Weekly Coronavirus Update: Tuesday, November 24, 2020

Happy Tuesday, everyone. I never get personal on these posts, but today I can’t seem to write this without sharing that over the past week, this virus is feeling more and more personal to me. Last week someone I know from high school lost her mom to Covid after 26 days in the ICU. Over the weekend my partner lost a doctor friend he used to work with due to Covid. And two days ago I found out that the parents of one of my family members are both in the ICU with Covid. I literally hear from someone every single day in the US to tell me they or someone close to them tested positive for this virus. The deaths, hospitalizations, and knowing that people I care about are dealing with this are devastating. For the sake of your own health and that of your loved ones, please stay home this holiday season. Thanksgiving is two days away. The virus will not be gone at Christmas, either. Nor New Year’s. Please weigh the short-term benefit of seeing your family or friends for one day during an incredibly risky time versus waiting 3–6 more months when a vaccine will be available for most of us and you can gather with your loved ones with much greater protection.

Now, personal thoughts aside, here is your weekly update with Coronavirus-related research and news.

1) This week’s edition of the CDC’s Morbidity and Mortality Weekly Report presented new research-based evidence supporting the use of masks to slow the spread of Coronavirus. The study examined the state of Kansas and its Covid-19 cases following a statewide mask mandate. The 24 counties that followed the mandate experienced a 6% decrease in cases, while the 81 counties that did not enforce the mandate saw a 100% increase in cases during the same time period (measured from June 1 — August 23, 2020). An NPR article covering the study noted, “The coronavirus is a respiratory virus. It spreads from person to person, primarily via respiratory droplets expelled when we are in close proximity to others. These droplets can hang in the air — especially indoors, in poorly ventilated spaces. So, blocking the dispersion of such droplets with a mask is a good strategy to cut down on transmission.” You can read the full study here: https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6947e2-H.pdf and the previously mentioned NPR article here: https://www.npr.org/sections/health-shots/2020/11/23/937173060/mask-mandates-work-to-slow-spread-of-coronavirus-kansas-study-finds?utm_term=nprnews&utm_campaign=npr&utm_medium=social&utm_source=facebook.com&fbclid=IwAR06lebAxacUrUYrDkzxF_XFMZSY6Y56ekbGOGYjYjthhTT7nCHIYnTsKC0

2) One of the biggest questions a lot of us have about this virus is in regard to immunity after recovering from an infection. A new study by researchers at the University of California San Diego (which is still awaiting peer review) found that although antibody levels often fall to undetectable levels weeks or months after infection, immune memory in B cells and two classes of T cells were still present at least five months after infection. The researchers studied 185 people who represented a wide range of severity of the virus, ranging from asymptomatic to severe, although the majority (90%) had mild cases. Of the participants, 90% had immune memory in all three of these immunological compartments (memory B cells, CD4 T cells, CD8 T cells) over five months after infection. The authors wrote that their results indicated “that durable immunity against 2o COVID-19 disease is a possibility in most individuals.” You can read the full study here: https://www.biorxiv.org/content/10.1101/2020.11.15.383323v1 and a short write-up about it from the website Nature here: https://www.nature.com/articles/d41586-020-00502-w

3) A study conducted by several researchers at British hospitals and universities examined 201 young, low-risk patients who had ongoing symptoms of Covid. They found that 70% of the patients had damage to at least one organ four months after contracting the virus. Of the 201, the mean age was 44, 70% were female, 87% were white, and few had any pre-existing conditions. Of the organs found to be damaged, 33% had lung damage, 32% had heart damage, 17% had pancreatic damage, 12% had kidney damage, 10% had liver damage, and 6% had damage to the spleen. Of the 25% who had damage to multiple organs, there was a significant association with prior Covid hospitalization. The authors noted that the results “signal the need for monitoring and follow-up in at least the medium and longer term”. In addition to the organ damage these patients exhibited four months after testing positive, they also continued to experience Covid symptoms such as fatigue (98%), muscle aches (88%), breathlessness (87%), and headaches (83%). The study has not yet undergone peer review (important point!) and you can read the full text version here: https://www.medrxiv.org/content/10.1101/2020.10.14.20212555v1.full.pdf as well as a summary article about it published in The British Medical Journal here: https://www.bmj.com/content/371/bmj.m4470

4) You probably heard that a third Covid vaccine, this one from the pharmaceutical company AstraZeneca and British university Oxford, was found to be up to 90% effective in its clinical trials. The trials involved testing different doses of the vaccine, and interestingly, the most effective dose appears to be one in which a half dose is given first, and then a full dose a month later. I have read countless articles theorizing why this might be the case. Whatever the case, though, for now what we know is that there is a third vaccine that has shown to be effective against Covid. While the Pfizer and Moderna vaccines both use mRNA, the AstraZeneca vaccine is similar to the flu vaccine many of us receive every year, using a live virus. This means it does not need to be stored at extremely cold temperatures and can be stored for up to 6 months. The British government has a contract with Oxford/AstraZeneca to receive 100 million doses of the vaccine when it is available, which would be nearly enough to vaccinate the entire country. You can read about the vaccine here: https://www.theguardian.com/society/2020/nov/23/astrazeneca-says-its-coronavirus-vaccine-has-70-per-cent-efficacy-covid-oxford-university

5) While we’re still waiting on peer-reviewed research to be published confirming the efficacy of three vaccines mentioned in the last point, a peer-reviewed article published in The Lancet suggested that the AstraZeneca vaccine could build robust immunity in elderly populations of age 70 and over based on the findings of their clinical trials. Additionally, those in the older age group were less likely to experience adverse reactions to the vaccine than those in the younger groups. As elderly populations are much more susceptible to serious cases of Covid, it is important for a vaccine to be effective in these groups. Therefore, the findings of this study are positive in terms of protecting elderly populations. You can view the full study here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32466-1/fulltext#seccestitle150

6) In other vaccine news, a peer-reviewed study published in the journal mBio found that the Measles-Mumps-Rubella (MMR) II vaccine that many of us received as children (MMR II was developed in 1979; most people aged 40 or younger would have received this version of it) was significantly correlated with better Covid outcomes than those who did not receive the vaccine. Those who had the MMR II vaccine and had asymptomatic cases of Covid were found to have higher mumps titers, whereas more severe cases of Covid were found in those with much lower mumps titers. This might explain why children have fared so much better with Covid than adults, as they would have more recently received the MMR II vaccine. As the sample size for this study was quite small at 80 people, the authors recommended that larger studies take place to test their findings, including randomized controlled clinical trials. You can read the study here: https://mbio.asm.org/content/11/6/e02628-20?fbclid=IwAR2dRZ4aYCJNkyeazyj6oHajz3_eT9oXp53evdxQ8Pk1FE7JxaoN5TjVo1A

7) Regeneron’s monoclonal antibody treatment (the one Trump received) was granted emergency use authorization by the FDA for use in patients with mild to moderate Covid-19. Approximately 30,000 doses of the treatment are being distributed to US hospitals starting today and will be allocated to those states with the highest case numbers and hospitalizations. By the end of January the company hopes to have 300,000 doses of the treatment available. This treatment is very similar to the one from Eli Lilly, which received emergency use authorization recently and is already being used in hospitals. You can read more about the Regeneron treatment in this Reuters article: https://uk.reuters.com/article/idUKKBN2832P8

8) In other treatment news, last Thursday the World Health Organization (WHO) recommended against using remdesivir, an antiviral treatment, to treat Covid-19 patients. The WHO published a paper in the British Medical Journal based on the recommendations of an expert panel, which found “a lack of evidence that remdesivir improved outcomes that matter to patients such as reduced mortality, need for mechanical ventilation, time to clinical improvement, and others.” The panel did not feel the drug was dangerous to Covid patients, just that it did not have any significant effects on their outcomes from the virus. You can read the full paper here: http://press.psprings.co.uk/bmj/november/remdesivir.pdf

9) Finally, your world update. The US had its highest daily number of cases on Friday, with 198,633. Over the last two weeks, the number of daily cases in the US has risen 49%, deaths have increased by 62%, and hospitalizations have increased 49%. Hawaii is the only state in which new cases are decreasing. Yesterday the US set its 13th straight daily record for hospitalizations. For my Indiana readers, your seven-day average number of new cases is 6,322. Over the last two weeks, cases are up 51%, deaths are up 45%, and hospitalizations are up 55%.
— In the UK, the number of daily new cases is beginning to drop now that we’re on lockdown. Yesterday there were 15,450 new cases, and over the past two weeks the number of new cases has dropped by 14%. Deaths are on the rise, though, with a 29% increase over the past two weeks. Yesterday the government announced that when lockdown ends on December 2, we will enter a new three-tier system of restrictions that is stricter than the old three-tier system. It has yet to be announced which regions will be in which tier.
— Elsewhere, Australia has reopened the border between New South Wales and Victoria, and the border between NSW and Queensland will open on December 1. Japan announced it will suspend domestic travel campaign in Osaka and Sapporo as case numbers rise in both cities. India, which saw the virus peak in September, has remained below the 50,000 mark for daily new cases for two weeks now, recording 37,975 new cases yesterday.
US numbers: https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html?name=styln-coronavirus&region=TOP_BANNER&block=storyline_menu_recirc&action=click&pgtype=LegacyCollection&impression_id=cbb3c832-2e3a-11eb-a507-73b82b589c0c&variant=1_Show and https://www.wsj.com/livecoverage/covid-2020-11-23
Indiana numbers: https://www.nytimes.com/interactive/2020/us/indiana-coronavirus-cases.html
UK numbers: https://www.nytimes.com/interactive/2020/world/europe/united-kingdom-coronavirus-cases.html
UK’s new three-tier system: https://www.theguardian.com/world/2020/nov/23/england-new-post-lockdown-covid-tier-system-explained
World updates: https://www.theguardian.com/world/live/2020/nov/24/coronavirus-live-news-who-says-foreign-experts-to-go-to-china-soon-us-records-more-than-10000-weekly-deaths?page=with:block-5fbc864c8f0868ed26c110b5#block-5fbc864c8f0868ed26c110b5

That is all for this week. Please stay safe, everyone.