaccines now being tested by large pharmaceutical companies such as Pfizer Inc., AstraZeneca PLC and Moderna Inc., will be available.

Important Statistics/Quotes

IgG antibody titers are detectable 7–10 days after infection and peak at approximately 49 days. SARS-CoV-2-activated T cell responses appear within the first week of infection, peak within two weeks after infection, and can remain at detectable levels up to 100 days after infection.
Centers for Disease Control and Prevention (CDC) director Robert Redfield stated on Wednesday that the majority of the American public will likely not have access to a COVID-19 vaccine until late spring or summer of 2021.
“I agree 100 percent. That’s part of why we have really been pushing to have a decision-making matrix that helps us communicate why it’s safe to be back, by looking at the data. But yes, it’s a crazy world when we’re saying it’s not safe for teachers but people who make $15 to $20 an hour can come back. I’ve said to my teachers, I’ve said to my school board, “I don’t want to be the leader of an organization that believes that.” — Cordova
“The drive to pursue education was based not on any guarantee that it would lead to a job, but because we knew that education was the key to freedom and empowerment in this country. It still is.” — Noguera
“We really are trying to make sure that people of colour, who have been disproportionately impacted, will also have priority — but for the factors that put them at risk, not highlighting just their racial and ethnic makeup,” — Helene Gayle, co-chair of the United States National Academies of Sciences, Engineering, and Medicine committee

Headlines from this Week

Researchers Urged Vaccine Companies to Release Clinical Trial Protocols, Pfizer and Moderna Complied. The New York Times. The Washington Post.

On Saturday, September 12, The New York Times released an article titled “Vaccine Makers Keep Safety Details Quiet, Alarming Scientists,” highlighting the fact that protocols for the Phase 2/3 COVID-19 vaccine clinical trials being conducted by AstraZeneca and Pfizer had not been made public, despite continued pressure from researchers for their release. A poll by the Kaiser Family Foundation the previous week indicated that 62% of Americans are worried the Food and Drug Administration (FDA) will rush to approve a COVID-19 vaccine without adhering to adequate safety and efficacy standards, under intense political pressure by the Trump Administration. Experts have said that low rates of vaccine confidence could be partially assuaged by increased transparency of clinical trials. Recent events, including the lack of public disclosure of the pausing of the AstraZeneca clinical trial after a participant developed a serious inflammatory condition, and the plan of expansion of the Pfizer clinical trial to include 14,000 additional participants, without details for how the safety and efficacy of their vaccine will be analyzed with such an expansion, heightened worry and increased calls for the companies to release their protocols. Specifically, researchers like to be able to examine the trials’ statistical analysis plans, guidelines for interim analyses of early results by independent boards, guidelines for early termination of the trials, and thus guidelines for application of FDA emergency authorization of a vaccine.

On Thursday, September 17, Pfizer and Moderna released the protocols and statistical analysis plans behind their vaccine clinical trials, citing the need for greater transparency in the face of the COVID-19 pandemic. There is precedent for the public release of clinical trial protocols. The RECOVERY trial being run by the University of Oxford, which determined the therapeutic benefit of dexamethasone, has released its protocol and statistical analysis plans. The protocols from Pfizer and Moderna outline specific guidelines for interim analyses of vaccine efficacy, at specific numbers of participant infections with COVID-19. Interim analyses and the possibility of early approval by the FDA based on the early results of an interim analysis have been the focus of much media coverage. However, experts warn that early approval of a vaccine candidate based on interim analysis of clinical trial data is the exception rather than the norm. Furthermore, many experts stress the need for interim analyses from independent boards free from political pressure. The logical grounds for early approval are not just that the vaccine is very efficacious, but also that it is reasonable to consider it unethical to continue the clinical trial, due to the significantly high level of vaccine efficacy.

Will this be a Lost Year for America’s Children? The New York Times.

School districts, and the American education system in general, are facing an array of challenges; however, many schools have found that their bundles of issues are unique to the individual student and teacher, making them harder to address fully. While COVID-19 outbreaks have been of high concern within schools, it is impossible to enforce full closures as shutting down all schools and going completely remote may inflict other serious costs: a loss of learning and a lack of social-emotional development within kids. This slowed or lower educational attainment can translate to lower earnings, worse health problems, and shorter life spans later in life.

Furthermore, these detrimental affects are exponentially greater within marginalized communities. Students in high-poverty districts are the most likely to start the year with fully remote learning, indicating a reduced assurance of information retainment and appropriate social-emotional development. In fact, ⅔ to ¾ of teachers said their students were less engaged during remote instruction than before the pandemic. Further, instructors of low-income students and students of color were also more likely to report that their students were not regularly engaged in remote learning. This equates to a projected lost education time of 9 months on average for Latino students and 10 months for African-American students. Some students are not even able to access their remote curriculum with nearly 8 million kids left without any internet access at home.

What has come of these critical discussions is the conclusion that the United States needs a national commitment to make up for the pandemic’s affects on the education system; it is now more critical than ever to address the inequities within schools. This is the time to “humanize education” and meet the kids where they are at.

Plans for COVID-19 Vaccine Production and Allocation: Addressing inequity and vulnerable populations. The Wall Street Journal. Nature.

A group of developing countries, backed by United Nations agencies and activist groups, is pushing to limit patent protections for Covid-19 vaccines being tested by some of the world’s biggest pharmaceutical companies so that inexpensive copies can be produced for poorer nations. Many countries, including South Africa, Ghana, Senegal, and Pakistan, argue that they will be unable to protect their people without lower-cost, generic alternatives to the vaccines now being tested by companies such as Pfizer Inc., AstraZeneca PLC and Moderna Inc. That stance puts the countries at odds with the pharmaceutical industry, which says it supports wide distribution of the vaccines but warns that allowing drugs to be copied would undermine innovation and raise the risk of unsafe vaccines.

Last week, an advisory group at the World Health Organization (WHO) weighed in to a draft plan from a panel at the United States National Academies of Sciences, Engineering, and Medicine (NASEM) offering preliminary guidance and recommendations for global vaccine allocation. The WHO’s guidance identified groups that should be prioritized in receiving early access, which are ranked within the five-tier plan drafted from NASEM and requested by the U.S. Center for Disease Control (CDC) and National Institute of Health (NIH). Many nations have general vaccine allocation plans already, most of which are tailored instead to an influenza pandemic and typically prioritize children and pregnant women. However, the historic scale and unique epidemiology of COVID-19 calls for a different plan. At the top are health-care workers, followed by medically vulnerable groups, including older people living in crowded settings and individuals with multiple existing conditions at high risk for serious COVID-19 infection. Following them is essential workers, people who live in certain crowded settings such as homeless shelters and prisons, and, lastly, the approximately 5–15% remainder of the population.

Spread of COVID-19 in School Settings

Assessment of Mental Health of Chinese Primary School Students Before and After School Closing and Opening During the COVID-19 Pandemic. JAMA Network Open.

In China, the outbreak of COVID-19 took place during the students’ winter vacation while most students were home.
On January 27, China’s Ministry of Education announced that the spring semester would be postponed to late April, affecting 278 million students across the country.
School closures have been associated with mental health problems among students due to the physical isolation from peers, teachers, and other community networks.
Findings consistent with reviews suggesting the association between social isolation and future mental health problems among children and adolescents.

The pandemic is spotlighting longstanding issues with America’s school buildings. Chalkbeat.

America’s school facilities are a national crisis
1 in 3 public school students — some 14 million — were learning in a building in need of extensive repair
Schools struggling to follow the CDC’s recommendations for improving ventilation. Some strategies to mitigate this problem:
Open classroom windows
Place portable air filters
Make sure the building’s ventilation system is working well
Affluent districts spend over $1,000 per student annually on capital construction while high-poverty districts spend around $700 per student

How much online learning is too much? Schools’ shift to live virtual classes sparks pushback. Chalkbeat.

An estimated 85% of school districts nationwide are continuing to offer some remote learning this fall
Remote learning has gone from on-your-own to always-on
Some students are expected to attend online classes with consecutive periods of live video lessons
In Newark, elementary and middle schools must provide 290 to 350 minutes of remote learning each day
In Chicago, teachers union leaders say the district is trying to squeeze too much online learning into the school day
In Broward County in southeastern Florida, district officials promised to reduce the amount of live instruction in the lower grades

New York City Schools Delay In-Person Instruction for Second Time. The Wall Street Journal.

Just days before New York City schools were supposed to start, officials delayed opening for in-person classes — for the second time.
Many schools lacked enough staff to supervise all the children
The nation’s largest school district offered 1 million students the option of fully-remote learning or a hybrid model
Schools serving grades kindergarten through fifth grade and kindergarten through eighth will reopen on Sept. 29
High schools and middle schools serving grades six through eight will begin on Oct. 1
Teacher shortages were the key factor that led to the decision to delay
An additional 10,000 teachers would be needed to meet the city’s demands; the city told principals to try to have three sets of teachers: one set for students in school, another for the same children when they are home, and another for those choosing to learn remotely full time.
The extra weekly cost of running New York City’s public schools will be about $32 million a week

Infection Rates Among Children

Clinical Outcomes in Young US Adults Hospitalized With COVID-19. JAMA Internal Medicine.

Young adults from 18 to 34 years hospitalized with COVID-19 experienced substantial rates of adverse outcomes
21% required intensive care
10% required mechanical ventilation
2.7% died
Morbid obesity, hypertension, and diabetes were common and associated with greater risks of adverse events
Young adults with more than 1 of these conditions faced risks comparable with those observed in middle-aged adults without them.
Most patients requiring hospitalization were Black or Hispanic

Frequency of Children vs Adults Carrying Severe Acute Respiratory Syndrome Coronavirus 2 Asymptomatically (Research Letter). JAMA Pediatrics.

Children have been suggested as the facilitators of SARS-CoV-2 transmission because many affected children might be asymptomatic
In this study, about 1% of children and 9% of adults without any symptoms or signs of SARS-CoV-2 infection tested positive for the virus
Approximately 80% of adults with SARS-CoV-2 are asymptomatic.
Children who are asymptomatic might be 15% of individuals positive for SARS-CoV-2

CDC study: Covid-19 complications killed 121 Americans under age 21 through July. STAT.

Children and young adults with underlying health conditions and those who were Latinx, Black, or American Indian or Alaska Native faced worse outcomes
18- to 20-year-olds accounted for nearly half of the 121 deaths in the group during the time period studied — mid-February to the end of July
10% of fatal cases occurred in children under 1 year old.
75% of the fatal cases were among children and young adults with existing medical problems (i.e. chronic lung diseases like asthma, obesity, neurologic or developmental conditions, or heart conditions)
Incidence of cases among children could change as schools reopen

Emerging Prevention & Treatment Strategies

Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children. JAMA Network Open.

A retrospective cohort study of children diagnosed with COVID-19 and seasonal influenza (mean age of 8.3 and 3.9 years, respectively) at the Children’s National Hospital in Washington, DC between March 25 and May 15, 2020, and October 1, 2019 and June 6, 2020, respectively, indicated lack of statistically significant differences in hospitalization rates, intensive care admission, and mechanical ventilator use.
There were statistically significant differences in clinical symptoms, with higher rates of presentation with fever, diarrhea or vomiting, headache, body ache or myalgia, and chest pain in COVID-19 patients.
There were no differences in presentation with cough or shortness of breath between children diagnosed with COVID-19 and influenza.
Compared with influenza, more COVID-19 patients hospitalized were 15 years or older and more had underlying medical conditions.
There were no reports of co-infection with influenza and SARS-CoV-2.
However, influenza cases detected in the Children’s National Hospital dramatically decreased after school closures and stay-at-home orders took effect during the week of March 23, 2020, suggesting that such co-infection may not have been identified even if it did occur.

AstraZeneca resumes Covid-19 vaccine trials in the U.K. STAT.

The Phase 3 trial of the AstraZeneca COVID-19 vaccine was resumed this week in the U.K after it was previously paused due to a suspected adverse reaction of a participant.
However, the Phase 2/3 or Phase 3 trials in the U.S. and Brazil, and the Phase 1/2 trial in South Africa have not yet been resumed.
The nature of the illness developed by the participant has not been formally disclosed due to privacy concerns, but AstraZeneca CEO Pascal Soriot told the press that symptoms were consistent with transverse myelitis, a serious inflammatory condition affecting the spinal cord.
An independent investigation in the U.K. by the Medicines Health Regulatory Authority (MHRA), the British equivalent to the Food and Drug Administration (FDA) in the U.S., has concluded and indicated that the Phase 3 trials can be continued.

Exclusive: U.S. hospitals turn down remdesivir, limit use to sickest COVID-19 patients. Reuters.

U.S. hospitals have only accepted about two-thirds of the remdesivir supply that state and terrritory public health systems have accepted since July.
Many hospitals have cited adequate supply, as they only treat severe COVID-19 patients requiring oxygen support with the drug.
Additionally, many hospitals are stocking up on remdesivir, in preparation for the potential acceleration of the pandemic in the winter months.
Remdesivir, which costs $3,120 for a 6-vial intravenous course, has been shown to decrease the time to hospital recovery in severe COVID-19 patients.
One study published in JAMA indicated modest benefit to patients that do not require oxygen support, resulting in a change in use recommendations and guidelines from the Food and Drug Administration (FDA).
However, many hospitals have not changed their protocols for remdesivir administration based off of this study.

COVID-19 and the Path to Immunity. JAMA.

A review of short and long term immune responses to SARS-CoV-2 infection presents important roles for both neutralizing antibodies, plasmablasts, and memory B cells in humoral immunity, as well as CD8+ T cells and Th1 CD4+ T cells in cell-mediated immunity.
IgG antibody titers are detectable 7–10 days after infection and peak at approximately 49 days.
SARS-CoV-2-activated T cell responses appear within the first week of infection, peak within two weeks after infection, and can remain at detectable levels up to 100 days after infection.
Reports of reinfection are beginning to arise, 8 months after the beginning of the pandemic, suggesting that sterilizing immunity may be short lived.
However, many reports of reinfection have been associated with asymptomatic or mildly symptomatic cases, suggesting limited SARS-CoV-2 replication and disease severity at reinfection.
Thus, COVID-19 vaccines should target and exploit both induction of high titers of neutralizing antibodies and CD4+ follicular T helper cells in providing clinical protection and reducing disease severity.

Covid-19 Antibody Drug Shown to Reduce Hospitalizations, Eli Lilly Says. The Wall Street Journal.

Eli Lilly has reported that their monoclonal antibody therapy reduced hospitalizations in a study of individuals diagnosed with COVID-19 who initially experienced mild to moderate symptoms.
The study enrolled 302 patients who received the monoclonal antibody and 150 who received a placebo.
1.7% of those receiving antibody and 6% of those receiving placebo were hospitalized due to COVID-19 complications.
These are preliminary results, but suggest the potential for the antibody to have a therapeutic benefit in COVID-19 patients.
Eli Lilly indicated that the therapeutic would be prioritized for high risk individuals such as the elderly and those with higher body mass index (BMI).
The National Institutes of Health (NIH) are additionally conducting clinical trials of Eli Lilly’s monoclonal antibody to determine its efficacy for treatment of hospitalized patients and disease prevention in residents and staff of long term care facilities that have had a confirmed case of COVID-19.

In Global Covid-19 Vaccine Race, Chinese Shot Receives First Foreign Approval. The Wall Street Journal.

The United Arab Emirates (U.A.E.) has approved the Chinese Sinopharm vaccine for emergency use among health workers, after what a spokeswoman for the U.A.E. Foreign Ministry called successful Phase 3 trials in the country.
Other Phase 3 trials of Chinese vaccines are being conducted in Brazil, Morocco, Argentina, Pakistan, and Russia.
The Chinese approach to vaccine development differs from that of many Western developers, many of whom recently signed an agreement to not seek governmental approval to market their vaccine candidate to the public before Phase 3 clinical trials were complete.
Phase 3 results for the Sinopharm vaccine have not yet been made public.

CDC director says coronavirus vaccines won’t be widely available till the middle of next year. The Washington Post.

Centers for Disease Control and Prevention (CDC) director Robert Redfield stated on Wednesday that the majority of the American public will likely not have access to a COVID-19 vaccine until late spring or summer of 2021.
While a vaccine candidate will likely be approved before this time period, it will first be distributed to higher risk groups, such as front line medical workers and individuals in long term care facilities.
Access will be gradually expanded to include those at lower risk of infection and at lower risk of severe disease.

Antigen-specific adaptive immunity to SARS-CoV-2 in acute COVID-19 and associations with age and disease severity. Cell.

SARS-CoV-2-specific CD4+ and CD8+ T cells were associated with milder forms of the disease.
SARS-CoV-2-specific coordinated adaptive immune responses were disrupted in individuals greater than or equal to 65 years of age.
These findings suggest protective roles for CD4+ T cells, CD8+ T cells, and neutralizing antibodies.
Uncoordinated immune responses to SARS-CoV-2 infection can fail to control disease progression and are associated high aging.

UK tests if COVID-19 vaccines might work better inhaled. The Associated Press.

Researchers at Imperial College London and Oxford University will begin trials of their respective COVID-19 vaccine candidates that will seek to determine if an inhaled version, in the form of a nasal spray, elicits a similar immune response as a typical intramuscular injection.
Inhaled forms of influenza vaccines have been shown to be effective, and considering the parallels between these two respiratory diseases, researchers want to determine if directly targeting the airway in a COVID-19 vaccine provides an effective response.
It is possible that a lower dose may be required for a nasal spray compared with an intramuscular injection, providing further incentive for study, with the existence of limited supplies for worldwide vaccination efforts.
The Imperial College London vaccine is mRNA based, while the Oxford vaccine is an adenovirus vector carrying the spike protein antigen.

Association of Use of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers With Testing Positive for Coronavirus Disease 2019 (COVID-19). JAMA Cardiology.

Patients with hypertension, diabetes, and cardiovascular diseases are often treated with angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs).
Throughout the COVID-19 pandemic, there has been discussion and worry about individuals on such medications being at higher risk for SARS-CoV-2 infection and developing worse clinical outcomes.
In animal models, both drugs increase ACE2 expression, which is the receptor that SARS-CoV-2 binds and through which it enters endogenous cells.
However, human plasma studies show mixed results and studies of lung-specific ACE2 expression have shown no such increase.
Current clinical guidelines do not recommend discontinued administration of ACEIs and ARBs.
This retrospective cohort study conducted within the Cleveland Clinic Health System in Ohio and Florida sought to characterize the effect of ACEIs and ARBs on COVID-19 test positivity rates and disease severity.
The authors found no effect of ACEIs or ARBs on COVID-19 test positivity rates, and could not make definitive conclusions concerning the association between ACEI or ARB use and clinical measures of COVID-19 severity.

Extracorporeal Membrane Oxygenation Support in Severe COVID-19. The Annals of Thoracic Surgery.

There are high mortality rates among COVID-19 patients requiring mechanical ventilation.
This retrospective cohort study sought to determine clinical utility of extracorporeal membrane oxygenation (ECMO) in critically ill COVID-19 patients.
321 patients were included in the study that were intubated for COVID-19, of which 24% were evaluated for ECMO support and 8.4% (27 patients) were placed on ECMO.
Of those 27 patients, one died, 13 remain on ECMO support, and 13 were successfully decannulated.
The study suggests that these early outcomes indicate that ECMO support in severe COVID-19 may be clinically beneficial.

Methods & Effectiveness of Risk Mitigation & Transmission Prevention

A World in Disorder — Global Preparedness Monitoring Board. The World Health Organization.

The Global Preparedness Monitoring Board details lessons learned so far from COVID-19 and presents a call to action to strengthen the current response to COVID-19 and prepare the world for future pandemics and health emergencies.
The board highlights the importance of both adept political leadership and caring individual behavior in the management of the pandemic, the severe social and economic effects of COVID-19, the inadequacy of current pandemic preparedness, and the significant return on investment that improving preparedness in the future would represent.
It also emphasizes that this is a global event and thus “no one is safe until all are safe.”
The board calls for responsible leadership, engaged citizenship, strong and agile national and global systems for global health security, sustained investment in prevention and preparedness, commensurate with the scale of a pandemic threat, and robust global governance of preparedness for health emergencies.

Even as Cases Rise, Europe Is Learning to Live With the Coronavirus. The New York Times.

Europe, while imposing stringent lockdown measures during the height of the pandemic in March and April, is now echoing a message of learning “how to live with the virus.”
Public health officials and epidemiologists admit that they are unable to completely eliminate transmission or quickly develop a vaccine, and now urge a return to a sense of normalcy with continued preventative measures in place.
These measures include mask wearing, social distancing, testing, and contact tracing, although adherence varies significantly between European countries and between areas within countries.
Infection rates have spiked again in countries such as Spain and France, but hospitalization rates and deaths have not, a finding that experts attribute in large part to infection shifting more toward younger populations.
France and Germany are now conducting over a million COVID-19 diagnostic tests per week, but concerns remain over the lack of priority testing guidelines for individuals presenting in more high risk manners.
Contact tracing efforts in France peaked in efficacy in July, with infected inviduals giving, on average, the names of five others who they had contacted, but since then the average number of names has decreased and plateaued to less than three per person.

Seeking the causes of post-Covid symptoms, researchers dust off data on college students with mononucleosis. STAT.

Previous prospective studies of mononucleosis and subsequent development of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in originally healthy college students carried out by DePaul University psychologist Leonard Jason and colleagues provides a foundational format for prospective analysis of the so-called “long-COVID”, in which symptoms persist for weeks to months after an individual was infected with COVID-19.
Such prospective studies take years to complete, but can produce important findings related to disease mechanisms and progression.
Researchers have also indicated that findings could be released in stages, potentially providing information about COVID-19 in a more timely manner, as it is determined.
Communities of patients undergoing “long-COVID” have launched large surveys that report a wide array of symptoms, which additionally help to provide insight into the condition.
However, these surveys only provide a cross-sectional snapshot in comparison with the longitudinal data compiled by prospective studies.

COVID-19 Transmission Dynamics and Effectiveness of Public Health 3 Interventions in New York City during the 2020 Spring Pandemic Wave. MedRxiv (PrePrint).

A preprint study of the transmission dynamics of COVID-19 in New York City during its initial wave of infection from March 2020 to May 2020 indicates a reproductive rate 2.99 at the beginning of the pandemic and a reduction to a reproductive rate of 0.93 one week after the stay-at-home mandate went into effect.
The study assesses the effects of non-pharmaceutical interventions (NPIs) that reduce contacts between individuals, including school closures and stay-at-home orders, and face coverings at reducing viral transmission.
Interventions reducing contact rates were associated with an overall 70.7% reduction in transmission.
The authors extrapolate their findings to suggest that face coverings could reduce transmission by up to 28–32% when lockdown-like measures are lifted.

Is there coronavirus in your car? Here’s how you can protect yourself. USA Today.

Cars present a small, enclosed area in which there are often a high number of individuals for extended periods of time and less air circulation than a typical home.
These factors present an environment high in probability of COVID-19 transmission.
Simple methods of opening car windows, verifying that the air condition is bring in fresh, outdoor air rather than recirculating air within the car, wearing masks, and washing hands after a car ride significantly decrease the risk of COVID-19 transmission in this setting.

Associations between phone mobility data and COVID-19 cases. The Lancet.

This study analyzed phone mobility data to quantify, to a degree, social distancing measures that populations undergo.
They found a significantly stronger correlation between phone mobility ratios and COVID-19 transmission between March 27 and April 20, 2020 when compared with later time periods in the pandemic, including from April 21 to May 24, 2020 and from May 25 to July 22, 2020.
These data suggest that other transmission prevention efforts, such as mask wearing, have been more important in later stages of the pandemic, and provide greater transmission prevention than social distancing alone.
Additionally, overdispersion was identified in the data, in which a small number of individuals accounted for large portions of transmission, promoting the importance of previously characterized “super spreading” events.

C.D.C. Testing Guidance Was Published Against Scientists’ Objections. NY Times.

A guideline saying people without Covid-19 symptoms didn’t need to get tested for the virus was released by H.H.S. officials; it skipped the C.D.C.’s scientific review process.
Officials told The Times that the Department of Health and Human Services did the rewriting and then “dropped” it into the C.D.C.’s public website
The guidelines state that people without symptoms “do not necessarily need a test” even if they have been in close contact with an infected person for more than 15 minutes
After the new guidance was published, there was a lot of conflict between HHS and the CDC, leaving many CDC scientists frustrated

Disparities Among Race, Ethnicity, & Geography

Change in Donor Characteristics and Antibodies to SARS-CoV-2 in Donated Blood in the US, June-August 2020. JAMA

Examined whether testing of donations for SARS-CoV-2 antibodies was associated with changes in donor characteristics and reactivity of donated blood
It found that the proportion of first-time donors increased, and donations from younger and racial and ethnic minority donors were more likely to be reactive.
This increase may be due to donors with higher rates of prior exposure donating to obtain antibody test results, particularly first-time donors, but may also reflect increased exposure in the general population or increased recognition of the need for convalescent plasma.
The distribution of anti–SARS-CoV-2 reactive test results was similar to results reported for patients with clinically diagnosed COVID-19, with higher rates among African American and Hispanic donors and those from the Northeast.

Social Disadvantage, Politics, and SARS-CoV-2 Trends: A County-Level Analysis of United States Data Clinical Infectious Diseases — Oxford Academic

It was found that medium-sized metropolitan status, higher proportion of Black residents, and Republican victory in the 2016 presidential elections were independently associated with rising SARS-CoV-2 county case counts during June 2020
In the US, the bulk of cases during the first two months were in urban areas on the East and West coasts, but with time the pandemic has taken root in smaller metropolitan and rural areas. The racial disparity in cases persists — and has been demonstrated by several other studies.
However, the finding that voting patterns were independently associated with increased case numbers during June 2020 bears further examination

Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements BMJ Global Health

The perspectives and experiences of healthcare access in seven slums in Bangladesh, Kenya, Nigeria and Pakistan were explored for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns
Pre-COVID-19, diagnostic and treatment services were available for slum dwellers
Preventive services were well used but services for mental health and gender-based violence were limited or non-existent.
A perceived reduction was found in access to all healthcare services in slums during COVID-19 lock-downs. Barriers to healthcare access included increased cost of healthcare, reduced household income, increased challenges in physically reaching healthcare facilities and exacerbated reluctance of residents to seek healthcare due to fear of infection and stigmatisation.

Coronavirus kills far more Hispanic and Black children than White youths, CDC study finds The Washington Post

According to reports by the Centers for Disease Control and Prevention (CDC), among 121 of reported COVID-19 associated deaths among persons aged 21 and younger by July 31, 2020, 78% have been Hispanic, Black and American Indian/Alaskan Native children, even though they represent 41 percent of the U.S. population.
One key reason for this could be underlying health disparities among minority children and young adults. About 75 percent of those who died had at least one underlying condition, the most frequent being asthma and obesity — two conditions that disproportionately occur in minority youths.
The CDC report also pointed to underlying social disparities that minority children are more likely to experience than their White peers: crowded living conditions, food and housing insecurity, parents who are essential workers and cannot work from home, wealth and education gaps and difficulty accessing health care because of a lack of family resources including insurance, child care, transportation or sick leave.

Understanding Mexican health worker COVID-19 deaths The Lancet

A report from Amnesty International on September 3 showed that more Mexican health-care workers had died of COVID-19 (1,320) than in any other country. The USA and the UK had the second- and third-most with 1,077 and 677 deaths of health care workers, respectively.
The Mexican health secretariat did not dispute the figures, but called the comparison with other countries unfair because none used the same method for recording deaths. In a press conference, Mexico’s Director of Epidemiology José Luis Alomía said that Mexican health-care workers with COVID-19 had a mortality rate of 3·8%, lower than that of the general population.
1410 health-care workers had died, almost half of whom were doctors. Health-care workers, nurses, and researchers offered varying explanations for Mexico’s numbers, based mostly on working conditions.
Rafael Soto, an IMSS nurse and spokesperson for the National Union of Health Workers, said that unions representing health workers were keeping quiet on issues of workplace safety in order to please the government. He added that protest leaders have had their jobs terminated by their employers or have been sanctioned by their unions.
Another reason stated that physicians in Mexico routinely have multiple jobs, compounding stress and exhaustion. Furthermore, salaries in Mexico’s top public hospitals seldom top £1000 monthly, with most physicians earning substantially less, according to interviewees.

2020 Goalkeepers Report COVID-19: A Global Perspective Bill and Melinda

In recent years, the world has improved on every single one of the United Nations’ Sustainable Development Goals (SDGs). This year, there has been regression on the vast majority of these. The pandemic has become an economic crisis, a food crisis, a housing crisis, and a political crisis.
As governments implemented necessary policies to slow the spread of the virus, and people changed their behavior to limit their exposure, global supply chains started to shut down, contributing to an economic catastrophe.
Schools closed, and hundreds of millions of students are still trying to learn on their own at home, an educational catastrophe.
People in high- and low-income countries alike report skipping meals, a nutritional catastrophe that will make the others worse. there are inherent limits to what lower-income countries are able to do to backstop their economies, regardless of how effectively those economies have been managed.
We cannot rebuild health systems, economic systems, educational systems, and food systems — to say nothing of making them better than they were when this year began — until the virus that is tearing them all down is under control.

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