Category: Health

By Allison Gasparini (Courtesy: FORBES)

By Michael Sainsbury (Courtesy: UCANews)

Second waves of the Covid-19 pandemic are beginning to emerge across the Asia-Pacific region, even though other nations have barely felt (at least officially) the impact of the disease’s first surge.

With predictions of a vaccine not being available until 2021 at the earliest, these new surges will not be the last.

A corollary of this is that the disease, like all viruses, is also random in the way that it spreads, but contagion is usually denser in urban areas where close human contact is nearly unavoidable.

This means that outbreaks have been patchy. In India, for instance, Mumbai is in all sorts of trouble while Kerala seems largely safe, at least for now.

Similarly, in Indonesia, Jakarta is the epicenter of the virus but far-flung islands like Flores and Bali have been relatively unscathed so far.

Of course, a lack of testing accounts for some of this, but not all. Yet it is a major mistake to think that any particular town, city or region will escape the coronavirus. Its contagion is such that one infected person can infect many.

In Singapore, authorities were forced to ramp up lockdowns after infections surged in the dormitories of migrant workers, the city’s largely “out of sight, out of mind” underclass.

In South Korea, bars and nightclubs were shuttered almost as quickly as they were reopened — a matter of days — when nightspots turned out to be the center of fresh clusters on infections.

And let’s not forget China where a growing number of towns and cities are being locked down as infections spike, especially in the northeast near Russia and North Korea. Chinese experts have openly spoken about future waves of the coronavirus.

“The majority of Chinese at the moment are still susceptible to Covid-19 infection because of a lack of immunity,” Dr. Zhong Nanshan, a senior medic involved in China’s top-level response, was reported as saying. “We are facing a big challenge; it’s not better than other countries, I think, at the moment.”

He also tacitly admitted that China’s infection numbers may be under-reported, a widespread problem in the region according to experts.

The message from these countries, all of whom have been held up as having responded best to the virus in terms of containment, is that this disease requires constant vigilance in the absence of any vaccine or cure.

Second waves of outbreaks are also emphasizing the discrimination through Covid-19 shaming that has emerged during the still-early stages of this pandemic and which is fast become a toxic byproduct of the virus.

In Singapore, foreign workers are being blamed for spreading the virus — a reaction that is unfortunately commonplace in the region.

In Malaysia, migrant workers from Indonesia and Myanmar have been blamed for carrying and spreading it when in fact the first recorded hotspot was at a middle-class Muslim summit.

In South Korea, many LGBTQ people are in hiding because a gay nightclub was named as a recent hotspot.

Chinese people were racially targeted initially in the region and around the globe. Then in Asia, it was the turn of Europeans who were accused of bringing the disease back to Asia after outbreaks in southern Europe.

Over time, there will be second, third and fourth waves of the virus simply because this slippery disease is so highly contagious. It is therefore imperative that we find sustainable new ways to interact, to work, to socialize and to worship.

As we do this, we must keep in mind that this disease knows no borders and does not respect race, class or ideology. Fighting and protecting ourselves against this virus should be something that brings us together, not something which tears us further apart.

‘Patients have evaporated’

‘Clear priority’

For the first time, a major study suggests that an experimental drug works against the new coronavirus, and U.S. government officials said Wednesday that they would work to make it available to appropriate patients as quickly as possible.

In a study of 1,063 patients sick enough to be hospitalized, Gilead Sciences’s remdesivir shortened the time to recovery by 31% – 11 days on average versus 15 days for those just given usual care, officials said. The drug also might be reducing deaths, although that’s not certain from the partial results revealed so far.

“What it has proven is that a drug can block this virus,” the National Institutes of Health’s Dr. Anthony Fauci said.

“This will be the standard of care,” and any other potential treatments will now have to be tested against or in combination with remdesivir, he said.

A possible treatment for the coronavirus that set off a rally on Wall Street powerful enough to override data showing the U.S. economy had logged its worst quarterly performance since 2009.

No drugs are approved now for treating the coronavirus, which has killed about 226,000 people worldwide since it emerged late last year in China. An effective treatment for COVID-19 could have a profound effect on the pandemic’s impact, especially because a vaccine is likely to be a year or more away.

Fauci revealed the results while speaking from the White House. Remdesivir was being evaluated in at least seven major studies, but this one, led by the NIH, was the strictest test. Independent monitors notified study leaders just days ago that the drug was working, so it was no longer ethical to continue with a placebo group.

Dr. Elizabeth Hohmann, who enrolled 49 patients in the experiment at Massachusetts General Hospital, said study leaders were told Tuesday night that the results are based on “the first cut of 460 patients.”

“There’s over 1,000 in the study so there’s a lot more information to come” and full results need to be seen, she said. “I’m cautiously optimistic.”

Dr. Babafemi Taiwo, chief of infectious diseases at Northwestern Medicine, which also participated in the study, called the results “really exciting.”

“For the first time we have a large, well-conducted trial” showing a treatment helps, he said. “This is not a miracle drug … but it’s definitely better than anything we have.”

Newswise — (New York, NY – April 23, 2020) – A team of researchers at the Icahn School of Medicine at Mount Sinai, in collaboration with GenScript, is developing a synthetic antibody to SARS-CoV-2, the virus that causes coronavirus disease (COVID-19). This antibody is intended to block the virus from entering human lung cells, and would be another potential treatment option for COVID-19.

The efforts are being led by Mone Zaidi, MD, PhD, MACP, Director of the Mount Sinai Bone Program and Professor of Medicine (Endocrinology, Diabetes and Bone Disease) at the Icahn School of Medicine at Mount Sinai, and Tony Yuen, PhD, Associate Director for Research for the Mount Sinai Bone Program and Assistant Professor of Medicine at the Icahn School of Medicine at Mount Sinai.

Coronaviruses, including SARS-CoV-2, have many protein “spikes” protruding from their outer surface. A specific region of the “spike” called the S1 protein binds to a molecule called angiotensin-converting enzyme 2 or ACE2, which is found on the surface of many human cells, including those in the lungs. This is the entry point by which the virus infects a person.

In hopes of developing a treatment that could block the viral entry into cells, Dr. Zaidi and his team, including Sakshi Gera, PhD, a postdoctoral fellow at the Icahn School of Medicine at Mount Sinai, are creating an antibody targeted to a peptide sequence of the S1 spike protein that should interfere with, and thereby block, the virus and prevent its initial attachment and entry into human cells.

The artificial blocking antibody then could be given to people with COVID-19 to stop the virus from infecting additional cells, much as doctors are already doing with natural antibodies harvested from people who have survived COVID-19, in what is known as convalescent plasma therapy.

“Given that convalescent plasma is showing promise and potential in treating this novel virus, the same strategy should be adopted for treatment in sick patients by creating a targeted antibody, which we hope will have the ability to disengage and block COVID-19 from entering our cells. Having experience with antibody development, my lab has embarked on this task together with the generous support of GenScript,” said Dr. Zaidi.

The first step, now underway, is to create a custom version of the S1 spike’s peptide sequence, which will be used to generate the antibody. Once the peptide sequence is available, Dr. Zaidi’s team will collaborate with GenScript to generate a human antibody which will be tested for efficacy in human cells in culture and animal models. Dr. Zaidi and his team hope to then collaborate with Mount Sinai’s Department of Microbiology for further antibody testing. “It’s hard to project how long it will take to have something we can test in patients, but my aim is to have a targeted antibody for first human trials within the next 12 months if all goes as planned, but it could be earlier,” said Dr. Zaidi.

“GenScript’s collaboration with Dr. Zaidi’s lab to co-develop a COVID-19 antibody program signifies GenScript’s ongoing commitment to work with scientific communities to annihilate and prevent COVID-19 beyond its business model. We expect that GenScript’s antibody discovery and development expertise, especially in the field of COVID-19, will fuel Mount Sinai’s first-rate research and development capabilities to bring this important medication to patients,” said Kenneth Lee, Head of US Commercial Division at GenScript ProBio.

For more information about Mount Sinai’s COVID-19 research and response effort, visit https://www.mountsinai.org/covid19.

About GenScript

GenScript is the world leader in biotechnology reagent services and biologics. Established in 2002 in New Jersey, United States, the company was the first to commercialize gene synthesis and successfully establish fully integrated capabilities for custom peptide synthesis, protein expression and engineering, custom antibody development and engineering, in vitro/in vivo pharmacology as well as a variety of catalogue products. GenScript has now expanded its business into immunotherapy, CDMO, laboratory equipment, and microbial industry to further fulfill its mission in making people and nature healthier through biotechnology. GenScript has also established open and innovative technology-driven platforms and GMP facilities for pre-clinical drug discovery and pharmaceutical products development.

About the Mount Sinai Health System

The Mount Sinai Health System is New York City’s largest academic medical system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai is a national and international source of unrivaled education, translational research and discovery, and collaborative clinical leadership ensuring that we deliver the highest quality care—from prevention to treatment of the most serious and complex human diseases. The Health System includes more than 7,200 physicians and features a robust and continually expanding network of multispecialty services, including more than 400 ambulatory practice locations throughout the five boroughs of New York City, Westchester, and Long Island. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report‘s “Honor Roll” of the Top 20 Best Hospitals in the country and the Icahn School of Medicine as one of the Top 20 Best Medical Schools in the country. Mount Sinai Health System hospitals are consistently ranked regionally by specialty by U.S. News & World Report.

There are now more than 70 vaccines currently being developed globally, including here in North America, as research teams race to find a successful vaccine against the novel coronavirus and help countries escape lockdowns.

The World Health Organization (WHO) has reported that more than 70 vaccines are being developed globally for Covid-19, which has infected more than two million people and killed 128,886 across the world.

However, experts say there is still a long road ahead to find out if they work. Timelines for when a vaccine becomes widely available remain at 12 to 18 months.

Meanwhile, Oxford University scientists are to begin human trials of a potential coronavirus vaccine next week. Researchers said the jab could be ready to be rolled out for emergency use by the autumn following significant progress in the early stages of development.

The Oxford team has tested the vaccine successfully on several animal species.

Researchers at the University of Oxford are aiming to get efficacy results of a clinical trial and be able to produce a million doses by September. The researchers have recruited 500 volunteers from the age group of 18 to 55 for early and mid-stage randomised controlled trials, reports Bloomberg. It will then be extended to older adults and to a final stage trial of 5,000 people, Sarah Gilbert, the lead researcher developing the vaccine, said.

The team at the University of Oxford had been preparing for an event like the Covid-19 pandemic before the current global outbreak, reports BBC. They had already created a genetically engineered chimpanzee virus that would form the basis for the new vaccine. They then combined it with parts of the new coronavirus, it reports.

The Oxford team join three other groups of researchers – two in the United States and one in China – in beginning trials on humans.

At the University of Western Ontario, Chil-Yong Kang, a professor of virology, and his team have been working 12 hours a day, seven days a week to find a vaccine for SARS-CoV-2, the virus that causes COVID-19.

Their work is being built on research done for a vaccine candidate Kang previously produced for Middle East respiratory syndrome (MERS), caused by a coronavirus similar to the one that causes COVID-19.

Coronaviruses invade human cells through so-called “spike proteins” — the crowns or corona on the virus — which bind to cell receptors and then begin infection. “If you make an antibody against that spike protein, it will cover up the spike and it will not be able to attach to the cell,” Kang said. “There you have a prevention of infection.”

Kang said his team is working to make six different versions of the vaccine candidate and hopes to have human trials underway by July or August. “We come in every day, and lab workers are here sometimes 12 or 13 hours a day,” he said. “We have both a responsibility and a deep sense of duty to end this COVID-19 pandemic.”

The Oxford University project has recruited 510 people, ranging from 18 to 55 years old, to take part in the trials, said lead researcher Professor Adrian Hill.

“We are going into human trials next week. We have tested the vaccine in several different animal species,” he added. “We have taken a fairly cautious approach, but a rapid one to assess the vaccine that we are developing.”

Professor Sarah Gilbert, a vaccinologist at Oxford, has said she is “80 per cent” confident it will be a success. There is now hope that the jab, developed by the clinical teams at the Jenner Institute and Oxford Vaccine Group, could be ready from as early as September.

“We’re a university, we have a very small in house manufacturing facility that can do dozens of doses. That’s not good enough to supply the world, obviously,” he told the BBC World Service.

“We are working with manufacturing organizations and paying them to start the process now.

 “So by the time July, August, September comes – whenever this is looking good – we should have the vaccine to start deploying under emergency use recommendations.

“That’s a different approval process to commercial supply, which often takes many more years.

“There is no point in making a vaccine that you can’t scale up and may only get 100,000 doses for after a huge amount of investment. “You need a technology that allows you to make not millions but ideally billions of doses over a year.”

The UK’s chief scientific adviser Sir Patrick Vallance has said it would be “very lucky” if a coronavirus vaccine was widely available within a year. Sir Patrick told ITV: ”A vaccine that can be used generally – we’d be very lucky to get one within a year.”

Evaluating Gimsilumab in COVID-19 Patients for the Prevention and Treatment of Acute Respiratory Distress Syndrome

• BREATHE is an adaptive, randomized, double-blind, placebo-controlled trial expected to enroll up to 270 patients, with a planned interim analysis
• FDA has agreed that this study could support registration if successful
• This is the first pivotal study for an anti-GM-CSF therapy known to initiate dosing in COVID-19 patients
• GM-CSF is a pro-inflammatory cytokine up-regulated in COVID-19 patients at risk of developing Acute Respiratory Distress Syndrome (ARDS)

NEW YORK and BASEL, Switzerland, April 15, 2020 /PRNewswire/ — Roivant Sciences announced today that the first patient was dosed at Temple University Hospital in Philadelphia in an adaptive, randomized, double-blind, placebo-controlled, multi-center pivotal trial evaluating the impact of intravenous (IV) treatment with gimsilumab on mortality in COVID-19 patients with lung injury or ARDS. Dosing will commence at Mount Sinai Hospital in New York City and other trial sites imminently.

COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many hospitalized COVID-19 patients experience an overactive immune response consisting of cytokine dysregulation and increased inflammatory myeloid cells that infiltrate the lung, leading to lung injury, ARDS, and ultimately death.¹ Granulocyte macrophage-colony stimulating factor (GM-CSF), a myelopoietic growth factor and pro-inflammatory cytokine, is believed to be a key driver of lung hyper-inflammation and to operate upstream of other pro-inflammatory cytokines and chemokines. Previous evidence from SARS-CoV-1 animal models and emerging data from COVID-19 patients suggest that GM-CSF contributes to the immunopathology caused by SARS-CoV-2 infection in patients with or at risk of developing ARDS.^2-5

Gimsilumab is a fully human monoclonal antibody targeting GM-CSF. Gimsilumab has been tested in numerous non-clinical studies and two prior clinical studies, including a 4-week Phase 1 study in healthy volunteers conducted by Roivant which completed dosing in February. Gimsilumab has demonstrated a favorable safety and tolerability profile based on data collected to date.

“GM-CSF-targeted immunomodulation to address the aberrant host immune response in COVID-19 appears promising for reducing lung injury and death in this aggressive illness,” said Dr. Mandeep Mehra, Professor of Medicine at Harvard Medical School and William Harvey Distinguished Chair in Advanced Cardiovascular Medicine at Brigham and Women’s Hospital. “The rapid initiation of this pivotal trial with gimsilumab is impressive given the pressing need for effective therapies that reduce the morbidity encountered with COVID-19.”

“Emerging evidence suggests that GM-CSF may contribute to clinical worsening in COVID-19,” said Dr. Gerard Criner, Professor and Chair of the Department of Thoracic Medicine and Surgery at the Lewis Katz School of Medicine at Temple University and Principal Investigator for the BREATHE Study at Temple University Hospital. “We are proud to participate in this clinical trial testing gimsilumab in this vulnerable patient population.”

About the BREATHE Study
Roivant’s clinical trial is expected to enroll up to 270 patients with a confirmed diagnosis of COVID-19 and clinical evidence of acute lung injury or ARDS. Subjects will be randomized 1:1 to receive either gimsilumab or placebo. The primary endpoint of the study is incidence of mortality by Day 43. Key secondary endpoints include the incidence and duration of mechanical ventilation use during the study, number of days in the ICU, and number of days of inpatient hospitalization. The study is being conducted with an adaptive design and includes a planned interim analysis.

About GM-CSF and COVID-19
COVID-19 is an infectious disease caused by SARS-CoV-2. COVID-19 has become a global pandemic, with over 2 million confirmed cases and over 125,000 deaths reported to date. Patients with severe cases of COVID-19 experience severe viral pneumonia that often persists despite a decrease in viral load and can progress to lung injury, ARDS, and death.

GM-CSF is a cytokine implicated in many autoimmune disorders that acts as a pro-inflammatory signal, prompting macrophages to launch an immune cascade that ultimately results in tissue damage. GM-CSF has been found to be up-regulated in the serum of COVID-19 patients according to recent data from patients in China.² The percentages of GM-CSF-expressing CD4+ T cells (Th1), CD8+ T cells, NK cells, and B cells have been observed to be significantly higher in the blood of ICU-admitted COVID-19 patients when compared with healthy controls.³ These reported immunological changes also appear to be more pronounced in ICU-admitted COVID-19 patients versus non-ICU patients.³

GM-CSF boosts the expression of pro-inflammatory cytokines such as TNF, IL-6, and IL-23 in addition to promoting the differentiation of Th1/17 cells and the polarization of macrophages to a M1-like phenotype.⁴ Increased levels of GM-CSF result in positive feedback which further elevates these inflammatory mediators. In severe COVID-19 patients, it has been suggested that GM-CSF could be the key link between the ‘pulmonary syndrome-initiating capacity’ of pathogenic Th1 cells and the feedback loop of inflammatory monocytes – which in turn secrete additional GM-CSF and IL-6.³ Taken together with the differentially elevated levels of GM-CSF observed in seriously ill COVID-19 patients, GM-CSF’s breadth of activity and its potential role as a central driver of pathology make it a promising target for clinical research.

About ARDS
ARDS is an acute, life-threatening inflammatory lung injury characterized by hypoxia – a lack of oxygen to the tissue – and stiff lungs due to increased pulmonary vascular permeability. ARDS necessitates hospitalization and mechanical ventilation. A rapid increase in patients with ARDS presents a major challenge for the global public health system given limited hospital beds and ventilators. When implementing standard of care, including mechanical ventilation, ARDS has an overall mortality rate of 41%.⁶

About Roivant Sciences
Roivant Sciences aims to improve health by rapidly delivering innovative medicines and technologies to patients. Roivant does this by building Vants – nimble, entrepreneurial biotech and healthcare technology companies with a unique approach to sourcing talent, aligning incentives, and deploying technology to drive greater efficiency in R&D and commercialization. For more information, please visit www.roivant.com.

Efforts to accurately track the outbreak of COVID-19 in the U.S. have been hampered by a lack of access to testing. While the number of tests performed in the U.S. has scaled up rapidly in the past two weeks, so has the underlying number of infected individuals in need of testing. New data from Gallup suggest that the number of confirmed COVID-19 cases measured March 31 would more than double (or more precisely increase by a factor of 2.5) if people who requested a test, were symptomatic, and visited with a healthcare provider were actually tested.

As of the three-day polling period ending March 31, I estimate that at least 266,000 Americans would test positive for COVID-19 if all symptomatic people who wanted a test got one. That compares to an estimated 106,000 Americans who have tested positive, according to survey data from the Gallup Panel, and 165,000 reported cases through March 31, according to data published from official sources.

Estimated Disease Prevalence of COVID-19 for Symptomatic Cases If Everyone Who Requested a Test Through a Health Provider Received One

The implication of this research is that the number of cases reported at any given time (239,279, as of April 3) should be multiplied by 2.5 to account for lack of access to testing for symptomatic people who seek treatment. That suggests a current caseload of roughly 600,000 through April 3. This is a conservative estimate for several reasons. First, it ignores nonresponse error, which may be an issue for people too sick to respond to the survey or already hospitalized. In fact, we estimate that an additional 198,000 confirmed COVID-19 cases could be present within the households of surveyed respondents. Second, this analysis assumes that only people who are symptomatic and seek treatment are COVID-19 positive, which we know is not the case. One recent study found that 18% of people with COVID-19 are asymptomatic, which, if applied to the most recent estimate, would bring the April 3 case total estimate to 730,000 Americans with COVID-19. We cannot know with current information how many people with symptoms who do not seek treatment are COVID-19 positive, but that is another reason to believe these are conservative estimates.

The 2.5 factor is likely to respond to the rate of testing. As testing capacity expands, it will likely fall. Our data show the ratio would have been 13.7 for the three-day period ending on March 23. Gallup will monitor dynamics in this rate.

The survey includes two screening questions before people are asked if they have been tested for COVID-19. First, people are asked whether they have been ill with a fever within the past 30 days. If they answer yes, which 6.4% of people did, they are then asked whether they saw a health professional for the illness, which applies to 2.2%. Among those who said they have had a fever in the past 30 days, two-thirds (65%) said they did not seek treatment.

Those who report having had a fever and visiting a health professional are then asked whether they received a novel coronavirus (COVID-19) test: 95% did not receive one. Among those who did not receive a COVID-19 test, a test was requested in 13% of cases — either by the individual or their attending healthcare professional.

The COVID Tracking Project, which collects data from state health departments, shows that 18% of all U.S. tests for COVID-19 are positive, which nearly matches the rate found in Gallup survey data over most of March (17%, from March 13 to March 31). Applying the 18% positive testing rate number to the symptomatic population who sought treatment but were denied a test upon request suggests that 0.05% of the U.S. population would test positive if given full access. That compares to 0.03% of Americans who have been tested. This translates into an additional 159,643 cases that are currently going undetected despite the patient seeking treatment and having symptoms.

These results are sensitive to the dates used in the analysis, but recent dates consistently show that the number of undetected symptomatic cases is at least equal to the detected symptomatic cases. The figure above plots the results for both of these estimates and the total number of cases by day using a three-day moving average to smooth out daily variation. This longer analysis was conducted from a representative survey of 22,709 U.S. adults conducted by Gallup March 13-March 31 through the Gallup Panel, a group of people who were previously randomly selected for Gallup surveys and agreed to be recontacted.

These results shed light on one aspect of this pandemic that has been difficult to measure, as testing access remains a problem. When asked if they were confident they could get a coronavirus test if they thought they had the disease, 27% of the population said no. Data on the percentage of tests yielding positive results has been increasing, according to data from state sources compiled by The COVID Tracking Project. This suggests that testing capacity may be under strain as the disease spreads.

Beyond obtaining more accurate estimates for symptomatic cases, expanded testing capacity would also shed light on the large number of people thought to be asymptomatic carriers and potential transmitters of the disease. In a recent interview, Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, stated that “a significant number of individuals that are infected actually remain asymptomatic.” Whether asymptomatic or not, failing to identify people with the disease will make quarantine and suppression much more difficult.

Dr. Tedros Adhanom Ghebreyesus said countries should be cautious about easing restrictions, even as some struggle with the economic impact. Europe’s worst hit countries, Spain and Italy, are both relaxing some measures, while their lockdowns continue.

Globally there are 1.6 million cases of coronavirus and 101,000 deaths. Speaking at a virtual news conference in Geneva, Dr Tedros said there had been a “welcome slowing” of the epidemics in some European countries.

He said the WHO was working with governments to form strategies for easing restrictions, but that this should not be done too soon.

“Lifting restrictions too quickly could lead to a deadly resurgence,” he said.

“The way down can be as dangerous as the way up if not managed properly.”

How are Spain and Italy easing curbs?

The government in Spain is preparing to allow some non-essential workers in sectors including construction and factory production to return to their jobs on Monday.

Spain recorded its lowest daily death toll in 17 days on Friday, with 605 people dying. According to the latest figures, Spain has now registered 15,843 deaths related to the virus.

However, the government has urged people to continue to uphold social distancing rules over the Easter long weekend.

In Italy, Prime Minister Giuseppe Conte extended the national lockdown until 3 May, warning that the gains made so far should not be lost. However, a small proportion of businesses that have been shut since 12 March will be permitted to reopen on Tuesday.

Conte specifically mentioned bookshops and children’s clothing shops, but media reports suggest laundrettes and other services may also be included

Only grocery stores and pharmacies have been allowed to operate since the lockdown started.

The number of deaths in Italy rose by 570 on Friday, down from a daily figure of 610 the day before, and the number of new cases also slowed slightly to 3,951 from 4,204.

Elsewhere:

Irish Prime Minister Leo Varadkar has announced his country’s lockdown measures will be extended until 5 May

Turkey has ordered a 48-hour curfew in 31 cities – including Istanbul and Ankara – to start at midnight. The announcement, made just two hours before the curfew was due to start, sparked panic buying and crowds of shoppers

Portugal’s state of emergency is set to stay in place until 1 May, according to President Marcelo Rebelo de Sousa

The UK government is under pressure to explain how curbs could eventually be lifted but says lockdown restrictions will remain until evidence shows the peak has passed

South Africa’s President Cyril Ramaphosa said late on Thursday that the country’s 21-day lockdown would be extended for a further 2 weeks – a move the main opposition party said would cause economic disaster

The number of people who have died with Covid-19 in France went up by nearly 1,000 to 13,197 on Friday. However, the number of people in intensive care units fell slightly for the second day in a row.  “We seem to be reaching a plateau, albeit a high level,” Director of Health Jérôme Salomon said.

WHO head Dr Tedros welcomed the apparent slowdown in infections in some European countries on Friday.  US officials also say the coronavirus outbreak may be starting to level off there. Deborah Birx, the coordinator of the White House coronavirus task force, said on Friday that while there were encouraging signs, the epidemic had not yet reached its peak.

Media captionThe Surgeon General showed his inhaler while discussing the impact of coronavirus on people of colour

Meanwhile, Dr Tedros has warned that the virus is now spreading rapidly in other countries. He highlighted Africa, where he said the virus had reached rural areas.

“We are now seeing clusters of cases and community spread in more than 16 countries” on the continent, he said.

“We anticipate severe hardship for already overstretched health systems, particularly in rural areas, which normally lack the resources of those in cities.”

Speaking on Wednesday, Director-General Tedros Adhanom Ghebreyesus defended the WHO’s work and called for an end to the politicisation of Covid-19.

The Ethiopian also said that he had received deaths threats and has been subjected to racist abuse.

Trump said he would consider ending US funding for the UN agency. He accused the WHO of being “very China-centric” and said they “really blew” their pandemic response.

Dr Tedros has now dismissed the comments, insisting: “We are close to every nation, we are colour-blind.”

After first attacking the WHO the previous day, President Trump renewed his criticism at his news briefing on Wednesday, saying the organisation must “get its priorities right”. He said the US would conduct a study to decide whether it would continue paying contributions,

Also answering questions at the briefing on Wednesday, US Secretary of State Mike Pompeo said the administration was “re-evaluating our funding” of the WHO, adding; “Organisations have to work. They have to deliver the outcomes for which they were intended”.

Covid-19 first emerged last December in the Chinese city of Wuhan, which has just ended an 11-week lockdown. An advisor to the WHO chief earlier said their close work with China had been “absolutely essential” in understanding the disease in its early stages.

Trump’s attacks on the WHO come in the context of criticism of his own administration’s handling of the pandemic, especially early problems with testing.

The WHO approved a coronavirus test in January – but the US decided against using it, developing its own test instead. However, in February, when the testing kits were despatched, some of them didn’t work properly and led to inconclusive results.  Public health experts say the delay enabled the virus to spread further within the US.

(Courtesy: The Washington Post)

A leading forecasting model used by the White House to chart the coronavirus pandemic predicted Monday that the United States may need fewer hospital beds, ventilators and other equipment than previously projected and that some states may reach their peak of covid-19 deaths sooner than expected.

That glimmer of potential good news came on the same day New York Gov. Andrew M. Cuomo (D) said his state may already be experiencing a “flattening of the curve.” New York reported 599 new deaths Monday, on par with Sunday’s count of 594 and down from 630 on Saturday.

Experts and state leaders, however, continued to steel themselves for grim weeks ahead, noting that the revised model created by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington conflicts with many other models showing higher equipment shortages, deaths and projected peaks.

Some state leaders have also grown increasingly concerned about how the federal government is using IHME’s lower estimates to deny states’ increasingly desperate requests for equipment and help in preparations. The stark differences between the IHME model and dozens of others being created by states exposes the glaring lack of national models provided publicly by the White House or agencies such as the Centers for Disease Control and Prevention for local leaders to use in planning or preparation.

“It’s unclear exactly what the White House is doing on this front,” said Dylan George, who helped the Obama White House develop models to guide its Ebola response in 2014. “As a result, you have every state trying to create their own models to anticipate their needs. And you have one model like IHME being adopted as the national guide.”

The danger of relying so heavily on one model is that model could be wrong or overly optimistic.

“When you plan, you want to plan for the worst-case, not for the average or best-case,” said Natalie Dean, an assistant professor of biostatistics at University of Florida. “Because the risk is not proportional.”

Big differences

This is how starkly models can differ.

Local leaders in the District said on Friday that their model estimates the outbreak in the nation’s capital will peak June 28. The IHME model predicts the peak is coming in just days, on April 16. The District’s model predicts hospitals will need 1,453 ventilators at the peak. IHME predicts a need for only 107. The District is using the IHME model as a best-case scenario and the more dire model to prepare for a likely surge.

D.C. mayor says peak in possible coronavirus hospitalizations will be in mid-summer

D.C. Mayor Muriel E. Bowser (D) said on April 2 that data projections reveal the peak in possible covid-19 infections will come in late-June or early July. (D.C. Mayor Muriel E. Bowser)

“While we hope that our experience will follow a curve closer to the IHME model, we cannot use a single model for our preparation and risk being underprepared. We continue to refine our models and assumptions and are tailoring them to the DC population and context,” spokeswoman Alison Reeves said in an email.

In states more populous than the District, that vast gap in planning and modeling could mean a life-or-death difference for tens of thousands of people.

LaQuandra S. Nesbitt, director of the District’s Department of Health, explained how the city’s leaders chose their model. It’s called CHIME and was created by researchers at the University of Pennsylvania.

“We felt that a model that determined the District would have essentially no medical surge needs was not indicative of what we anticipated would be our reality in the District and thought that a model that did not overestimate the impact of social distancing in the United States” was the right one, Nesbitt said.

In the two weeks since IHME’s model was originally released — the researchers announced revisions Monday — it has been criticized by some experts as overly optimistic. But even critics are quick to note that in the absence of any tool offered by the federal government and with no other model offering nationwide state-by-state estimates, IHME could be a lifesaver.

To coordinate their response, some states with few modeling resources or home-state experts have used the IHME forecast that projects peak deaths and the resources needed. The White House relied on it in part to generate its estimate last week that the epidemic would kill 100,000 to 240,000 people nationwide.

Most epidemiological models look at different populations that interact in an outbreak — people susceptible to infection, those who are infectious and those already infected who go on to die or recover.

Funded by the Bill & Melinda Gates Foundation, the IHME model embraces an entirely different statistical approach, taking the trending curve of deaths from China, and “fitting” that curve to emerging death data from U.S. cities and counties to predict what might come next.

For that reason, many experts saw IHME as overly optimistic when it was launched March 26. Few U.S. states or cities are taking action as drastic as what was adopted in Wuhan, China — the birthplace of the coronavirus pandemic — or even Northern Italy in locking down residents.

Another big difference between IHME and other models is a fundamental assumption about how effective social distancing can be. The creator of IHME’s model, Christopher Murray, said many state models assume that social distancing will only slow or reduce transmission to some degree. The IHME model, drawing from the example of Wuhan, assumes policies such as social distancing and stay-at-home orders, can effectively reduce transmission to the point where an epidemic — at least in its first wave — is actually brought under control by authorities.

At the White House Coronavirus Task Force briefing Monday, health officials said they thought it was possible to have fewer deaths than have been projected by models, because of the extreme social distancing efforts being undertaken by Americans.

“Models are good, they help us to make projections. But as you get data in, you modify your model,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “I don’t accept everyday we’re going to have to have 100,000 to 200,000 deaths. I think we can really bring that down.”

More models, better prediction

When it comes to predictions, statisticians have a favorite maxim: “All models are wrong, but some are useful.”

By drawing on the multiple models, experts are often able to better triangulate their predictions and assumptions. This is why weather experts often draw on several models rather than one in forecasting storms, using an “ensemble” or “suite” of models. Such ensembles are also what generate the cone of uncertainty for hurricanes.

In Illinois, state leaders are using four models — a version of the CHIME model and models from the University of Chicago, Northwestern University and the University of Illinois at Urbana-Champaign. New York state officials have said they are drawing on at least four different models, including IHME’s.

In North Carolina, state leaders are using a “weather forecasting” approach that combines several models — and instead of focusing on specific dates or numbers of beds or ventilators, they have decided to predict the likelihood that the medical system is overwhelmed.

 “What we’ve been focusing on is less about ‘what is the exact timing of the peak?’ and ‘what is the exact height of the peak?’ and more about how likely is it that the demand for health care is going to outstrip the supply,” said Kimberly Powers, an epidemiologist at the University of North Carolina at Chapel Hill. “Are we going to need more than we have?”

Their composite models predicts a peak in mid- to late-May. As long as social distancing continues, they predict only a 1 in 4 chance of exceeding the capacity of acute care hospital beds. But if those orders were lifted after April, the chances of overwhelming hospital capacity doubled.

One concern from some experts is that the IHME model is being used too much like a crystal ball with undue weight given to its predicted needs for ventilators and hospital beds and staffing.

Leaders in one state said Trump administration officials have used IHME’s numbers to push back and in some cases deny their requests for equipment and help. Officials in that state cited emails and documents in which federal officials highlight IHME projections as evidence the state needs thousands fewer ventilators and beds than the state’s models project. The state officials spoke on the condition of anonymity because they said they fear retaliation by the Trump administration that could result in even fewer ventilators and less federal assistance.

“If the federal government is really making these kinds of life-or-death decisions on a single model and on only on the lower end of that model, that’s scary,” said one state official.

Murray said he is well aware of the criticism of his model

But in the absence of any other state-by-state planning tool, he noted in a Monday briefing with reporters, his model is providing a much-needed public service — a point even critics of the IHME model are often quick to point out.

Murray and his team have worked around the clock since they first released their model to feed newly emerging data and sharpen it its projections.

On Monday, they announced their biggest revisions to date — driven by a large amount of new domestic and international data.

While their original model relied only on Wuhan’s curve, the updated model now incorporates curves from seven regions from Italy and Spain where epidemics have also peaked.

The newer version also found that deaths in some states — such as Florida, Virginia, Louisiana and West Virginia — could peak earlier than previous projections. But the deaths nationally were still projected to peak April 16. The newer model suggests the number of acute care hospital beds needed at the peak could be cut almost in half and the number of ICU beds needed at the peak of the surge could drop from 40,000 to 29,000. The model also suggested the total number of deaths would be lower, with an estimated 82,000 deaths from the first wave of infection, although the number could range from 49,000 to 136,000.

Murray agreed with the critique of others that multiple models should be used.

“I could not agree more,” Murray said. “What we’ve learned from 30 years of weather forecasting, even Netflix predictions for movies … you make better predictions when using multiple models.”

Coronavirus: What you need to read

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Updated April 7, 2020

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While several studies have examined the novel coronavirus, a new study — conducted by researchers from the University of Hong Kong and published in medical journal The Lancet — adds to the rapidly growing research about its stability. (Last month, American researchers had pointed out the virus was stable on plastic and steel for up to 72 hours, but did not last more than four hours on copper or 24 hours on cardboard.)

In the new analysis, researchers tested how long the coronavirus survives on various surfaces at room temperature. Subsequently, they found that on cloth(like a standard cotton lab jacket) and treated wood, it disappears by the second day. On bank notes and glass, it survived for two to four days, while on stainless steel and plastic, it remained for four to seven days. However, as for the outer layer of a surgical face mask, the researchers “strikingly” found detectable levels of infectious coronavirus even after seven days!

The study also observed that the concentration of the virus on all the studied surfaces reduced quite rapidly over time. Moreover, the virus died instantly when touched by common household disinfectants, including bleach.

Note: The presence of the virus on these objects and surfaces was detected by laboratory tools, and not fingers and hands — as the case would normally be. Therefore, the results do not necessarily reflect the potential to pick up the virus from casual contact.

Indian-American journalist Brahm Kanchibotla has died of COVID-19 that is ravaging New York, the epicentre of the pandemic in the US. The journalist died on Monday April 5th after nine days in a hospital, his son Sudama Kanchibotla said.

Brahm Kanchibotla, 66, was a correspondent for United News of India.

During his 28-year career in the US, he had worked for 11 years as a content editor for Merger Markets, a financial publication, and also did a stint with News India-Times weekly newspaper.

He had emigrated to the US in 1992 after having worked for several publications in India. Sudama Kanchibotla said that the family was not sure of the last rites for him because of the restrictions in New York.

“We have not set a date and it will have to be a very small gathering because only ten people are allowed at funerals,” he said.

Brahm Kanchibotla showed COVID-19 symptoms on March 23. When his conditions worsened, he was admitted to a hospital on Long Island on March 28 and given an oxygen mask, Sudama Kanchibotla said. On March 31, he was put on ventilator and on Monday he had a cardiac arrest.

Besides Sudama, Brahm Kanchibotla is survived by his wife Anjana and daughter Siujana. As of Monday night, 4,758 people have died of COVID-19 in New York City. The US has recorded a total of 368,196 confirmed cases, while the death toll stood at 10,986.