COVID-19 Research Roundup 6: 10/26/20–11/1/20

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Greenlight

17 min readNov 9, 2020

Summaries from new articles and research papers exploring COVID-19, disparities, schools, novel treatments, and prevention strategies for 10/26/20–11/1/20.

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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

An editorial from the Lancet summarized what is currently known about routes of transmission of SARS-CoV-2 and what risk mitigation and transmission prevention measures are needed in the near future to reduce spread of the virus as the U.S. enters the winter months. The director-general of the World Health Organization (WHO) stated that “giving up on control [of COVID-19] is dangerous” and “control should… be part of the strategy” likely in part to some comments previously made by White House Chief of Staff Mark Meadows that appeared to indicate that containment of the virus is not possible in the United States. The Morbidity and Mortality Weekly Report (MMWR) found that the majority of Americans adhere to most or all of the SARS-CoV-2 transmission mitigation behaviors surveyed, a smaller percentage of adults aged <60 years, particularly those aged 18–29 years, reported engaging in the mitigation behaviors assessed compared with adults aged ≥60 years, and while mask wearing increased over time in all age groups, other mitigation behaviors remained the same or decreased over time from April to June. A cluster of COVID-19 cases among a university’s men’s and women’s soccer teams demonstrated the risks inherent in college campus settings for COVID-19 outbreaks.

On Tuesday, front-runner Pfizer revealed in an earnings call that the first interim analysis in its Phase 3 clinical trial has not yet occurred. That means there hadn’t yet been enough Covid infections among the trial participants to take a first stab at analyzing whether the people randomly assigned to receive vaccine were infected at a lower rate than people who were assigned to get a placebo injection. Pauses in clinical trials to investigate potential safety issues, a slower-than-expected rate of infections among participants in at least one of the trials, and signals that an expert panel advising the Food and Drug Administration may not be comfortable recommending use of vaccines on very limited safety and efficacy data appear to be adding up to a slippage in the estimates of when vaccine will be ready to be deployed.

The education system is facing overwhelming dilemmas as many experience failed attempts to offer in-person learning options to the most vulnerable communities; marginalized community members are less likely to send their kids back to school out of fear of health concerns, widening the learning gap and causing concern among educators and school districts. Parents and teachers are also worried about what dire effects virtual learning environments may have on Kindergarteners, where engaging with other students and materials is especially critical for development. The big question that most school districts seem to be facing is — how can we reach our students?

If you have any questions or comments concerning this report or previous reports, or have any suggestions for future reports, please email them to dihicovidnc@gmail.com. We would love any and all feedback! Additionally, the personal emails of the authors can be found here: christopher.honeycutt@duke.edu, joanne.kim@duke.edu, tamara.tran@duke.edu. Thank you!

Important Statistics/Quotes

A smaller percentage of adults aged <60 years, particularly those aged 18–29 years, reported engaging in the mitigation behaviors assessed compared with adults aged ≥60 years. Morbidity and Mortality Weekly Report (MMWR).
The director-general of the World Health Organization (WHO), Tedros Adhamon Ghebreyesus, stated that “giving up on control [of COVID-19] is dangerous” and “control should… be part of the strategy.” STAT.

COVID-19 & the Education System

What kids stand to lose if 2020 steals kindergarten. The Hechinger Report.

Facing many technical barriers; younger students have a difficult time even logging on correctly
The virtual learning environment may cover pre-literacy and math skills, but it cannot provide the experience of building block towers, playing make-believe and mastering the playground equipment — all critical elements of child development
Laura Bornfreund, the director of early and elementary education policy at New America, a progressive think tank. “But the foundational knowledge, the skills to be able to learn and do well in school later are so important. Kindergarten matters a lot.”
62% of predicted 3.7 million 5-year-olds are learning virtually
Research has shown that early education especially helps children from low-income families through to their adulthood.
Missing kindergarten could become a permanent handicap for the most vulnerable students
Many districts are working to bring their youngest students back to school; however, students of color were the least likely to return to school in person this fall.
A September survey of 677 school districts found that 79 percent of Hispanic students, 75 percent of Black students and 51 percent of white students wouldn’t have the option of in-person learning in September
This year’s kindergartners will enter first grade knowing less than they would have learned in a typical year.
A research team based at the University of Oregon estimates that as many as 600,000 fewer children than expected have enrolled in public kindergarten this fall — a 17 percent decline in kindergarten enrollment.
Some parents have enrolled their children in private schools or decided to pay special child care centers to supervise their kids learning online

Educators Wanted Vulnerable Students To Return First for In-Person Learning, But a Racial Divide Spoiled Their Plans. The 74.

In school districts with more Black and Latino students, families have been hesitant to send their kids to in-person classes, in part because of health concerns.
These families live in multi-generational families
Less likely to have health insurance
Districts have yet to earn their trust
Disastrous academic consequences that will widen the learning gaps between white, Black, and Latino students.
Black and Latino parents have their children in remote learning at much higher rates than white families.
Many marginalized individuals are afraid of the health risks: a recent report from the Centers for Disease Control revealed that 75% of COVID-19 deaths for people under age 21 identified as Black, Latino, or American Indian/Alaska Native. White patients are under represented in nearly every mortality measure of the disease. These may be due to various factors:
20% of Latinos and 15% of Black people 65 and under do not have health insurance.
Marginalized individuals are less likely to have jobs that offer paid time off and family sick leave
These groups are also more likely to have underlying conditions that make the virus more deadly.
Black and Latino families are more likely to reside in smaller, more crowded homes
More likely than white families to have a grandparent in the home
Most schools have tried to tap into emergency funding to provide personal protective equipment and sanitation supplies
Black and Latino parents may feel that the safety of their children will be drowned out by federal, state, and local political agendas

Missing in the Margins: Estimating the Scale of the COVID-19 Attendance Crisis. Bellwether Education Partners.

3 million of the most educationally marginalized students in the country, may not have access to any formal education
Many lack the devices and Wi-Fi access to fully participate in virtual instruction.
16.9 million children lacked home internet access
7.3 million children did not have a computer at home
These students disproportionately live in low-income households and are more likely to be Black, Latinx, or Native American
Gaps in technology access persist
Many English learners and students with disabilities have no good options to receive the educational accommodations and services they need
Isolated children and youth experiencing abuse, neglect, or acute mental health needs, no longer have teachers and other school staff trained to spot warning signs.
Early local reporting suggests widespread decreases in child abuse reporting, increases in child deaths, and more older children being killed
Once a student leaves school, it is difficult to reenter.
One study of a large, urban district found that 2/3 of high school dropouts never re-enrolled
Much shorter disruptions to learning can have long-term consequences on students’ knowledge and skills, achievement, college and career trajectories, and lifetime wages
Arrived at 3 million students using two broad methods:
Observed media reports and district and state survey data to figure out which student groups faced difficulty engaging in or accessing education in spring and fall 2020
Gathered existing federal data sources to estimate how many students fell into higher-risk groups in every state and nationally
3 million students includes the children who are offline and hard to reach and the children who have made a transition away from school engagement permanently

There are four things that public leaders can do to support students:

School districts and states must collect and report disaggregated attendance data in real time; follow up with lost students
Schools, districts, and communities must develop and implement attendance intervention strategies
Social service agencies, telecommunications companies providing Wi-Fi access, and community-based organizations must work with local and state education agencies to develop plans for the most vulnerable children
State and federal government leaders need to provide guidance, funding, and resources for schools and other social services to support these plans

Further Literature:

Colleges Slash Budgets in the Pandemic, With ‘Nothing Off-Limits’. New York Times.

High school seniors have made no progress in math or reading on closely watched federal test. Chalkbeat.

Why schools probably aren’t COVID hotspots. Nature.

Why is Europe Keeping Its Schools Open, Despite New Lockdowns?. New York Times.

Staffing shortages prevent Champlain Valley schools from bringing back students. Burlington Free Press.

Disparities Among Race, Ethnicity, & Geography

COVID-19 Racism and Mental Health in Chinese American Families. Pediatrics.

This study revealed that a high percentage of Chinese American parents and their children personally experienced or witnessed anti-Chinese or anti–Asian American racial discrimination both online and in person due to the COVID-19 pandemic. One in 4 parents and youth reported vicarious racial discrimination almost every day, and most respondents reported directly experiencing or witnessing racial discrimination against other Chinese or Asian American individuals due to COVID-19 at least once. These numbers are highly concerning and support the calls for attention to the issue of racism during the COVID-19 pandemic.
The study assessed parents’ and youth’s perceptions of collective racism toward their racial-ethnic group (Sinophobia) and found that participants, especially youth, perceived that many Americans consider Chinese people and culture to be a threat to public health in the United States. More than half of parents and youth also believed that this fear and/or dislike of China, Chinese people, or Chinese culture was presented and promoted by the media. These findings likely reflect the source of the outbreak and the use of the terms “China or Chinese Virus” or “Kung Flu” by government officials and the media.
The study found that COVID-19-experiences of racial discrimination were associated with higher levels of reported generalized anxiety and depressive symptoms, consistent with previous studies on daily discrimination. Racial discrimination experiences can threaten individuals’ identity and sense of control and thus foster hopelessness and the internalization of negative attitudes from the dominant group. Being the direct target of racial discrimination, both in person and online, and perceptions of Sinophobia were also associated with poorer psychological well-being in adults, indicating that direct experiences may have additional detrimental effects on positive functioning. The patterns of associations between racial discrimination and mental health were also similar for youth.

Infection Prevention and Treatment Strategies

COVID-19 Mitigation Behaviors by Age Group — United States, April–June 2020. Morbidity and Mortality Weekly Report (MMWR).

This Morbidity and Mortality Weekly Report analyzed data from the COVID Impact Survey, which asked respondents about the risk mitigation and transmission prevention practices that they were undertaking as a part of their daily life during the COVID-19 pandemic. Participants were asked “Which of the following measures, if any, are you taking in response to the coronavirus?”, from which three responses were analyzed: “wore a face mask,” “washed or sanitized hands,” and “kept six feet distance from those outside my household.” Additionally, three social mitigation behaviors aligning with Centers for Disease Control and Prevention (CDC) considerations and White House guidelines from March and April 2020 also were selected for analysis: “avoided public or crowded places,” “cancelled or postponed social or recreational activities,” and “avoided some or all restaurants.”
Findings from the study included that the majority of U.S. adults reported engaging in most or all of the six mitigation behaviors assessed. Age was an important determinant of engagement in mitigation behaviors overall. A smaller percentage of adults aged <60 years, particularly those aged 18–29 years, reported engaging in the mitigation behaviors assessed compared with adults aged ≥60 years. Furthermore, while reported use of face masks increased significantly across all age groups over time, other reported mitigation behaviors declined or did not change significantly across age groups. Finally, compared with adults who reported wearing a mask, those who did not report mask use also reported engaging in significantly fewer other mitigation behaviors during the same period, with significant declines in all other behaviors from April to June.
These findings indicate the need for effective strategies for increasing compliance to risk mitigation and transmission prevention methods. Some potential methods include the engagement of trusted leaders and social media influencers in promoting such a message, offering practical tips for engagement, appealing to personal values, and addressing social and emotional challenges potentially associated with social distancing behaviors, and engaging communities, businesses, employers and institutes of higher education to ensure mitigation behaviors are both feasible and actively encouraged where young adults work, study, and engage in recreational activities.

COVID-19 transmission — up in the air. The Lancet Respiratory Medicine.

There are three main forms of transmission of SARS-CoV-2: contact transmission, droplet transmission, and airborne transmission. Contact transmission contains within it both transmission through direct contact with another individual who is infected with COVID-19 and surface transmission, which is contact with surfaces on which SARS-CoV-2 is residing. The latter has been shown to be a relatively minor form of transmission, with one piece of evidence being that while SARS-CoV-2 RNA has been found to persist on inanimate objects for days, scientists have been unable to culture virus from these surfaces, suggesting that transmission would not be possible from those surfaces.
Droplet transmission has canonically been the predominant form of SARS-CoV-2 transmission, in which the virus is spread in large droplets produced by infected individuals when coughing, sneezing, or breathing in close proximity with other individuals. Such indications have resulted in the explosion of social distancing as one of the principal forms of viral transmission prevention across the globe. Major health organizations have released differing guidelines on social distancing measures, with the World Health Organization (WHO) suggesting that 1 meter is sufficient while the Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH) suggesting 2 meters.
However, both recommendations do not account for airborne transmission of SARS-CoV-2, in which small particle aerosols, less than 5 um in size, can persist for much longer periods of time in the air and thereby infect individuals who are more that 2 meters from an infected individual. Such cases have been reported relatively rarely, and mostly in instances in which there is inadequate ventilation in indoor settings and infected individuals are present in the room for very extended periods of time. With it becoming increasingly difficult to socialize and exercise outdoors in the U.S. and Europe due to colder temperatures, and rising daily COVID-19 case counts, it is incredibly important to listen to the newest scientific findings and advice to avoid increasing rates of transmission and mortality from COVID-19 due in part to pandemic fatigue.

WHO warns giving up on efforts to control Covid-19 would be ‘dangerous’. STAT.

The director-general of the World Health Organization (WHO), Tedros Adhamon Ghebreyesus, stated that “giving up on control [of COVID-19] is dangerous” and “control should… be part of the strategy.” These comments came following comments by White House Chief of Staff Mark Meadows that appeared to indicate that containment of the virus is not possible in the United States. This line of thinking is not shared by all within the Trump administration, as Brett Giroir, assistant secretary for health, told reporters that he thought SARS-CoV-2 could still be contained within the U.S.
Over the past week, the U.S. has averaged more than 70,000 new cases of COVID-19 per day, which puts transmission back at the levels seen in late July. The WHO has indicated that it believes strict lockdowns are not necessary in areas in which containment measures, such as effective testing, contact tracing, quarantine, social distancing, and mask wearing are carried out in a sufficient and effective manner. However, such measures have largely been insufficient in reducing the spread of SARS-CoV-2 in the U.S., resulting in a current situation in which there is the potential for hospital capacities to be overwhelmed in the future.

Further literature:

COVID-19–Associated Hospitalizations Among Health Care Personnel — COVID-NET, 13 States, March 1–May 31, 2020. Morbidity and Mortality Weekly Report (MMWR).
SARS-CoV-2 Neutralizing Antibody LY-CoV555 in Outpatients with Covid-19. The New England Journal of Medicine.
Frequency of Routine Testing for Coronavirus Disease 2019 (COVID-19) in High-risk Healthcare Environments to Reduce Outbreaks. Clinical Infectious Diseases.

The Race for a Vaccine

No news on Pfizer’s Covid-19 vaccine is good news — and bad news. STAT.

Pfizer revealed Tuesday that researchers have not yet conducted an analysis of the efficacy of the vaccine it is developing against Covid-19. Umer Raffat, a senior managing director at the investment bank Evercore ISI, wrote in an analyst note that the fact that Pfizer hasn’t conducted an interim analysis was “a good thing” because it means that, based on the details of the trial protocol, the vaccine had not failed to prevent more than 77% of Covid cases, the benchmark for success at this early juncture.
But it also suggests that cases of Covid are being reported less frequently among participants in the Pfizer study than in the U.S. as a whole. That means that the study is progressing more slowly than Pfizer and its partner, BioNTech, originally expected. In August, Pfizer had thought that the first interim analysis could occur as early as September.
Pfizer and BioNTech are under a white-hot spotlight because their Covid-19 vaccine, by design, is likely to be the first to have any efficacy data. But that first analysis will come when there have been a total of only 32 cases of Covid-19 across the company’s entire 42,000-volunteer study. It would be considered to be positive, Pfizer has said, if six or fewer of those 32 cases occurred in the group that received the vaccine, with the rest occurring in the group that received the placebo. The trial is expected to continue until 150 of the volunteers in the study have had Covid-19.

Maintaining confidentiality of emerging results in COVID-19 vaccine trials is essential. The Lancet.

It is widely recognized that emerging data by intervention group from clinical trials must be kept confidential — ie, accessible only to the trial Data Monitoring Committee (DMC).2 However, less well recognized are the risks to trial integrity from the release of data pooled across vaccine and placebo groups. Public comments by some sponsors of COVID-19 vaccine trials about the precise timing of efficacy analyses, or expected trial results suggest that data pooled across vaccine and placebo groups may be routinely shared with vaccine sponsors. Knowledge of the pooled event rate alone, if lower or higher than expected on the basis of the trial design, could lead sponsors and others to predict that a vaccine is better or worse than hoped. If such a prediction led to changes in the trial design — eg, reduction in sample size or change in the primary endpoint if pooled data on a secondary endpoint seemed more promising — this would seriously damage the interpretability of the final results and violate the fundamental assumption that the same data are not used both to generate and to confirm hypotheses.
Similarly, access to information on the timing of events — ie, the event rate by time after randomization — in the pooled data could be informative about vaccine effects, since such a rate in the placebo group would be expected to be fairly constant over time. Thus, such information should not be used to alter criteria for defining primary events or for changing the time after the last vaccine or placebo dose when events would be included in the primary analysis. Although procedures implemented for data sharing, unfortunately, may allow sponsors ongoing access to information pooled across vaccine and placebo groups in COVID-19 vaccine trials, such sponsor access should not be used to implement protocol changes that bias the likelihood of a trial meeting its success criteria.

FDA shows signs of cold feet over emergency authorization of Covid-19 vaccines. STAT.

There are serious signs the Food and Drug Administration is getting cold feet over the notion of issuing emergency use authorizations to allow for the widespread early deployment of Covid-19 vaccines.
Instead, it appears the agency may be exploring the idea of using expanded access — a more limited program that is typically used for investigational drugs — in the early days of Covid vaccine rollouts. Whereas a few weeks ago the agency’s concern was to protect against the possibility that unproven vaccines would be pushed out prematurely due to pressure from President Trump, now the fear is that early authorization of vaccines could squander a one-time chance to determine how well the various vaccines work and which work best in whom.
The problem stems from thorny ethical questions about whether — once a vaccine has been cleared for use by the FDA — the people who were randomly assigned to receive a placebo in its clinical trial must be informed and offered vaccine. Vaccinating the people who received placebo injections — the trial’s control arm — would end the ability to continue to compare the two groups after what would have been a short trial.
The EUA could trigger another related problem. People in clinical trials might choose to pull out and try to get the vaccine that has been authorized for emergency use, especially if they are in a high-risk group that is likely going to be at the front of the line when vaccines begin to become available. Enrollment in the vaccine trials for other Covid vaccines might slow as people decide they don’t want to risk being randomized to receive a placebo, and instead wait for their turn to get vaccine cleared under an EUA.

Further literature:

Covid-19 vaccine trials from AstraZeneca, Johnson & Johnson to restart. STAT.
There’s no place like home for older and high-risk people to get Covid-19 vaccines. STAT.
What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. The Lancet.
It may be time to reset expectations on when we’ll get a Covid-19 vaccine. STAT.

Infection Rates and Disease Course in Children

COVID-19 Outbreak Among a University’s Men’s and Women’s Soccer Teams — Chicago, Illinois, July–August 2020. Morbidity and Mortality Weekly Report (MMWR).

Data on transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), among college athletes are limited. In August 2020, the Chicago Department of Public Health (CDPH) was notified of a cluster of COVID-19 cases among a university’s men’s and women’s soccer teams. CDPH initiated an investigation, interviewed members of both teams, and collated laboratory data to understand transmission of SARS-CoV-2 within the teams. Numerous social gatherings with limited mask use or social distancing preceded the outbreak.
Transmission resulted in 17 laboratory-confirmed COVID-19 cases across both teams (n = 45), likely from a single source introduction of SARS-CoV-2 (based on whole genome sequencing) and subsequent transmission during multiple gatherings.
Colleges and universities are at risk for COVID-19 outbreaks because of shared housing and social gatherings where recommended prevention guidance is not followed. Improved strategies to promote mask use and social distancing among college-aged adults need to be implemented, as well as periodic repeat testing to identify asymptomatic infections and prevent outbreaks among groups at increased risk for infection because of frequent exposure to close contacts in congregate settings on and off campus.

Live Trackers/Important Links

Credits and Contact

If you have any questions or comments concerning this report or previous reports, or have any suggestions for future reports, please email them to dihicovidnc@gmail.com.

This brief was authored by Christopher Honeycutt, Joanne Kim, and Tamara Tran interns at the Duke Institute for Health Innovation.