H5N1

Syndemic responses to COVID-19 should include an ecological dimension

Correspondence in The Lancet: Syndemic responses to COVID-19 should include an ecological dimension

Richard Horton argued persuasively that COVID-19 should be addressed as a syndemic of biological and social interactions. When planning the “national revival” he calls for, I consider it crucial that this syndemic approach includes an ecological dimension. Studies have found that widespread anthropogenic ecosystem degradation has played a crucial role in explaining why the rate of emergence of zoonoses has been increasing over the past 40 years. 

For example, deforestation, intensified agriculture and livestock production, and climate change have been linked to the emergence of Ebola virus, HIV, Nipah virus, severe acute respiratory syndrome coronavirus, and Zika virus. Unless reversed, the anthropogenic destruction of habitats will probably lead to the continued emergence of new zoonoses from the estimated 700 000 other unidentified viruses with zoonotic potential. 

As argued in the recent Living Planet Report, COVID-19 is “nature sending us a message”: we need to cut human consumption to within the planet's “safe operating space”. For the vital reasons Horton outlines, this needs to be done in a way which promotes, rather than exacerbates, national and international socioeconomic equity. National revival plans could play an important role in this process but should be subordinate to international plans that are based on determinations of both global equity and ecological constraints.

What defines an efficacious COVID-19 vaccine?

Via The Lancet Infectious Diseases: What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. The summary:

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused more than 1 million deaths in the first 6 months of the pandemic and huge economic and social upheaval internationally. An efficacious vaccine is essential to prevent further morbidity and mortality. 

Although some countries might deploy COVID-19 vaccines on the strength of safety and immunogenicity data alone, the goal of vaccine development is to gain direct evidence of vaccine efficacy in protecting humans against SARS-CoV-2 infection and COVID-19 so that manufacture of efficacious vaccines can be selectively upscaled. 

A candidate vaccine against SARS-CoV-2 might act against infection, disease, or transmission, and a vaccine capable of reducing any of these elements could contribute to disease control. However, the most important efficacy endpoint, protection against severe disease and death, is difficult to assess in phase 3 clinical trials. 

In this Review, we explore the challenges in assessing the efficacy of candidate SARS-CoV-2 vaccines, discuss the caveats needed to interpret reported efficacy endpoints, and provide insight into answering the seemingly simple question, “Does this COVID-19 vaccine work?”

Mainland China reports most new COVID-19 cases in more than two months

Via Reuters: Mainland China reports most new COVID-19 cases in more than two months. The report and then a comment:

SHANGHAI (Reuters) - Mainland China reported 42 new COVID-19 cases on Oct. 27, the highest daily toll in more than two months due to a rise in infections in the northwestern Xinjiang region, the country’s health authority said on Wednesday. 

Of the new cases, 22 in the city of Kashgar in Xinjiang were previously asymptomatic patients. The region’s health authorities also reported another 19 symptomless infections, which China does not recognise as confirmed COVID-19 cases, which accounted for half the new asymptomatic cases reported.  

The daily toll marks the highest since 44 confirmed infections were reported on Aug. 10, though it remains far off the peaks in February at the height of the outbreak in mainland China that forced the country into a virtual standstill.  

Kashgar health officials said the COVID-19 testing drive for the 4.75 million people in the area was completed as of Tuesday afternoon and a total of 183 people were confirmed to have been infected with the novel coronavirus. The cases are linked to a garment factory, though it’s not yet clear how the infections began. 

The total number of confirmed COVID-19 infections in mainland China now stands at 85,868, while the death toll remained unchanged at 4,634.

Washington state has 104,027 cases and 2,337 deaths tonight. Florida has 858,554 cases and 16,709 deaths. Canada has 222,8887 cases and 10,001 deaths.

Regional and global contributions of air pollution to risk of death from COVID-19

Via Cardiovascular Research: Regional and global contributions of air pollution to risk of death from COVID-19. The abstract:

Aims 

The risk of mortality from the coronavirus disease that emerged in 2019 (COVID-19) is increased by comorbidity from cardiovascular and pulmonary diseases. Air pollution also causes excess mortality from these conditions. Analysis of the first severe acute respiratory syndrome coronavirus (SARS-CoV-1) outcomes in 2003, and preliminary investigations of those for SARS-CoV-2 since 2019, provide evidence that the incidence and severity are related to ambient air pollution. We estimated the fraction of COVID-19 mortality that is attributable to the long-term exposure to ambient fine particulate air pollution. 

Methods and results 

We characterized global exposure to fine particulates based on satellite data, and calculated the anthropogenic fraction with an atmospheric chemistry model. The degree to which air pollution influences COVID-19 mortality was derived from epidemiological data in the USA and China. We estimate that particulate air pollution contributed ∼15% (95% confidence interval 7–33%) to COVID-19 mortality worldwide, 27% (13 – 46%) in East Asia, 19% (8–41%) in Europe, and 17% (6–39%) in North America. Globally, ∼50–60% of the attributable, anthropogenic fraction is related to fossil fuel use, up to 70–80% in Europe, West Asia, and North America.  

Conclusion 

Our results suggest that air pollution is an important cofactor increasing the risk of mortality from COVID-19. This provides extra motivation for combining ambitious policies to reduce air pollution with measures to control the transmission of COVID-19.

US COVID-19 outlook continues to worsen

Via The New York Times: Covid-19 Live Updates: U.S. Coronavirus Outlook Continues to Worsen. Excerpt:

The United States reported more than 74,300 new cases of the coronavirus on Monday, pushing the country’s daily average over the past week above 71,000, the most in any seven-day stretch of the pandemic.  

Across the country, the outlook continues to worsen. More than 20 states are reporting case numbers at or near record levels. Bars and restaurants are facing new limits. In a handful of places, business curfews have been ordered or field hospitals have opened. 

“There seems to be a Covid storm on the rise, and we have to get prepared,” said Gov. J.B. Pritzker of Illinois, who has imposed new restrictions on businesses in much of the state as cases have surged to record levels. 

On a per-capita basis, the Upper Midwest and Mountain West continue to face the worst of the latest surge. A field hospital at the Wisconsin state fairgrounds has started accepting patients. Idaho is averaging around 900 cases each day, up from about 260 in mid-September. Five percent of all North Dakotans have now tested positive for the virus, the highest rate of any state. 

Dr. Deborah L. Birx, the White House coronavirus response coordinator, visited North Dakota on Monday and warned that “there’s a whole other set of cases underneath those cases, of asymptomatic young people who are still getting together, or even 40-, 50- and 60-year-olds who I saw throughout Bismarck not wearing masks and not physically distancing yet being indoors.”  

But it is not just the Northern Plains and rural West struggling. Pennsylvania set a single-day case record on Monday with 2,492 new cases. And North Carolina has reported a record number of coronavirus deaths in the past week.  

All nonessential businesses in Newark, N.J., will have to close at 8 p.m. beginning Tuesday, city officials announced. As of Sunday, the deaths of 672 Newark residents had been linked to Covid-19, the disease caused by the virus, and the three-day average citywide positivity rate was 11.2 percent, more than double the statewide rate for the same period, the city said Monday.  

Newark is the first municipality in New Jersey to adopt new, targeted shutdown measures, which come as the number of virus cases is increasing across the state. As of Monday, New Jersey has had an average of 1,211 new cases every day for the past week, an increase of 57 percent from the average two weeks earlier, according to a New York Times database.  

Texas has overtaken California as the state that has recorded the most cases, with at least 916,000 since the pandemic began and a per capita case rate that ranks 17th in the nation. Its seven-day average of new cases is about 6,100, far below its July peak of over 10,000 but climbing sharply.  

In El Paso, the number of people hospitalized with Covid-19 has more than tripled over the past three weeks, leading local officials to take drastic action, including the imposition of a two-week stay-at-home order and a 10 p.m. to 5 a.m. curfew that took effect Sunday.

As cases soar, Trump declares pandemic ending

Via The Washington Post: As cases soar, Trump declares pandemic ending and Biden criticizes his handling of it. Excerpt:

Faced with record levels of U.S. coronavirus infections and a new White House outbreak, President Trump declared Monday that the pandemic was “ending anyway,” further tying his reelection bid to his ability to convince voters, including those at large rallies that defy health authorities, that the viral danger is fading. 

Financial markets fell as he spoke, with investors reacting to the growing infection rates and dwindling hope of a pre-election stimulus package. Vice President Pence canceled a planned appearance at the U.S. Senate for the expected confirmation of Amy Coney Barrett as a Supreme Court justice, after Democrats objected because he has been in close contact with at least one of the five staff members who tested positive for the disease in recent days. 

Over the past week, the nation has suffered a 20 percent increase in new diagnosed cases, a 13 percent rise in hospitalizations and an 11 percent rise in daily deaths, according to Johns Hopkins University, with the seven-day average of new cases reaching its highest level ever. The increase has been driven by spread in rural communities and northern states, including Wisconsin, Iowa, Minnesota and parts of Michigan, all of which could play a decisive role in the presidential contest.  

Trump nonetheless argued in three Pennsylvania rallies — where thousands gathered without social distancing or consistent mask-wearing — that the viral danger has been exaggerated by the news media and that Democratic politicians, including the governors of several swing states, had imposed unnecessary restrictions on large gatherings for political reasons.  

“It’s ending anyway. We are rounding the turn. It’s ending anyway,” Trump said of the virus at an outdoor stop in Allentown, Pa. “Normal life. That’s what we want, right? Normal life. Normal life. We just want normal life. It’s happening, very quickly.”

UK: Covid-19 death toll passes 60,000

Via The Guardian: UK coronavirus live: Covid-19 death toll passes 60,000. Excerpt:

The Covid-19 death toll across the UK has passed 61,000. 

The total number of deaths registered by the three statistical agencies across England and Wales, Scotland and Northern Ireland now stands at 59,927. 

However, more up-to-date UK government figures show that 1,189 deaths have occurred within 28 days of a positive test since the figures were registered in each nation: 1,044 in England, 62 in Scotland, 47 in Wales and 36 in Northern Ireland.  

This brings the number of deaths across the four nations of the UK to 61,116.

Germany 'could hit 20,000 new COVID-19 cases within days'

Via The Guardian: Coronavirus live news: Germany 'could hit 20,000 new cases within days'; Sweden registers record case high. Excerpt:

The number of new coronavirus infections in Germany is likely to reach 20,000 a day by the end of the week, economy minister Peter Altmaier said on Tuesday, according to a report by Reuters. 

He told a virtual German-French economic conference in Berlin:  

"We are dealing with exponential growth. In Germany, the number of new infections is rising by 70-75% compared with the week before."  

According to Altmaier’s forecast, Germany is contending with a faster upswing in coronavirus cases than previously expected. At the end of September, chancellor Angela Merkel said there could be 19,200 cases a day by Christmas. 

On Tuesday, the number of confirmed coronavirus cases rose by 11,409. That compares with 6,868 cases last Tuesday and with the record 14,714 reported on Saturday.

COVID-19 on Monday night: 43,444,797 cases, 1,158,882 deaths

A screenshot from the Johns Hopkins Coronavirus COVID-19 (2019-nCoV) dashboard:

COVID-19: Belgian hospitals could run out of beds in fifteen days

Via Reuters: Belgian hospitals could run out of beds in fifteen days: official. Excerpt:

BRUSSELS (Reuters) - Belgium could run out of beds in intensive care units within two weeks if the number of people in hospitals continue to increase at its current rate, an official said on Wednesday. 

The nation of 11 million people has Europe’s second highest infection rate per capita after the Czech Republic, with new cases doubling every thirteen days and hitting a peak of more than 18,000 on Oct. 20, almost a ten-fold increase from the peak of the spring wave of the pandemic.  

The number of patients in intensive care units (ICUs) is doubling every eight days - to 757 as of Sunday - with 4,827 people in hospitals. 

Health Ministry spokesman Yves Van Laethem told a news conference Belgium’s maximum capacity of 2,000 ICU beds might be reached in two weeks if the increases continues.  

“Within four days, by the end of the week, we should pass the milestone of 1,000 patients in intensive care,” Van Laethem said.  

“If the curve doesn’t change with our behaviour, we should reach 2,000 patients in intensive care in two weeks, our maximum capacity.”