Category Archives: Covid-19

Moderna Therapeutics, a biotech company based in Cambridge, Mass., has shipped the first batches of its COVID-19 vaccine. The vaccine was created just 42 days after the genetic sequence of the COVID_19 virus, called SARS-CoV-2, was released by Chinese researchers in mid-January. The first vials were sent to the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health (NIH) in Bethesda, MD, which will ready the vaccine for human testing as early as April.

NIH scientists also began testing an antiviral drug called remdesivir that had been developed for Ebola, on a patient infected with SARS-CoV-2. The trial is the first to test a drug for treating COVID-19, and will be led by a team at the University of Nebraska Medical Center. The first patient to volunteer for the ground-breaking study is a passenger who was brought back to the US after testing positive for the disease aboard the Diamond Princess. Others diagnosed with COVID-19 who have been hospitalized will also be part of the study.

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Remdesivir showed encouraging results among animals infected with two related coronaviruses, one responsible for severe acute respiratory syndrome (SARS) and another for causing Middle East respiratory syndrome (MERS). Volunteers will be randomly assigned to receive either the drug or a placebo intravenously for 10 days, and they will have blood tests and nose and throat swabs taken every two days to track the amount of virus in their bodies. Even if the drug shows some efficacy in keeping blood levels of SARS-CoV-2 from growing, it could help to contain spread of the infection.

Modernas vaccine against COVID-19 was developed in record time because its based on a relatively new genetic method that does not require growing huge amounts of virus. Instead, the vaccine is packed with mRNA, the genetic material that comes from DNA and makes proteins. Moderna loads its vaccine with mRNA that codes for the right coronavirus proteins which then get injected into the body. Immune cells in the lymph nodes can process that mRNA and start making the protein in just the right way for other immune cells to recognize and mark them for destruction.

As Dr. Stephen Hoge, president of Moderna, told TIME earlier this month, mRNA is really like a software molecule in biology. So our vaccine is like the software program to the body, which then goes and makes the [viral] proteins that can generate an immune response. That means that this vaccine method can be scaled up quickly, saving critical time when a new disease like COVID-19 emerges and starts infecting tens of thousands of people.

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COVID-19 Vaccine Shipped, and Drug Trials Start | Time

In just a few short weeks, weve all made the collective journey from pandemic ignoramuses to budding armchair virologists with a decent grasp of once-arcane terms like personal protective equipment, social distancing and "flatten the curve".

But theres one phrase that might still leave a few justifiably scratching their heads: the R number. The coronavirus has one, and governments around the world are keen to see it shrink as much as possible. But what is it?

R refers to the effective reproduction number and, basically put, its a way of measuring an infectious diseases capacity to spread. The R number signifies the average number of people that one infected person will pass the virus to.

The R number isnt fixed, but can be affected by a range of factors, including not just how infectious a disease is but how it develops over time, how a population behaves, and any immunity already possessed thanks to infection or vaccination. Location is also important: a densely populated city is likely to have a higher R than a sparsely peopled rural area.

Because Sars-CoV-2 to give the novel coronavirus its full honorific is a new pathogen, scientists at the start of the outbreak were scrambling to calculate its R0, or R nought: the viruss transmission among a population that has no immunity. Studies on early cases in China indicated it was between 2 and 2.5; more recent estimates have placed it as high as 6.6.

To put these figure in context, says Wired science editor Matt Reynolds, they're worse than seasonal flu, which has an R0 of 1.3, but miles better than measles, whose R0 is between 12 and 18. The kicker, though, is that for each of those diseases we have a vaccine, and so the effective reproduction number the R is way below 1.

This threshold an R of 1 will become increasingly crucial over the next few months. As the UK government explained in the video that accompanied its press briefing on 30 April, an R figure that is even slightly over 1 can lead quickly to a large number of cases thanks to exponential growth.

Here's how that works. Say a disease has an R of 1.5. This may seem like a manageable figure, but a glance at the figures quickly proves that isn't the case. An R of 1.5 would see 100 people infect 150, who would in turn infect 225, who would infect 338. In three rounds of infection, the number of people with the virus would have more than quadrupled to 438. As worldwide cases now exceed 3.5 million, this helps explain why the novel coronavirus was able to rip so quickly among a global population with no previous immunity.

Image: BBC

Conversely, an R of less than 1 means that the virus will eventually peter out the lower the R, the more quickly this will happen. An R of 0.5 means that 100 people would infect only 50, who would infect 25, who would infect 13. As the number of cases drops and ill people either die or recover, the virus will be brought under control as long as the R can be kept low.

So an R of 1 and above tends towards exponential growth. An R of below 1 tends towards the end of the outbreak. All we need to do is keep the R below 1. Simple, right?

Not so fast. As stated above, the R value is ever-changing. Thanks to lockdown measures, many governments have been able to push R to below 1. In the UK, chief scientific officer Patrick Vallence said that the nations R number is currently thought to be between 0.6 and 0.9, though it varies regionally and in London could be as low as 0.5 to 0.7.

This was only achieved, however, thanks to a heroic, unprecedented series of adjustments which have brought our lives and our economies to a juddering halt and all of this to produce an R of 0.6 to 0.9. This doesnt give us a huge amount of leeway.

Lockdown helped drop Germanys R down to about 0.7 in early April, but researchers at the Robert Koch Institute in Berlin said it had recently increased back to 0.9, before sinking again to 0.75. Even within lockdown, if people start losing patience with restrictions or need to go out to work, R could quickly rise again.

Another difficulty that scientists and policymakers are facing is that its still not entirely clear how much of a role each measure plays. Is shutting schools doing the heavy lifting, or restricting access to shops? How much of a boost could wearing masks provide?

As governments tentatively ease lockdown restrictions around the world, they will be monitoring R very carefully for signs of a sudden jump. If R sneaks above 1 even a fraction, it could trigger a damaging second wave of the virus.

Once R is consistently low and the number of cases is manageable, governments can implement more precise measures to restrict R, such as contact-tracing and location-tracking apps approaches that paid dividends when introduced early on in nations such as South Korea and Singapore.

A couple kisses at Duomo Square, Catania, Sicily, as Italy begins a staged end to a nationwide lockdown, 4 May 2020.

Image: Reuters/Antonio Parrinello

There are a number of ways to calculate R, as Wired notes. One is by monitoring hospitalisation and death figures to get a sense of how many people have the virus but the problem with this is that, since the viruss incubation period is so long, it only gives an accurate picture of a few weeks ago. To check transmission rates in a more accurate way, scientists at Imperial College London in the UK have started testing randomised 25,000 groups of the population to see how many are ill.

Its important to note that R isnt the only key measure in assessing the impact of this pathogen, says the BBC. Another crucial yardstick is the number of cases of COVID-19, the disease caused by Sars-CoV-2. If we have a large number of cases and an R of 1 or just below, that still equates to a large number of infections so ideally we need to restrict both R and bring down the number of cases at the same time.

An additional key measure to look out for is the number of ICU beds available in any given country, since this will have a big effect on mortality rate.

Ultimately, the best weapon in the fight to reduce R is a vaccine. But exactly when this will be available or indeed if it will ever happen at all is currently unclear.

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What is COVID-19's R number and why does it matter? - World Economic Forum

Remdesivir, an experimental antiviral drug made by Gilead Sciences, has been authorized by the Food and Drug Administration for emergency use in treating severely ill COVID-19 patients. Ulrich Perry/POOL/AFP via Getty Images hide caption

Remdesivir, an experimental antiviral drug made by Gilead Sciences, has been authorized by the Food and Drug Administration for emergency use in treating severely ill COVID-19 patients.

Now that the Food and Drug Administration has authorized remdesivir for emergency use in seriously ill COVID-19 patients, the experimental drug is another step closer to full approval. That's when most drugs get price tags.

Gilead Sciences, which makes remdesivir, is donating its initial supply of 1.5 million doses, but the company has signaled it will need to start charging for the drug to make production sustainable. It's unclear when that decision might be made.

"Going forward, we will develop an approach that is guided by the principles of affordability and access," Gilead CEO Daniel O'Day told shareholders during the company's annual meeting Wednesday.

In a quarterly financial filing made the same day, Gilead said its investment in remdesivir this year "could be up to $1 billion or more," much of it for scaling up manufacturing capacity.

The company also acknowledged that it's in the spotlight. "[G]iven that COVID-19 has been designated as a pandemic and represents an urgent public health crisis, we are likely to face significant public attention and scrutiny about any future business models and pricing decisions with respect to remdesivir," Gilead said in the quarterly filing.

How will the company balance its business calculations with the drug's potential value to society?

"Gilead has not yet set a price for remdesivir," company spokeswoman Sonia Choi wrote in an email to NPR. "At this time, we are focused on ensuring access to remdesivir through our donation. Post-donation, we are committed to making remdesivir both accessible and affordable to governments and patients around the world."

Among potential treatments for COVID-19, remdesivir, an intravenous drug that was once studied for Ebola, is one of the furthest along.

"It's hard to imagine a situation in which there will be more public scrutiny," said Michael Carrier, a professor at Rutgers School of Law who specializes in antitrust and pharmaceuticals. "On the one hand, Gilead will try to recover its R&D in an atmosphere in which it is able to potentially make a lot of money. On the other hand, the pressure will be intense not to charge what's viewed as too high a price."

Breaking with its usual practices, the Institute for Clinical and Economic Review, or ICER, an influential nonprofit that analyzes drug pricing, issued an expedited report on remdesivir.

"Under normal circumstances, we would be unlikely to do a report when the evidence is this raw and immature," ICER President Steven Pearson said in an interview with NPR. "But it was quite clear that the world is moving at a much quicker pace."

If the price is based just on the cost of making the drug, then a 10-day course of remdesivir should cost about $10, according to the ICER report. (Gilead said results of a recently completed study suggest a five-day course of treatment may be just as effective.)

But if the drug is priced based on the drug's effectiveness, ICER estimates it should cost around $4,500 assuming the drug is proven to have some benefit on mortality. If it doesn't and the drug only shortens hospital stays, that value-based price goes down to $390.

Results from a federally funded study described by Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, suggested that remdesivir could reduce recovery time by a median of four days 11 days to recovery for patients treated with remdesivir compared with 15 days for those who got a placebo. A potential survival benefit is less clear.

Rutgers' Carrier said he expects Gilead to set the remdesivir price somewhere between the $10 and $4,500 that ICER estimated. The company has already shown that it can respond to public pressure when it asked the FDA to rescind the orphan drug status it won for remdesivir, he pointed out.

"When you see that $10 figure, that sets a benchmark for a figure that is eminently affordable," Carrier said. Ultimately, he said a price more than $1,000 per treatment course would be unpopular.

Gilead "will be watched very carefully," he said, because of its prior history of pricing. He referred to two other Gilead drugs that drew scrutiny over high price tags. The company charged $1,000 per pill for Sovaldi, a cure for hepatitis C. And its HIV drug Truvada can cost $22,000 per year.

But there is such a thing as pricing remdesivir too low, said Craig Garthwaite, who directs the health care program at Northwestern University's Kellogg School of Management.

"We don't think this is the only drug we need," he said, adding that remdesivir doesn't appear to be a "home run" against the coronavirus, based on existing data. "The thing that would worry me the most is that we're somehow telling people that if you take the risky bet to try, and you'll go after a coronavirus cure and you do it, you're not going to get paid."

Instead, he said he would like to see acceptance of a generous price for remdesivir to send the message to drug companies that the best thing they can do is "dedicate every waking moment to trying to develop that cure, and that if they do that, we will pay them the value they create," he said.

During a Gilead earnings call on April 30, analysts asked executives whether they could expect similar financial returns on remdesivir as they've seen with Gilead's other drugs.

"There is no rulebook out there, other than that we need to be very thoughtful about how we can make sure we provide access of our medicines to patients around the globe," Gilead CEO O'Day said. "And do that in a sustainable way for the company, for ... shareholders, and we acknowledge that."

On May 1, the FDA authorized remdesivir for emergency use, meaning it will be easier to administer to hospitalized patients with severe disease during the pandemic, but the drug is not yet officially approved. The federal government is coordinating distribution of the treatment.

O'Day acknowledged on the recent earnings call that the company "could" charge for remdesivir under an emergency use authorization, but he stressed that Gilead is donating its current supply, which should last through "early summer."

To date, the National Institutes of Health said it has obligated $23 million toward its COVID-19 remdesivir trial. And the U.S. Army Medical Research Institute of Infectious Diseases did some of the early in vitro and animal studies with the medicine prior to the pandemic.

"Taxpayers are often the angel investors in pharmaceutical research and development, yet this is not reflected in the prices they pay," Reps. Lloyd Doggett, D-Texas, and Rosa DeLauro, D-Conn., wrote in an April 30 letter to Health and Human Services Secretary Alex Azar.

Concerned about remdesivir's price, they asked for a full breakdown of taxpayer funds that have gone toward the development of the medicine. "An unaffordable drug is completely ineffective," they wrote in the letter. "The substantial taxpayer investments in COVID-19 pharmaceutical research must be recognized."

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Remdesivir Price Still A Puzzle To Be Solved By Gilead Sciences : Shots - Health News - NPR

As coronavirus disease 2019 (COVID-19) has spread, public health and economic well-being are increasingly in conflict. Governments are prioritizing public health, but the current solutionsocial isolationis costly as commerce remains shut down. Restarting economies could rekindle the pandemic and cause even worse human suffering. Innovation can help societies escape the untenable choice between public and economic health. The world needs effective vaccines, therapies, or other solutions. But how do we achieve these solutions, and achieve them quickly?

Innovation policy can accelerate advances, with high returns. In the United States, COVID-19 has reduced gross domestic product (GDP) by 30%. What if additional investment in research and development (R&D) could bring forward an effective vaccine by just 1 day? If this investment costs less than the daily loss in GDP ($18 billion in the United States alone), it would pay for itself. Even large incremental funding to support R&D will be miniscule in scale compared to the $2.8 trillion the U.S. government is spending to compensate for the economic shutdown.

What principles should guide government innovation policy to battle COVID-19? It is critical to support many independent avenues of research. Outcomes from R&D investments are uncertain. Many avenues will be dead ends, so many different pathseach corresponding to an independent effortshould be pursued. Consider funding 10,000 such efforts. Even if each had only a 0.1% chance of producing an advance in prevention, treatment, or infection control, the probability of at least five such advances would be 97%. By contrast, if efforts crowd into only a few prospects, the odds of collective failure can become overwhelming.

This innovative push must draw widely on talent. Research talent is plentiful, but many laboratories and teams are now shuttered and dispersed by the pandemic. Private investment gravitates toward marketable solutions, but key insights are likely to come from asking why questions (for example, basic research into the pathophysiology of the disease) and not simply from shovel ready drug development projects. Moreover, good ideas often come from unexpected corners. Useful solutions may be discovered outside biomedicine, including through engineering disciplines and information technology.

What would a bold innovation policy agenda look like? In the United States, funding for R&D must be fortified, as recently called for by the Task Force on American Innovation and 17 other organizations. Also, a principal investigator already receiving public funding should be able to receive immediate support to work on COVID-19 with minimal application burden and decisions within 1 week. The National Institutes of Health (NIH) has taken some first steps with emergency procedures to supplement existing grants, but these efforts need to draw on additional labs and talent, and to accelerate review. The marginal investment through the NIH, at $3 billion, appears modest in size, equating to the U.S. GDP loss in just 4 hours. Globally, researchers with relevant expertise are essential workers; they should have access to their labs and additional resources to engage in the COVID-19 battle.

Government support for private sector R&D should be delivered at great speed. A Pandemic R&D Program could deploy loans that are forgivable later, based on actual investment in COVID-19related innovations, thus ensuring that financial constraints do not slow down solutions. More support could come through supplementing the R&D tax credit system, which already exists in the United States and other countries.

In June 1940, the U.S. government created the National Defense Research Committee (NDRC), composed of eminent scientists and innovators in the public and private sectors, with the mandate to achieve innovations related to the war effort. This leadership structure drove the rapid development of numerous technologies, including weapons systems but also antimalarial drugs and penicillin manufacturing. A COVID-19 Defense Research Committee could similarly be empowered to coordinate and fund solutions to the pandemic. This group would track R&D efforts, create a public clearinghouse documenting the avenues pursued, fund innovations and the scaling of successful advances, and streamline bureaucracy. The new vaccine effort, Operation Warp Speed, moves in this direction. But we also need efforts beyond vaccines.

COVID-19 presents the world with a brutal choice between economic and public health. Innovation investments are essential to avoiding that choiceyet tiny in cost compared to current economic losses and other emergency programs. Even the slight acceleration of advances will bring massive benefits.

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Beat COVID-19 through innovation - Science Magazine

More than 60 days after Fairfax County had its first case of COVID-19, the county has, by far, the most cases, hospitalizations and deaths than any other in Virginia and now the county's emergency information department is giving three reasons why.

More than 60 days after Fairfax County announced its first case of COVID-19, the county has, by far, the most infections, hospitalizations and deaths than any county in Virginia and now the countys emergency information department is giving three reasons why.

The county, the largest in population in the state, said Thursday its pandemic curve is still in the exponential growth phase. As of Wednesday night, Fairfax County has 5,045 cases, 832 hospitalized and 211 deaths from COVID-19 each of those numbers is more than twice the total of the next highest county.

Fairfax County outlined the causes:

Fairfax County said it has taken proactive measures to slow the spread of the virus in high-risk places like nursing homes and assisted living facilities.

The county said even as Virginia and other states begin to ease restrictions, residents should stay vigilant with mitigation actions and think of these measures as a marathon, rather than a sprint.

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3 reasons COVID-19 is on the rise in Fairfax County - WTOP

The numbers that state health officials report each day keep going up and up and up. The number of people tested for the coronavirus, the number of people who have been diagnosed with COVID-19, the number of people who have been killed by the virus. There's another number that does not get reported but also keeps rising -- the number of people in Massachusetts who have recovered from COVID-19.

"People can and do recover, and we need to remember that," Public Health Commissioner Monica Bharel said late last month after she recovered from her own COVID-19 diagnosis and returned to work.

There have been 73,721 cases of COVID-19 confirmed in Massachusetts since Feb. 1. As of Thursday, 4,552 people have died of the disease and another 3,436 people are currently hospitalized with the virus. That leaves 65,733 people who could be sick with the virus but not badly enough to need hospital care, could have been treated at a hospital and released, or could have made a full recovery like Bharel.

A COVID-19 simulator built by Massachusetts General Hospital estimates that the number of active cases of COVID-19 in Massachusetts -- meaning "anyone who is in the infectious period" -- is roughly 6,200. But there is no real way to know for sure yet.

Clinicians in Massachusetts are required to report positive cases of COVID-19, but are not required to report when a patient recovers and the Mass. Department of Public Health does not track the number of recoveries in the state, a DPH spokeswoman said.

Many local boards of health do track the number of COVID-19 recoveries in their own communities. Boston said Thursday that 2,882 of the 10,589 residents who have been diagnosed with COVID-19 have recovered. Somerville reported 291 recoveries among 665 positive tests in its city. Framingham reports the total number of cases (1,146 as of Wednesday) and then breaks it down into fatalities (42), recoveries (290) and active cases (814). Pittsfield does the same. Brockton reports the cumulative number of confirmed cases, the number of deaths and the number of active cases, making it easy to determine the number of people who have recovered.

A number of states around the country report statewide recovery numbers daily or weekly, too. But things get murky in the fine print of each state's report.

"Currently, there are multiple ways for recovered cases to be recorded and several methods are used by different countries and states. Some states and countries measure a case as recovered when a person has had COVID-19 for more than 14 days, while others upon hospital discharge data -- neither of which completely capture recovery of the full COVID positive population," the Florida Department of Health, which like Massachusetts does not report statewide recoveries, said in a statement.

To cut through some of that static, Massachusetts is among a group of states talking with the U.S. Centers for Disease Control and each other about coming up with a standardized definition of what it means to have recovered from COVID-19, DPH confirmed to the News Service.

Alaska's Department of Health and Social Services publishes a chart that visually displays the number of cumulative cases along with how many of those are active, how many patients have died and how many people have recovered. The chart shows that while the cumulative number of cases increases, so too does the number of recoveries.

As of Wednesday, Alaska reported that about 78 percent of people who have tested positive in that state have recovered. The state defines a recovered patient as someone "whose symptoms have improved enough to meet the CDC criteria to be released from home isolation, and are no longer considered to be infectious."

Michigan reports a cumulative number of people who have recovered from COVID-19 infection each Saturday. Last weekend, the state said 15,659 of the 44,397 people who had been diagnosed with the virus had recovered, about 35 percent of all cases.

There, public health officials count as recovered any COVID-19 patient who is still alive 30 days after testing positive for the virus.

On Sunday, Texas Gov. Greg Abbott tweeted that more people in his state had recovered from COVID-19 than had been newly diagnosed with it over the last two days.

"That's exactly what we want to see," the governor wrote. "Texas ranks 3rd highest among states for number of people who have recovered from #coronavirus."

In Abbott's state, the Department of State Health Services reports daily on the number of cumulative COVID-19 cases in the state, and estimated numbers of active cases and of patients who have recovered from the virus.

But the fine print on the state's COVID-19 dashboard reveals that the estimates are "based on several assumptions related to hospitalization rates and recovery times, which were informed by data available to date" and that the estimates "are subject to change as we learn more about COVID-19." The estimates also do not include any cases reported before March 24.

Tennessee, which got its first COVID-19 case from Massachusetts, reports recoveries and counts in that category "people who (1) have been confirmed to be asymptomatic by their local or regional health department and have completed their required isolation period or (2) are at least 21 days beyond the first test confirming their illness."

As of Tuesday, Tennessee reported that 6,783 people had recovered from COVID-19, representing about 48 percent of the state's cumulative cases.

Mississippi public health officials put out a number for "presumed recovered cases," which is a count of all living COVID-19 patients who were not hospitalized and are 14 days beyond their initial positive test, plus the number of patients who were hospitalized but are 21 days beyond their initial positive test.

In Wyoming, a patient is considered recovered "when there is resolution of fever without the use of fever-reducing medications and there is improvement in respiratory symptoms (e.g. cough, shortness of breath) for 72 hours AND at least 7 days have passed since symptoms first appeared."

Having a uniform definition of what it means to have recovered from this new virus could play a major role as states reopen their economies and send people back to work. Some have suggested that people who have recovered could return to work sooner or could be asked to take frontline jobs in medicine or retail, if studies show that recovery from COVID-19 comes with some level of immunity from re-infection. But that all hinges on knowing what recovered actually means.

"We've asked the CDC this question so we don't all define it in different ways just based on the state," North Carolina Health and Human Services Secretary Mandy Cohen said in an April 16 news conference. "We're trying to figure out how we as a country can all define recovery so we have that sort of standardization and not apples to oranges if we define it in different ways."

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A Little-Reported Mass. COVID-19 Number That's Also Rising: Those Who Recover - wgbh.org

A medical worker walks in front of Transform MD Medical Center in White Plains, N.Y., where antibody testing was being offered. Pablo Monsalve/VIEW press/Corbis via Getty Images hide caption

A medical worker walks in front of Transform MD Medical Center in White Plains, N.Y., where antibody testing was being offered.

Most people infected with the novel coronavirus develop antibodies in response.

But scientists don't know whether people who have been exposed to the coronavirus will be immune for life, as is usually the case for the measles, or if the disease will return again and again, like the common cold.

"This to me is one of the big unanswered questions that we have," says Jeffrey Shaman, a professor of environmental health sciences at Columbia University, "because it really says, 'What is the full exit strategy to this and how long are we going to be contending with it?' "

He's one of many scientists on a quest for answers. And the pieces are starting to fall into place.

Antibodies, which are proteins found in the blood as part of the body's immune response to infection, are a sign that people could be developing immunity. But antibodies are by no means a guarantee a person will be protected for life or even for a year.

Shaman has been studying four coronaviruses that cause the common cold. "They're very common and so people seem to get them quite often," Shaman says. Ninety percent of people develop antibodies to those viruses, at least in passing, but "our evidence is those antibodies are not conferring protection."

That may be simply because colds are relatively mild, so the immune system doesn't mount a full-blown response, suggests Stanley Perlman, a pediatrician who studies immunology and microbiology at the University of Iowa. "That's why people get colds over and over again," he says. "It doesn't really tickle the immune response that much."

He's studied one of the most severe coronaviruses, the one that causes SARS, and he's found that the degree of immunity depended on the severity of the disease. Sicker people remained immune for much longer, in some cases many years.

For most people exposed to the novel coronavirus, "I think in the short term you're going to get some protection," Perlman says. "It's really the time of the protection that matters."

Perlman notes that for some people the symptoms of COVID-19 are no worse than a cold, while for others they are severe. "That's why it's tricky," he says, to predict the breadth of an immune response.

And it's risky to assume that experiences with other coronaviruses are directly applicable to the new one.

"Unfortunately, we cannot really generalize what kind of immunity is needed to get protection against a virus unless we really learn more about the virus," says Akiko Iwasaki, a Howard Hughes Medical Institute investigator at the Yale University School of Medicine.

An immunobiologist, she is part of a rapidly expanding effort to figure this out. She and her colleagues are already studying the immune response in more than 100 patients in the medical school hospital. She's encouraged that most people who recover from the coronavirus have developed antibodies that neutralize the coronavirus in a petri dish.

"Whether that's happening inside the body we don't really know," she cautions.

Research like hers will answer that question, eventually.

But not all antibodies are protective. Iwasaki says some can actually contribute to the disease process and make the illness worse. These antibodies can contribute to inflammation and lead the body to overreact. That overreaction can even be deadly.

"Which types of antibodies protect the host versus those that enhance the disease? We really need to figure that out," she says.

The studies at Yale will follow patients for at least a year, to find out how slowly or quickly immunity might fade. "I wish there was a shortcut," Iwasaki says, "but we may not need to wait a year to understand what type of antibodies are protective."

That's because she and other immunologists are looking for patterns in the immune response that will identify people who have long-term immunity.

Researchers long ago figured out what biological features in the blood (called biomarkers) correlate with immunity to other diseases, says Kari Nadeau, a pediatrician and immunologist at the Stanford University School of Medicine. She expects researchers will be able to do the same for the new coronavirus.

Nadeau is working on several studies, including one that seeks to recruit 1,000 people who were previously exposed to the coronavirus. One goal is to identify people who produce especially strong, protective antibody responses. She says the antibody-producing cells from those people can potentially be turned into vaccines.

Another critical question she's zeroing in on is whether people who become immune are still capable of spreading the virus.

"Because you might be immune, you might have protected yourself against the virus," she says, "but it still might be in your body and you're giving it to others."

It would have huge public health implications if it turns out people can still spread the disease after they've recovered. Studies from China and South Korea seemed to suggest this was possible, though further studies have cast doubt on that as a significant feature of the disease.

Nadeau is also trying to figure out what can be said about the antibody blood-tests that are now starting to flood the market. There are two issues with these tests. First, a positive test may be a false-positive result, so it may be necessary to run a confirmatory test to get a credible answer. Second, it's not clear that a true positive test result really indicates a person is immune and, if so, for how long.

Companies would like to be able to use these tests to identify people who can return to work without fear of spreading the coronavirus.

"I see a lot of business people wanting to do the best for their employees, and for good reason," Nadeau says. "And we can never say you're fully protected until we get enough [information]. But right now we're working hard to get the numbers we need to be able to see what constitutes protection and what does not."

It could be a matter of life or death to get this right. Answers to these questions are likely to come with the accumulation of information from many different labs. Fortunately, scientists around the world are working simultaneously to find answers.

You can contact NPR Science Correspondent Richard Harris at rharris@npr.org.

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Do Antibodies Against The Novel Coronavirus Prevent Reinfection? : Shots - Health News - NPR

Jackie Stockton (left) and daughter Alice Stockton-Rossini at the Philadelphia Flower Show in March 2019. The two women have recovered from COVID-19 after an outbreak hit their New Jersey community. Courtesy of Alice Stockton-Rossini hide caption

Jackie Stockton (left) and daughter Alice Stockton-Rossini at the Philadelphia Flower Show in March 2019. The two women have recovered from COVID-19 after an outbreak hit their New Jersey community.

Alice Stockton-Rossini and her 90-year-old mother, Jackie Stockton, survived COVID-19.

But the virus took the lives of some of their friends and a relative.

The outbreak in their community in Ship Bottom, N.J., can be traced back to Stockton's 90th birthday party, held at her church on March 8 before much of the U.S. began practicing social distancing.

In a recent remote StoryCorps conversation, Stockton told her 62-year-old daughter that she didn't realize she had contracted the virus until she landed in the hospital.

"One day I was at church and that's all I remember, until I woke up in the hospital and apparently, I'd been there awhile," she said. Stockton was hospitalized from March 16 to March 22.

At least eight family members became infected.

"I lost my brother-in-law, and five members of our church are dead," Stockton-Rossini said. "It's just it's mind-blowing, it really is."

The devastation from the coronavirus seems incomparable to other major events in Stockton's life.

"I remember 9/11 as though it just happened, but then it was over," she said. "This will never, ever be over. This is different much more personal."

The hardest part, she said, is losing her best friend, 76-year-old Sandy Medford, who died on March 20.

"I've known her since she was a young girl, and then suddenly she was gone. And nobody would tell me," Stockton said.

Her daughter responded, "We couldn't tell you right away."

She held off telling her mom the news until her mom was out of the hospital and had regained some of her strength.

Stockton said she worries most about her loved ones.

"I always worry about my family. Always," she said. "It takes a long time to say my prayers at night. I have so many kids, grandkids. Gotta pray for everybody."

But she said one thing is getting her through this crisis: "Faith that things will get better. Faith that people will come together more instead of tearing each other apart."

Stockton said her family has a history of weathering hardships.

"There's always been something," she said. "And we've come through it."

She told her daughter that the grandmother of Stockton-Rossini's father, who raised him, endured the deaths of eight of her 17 children. At least one of her kids died during the 1918 flu pandemic.

"She lived through the worst kind of hell having to bury so many of your children," she said. "But look how she came through it. She was an amazing woman and so was her husband. They just did the things they needed to do. And they survived."

Her daughter added, "Put one foot in front of another. Take one day at a time. What did you always say, Mom? 'One minute at a time.' "

Stockton agreed. "You gotta keep going. That's for sure."

Audio produced for Morning Edition by Kerrie Hillman and Michael Garofalo.

StoryCorps developed a new way to bring people together that makes it possible to record interviews remotely. Go to storycorpsconnect.org to try it out.

StoryCorps is a national nonprofit that gives people the chance to interview friends and loved ones about their lives. These conversations are archived at the American Folklife Center at the Library of Congress, allowing participants to leave a legacy for future generations. Learn more, including how to interview someone in your life, at StoryCorps.org.

The rest is here:

'This Is ... Personal': After Surviving COVID-19, A Mom And Daughter Mourn Loved Ones - NPR

The serious inflammatory syndrome sending some children and teens to the hospital remains extremely uncommon, doctors say. But if your child spikes a high, persistent fever, and has severe abdominal pain with vomiting that doesn't make them feel better, call your doctor as a precaution. Sally Anscombe/Getty Images hide caption

The serious inflammatory syndrome sending some children and teens to the hospital remains extremely uncommon, doctors say. But if your child spikes a high, persistent fever, and has severe abdominal pain with vomiting that doesn't make them feel better, call your doctor as a precaution.

Sixty-four children and teens in New York State are suspected of having a mysterious inflammatory syndrome that is believed to be linked to COVID-19, the New York Department of Health said in an alert issued Wednesday. A growing number of similar cases including at least one death have been reported in other parts of the U.S. and Europe, though the phenomenon is still not well-understood.

Pediatricians say parents should not panic; the condition remains extremely rare. But researchers also are taking a close look at this emerging syndrome, and say parents should be on the lookout for symptoms in their kids that might warrant a quick call to the doctor a persistent high fever over several days and significant abdominal pains with repeated vomiting, after which the child does not feel better.

"If [the child is] looking particularly ill, you should definitely call the doctor," says Dr. Sean O'Leary, a pediatric infectious disease specialist at Children's Hospital Colorado Anschutz Medical Campus and member of the infectious disease committee for the American Academy of Pediatrics.

The new condition associated with COVID-19 is called Pediatric Multi-System Inflammatory Syndrome. Symptoms include persistent fever, extreme inflammation and evidence of one or more organs that are not functioning properly, says cardiologist Jane Newburger, a professor of pediatrics at Harvard Medical School and director of the Kawasaki Program at Boston Children's Hospital.

"It's still very rare, but there's been a wave of cases. Physicians and scientists are working hard to understanding the mechanisms at play, and why only some children are so severely affected," Newburger says.

Some symptoms can resemble features of Kawasaki Disease Shock Syndrome. Kawasaki disease is an acute illness in children involving fever with symptoms including rash; conjunctivitis; redness in the lips, tongue and mucous membranes of the mouth and throat; swollen hands and/or feet; and sometimes an enlarged group of lymph nodes on one side of the neck, says Newburger. Some children with the condition develop enlargement of the coronary arteries and aneurysms in those blood vessels.

A small percentage of Kawasaki cases go on to develop symptoms of shock, which can include a steep drop in systolic blood pressure and difficulty with sufficient blood supply to the body's organs. Kawasaki disease and KDSS more often affect young children, although they can sometimes affect teens, Newburger says.

Some cases of the new inflammatory syndrome have features that overlap with KD or with KDSS including rash, conjunctivitis, and swollen hands or feet. The new inflammatory syndrome can affect not only young children but also older children and teens.

But patients with the new syndrome have lab results that look very different, in particular, "cardiac inflammation to a greater degree than we typically see in Kawasaki shock syndrome," which is usually very rare, O'Leary says. In New York City and London, which have seen large numbers of COVID-19 cases, "those types of patients are being seen with greater frequency."

Some patients "come in very, very sick," with low blood pressure and high fever, O'Leary says. Some children have had coronary artery aneurysms, though most have not, he adds.

Other patients exhibit symptoms more similar to toxic shock syndrome, with abdominal pain, vomiting and diarrhea, and high levels of inflammation in the body, including the heart, O'Leary says. Most cases are treated in the intensive care unit, he says. Treatment includes intravenous immunoglobulin, which can "calm the immune system," says Newburger, as well as steroids and cytokine blockers.

The evidence so far from Europe, where reports of the syndrome first emerged, suggests most children will recover with proper supportive care, says O'Leary, though one adolescent, a 14-year-old boy in London, has died, according to a report published Wednesday in The Lancet.

Most children with the syndrome, O'Leary and Newburger note, have either tested positive for a current infection with the coronavirus, or for antibodies to the virus, which would suggest they were infected earlier and recovered.

And, according to case reports, some of the kids with the inflammatory syndrome who tested negative on coronavirus tests had been exposed at some point to someone known to have COVID-19. The inflammatory syndrome can appear days to weeks after COVID-19 illness, doctors say, suggesting the syndrome arises out of the immune system's response to the virus.

"One theory is that as one begins to make antibodies to SARS-COV-2, the antibody itself may be provoking an immune response," says Newburger. "This is only happening in susceptible individuals whose immune systems are built in a particular way. It doesn't happen in everybody. It's still a really uncommon event in children."

In late April, the U.K.'s National Health Service issued an alert to pediatricians about the syndrome. Reports have also surfaced in France, Spain and Italy, and probably number in the dozens globally, Newburger and O'Leary say, though doctors still don't have hard numbers. Newburger says there needs to be a registry where doctors can report cases "so we can begin to generate some statistics."

"Doctors across countries are talking to each other, but we need for there to be some structure and some science so that everybody can interpret," she says.

Earlier this week, the New York City Health Department issued an alert saying 15 children ranging in age from 2 to 15 had been hospitalized with the syndrome. Newburger says that she's been contacted about cases in New Jersey and Philadelphia, as well.

While the syndrome's precise connection to the coronavirus isn't yet clear, O'Leary says the fact that the children in most of these cases are testing positive for exposure to the virus, one way or another, provides one point of evidence. The sheer number of cases small in absolute terms, but still "much higher than we would expect normally for things like severe Kawasaki or toxic shock syndrome" provides another, he says.

And then there's the fact that most reports of the syndrome have come out of the U.K. and New York City, places that have been hit with large numbers of COVID-19 cases.

"It's pure speculation at this point," he says, "but the U.K. cluster kind of went up about a month after their COVID-19 infections went up, which would suggest that it is some kind of an immune phenomenon."

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Mystery Inflammatory Syndrome In Kids And Teens Likely Linked To COVID-19 - NPR

Overnight, it seems the world has turned upside down. We are now practicing social distancing, isolating in our homes and worried about our loved ones living under different roofs. Many of us are juggling the demands of remote work and family life at home. Some of us are facing the unexpected and grim reality of unemployment and financial distress. And some of us have been sick with COVID-19, recovering alone, unable to hug loved ones for fear of getting them sick. Each day, as the death rate grows, many of us are tragically grieving the loss of loved ones.

A life-changing crisis has the ability to shake the foundations of our identity. Nothing feels normal. Without warning, we have lost control over so many aspects of our lives. We are so used to our identity and routines and we are caught off guard. People around us know what we are going through but they can't understand the internal storm we experience.

Stress accelerates and reaches new peaks every day and threatening news continues to trigger uncertainty and anxiety. In fact, according to a recent survey published by the Kaiser Family Foundation, nearly half of the people living in the United States feel the coronavirus crisis is harming their mental health. This is not something we anticipated and were prepared for and many of us feel lonely, helpless and are looking for much needed support in dealing with this life-changing crisis.

Nearly half of the people in the US say the coronavirus crisis is harming their mental health.

Research shows that professionally-led peer support groups can serve as an effective and critical coping tool, but when we look around we are surprised by the limited number of available group support options. Despite technological advances, the majority of emotional support groups still operate in person. Thus, the majority of support groups are often found in larger cities or more populous areas, making them inaccessible to so many who could benefit from them.

Those individuals who find support in an online group will have to compromise, as most group type support exists on social networks, forums, and other unstructured, outdated and unprofessional platforms. Only a few lucky ones will haphazardly find a professionally-led support group just right for them. Regrettably and unnecessarily, this leaves many individuals feeling lonely in our otherwise very connected world. The importance of connecting and finding online support with others going through similar life challenges was important before COVID-19, but we are finding it even more critical to connect in our new social distancing reality.

The time for a mental health revolution has come and affordable and accessible mental health care must be a fundamental part of the COVID-19 response. We are beginning to see that classic face-to-face treatment must evolve to support the demands of so many people in need of emotional support services.

As a result of COVID-19, online support has become a necessity. People are dealing with stress and anxiety related to their health, financial situations and isolation (with and without taking care of kids and managing to work at the same time) but are not able just to step outside of their home and seek support.

In this vacuum we see the rise of online services from hotlines and online psychotherapy, to newly emerging peer support and facilitated groups platforms. We are currently experiencing acceleration of the development and adoption of remote emotional support but this is just the beginning. These services will be here to stay, long after we overcome the current pandemic.

In the past year we at 7Chairs had over 450 groups and 3,000 users on our online support group platform. We witnessed two interesting trends: 1) an online setting increases the accessibility of support to everyone, everywhere; 2) there are some unique advantages to online support that enable anonymity and increase the level of openness, which are related. This is a revolution, which will impact millions who live in remote areas or are not able to attend face-to-face sessions.

COVID-19 is forcing a change in many areas of our life. Remote/online is becoming the new standard in education, work and health. The change in the way we feel and behave is foundational and will stay with us for a long time.

There is a positive angle, we are in the middle of a revolution and, at the end of the tunnel, we will have a world where many things, including emotional support, will be more accessible for people who truly need them.

A new strain of Coronavirus, COVID 19, is spreading around the world, causing deaths and major disruption to the global economy.

Responding to this crisis requires global cooperation among governments, international organizations and the business community, which is at the centre of the World Economic Forums mission as the International Organization for Public-Private Cooperation.

The Forum has created the COVID Action Platform, a global platform to convene the business community for collective action, protect peoples livelihoods and facilitate business continuity, and mobilize support for the COVID-19 response. The platform is created with the support of the World Health Organization and is open to all businesses and industry groups, as well as other stakeholders, aiming to integrate and inform joint action.

As an organization, the Forum has a track record of supporting efforts to contain epidemics. In 2017, at our Annual Meeting, the Coalition for Epidemic Preparedness Innovations (CEPI) was launched bringing together experts from government, business, health, academia and civil society to accelerate the development of vaccines. CEPI is currently supporting the race to develop a vaccine against this strand of the coronavirus.

For now, here are a few practical tips on strengthening your support system from our emotional support experts at 7chairs.co. It is surprising that despite how important social and emotional support is, many of us still find it an often overlooked and neglected part of our day-to-day.

1. Find and spend time with like-minded people

Social connections make us feel good, whereas loneliness and isolation can be detrimental to our mental health. Finding connection and trust with someone who shares a similar life experience can be a very empowering and supportive way of connecting. Life experiences can be uniquely complicated and expecting friends and family to truly understand the depth of our feelings is unrealistic, especially when our loved ones simply want us to find the quickest and easiest way to feel better. Joining a topic-specific support group can be an excellent way to connect and spend time with others just like you.

2. Real-time connection is important

Technology has made great strides in allowing us to connect with anyone, anywhere and at anytime and in a way that is user-friendly and readily available. Real-time connection is a game changer in allowing us to connect with others on a deeper, more personal level. When connecting with others and sharing feelings, real-time connection allows us to stay motivated and to get the feedback and support we need, when we need it.

3. Emotional support experts are key to designing impactful group support

The support of peers is just one piece of the dynamic puzzle which makes emotional support groups so effective. The other is the group facilitator. A group facilitator helps design the groups unique culture. Having a trained and skilled group facilitator can help channel the groups energy in impactful ways to foster the most benefit and healing to the groups participants.

4. Share one feeling a day

Talking about and opening up about your feelings is no easy feat. But getting in the habit and sharing a feeling with someone every day is a great way to begin feeling comfortable with your emotions and the process of sharing them. Sharing feelings also reduces stress and anxiety, allowing us to feel connected and supported by those we are sharing with.

5. Ask one person a day how they feel

Empathy is understanding and recognizing emotions in others and learning how to put yourself in another persons shoes. Feeling heard and understood is a basic human need and important in all relationships. To empathize with others can be an empowering and humbling experience. Further, it allows us to regulate our own emotions and allows us to have compassion for others.

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Mental health care will undergo a revolution post COVID-19 - World Economic Forum