The Ride Never Ends – EOH 8/28

Just when you thought the lockdowns were almost over, the consequences from the global lockdowns are just beginning to be felt. Turns out lockdowns discriminate against the young (the lowest risk of a severe COVID outcome)  and lead to an increase in anxiety, depression, and thoughts of suicide, especially for those 25 and younger. On the bright side, more evidence is pointing to a lower herd immunity threshold (HIT)Turns, Guayaquil, Ecuador potentially reached herd immunity with less than 33% of their population having measured  antibodies. 

In an unfortunate outcome, several nations that were lauded with strict lockdowns or aggressive mitigation are having a second spike, similar to the US’s summer spike in the south. South Korea is currently dealing with a new outbreak. An EU minister had to resign after he was violating his own lockdown and took a vacation. 

In the end, every nation will be humbled by COVID.  

COVID News

New CDC guidelines are aligned with science

The CDC’s updated testing guidelines by focusing on high risk individuals are more aligned with how COVID-19 spreads in the real world.  

“On August 24, the CDC updated its guidance on testing for SARS-CoV-2 to state that an individual who does not have COVID-19 symptoms and has not been in close contact with someone known to have a COVID-19 infection does not need a test. The guidance also states that individuals do not necessarily need a test if they’ve been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms. Testing is also not needed for individuals who are “in a high COVID-19 transmission area and attend a public or private gathering of more than 10 people (without widespread mask wearing or physical distancing).” COVID-19 tests are mainly rRT-PCR (real-time reverse transcription polymerase chain reaction) tests, while a smaller number are antigen tests. All tests were approved under Emergency Use Authorizations, and information about their specificity and sensitivity is nearly impossible to find, even if you know which test a particular lab is using. The fact sheet for the Quest Diagnostics SARS-CoV-2 rRT-PCR test states, “This test is to be performed only using respiratory specimens collected from individuals suspected of COVID-19 by their healthcare provider.”

44% of Californians report clinical levels of anxiety, depression during COVID-19 pandemic

Turns out being locked up inside all day due to lockdowns leads to depression.

“It’s official, California: COVID-19 has left us sick with worry and increasingly depressed. And our youngest adults — those ages 18 to 29 — are feeling it the worst. Weekly surveys conducted by the U.S. Census Bureau from late April through late July offer a grim view of the toll the pandemic has taken on mental health in the Golden State and across the nation. By late July, more than 44% of California adults reported levels of anxiety and gloom typically associated with diagnoses of generalized anxiety disorder or major depressive disorder — a stunning figure that rose through the summer months alongside the menacing spread of the coronavirus.”

How the media has us thinking all wrong about the coronavirus

https://www.washingtonpost.com/opinions/2020/08/25/how-media-has-us-thinking-all-wrong-about-coronavirus/

With the absence of reliable data,COVID response policy  has tended be extreme such as banning safe activities like  hiking. 

“The problem is that reporting on covid-19 tends to follow the shark-attack example. We’re unaccustomed to what the virus has wrought — hospitals overwhelmed, celebrities and world leaders suffering near-death experiences in the public eye. These “surprises” are what the media focuses on. The challenge with the novel coronavirus, however, is exactly that: It’s completely novel. Nothing about it should be expected. All of the ways it behaves — and doesn’t behave — are new. In that sense, a nursing home with zero infections should be just as newsworthy as a nursing home with several. Because of the overwhelming bias in what gets reported about covid-19, the public lacks essential context for making reasoned, well-informed decisions. Researchers found, for example, that droplets containing the virus can, in theory, travel far in the air. That discovery was widely reported. Overlooked was the fact that, even if droplets can travel far in the air, we don’t have evidence that they usually do. So hiking trails and other open-air facilities were closed, despite the fact there are no documented cases of covid-19 caused by hiking.”

Pandemic-related ‘deaths of despair’ were forecast at about 75,000 back in May — now they could be up to 150,000

https://www.businessinsider.com/coronavirus-deaths-suicide-drugs-alcohol-depression-unemployment-2020-8

Preventing people from working leads to poverty with lethal consequences.

“For one woman living in Beloit, Wisconsin, life is full of bills, stress, depression, and sleepless nights. The woman, who asked to remain anonymous for privacy, lost her job as a bartender in mid-March and, like many Americans, is struggling to get back on her feet.  When asked how she’s getting by on a day-to-day basis, she responded simply, “I’m not.” The bar she worked for permanently closed and new job opportunities are slim to none. She relies on a food share to eat. Her biggest fears are the possibility of eviction, becoming homeless, and “losing everything I worked hard for,” she told Business Insider via email.  Her struggle is all too familiar to the 13 million Americans who have remained jobless since mid-March, per the Bureau of Labor Statistics. With each passing week, more will become long-term unemployed, or those who’ve been unemployed for six months or more. But this isn’t just an economic issue. It’s a public health crisis waiting to happen. Back in May, researchers from the nonprofit the Well Being Trust projected that the pandemic’s economic fallout would lead to a median of 75,000 additional “deaths of despair” over a 10-year period.  “Deaths of despair” are deaths related to isolation, unemployment, and financial struggle, usually by overdose, suicide, or alcohol or drug-abuse-related illnesses. The term was coined by Princeton economist Anne Case and Nobel Prize winner Angus Deaton.  But now, due to the economy’s slow recovery — and a lack of adequate investment in mental health funding — researchers who made that projection say the number of deaths could be even higher, up to 150,000.”

Idaho House passes resolution to end coronavirus emergency declaration

https://www.ktvb.com/article/news/local/idaho-legislature-special-session-emergency-declaration-resolution-house/277-79aa309d-67f9-4886-ad20-ffdc31d854e7

One state’s legislature gets involved and to end any future shutdowns.

“Little called the session to address the upcoming election and limiting civil liability connected to the pandemic. Rep. Steven Harris, R-Meridian and the sponsor of the resolution, said Little’s original declaration of emergency was intended to ensure that COVID-19 cases did not outstrip Idaho hospitals’ ability to care for patients. Hospital capacity has remained more than adequate since the pandemic began, Harris said, but the governor’s declaration and stay-home order caused “extensive collateral damage” to citizens. Rep. Christy Zito, R-Hammett, agreed during the debate that restrictions should be lifted, saying she was disturbed by some of the precautions related to the pandemic. “We are putting our children in plexiglass cages,” she said. “We are masking faces so those that are hearing-impaired feel lost and cannot function. We are masking faces so that children like my grandson, who is borderline autistic, is traumatized often by faces that he can’t see and relate to.”

Research

Cities: build networks and share plans to emerge stronger from COVID-19

https://www.nature.com/articles/d41586-020-02459-2

While cities are starting to learn about what does and doesn’t help fight COVID-19, the initial strict response of several  cities caused a lot of preventable fatalities.

“Cities’ scorecards on COVID-19 are mixed. Although the picture is evolving, they already tell us a lot about what works and what doesn’t. First, strong leadership and governance at all levels are crucial to ensure rapid responses. Well-run cities such as Hanoi in Vietnam were able to avoid major outbreaks at the outset by rapidly restricting travel and scaling up testing, tracing and quarantining. Similarly, Thiruvananthapuram (Trivandrum), the capital of the Indian state of Kerala with an estimated population of more than 2.5 million, has one of the lowest infection and death rates in the country — just over 4,000 confirmed cases and 12 deaths by 1 August — despite having thousands of returning international students and workers. By contrast, places such as São Paulo in Brazil, Delhi and New York City that reacted slowly or ineffectively ended up with overstretched hospitals and hundreds of times more deaths. Timely, reliable, accurate and science-based information is crucial. Individuals need to know why and how they should maintain a social distance, wear masks and quarantine. For instance, Bangalore in India publishes a daily dashboard and maps of newly diagnosed infections used for local tracing (https://covid19.bbmpgov.in). Yet confusion, contradiction and underestimation are more often the norm. The Chinese city of Wuhan has been criticized for being slow in responding to the emergence of the virus. Lack of notice of lockdowns in India left millions of migrant workers scrambling to arrange transport home in March and May.”

Two metres or one: what is the evidence for physical distancing in covid-19?

https://www.bmj.com/content/370/bmj.m3223

The original 6-feet rule for social distancing is outdated and  the rule doesn’t make sense in real world scenarios. 

“Instead of single, fixed physical distance rules, we propose graded recommendations that better reflect the multiple factors that combine to determine risk. This would provide greater protection in the highest risk settings but also greater freedom in lower risk settings, potentially enabling a return towards normality in some aspects of social and economic life. The study of how droplets are emitted during speech or more forcefully when coughing or sneezing began in the 19th century, with scientists typically collecting samples on glass or agar plates. In 1897, for example, Flugge proposed a 1-2 m safe distance based on the distance over which sampled visible droplets contained pathogens. In the 1940s, visual documentation of these emissions became possible with close-up still imaging of sneezing, coughing, or talking (fig 1). A study in 1948 of haemolytic streptococci spread found 65% of the 48 participants produced large droplets only, fewer than 10% of which travelled as far as 5½ feet (1.7 m). However, in 10% of participants, haemolytic streptococci were collected 9½ feet (2.9 m) away. Despite limitations in the accuracy of these early study designs, especially for longer ranges, the observation of large droplets falling close to a host reinforced and further entrenched the assumed scientific basis of the 1-2 m distancing rule.”

Charts and Graphics

Density Has Little Impact

Metro density doesn’t directly correlate to a larger number of COVID-19 cases.  

Best and Worst Supplied

The UK and US are now rapidly preparing to provide COVID-19 vaccines for each person in their country. 

Map of z-scores by country (Excess Mortality)

The majority of countries in Western Europe have no excess deaths. 

Comparing COVID-19 Deaths Per Week Between Stockholm Region, Skane & Vastra Gotaland

The decline in COVID-19 deaths in Sweden is a universal trend, affecting urban, suburban, and rural regions. 

Weekly COVID-19 Deaths Per Million, New York and News Jersey versus the Rest of the Country

 As the pandemic recedes in the US, New York and New Jersey are the outliers, in a bad way. 

International News

EU trade chief Hogan quits over Ireland COVID-19 ‘golfgate’ controversy

https://www.reuters.com/article/us-health-coronavirus-ireland-eu/eu-trade-chief-hogan-quits-over-ireland-covid-19-golfgate-controversy-idUSKBN25M2HP

Do as I say not as I do…

“Phil Hogan quit as the EU’s Trade Commissioner on Wednesday after days of pressure over allegations he breached COVID-19 guidelines during a trip to his native Ireland, saying it had become clear the controversy was a distraction from his work.The forced exit of a heavyweight from the bloc’s executive will be a credibility blow for the team led by European Commission President Ursula von der Leyen for less than a year. The Commission will play a key role in pushing across the line a 750 billion-euro recovery fund for EU economies hammered by the coronavirus crisis, and Hogan himself had been making headway in fraught trade talks with the United States. “It was becoming increasingly clear that the controversy concerning my recent visit to Ireland was becoming a distraction from my work as an EU Commissioner and would undermine my work in the key months ahead,” Hogan said in a statement. “I deeply regret that my trip to Ireland – the country that I have been so proud to represent as a public servant for most of my adult life – caused such concern, unease and upset.” Hogan attended a golf dinner last week that outraged the Irish public and led to the resignation of an Irish minister and the disciplining of several lawmakers. He had insisted on Tuesday that he adhered to all rules during the trip.”

In the Brazilian Amazon, a sharp drop in coronavirus sparks questions over collective immunity

https://www.washingtonpost.com/world/the_americas/brazil-coronavirus-manaus-herd-immunity/2020/08/23/0eccda40-d80e-11ea-930e-d88518c57dcc_story.html

Less then 33% Guayaquil residents have COVID antibodies and cases declined dramatically, which implies a mucher lower herd immunity threshold. 

“European cities that were pummeled by the disease have begun to reopen without crippling second waves. In Guayaquil, the Ecuadoran metropolis where bodies were left on the streets, scientists have cautiously speculated that collective immunity has been reached. Some researchers are now suggesting the same about New York City. The factors that are helping to keep the virus at bay in Manaus and other cities remain unclear. Changed behaviors and individual community characteristics surely play a role. Manaus is testing far more than it once did. But whatever the dynamic, scientists and health officials are starting to wonder whether early prognostications about herd immunity overshot the mark. It was initially believed that between 60 and 70 percent of the population needed to develop antibodies to reach collective immunity. But Guayaquil never broke 33 percent. Manaus, the capital of Amazonas state, never got past 20. “Manaus is an interesting case, indeed,” said Jarbas Barbosa da Silva, assistant director of the Pan American Health Organization. “The hypothesis — and this is just a hypothesis — is that the peak we had in Manaus was very strong, and there was such widespread community transmission that it may have produced some kind of collective immunity.” Draconian restrictive measures reduce the disease sharply, Barbosa said. But in Manaus, the reduction has been gradual, with a steady progression of new cases still arriving every day. That curve suggests the disease followed a “natural dynamic,” Barbosa said.”

South Korea on brink of nationwide virus outbreak, officials warn

https://www.bbc.com/news/world-asia-53888219

Yet another country lauded by experts for its early handling COVID-19 is dealing with a surprise second surge in COVID cases. 

“South Korea, a country held up as a model for its response to Covid-19, is on the brink of a new nationwide outbreak, according to officials. The latest outbreak of coronavirus cases centred around a right-wing Presbyterian church has spread to all 17 provinces throughout the country for the first time. Each day brings a new three digit virus total. Social distancing rules have been stepped up. Masks are now mandatory in Seoul. The government is also considering whether to close schools and businesses. Infectious diseases experts in the country have called on the government to step up social distancing measures even further, warning that “hospital beds are quickly filling up and the medical system is nearing its limits”. The Korea Centers for Disease Control and Prevention (KCDC) has admitted that about 20% of all new cases are of unknown origin – despite the country’s efficient contact tracing system which can track down around 1,000 potentially infected patients in an hour. South Korea’s fight against Covid-19 began in February after an outbreak at a Christian cult called the Shincheonji Church of Jesus in the city of Daegu, about 200km (124 miles) south of Seoul. Within weeks, the outbreak was under control. But things are different this time.”

Covid hunger: Kenyans forced to hunt giraffe for food

https://www.telegraph.co.uk/global-health/climate-and-people/giraffe-covid-threat-kenya-hunger/

Denying people of their livelihood will lead to people taking extreme measures, in this case hunting giraffes for food.  

“In parts of Kenya, the economic damage wrought by the coronavirus pandemic has been so catastrophic that people have started to kill endangered wildlife for food. Last week, The Telegraph trekked with rangers through the Tsavo conservation area, a region larger than Wales in southeastern Kenya, and found a Masai giraffe which had been stripped bare by poachers for bushmeat.“They have really done a hell of a job on this one,” muttered a ranger when we came across the mass of bloodied bones, organs and skinned hide. “They’ve even cut the meat out from in-between his ribs.””

Reopening schools: the case against remote education

https://thecritic.co.uk/reopening-schools-the-case-against-remote-education/

Will reason win in the UK and allow children to go to school in person? Hopefully. Yet fear mongering about in-person schooling in the UK continues just like in the US. 

“It has been clear since the start of the Covid-19 pandemic that children do not contract severe infections and do not easily infect others. Therefore, the decision to close schools to curtail community transmission was always about protecting teachers and their families. The latest research suggests that teachers are far more likely to bring Covid-19 into the classroom from home than contract it from children, but in the event that they infect their pupils it will do them little harm. At the peak of the crisis and before effective medical interventions were clarified, every measure to slow the spread of Covid-19 could be justified, including school closures for older children, although the efficacy of closing primary schools was widely questioned. In Sweden, as is now well known, schools for the youngest were never closed. In the UK, to the credit of the government and its advisers, schools remained open for children of essential workers and those with special needs. Moreover, the youngest children were returned to schools across England on 1 June for a mini summer term. The return of 1.6 million children, and 520,000 staff, to schools for two months offered Public Health England (PHE) the opportunity properly to study coronavirus transmission in multiple education settings between children, between children and adults (teachers and other staff), and between adults. The results are an absolute vindication of the policy of reopening schools, provoking the UK’s Chief Medical Adviser, Prof. Chris Whitty, to observe that “Missing school is worse than the virus for children”. For many in the UK, what is “safe” is determined by fear and politics”

New Tools

We recently added a new interactive tool on our website to look at the correlation between mask usage and COVID-19 cases.

Take a look!