COVID-19 Research Roundup 4: 9/26/20–10/2/20

Published in

Greenlight

25 min readNov 10, 2020

Executive Summary

Summaries from new articles and research papers exploring COVID-19, disparities, schools, novel treatments, and prevention strategies for 9/26/20–10/2/20.

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

Researchers are searching for better pooling and testing strategies which are more cost-effective, accurate, and have faster turn around rates. All the while, New York City and many college campuses just experienced an uptick of cases, raising concerns about opening up schools. School districts are still struggling to balance the fear of outbreaks and the challenges of providing the best mode of instruction to their students. Still, several districts have turned to innovative protocols and policies to help students in their virtual learning environments.

Coronavirus deaths officially passed one million worldwide, although the true death count is likely much higher. A cross sectional study of dialysis patients in the U.S. indicated that seroprevalence (existence of antibodies to SARS-CoV-2) was 9.3%, with a range from 3.5% in the West to 27.2% in the Northeast. Residents of non-Hispanic Black and Hispanic neighborhoods experienced higher odds of seropositivity than residents of predominantly non-Hispanic white neighborhoods. RNAemia, defined as the existence of SARS-CoV-2 in plasma, was identified as a potential prognosticator for severe COVID-19 disease course. A study found that COVID-19 incidence was higher in the 12–17-year age group than the 5–11-year age group. The case study of a large university in North Carolina was presented as an example of rapid transmission of COVID-19 in a college or university campus setting when adequate prevention efforts, testing, isolation, and quarantine measures were not in place. COVID-19 induced acute respiratory distress syndrome (ARDS) was found to be associated with higher rates of gastrointestinal complications than non-COVID-19 induced ARDS. A meta-analysis of tocilizumab treatment of COVID-19 showed a 10% decrease in mortality compared with control, highlighting the need for randomized, placebo-controlled clinical trials to determine its therapeutic benefit. A study found that older persons were largely excluded from clinical and vaccine trials, likely leading to significant deleterious health effects for this population through lack of development of adequate dosing recommendations of COVID-19 vaccines and therapeutics and lack of knowledge gathering of adverse effects. No evidence of vertical transmission of COVID-19 was found from mother to newborn. 8 weeks of daily hydroxychloroquine administration was found not to have a pre-exposure prophylactic effect in health care workers.

In North Carolina, no-cost testing events are being deployed across the state and testing turnaround times are improving. Among other metrics, personal protective equipment (PPE) supplies, hospital trajectories, positive testing rates, and confirmed cases have remained stable since September. As North Carolina’s metrics and capacity remain stable, the state will cautiously ease some restrictions starting October 2nd including regulations regarding outdoor and indoor venues, mass gatherings, bars, movie theaters, conference parks, and amusement parks.

Important Statistics/Quotes

“The logistics of setting this up [national tutoring corps] on the kind of scale we need to to address the problem is more complicated than we initially realized. To try to set this up and deal with the operational challenges of making it easy for the students to actually receive the help, to ensure safety, to find the right match — the progress can be slower than we’d like.” — Philip Oreopoulos, a public policy professor at the University of Toronto
A report from the CDC indicates that during August 2 through September 5, 2020, COVID-19 incidence among those ages 18–22 years increased 62.7%, with the greatest increases occurring in the Northeast, followed by the Midwest, and the South.
Patients with COVID-19 ARDS were significantly more likely to develop gastrointestinal complications than patients with non COVID-19-induced ARDS (74% versus 37%).

Headlines from this Week

Educating Through a Pandemic: From Alaska Schools Creating Digital Networks to Aid Remote Learning to a Homework Freeze in Texas to Limit Screen Time, 9 Ways States Are Aiding Schools Amid COVID-19. The 74.

The pandemic has affected different schools in different ways, prompting many districts to think of and implement a variety of innovative policies and technologies to ensure improved virtual learning environments for their students. Here is a short list and summary of what some states and their school districts are doing to tackle the challenges of virtual learning and controlling for COVID outbreaks in classrooms:

In an effort to reduce screen time, El Paso Independent School District announced a temporary freeze on homework.
The Aleutians East Borough School District is creating its own digital content delivery system, akin to a local network, that does not require internet access and can be delivered to individual homes.
Childcare organizations and education nonprofits in Montana have expanded their services to adapt to changes to education in the state.
Gov. Jared Polis of Colorado has launched a $32.7 million grant program to encourage innovations that will help the state’s most disadvantaged student populations.
New Mexico’s Legislative Disabilities Concerns Subcommittee held a remote meeting earlier this month, allowing parents and advocates of special needs kids to express their concerns to state lawmakers.
Pennsylvania Gov. Tom Wolf announced that his state’s share of Coronavirus Aid, Relief and Economic Security (CARES) Act funding will be used by schools to secure broadband internet, mobile hotspots and other platforms.
The Clark County Teachers Health Trust, the largest public-school employee health plan in Nevada, will test up to 62,500 teachers and support staff.

Dialysis Seroprevalence Trial Uncovers that Approximately 10% of the U.S. Population has Antibodies to SARS-CoV-2. The Lancet.

A cross sectional study was conducted to analyze the plasma of 28,503 randomly selected adult patients receiving dialysis in July, 2020, for antibodies to the SARS-CoV-2 spike protein receptor binding domain. Data were obtained from a central laboratory that receives samples from approximately 1300 dialysis facilities across the U.S. Adults receiving dialysis are the ideal current population to study for SARS-CoV-2 antibodies, as these patients undergo monthly follow ups, in which there is ready access to the bloodstream. Additionally, the dialysis population is rich in demographic and medical risk factors for infection with COVID-19. Seroprevalence (existence of antibodies to SARS-CoV-2) was found to be 9.3% when data were standardized to the overall U.S. adult population. Seroprevalence standardized to the U.S. dialysis population indicated a range from 3.5% in the west to 27.2% in the northeast, suggesting significant differences in regional infection rates during the first wave of COVID-19. The study also found that, when comparing seroprevalence to case counts per 100,000 individuals, 9.2% of seropositive patients were diagnosed. Finally, the study found that residents of non-Hispanic Black and Hispanic neighborhoods experienced higher odds of seropositivity than residents of predominantly non-Hispanic white neighborhoods.

Governor Cooper Moves North Carolina to Phase 3 With Stable Numbers. NC Governor Roy Cooper.

North Carolina will ease cautiously some restrictions while continuing safety measures to combat the spread of COVID-19 as the state’s metrics, including trajectory of lab-confirmed cases, percent of tests returning positive, and trajectory of hospitalizations, remained stable in September. No-cost testing events are being deployed across the state and testing turnaround times are improving. New contact tracers are bolstering the efforts of local health departments. A new NCDHHS app, SlowCOVIDNC, is notifying users of exposure to the virus. Personal protective equipment (PPE) supplies are stable. Executive Order 169 begins Oct. 2 at 5 p.m. and continues for three weeks through October 23. Its new provisions include the following:

Large outdoor venues with seating greater than 10,000 may operate with 7% occupancy for spectators.
Smaller outdoor entertainment venues, like arenas or amphitheaters, may operate outdoors at 30% of outdoor capacity, or 100 guests, whichever is less.
Movie theaters and conference centers may open indoor spaces to 30% of capacity, or 100 guests, whichever is less.
Bars may operate outdoors at 30% of outdoor capacity, or 100 guests, whichever is less.
Amusement parks may open at 30% occupancy, outdoor attractions only.
The limits on mass gatherings will remain at 25 people indoors and 50 people outdoors.
The 11 pm curfew on alcohol sales for in-person consumption in locations such as restaurants and outdoor bars will be extended to October 23.

COVID-19 & the Education System

Feds to ship millions of tests in bid to reopen K-12 schools. AP

President Donald Trump announced that the federal government will begin distributing millions of rapid coronavirus tests to states this week
Urging governors to use them to reopen schools for students in K-12
The tests will go out to states based on their population and can be used at the governors’ discretions but the administration is encouraging states to place a priority on schools
Emphasizing testing in schools because it’s important to the physical, social and emotional development of students to be back in classrooms
States could do some baseline surveillance testing (testing proportion of students per week).
The Abbott Laboratories tests would allow parents to know whether their symptomatic child has COVID-19.
The company’s rapid test, the size of a credit card, is the first that does not require specialty computer equipment to process.
Important advancement because of its low cost and easy-to-use format
The nonprofit Rockefeller Foundation says the U.S. will need roughly 200 million tests per month to safely reopen schools as part of a broader phased approach to easing restrictions
The Trump administration announced earlier this month that the Abbott tests would also go to assisted-living facilities

7 Things a National Survey of Librarians Told Us About the State of School Libraries Amid the Pandemic. The 74.

1 in 4 school libraries are not open right now; only 12% will be fully open and operational
1 in 6 libraries are being converted to standing classrooms
Most will encourage a greater use of e-books than physical books
Most schools are making their libraries mobile and virtual
Librarians will spend 6% of their budget on personal protective equipment
Despite the pandemic, libraries will still spend around 48% of their budgets on physical books
Top concern: are all learners at a level to understand digital citizenship skills and successfully navigate remote learning?

As colleges reopened, many more young people got covid-19, CDC reports. The Washington Post.

Northeast saw greatest spike in cases among 18–22 years olds with 144% increase
In Midwest, it was a 123% increase
45% of 18–22-year olds are enrolled in college
Universities should take precautions to limit the spread: reduce the number of people in dorms, ensure that public health guidelines are being practices, increase testing, and discourage gatherings
Under current guidelines, classrooms will close if the test positivity rate exceeds 3% over a 7-day rolling average

N.Y.C. Reports Large Uptick in Virus Cases. The New York Times.

As public high schools reopened in New York, the city’s number of positive tests rose to 3.25% — the highest rate since June
For several weeks, the number of positive cases had generally been 1% to 2%
The city will fine anyone who refuses to wear a mask
Nonpublic schools and childcare centers that also fail to adhere to safety measures will also be forced to close

Using Tutors to Combat COVID Learning Loss: New Research Shows That Even Lightly Trained Volunteers Drive Academic Gains. The 74.

Many families have turned to hiring professional tutors
The turn to tutors has endangered controversy: if a small portion of advantaged families can hire tutors while millions of other families struggle to even access virtual learning then the learning gaps will expand
Policymakers have debated the idea of offering tutoring to all students, but the cost has kept many from passing a bill
A recent study conducted by economists showed that tutoring had transformative academic impacts
Tutoring led by teachers and paraprofessionals was most successful at lifting academic performance
Results were stronger for elementary students overall
Reading tutoring was more effective than math tutoring in students in earlier grades and the opposite for older students
Programs that happened frequently during the day as supplemental classes worked best
Tutoring DURING school can be very effective
1 to 1 models have shown remarkable success
One possible solution is a national tutoring corps funded by the national government and drawn from college students
There should be less emphasis on who is teaching and tutoring and more emphasis on the sustainable nature of the program itself

Infection Rates and Disease Course in Children

High Frequency of SARS-CoV-2 RNAemia and Association With Severe Disease. Clinical Infectious Diseases.

This study investigated the existence of SARS-CoV-2 extrapulmonary RNA, termed RNAemia, in patients receiving care in Stanford Health Care between March 2 and April 8, 2020.
85 patients were included in the analysis with paired nasopharyngeal and plasma samples of RNA that were tested for RNA by real time reverse transcriptase polymerase chain reaction (rRT-PCR).
RNAemia was detected in 28 of these patients, and 121 additional plasma samples were taken from this patient cohort to assess longitudinal changes in viral RNA.
The study found that RNAemia (plasma viral detection) was associated with older age and adverse clinical outcomes, including intensive care unit (ICU) admission, endotracheal intubation and mechanical ventilation, and 30 day all-cause mortality.
The authors take these findings and suggest that detection of viral RNA in the plasma could potentially be used as a clinical prognosticator for severity of COVID-19 disease course.

COVID-19 Trends Among School-Aged Children — United States, March 1–September 19, 2020. Morbidity and Mortality Weekly Report.

This report analyzed COVID-19 testing rates, positivity, hospitalization, intensive care unit (ICU) admission, and death in children separated into two disparate age groups, 5 to 11 years, and 12–17 years, from March 1 to September 19, 2020 in the United States.
A significant increase in testing rates and positivity occurred from March into mid-July.
Testing rates generally plateaued after that period, and positivity rates decreased following that period.
COVID-19 incidence was consistently higher in the 12 to 17 year age group, over the 5 to 11 year age group.
Underlying conditions were common among children hospitalized with COVID-19.
ICU admission and mortality were both extremely low in children of both age groups, compared with adults.
Nevertheless, Black race and Hispanic ethnicity were associated with higher risk of hospitalization and mortality among children.
These findings represent an important baseline for national incidence and prevalence of COVID-19 in children.
It is necessary to continue to collect such data in order to better inform transmission risk mitigation strategies in the face of school reopenings and increasingly relaxed COVID-19 transmission prevention policies in the U.S.

Multiple COVID-19 Clusters on a University Campus — North Carolina, August 2020. Morbidity and Mortality Weekly Report.

There were 670 laboratory-confirmed cases of COVID-19 in university A undergraduate students in North Carolina.
This rapid spread of SARS-CoV-2 on this campus resulted in all classes transitioning online within the first two weeks that students returned to campus at the beginning of August.
This university implemented some transmission prevention measures, including scheduling move-in appointments during a one week period, reduction in classroom student density to facilitate physical distancing, reduction in the maximum capacity of dining halls, increase in the dining hall takeout options, and requirement to sign an acknowledgement of community standards and university guidelines on COVID-19.
Approximately 95% of students signed the agreement, but adherence was not recorded or analyzed.
During the two week rapid spread of COVID-19 on this campus, there were 18 reported epidemiological clusters and 30% of reported cases were linked to clusters.
Overall, this case study of university A in North Carolina indicates the need for stringent transmission prevention policies in universities that open in-person classes to their student body.
These mitigation strategies should include large amounts of COVID-19 diagnostic testing of the student body, significant reduction of the on-campus housing density, enforcement of mask wearing requirements, and discouragement of student gatherings.

Coronavirus Deaths Pass One Million Worldwide. The New York Times.

Deaths from COVID-19 have officially passed one million this week.
However, the true death count is likely much higher.
The virus has infiltrated almost every patch of the globe, disrupting economies and livelihoods, and, more importantly, ending human lives prematurely.
Some countries have implemented relatively sufficient transmission mitigation efforts and have dramatically reduced the case counts and mortality from COVID-19.
Others, including the U.S. and many lower income countries, have generally failed to respond adequately to the spread of SARS-CoV-2 and thus the lives of many have been lost that could have been prevented.
The pandemic has elucidated to many individuals and groups many underlying truths about their institutions, governments, and friends.

Gastrointestinal Complications in Critically Ill Patients With and Without COVID-19. The Journal of the American Medical Association.

This single center study of patients admitted to the intensive care unit (ICU) at Massachusetts General Hospital from March 13 to May 7, 2020 compared gastrointestinal complications in patients with COVID-19-induced acute respiratory distress syndrome (ARDS) with patients with non COVID-19-induced ARDS.
Patients with COVID-19 ARDS were significantly more likely to develop gastrointestinal complications than patients with non COVID-19-induced ARDS (74% versus 37%).
Specifically, these patients developed higher rates of transaminitis, severe ileus, and bowel ischemia.
One potential explanation of such disparities in gastrointestinal complications between these two groups is the significantly high expression levels of the angiotensin converting enzyme 2 (ACE2) in the epithelial lining of the gut, which SARS-CoV-2 uses as the receptor to promote its entry into host cells.

Emerging Prevention & Treatment Strategies

Double-blind, randomized, placebo-controlled trial with N-acetylcysteine for treatment of severe acute respiratory syndrome caused by COVID-19. Clinical Infectious Diseases.

A double-blind, randomized, placebo-controlled study was conducted at the Emergency Department of Hospital das Clínicas, São Paulo, Brazil enrolling 135 patients with severe COVID-19.
The therapeutic effect of N-acetylcysteine administration was assessed compared with placebo.
The endpoint of assessment was mechanical ventillation, with secondary endpoints of duration of mechanical ventilation, admission to the intensive care unit (ICU), duration of stay in the ICU, and mortality.
COVID-19 may induce increased local concentrations of angiotensin II, as angiotensin converting enzyme 2 is inactivated upon SARS-CoV-2 binding and entry into host cells.
This local increase in angiotensin II may result in a redox imbalance in alveolar epithelial cells, resulting in apoptosis, increased inflammation, and decreased gas exchange.
The authors hypothesized that N-acetylcysteine may be able to restore redox homeostasis, leading to therapeutic benefit in severe COVID-19.
However, in this study, no differences between treatment and placebo groups were observed in either the primary endpoint, endotracheal intubation, or the variety of secondary endpoints.

Decreased mortality in COVID-19 patients treated with Tocilizumab: a rapid systematic review and meta-analysis of observational studies. Clinical Infectious Diseases.

A meta analysis of 10 studies of the IL-6 receptor antagonist tocilizumab in the treatment of COVID-19 showed a 10% decrease in mortality in patients treated with tocillizumab compared with control.
IL-6 has been identified as a potentially upregulated inflammatory molecule in the “cytokine storm” that is often experienced in patients with severe COVID-19.
It is therefore proposed that IL-6 receptor antagonists may be able to tamp down the cytokine storm to an extent, improving patient outcomes in severe COVID-19.
Early clinical and biochemical signs have been optimistic, with observed decreases in levels of ferritin, C reactive protein and D-dimer.
The authors determined that 9 of 10 studies were of “high quality.”
Despite the encouraging findings of this meta analysis, large, randomized, placebo controlled studies of IL-6 receptor antagonists are necessary to determine the validity of its potential therapeutic effect.

The Exclusion of Older Persons From Vaccine and Treatment Trials for Coronavirus Disease 2019 — Missing the Target. JAMA Internal Medicine.

This research letter analyzes COVID-19 clinical and vaccine trials to better understand the potential exclusion of older adults from these trials.
Older adults are at a much greater risk for severe COVID-19 and death.
Globally, while adults older than 65 years of age account for only 9% of the population, they account for 30–40% of hospitalizations and 80% of deaths.
However, there is a lot history of exclusion of such individuals from clinical trials.
Here, the authors find that older adults are likely to be excluded from over 50% of COVID-19 clinical trials and 100% of vaccine trials due to both age-specific exclusions and cut-offs, as well as non-specific exclusions.
Such exclusions will have significant adverse health effects for older adults, as adequate dosing recommendations of COVID-19 vaccines and therapeutics and adverse effects will be less well defined.
Older adults compose arguably the age group that could benefit the most from COVID-19 vaccines and therapeutics, as they are at a higher risk for severe disease, but exclusion from clinical and vaccine trials could preclude such positive health effects of medical and scientific advances.

Outcomes of Maternal-Newborn Dyads After Maternal SARS-CoV-2. Pediatrics.

A study of 149 mother-newborn dyad pairs with mothers who tested positive for SARS-CoV-2 at the time of admission to the labor unit found no evidence of vertical transmission of the virus from mother to newborn.
However, the study did find statistically significant perinatal morbidities for both mothers and newborns.
There was a higher risk for preterm delivery in symptomatic mothers infected with SARS-CoV-2 and a higher risk for admission of newborns to the intensive care unit (ICU) than in asymptomatic mothers infected with SARS-CoV-2.

Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis Among Health Care Workers. JAMA Internal Medicine.

In a placebo controlled clinical trial of daily hydroxchloroquine administration (600 mg) in health care workers as pre-exposure prophylaxis for COVID-19, there was no significant preventative benefit of hydroxchloroquine administration.
However, the trial was terminated early and may not have had sufficient power to fully assess the effects of drug administration.
The trial enrolled 132 full time hospital based health care workers, of whom 125 initially were asymptomatic and had negative results for SARS-CoV-2 by nasopharyngeal swab.
Participants were enrolled at 2 urban tertiary care facilities from April 9 to July 14, 2020, and follow up continued until August 4, 2020.
Participants were administered either 600 mg hydroxchloroqine or size matched placebo daily for a period of 8 weeks.
There were no significant differences in infection rates between the treatment and placebo groups.
Mild adverse events were more common in participants receiving hydroxychloroquine compared with participants receiving placebo.

Protecting workers aged 60–69 years from COVID-19. The Lancet Infectious Diseases.

Many isolation and transmission prevention strategies and recommendations focus on the protection of older adults aged 70 years and older, as they have been identified as one of the groups most at risk for severe disease and death from COVID-19.
Data and estimates from the U.K. indicate that while 70% of all deaths occur in the 70-and-above age group, two thirds of remaining deaths occur in the 60–69 year age group.
Many individuals in this age group have continued to work, sometimes at the front line of health care and other industries.
The authors thus argue for protection strategies that promote the health and safety of the 60 years and above age group, rather than solely the 70 years and above age group.

Preventing and Responding to COVID-19 on College Campuses. The Journal of the American Medical Association.

SARS-CoV-2 has spread significantly on college campuses across the U.S., with more than 130,000 cases at 1,300 colleges reported by September 25, 2020.
While young adults with no underlying health problems are at a relatively low risk for severe COVID-19 disease course, faculty and staff of colleges and universities are at much higher risks, as well as multiple groups in the surrounding communities, including racial and ethnic minorities.
A report from the Centers for Disease Control and Prevention (CDC) elucidates the possibility of rapid transmission of SARS-CoV-2 within the student body of a large university in North Carolina, with much transmission occurring through social events rather than through in-person classroom settings.
Another report from the CDC indicates that during August 2 through September 5, 2020, COVID-19 incidence among those ages 18–22 years increased 62.7%, with the greatest increases occurring in the Northeast, followed by the Midwest, and the South.
Stringent transmission prevention efforts, robust testing, and rapid and efficacious quarantine and isolation in response to COVID-19 incidence is necessary for reduction of COVID-19 transmission on college and university campuses, and in the surrounding communities.

Methods & Effectiveness of Risk Mitigation & Transmission Prevention

The Right Kind of Pooled Testing for the Novel Coronavirus: First, Do No Harm. American Journal of Public Health.

If the nation is to overcome testing challenges, the U.S. may need to start more pooled testing
In mid-July 2020, the U.S. Food and Drug Administration (FDA) gave Quest Diagnostics approval to pool samples of its diagnostic test for the virus
The U.S. Department of Health and Human Services (HHS) and Quest is attempting to use the Dorfman protocol: several samples are pooled together and if even one tests negative or positive the entire pool is considered negative or positive.
Dangerous because it would produce high rates of false negative results
Better method of pool-testing: split pooling
If a pool of samples tests negative, a new pool with the same samples is tested again to confirm the first result
If the second pooling comes out positive, then the original pool is split into two smaller pools and retested
Produces less false positives and false negatives
Fewer than 6000 false positives will occur in contrast to individual testing which produces 99,960 false positives

Flu vaccine for children in the time of COVID. Mott Poll Report.

Important for people of all ages to get seasonal flu vaccine this year during the COVID pandemic
In August 2020, the C.S. Mott Children’s Hospital National Poll on Children’s Health asked a national sample of parents about getting the flu vaccine for their children
2/3 of parents intend to have their child get flu vaccine this year (49% very likely and 19% likely)
Only 28% of parents say that their child is likely to get the flu vaccine this year if they did not get it last year
Only 44% of parents say their child’s regular health care provider strongly recommends the flu vaccine this year
The most common concerns are about the side effects of the vaccine (42%) and the belief that the flu vaccine is not necessary (40%) or effective (32%)
14% of parents will not seek flu vaccine because they are keeping children away from health care sites due to COVID
Health care providers should make it a point to clearly state their recommendation of getting the flu shot during all visits and also make changes to their websites to indicate the site’s safe social distancing measures

Mass screening of asymptomatic persons for SARS-CoV-2 using saliva. Clinical Infectious Diseases.

Self-collected saliva provides highly accurate results and should be considered as easier and cost-efficient alternative to mass screenings of asymptomatic individuals
Currently, there is few data on the accuracy of PCR testing in asymptomatic people
In mass screening study of 1,924 individuals, the sensitivity of nucleic acid amplification testing with nasopharyngeal (NPS) and saliva specimens were 86% and 92% respectively
The specificity of NPS and saliva were 99.93%
Nasopharyngeal and saliva specimens have high sensitivity and specificity
Saliva may be more beneficial to NPS fluid for detecting COVID-19 as self-collected saliva has significant advantages over NPS sampling
Saliva collection is non-invasive/does not require specialized personnel/minimizes discomfort for patient

Preventing and Responding to COVID-19 on College Campuses. JAMA.

Through the summer, young people accounted for increasingly more COVID cases with highest incidence among young adults ages 20 through 29
Multiple campuses are undergoing different forms of testing:
Universal entry screening: prearrival testing
2-phased universal screening: prearrival testing paired with a follow-up test
Scheduled screening with repeated testing of entire population
Random screening
Testing on demand
Wastewater testing to detect virus in sewage
Strategy of entry screening combined with regular serial testing might prevent or reduce transmission of COVID
Survey of more than 1600 colleges identified more than 26,000 COVID-19 cases at 750+ colleges by August 26
Urgent need to implement effective mitigation strategies across all campuses to protect students and the broader community

Disparities Among Race, Ethnicity, & Geography

COVID-19 Racial/Ethnic Inequities in Acute Care and Critical Illness Survivorship. Annals of the American Thoracic Society.

Beyond an increased mortality, communities of color experience other disparities in clinical care such as limited access to specialty care physicians and differences in rates of diagnostic testing.
During hospitalization, language barriers may limit effective communication with patients from various ethnic backgrounds.
In many states, allocation of resources is based on probability of survival
Sequential Organ Failure Assessment (SOFA) scores are calculated to prognosticate short term survival
Co-morbidities are calculated to prognosticate 1 to 5-year survival
Co-morbidities are often weighed equally with SOFA scores
However, most co-morbidities considered in prognostication are complex, heterogeneous diseases, making prognostication on this basis questionable
Critically ill patients are at risk of subsequent physical, psychological and cognitive burdens — post intensive care syndrome (PICS), and thus may have additional ongoing care needs requiring stable access to services.

Risk Factors for In-hospital Mortality from COVID-19 Infection among Black Patients — An Urban Center Experience. Clinical Infectious Diseases.

This study assessed risk factors for death from COVID-19 among black inpatients at an urban center in Detroit, MI.
The Detroit area, part of Wayne county in southeast Michigan, was among the earlier metro locations to experience a sudden and rapid rise in cases.
The study showed a mortality of 29.1% among hospitalized black patients resulting from COVID-19 infection.
High mortality was attributed to an older population with chronic co-morbidities, higher number of patients admitted from nursing facilities, an inflammatory state with elevated CRP on admission, severe disease as evident from altered mentation on presentation, need for mechanical ventilation and presence of shock and ARDS during their illness.
These demographic, clinical and laboratory findings should alert healthcare providers to identify black patients at highest risk for severe COVID-19 associated outcomes.

Those Dying From Covid-19 Are Least Likely to Own Life Insurance. The Wall Street Journal.

U.S. life insurers are paying out far fewer Covid-19 death claims than initially expected, largely because the virus is disproportionately killing people with little to no insurance.
Older people often have smaller policies than people who are still in the workforce.
Based on data through mid-September, the federal Centers for Disease Control and Prevention calculates that approximately four-fifths of U.S. deaths involving Covid-19 have been of people at least 65 years old. Its current total shows just over 200,000 total U.S. deaths.
There has also been a disproportionate impact on minorities, such as African-Americans.
More than a fifth of Covid-19 deaths have been non-Hispanic Black people, above their roughly 13% representation in the overall population, according to government data.
Historically, many life insurers gravitated toward selling larger life insurance policies to middle and upper-income households, where Black Americans were underrepresented.
Covid-19 deaths have been more heavily focused on low income individuals who tend to have less life insurance and those with pre-existing conditions who can be denied life insurance coverage as part of the underwriting process.

As insurers move this week to stop waiving telehealth copays, patients may have to pay more for virtual care. STAT.

Starting Oct. 1, several private health insurers will no longer fully pay for virtual visits under certain circumstances — effectively reinstituting costs for patients reliant on the virtual care that has been heralded as a lifeline at a time when Covid-19 is still killing more than 700 Americans each day.
The insurance giant United Healthcare is ending a “virtual visit” benefit that had been expanded to many members during the Covid-19 pandemic, through which it was covering the full cost of visits — without any cost to patients — for individuals who were seeing in-network providers virtually for medical issues not related to Covid-19.
Anthem, the company behind a number of affiliated health plans across the country, will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to Covid-19.
It’s not clear yet how much patients affected by the changes being implemented this week can expect to have to pay for telehealth visits, nor is it clear how those costs will compare to copays for an in-person visit.

Legal, Policy, Regulatory, and Economic Considerations for COVID-19

New Report Estimates School Closures’ Long-Term Impact on the U.S. Economy at More Than $14 Trillion. The 74.

In the U.S., the closures could ultimately amount to a loss of almost $14.2 trillion over the next 80 years, according to a study released by the Organization for Economic Cooperation and Development, an international group promoting economic growth policies.
Another three months of learning losses could stretch that figure to almost $28 trillion.
Even if school performance were to immediately return to pre-pandemic levels, countries would continue to see economic declines, because learning loss will lead to skill loss, and the skills people have relate to their productivity.
Forecasts predict that the pandemic will lead to slower growth in government spending in the coming year.
If the share of government spending devoted to education were to remain unchanged, education spending would continue to grow but at significantly lower rates than before the pandemic.

U.S. Department of Education Announces Flexibility in Afterschool Funding to Accommodate Learning Hubs and Centers During Virtual School Days. The 74.

As school districts and community organizations clamor to arrange learning “hubs” and pod-like arrangements for needy students who can’t stay home during remote school days, education officials are pushing for clarity about whether federal afterschool funds can be used to support those efforts.
On Aug. 14, the Administration for Children and Families, part of the U.S. Department of Health and Human Services, released a document clarifying that the Child Care and Development Fund can be used “for child care services when children are completing remote, virtual, or online schoolwork or instruction while in child care.”
Child care subsidies for low-income families have tighter income rules and also don’t cover services for children over 12. In addition, with social distancing requirements, programs will need more space and staff to accommodate smaller group sizes.
The Afterschool Alliance, the Bipartisan Policy Center and a long list of other groups leading out-of-school-time efforts are advocating for $6.2 billion for the 21st Century program in the next federal relief package.

House Passes $2.2 Trillion Coronavirus Relief Bill in Absence of Bipartisan Deal. The Wall Street Journal.

The House passed a $2.2 trillion coronavirus relief bill Thursday as bipartisan negotiations with the Trump administration dragged on, with Democrats moving forward on their legislation in the absence of a deal with Republicans.
The vote had earlier been postponed to give House Speaker Nancy Pelosi (D., Calif.) and Treasury Secretary Steven Mnuchin more time to agree on an aid package.
But those conversations haven’t yet yielded a bipartisan agreement. The Democratic bill would give money to state and local governments, send another round of stimulus checks to many Americans, reinstate a $600 weekly supplement to unemployment benefits, and give assistance to airlines, restaurants and performance venues, among other measures.
Republicans have panned the bill, giving it no chance of passage in the GOP-controlled Senate.
White House press secretary Kayleigh McEnany said Thursday that Mrs. Pelosi should accept the administration’s new offer.

Covid-19 Vaccine’s Development Won’t Be Affected by Politics, Pfizer CEO Says. The Wall Street Journal.

Pfizer Inc.’s PFE 0.03% chief executive sought to assure the drugmaker’s employees Thursday that their experimental Covid-19 vaccine wouldn’t be influenced by politics, two days after President Trump mentioned the company during the debate.
Chief Executive Albert Bourla sent a letter to all employees saying Pfizer “would never succumb to political pressure” as it develops a Covid-19 vaccine.
The president’s comments at the debate, as well as remarks beforehand saying he sought a vaccine’s authorization before Election Day, have touched off partisan fighting over whether his administration would push for a vaccine’s use before it has been fully vetted.
Surveys show significant numbers of Americans harbor concerns about taking a vaccine, partly out of fear a shot might be unsafe.
Pfizer is recruiting 44,000 people to enroll at more than 100 sites across six countries to test its vaccine in a late-stage study.
Dr. Bourla has said in public appearances that the company could know results about whether it works as early as this month.

Behind the White House Effort to Pressure the C.D.C. on School Openings. The New York Times.

Top White House officials pressured the CDC this summer to play down the risk of sending students back to school.
This behind the scenes effort was a strikingly political intervention in one of the most sensitive public health debates of the pandemic.
White House officials also tried to circumvent the C.D.C. in a search for alternate data showing that the pandemic was weakening and posed little danger to children.
The White House spent weeks trying to press public health professionals to fall in line with President Trump’s election-year agenda of pushing to reopen schools and the economy as quickly as possible.

Live Trackers/Important Links