Denmark announces cull of 15 million mink over COVID mutation fears

Employees from the Danish Veterinary and Food Administration deal with a Covid outbreak at a mink farm in Jutland in October. Photograph: Henning Bagger/Ritzau Scanpix/Reuters

Mutated virus infects 12 humans, sparking concerns that effectiveness of future vaccine could be affected

The world’s largest mink producer, Denmark, says it plans to cull more than 15 million of the animals, due to fears that a Covid-19 mutation moving from mink to humans could jeopardise future vaccines.

At a press conference on Wednesday, the Danish prime minister, Mette Frederiksen, said 12 people are already infected with the mutated virus and that the mink are now considered a public health risk.

“The mutated virus in mink may pose a risk to the effectiveness of a future vaccine,” Frederiksen said.

She said the army, police, and national emergency service would be mobilised to help farms with the mink cull, which will eradicate the entire Danish herd.The authorities and breeders have already been culling the animals over the past few weeks in a bid to contain the spread of Covid-19.

Reuters reported that Denmark’s health minister said about half of 783 infected people in northern Denmark, home to a large number of mink breeders, had been found to have infections stemming from the farms.

Denmark is the world’s largest producer of mink fur and has 15 to 17 million animals on about 1,100 farms. According to reports, the latest figures from the Danish Veterinary and Food Administration, say Covid-19 infections have been found on more than 200 mink farms. The figures were confirmed by a Danish police press officer.

Finnish fur auctioneer Magnus Ljung, CEO of Saga Furs, was watching the Danish announcement. “It’s a shock. They will kill all mink in Denmark. They are talking about the risk of Covid-19 mutating in the mink, and going from mink to humans, and potentially affecting a future human vaccine.”

Ljung estimated the value of the 2020 mink population in Denmark to be between €350m and €400m (£270m-£360m).

“They got control of [Covid-19 mink infections] in Holland and there were a few cases in Spain and in Sweden. But it was all kept under control. [The Danish cull] is unexpected, for sure. Yes, it could happen in other countries. But I don’t want to speculate,” said Ljung.

“What we really need to do is end mink farming entirely and retrain the farmers,” said Birgitte Damm, policy adviser and vet with NGO Animal Protection Denmark.

Speaking from Amsterdam, Dr Joanna Swabe, Humane Society International/Europe’s senior director of public affairs, said: “Denmark is one of the largest fur producers on the planet, so a total shutdown of all Danish mink fur farms amid spiralling Covid-19 infections is a significant development.

“Although not a ban on fur farming, this move signals the end of suffering for millions of animals confined to small wire cages on Danish fur farms solely for the purposes of a trivial fur fashion that no one needs. We commend the Danish prime minister on her decision to take such an essential and science-led step to protect Danish citizens from the deadly coronavirus.”

Hot or cold, weather alone has no significant effect on COVID-19 spread

University of Texas at Austin

New research is adding some clarity on weather's role in COVID-19 infection, with a new study finding that temperature and humidity do not play a significant role in coronavirus spread.

At the onset of the coronavirus pandemic, there were high hopes that hot summer temperatures could reduce its spread. Although summer didn't bring widespread relief, the connection between the weather and COVID-19 continues to be a hot topic.

The link between weather and COVID-19 is complicated. Weather influences the environment in which the coronavirus must survive before infecting a new host. But it also influences human behavior, which moves the virus from one host to another.

Research led by The University of Texas at Austin is adding some clarity on weather's role in COVID-19 infection, with a new study finding that temperature and humidity do not play a significant role in coronavirus spread.

That means whether it's hot or cold outside, the transmission of COVID-19 from one person to the next depends almost entirely on human behavior.

"The effect of weather is low and other features such as mobility have more impact than weather," said Dev Niyogi, a professor at UT Austin's Jackson School of Geosciences and Cockrell School of Engineering who led the research. "In terms of relative importance, weather is one of the last parameters."

The research was published Oct. 26 in the International Journal of Environmental Research and Public Health.

Co-authors are Sajad Jamshidi, a research assistant at Purdue University, and Maryam Baniasad, a doctoral candidate at Ohio State University.

The study defined weather as "equivalent air temperature," which combines temperature and humidity into a single value. The scientists than analyzed how this value tracked with coronavirus spread in different areas from March to July 2020, with their scale ranging from U.S. states and counties, to countries, regions and the world at large.

At the county and state scale, the researchers also investigated the relationship between coronavirus infection and human behavior, using cellphone data to study travel habits.

The study examined human behavior in a general sense and did not attempt to connect it to how the weather may have influenced it. At each scale, the researchers adjusted their analyses so that population differences did not skew results.

Across scales, the scientists found that the weather had nearly no influence. When it was compared with other factors using a statistical metric that breaks down the relative contribution of each factor toward a particular outcome, the weather's relative importance at the county scale was less than 3%, with no indication that a specific type of weather promoted spread over another.

In contrast, the data showed the clear influence of human behavior -- and the outsized influence of individual behaviors. Taking trips and spending time away from home were the top two contributing factors to COVID-19 growth, with a relative importance of about 34% and 26% respectively. The next two important factors were population and urban density, with a relative importance of about 23% and 13% respectively.

"We shouldn't think of the problem as something driven by weather and climate," Jamshidi said. "We should take personal precautions, be aware of the factors in urban exposure."

Baniasad, a biochemist and pharmacist, said that assumptions about how coronavirus would respond with weather are largely informed by studies conducted in laboratory settings on related viruses. She said that this study illustrates the importance of studies that analyze how the coronavirus spreads through human communities.

"When you study something in lab, it's a supervised environment. It's hard to scale up to society," she said. "This was our first motivation to do a more broad study."

Marshall Shepherd, an atmospheric sciences professor at the University of Georgia who was not part of the study, said that the research offers important insights about weather and coronavirus across scales.

"This important work clarifies some of the innuendo about weather-COVID-19 connections and highlights the need to address science challenges at the appropriate scales," Shepherd said.

Niyogi said that one of the key lessons of the coronavirus pandemic is the importance of analyzing phenomena at the "human scale" -- the scale at which humans live their day-to-day lives. He said that this research is an example of this type of perspective.

"COVID, it is claimed, could change everything," Niyogi said. "We have been looking at weather and climate outlooks as a system that we scale down, down, down and then seeing how it might affect humans. Now, we are flipping the case and upscaling, starting at human exposure scale and then going outwards. This is a new paradigm we will need for studying virus exposure and human environmental modeling systems involving new sensing and AI-like techniques."

The University of Texas at Austin, NASA and the National Science Foundation funded the research.

Biggest carbon dioxide drop: Real-time data show COVID-19's massive impact on global emissions

Potsdam Institute for Climate Impact Research (PIK)

While the ongoing coronavirus pandemic continues to threaten millions of lives around the world, the first half of 2020 saw an unprecedented decline in carbon dioxide emissions -- larger than during the financial crisis of 2008, the oil crisis of the 1979, or even World War II.

While the ongoing coronavirus pandemic continues to threaten millions of lives around the world, the first half of 2020 saw an unprecedented decline in CO2 emissions -- larger than during the financial crisis of 2008, the oil crisis of the 1979, or even World War II. An international team of researchers has found that in the first six months of this year, 8.8 percent less carbon dioxide was emitted than in the same period in 2019 -- a total decrease of 1551 million tonnes. The groundbreaking study not only offers a much more precise look at COVID-19's impact on global energy consumption than previous analyses. It also suggests what fundamental steps could be taken to stabilize the global climate in the aftermath of the pandemic.

"What makes our study unique is the analysis of meticulously collected near-real-time data," explains lead author Zhu Liu from the Department of Earth System Science at Tsinghua University in Beijing. "By looking at the daily figures compiled by the Carbon Monitor research initiative we were able to get a much faster and more accurate overview, including timelines that show how emissions decreases have corresponded to lockdown measures in each country. In April, at the height of the first wave of Corona infections, when most major countries shut down their public life and parts of their economy, emissions even declined by 16.9 %. Overall, the various outbreaks resulted in emission drops that we normally see only on a short-term basis on holidays such as Christmas or the Chinese Spring Festival."

The study, published in the latest issue of Nature Communications, shows which parts of the global economy were most impacted. "The greatest reduction of emissions was observed in the ground transportation sector," explains Daniel Kammen, professor and Chair of the Energy and Resources Group and also professor in the Goldman School of Public Policy, University of California, Berkeley. "Largely because of working from home restrictions, transport CO2 emissions decreased by 40 % worldwide. In contrast, the power and industry sectors contributed less to the decline, with -22 % and -17 %, respectively, as did the aviation and shipping sectors. Surprisingly, even the residential sector saw a small emissions drop of 3 %: largely because of an abnormally warm winter in the northern hemisphere, heating energy consumption decreased with most people staying at home all day during lockdown periods."

To paint this comprehensive and multidimensional picture, the researchers based their estimates on a wide array of data: precise, hourly datasets of electricity power production in 31 countries, daily vehicle traffic in more than 400 cities worldwide, daily global passenger flights, monthly production data for industry in 62 countries as well as fuel consumption data for building emissions in more than 200 countries.

The researchers also found strong rebound effects. With the exception of a continuing decrease of emissions stemming from the transportation sector, by July 2020, as soon as lockdown measures were lifted, most economies resumed their usual levels of emitting CO2. But even if they remained at their historically low levels, this would have a rather minuscule effect on the long-term CO2 concentration in the atmosphere.

Thus, the authors stress that the only valid strategy to stabilize the climate is a complete overhaul of the industry and commerce sector. "While the CO2 drop is unprecedented, decreases of human activities cannot be the answer," says Co-Author Hans Joachim Schellnhuber, founding director of the Potsdam Institute for Climate Impact Research. "Instead we need structural and transformational changes in our energy production and consumption systems. Individual behavior is certainly important, but what we really need to focus on is reducing the carbon intensity of our global economy."

Why COVID-19 is a litmus test for corporate attitudes to sustainability

Maxim Remchukov

• ESG is growing in importance for businesses and stakeholders everywhere.

• The pandemic is helping increase awareness that companies must focus on long-term sustainability over short-term profits.

• It will serve as a litmus test, dividing those firms who are serious about a low-carbon future – and those who are not.

The pandemic has proven the viability of the environmental, social and governance (ESG) agenda for both stakeholders and investors. It has specifically elevated the significance of social factors in the current moment, and environmental factors in the long-term.

In the first four months of 2020, investors poured a record $12.2 billion into ESG funds. The steady inflow is explained by the profitability of ESG investments, which have turned out to be remarkably resilient to disruption. For instance, more than 70% of ESG funds for all asset classes outperformed their competitors. And at the end of the second quarter there were 534 index funds focused on sustainability, overseeing a combined $250 billion in Europe and the United States.

Businesses with agile management systems, a corporate commitment to ESG goals and structural resilience are set to emerge as major beneficiaries of this shifting paradigm. A recent study showed that ESG has become an even greater focus for 23% of respondents and that the perceived importance of social considerations has risen by 20% since the onset of the pandemic.

The COVID-19 crisis is likely to increase awareness that companies must consider societal needs and ethical standards, not just short-term profits. This is particularly important for companies seeking to retain the skillsets of their workers and politicians striving to avoid societal discontent. Another study found that following layoffs at a firm, the remaining employees saw a 41% decline in job satisfaction, a 36% decrease in organizational commitment and a 20% decline in job performance. Such numbers further point to long-term negative impacts on health and, as a result, skillsets.

More studies prove that stock market outperformance depends on companies focusing on ESG factors that have a material impact on their business, such as waste reduction. In effect, the pandemic has highlighted concerns about the safety of secondary raw materials, the accumulation of medical plastic waste and the need for their proper disposal.

During the past months we have rediscovered the role of polymers in our lives, including disposable ones. In medicine, plastic remains one of the most important materials, since it almost completely solves the problem of contamination. In addition, it comes with reasonable price, ductility and high chemical resistance.

Four years ago, Mckinsey predicted that the volume of global plastic waste would grow to 460 million tons per year by 2030, taking a serious environmental problem to a whole new level. More than 76% of all plastic ends up as waste, and nearly 50% of plastics are used just once. The pandemic hasn’t changed this calculus and the problem of recycling and returning plastic waste to the cycle remains and requires a comprehensive solution.

Currently we are witnessing a tendency to suspend the transition to reusable products due to the epidemiological danger. But it is important to remember that the pandemic is not the time to negate the importance of the waste management problem. In contrast, it highlights the most vulnerable links in the supply chain that all industry players must work on.

When polymer waste cannot reach the processors due to epidemiological restrictions and more waste goes to landfill and incineration, the need for a systematic approach becomes more obvious. For instance, more than 450 organizations have signed up to a vision for a global plastics system in which plastics never become waste as part of the New Plastics Economy Global Commitment.

It is evident that we need more complex recycling practices and policies against plastic pollution that take into account extensive networks of transnational ties. The growing importance of sustainable development could be a good way to start treating the issue more effectively, in order to enable long-term environmental and economic benefits.

It is also worth keeping in mind that the scale of the current disruption might be just a rehearsal of a more dramatic slump in the future. Currently there is no shortage of studies predicting an apocalyptic future unless the world collectively reconsiders its commitment to ESG. https://www.youtube.com/embed/1ILv-IgYvxE?enablejsapi=1&wmode=transparent

Sustainable development goals and their integration into corporate strategies should perform the core role across corporate governance systems. This should not only reflect a popular recognition of the sustainability agenda, but also a keen commitment to take responsibility, which does not always entail maintaining a balance of costs and effect. For instance, economic recovery and adherence to ESG principles could facilitate the emergence of new ‘green’ financial instruments and social bonds.

The current crisis is likely to serve as a litmus test for those countries and corporations that are truly serious about ‘low-carbon investments’, and adhere to previously accepted ESG goals, and those that are not.

For instance, climate neutrality by 2050 is at the heart of the European Union’s Green Deal and is in line with the commitment to global climate action under the Paris Agreement. The proposed €750 billion fund to help the bloc recover will have a green focus, with 25% of all funding allocated for climate action.

Financing Sustainable Development

The world’s economies are already absorbing the costs of climate change and a “business as usual” approach that is obsolete. Both scientific evidence and the dislocation of people are highlighting the urgent need to create a sustainable, inclusive and climate-resilient future.

This will require no less than a transformation of our current economic model into one that generates long-term value by balancing natural, social, human and financial conditions. Cooperation between different stakeholders will be vital to developing the innovative strategies, partnerships and markets that will drive this transformation and allow us to raise the trillions of dollars in investments that are needed.

To tackle these challenges, Financing Sustainable Development is one of the four focus areas at the World Economic Forum’s 2019 Sustainable Development Impact summit. A range of sessions will spotlight the innovative financial models, pioneering solutions and scalable best practices that can mobilize capital for the the world’s sustainable development goals. It will focus on the conditions that both public and private institutions should create to enable large-scale financing of sustainable development. It will also explore the role that governments, corporations, investors, philanthropists and consumers could play to deliver new ways of financing sustainable development.

There are many good examples across the corporate sector. Euinor, Shell and Total have decided to invest in the Northern Lights project in Norway’s first exploitation license for CO2 storage on the Norwegian Continental Shelf. Total has also committed to become a net-zero emission company for all its European businesses by 2050. These cases should be applauded universally and used to motivate other companies to follow suit.

The best way to continue is to acknowledge that there is a need of maintaining a balance between ESG factors and strict corporate commitment to their resilience.

The growing maturity of the ESG agenda contributes to the sustainability goals and businesses’ ability to withstand external challenges. Since the risks in sustainable development are financially expressed in one way or another, the ability to manage them does not lose its relevance during any external crises and is one of the factors of long-term “survival”.

'Hunker down': The fall Covid-19 surge is here

Christina Maxouris and Holly Yan

As predicted, the US is now grappling with a new Covid-19 surge -- one that could overwhelm hospitals, kill thousands of Americans a day by January and leave even young survivors with long-term complications.

"We went down to the lowest point lately in early September, around 30,000-35,000 new cases a day. Now we're back up to (about) 50,000 new cases a day. And it's going to continue to rise," Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said Tuesday.

"This is the fall/winter surge that everyone was worried about. And now it's happening. And it's happening especially in the northern Midwest, and the Northern states are getting hit very hard -- Wisconsin, Montana, the Dakotas. But it's going to be nationally soon enough."

Across the country, more than 30 states have reported more Covid-19 cases this past week than they reported the previous week, according to data from Johns Hopkins University.

And Dr. Anthony Fauci, the nation's top infectious disease expert, sounded an alarm about certain states' test-positivity rates, saying they may be a good indicator that steeper climbs in case rates are ahead.

For the whole country, test positivity averaged 5.1% over the past week as of Tuesday. But in at least 13 states, the figure was above 10%: in Alabama, Florida, Iowa, Idaho, Indiana, Kansas, Montana, Nebraska, Nevada, South Dakota, Utah, Wisconsin and Wyoming, according to the COVID Tracking Project.

"You'd like to see (the rates) less than 3%, optimally 1% or less," Fauci, director of the National Institute of Allergy and Infectious Diseases, said at an event hosted by the College of American Pathologists.

"We're starting to see a number of states well above that, which is often -- in fact, invariably -- highly predictive of a resurgence of cases, which historically we know leads to an increase in hospitalizations and then ultimately an increase in deaths," he said.

In Denver, recent case counts are as "high right now as they were at the height of the pandemic back in May," Mayor Michael Hancock said Monday.

He said hospitalizations have also soared, and residents could face tighter Covid-19 restrictions if the numbers keep going up.

Kansas has broken its record for the highest average number of daily cases with more than 700 cases per day this past week, Gov. Laura Kelly said.

More than 1,000 new cases were reported Tuesday in Colorado. "It's very worrisome. It's very alarming. This is our highest single-day caseload since March," Gov. Jared Polis said.

In Wisconsin, a field hospital is opening this week to handle a rapid rise in coronavirus patients. The state recently reported record-high numbers of Covid-19 cases, hospitalizations and daily deaths.

If Americans don't turn the tide, the US could be in for a devastating winter. The University of Washington's Institute for Health Metrics and Evaluation projects more than 135,000 people in the US could die within the next three months.

"This winter -- this November, December, January, February -- could be the worst time in our epidemic," Hotez said. "Get ready to hunker down."

How overwhelmed hospitals can affect all patients

As we've seen throughout this pandemic, surges in new Covid-19 cases may lead to increased hospitalizations and deaths in the following weeks.

At least 10 states have reported record-high Covid-19 hospitalizations since Friday, according to data from the COVID Tracking Project. Five of them -- Arkansas, Montana, North Dakota, Oklahoma and Wisconsin -- reported records on Monday.

"Hospitals could again become overwhelmed," emergency medicine physician Dr. Leana Wen said. "And then we're not just talking about patients with coronavirus who might be in trouble. It's also about other patients who might be coming in for heart attacks and strokes and car accidents who may find a situation that's really untenable."

Kentucky Gov. Andy Beshear expressed concern about a rising number of hospitalizations. The commonwealth reported 741 Kentuckians are currently hospitalized for coronavirus, with 170 in the intensive care unit and 90 on a ventilator, he said.

Utah Gov. Gary Herbert said the state has seen infection rates and case counts skyrocket over the past month to the highest they've been, with new cases hovering around 1,000 per day since October 4.

"We are utilizing 15.8% of our ICU beds to treat COVID-19 patients, more than double what we were before, and our total ICU utilization is at 69.6%," Herbert tweeted. "This leaves our hospitals precariously close to being unable to treat COVID and non-COVID patients in need of critical care."

Some health care workers in the US still don't have adequate personal protective equipment and testing supplies, emergency medicine physician Dr. Megan Ranney said.

"We're quite fearful for what we are heading into," she said.

Nationwide, hospitalizations have been ticking up -- 35,072 were reported Monday, and the daily count has climbed relatively steadily since a recent low of about 28,600 on September 20.

A vaccine trial is paused, but that's 'completely expected'

As Americans wait for a safe and effective vaccine, Johnson & Johnson has paused the advanced clinical trial of its experimental vaccine because of an unexplained illness in one of the volunteers, the company announced.

The drugmaker said Tuesday that it didn't know immediately know whether the ill volunteer had received the vaccine candidate or a placebo, and that it had little information about the illness itself.

Johnson & Johnson said that it learned of the illness Sunday and immediately informed the study's independent Data Safety Monitoring Board (DSMB), which is reviewing the illness.

"It's not at all unusual for unexpected illnesses to occur in large studies over their duration," and sometimes they have nothing to do with the drug candidate, Mathai Mammen, global head of research at Johnson & Johnson's pharmaceutical division, Janssen, said Tuesday in the company's third-quarter earnings call.

As of Tuesday morning, the study was still blinded, meaning neither those directly administering the drugs or placebos nor the volunteers know which volunteers are receiving which elements of the study, Mammen said. The DSMB can "unblind" the study to investigate the illness if necessary, he said.

This kind of pause isn't immediately concerning, said Dr. Ashish Jha, dean of the Brown University School of Public Health.

"This is completely expected, and it's just a reminder how ridiculous it is to try and meet a political timeline of having a vaccine before November 3," Jha said, referring to President Donald Trump's wishes to have a vaccine ready for the public by Election Day.

"The Johnson & Johnson trial is the biggest trial of the vaccine that I know of -- 60,000 people," Jha said. "Within that trial, you'd expect a few pauses."

This is the second Phase 3 Covid-19 vaccine trial to hit the pause button in the US. AstraZeneca's vaccine trial was paused last month because of a neurological complication in a volunteer. While that trial has resumed in other parts of the world, it remains paused in the US while health officials investigate.

Fauci said Tuesday that current efforts toward vaccine development are "on a really good track" despite the Johnson & Johnson news.

"A couple of the vaccines are very close to getting some sort of information," Fauci said during a call with the nation's governors, according to audio of the call obtained by CNN.

Fauci mentioned vaccines being tested by Moderna and Pfizer. "We're getting to the point where we're almost being able to look at the first look at the data, which is a predetermined thing done by the data and safety monitoring board," he said.

The vaccine effort, more broadly, "is on really a good track," he said. "We should know by November or December whether or not we have a safe and effective vaccine. ... It is conceivable that we might even know before then."

When a vaccine does become available, health experts have said it's crucial that enough people become immunized for the preventative to be effective -- and many are worried that won't be the case.

"I'm extremely worried about how politicized this situation is around the vaccine and how people are reacting to it," Moncef Slaoui, the scientific head of the US government's initiative to develop a vaccine as soon as possible, said Tuesday.

"We will be fully transparent: People will understand exactly the performance of the vaccines, their safety and their benefit," Slaoui said in an interview on Fox News.

"And I hope people will realize that the only way really to allow us to move away and control this pandemic will be through mass vaccination," he said.

Coronavirus Reinfections Are Real but Very, Very Rare

 Apoorva Mandavilli

A case in Nevada has spurred new concerns that people who have recovered from the infection may still be vulnerable. That’s unlikely, experts say.

Reports of reinfection with the coronavirus evoke a nightmarish future: Repeat bouts of illness, impotent vaccines, unrelenting lockdowns — a pandemic without an end.

A case study published on Monday, about a 25-year-old man in Nevada, has stoked those fears anew. The man, who was not named, became sicker the second time that he was infected with the virus, a pattern the immune system is supposed to prevent.

People waited to be tested for coronavirus at Elmhurst Hospital Center in New York in March.Credit...John Minchillo/Associated Press

But these cases make the news precisely because they are rare, experts said: More than 38 million people worldwide have been infected with the coronavirus, and as of Monday, fewer than five of those cases have been confirmed by scientists to be reinfections.

“That’s tiny — it’s like a microliter-sized drop in the bucket, compared to the number of cases that have happened all over the world,” said Angela Rasmussen, a virologist at Columbia University in New York.

In most cases, a second bout with the virus produced milder symptoms or none at all. But for at least three people, including one patient in Ecuador, the illness was more severe the second time around than during the first infection. An 89-year-old woman in the Netherlands died during her second illness.

Rare as these cases may be, they do indicate that reinfection is possible, said Akiko Iwasaki, an immunologist at Yale University, who wrote a commentary accompanying the Nevada case study, published in The Lancet Infectious Diseases.

“It’s important to note that there are people who do get reinfected, and in some of those cases you get worse disease,” Dr. Iwasaki said. “You still need to keep wearing masks and practice social distancing even if you have recovered once from this infection.”

We asked experts what is known about reinfections with the coronavirus, and what the phenomenon means for vaccinations and the course of the pandemic.

Reinfection with the coronavirus is an unusual event.

First, the good news: Reinfection seems to be vanishingly rare.

Since the first confirmed case of reinfection, reported in Hong Kong on Aug. 24, there have been three published cases; reports of another 20 await scientific review.

But it’s impossible to know exactly how widespread the phenomenon is. To confirm a case of reinfection, scientists must look for significant differences in the genes of the two coronaviruses causing both illnesses.

In the United States, where testing was a rare resource much of this year, many people were not tested unless they were sick enough to be hospitalized. Even then, their samples were usually not preserved for genetic analysis, making it impossible to confirm suspected reinfections.

A vast majority of people who do get reinfected may go undetected. For example, the man in Hong Kong had no symptoms the second time, and his infection was discovered only because of routine screening at the airport.

“There are a lot of people that are going to also have been exposed that aren’t having symptoms, that we’re never going to hear about,” said Marion Pepper, an immunologist at the University of Washington in Seattle.

People whose second infections are more severe are more likely to be identified, because they return to the hospital. But those are likely to be even rarer, experts said.

“If this was a very common event, we would have seen thousands of cases,” Dr. Iwasaki said.

In most people, the immune system works as expected.

Reinfections can occur for any number of reasons: because the initial infection was too mild to produce an immune response, for example, or because the immune system was compromised by other health conditions. On occasion, a patient may be exposed to a large amount of virus that seeded an infection before the immune response could respond.

This variability is entirely expected, experts said, and has been observed in patients with diseases like measles and malaria.

Corona and the climate: a comparison of two emergencies

Kira Vinke1 , Sabine Gabrysch1,2, Emanuela Paoletti1, Johan Rockström1,3 and Hans Joachim Schellnhuber1

Lessons from the corona crisis can help manage the even more daunting challenge of anthropogenic global warming

Introduction

Within a few months, the COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has brought the everyday lives of billions of people to a halt, inducing great human suffering and unexpected economic shocks. Institutional deficits, including a lack of preparedness and hesitant decision-making, are exposed as the crisis unfolds. As the parallels between this global health emergency and the climate emergency become apparent, we reflect on how global society can manage shared risks and avert emergencies.

1 Potsdam Institute for Climate Impact Research (PIK), PO Box 60 12 03, 14412 Potsdam, Germany; 2 Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany and 3 University of Potsdam, 14469 Potsdam, Germany

Protecting health during COVID-19 and beyond: A global examination of paid sick leave design in 193 countries*

GLOBAL PUBLIC HEALTH

Jody Heymann , Amy Raub, Willetta Waisath, Michael McCormack, Ross Weistroffer, Gonzalo Moreno, Elizabeth Wong and Alison Earle

ABSTRACT

Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.

KEYWORDS : COVID-19; infectious disease spread; paid sick leave; global policy analysis; workplace

A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19

Journal of Critical Care

Andrea Cortegiani, Giulia Ingoglia, Mariachiara Ippolito, Antonino Giarratano, Sharon Eina

Abstract

PurposeCOVID-19 (coronavirus disease 2019) is a public health emergency of international concern. As of this time, there is no known effective pharmaceutical treatment, although it is much needed for patient contracting the severe form of the disease. The aim of this systematic review was to summarize the evidence regarding chloroquine for the treatment of COVID-19.

Methods

PubMed, EMBASE, and three trial Registries were searched for studies on the use of chloroquine in patients with COVID-19.

Results

We included six articles (one narrative letter, one in-vitro study, one editorial, expert consensus paper, two national guideline documents) and 23 ongoing clinical trials in China. Chloroquine seems to be effective in limiting the replication of SARS-CoV-2 (virus causing COVID-19) in vitro.

Conclusions

There is rationale, pre-clinical evidence of effectiveness and evidence of safety from long-time clinical use for other indications to justify clinical research on chloroquine in patients with COVID-19. However, clinical use should either adhere to the Monitored Emergency Use of Unregistered Interventions (MEURI) framework or be ethically approved as a trial as stated by the World Health Organization. Safety data and data from high-quality clinical trials are urgently needed.

Keywords: SARS-CoV-2COVID-19ChloroquinePneumoniaCoronavirus

Breaking News ‘Don't You Think This Whole COVID-19 Thing is Overblown?’

Emergency Medicine
Volume 42, Issue 4A

Mosley, Mark

Introduction

I work in an emergency department in Wichita, KS. That may not matter, but it's important to have context. We have one confirmed case of COVID-19 (from a cruise ship) as I'm writing this on March 19. But we are testing hardly anyone—yet. Patients and friends ask several times a day, “Don't you think this whole thing is overblown?”.

Keywords

Clinical aspects, diagnosis, treatment

Breaking News: 16 Common-Sense Tips and Facts for Dealing with COVID-19

Emergency Medicine News
Volume 42 - Issue 4A 

Mosley, Mark

Introduction

Many of these suggestions are not new, but we need new vigilance in the wake of COVID-19.

1. Wash your hands with every entry into and exit from a room.

Wash your hands for 20 seconds. Think of something to say, sing, or pray that takes 20 seconds, or do three rounds of slow, deep meditative breathing. Water with soap may be better, especially if there is a sanitizer shortage. The virus has a lipid layer, so soap or alcohol that is 60% or higher breaks it down.

Keywords

Epidemiology

Artificial Intelligence and Machine Learning to Fight COVID-19

Physiological Genomics
Volume 52, Issue 4, April 2020, Pages 200-202

Alimadadi, Ahmad; Aryal, Sachin; Manandhar, Ishan; Munroe, Patricia B.; Joe, Bina; Cheng, Xi

Introduction

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (13), has become an unprecedented public health crisis. Coronavirus Resource Center at Johns Hopkins University of Medicine has reported a total of 23,638 deaths as worldwide COVID-19 infections surpass 500,000 (as of 5 PM EST on March 26, 2020). On March 16, 2020, the White House, collaborating with research institutes and tech companies, issued a call to action for global artificial intelligence (AI) researchers for developing novel text and data-mining techniques to assist COVID-19-related research.

Keywords

Artificial Intelligence, COVID-19, Machine Learning, SARS-CoV-2

Elevated Plasmin (Ogen) As A Common Risk Factor For COVID-19 Susceptibility

Physiological reviews
Volume 100, Issue 3, July 2020, Pages 1065-1075

Ji, Hong-Long; Zhao, Runzhen; Matalon, Sadis; Matthay, Michael A.

Introduction

Patients with hypertension, diabetes, coronary heart disease, cerebrovascular illness, COPD, and kidney dysfunction have worse clinical outcomes when infected with SARS-CoV-2, for unknown reasons. The purpose of this review is to summarize the evidence for the existence of elevated plasmin(ogen) in COVID-19 patients with these comorbid conditions. Plasmin, and other proteases, may cleave a newly inserted furin site in the S protein of SARS-CoV-2, extracellularly, which increases its infectivity and virulence. Hyper-fibrinolysis associated with plasmin leads to elevated D-dimer in severe patients. The plasmin(ogen) system may prove a promising therapeutic target for combating COVID-19.

Keywords

Comorbidity, COVID-19, fibrinolysis, plasmin(ogen), SARS-CoV-2

Sound Science Before Quick Judgement Regarding RAS Blockade in COVID-19

Clinical journal of the American Society of Nephrology: CJASN

Matthew A. Sparks, Andrew South, Paul Welling, J. Matt Luther, Jordana Cohen, James Brian Byrd, Louise M. Burrell, Daniel Batlle, Laurie Tomlinson, Vivek Bhalla, Michelle N. Rheault, María José Soler, Sundar Swaminathan and Swapnil Hiremath 

Abstract

There has been much speculation in journals as well as social and traditional media about a link between popularly used classes of drugs that inhibit the renin-angiotensin system (RAS) and novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) infection or coronavirus disease 2019 (COVID-19) disease severity. After examining the available evidence, we advise that inhibitors of the RAS pathway should be continued in patients with COVID-19 who are taking these drugs for evidence-based indications. The putative link between SARS-CoV-2 angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) can be rationalized by the biology of virus entry. The spike protein of SARS-CoV-2 uses angiotensin-converting enzyme 2 (ACE2) as a receptor to enter type II pneumocytes or enterocytes (and likely, other cells).

Keywords

angiotensinrenin angiotensin systemvirology, hypertension, ACE inhibitors, COVID-19, severe acute respiratory syndrome coronavirus 2, Renin-Angiotensin System, Angiotensin-Converting Enzyme Inhibitors

Protecting high-risk cardiac patients during the Covid-19 outbreak

Journal of Cardiothoracic and Vascular Anesthesia

Pisano, Antonio; Landoni, Giovanni; Zangrillo, Alberto

Abstract

In the effort to face the ongoing Coronavirus Disease 2019 (COVID-19) epidemic, which caused severe pneumonia requiring intensive care unit (ICU) admission in up to 15% of confirmed cases so far, many hospitals in Italy are setting up new ICUs, stopping nonurgent admissions, limiting the access to emergency rooms and wards, and providing separate pathways for suspected COVID-19 and other diseases. In parallel, it is mandatory to continue ensuring the provision of non-postponable treatments (eg, primary percutaneous coronary interventions or urgent/emergency cardiac surgical procedures).

Keywords

Clinical aspects, diagnosis, treatment

Translating COVID-19 Pandemic Surge Theory to Practice in the Emergency Department: How to Expand Structure

Disaster Medicine and Public Health Preparedness
27 March 2020, pp. 1-33

Matteo Paganini, Andrea Conti, Eric Weinstein, Francesco della Corte and Luca Ragazzoni 

Abstract

Multiple professional societies, nongovernment and government agencies have studied the science of sudden onset disaster mass casualty incidents to create and promote surge response guidelines. The COVID-19 pandemic has presented the health care system with challenges that have limited science to guide the staff, stuff and structure surge response.

This study reviewed the available surge science literature specifically to guide an Emergency Department's surge structural response using a translational science approach to answer the question: How does the concept of sudden onset mass casualty incident (MCI) surge capability apply to the process to expand COVID-19 Pandemic surge structure response?

The available surge structural science literature was reviewed to determine the application to a pandemic response. The on-line ahead of print and print COVID-19 scientific publications, as well as grey, literature were studied to learn the best available COVID-19 surge structural response science. A checklist was created to guide the Emergency Department team's COVID-19 surge structural response.

Keywords

COVID-19, SARS-CoV-2, Surge Capacity, Pandemics, Translational Science

Assessment of health information about the prevention of COVID-19 on the Internet

JMIR Public Health and Surveillance

Hernández-García, Ignacio; Giménez-Júlvez, Teresa

Abstract

Background: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users.

Objective: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet.

Methods: On February 29, 2020, we performed a Google search with the terms "Prevention coronavirus," "Prevention COVID-19," "Prevención coronavirus," and "Prevención COVID-19". A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO).

Results: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was "wash your hands frequently" (n=65, 81%). A less frequent recommendation was to "stay home if you feel unwell" (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as "wash your hands frequently" (OR 9.82), "cover your mouth and nose with your bent elbow or tissue when you cough or sneeze" (OR 4.59), or "stay home if you feel unwell" (OR 0.31).

Conclusions: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them.

Keywords

Clinical aspects, diagnosis, treatment; Epidemiology

Initial Experience of an Emergency Department in Shenzhen in Responding to the Emerging Wuhan Coronavirus Pneumonia

Annals of Emergency Medicine
Volume 75, Issue 4, April 2020, Page 556.

Lu, K. L.; Chen, S.; Leung, L. P.

Since the emergence of a cluster of patients with pneumonia caused by a novel coronavirus (COVID-19) in Wuhan, Hubei, China, in December 2019, emergency departments (EDs) in China have instituted special measures to manage patients with potential exposure to the virus. We describe our initial experience in managing the current outbreak caused by COVID-19…

Keywords

Epidemiology

The Cardiovascular Burden Of Coronavirus Disease 2019 (COVID-19) With A Focus On Congenital Heart Disease

International Journal of Cardiology

Tan, Weiyi; Aboulhosn, Jamil

Introduction

Coronavirus disease 2019 (COVID-19), caused by a novel betacoronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first described in a cluster of patients presenting with pneumonia symptoms in Wuhan, China, in December of 2019. Over the past few months, COVID-19 has developed into a worldwide pandemic, with over 400,000 documented cases globally as of March 24, 2020. The SARS-CoV-2 virus is most likely of zoonotic origin, but has been shown to have effective human-to-human transmission. COVID-19 results in mild symptoms in the majority of infected patients, but can cause severe lung injury, cardiac injury, and death. Given the novel nature of COVID-19, no established treatment beyond supportive care exists currently, but extensive public-health measures to reduce person-to-person transmission of COVID-19 have been implemented globally to curb the spread of disease, reduce the burden on healthcare systems, and protect vulnerable populations, including the elderly and those with underlying medical comorbidities. Since this is an emerging infectious disease, there is, as of yet, limited data on the effects of this infection on patients with cardiovascular disease, particularly so for those with congenital heart disease. We summarize herewith the early experience with COVID-19 and consider the potential applicability to and implications for patients with cardiovascular disease in general and congenital heart disease in particular.

Keywords

Clinical aspects, diagnosis, treatment

Breaking News: Brace for Chloroquine Poisonings Because of the Coronavirus Pandemic

Emergency Medicine
Volume 42, Issue 4A

Gussow, Leon

Introduction

President Trump voiced enthusiasm in a March 19 press conference for using the drug chloroquine against the coronavirus, saying, “It's been around a long time, so if things don't go well, we know it won't kill anyone.”

Keywords

Clinical aspects, diagnosis, treatment