H5N1

COVID-19 in September: 8,312,905 cases, 161,542 deaths

A screenshot from the Johns Hopkins COVID-19 dashboard taken on the morning of September 1:

And a screenshot from the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard taken on the night of September 30:

So an average day in September 2020 saw 277,096 new cases and 5,384 deaths. Now we will see what happens to those rates in October.

Modelling the allocation and impact of a COVID-19 vaccine

Imperial College London was so quiet for so long that I'd stopped checking their website for new reports. Now I see they're active again, with 3 reports this month. Here's Report 33 - Modelling the allocation and impact of a COVID-19 vaccine. The summary:

Several SARS-CoV-2 vaccine candidates are now in late-stage trials, with efficacy and safety results expected by the end of 2020. Even under optimistic scenarios for manufacture and delivery, the doses available in 2021 are likely to be limited. Here we identify optimal vaccine allocation strategies within and between countries to maximise health (avert deaths) under constraints on dose supply. 

We extended an existing mathematical model of SARS-CoV-2 transmission across different country settings to model the public health impact of potential vaccines, using a range of target product profiles developed by the World Health Organization. 

We show that as supply increases, vaccines that reduce or block infection – and thus transmission – in addition to preventing disease have a greater impact than those that prevent disease alone, due to the indirect protection provided to high-risk groups. We further demonstrate that the health impact of vaccination will depend on the cumulative infection incidence in the population when vaccination begins, the duration of any naturally acquired immunity, the likely trajectory of the epidemic in 2021 and the level of healthcare available to effectively treat those with disease. 

Within a country, we find that for a limited supply (doses for <20% of the population) the optimal strategy is to target the elderly and other high-risk groups. However, if a larger supply is available, the optimal strategy switches to targeting key transmitters (i.e. the working age population and potentially children) to indirectly protect the elderly and vulnerable. 

Given the likely global dose supply in 2021 (2 billion doses with a two-dose vaccine), we find that a strategy in which doses are allocated to countries in proportion to their population size is close to optimal in averting deaths. Such a strategy also aligns with the ethical principles agreed in pandemic preparedness planning.

India: Largest COVID-19 study highlights role of super-spreaders

Via the Los Angeles Times, a long, informative article: Largest COVID-19 study highlights role of super-spreaders. Excerpt:

SINGAPORE —  In the bleak ranking of worst COVID-19 outbreaks, the United States, with 7.2 million infections, is likely to be eclipsed only by India, which has 1 million fewer cases but is catching up fast. 

Yet parts of India have led the world in one aspect of the pandemic response: contact tracing — the labor-intensive, time-sensitive, painstaking work of identifying people who were exposed to a known infected person. 

Extensive contact tracing in two southern Indian states offers the strongest evidence yet that a few super-spreading individuals are responsible for a disproportionate share of new coronavirus infections, according to a study published Wednesday in the journal Science. It also suggests that children are more efficient transmitters of the virus than widely believed.

A team of Indian and U.S. researchers examined data from 575,071 individuals who were tested after coming into contact with 84,965 people with confirmed cases of COVID-19. That’s an average of seven contacts per case, and a cohort more than 10 times larger than in a previous study from South Korea that mapped how the virus was transmitted. 

“It’s the largest epidemiological study anywhere on COVID by far,” said the lead author, Ramanan Laxminarayan of the Center for Disease Dynamics, Economics and Policy, in New Delhi. 

Laxminarayan and his colleagues found that just 8% of people with COVID-19 accounted for 60% of the new infections observed among the contacts. Meanwhile, 7 out of 10 COVID-19 patients were not linked to any new cases. 

The finding underscores the essential role of super-spreaders in the COVID-19 pandemic: One individual or event, such as in a poorly ventilated indoor space, can trigger a high number of new infections, while others might not transmit the virus at all.  

In the new study, researchers tracked down 78 people who had shared a bus or train with one of eight known infected people and sat within three rows of that person for more than six hours. Health workers visited these contacts at their homes to conduct follow-up screenings and determined that nearly 80% of them had contracted the coronavirus. 

By contrast, people who were known to be exposed to infected individuals in lower-risk environments — such as being in the same room but more than three feet away — became infected only 1.6% of the time. 

“Super-spreading events are the rule rather than the exception,” Laxminarayan said. “It has lots of implications for modeling COVID, for how to keep places safe.”  

The study suggests that super-spreading events are influenced by behavior — that proximity to an infected person, length of contact and ambient conditions determine the level of risk. It doesn’t examine whether some infected people spread the virus more efficiently because of biological factors, a question scientists are still trying to answer.

WHO orders rapid COVID-19 tests for world′s poor

Via DW: WHO orders rapid COVID-19 tests for world′s poor | Science| In-depth reporting on science and technology. Excerpt:

The World Health Organization, along with its global partners in the fight against the COVID-19 pandemic, has announced that it will provide 120 million rapid-diagnostic antigen tests to people in lower- and middle-income countries over the next six months. The tests represent a "massive increase" in testing worldwide, according to the Global Fund, a partnership that works to end epidemics.  

"We have an agreement, we have seed funding and now we need the full amount of funds to buy these tests,'' said WHO Director-General Tedros Adhanom Ghebreyesus on Monday, without providing further details. The program will initially require $600 million (€511 million) and is planned to start as early as October.

This mass testing campaign is part of a global initiative launched in April by the WHO, the European Commission, the Bill & Melinda Gates Foundation and the French government. Additional partner organizations include the Global Fund, the Africa Centres for Disease Control and Prevention, the Clinton Health Access Initiative, the Foundation for Innovative New Diagnostics (FIND) and Unitaid. 

The test manufacturers, South Korea's SD BioSensor and US-based Abbott Laboratories, have agreed to provide 20% of their test kits to lower- and middle-income countries. The remainder will be made available to wealthier nations, some of whom are helping to finance the test drive. Germany, for example, has already ordered some 20 million test kits.

Quick test can break infection chains 

"These tests provide reliable results in approximately 15 to 30 minutes, rather than hours or days, at a lower price with less sophisticated equipment,'' said WHO head Tedros, adding that the tests would cost as little as $5 (€4.30) each, and could become cheaper still. He said the rapid tests would help expand testing to hard-to-reach areas which aren't as well-equipped, or which are lacking trained health workers. 

"High-quality rapid tests show us where the virus is hiding, which is key to quickly tracing and isolating contacts and breaking the chains of transmission," said Tedros. "The tests are a critical tool for governments as they look to reopen economies and ultimately save both lives and livelihoods."

Iran's COVID-19 death toll rises above 26,000 - state media

Via Reuters: Iran's coronavirus death toll rises above 26,000 - state media.

DUBAI (Reuters) - Iran’s death toll from the coronavirus rose by 183 to 26,169 on Wednesday, the highest in the Middle East, with the total number of identified cases rising to 457,219, state media reported. 

Health Ministry spokeswoman Sima Sadat Lari said 3,582 new cases had been identified in the previous 24 hours, the state broadcaster IRIB reported on its website. 

Interior Minister Abdolreza Rahmani Fazli on Wednesday voiced alarm over a surge in infections, especially in the capital Tehran, and warned that fines may soon be imposed on people in the city not wearing face masks or flouting other health precautions.  

“If the plan is approved by the national coronavirus taskforce, people who do not follow health protocols will be fined ... Tehran has been proposed as a model for the implementation of this plan,” state media quoted the minister as saying.

WHO to probe 'sexual exploitation' by Ebola aid workers in DR Congo

This is bad. Via BBC News: WHO to probe 'sexual exploitation' by aid workers in DR Congo. Excerpt:

The World Health Organization (WHO) has pledged to investigate allegations that aid workers tackling the Ebola outbreak in the Democratic Republic of Congo sexually abused and exploited women. 

WHO and other aid agency staff were accused by 50 women in a joint investigation by two news agencies. 

Local women were allegedly plied with drinks, "ambushed" in hospitals, forced to have sex, and two became pregnant. 

The allegations cover the period between 2018 and March this year. 

The New Humanitarian news agency and the Thomson Reuters Foundation have carried out an almost year-long investigation. 

The WHO said the allegations would be "robustly investigated". 

"Anyone identified as being involved will be held to account and face serious consequences, including immediate dismissal," it said in a statement. 

"The betrayal of people in the communities we serve is reprehensible." 

More than 2,000 people died in the Ebola outbreak in DR Congo. 

The WHO, which spearheaded global efforts to curb the spread of the outbreak, declared it over in June this year. 

The UN and aid agencies have previously promised zero tolerance of sexual abuse following similar allegations against some of their staff in other countries. 

A spokesperson for the UK's Foreign, Commonwealth and Development Office said it would scrutinise the WHO findings closely, adding: "Sexual exploitation and abuse are completely abhorrent. We regularly assess all of our partners against the highest safeguarding standards." 

Who does the investigation implicate the most? 

Most of the allegations of sexual abuse and exploitation were against men, including doctors, said to be from the WHO. At least 30 women made allegations against them, the news agencies reported. 

The next highest number of allegations - made by eight women - were against men said to be from DR Congo's health ministry. 

Two other UN agencies, and four international charities, were also named in the report.

Some of the accused men came from Belgium, Burkina Faso, Canada, France, Guinea-Conakry and Ivory Coast. 

Many men refused to wear condoms, and at least two women said they became pregnant as a result of the abuse, the news agencies reported.

Dr. Tedros: Never too late to fight back against COVID-19

Via WHO, Dr. Tedros writes: Never too late to fight back against pandemic. Excerpt:

One million people have now been lost to COVID-19 and many more are suffering because of the pandemic. This milestone is a difficult moment for the world but there are glimmers of hope that encourage us now and in the near future.  

Just nine months on from the virus first being identified, some of the best scientists in the world have collectively developed tests to diagnose cases, identified treatments like corticosteroids to reduce mortality in the most severe cases of COVID-19, and produced vaccine candidates that are now in final phase three trials. 

While we await further breakthroughs, we have seen that the virus can be effectively contained through the application of tried and tested public health measures.   

Many countries have driven an all-of-government, all-of-society response. With the right preparedness infrastructure in place, they were able to act early to contain outbreaks before transmission got out of hand.   

Thailand has a well-resourced medical and public health system. Informed by the best available scientific advice, and a trained and committed community health workforce, Thai authorities acted decisively to suppress the virus, to build trust and to increase public confidence. 

Italy was one of the first countries to experience a large outbreak outside China, and in many ways was a pioneer for other countries. Learning from the Wuhan experience, Italy put strong measures in place and was able to reduce transmission and save many thousands of lives. National unity and solidarity, combined with the dedication and sacrifice of health workers, and the engagement of the Italian people helped bring the outbreak under control.  

Although the Americas has so far been the most-affected region, Uruguay has reported the lowest number of cases and deaths in Latin America, both in total and on a per capita basis. This is not an accident. Uruguay has one of the most robust and resilient health systems in Latin America, with sustainable investment based on political consensus on the importance of investing in public health. 

Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children against polio have been redeployed and utilized for surveillance, contact tracing and care. This has both suppressed the virus and, as the country stabilizes, the economy is also now picking up once again. Reinforcing the lesson that the choice is not between controlling the virus or saving the economy; the two go hand-in-hand.  

There are many other examples including Cambodia, Mongolia, Japan, New Zealand, the Republic of Korea, Rwanda, Senegal, Spain, Vietnam and more. Many of these countries learnt lessons from previous disease outbreaks of SARS, MERS, measles, polio, Ebola and flu to hone their health system and respond to this new pathogen. 

But the key lesson is the same: no matter where a country is in an outbreak, it is never too late to turn things around. 

Pandemic is far from over, experts say, despite Trump allies’ claims

Via The New York Times: Pandemic Is Far From Over, Experts Say, Despite Trump Allies’ Claims. Excerpt:

In the last week, leading epidemiologists from respected institutions have, through different methods, reached the same conclusion: About 85 to 90 percent of the American population is still susceptible to SARS-CoV-2, the virus causing the current pandemic. 

The number is important because it means that “herd immunity” — the point at which a disease stops spreading because nearly everyone in a population has contracted it — is still very far off.  

The evidence came from antibody testing and from epidemiological modeling. At the request of The New York Times, three epidemiological teams last week calculated the percentage of the country that is infected. What they found runs strongly counter to a theory being promoted in influential circles that the United States has either already achieved herd immunity or is close to doing so, and that the pandemic is all but over. That conclusion would imply that businesses, schools and restaurants could safely reopen, and that masks and other distancing measures could be abandoned.  

“The idea that herd immunity will happen at 10 or 20 percent is just nonsense,” said Dr. Christopher J.L. Murray, director of the University of Washington’s Institute for Health Metrics and Evaluation, which produced the epidemic model frequently cited during White House news briefings as the epidemic hit hard in the spring.  

That belief began circulating months ago on conservative news programs like those of Rush Limbaugh and Laura Ingraham. It has been cited several times by Dr. Scott W. Atlas, President Trump’s new pandemic adviser. It appears to be behind Mr. Trump’s recent remarks that the pandemic is “rounding the corner” and “would go away even without the vaccine.”  

But it is also gaining credence on Wall Street and among some business executives, said prominent public health experts, who consider the idea scientifically unfounded as well as dangerous; its most vocal adherents are calling for mask-wearing and social distancing to end just as cold weather is shifting social activity indoors, where the risk of transmission is higher. 

Even in places where the pandemic hit especially hard — a French aircraft carrier, the Brazilian city of Manaus, the slums of Mumbai and a neighborhood in Queens, N.Y. — infections did not noticeably slow down until almost 60 percent of the inhabitants were infected. And even those levels may not suffice, given that cases are increasing again in Brazil and in Brooklyn areas that had seen cases spike and then drop off.  

“Immunity in 2020 is no closer to being just around the corner than prosperity was in 1930,” said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention. “The route to immunity without a vaccine would be through graveyards filled with hundreds of thousands of Americans who did not have to die.”

Netherlands: Strong increase in new COVID-19 infections, hospital and ICU admissions

From the Dashboard Coronavirus COVID-19 | Government.nl:

The number of people who newly tested positive has increased by 60% in the past week (16 to 22 September). The provinces of South-Holland, North-Holland, Utrecht and Groningen had most new infections. There is a rising trend of infections among nursing home residents. The number of admissions of Covid-19 patients to the hospital and ICU also strongly increased. 

Risk level per region can be ‘watchful’ (level 1), ‘worrisome’ (level 2) or ‘serious’ (level 3). The situation in 11 of the 25 safety regions is worrisome. In Amsterdam-Amstelland, Haaglanden and Rotterdam-Rijnmond, the situation is considered serious.

Moscow extends school holiday as COVID-19 cases rise

Via Reuters: Moscow extends school holiday as coronavirus cases rise. Excerpt:

MOSCOW (Reuters) - Moscow Mayor Sergei Sobyanin on Tuesday extended an upcoming school holiday by a week to limit the spread of the coronavirus, days after sources told Reuters that the capital’s hospitals had been told to free up hundreds of beds.

COVID-19 infections have been rising across Europe in the weeks since the start of the new academic year and some other countries have also considered extending October school holidays to try to slow the spread. 

The Kremlin said last week it did not plan to impose severe lockdown restrictions despite a growing number of new cases of COVID-19, but Sobyanin advised anyone with chronic health problems or those older than 65 to stay home. 

On Tuesday, Sobyanin said students would be off school from Oct. 5-18, and urged parents to keep their children at home. 

“Today a significant proportion of the sick - who are often asymptomatic - are children,” Sobyanin said on his website. 

“When they come home, they easily transmit the virus to adults and elderly family members who get much more sick.”  

The upsurge in Moscow has escalated since Russia reopened schools on Sept. 1. The number of new daily infections has more than doubled compared to late August.