Sewage poses potential COVID-19 transmission risk, experts warn

University of Stirling

Environmental biologists at the University of Stirling have warned that the potential spread of COVID-19 via sewage "must not be neglected" in the battle to protect human health.

The response to the global pandemic has focused upon preventing person-to-person transmission, however, experts now believe the virus could also be spread in wastewater.

Earlier this week, it emerged that analysis of sewage in the UK could provide important data on the spread of COVID-19. However, Professor Richard Quilliam's new paper -- published May 6 -- now warns that the sewerage system itself could pose a transmission risk.

Writing in the journal Environment International, Professor Quilliam and colleagues from Stirling's Faculty of Natural Sciences are calling for "an investment of resources" to investigate their concerns.

Professor Quilliam -- who is currently leading a £1.85 million study into the transport of bacteria and viruses in marine environments -- said: "We know that COVID-19 is spread through droplets from coughs and sneezes, or via objects or materials that carry infection. However, it has recently been confirmed that the virus can also be found in human faeces -- up to 33 days after the patient has tested negative for the respiratory symptoms of COVID-19.

"It is not yet known whether the virus can be transmitted via the faecal-oral route, however, we know that viral shedding from the digestive system can last longer than shedding from the respiratory tract. Therefore, this could be an important -- but as yet unquantified -- pathway for increased exposure."

The authors of the peer-reviewed paper presented the example of the severe acute respiratory syndrome (SARS) outbreak in 2002-2003, when SARS-CoV-1 -- closely linked to the COVID-19 virus strain (SARS-CoV-2) -- was detected in sewage discharged by two hospitals in China.

Professor Quilliam highlights that, as most COVID-19 patients are asymptomatic or experience just mild symptoms and remain at home -- not in hospitals, there is significant risk of "widespread" distribution through sewers.

Professor Quilliam authored the paper alongside Professor Manfred Weidmann, Dr Vanessa Moresco, Heather Purshouse, Dr Zoe O'Hara, and Dr David Oliver.

The biologists said a lack of testing "makes it difficult" to predict the scale of the potential spread and the public health implications of the virus arriving at wastewater treatment works, whilst the implications of consequent discharge into the wider environment are only just beginning to be investigated.

They added that the structural makeup of COVID-19 -- specifically its lipid envelope covering -- suggests that it will behave differently in aqueous environments, compared to other viruses typically found in the intestine. There is currently limited information on the environmental persistence of COVID-19, but other coronaviruses can remain viable in sewage for up to 14 days, depending on the environmental conditions.

On the risk of human exposure, the authors said: "The transport of coronaviruses in water could increase the potential for the virus to become aerosolised, particularly during the pumping of wastewater through sewerage systems, at the wastewater treatment works, and during its discharge and the subsequent transport through the catchment drainage network.

"Atmospheric loading of coronaviruses in water droplets from wastewater is poorly understood but could provide a more direct respiratory route for human exposure, particularly at sewage pumping stations, wastewater treatment works and near waterways that are receiving wastewater."

Risk could be further increased in parts of the world with high levels of open defecation, or where safely managed sanitation systems are limited and waterways are used as both open sewers and sources of water for domestic purposes.

"Such settings are commonly accompanied by poorly resourced and fragile healthcare systems, thus amplifying both exposure risk and potential mortality," the authors said.

Currently, all published data on faecal shedding of SARS-CoV-2 derive from hospitalised patients -- with limited information available on mild and asymptomatic cases. The paper concludes: "In the immediate future, there needs to be an investment of resources to improve our understanding of the risks associated with faecal transmission of SARS-CoV-2, and whether this respiratory virus can be disseminated by enteric transmission.

"Understanding the risk of spread via the faecal-oral route, while still at a fairly early stage of the pandemic, will allow more evidence-based information about viral transmission to be shared with the public. Furthermore, the risks associated with sewage loading during the remainder of the COVID-19 outbreak need to be rapidly quantified to allow wastewater managers to act quickly and put in place control measures to decrease human exposure to this potentially infectious material.

"At a time when the world is so focused on the respiratory pathways of a respiratory virus, understanding the opportunities for SARS-CoV-2 to be spread by the faecal-oral route must not be neglected."

COVID-19 – A Nature’s Self-Healing Mechanism

 Ekta Chaudhary

The recent CORONA outbreak is currently posing as one of the biggest epidemic disease hovering over the World. Due to this recent outbreak of this epidemic, the World has come to a standstill. The never stopping life on the Earth has been stopped abruptly. As we all know, the Nature always find its way. In this recent Corona Outbreak, the nature has found its way to help heel itself. With the onset of this epidemic disease all over the world, the nature has started healing itself at a very fast pace.

As this COVID-19 situation is proving to be out of the human reach, the only preventive measure for this disease is to maintain social distancing. As this disease is a communicable disease, it is spreading very rapidly from individual to individual. To prevent this contamination chain, the World Health Organisation (WHO) has declared maintain social distancing as the only possible measure to prevent the spread of the disease.

Following the WHOs advisory, affected countries over the world have adopted social distancing for preventing their people form this infection. The World is currently undergoing a total lockdown mode. The World has been on the shutdown mode since this COVID-19 outbreak. The World’s lockdown is been proving as a boon for the deteriorating environmental conditions of the World.

EFFECTS ON AIR QUALITY

Image Source: Twitter

Countries have imposed stricter restrictions on the movement of modes of transportation causing a drastic decrease in the pollution level in the atmosphere. The streets are empty with more people inside their houses. As per the NASA report, the air pollution levels have been decreased drastically since the COVID-19 outbreak. Since the factories, industries, and all the workplaces are on the shutdown mode, the CO2 and CO emission levels have also been reduced. According to the World Air Quality, the average concentration of PM 2.5 in New Delhi came down by 71 percent.

Image Source: Twitter@RameshPandeyIFS

As a result of decreased air pollution levels, the Himalayan ranges were clearly visible from the Jalandhar area. It is on of the rarest cases that happened to be in India. According to the local people, the incident has happened after a huge interval of 30 years. The distance of the Jalandhar city from the Dhauladhar ranges is approx. 200 km.

In another rare sighting due to decreased levels of AQI, the inner Himalayan peaks of Bandarpunch and Gangotri became visible from the town of Saharanpur in Uttar Pradesh

EFFECT ON WATER QUALITY

The clear water of Ganga River at Haridwar, Uttarakhand (Image Source: PTI)

The water transport movement, water activities has also been stopped resulting in the improvement of the water quality. The water in the famous Venice lake has been marked absolutely clear. The huge reduction of tourist numbers and commuting workers in the city may also be leading to an improvement in the water quality due to a reduction of sewage discharges into the canals.

image Source: https://www.cnbc.com/2020/03/18/photos-water-in-venice-italys-canals-clear-amid-covid-19-lockdown.html)

Many industries and offices are closed due to the lockdown these days and therefore the water quality of many rivers has improved. The stoppage of industrial pollutants and industrial waste has definitely had a positive effect on water quality. The water quality of river Ganga, in India, is also been marked as fit for drinking as per recent research by Indian scientists.

image Source: https://www.cnbc.com/2020/03/18/photos-water-in-venice-italys-canals-clear-amid-covid-19-lockdown.html)

As several religious activities have decreased as the lockdown effect, the banks of river Ganga at Varanasi and Haridwar areas are comparatively clearer and cleaner than before.

• The COVID-19 pandemic is also likely to have a significant impact on other environmental factors, including the emission of greenhouse gases as the global economy heads into recession.

• The quarantine protocols may also have a deep, but short-term, impact on greenhouse gas emissions and other pollutants, as fewer people are traveling and fewer businesses are operating.

As per the recent records, there is currently a total of 32,56,846 confirmed cases of COVID -19. The total number of people worldwide who have lost their lives is 2,33,388. The total number of recovered cases at present is 10,14,753.

Speaking of India’s context, a total of 35,043 are the total active cases with a total of 1,147 deaths across the country, A total of 8,889 cases have reportedly been cured of the disease.

(Data as on 01-05-2020).

The role of immunity in fighting against COVID-19

As the world fidgets in returning to its regular activities, it seems as if the fight against COVID-19 has been lost already (we do not believe so). The race of producing a vaccine by world leaders seem no longer enthralling and exciting. Gradually, the bane of lethargy is creeping upon us. We are now seeing COVID-19 as a next-door neighbor with whom we have to live peaceably together. With this kind of relationship becoming a last resort, health workers have encouraged people around the world to boost their immune system. In essence, we have chosen a strategy of defense against our fight with COVID-19. Hence the need to strengthen this last line of defense.

What is immunity? Contextually speaking (relative to health), immunity is the response of our body mechanisms against the invasion of foreign bodies. These foreign bodies are usually disease-causing organisms that seek to alter the normal body working conditions, leading to ill health. This role of immunity is provided for by our immune system, and like every other system, it needs to be constantly 'upgraded' for maximum performance. The quality or strength of our immune system will determine how often we are plagued with sicknesses and diseases. To this effect, the need for strengthening our immune system cannot be overemphasized.

How can we boost our immune system? Ever heard of the phrase 'garbage in garbage out"? Our body systems reproduce whatever 'message' we send to it. The immune system works similarly. We are what we eat. Therefore, credence should be given to the kinds of food we take into our body system. Summarily, we should eat healthily. Let us avoid much of synthesized foods and drinks. As we are observing social distance from the pandemic, keeping our distance from inorganic foods will go a long way in the long term. Inorganic foods are foods produced through human-induced processes making use of chemicals and additives to boost production. The resultant effect of such foods is usually seen in developed countries. Consumers develop a variety of ailments as a result of their intake. Conditions such as obesity, cancer, and mutation are all too common due to the massive consumption of inorganic foods. Another important lesson of the COVID-19 pandemic is the need for us to have a transformation of diet. We need to transition from our heavy dependence on synthesized foods to organic foods. Organic foods are those foods produced sustainably without industrially influencing their growth stages and value chain. Foods such as vegetables and fruits are primary examples of organic foods. For an effective transition to sustainable food farming and consumption, it becomes compulsory for the masses and stakeholders to be educated in sustainable agriculture. This education is provided through sustainability courses offered by the Green Institute. Remember, eat healthily and stay alive.

Best Regards.

The Green Team

Randomized Clinical Trials and COVID-19 Managing Expectations

Howard Bauchner, MD, and Phil B. Fontanarosa, MD, MBA

Despite the millions of cases and hundreds of thousands of deaths that have occurred in this devastating coronavirus disease 2019 (COVID-19) pandemic, no peer-reviewed studies of specific therapies proven to be effective in reducing mortality have been published and a vaccine is many months to years away. To date, more than 1000 studies addressing various aspects of COVID-19 are registered on ClinicalTrials.gov, including more than 600 interventional studies and randomized clinical trials (RCTs).1 During the next few weeks and months, the results of numerous RCTs involving therapies for COVID-19 will be reported. Indeed, preliminary results from some studies have already been reported in social media and the popular press. How will clinicians, the public, and politicians understand the results of these much-anticipated and critically needed clinical trials?

First, the interventions in some of these trials are being evaluated in various ways. For instance, some studies do not have a control group, whereas others lack true “controls” such as trials that compare different dosages of the same drugs. This will limit the inferences that can be drawn, likely necessitating further research to define the true benefit of a specific treatment. In addition, in some trials, the investigational agents are administered in combination with multiple other therapies given at various time points in the disease process. Without rigorous design and attention to trial protocols for study drug administration, there will be challenges disentangling the true effect of the intervention.

Second, many ongoing trials were designed prior to emerging information that is providing a better understanding of the disease process. It has become clear that some critically ill patients with COVID-19 have substantially different manifestations, including profound hypoxia, extensive inflammatory activation, or evidence of coagulopathy. Accordingly, there may be significant heterogeneity of treatment effects based on the timing or constellation of disease manifestations. It is possible that an antiviral agent or other agents, such as those directed against inflammatory markers (ie, certain cytokines), could be helpful for critically ill patients who do not have overwhelming inflammation but would not be effective for patients in whom the inflammatory cascade is markedly activated. Given that the size of many ongoing trials is limited, few investigations will be appropriately powered to conduct meaningful secondary and subgroup analyses. Most additional analyses should likely be considered exploratory.

Third, the outcomes for many of these trials involve time to symptom resolution, improvement of laboratory or radiographic abnormalities, or reduction in the use of mechanical ventilation. Few of the studies will be sufficiently powered to detect a difference in mortality. Although these are important clinical outcomes, and use of mechanical ventilation is associated with mortality, it will be important to objectively assess and accurately describe the outcomes from ongoing trials and what the results potentially mean in terms of improving overall survival. In addition, for trials with unblinded treatment allocation and unblinded outcome assessment, interpretation of findings, such as symptom resolution, may be problematic.

Fourth, even a highly successful trial is likely to reduce the mortality outcome by only a 5% to 10% absolute difference; hence, the number needed to treat will be a minimum of 10 to 20. Smaller absolute differences would have greater numbers needed to treat. This remains a challenging issue for clinicians and patients to understand. Given these likely numbers needed to treat, most patients will not benefit from even a successful treatment. Moreover, even though there have been reports of studies that some interventions have reduced the duration of intubation or length of hospital stay represent progress against COVID-19, these findings do not indicate that patients with this disease are “cured” with the drugs used in these investigations.

Fifth, most of these trials are directed at treatment, and even if some trials show clinically important results, most will not address prevention of COVID-19. The results of these trials (most of which are being conducted among hospitalized patients in whom the disease is well-established) might not necessarily be directly applicable for altering the incidence of disease in the coming months or preventing future surges of disease. Numerous observational studies using existing databases are being conducted to determine whether the use of certain drugs is associated with COVID-19 disease outcomes, such as whether hydroxychloroquine is associated with less disease, or whether use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers is associated with an increased risk of disease. However, these will be observational studies with all the attendant limitations. Accordingly, the findings of rigorous clinical trials of vaccines and possible other therapies will be essential in determining how to effectively prevent COVID-19.

Sixth, it will be helpful if investigators share individual patient data from similar trials with one another. This will allow for additional analyses, even if the analyses of the combined data were not preplanned and would be considered exploratory. The goal is to expand what is known about possible treatments, so that future trials can be improved, perhaps by using approaches such as large adaptive platform trials.

The clinical trials community around the world, in conjunction with numerous funders, has rapidly mounted important RCTs during the COVID-19 pandemic. This is a remarkable achievement. However, presenting and interpreting the results of these studies clearly, and communicating findings appropriately to clinicians, the public, and policy makers, is critically important. Because much of the focus is now on preventing recurrence of the pandemic, it will be important for investigators, journals, and the media to accurately report the results of the studies responsibly and what they mean both for individuals and for population health.

Article Information

Corresponding Author: Howard Bauchner, MD, JAMA, 330 N Wabash Ave, Chicago, IL 60611 (Howard.Bauchner@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Derek C. Angus, MD, MPH (associate editor, JAMA), and Rob Golub, MD (deputy editor, JAMA), for their valuable comments.

References

1.US National Library of Medicine. ClinicalTrials.gov. Accessed April 30, 2020. https://clinicaltrials.gov/

[SDSN Global]: Take the global COVID-19 Survey

Dear Friends,

 How are you coping with the spread of COVID-19?

SDSN and the World Happiness Report has partnered with the international research consortium running the largest Covid19 survey globally to measure how people cope with the situation.

Please join 100,000+ volunteers and help inform evidence-based policy for happiness and well-being. Feel free to complete the survey again at a later stage, as each set of answers will be interpreted against the background of the current progress of the epidemic in your own region.

The 5-minute survey is available in 60+ languages, share your thoughts, and share with your social and business networks too!

Thank you,
Jeff Sachs

Take the Survey #covid19study

Jeffrey Sachs: What Asian nations know about squashing Covid

devex.com

The number of Americans who have died from Covid-19 now significantly exceeds the total US troop fatalities during the Vietnam War.
 
While the coronavirus continues to ravage the country, with confirmed cases exceeding 1 million and deaths rising by the day, some states are lifting stay at home orders in hopes of salvaging the economy. With so many lives at stake, it's time the United States looked to those countries in the Asia Pacific region that have successfully controlled the pandemic to figure out how to save ourselves and the economy.
 
Several places in the Asia-Pacific, including Australia, China, New Zealand, South Korea, Taiwan and Vietnam, have suppressed the estimated effective reproduction number -- the average number of people who will catch the disease from a single infected person -- to below 1, without the need for continued, widespread lockdowns.
 
They are now rapidly and successfully suppressing outbreaks of the disease by isolating those who are infected and their contacts who are likely to be infected.
           
It's as if there are two worlds.
 
The United States has had more than 66,000 deaths, or about 20 deaths per 100,000 people. The number of deaths per 100,000 people reported in Western European countries is also very high: Belgium, 67; France, 37; Italy, 47; Germany, 8; Spain, 53; and Sweden, 26.

Meanwhile, the reported rates in Asia and Oceania are considerably lower: Australia, 0.4; China, 0.3; New Zealand, 0.4; South Korea, 0.5; Taiwan, 0.03.
 
Despite the stark disparities, America seems blind to the strategies other countries have used to control the virus. How is it that one part of the world is succeeding, while the other part refuses to learn the lessons of success?
 
On Tuesday, The Wall Street Journal extolled the virtues of Germany's efforts in comparison with the United States, France, Italy, and Spain, without even a mention that Germany's mortality rate per million is itself more than 100 times higher than Taiwan and Hong Kong, and more than 10 times higher than in Australia, Japan, New Zealand and South Korea.
 
How have these countries succeeded to date?
 
Many have adopted nationwide public-health standards, using mobile technologies, professionalism of government, widespread use of face masks and hand sanitizers, and intensive public health services to isolate infected individuals or those likely to be infected.
 
Testing has played an important role, but has not been the be-all-and-end-all as is sometimes believed in the United States.
 
Vietnam has succeeded, for example, with contact tracing and an aggressive quarantine regime. When one person is confirmed positive, many of his or her close contacts -- even those without symptoms -- are isolated. As a result, Vietnam tested only a moderate number of people as a share of the population because it managed to contain outbreaks so effectively. Vietnam, with about 95 million people, has not reported a single Covid-19 death so far.
 
In New Zealand, the government is starting to ease lockdown restrictions as officials say they are now in a position to test and trace any new clusters of infection.

Here are the careful and precise words of New Zealand Prime Minister Jacinda Ardern. "There is no widespread undetected community transmission in New Zealand. We have won that battle. But we must remain vigilant if we are to keep it that way."
 
There are similar success stories across much of the region.
 
South Korea, which has dramatically broken the epidemic with aggressive testing, contact tracing and basic public health measures such as thermal monitoring, has also employed digital technology in the fight against Covid-19, according to a new report. South Korea uses a text alert system to keep the public informed, while various apps allow people to track new Covid-19 cases, make doctor's appointments or monitor hotspots to avoid.
 
The government also uses apps to monitor people in quarantine, through self-reported symptoms and location tracking. Despite the fact that these apps may raise privacy issues in the United States, the upshot is an economy that is open, albeit cautiously so, together with a suppression of new infections.
 
The US government has been utterly incapable of learning from these cases of success.
                   
President Donald Trump is incompetent and his appointees at Health and Human Services, the US Centers for Disease Control and Prevention, and Transport Security Administration have failed to provide leadership. America First has put us first in deaths in the world, with tens of thousands of lives squandered as a result.
 
We can save ourselves and our economy, if we look to and learn from the achievements of other nations. And if the federal government continues to fail, as seems likely, our governors and mayors must step forward to do the job.

Sustainable Response to inundated global economic recess caused by COVID-19

As the mystery of COVID-19 is yet to be fully uncovered, the importance of microbial and sustainability education has never been more demanding.

It is not surprising that global leaders are eager to jumpstart their respective economies and reclaim their top spot as economy behemoths. However, what is disturbing are the policies they are likely to adopt in revamping the economy. World organizations such as the United Nations (UN) and the International Monetary Fund (IMF) has bemoaned the downward spiral of the economy. As global leaders rally round to implement policies of equality and solidarity, their national counterparts have relegated to nationalism and protectionism. These leaders have hinted at the possibility of uplifting environmental protection laws, banning immigration, and implementing border closure in the guise of emergency responses to the pandemic. According to estimates, if current conditions persist, global economic growth could be reduced to 2% per month and global trade could also fall by 13% to 32%. The International Monetary Fund (IMF) propounded that government expenditures and revenue measures adopted through mid-April 2020 amounted to $3.3trillion, while loans, equity injections, and guarantees totaled an additional $4.5 trillion. Consequently, the IMF estimates global governments' borrowing to increase from 3.7% of Gross Domestic Product(GDP) in 2019 to 9.9% in 2020.

Strategies have been put in place by both developed and developing countries to tackle these economic challenges. The Federal Reserve has adopted and implemented policy measures never taken since the 2008-2009 global financial crisis to confront the economic effects of COVID-19. These measures include; quantitative easing, discount window, and reduction of reserve requirements. Also in other countries, central banks have cut down interest rates, reduced bank reserves ratios, relaxed capital buffers, and injected huge liquidity into capital markets. However, policymakers are in a dilemma of tackling short-term economic restraints in a bid to avoid mortgaging long-term environmental impacts of Post COVID-19. If caution is thrown to the wind, the world could see itself backdating to the Industrial Era after COVID-19. The deplorable state of living conditions, rising inequality, and environmental pollution that characterized that era could become our reality in Post COVID-19 Era. This reality can only be avoided if we stick to our trajectory of sustainable development amidst the assault of the COVID-19 pandemic.

As the economy and health sector face a steep decline from the menace of COVID-19, governments are unduly pressured to rescind their commitment to achieving the Sustainable Development Goals. The challenge of achieving these goals and Agenda 2030 has never been more imminent and pressing. More so, the credibility and solidity of our multilateral structures are brought to question by the pandemic. However, this is not the time for us to lose focus and derail from the path of sustainability. On the contrary, our present crises should give us more reasons to strengthen multilateral agreements, remain steadfast, and advocate for sustainable development. The onus doesn’t rest entirely on global leaders alone, but also on individuals in our quest for a sustainable future.

Best Regards

The Green Team.

Rising rates of unemployment as COVID-19 calls the shot on Workers' Day

May 1st has always been recognized internationally as Workers' Day/May Day/International Workers' Day/Labor Day depending on the country. This Day commemorates the historical struggles and gains made by workers and the labor market in different countries. Never has the world been brought to its knees in rising unemployment in such a short period (a quarter of a year). Workers in developed countries are filing for unemployment benefits while those in the developing and least developed countries are battling with social unrest. The glorified average American worker has lost faith in job security. The average worker in developing countries is questioning if he was ever employed. The mandatory lockdown has led to salary reduction, deferment, and ultimately loss of jobs. The agitation of global workers does not in any way call for celebration. May 1st, 2020 would go down in history as a day of celebration without a cause to celebrate, a public holiday celebrated in lockdown.

The link between unemployment and the economy is increasingly becoming clearer. As millions of workers lose their jobs, the economy is dealt a blow due to a fall in demand and supply. When workers become unemployed, their purchasing power is limited, leading to a reduction in their demand for goods and services. Consequently, there is a proportional decrease in the supply of goods and services whose resultant effect is an economy on life support. The repetition of this cycle drags the economy into phases of repression and depression until it is bailed out by ‘economic experts.'

Historically, the underlying causes of unemployment were a combination of both structures and systems. Presently, rising unemployment is spearheaded single-handedly by the Coronavirus invasion. As millions of workers around the globe adhere to the lockdown, so does their jobs face an imminent threat of indefinite lockdown. COVID-19 has placed all workers on a standstill as they are forced to stay at home and observe social distancing. The usual celebration of jubilant workers marching down the streets in some countries has been postponed. Workers around the globe are having a solemn rethink of their employment status.

However, it seems that the only workers whose jobs are not on the line are the health workers. These workers are at the forefront of this pandemic, risking their lives in attending to patients of the virus. They are also leading in the area of Research and Development (R&D) in a race to find a vaccine for the cure. To this effect, they deserve our gratitude and assigning May 1st 2020 as Health Workers Day in lieu of COVID-19 is not too much an honorarium.

In conclusion, could this be the right time for workers and upcoming workers alike to rethink the ‘false hope' laid in job security? Could this be the time that the idea of entrepreneurship is taken seriously? Could this be the right time to emphasize the need for economic diversification? Could this be the time workers realize that they need financial freedom, not more jobs? Could this be the right time to enroll in sustainability courses? Could this be the time…? Only time will tell! 

Question of the day: What will 2020 hold?

Best Regards.

The Green Team.

What happens after COVID-19? A message of hope

This question resonates our mind amidst saddening news about new COVID-19 cases and rises in death tolls around the world. Howbeit, there is a reason for the world to have hope and look forward expectantly to the future. This would not be the first time the world is undergoing such an impact of magnitude proportions. We have been here before in different ways. The impacts of global challenges should serve as a gentle reminder of ties that binds us as a global community. Notwithstanding our diversities of culture, development, religion, ideologies, and all what not, issues like COVID-19 pandemic should engender altruistic traits amongst us. Times like this should not be punctuated by apportioning of blames, race to economic and technological superiority, or outright negligence of lending humanity a helping hand.

Moreover, this serves as a reminder of the frailty of human systems and infrastructures. We must learn to harmonize our activities with nature and refrain from applying 'brute force' in our quest to conquer nature. Once more, we are brought together to question our trajectory towards development. The novelty of the coronavirus and our quest to unravel its mystery speaks volumes of our limitations despite burgeoning advancements.

As every global sector experiences a steep decline from the COVID-19 menace, let's call to remembrance past global crises where we came out triumphant. How about briefly taking stock of past global crises and taking courage for the present. Humanity had gone through centuries of the dark age that kept us in a perpetual state of knowledge lockdown, YET WE STOOD. We've been through bouts of economic depression (for example, The Great Depression), and repression that brought the world to its knees, YET WE STOOD. We've gone through two world wars that made us question our fate as humanity, YET WE STOOD. We've been through seasons of natural disasters and disease epidemics, YET WE STOOD. Time and space would be limited to recount our human Odyssey in the face of global challenges and how we survived as a people. I believe these few should go a long way in restoring our hope for the future.

However, our hope is not ignorant of our loved ones who lost their lives during these crises. Our hearts are with them. Presently, our deepest gratitude goes to our health workers who are at the forefront of combating the COVID-19 pandemic. We also extend our deepest condolence to families of victims who lost their lives. Our prayers are with the infected persons for quick recovery, and we want to appreciate our governments for their efforts in abating this menace. We may not fully be able to paint a clear picture of what an era of Post COVID-19 will look like, but one thing is for sure, WE WILL STAND. May God grant us all amnesty. #StaySafe.

Best regards

With love from The Green Institute.

Six nature facts related to coronaviruses

Did you know that around 60 per cent of all infectious diseases in humans are zoonotic, as are 75 per cent of all emerging infectious diseases, in other words they come to us via animals?

Zoonoses that emerged or re-emerged recently are Ebola, bird flu, Middle East respiratory syndrome (MERS), the Nipah virus, Rift Valley fever, sudden acute respiratory syndrome (SARS), West Nile virus, Zika virus disease, and, now, the coronavirus. They are all linked to human activity.

The Ebola outbreak in West Africa was the result of forest losses leading to closer contacts between wildlife and human settlements; the emergence of avian influenza was linked to intensive poultry farming; and the Nipah virus was linked to the intensification of pig farming and fruit production in Malaysia.

Scientists and specialists working at the United Nations Environment Programme (UNEP) have been pulling together the latest scientific facts about the coronavirus—what we know about the virus and what we don’t know.

While the origin of the outbreak and its transmission pathway are yet to be discovered, here are six important points worth knowing:

1. The interaction of humans or livestock with wildlife exposes them to the risk of spillover of potential pathogens. For many zoonoses, livestock serve as an epidemiological bridge between wildlife and human infections.

2. The drivers of zoonotic disease emergence are changes in the environment—usually the result of human activities, ranging from land use change to changing climate; changes in animals or human hosts; and changes in pathogens, which always evolve to exploit new hosts. 

3. For example, bat-associated viruses emerged due to the loss of bat habitat from deforestation and agricultural expansion. Bats play important roles in ecosystems by being night pollinators and eating insects.

4. Ecosystem integrity underlines human health and development. Human-induced environmental changes modify wildlife population structure and reduce biodiversity, resulting in new environmental conditions that favour particular hosts, vectors, and/or pathogens.

5. Ecosystem integrity can help regulate diseases by supporting a diversity of species so that it is more difficult for one pathogen to spill over, amplify or dominate.

6. It is impossible to predict where the next outbreak will come from or when it will be. Growing evidence suggests that outbreaks or epidemic diseases may become more frequent as climate continues to change.

“Never before have so many opportunities existed for pathogens to pass from wild and domestic animals to people, says UNEP Executive Director Inger Andersen. “Our continued erosion of wild spaces has brought us uncomfortably close to animals and plants that harbour diseases that can jump to humans.”

Nature is in crisis, threatened by biodiversity and habitat loss, global heating and toxic pollution. Failure to act is failing humanity. Addressing the novel coronavirus (COVID-19) pandemic and protecting ourselves against future global threats requires sound management of hazardous medical and chemical waste; strong and global stewardship of nature and biodiversity; and a clear commitment to “building back better”, creating green jobs and facilitating the transition to carbon neutral economies. Humanity depends on action now for a resilient and sustainable future.

Researchers identify cells likely targeted by Covid-19 virus

Anne Trafton

Study finds specific cells in the lungs, nasal passages, and intestines that are more susceptible to infection.

Researchers at MIT; the Ragon Institute of MGH, MIT, and Harvard; and the Broad Institute of MIT and Harvard; along with colleagues from around the world have identified specific types of cells that appear to be targets of the coronavirus that is causing the Covid-19 pandemic.

Using existing data on the RNA found in different types of cells, the researchers were able to search for cells that express the two proteins that help the SARS-CoV-19 virus enter human cells. They found subsets of cells in the lung, the nasal passages, and the intestine that express RNA for both of these proteins much more than other cells.

The researchers hope that their findings will help guide scientists who are working on developing new drug treatments or testing existing drugs that could be repurposed for treating Covid-19.

“Our goal is to get information out to the community and to share data as soon as is humanly possible, so that we can help accelerate ongoing efforts in the scientific and medical communities,” says Alex K. Shalek, the Pfizer-Laubach Career Development Associate Professor of Chemistry, a core member of MIT’s Institute for Medical Engineering and Science (IMES), an extramural member of the Koch Institute for Integrative Cancer Research, an associate member of the Ragon Institute, and an institute member at the Broad Institute.

Shalek and Jose Ordovas-Montanes, a former MIT postdoc who now runs his own lab at Boston Children’s Hospital, are the senior authors of the study, which appears today in Cell. The paper’s lead authors are MIT graduate students Carly Ziegler, Samuel Allon, and Sarah Nyquist; and Ian Mbano, a researcher at the Africa Health Research Institute in Durban, South Africa.

Digging into data

Not long after the SARS-CoV-2 outbreak began, scientists discovered that the viral “spike” protein binds to a receptor on human cells known as angiotensin-converting enzyme 2 (ACE2). Another human protein, an enzyme called TMPRSS2, helps to activate the coronavirus spike protein, to allow for cell entry. The combined binding and activation allows the virus to get into host cells.

“As soon as we realized that the role of these proteins had been biochemically confirmed, we started looking to see where those genes were in our existing datasets,” Ordovas-Montanes says. “We were really in a good position to start to investigate which are the cells that this virus might actually target.”

Shalek’s lab, and many other labs around the world, have performed large-scale studies of tens of thousands of human, nonhuman primate, and mouse cells, in which they use single-cell RNA sequencing technology to determine which genes are turned on in a given cell type. Since last year, Nyquist has been building a database with partners at the Broad Institute to store a huge collection of these datasets in one place, allowing researchers to study potential roles for particular cells in a variety of infectious diseases.

Much of the data came from labs that belong to the Human Cell Atlas project, whose goal is to catalog the distinctive patterns of gene activity for every cell type in the human body. The datasets that the MIT team used for this study included hundreds of cell types from the lungs, nasal passages, and intestine. The researchers chose those organs for the Covid-19 study because previous evidence had indicated that the virus can infect each of them. They then compared their results to cell types from unaffected organs.

“Because we have this incredible repository of information, we were able to begin to look at what would be likely target cells for infection,” Shalek says. “Even though these datasets weren’t designed specifically to study Covid, it’s hopefully given us a jump start on identifying some of the things that might be relevant there.”

In the nasal passages, the researchers found that goblet secretory cells, which produce mucus, express RNAs for both of the proteins that SARS-CoV-2 uses to infect cells. In the lungs, they found the RNAs for these proteins mainly in cells called type II pneumocytes. These cells line the alveoli (air sacs) of the lungs and are responsible for keeping them open.

In the intestine, they found that cells called absorptive enterocytes, which are responsible for the absorption of some nutrients, express the RNAs for these two proteins more than any other intestinal cell type.

“This may not be the full story, but it definitely paints a much more precise picture than where the field stood before,” Ordovas-Montanes says. “Now we can say with some level of confidence that these receptors are expressed on these specific cells in these tissues.”

Fighting infection

In their data, the researchers also saw a surprising phenomenon — expression of the ACE2 gene appeared to be correlated with activation of genes that are known to be turned on by interferon, a protein that the body produces in response to viral infection. To explore this further, the researchers performed new experiments in which they treated cells that line the airway with interferon, and they discovered that the treatment did indeed turn on the ACE2 gene.

Interferon helps to fight off infection by interfering with viral replication and helping to activate immune cells. It also turns on a distinctive set of genes that help cells fight off infection. Previous studies have suggested that ACE2 plays a role in helping lung cells to tolerate damage, but this is the first time that ACE2 has been connected with the interferon response.

The finding suggests that coronaviruses may have evolved to take advantage of host cells’ natural defenses, hijacking some proteins for their own use.

“This isn’t the only example of that,” Ordovas-Montanes says. “There are other examples of coronaviruses and other viruses that actually target interferon-stimulated genes as ways of getting into cells. In a way, it’s the most reliable response of the host.”

Because interferon has so many beneficial effects against viral infection, it is sometimes used to treat infections such as hepatitis B and hepatitis C. The findings of the MIT team suggest that interferon’s potential role in fighting Covid-19 may be complex. On one hand, it can stimulate genes that fight off infection or help cells survive damage, but on the other hand, it may provide extra targets that help the virus infect more cells.

“It’s hard to make any broad conclusions about the role of interferon against this virus. The only way we’ll begin to understand that is through carefully controlled clinical trials,” Shalek says. “What we are trying to do is put information out there, because there are so many rapid clinical responses that people are making. We’re trying to make them aware of things that might be relevant.”

Shalek now hopes to work with collaborators to profile tissue models that incorporate the cells identified in this study. Such models could be used to test existing antiviral drugs and predict how they might affect SARS-CoV-2 infection.

The MIT team and their collaborators have made all the data they used in this study available to other labs who want to use it. Much of the data used in this study was generated in collaboration with researchers around the world, who were very willing to share it, Shalek says.

“There’s been an incredible outpouring of information from the scientific community with a number of different parties interested in contributing to the battle against Covid in any way possible,” he says. “It’s been incredible to see a large number of labs from around the world come together to try and collaboratively tackle this.”

The research was funded by the Searle Scholars Program, the Beckman Young Investigator Program, the Pew-Stewart Scholars Program for Cancer Research, a Sloan Fellowship in Chemistry, the National Institutes of Health, the Aeras Foundation, the Bill and Melinda Gates Foundation, the Richard and Susan Smith Family Foundation, the National Institute of General Medical Sciences, the UMass Center for Clinical and Translational Science Project Pilot Program, the MIT Stem Cell Initiative, Fondation MIT, and the Office of the Assistant Secretary of Defense for Health Affairs.

Who's Hit Hardest By COVID-19? Why Obesity, Stress And Race All Matter

ALLISON AUBREY

As data emerges on the spectrum of symptoms caused by COVID-19, it's clear that people with chronic health conditions are being hit harder.

While many people experience mild illness, 89% of people with COVID-19 who were sick enough to be hospitalized had at least one chronic condition. About half had high blood pressure and obesity, according to data from the Centers for Disease Control and Prevention. And about a third had diabetes and a third had cardiovascular disease. So, what explains this?

"Obesity is a marker for a number of other problems," explains Dr. Aaron Carroll, a public health researcher at the Indiana University School of Medicine. It's increasingly common for those who develop obesity to develop diabetes and other conditions, as well. So, one reason COVID-19 is taking its toll on people who have obesity is that their overall health is often compromised.

But does obesity specifically affect the immune system? Perhaps.

Prior research has shown that people with obesity are less protected by the flu vaccine. They tend to get sicker from the respiratory disease even if they've been immunized. In fact, researchers have found that as people gain excess weight, their metabolism changes and this shift can make the immune system less effective at fighting off viruses.

"What we see with obesity is that these [immune] cells don't function as well,' says Melinda Beck, a health researcher at University of North Carolina, Chapel Hill. Basically, she explains, obesity throws off the fuel sources that immune cells need to function. "The [immune cells] are not using the right kinds of fuels," Beck says. And, as a result, the condition of obesity seems to "impair that critical immune response [needed] to deal with either the virus infection or [the ability] to make a robust response to a vaccine."

So this is one explanation as to why people with obesity seem more vulnerable to serious infection. But, there are many more questions about why some people are hit harder, including whether race is a factor.

The CDC found that 33% of people who've been hospitalized with COVID-19 are African American, yet only 13% of the U.S. population is African American. Some local communities have found a similar pattern in their data. Among the many (26) states reporting racial data on COVID-19, blacks account for 34% of COVID deaths, according to research from Johns Hopkins University.

This disproportionate toll can be partially explained by the fact that there's a higher prevalence of obesity, high blood pressure and diabetes among African Americans compared with whites.

And as Dr. Anthony Fauci of the National Institutes of Health said last week at a White House coronavirus task force briefing, this crisis "is shining a bright light on how unacceptable that is, because yet again, when you have a situation like the coronavirus, [African Americans] are suffering disproportionately."

There are several factors, including some genetic ones, that may make African Americans more vulnerable to COVID-19. "There have been a few studies that have pointed to African Americans potentially having genetic risk factors that make them more salt-sensitive," says Renã Robinson, a professor of chemistry who researches chronic disease at Vanderbilt University. This may increase the likelihood of high blood pressure, which, in turn, is linked to more serious forms of COVID-19. "It could be a contributing factor," she says, but there are likely multiple causes at play.

Another issue to consider, she says, may be high stress levels. She says when a person experiences racial discrimination, it can contribute to chronic stress. She points to several studies that link discrimination and stress to higher levels of inflammation among black adults. "And chronic stress can make one more vulnerable to infection because it can lower your body's ability to fight off an infection," she says.

Chronic stress is linked to poverty — so this could be a risk factor for low-income communities. In fact, research has shown that people who report higher levels of stress are more likely to catch a cold, when exposed to a virus, compared with people who are not stressed.

According to a new survey from Pew Research Center, health concerns about COVID-19 are much higher among Hispanics and blacks in the U.S. While 18% of white adults say they're "very concerned" that they will get COVID-19 and require hospitalization, 43% of Hispanic respondents and 31% of black adults say they're "very concerned" about that happening.

And other aspects of structural racism could contribute to the elevated risk for black Americans.

"Every major crisis or catastrophe hits the most vulnerable communities the hardest," say Marc Morial, president and CEO of the National Urban League. And he points to several factors that help to explain the racial divide.

"Black workers are more likely to hold the kinds of jobs that cannot be done from home," Morial says. So, they may be more likely to be exposed to the virus, if they are working in places where it's difficult to maintain social distancing. In addition, he points to longstanding inequities in access to quality care.

"There also is bias among health care workers, institutions and systems that results in black patients ... receiving fewer medical procedures and poorer-quality medical care than white individuals," he says. He says an expansion of Medicaid into those states that still haven't expanded would be one effective policy to address these inequities.

The characteristics of the communities where people live could affect risk, too especially for those who live in low-income neighborhoods. The roots of chronic illness stem from the way people live and the choices that may or may not be available to them. People who develop the chronic illnesses that put them at higher risk of COVID-19 often lack access to affordable and healthy foods or live in neighborhoods where it's not safe to play or exercise outside.

"Let's take a patient with diabetes for example. They are already at high risk for COVID-19 by having a chronic condition," says Joseph Valenti, a physician in Denton, Texas, who promotes awareness of the social determinants of health through his work with the Physicians Foundation.

"If they also live in a food desert, they have to put themselves in greater risk if they want access to healthy food. They may need to take a bus, with people that have COVID-19 but aren't showing symptoms, to get access to nutritious food or even their insulin prescription," he says.

Poor nutrition, and the obesity linked to it, is a leading cause of premature death around the globe. And, this pandemic brings into focus the vulnerability of the millions of people living with lifestyle-related, chronic disease.

"We're seeing the convergence of chronic disease with an infection," says UNC's Beck. And the data suggest that the combination of these two can lead to more serious illness. "We're seeing that obesity can have a great influence on infection," she says.

So, will this shine a spotlight on the need to address these issues? "Hopefully," Beck says. "I think paying attention to these chronic diseases like obesity is in everybody's best interest."

Global COVID-19 total tops 2 million; WHO responds to US funding freeze

Lisa Schnirring

As the global COVID-19 total topped 2 million cases today, the World Health Organization (WHO) pandemic response was buffeted by fresh attacks from US President Donald Trump, who announced yesterday that his administration would freeze its funding for the agency.

Meanwhile, steady activity in hot spots in the United States and Europe pushed the global total to 2,034,425 cases from 185 countries, along with 133,261 deaths, according to the Johns Hopkins online dashboard.

WHO to review impact of US funding withdrawal

At a White House briefing yesterday, Trump said the United States—the WHO's biggest funder—would withhold contributions to the WHO until it can review the group's role in managing the outbreak. Trump has accused the WHO of mismanaging the outbreak and siding with China, though the president in the past has praised China's response and has faced criticism for downplaying the threat in the initial months of the outbreak.

Trump's announcement drew widespread condemnation from several groups and individuals, many of whom defended the WHO but said reviews are needed after the pandemic to assess how groups including the WHO responded to the pandemic and what lessons can be learned.

For example, Wellcome Trust Director Jeremy Farrar, MD, PhD, said the WHO plays a critical role and needs more resources, not less, and that only global collaboration can end the pandemic. "We are facing the greatest challenge of our lifetime and the WHO is doing an extraordinary job ensuring that every country can tackle this virus."

On Twitter this morning, Microsoft cofounder Bill Gates, a philanthropist involved in funding global health efforts, said, "Halting funding for the World Health Organization during a world health crisis is as dangerous as it sounds. Their work is slowing the spread of COVID-19 and if that work is stopped no other organization can replace them."

Russia's Deputy Foreign Minister Sergei Ryabkov was quoted by Russia's TASS news agency as saying the US announcement was very alarming and selfish, Reuters reported.

WHO Director-General Tedros Adhanom Ghebreyesus, PhD, who mainly brushed aside earlier criticism from Trump, addressed the latest announcement head-on at a media briefing today. He said the United States has been a longstanding and generous friend to WHO, and the group hopes it will continue to be.

"We regret the decision of the President of the United States to order a halt in funding to the World Health Organization," he said, adding that with support from the US people and its government, the WHO works to improve the health of many of the world's poorest and most vulnerable populations, tackling not only COVID-19, but also threats such as measles, malaria, Ebola, HIV, polio, and many other diseases and chronic conditions.

Tedros said he is reviewing the impact on the US funding withdrawal on its work and will work with partners to fill any financial gaps to prevent interruptions in its work. He also pushed back on accusations that the WHO is biased toward China. "Our commitment to public health, science and to serving all the people of the world without fear or favor remains absolute," he said.

He also said that, after the pandemic, member states and independent groups will review the WHO's response to ensure transparency and accountability, a process that is built into its usual processes. "No doubt, areas for improvement will be identified and there will be lessons for all of us to learn," Tedros said. "But for now, our focus—my focus—is on stopping this virus and saving lives."

Russia's outbreak expands

Russia today reported its highest daily case total, adding 3,388 more illnesses for a total of 23,490, the Moscow Times reported. About 14,880 of the cases are in Moscow, but the virus has now been detected in all of the country's regions, except for Altai in Siberia.

Meanwhile, a surge of cases continued in Turkey, one of the few countries in Europe where leaders didn't order a lockdown. The country reported 4,281 new cases today, up from 4,062 yesterday, for a total of 69,392 cases, making it the sixth hardest hit European country.

In other European developments today, Germany has fleshed out a draft plan to extend its social distancing measures 2 more weeks until May 3, Reuters reported. The draft proposal agreed on between Chancellor Angela Merkel and state governors would include opening schools gradually, starting on May 4, and requiring schools to have hygiene plans in place. The ban on religious gatherings would remain, but some retailers will be allowed to reopen.

Brazil ministry shake-up, Korean voting safety measures

In other global COVID-19 developments:

• A top Brazilian health official resigned today amid expectations that President Jair Bolsonaro would fire the health minister over disagreements over how to manage the country's escalating COVID-19 outbreak, Reuters reported. Brazil's president has repeatedly downplayed the epidemic, promoted unproven drugs, and criticized governors over their lockdown orders.
  

• South Korea voters took part in a general election today at 14,000 polling places across the country, following strict precautions that included wearing masks, having temperatures checked, using hand sanitizer, wearing gloves, and observing social distancing, Reuters reported.

• The Tour de France today announced that the event will be held Aug 29 to Sep 20, following an announcement from France's president yesterday that large events remain banned until the middle of July.

The link between viruses, habitat destruction and climate change

 Carl Meyer

The respiratory disease affects animals like the harbour seal, of which it was responsible in 1988 for tens of thousands of deaths in the North Atlantic off the coast of Europe. More recently, scientists discovered, it had also infected northern sea otters — on the other side of the world.

Climate change is heating the atmosphere and shrinking the Arctic ice cap to such an extent that gaps are appearing. When these channels in the ice open up, it allows animals to move across territory they couldn’t previously access, researchers have found.

U.S. NOAA Photo: ​​​​​Dr. Brandon Southall, NMFS/OPR

Plying these newly ice-free waters, the animals may have unwittingly provided a free ride for PDV, which eventually jumped across the species barrier to sea otters in the North Pacific, according to the study in the journal Scientific Reports.

“We saw peaks of infection in the years after there had been a channel in the ice,” said Tracey Goldstein, a professor in the department of pathology, immunology and microbiology at the University of California, Davis and one of the researchers, in an interview.

“So that does suggest that, when there was an opening in the ice, the animals were able to move, and bring their viruses with them.”

'Put the Arctic Ocean in quarantine'

Phocine Distemper Virus (PDV) is not known to be zoonotic, which means a disease that jumps from animals to humans.

But scientists have long expressed concerns there might be “zombie diseases” preserved in the frozen Arctic ice, and that climate change would melt away the barriers to these diseases, opening up a “Pandora's box."

A 2019 strategy document from Canada's national Inuit organization, Inuit Tapiriit Kanatami, noted that one of the impacts of climate change on Inuit populations would be an increased exposure to zoonotic diseases.

As the COVID-19 pandemic unfolds against the backdrop of the climate crisis, which is heating up the Arctic at twice the rate of the planet, these concerns have resurfaced.

"The Arctic Ocean does not only keep our planet cool...it keeps the local permafrost, with its payload of pathogens, frozen," reads a March 30 statement from the Parvati Foundation.

"To protect our global immunity, we must put the Arctic Ocean in quarantine now. We are seeing today the deadly consequences of delay in clamping down to prevent disease."

Polar sea ice coverage in both the Arctic and Antarctic oceans had their second-smallest average annual coverage of sea ice in 2019, according to the U.S. National Oceanic and Atmospheric Administration.

Arctic sea ice has thinned to the point where it is now likely "unprecedented for at least 1,000 years," said the Intergovernmental Panel on Climate Change.

As the ice continues to shrink, it’s not just animals that are changing their behaviour, it’s people, too, noted Goldstein, one of the 22 researchers who published the study showing how PDV spread.

A recent Arctic Council report showed that ship traffic in the region jumped by a quarter from 2013 to 2019. These ships can introduce pollution, such as dirty marine fuel, into the region.

“I do think that is not a great thing for the environment, it is not a great thing for the animals,” Goldstein said.

“And it’s probably not a great thing for spreading pathogens.”

Animals losing habitat share viruses

Human activity is forcing animals all over the world to change their behaviour. Now, scientific research is demonstrating how closely tied together animals, humans and nature are when it comes to some infectious diseases.

Scientists have suggested that the novel coronavirus itself came from bats, possibly via another intermediary animal. The SARS coronavirus jumped from bats to civets, and then to humans, triggering the outbreak in 2002.

Research in Proceedings of the Royal Society released on April 8 showed that wild animals at risk of extinction due to human activity carried over twice the zoonotic diseases, as compared to animals that were not at risk of being wiped out.

“Among threatened wildlife species, those with population reductions owing to exploitation and loss of habitat shared more viruses with humans,” the study reads.

“Our findings provide further evidence that exploitation, as well as (human) activities that have caused losses in wildlife habitat quality, have increased opportunities for animal-human interactions and facilitated zoonotic-disease transmission.”

'Climate change is unleashing biological mysteries'

Goldstein's team worked with groups in Alaska to put satellite tags on animals, trying to understand what habitat they would use as the ice disappears.

The live data they received helped them examine how far animals could move in a week, or two weeks, or a month — and see whether it was plausible to bring a virus with them.

“What we found was, indeed, this animal movement was a potential possibility of a way a virus could move down into these other species,” she said.

Priyanka Mishra, a post-doctoral scientist in the molecular biology and biochemistry department at Simon Fraser University, said it was important to remember that the carbon stored in permafrost is also of major concern, not just potential viruses.

The established threat of climate change must remain a central focus, but humans also shouldn't be ignoring the risk of disease, she said.

“The bottom line is, climate change is unleashing biological mysteries,” said Mishra.

“It’s impossible to predict what surprises we might find.”

FAQ: What you need to know about hydroxychloroquine, chloroquine and coronavirus

Christopher Rowland

Medical experts say there is not enough evidence that anti-malarials chloroquine and hydroxychloroquine benefit patients with covid-19

The lack of vaccines and treatment for the novel coronavirus has allowed it to sweep the planet virtually unchecked. With a regimen of hunkering down and hand-washing the only effective way to slow its path, national leaders are desperate to find a medicine that could have an effect. But President Trump’s cheerleading for anti-malarial drugs has raised hopes beyond what is supported by the scientific facts.

What are chloroquine and hydroxychloroquine?

Bayer invented the medicine chloroquine in 1934, and it has been used for decades to treat malaria throughout the world. Hydroxychloroquine was invented during World War II to provide an alternative with fewer side effects.

Hydroxychloroquine, sold under the brand name Plaquenil, is also used by patients with lupus and rheumatoid arthritis to control inflammation. Both drugs, chloroquine and hydroxychloroquine, are available as generics, but public and political interest has caused runs, hoarding and severe shortages in recent weeks.

Despite the lack of rigorous evidence, Trump has promoted the drugs as important treatments for covid-19, the disease the coronavirus causes, and the Food and Drug Administration has issued an emergency authorization to permit their widespread use to treat severely ill patients in hospitals.

What evidence is there that they work to treat coronavirus?

There is no clear evidence that the drugs work against the coronavirus, despite their use by hospitals and doctors in the United States and other countries since the outbreak began. Their antiviral properties have been proved in test tubes, but rigorous clinical trials to test their effectiveness in humans have not been completed.

Limited studies on coronavirus patients have been published by researchers in France and China, but their extremely small size and other problems prevented them from being statistically significant. The French study included a combination of hydroxychloroquine with the antibiotic azithromycin that showed benefit in six patients, results that Trump has touted. Another study in 11 patients in France showed no evidence the regimen works. A Chinese study also showed no benefit over the standard course of treatment.

What does mainstream science say?

Mainstream scientists caution against using the drugs without more evidence they are effective. Anthony S. Fauci, chief of the National Institute for Allergy and Infectious Diseases, has accompanied Trump at the White House lectern and openly rebutted his declarations that the drugs are “game-changers” in the fight against the coronavirus.

Trump prevented Fauci from answering a question about the subject on Sunday, but that has not changed the assessment among academics that there is not enough evidence about the ability of these drugs to reduce viral load and prevent the inflammatory response that devastates the lungs of seriously ill coronavirus patients. The FDA was equivocal about possible benefits when it issued its emergency use authorization last month: “It is reasonable to believe that chloroquine phosphate and hydroxychloroquine sulfate may be effective in treating covid-19,” the agency said.

What are the dangers of side effects with these drugs?

(John Phillips/Getty Images)

The dangerous side effects of the drugs are much better known. Most seriously, the drugs can trigger arrhythmia, which can lead to a fatal heart attack in patients with cardiovascular disease or who are taking certain drugs, including anti-depression medications. Doctors recommend screening with an electrocardiogram to prevent the drug from being given to the 1 percent of patients at the greatest risk of a cardiac event. The drugs also can cause vision loss called retinopathy with long-term use, and chloroquine has been associated with psychosis.

Why does Trump keep touting their benefits?

As the coronavirus has spread from China across the world and to the United States, the dire reality is that there is no vaccine and no approved drug available to treat the serious respiratory symptoms that are claiming thousand of lives.

In repeatedly trumpeting unproven drugs from the White House briefing room, Trump has rallied elements of his base around the potential for a cure and sought to portray himself as a wartime president taking action. Trump has said he is eager to push the FDA to approve drugs and get them into hospitals quickly, regardless of the lack of evidence that they work. “The president is talking about hope for people. And it’s not an unreasonable thing to hope for people,” Fauci said at the White House on March 21.

Social media can accurately forecast economic impact of natural disasters—including COVID-19 pandemic

 University of Bristol

Social media should be used to chart the economic impact and recovery of businesses in countries affected by the COVID-19 pandemic, according to new research published in Nature Communications. University of Bristol scientists describe a 'real time' method accurately trialled across three global natural disasters which could be used to reliably forecast the financial impact of the current global health crisis.

Traditional economic recovery estimates, such as surveys and interviews, are usually costly, time-consuming and do not scale-up well. However, researchers from Bristol's Departments of Engineering Maths and Civil Engineering show they were able to accurately estimate the downtime and recovery of small businesses in countries affected by three different natural hazards using aggregated social media data.

The method relies on the assumption that businesses tend to publish more social media posts when they are open and fewer when they are closed, hence analysing the aggregated posting activity of a group of businesses over time it is possible to infer when they are open or closed.

Using data from the public Facebook posts of local businesses collected before, during and after three natural disasters comprising the 2015 Gorkha earthquake in Nepal, the 2017 Chiapas earthquake in Mexico, and the 2017 hurricane Maria in Puerto Rico, the team charted the number of smaller urban businesses who were closed and then were able to measure their recovery post-event. The team validated their analysis using field surveys, official reports, Facebook surveys, Facebook posts text analysis and other studies available in literature.

Importantly, the framework works in 'real time' without the need for text analysis which can be largely dependent on language, culture or semantic analysis and can be applied to any size area or type of natural disaster, in developed and developing countries, allowing local governments to better target the distribution of resources.

Dr. Filippo Simini, Senior Lecturer and lead author explains: "The challenge of nowcasting the effect of natural hazards such as earthquakes, floods, hurricanes, and pandemics on assets, people and society has never been more timely than ever for assessing the ability of countries to recover from extreme events.

"Often, small to medium-sized businesses slip through the net of traditional monitoring process of recovery. We noticed in areas struck by natural hazard events that not all areas and populations react in the same way."

Dr. Flavia De Luca, Senior Lecturer in Bristol's Department of Civil Engineering and lead author, added: "We had the idea of supporting post-emergency deployment of resources after a natural hazard event using public Facebook posts of businesses to measure how a specific region is recovering after the event. It was amazing to find out that the approach was providing information on the recovery in 'real time."

"We would like to test the method to measure the economic impact of the COVID-19 pandemic."

Jeffrey Sachs: This is how we conquer COVID-19

Jeffrey Sachs (SDSN) 

Since we lack effective drugs or a vaccine, there are only two ways to stop the Covid-19 epidemic short of catastrophe. They both involve stopping infectious individuals from spreading the disease.

The first is the rapid isolation of infected individuals. The second is a shutdown of economic and social activities to cut the number of face-to-face contacts each day. More than half the world's population is now under lockdown or stay at home orders.

It's urgent for every nation, indeed every community, to step up the rapid isolation of symptomatic individuals to save millions of lives and to make it possible to restart the economy as quickly as possible without setting off a new explosion of disease.

Every country now has lists of confirmed Covid-19 cases who should be contacted daily by the public health system. At the time of writing, the US confirmed active cases are around 362,000 people, a modest number by the standards of the digital age, when a presidential campaign can contact hundreds of thousands of people in a day.

Indeed, recent reports note that the Republican National Committee was able to make 1.5 million calls to voters using phone banks in a fully remote, digital outreach effort. If only the same energy were being put into phone banks for our national survival.

Countries in East Asia have been successfully using phone calls and online apps to support testing, tracing and isolation of infected individuals.

In Korea, infected individuals who are isolating at home are called twice daily to check on their symptoms. An online app monitors the movement of self-quarantined individuals.  Another popular Korean app helps individuals to keep a safe distance from the path of infected individuals and one app widely used in Singapore registers a digital signal when individuals are in close proximity in order to facilitate contact tracing. 

We don't really need the most advanced or intrusive features of those apps to achieve large benefits. The key is for the health system to make contact with those who have Covid-19 symptoms to promote early self-isolation and testing. Fortunately, after lagging behind in testing for two crucial months, the US is finally stepping up the rate of testing.    

Every country and US state should immediately organize phone and computer banks in which volunteers or paid staff working from home will contact each of the people on the confirmed Covid-19 list every day, and use the calls to check on symptoms, support self-isolation (including by providing them with public services they may need) and trace their contacts with family members, work colleagues and others. 

These contacts would then also be called to check on their own symptoms, helping to put those with new symptoms into quick isolation. The symptomatic individuals among these contacts would provide information on their close contacts as well, thereby identifying more and more people with Covid-19 symptoms and likely infections among pre-symptomatic and asymptomatic individuals.  

Every person with symptoms -- cough, fever, breathing difficulty -- should be regarded as a presumptive Covid case and put into immediate self-isolation. The public health authorities would maintain lists of "possible Covid cases" alongside the existing lists of "confirmed Covid cases."

In the best-case scenario, each of the suspected cases would be tested within 24 hours of viral exposure using one of the newly developed rapid diagnostic tests. 

A positive test would shift them from possible to confirmed cases.  A negative result, though, would not necessarily remove them from the possible list, because of the possibility of false-negative results. 

Individuals with Covid-19-type symptoms should remain in isolation until their symptoms disappear for several days and they test again negative.  

The confirmed list will grow quickly as it captures more and more of the infected population that has not yet been tested and isolated. The evidence from China's epidemic showed that a substantial proportion of the viral spread arose from cases that were not identified by the health system, tested and confirmed. 

The contact tracing and systematic outreach to all symptomatic individuals would greatly accelerate the early testing and self-isolation of more Covid-19 cases, and it would make it far easier for symptomatic individuals to register for testing, paid sick leave and social support.   

All symptomatic individuals who are in isolation should automatically receive guaranteed sick pay and time off from work. If self-employed, they should receive a daily living stipend. If unemployed, and not yet registered for unemployment compensation, they should be enabled to do so online.  

Nobody in this epidemic should ever have to choose between their job and staying home to protect others. There could be no better use of the federal funding than paid sick leave and other income support to help workers in need to stay home while also helping to end the epidemic itself.

A technical demonstration of how early isolation subdues the epidemic is found in a new paper published in the Proceedings of the National Academy of Sciences, in which I am a co-author as an economist among a group of stellar epidemiologists.

The epidemiologists emphasize the numerical force of early isolation in reducing the epidemic by reducing the number of days that infected people are contacting others and thereby spreading infections.  The economist's role is to help identify the public support systems and financial incentives to implement rapid self-isolation, such as guaranteed paid sick leave and social services. 

Our immediate national goal should be to get at least half of newly symptomatic cases (both those now measured in the data and those not yet measured) to self-isolate on the first day of symptoms -- and to go even higher after that.  If all newly symptomatic cases would self-isolate no more than one day after the appearance of their symptoms, they would most likely infect fewer than one other person on average.

The epidemic would quickly wane without the need for a continuing near-total lockdown.  The sooner we achieve a high rate of early isolation of symptomatic cases, the faster the lockdown can be ended. 

We've so far been paralyzed in the face of this crisis. The federal government has done too little, too late in its response to the crisis, largely leaving the battle to the governors and mayors. Even the so-called flight suspension from China that Trump incessantly brags about didn't actually stop the travel or infections from China.

Some 40,000 passengers arrived from China after Trump's announcement of the travel suspension.  Even more shocking, there has been little systematic contact tracing in the US, despite the growing list of Covid-19 confirmed cases, and there was little testing until recently because of the utterly botched rollout of tests by the Centers for Disease Control and Prevention (CDC). 

In short, we've been running without serious public health measures for more than three months since the CDC first learned directly about the new disease from China's CDC on January 3. 

There is no need or time for further delay. States such as California are stepping forward with online sites for testing, but the nation still lacks comprehensive contact tracing via phone or online apps. 

The phone banks for contact tracing and early self-isolation can and should start up immediately.  We should learn from East Asia's experience and from each other across the nation. We've been stymied at the federal level for three months and locked down for weeks. Our health workers have suffered grievously on the front lines. Too many Americans have already died.

It's time for public health now to bring this epidemic to a rapid end. 

What happens to people's lungs when they get coronavirus?

Graham Readfearn

What became known as Covid-19, or the coronavirus, started in late 2019 as a cluster of pneumonia cases with an unknown cause. The cause of the pneumonia was found to be a new virus – severe acute respiratory syndrome coronavirus 2, or Sars-CoV-2. The illness caused by the virus is Covid-19.

Now declared as a pandemic by the World Health Organisation (WHO), the majority of people who contract Covid-19 suffer only mild, cold-like symptoms.

WHO says about 80% of people with Covid-19 recover without needing any specialist treatment. Only about one person in six becomes seriously ill “and develops difficulty breathing”.

So how can Covid-19 develop into a more serious illness featuring pneumonia, and what does that do to our lungs and the rest of our body?

How is the virus affecting people?

Guardian Australia spoke with Prof John Wilson, president-elect of the Royal Australasian College of Physicians and a respiratory physician.

He says almost all serious consequences of Covid-19 feature pneumonia.

Wilson says people who catch Covid-19 can be placed into four broad categories.

The least serious are those people who are “sub-clinical” and who have the virus but have no symptoms.

Next are those who get an infection in the upper respiratory tract, which, Wilson says, “means a person has a fever and a cough and maybe milder symptoms like headache or conjunctivitis”.

He says: “Those people with minor symptoms are still able to transmit the virus but may not be aware of it.”

The largest group of those who would be positive for Covid-19, and the people most likely to present to hospitals and surgeries, are those who develop the same flu-like symptoms that would usually keep them off work.

A fourth group, Wilson says, will develop severe illness that features pneumonia.

He says: “In Wuhan, it worked out that from those who had tested positive and had sought medical help, roughly 6% had a severe illness.”

The WHO says the elderly and people with underlying problems like high blood pressure, heart and lung problems or diabetes, are more likely to develop serious illness.

How does the pneumonia develop?

When people with Covid-19 develop a cough and fever, Wilson says this is a result of the infection reaching the respiratory tree – the air passages that conduct air between the lungs and the outside.

He says: “The lining of the respiratory tree becomes injured, causing inflammation. This in turn irritates the nerves in the lining of the airway. Just a speck of dust can stimulate a cough.

“But if this gets worse, it goes past just the lining of the airway and goes to the gas exchange units, which are at the end of the air passages.

“If they become infected they respond by pouring out inflammatory material into the air sacs that are at the bottom of our lungs.”

If the air sacs then become inflamed, Wilson says this causes an “outpouring of inflammatory material [fluid and inflammatory cells] into the lungs and we end up with pneumonia.”

He says lungs that become filled with inflammatory material are unable to get enough oxygen to the bloodstream, reducing the body’s ability to take on oxygen and get rid of carbon dioxide.

“That’s the usual cause of death with severe pneumonia,” he says.

How can the pneumonia be treated?

Prof Christine Jenkins, chair of Lung Foundation Australia and a leading respiratory physician, told Guardian Australia: “Unfortunately, so far we don’t have anything that can stop people getting Covid-19 pneumonia.

“People are already trialling all sorts of medications and we’re hopeful that we might discover that there are various combinations of viral and anti-viral medications that could be effective. At the moment there isn’t any established treatment apart from supportive treatment, which is what we give people in intensive care.

“We ventilate them and maintain high oxygen levels until their lungs are able to function in a normal way again as they recover.”

Wilson says patients with viral pneumonia are also at risk of developing secondary infections, so they would also be treated with anti-viral medication and antibiotics.

“In some situations that isn’t enough,” he says of the current outbreak. “The pneumonia went unabated and the patients did not survive.”

Is Covid-19 pneumonia different?

Jenkins says Covid-19 pneumonia is different from the most common cases that people are admitted to hospitals for.

“Most types of pneumonia that we know of and that we admit people to hospital for are bacterial and they respond to an antibiotic.

Wilson says there is evidence that pneumonia caused by Covid-19 may be particularly severe. Wilson says cases of coronavirus pneumonia tend to affect all of the lungs, instead of just small parts.

He says: “Once we have an infection in the lung and, if it involves the air sacs, then the body’s response is first to try and destroy [the virus] and limit its replication.”

But Wilson says this “first responder mechanism” can be impaired in some groups, including people with underlying heart and lung conditions, diabetes and the elderly.

Jenkins says that, generally, people aged 65 and over are at risk of getting pneumonia, as well as people with medical conditions such as diabetes, cancer or a chronic disease affecting the lungs, heart, kidney or liver, smokers, Indigenous Australians, and infants aged 12 months and under.

“Age is the major predictor of risk of death from pneumonia. Pneumonia is always serious for an older person and in fact it used to be one of the main causes of death in the elderly. Now we have very good treatments for pneumonia.

“It’s important to remember that no matter how healthy and active you are, your risk for getting pneumonia increases with age. This is because our immune system naturally weakens with age, making it harder for our bodies to fight off infections and diseases.”

• Due to the unprecedented and ongoing nature of the coronavirus outbreak, this article is being regularly updated to ensure that it reflects the current situation at the date of publication. Any significant corrections made to this or previous versions of the article will continue to be footnoted in line with Guardian editorial policy.

Climate change is only going to make health crises like coronavirus more frequent and worse

Ibrahim AlHusseini, 
Opinion Contributor

While the world is currently facing down the COVID-19 pandemic, until we address an even broader issue  — climate change — we'll likely face additional pandemics for years to come. 

Scientists have long warned that climate change will impact not just our environment, but also our health by increasing rates of infectious disease.

Indeed, there's more than just water trapped in the ice caps and permafrost of high latitudes: as recently as 2015, researchers identified 28 previously undiscovered virus groups in a melting glacier. These harmful pathogens could make their way into streams, rivers, and waterways as the ice caps melt, wreaking havoc on our immune systems that have no natural resistance to these ancient diseases.  

If the COVID-19 outbreak is any indication, that future may now be our reality – which is why we have to act on climate change.

As early as 2001, the Intergovernmental Panel on Climate Change cited climate change as a severe risk to human health. Those findings initially received backlash: What could the climate have to do with health? But today it's clear that the criticisms – not the climate science – were baseless.

The 2001 IPCC report's findings are now accepted as fact by pillars of the healthcare community, including the World Health Organization and, even recently, the US Department of Defense. The question is no longer if climate change will impact our health. The question is, how badly will climate change impact our health?

We're already seeing the consequences today.

It's estimated that  90% of the world's children breathe toxic air every day. With health experts warning that these pollutants are damaging the developing lungs of children, it's no surprise that many now believe these toxins could also increase the risk of respiratory tract infections – including from viruses like the novel coronavirus.

In the US, extreme heat causes more death annually than all other weather events combined – and cities are getting the worst of it. These "urban heat islands" are associated with a much higher risk of death on warm summer days. 

Climate change leads to more food insecurity, and as a result, experts predict that humans will seek out alternative food sources like bushmeat and bats. Consumption of these animals leads to disease outbreaks and is even potentially to blame for coronavirus.

Then there's excessive rainfall and high humidity. Both are risk factors for the spread of waterborne diseases like malaria. 

Research suggests that even an increase of 2 to 3 degrees Celsius would increase the at-risk population by 3% to 5%, putting tens of millions of more people in danger, including large parts of the southern United States. And a 2013 paper found that the likelihood of early and severe influenza seasons increase following warmer than average winters. With this year's winter being abnormally warm, we need to prepare for the possibility that coronavirus could come back with a vengeance in the fall. 

Construction of new roads, mines, and hunting reserves is driving previously wild animals into contact with humans, leading to cross-contamination and infections from diseases like SARS, Avian Flu, and HIV.

These viruses do not disappear along with the habitats and animals they once inhabited; they tend to search for a new host – which all too often becomes us. As Eric Roston noted in a recent Bloomberg article, "unlike measles or polio, there is no vaccine for ecosystem destruction."

The good news is that these scenarios are by no means inevitable. But to avoid them, we need our elected leaders to inform the public about the connection between pandemics like COVID-19, and climate change. Because climate change is a problem we can solve, but only if we show the kind of international energy and cooperation that we are beginning to see in the fight against coronavirus.

As we head into the fall election in the US, and President Trump and former Vice President Biden debate their plans to confront this pandemic and the next one, both men would benefit from offering concrete steps to address the climate crisis. And businesses, even those who depend on fossil fuels, need to realize that the health of their customers and employees will suffer if they keep opposing climate-friendly policies and candidates.

We no longer need vague promises from our leaders: we need decisive action. Unless that happens, COVID-19 could be a harbinger of things to come.

Hydroxychloroquine and Covid-19: an explainer

 Eliott C. McLaughlin

The prospect of using hydroxychloroquine to treat Covid-19 amid the novel coronavirus pandemic has sparked rancor and disagreement among politicians and scientists.

There have been indications that the drug is effective in treating or preventing Covid-19, but the tests haven't endured the due diligence of extensive clinical trials.

Still, many -- including President Donald Trump -- are calling for doctors to prescribe hydroxychloroquine to Covid-19 patients. Here is what you should know:

What is its origin?

Hydroxychloroquine -- also known by the brand name Plaquenil -- and its analog, chloroquine, are derived from quinine, which French chemists in 1820 isolated from the bark of the cinchona tree, according to Medicines for Malaria Venture. In 1934, German scientists created the synthetic chloroquine as part of a class of anti-malarials, MMV said. Hydroxychloroquine is the less-toxic version of chloroquine.

Can it be used to treat Covid-19?

It's unclear. In labs it has demonstrated some efficacy against the severe acute respiratory syndrome coronavirus responsible for the present pandemic. But the White House's coronavirus response coordinator, Dr. Deborah Birx, has said that efficacy in test tubes doesn't mean it will work in humans.

Studies on humans have presented conflicting conclusions. For instance, a small Chinese study said the prognosis was "good" but the drug requires further investigation. Meanwhile, a French study combining the drug with a popular antibiotic -- which Trump said could be a game changer -- showed "no evidence of rapid antiviral clearance or clinical benefit."

CNN: Another French study showed promise in treating the virus, according to the medical journal The Lancet, "but virologists and infectious disease experts caution that the excitement is premature."

So it's an anti-malarial?

Yes, but since 2006, it has not been recommended for use in severe malaria because of problems with resistance, particularly in the Oceania region, according to the World Health Organization.

It also has value as a "disease-modifying anti-rheumatic drug" that can decrease the pain and swelling of arthritis, according to the American College of Rheumatology. It is used to treat rheumatoid arthritis, childhood arthritis, some symptoms of lupus and other autoimmune diseases.

"It is not clear why hydroxychloroquine is effective at treating autoimmune diseases. It is believed that hydroxychloroquine interferes with the communication of cells in the immune system," the college says.

Are more studies on humans coming?

Yes, lots of them. Drug makers have provided millions of doses to the federal government, and the US Food and Drug Administration, which has not officially approved hydroxychloroquine for treating Covid-19, issued an emergency use authorization to treat Covid-19 patients with it.

The drug should be used a last resort for extremely ill patients after they are "able to have a conversation with their health care provider about everything that they could possibly do to save their lives," US Surgeon General Jerome Adams told Fox News.

In Detroit, 3,000 patients at Henry Ford Hospital will be part of a trial whose results will be tracked in a formal study, said Vice President Mike Pence, who is heading the White House's coronavirus response. The federal government is also working to get millions of doses into areas with high infection rates, another White House official said.

Why does Trump keep mentioning it?

He believes the drug can be a powerful weapon against Covid-19, he says, "and there are signs that it works on this -- some very strong signs." He also feels taking the drug could be useful as a preventative measure for health care workers, he said.

Experts have not suggested the latter, but Trump is correct that there are promising signs. While health experts say it's best to wait until clinical trials determine if hydroxychloroquine is safe and effective in treating Covid-19, Trump wants faster results. It may not work, he said, but he doesn't want to wait 18 months to find out.

The US Department of Health and Human Services has also cited the encouraging anecdotal reports, but it, too, insisted more clinical trials are needed.

But it's safe?

Trump points to the fact it's been in use for decades, "so we know that if things don't go as planned, it's not going to kill anybody." Health experts indeed feel better about its safety than they would "a completely novel drug," Adams told Fox.

Hydroxychloroquine is well tolerated in Covid-19 patients, the US Centers for Disease Control and Prevention says, while the American College of Rheumatologists says it's well tolerated in general.

Side effects are rare, according to the college, and most commonly include nausea and diarrhea. Less common side effects include rashes, hair changes, weakness and, in rare instances, anemia or changes in vision.

That said, Nigerian officials have reported cases of overdoses, and an Arizona man who took a form of chloroquine used for cleaning fish tanks died.

Should people just take it and see what happens?

Lupus patients routinely use the drug to treat their symptoms -- for some, there is no alternative -- and it's the only known therapy for primary Sjögren's syndrome, another autoimmune disorder, The Lancet said.

Because of shortages spurred by coronavirus-related interest, the Lupus Foundation of America has called on drug makers to increase their production of hydroxychloroquine, and Kaiser Permanente is no longer filling routine prescriptions for chloroquine, The Lancet reported.

FDA Commissioner Stephen Hahn, who has called for a "large, pragmatic clinic trial" of the drug, has also urged caution, warning against "treating patients with a product that might not work when they could have pursued other, more appropriate treatments."