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Westlake Legal Group > Posts tagged "Research"

Study of 17 Million Identifies Crucial Risk Factors for Coronavirus Deaths

Westlake Legal Group merlin_171794538_53436b45-cf6b-44e4-a905-2969655c593e-facebookJumbo Study of 17 Million Identifies Crucial Risk Factors for Coronavirus Deaths your-feed-science your-feed-health Research Race and Ethnicity Nature (Journal) Minorities Medicine and Health gender England Elderly Deaths (Fatalities) Coronavirus (2019-nCoV) Black People

An analysis of more than 17 million people in England — the largest study of its kind, according to its authors — has pinpointed a bevy of factors that can raise a person’s chances of dying from Covid-19, the disease caused by the coronavirus.

The paper, published Wednesday in Nature, echoes reports from other countries that identify older people, men, racial and ethnic minorities, and those with underlying health conditions among the more vulnerable populations.

“This highlights a lot of what we already know about Covid-19,” said Uchechi Mitchell, a public health expert at the University of Illinois at Chicago who was not involved in the study. “But a lot of science is about repetition. The size of the study alone is a strength, and there is a need to continue documenting disparities.”

The researchers mined a trove of de-identified data that included health records from about 40 percent of England’s population, collected by the United Kingdom’s National Health Service. Of 17,278,392 adults tracked over three months, 10,926 reportedly died of Covid-19 or Covid-19-related complications.

“A lot of previous work has focused on patients that present at hospital,” said Dr. Ben Goldacre of the University of Oxford, one of the authors on the study. “That’s useful and important, but we wanted to get a clear sense of the risks as an everyday person. Our starting pool is literally everybody.”

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Updated 2020-07-09T10:26:01.207Z

Dr. Goldacre’s team found that patients older than 80 were at least 20 times more likely to die from Covid-19 than those in their 50s, and hundreds of times more likely to die than those below the age of 40. The scale of this relationship was “jaw-dropping,” Dr. Goldacre said.

Additionally, men stricken with the virus had a higher likelihood of dying than women of the same age. Medical conditions such as obesity, diabetes, severe asthma and compromised immunity were also linked to poor outcomes, in keeping with guidelines from the Centers for Disease Control and Prevention in the United States. And the researchers noted that a person’s chances of dying also tended to track with socioeconomic factors like poverty.

The data roughly mirror what has been observed around the world and are not necessarily surprising, said Avonne Connor, an epidemiologist at Johns Hopkins University who was not involved in the study. But seeing these patterns emerge in a staggeringly large data set “is astounding” and “adds another layer to depicting who is at risk” during this pandemic, Dr. Connor said.

Particularly compelling were the study’s findings on race and ethnicity, said Sharrelle Barber, an epidemiologist at Drexel University who was not involved in the study. Roughly 11 percent of the patients tracked by the analysis identified as nonwhite. The researchers found that these individuals — particularly Black and South Asian people — were at higher risk of dying from Covid-19 than white patients.

That trend persisted even after Dr. Goldacre and his colleagues made statistical adjustments to account for factors like age, sex and medical conditions, suggesting that other factors are playing a major role.

An increasing number of reports have pointed to the pervasive social and structural inequities that are disproportionately burdening racial and ethnic minority groups around the world with the coronavirus’s worst effects.

Some experts pointed out flaws in the researchers’ methodology that made it difficult to quantify the exact risks faced by members of the vulnerable groups identified in the study. For instance, certain medical conditions that can exacerbate Covid-19, like chronic heart disease, are more prevalent among Black people than white people.

The researchers removed such variables to focus solely on the effects of race and ethnicity. But because Black individuals are also more likely to experience stress and be denied access to medical care in many parts of the world, the disparity in rates of heart disease may itself be influenced by racism, said Usama Bilal, an epidemiologist at Drexel University who was not involved in the new analysis. Ignoring the contribution of heart disease, then, could end up inadvertently discounting part of the relationship between race and ethnicity and Covid-19-related deaths.

The study was also not set up to conclusively show cause-and-effect relationships between risk factors and Covid-19 deaths.

Regardless of the methodological drawbacks of this study, experts agree that “the causes of disparities, whether in Covid-19 or other aspects of health, are intricately linked to structural racism,” Dr. Mitchell said.

In the United States, Latino and African-American residents are three times as likely to become infected by the coronavirus as white residents, and nearly twice as likely to die.

Many of these individuals work as front-line employees, or are tasked with essential in-person jobs that prevent them from sheltering in place at home. Some live in multigenerational households that can compromise effective physical distancing. Others must cope with language barriers and implicit bias when they seek medical care.

Any study publishing data on an ongoing and fast-shifting pandemic will inevitably be imperfect, said Julia Raifman, an epidemiologist at Boston University who was not involved in the study. But the new paper helps address “a real paucity of data on race,” Dr. Raifman added. “These disparities are not just happening in the United States.”

With regard to the racial inequities in this pandemic, Dr. Barber said, “I think what we’re seeing is real, and it’s not a surprise. We can learn from this study and improve on it. It gives us clues into what might be happening.”

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Universities and Tech Giants Back National Cloud Computing Project

Westlake Legal Group 30cloud-facebookJumbo Universities and Tech Giants Back National Cloud Computing Project United States Politics and Government Research Law and Legislation Data Centers Computers and the Internet Colleges and Universities Cloud Computing Artificial Intelligence

Leading universities and major technology companies agreed on Tuesday to back a new project intended to give academics and other scientists access to the computing resources now available mainly to a few tech giants.

The initiative, the National Research Cloud, has received bipartisan support in both the House and the Senate. Lawmakers in both houses have proposed bills that would create a task force of government science leaders, academics and industry representatives to outline a plan to create and fund a national research cloud.

This program would give academic scientists access to the cloud data centers of the tech giants, and to public data sets for research.

Several universities, including Stanford, Carnegie Mellon and Ohio State, and tech companies including Google, Amazon and IBM backed the idea as well on Tuesday. The organizations declared their support for the creation of a research cloud and their willingness to participate in the project.

The research cloud, though a conceptual blueprint at this stage, is another sign of the largely effective campaign by universities and tech companies to persuade the American government to increase government backing for research into artificial intelligence. The Trump administration, while cutting research elsewhere, has proposed doubling federal spending on A.I. research by 2022.

Fueling the increased government backing is the recognition that A.I. technology is essential to national security and economic competitiveness. The national cloud legislation will be proposed as an amendment to this year’s defense budget authorization.

“We have a real challenge in our country from China in terms of what they are doing with A.I.,” said Representative Anna G. Eshoo, Democrat of California, a sponsor of the bill.

Funding for the project, the terms for paying the cloud providers and what data might be available would be up to the task force and Congress.

“This is a logical first step,” said Senator Rob Portman, Republican of Ohio, another sponsor of the proposed law. “The task force is going to have to grapple with how you pay for it and how you govern it. But you shouldn’t have to work at Google to have access to this technology.”

The national research cloud would address a problem that is a byproduct of impressive progress in recent years. The striking gains made in tasks like language understanding, computer vision, game playing and common-sense reasoning have been attained thanks to a branch of A.I. called deep learning.

That technology increasingly requires immense computing firepower. A report last year from the Allen Institute for Artificial Intelligence, working with data from OpenAI, another artificial intelligence lab, observed that the volume of calculations needed to be a leader in advanced A.I. had soared an estimated 300,000 times in the previous six years. The cost of training deep learning models, cycling endlessly through troves of data, can be millions of dollars.

The cost and need for vast computing resources are putting some cutting-edge A.I. research beyond the reach of academics. Only the tech giants like Google, Amazon and Microsoft can spend billions a year on data centers that are often the size of a football field, housing rack upon rack with hundreds of thousands of computers.

So there has been a brain drain of computer scientists from universities to the big tech companies, lured by access to their cloud data centers as well as lucrative pay packages. The worry is that academic research — the seed corn of future breakthroughs — is being shortchanged.

Academic work can be crucial particularly in areas where profits are not on the immediate horizon. That was the story with deep learning, which dates to the 1980s. A small band of academics nurtured the field for years. Only since 2012, with enough computing power and data, did deep learning really take off.

There have been smaller efforts for university research to tap into the big tech clouds. But the current concept of an ambitious public-private partnership for a National Research Cloud came in March from John Etchemendy and Fei-Fei Li, co-directors of the Stanford Institute for Human-Centered Artificial Intelligence.

They posted their idea online and sought support from other universities. The academics then promoted the idea to their political representatives and industry contacts.

The federal government has long backed major research projects like particle accelerators for high-energy physics in the 1960s and supercomputing centers in the 1980s.

But in the past, the government built the labs and facilities. The research cloud would use the cloud factories of the tech companies. Academic scientists would be government-subsidized customers of the tech giants, perhaps at rates below those charged to their business customers.

Many university researchers say that buying rather than building is the only sensible path, given the daunting cost of hyper-scale data centers.

“We need to get scientific research on the public cloud,” said Ed Lazowska, a professor at the University of Washington. “We have to hitch ourselves to that wagon. It’s the only way to keep up.”

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Why You May Not Be Spreading Coronavirus

At a May 30 birthday party in Texas, one man reportedly infected 18 friends and family with the coronavirus.

Reading reports like these, you might think of the virus as a wildfire, instantly setting off epidemics wherever it goes. But other reports tell another story altogether.

In Italy, for example, scientists looked at stored samples of wastewater for the earliest trace of the virus. Last week they reported that the virus was in Turin and Milan as early as Dec. 18. But two months would pass before northern Italy’s hospitals began filling with victims of Covid-19. So those December viruses seem to have petered out.

As strange as it may seem, these reports don’t contradict each other. Most infected people don’t pass on the coronavirus to someone else. But a small number pass it on to many others in so-called superspreading events.

“You can think about throwing a match at kindling,” said Ben Althouse, principal research scientist at the Institute for Disease Modeling in Bellevue, Wash. “You throw one match, it may not light the kindling. You throw another match, it may not light the kindling. But then one match hits in the right spot, and all of a sudden the fire goes up.”

Understanding why some matches start fires while many do not will be crucial to curbing the pandemic, scientists say. “Otherwise, you’re in the position where you’re always one step behind the virus,” said Adam Kucharski, an epidemiologist at the London School of Hygiene and Tropical Medicine.

When the virus first emerged in China, epidemiologists scrambled to understand how it spread from person to person. One of their first tasks was to estimate the average number of people each sick person infected, or what epidemiologists call the reproductive number.

The new coronavirus turned out to have a reproductive number somewhere between two and three. It’s impossible to pin down an exact figure, since people’s behavior can make it easier or harder for the virus to spread. By going into lockdown, for instance, Massachusetts drove its reproductive number down from 2.2 at the beginning of March to 1 by the end of the month; it’s now at .74.

This averaged figure can also be misleading because it masks the variability of spread from one person to the next. If nine out of 10 people don’t pass on a virus at all, while the 10th passes it to 20 people, the average would still be two.

In some diseases, such as influenza and smallpox, a large fraction of infected people pass on the pathogen to a few more. These diseases tend to grow steadily and slowly. “Flu can really plod along,” said Kristin Nelson, an associate professor at Emory University.

But other diseases, like measles and SARS, are prone to sudden flares, with only a few infected people spreading the disease.

Epidemiologists capture the difference between the flare-ups and the plodding with something known as the dispersion parameter. It is a measure of how much variation there is from person to person in transmitting a pathogen.

But James Lloyd-Smith, a U.C.L.A. disease ecologist who developed the dispersion parameter 15 years ago, cautioned that just because scientists can measure it doesn’t mean they understand why some diseases have more superspreading than others. “We just understand the bits of it,” he said.

When Covid-19 broke out, Dr. Kucharski and his colleagues tried to calculate that number by comparing cases in different countries.

If Covid-19 was like the flu, you’d expect the outbreaks in different places to be mostly the same size. But Dr. Kucharski and his colleagues found a wide variation. The best way to explain this pattern, they found, was that 10 percent of infected people were responsible for 80 percent of new infections. Which meant that most people passed on the virus to few, if any, others.

Dr. Kucharski and his colleagues published their study in April as a preprint, a report that has not been reviewed by other scientists and published in a scientific journal. Other epidemiologists have calculated the dispersion parameter with other methods, ending up with similar estimates.

In Georgia, for example, Dr. Nelson and her colleagues analyzed over 9,500 Covid-19 cases from March to May. They created a model for the spread of the virus through five counties and estimated how many people each person infected.

In a preprint published last week, the researchers found many superspreading events. Just 2 percent of people were responsible for 20 percent of transmissions.

Now researchers are trying to figure out why so few people spread the virus to so many. They’re trying to answer three questions: Who are the superspreaders? When does superspreading take place? And where?

As for the first question, doctors have observed that viruses can multiply to bigger numbers inside some people than others. It’s possible that some people become virus chimneys, blasting out clouds of pathogens with each breath.

ImageWestlake Legal Group merlin_172224546_86afedcd-4790-4b80-b39c-88177489c003-articleLarge Why You May Not Be Spreading Coronavirus your-feed-science Viruses Research medRxiv Coronavirus (2019-nCoV)
Credit… Brittainy Newman/The New York Times

Some people also have more opportunity to get sick, and to then make other people sick. A bus driver or a nursing home worker may sit at a hub in the social network, while most people are less likely to come into contact with others — especially in a lockdown.


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  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


Dr. Nelson suspects the biological differences between people are less significant. “I think the circumstances are a lot more important,” she said. Dr. Lloyd-Smith agreed. “I think it’s more centered on the events.”

A lot of transmission seems to happen in a narrow window of time starting a couple days after infection, even before symptoms emerge. If people aren’t around a lot of people during that window, they can’t pass it along.

And certain places seem to lend themselves to superspreading. A busy bar, for example, is full of people talking loudly. Any one of them could spew out viruses without ever coughing. And without good ventilation, the viruses can linger in the air for hours.

A study from Japan this month found clusters of coronavirus cases in health care facilities, nursing homes, day care centers, restaurants, bars, workplaces, and musical events such as live concerts and karaoke parties.

This pattern of superspreading could explain the puzzling lag in Italy between the arrival of the virus and the rise of the epidemic. And geneticists have found a similar lag in other countries: The first viruses to crop up in a given region don’t give rise to the epidemics that come weeks later.

Many countries and states have fought outbreaks with lockdowns, which have managed to draw down Covid-19’s reproductive number. But as governments move toward reopening, they shouldn’t get complacent and forget the virus’s potential for superspreading.

“You can really go from thinking you’ve got things under control to having an out-of-control outbreak in a matter of a week,” Dr. Lloyd-Smith said.

Singapore’s health authorities earned praise early on for holding down the epidemic by carefully tracing cases of Covid-19. But they didn’t appreciate that huge dormitories where migrant workers lived were prime spots for superspreading events. Now they are wrestling with a resurgence of the virus.

On the other hand, knowing that Covid-19 is a superspreading pandemic could be a good thing. “It bodes well for control,” Dr. Nelson said.

Since most transmission happens only in a small number of similar situations, it may be possible to come up with smart strategies to stop them from happening. It may be possible to avoid crippling, across-the-board lockdowns by targeting the superspreading events.

“By curbing the activities in quite a small proportion of our life, we could actually reduce most of the risk,” said Dr. Kucharski.

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Actual Coronavirus Infections Vastly Undercounted, C.D.C. Data Shows

Westlake Legal Group actual-coronavirus-infections-vastly-undercounted-c-d-c-data-shows Actual Coronavirus Infections Vastly Undercounted, C.D.C. Data Shows your-feed-science washington state utah Research New York City Missouri Florida Disease Rates Coronavirus Reopenings Coronavirus (2019-nCoV) Centers for Disease Control and Prevention
Westlake Legal Group 27virus-briefing-cdc1-facebookJumbo Actual Coronavirus Infections Vastly Undercounted, C.D.C. Data Shows your-feed-science washington state utah Research New York City Missouri Florida Disease Rates Coronavirus Reopenings Coronavirus (2019-nCoV) Centers for Disease Control and Prevention

The number of coronavirus infections in many parts of the United States is more than 10 times higher than the reported rate, according to data released on Friday by the Centers for Disease Control and Prevention.

The analysis is part of a wide-ranging set of surveys started by the C.D.C. to estimate how widely the virus has spread. Similar studies, sponsored by universities, national governments and the World Health Organization, are continuing all over the world.

The C.D.C. study found, for instance, that in South Florida, just under 2 percent of the population had been exposed to the virus as of April 10, but the proportion is likely to be higher now given the surge of infections in the state. The prevalence was highest in New York City at nearly 7 percent as of April 1.

The numbers indicate that even in areas hit hard by the virus, an overwhelming majority of people have not yet been infected, said Scott Hensley, a viral immunologist at the University of Pennsylvania who was not involved in the research.

“Many of us are sitting ducks who are still susceptible to second waves,” he said.

The difference between recorded infections and the actual prevalence in the data was highest in Missouri, where about 2.65 percent of the population was infected with the virus as of April 26, although many people might not have felt sick. This number is about 24 times the reported rate: nearly 162,000 compared with the 6,800 thought to have been infected by then.

The results confirm what some scientists have warned about for months: that without wider testing, scores of infected people go undetected and circulate the virus.

“Our politicians can say our testing is awesome, but the fact is our testing is inadequate,” Dr. Hensley said. “These are exactly the kind of studies we need right now.”

Dr. Robert Redfield, the director of the C.D.C., hinted at this trend on Thursday during a call with reporters.

“Our best estimate right now is for every case reported there were actually 10 other infections,” Dr. Redfield said.

The source for his claim was unclear at that time. The C.D.C. later posted the data on its website and on MedRxiv, a repository for scientific results that have not yet been vetted by peer review.

The C.D.C. researchers tested samples from 11,933 people across six regions in the United States during discrete periods from March 23 through May 3: The Puget Sound region of Washington where the first Covid-19 case in the country was diagnosed, as well as New York City, South Florida, Missouri, Utah and Connecticut.

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The samples were collected at commercial laboratories from people who came in for routine screening, such as cholesterol tests, and were evaluated for the presence of antibodies to the virus — which would indicate previous infection even in the absence of symptoms.

The researchers then estimated the number of infections in each area. New York City, for example, reported 53,803 cases by April 1, but the actual number of infections was 12 times higher, nearly 642,000.


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  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


The city’s prevalence of 6.93 percent is well below the 21 percent estimated by the state’s survey in April. That number was based on people recruited at supermarkets, and so the results would have been biased toward people who would be out shopping during a pandemic — young people, or those who had already had the virus and felt safe, experts said.

Saskia Popescu, an epidemiologist at the University of Arizona, said the C.D.C. survey might also be slanted by people with chronic conditions who are more likely to visit commercial labs. Still, it is more representative of the general population than other surveys because it included everyone who came to the labs for a variety of purposes, instead of limiting it to specific groups such as health care workers who felt sick from the coronavirus.

“So much of the serology testing that we’ve been seeing has really been focused on that — people who thought that they were exposed or felt sick at some point,” she said. “This approach is much more representative ultimately.”

She also praised the researchers for not making inferences from the study about the participants’ immune status, because it’s still unclear how the presence of antibodies relates to protection from the virus.

The analysis also highlights the wide disparities between different parts of the country — and the importance not just of enough tests, but also of lab capacity, Dr. Popescu said. In Arizona, she added, the backlog is delaying test results by five to six days.

Dr. Hensley said he was worried that New York and other Northeastern states might falsely believe themselves to be past the point of danger and reopen too soon.

“We need to turn to the South to see what a debacle things have been down there,” he said. “If we open up as Florida or Texas did, you can almost bet that we will be in the same position that they’re in now.”

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How the World Missed Covid-19’s Silent Spreaders

Symptomless transmission makes the coronavirus far harder to fight. But health officials dismissed the risk for months, pushing misleading and contradictory claims in the face of mounting evidence.

By Matt Apuzzo, Selam Gebrekidan and

June 27, 2020


MUNICH — Dr. Camilla Rothe was about to leave for dinner when the government laboratory called with the surprising test result. Positive. It was Jan. 27. She had just discovered Germany’s first case of the new coronavirus.

But the diagnosis made no sense. Her patient, a businessman from a nearby auto parts company, could have been infected by only one person: a colleague visiting from China. And that colleague should not have been contagious.

The visitor had seemed perfectly healthy during her stay in Germany. No coughing or sneezing, no signs of fatigue or fever during two days of long meetings. She told colleagues that she had started feeling ill after the flight back to China. Days later, she tested positive for the coronavirus.

Scientists at the time believed that only people with symptoms could spread the coronavirus. They assumed it acted like its genetic cousin, SARS.

“People who know much more about coronaviruses than I do were absolutely sure,” recalled Dr. Rothe, an infectious disease specialist at Munich University Hospital.

But if the experts were wrong, if the virus could spread from seemingly healthy carriers or people who had not yet developed symptoms, the ramifications were potentially catastrophic. Public-awareness campaigns, airport screening and stay-home-if-you’re sick policies might not stop it. More aggressive measures might be required — ordering healthy people to wear masks, for instance, or restricting international travel.

Dr. Rothe and her colleagues were among the first to warn the world. But even as evidence accumulated from other scientists, leading health officials expressed unwavering confidence that symptomless spreading was not important.

In the days and weeks to come, politicians, public health officials and rival academics disparaged or ignored the Munich team. Some actively worked to undermine the warnings at a crucial moment, as the disease was spreading unnoticed in French churches, Italian soccer stadiums and Austrian ski bars. A cruise ship, the Diamond Princess, would become a deadly harbinger of symptomless spreading.

ImageWestlake Legal Group merlin_170540889_773e07a6-e978-4dc4-ab9a-610c9b70b23f-articleLarge How the World Missed Covid-19’s Silent Spreaders Tests (Medical) Science and Technology Research Quarantines Coronavirus (2019-nCoV)
Credit…Andrew Testa for The New York Times
Credit…Kim Kyung-Hoon/Reuters

Interviews with doctors and public health officials in more than a dozen countries show that for two crucial months — and in the face of mounting genetic evidence — Western health officials and political leaders played down or denied the risk of symptomless spreading. Leading health agencies including the World Health Organization and the European Center for Disease Prevention and Control provided contradictory and sometimes misleading advice. A crucial public health discussion devolved into a semantic debate over what to call infected people without clear symptoms.

The two-month delay was a product of faulty scientific assumptions, academic rivalries and, perhaps most important, a reluctance to accept that containing the virus would take drastic measures. The resistance to emerging evidence was one part of the world’s sluggish response to the virus.

It is impossible to calculate the human toll of that delay, but models suggest that earlier, aggressive action might have saved tens of thousands of lives. Countries like Singapore and Australia, which used testing and contact-tracing and moved swiftly to quarantine seemingly healthy travelers, fared far better than those that did not.

Credit…Dmitry Kostyukov for The New York Times
Credit…Alessandro Grassani for The New York Times

It is now widely accepted that seemingly healthy people can spread the virus, though uncertainty remains over how much they have contributed to the pandemic. Though estimates vary, models using data from Hong Kong, Singapore and China suggest that 30 to 60 percent of spreading occurs when people have no symptoms.

“This was, I think, a very simple truth,” Dr. Rothe said. “I was surprised that it would cause such a storm. I can’t explain it.”

Even now, with more than 9 million cases around the world, and a death toll approaching 500,000, Covid-19 remains an unsolved riddle. It is too soon to know whether the worst has passed, or if a second global wave of infections is about to crash down. But it is clear that an array of countries, from secretive regimes to overconfident democracies, have fumbled their response, misjudged the virus and ignored their own emergency plans.

It is also painfully clear that time was a critical commodity in curbing the virus — and that too much of it was wasted.

On the night of Germany’s first positive test, the virus had seemed far away. Fewer than 100 fatalities had been reported worldwide. Italy, which would become Europe’s ground zero, would not record its first cases for another three days.

A few reports out of China had already suggested the possibility of symptomless spreading. But nobody had proved it could happen.

That night, Dr. Rothe tapped out an email to a few dozen doctors and public health officials.

“Infections can actually be transmitted during the incubation period,” she wrote.

Three more employees from the auto parts company, Webasto, tested positive the following day. Their symptoms were so mild that, normally, it’s likely that none would have been flagged for testing, or have thought to stay at home.

Dr. Rothe decided she had to sound the alarm. Her boss, Dr. Michael Hoelscher, dashed off an email to The New England Journal of Medicine. “We believe that this observation is of utmost importance,” he wrote.

Editors responded immediately. How soon could they see the paper?

Credit…Laetitia Vancon for The New York Times
Credit…Laetitia Vancon for The New York Times

The next morning, Jan. 30, public health officials interviewed the Chinese businesswoman by phone. Hospitalized in Shanghai, she explained that she’d started feeling sick on the flight home. Looking back, maybe she’d had some mild aches or fatigue, but she had chalked them up to a long day of travel.

“From her perspective, she was not ill,” said Nadine Schian, a Webasto spokeswoman who was on the call. “She said, ‘OK, I felt tired. But I’ve been in Germany a lot of times before and I always have jet lag.’”

When the health officials described the call, Dr. Rothe and Dr. Hoelscher quickly finished and submitted their article. Dr. Rothe did not talk to the patient herself but said she relied on the health authority summary.

Within hours, it was online. It was a modest clinical observation at a key time. Just days earlier, the World Health Organization had said it needed more information about this very topic.

What the authors did not know, however, was that in a suburb 20 minutes away, another group of doctors had also been rushing to publish a report. Neither knew what the other was working on, a seemingly small academic rift that would have global implications.

The second group was made up of officials with the Bavarian health authority and Germany’s national health agency, known as the Robert Koch Institute. Inside a suburban office, doctors unfurled mural paper and traced infection routes using colored pens.

Their team, led by the Bavarian epidemiologist Dr. Merle Böhmer, submitted an article to The Lancet, another premier medical journal. But the Munich hospital group had scooped them by three hours. Dr. Böhmer said her team’s article, which went unpublished as a result, had reached similar conclusions but worded them slightly differently.

Dr. Rothe had written that patients appeared to be contagious before the onset of any symptoms. The government team had written that patients appeared to be contagious before the onset of full symptoms — at a time when symptoms were so mild that people might not even recognize them.

The Chinese woman, for example, had woken up in the middle of the night feeling jet-lagged. Wanting to be sharp for her meetings, she took a Chinese medicine called 999 — containing the equivalent of a Tylenol tablet — and went back to bed.

Perhaps that had masked a mild fever? Perhaps her jet lag was actually fatigue? She had reached for a shawl during a meeting. Maybe that was a sign of chills?

Credit…Laetitia Vancon for The New York Times
Credit…Laetitia Vancon for The New York Times

After two lengthy phone calls with the woman, doctors at the Robert Koch Institute were convinced that she had simply failed to recognize her symptoms. They wrote to the editor of The New England Journal of Medicine, casting doubt on Dr. Rothe’s findings.

Editors there decided that the dispute amounted to hairsplitting. If it took a lengthy interview to identify symptoms, how could anyone be expected to do it in the real world?

“The question was whether she had something consistent with Covid-19 or that anyone would have recognized at the time was Covid-19,” said Dr. Eric Rubin, the journal’s editor.

“The answer seemed to be no.”

The journal did not publish the letter. But that would not be the end of it.

That weekend, Andreas Zapf, the head of the Bavarian health authority, called Dr. Hoelscher of the Munich clinic. “Look, the people in Berlin are very angry about your publication,” Dr. Zapf said, according to Dr. Hoelscher.

He suggested changing the wording of Dr. Rothe’s report and replacing her name with those of members of the government task force, Dr. Hoelscher said. He refused.

The health agency would not discuss the phone call.

Until then, Dr. Hoelscher said, their report had seemed straightforward. Now it was clear: “Politically, this was a major, major issue.”

On Monday, Feb. 3, the journal Science published an article calling Dr. Rothe’s report “flawed.” Science reported that the Robert Koch Institute had written to the New England Journal to dispute her findings and correct an error.

The Robert Koch Institute declined repeated interview requests over several weeks and did not answer written questions.

Dr. Rothe’s report quickly became a symbol of rushed research. Scientists said she should have talked to the Chinese patient herself before publishing, and that the omission had undermined her team’s work. On Twitter, she and her colleagues were disparaged by scientists and armchair experts alike.

“It broke over us like a complete tsunami,” Dr. Hoelscher said.

The controversy also overshadowed another crucial development out of Munich.

The next morning, Dr. Clemens-Martin Wendtner made a startling announcement. Dr. Wendtner was overseeing treatment of Munich’s Covid-19 patients — there were eight now — and had taken swabs from each.

He discovered the virus in the nose and throat at much higher levels, and far earlier, than had been observed in SARS patients. That meant it probably could spread before people knew they were sick.

Credit…Laetitia Vancon for The New York Times
Credit…Laetitia Vancon for The New York Times

But the Science story drowned that news out. If Dr. Rothe’s paper had implied that governments might need to do more against Covid-19, the pushback from the Robert Koch Institute was an implicit defense of the conventional thinking.

Sweden’s public health agency declared that Dr. Rothe’s report had contained major errors. The agency’s website said, unequivocally, that “there is no evidence that people are infectious during the incubation period” — an assertion that would remain online in some form for months.

French health officials, too, left no room for debate: “A person is contagious only when symptoms appear,” a government flyer read. “No symptoms = no risk of being contagious.”

As Dr. Rothe and Dr. Hoelscher reeled from the criticism, Japanese doctors were preparing to board the Diamond Princess cruise ship. A former passenger had tested positive for coronavirus.

Yet on the ship, parties continued. The infected passenger had been off the ship for days, after all. And he hadn’t reported symptoms while onboard.

Immediately after Dr. Rothe’s report, the World Health Organization had noted that patients might transmit the virus before showing symptoms. But the organization also underscored a point that it continues to make: Patients with symptoms are the main drivers of the epidemic.

Once the Science paper was published, however, the organization waded directly into the debate on Dr. Rothe’s work. On Tuesday, Feb. 4, Dr. Sylvie Briand, the agency’s chief of infectious disease preparedness, tweeted a link to the Science paper, calling Dr. Rothe’s report flawed.

With that tweet, the W.H.O. focused on a semantic distinction that would cloud discussion for months: Was the patient asymptomatic, meaning she would never show symptoms? Or pre-symptomatic, meaning she became sick later? Or, even more confusing, oligo-symptomatic, meaning that she had symptoms so mild that she didn’t recognize them?

To some doctors, the focus on these arcane distinctions felt like whistling in the graveyard. A person who feels healthy has no way to know that she is carrying a virus or is about to become sick. Airport temperature checks will not catch these people. Neither will asking them about their symptoms or telling them to stay home when they feel ill.

The W.H.O. later said that the tweet had not been intended as a criticism.

One group paid little attention to this brewing debate: the Munich-area doctors working to contain the cluster at the auto parts company. They spoke daily with potentially sick people, monitoring their symptoms and tracking their contacts.

Credit…Laetitia Vancon for The New York Times
Credit…Laetitia Vancon for The New York Times

“For us, it was pretty soon clear that this disease can be transmitted before symptoms,” said Dr. Monika Wirth, who tracked contacts in the nearby county of Fürstenfeldbruck.

Dr. Rothe, though, was shaken. She could not understand why much of the scientific establishment seemed eager to play down the risk.

“All you need is a pair of eyes,” she said. “You don’t need rocket-science virology.”

But she remained confident.

“We will be proven right,” she told Dr. Hoelscher.

That night, Dr. Rothe received an email from Dr. Michael Libman, an infectious-disease specialist in Montreal. He thought that criticism of the paper amounted to semantics. Her paper had convinced him of something: “The disease will most likely eventually spread around the world.”

On Feb. 4, Britain’s emergency scientific committee met and, while its experts did not rule out the possibility of symptomless transmission, nobody put much stock in Dr. Rothe’s paper.

“It was very much a hearsay study,” said Wendy Barclay, a virologist and member of the committee, known as the Scientific Advisory Group for Emergencies. “In the absence of real robust epidemiology and tracing, it isn’t obvious until you see the data.”

The data would soon arrive, and from an unexpected source. Dr. Böhmer, from the Bavarian health team, received a startling phone call in the second week of February.

Virologists had discovered a subtle genetic mutation in the infections of two patients from the Munich cluster. They had crossed paths for the briefest of moments, one passing a saltshaker to the other in the company cafeteria, when neither had symptoms. Their shared mutation made it clear that one had infected the other.

Dr. Böhmer had been skeptical of symptomless spreading. But now, there was no doubt: “It can only be explained with pre-symptomatic transmission,” Dr. Böhmer said.

Now it was Dr. Böhmer who sounded the alarm. She said she promptly shared the finding, and its significance, with the W.H.O. and the European Center for Disease Control and Prevention.

Neither organization included the discovery in its regular reports.

A week after receiving Dr. Böhmer’s information, European health officials were still declaring: “We are still unsure whether mild or asymptomatic cases can transmit the virus.” There was no mention of the genetic evidence.

Credit…Laetitita Vancon for The New York Times
Credit…Laetitia Vancon for The New York Times

W.H.O. officials say the genetic discovery informed their thinking, but they made no announcement of it. European health officials say the German information was one early piece of an emerging picture that they were still piecing together.

The doctors in Munich were increasingly frustrated and confused by the World Health Organization. First, the group wrongly credited the Chinese government with alerting the German authorities to the first infection. Government officials and doctors say the auto parts company itself sounded the alarm.


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  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


Then, the World Health Organization’s emergency director, Dr. Michael Ryan, said on Feb. 27 that the significance of symptomless spreading was becoming a myth. And Dr. Maria Van Kerkhove, the organization’s technical lead on coronavirus response, suggested it was nothing to worry about.

“It’s rare but possible,” she said. “It’s very rare.”

The agency still maintains that people who cough or sneeze are more contagious than people who don’t. But there is no scientific consensus on how significant this difference is or how it affects the spread of virus.

And so, with evidence mounting, the Munich team could not understand how the W.H.O. could be so sure that symptomless spreading was insignificant.

“At this point, for us it was clear,” said Dr. Wendtner, the senior doctor overseeing treatment of the Covid-19 patients. “This was a misleading statement by the W.HO.”

The Munich cluster was not the only warning.

The Chinese health authorities had explicitly cautioned that patients were contagious before showing symptoms. A Japanese bus driver was infected while transporting seemingly healthy tourists from Wuhan.

And by the middle of February, 355 people aboard the Diamond Princess cruise ship had tested positive. About a third of the infected passengers and staff had no symptoms.

But public health officials saw danger in promoting the risk of silent spreaders. If quarantining sick people and tracing their contacts could not reliably contain the disease, governments might abandon those efforts altogether.

In Sweden and Britain, for example, discussion swirled about enduring the epidemic until the population obtained “herd immunity.” Public health officials worried that might lead to overwhelmed hospitals and needless deaths.

Credit…Andres Kudacki for The New York Times
Credit…Victor Moriyama for The New York Times

Plus, preventing silent spreading required aggressive, widespread testing that was then impossible for most countries.

“It’s not like we had some easy alternative,” said Dr. Libman, the Canadian doctor. “The message was basically: ‘If this is true, we’re in trouble.’”

European health officials say they were reluctant to acknowledge silent spreading because the evidence was trickling in and the consequences of a false alarm would have been severe. “These reports are seen everywhere, all over the world,” said Dr. Josep Jansa, a senior European Union health official. “Whatever we put out, there’s no way back.”

Looking back, health officials should have said that, yes, symptomless spreading was happening and they did not understand how prevalent it was, said Dr. Agoritsa Baka, a senior European Union doctor.

But doing that, she said, would have amounted to an implicit warning to countries: What you’re doing might not be enough.

While public health officials hesitated, some doctors acted. At a conference in Seattle in mid-February, Jeffrey Shaman, a Columbia University professor, said his research suggested that Covid-19’s rapid spread could only be explained if there were infectious patients with unremarkable symptoms or no symptoms at all.

In the audience that day was Steven Chu, the Nobel-winning physicist and former U.S. energy secretary. “If left to its own devices, this disease will spread through the whole population,” he remembers Professor Shaman warning.

Afterward, Dr. Chu began insisting that healthy colleagues at his Stanford University laboratory wear masks. Doctors in Cambridge, England, concluded that asymptomatic transmission was a big source of infection and advised local health workers and patients to wear masks, well before the British government acknowledged the risk of silent spreaders.

The American authorities, faced with a shortage, actively discouraged the public from buying masks. “Seriously people — STOP BUYING MASKS!” Surgeon General Jerome M. Adams tweeted on Feb. 29. .

By early March, while the World Health Organization continued pressing the case that symptom-free transmission was rare, science was breaking in the other direction.

Credit…Max Whittaker for The New York Times
Credit…Adam Dean for The New York Times

Researchers in Hong Kong estimated that 44 percent of Covid-19 transmission occurred before symptoms began, an estimate that was in line with a British study that put that number as high as 50 percent.

The Hong Kong study concluded that people became infectious about two days before their illness emerged, with a peak on their first day of symptoms. By the time patients felt the first headache or scratch in the throat, they might have been spreading the disease for days.

In Belgium, doctors saw that math in action, as Covid-19 tore through nursing homes, killing nearly 5,000 people.

“We thought that by monitoring symptoms and asking sick people to stay at home, we would be able to manage the spread,” said Steven Van Gucht, the head of Belgium’s Covid-19 scientific committee. “It came in through people with hardly any symptoms.”

More than 700 people aboard the Diamond Princess were sickened. Fourteen died. Researchers estimate that most of the infection occurred early on, while seemingly healthy passengers socialized and partied.

Government scientists in Britain concluded in late April that 5 to 6 percent of symptomless health care workers were infected and might have been be spreading the virus.

In Munich, Dr. Hoelscher has asked himself many times whether things would have been different if world leaders had taken the issue seriously earlier. He compared their response to a rabbit stumbling upon a poisonous snake.

“We were watching that snake and were somehow paralyzed,” he said.

As the research coalesced in March, European health officials were convinced.

“OK, this is really a big issue,” Dr. Baka recalled thinking. “It plays a big role in the transmission.”

By the end of the month, the U.S. Centers for Disease Control announced it was rethinking its policy on masks. It concluded that up to 25 percent of patients might have no symptoms.

Since then, the C.D.C., governments around the world and, finally, the World Health Organization have recommended that people wear masks in public.

Still, the W.H.O. is sending confusing signals. Earlier this month, Dr. Van Kerkhove, the technical lead, repeated that transmission from asymptomatic patients was “very rare.” After an outcry from doctors, the agency said there had been a misunderstanding.

“In all honesty, we don’t have a clear picture on this yet,” Dr. Van Kerkhove said. She said she had been referring to a few studies showing limited transmission from asymptomatic patients.

Credit…Laetitia Vancon for The New York Times
Credit…Laetitia Vancon for The New York Times

Recent internet ads confused the matter even more. A Google search in mid-June for studies on asymptomatic transmission returned a W.H.O. advertisement titled: “People With No Symptoms — Rarely Spread Coronavirus.”

Clicking on the link, however, offered a much more nuanced picture: “Some reports have indicated that people with no symptoms can transmit the virus. It is not yet known how often it happens.”

After The Times asked about those discrepancies, the organization removed the advertisements.

Back in Munich, there is little doubt left. Dr. Böhmer, the Bavarian government doctor, published a study in The Lancet last month that relied on extensive interviews and genetic information to methodically track every case in the cluster.

In the months after Dr. Rothe swabbed her first patient, 16 infected people were identified and caught early. All survived. Aggressive testing and flawless contact-tracing contained the spread.

Dr. Böhmer’s study found “substantial” transmission from people with no symptoms or exceptionally mild, nonspecific symptoms.

Dr. Rothe and her colleagues got a footnote.

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Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

Coronavirus Attacks the Lungs. A Federal Agency Just Halted Funding for New Lung Treatments.

When the coronavirus kills, it attacks the lungs, filling them with fluid and robbing the body of oxygen. In chest X-rays, clear lungs turn white, a sign of how dangerously sick patients are.

But earlier this month, the Biomedical Advanced Research and Development Authority, or BARDA, a federal health agency, abruptly notified companies and researchers that it was halting funding for treatments for this severe form of Covid-19, the disease caused by the virus.

The new policy highlights how staunchly the Trump administration has placed its bet on vaccines as the way to return American society and the economy to normal in a presidential election year. BARDA has pledged more than $2.2 billion in deals with five vaccine manufacturers for the coronavirus, compared with about $359 million toward potential Covid-19 treatments.

But the shift in strategy also shows that the administration is backing away from the relatively modest funding it has provided so far for treatments that address the severe lung ailments, while continuing support for antiviral therapies that could treat people earlier in the course of the disease.

The decision to suspend investment in lung treatments blindsided academic researchers and executives at small biotech companies, who said they spent months pitching their proposals to BARDA, which is a division of the Department of Health and Human Services.

Some clinicians and bioethicists contend that BARDA should continue supporting research into treatments for lung conditions, while other experts contend the policy is a sensible way to spend limited federal dollars.

Vaccines are universally considered the world’s best hope for stopping the virus, but scientists and doctors treating patients hospitalized with Covid-19 caution that there is no guarantee a vaccine will be ready by the end of the year, as President Trump has promised. And no treatment or therapy has been proved to prevent the disease.

Most of the patients admitted to the intensive care unit for Covid-19 at Northwell Health in New York, a system of 23 hospitals at the epicenter of the region’s epidemic this spring, have developed severe respiratory distress, said Dr. Mangala Narasimhan, the regional director of critical care medicine at Northwell.

“You’re going to need other forms of treatments for a lot of those people, and I feel like that’s where there’s going to be a gaping hole,” she said.

Even if a vaccine is approved, she and others noted, people will still get sick from the virus because not everyone will get vaccinated, or the effectiveness of a vaccine may wane in months, or it may not work in older people or those with compromised immune systems. Thousands of people die from the flu in the United States each year even though there is a vaccine and treatments for that virus.

“Everybody deserves some piece of the pie,” said Dr. Arthur L. Caplan, a bioethicist at NYU Langone Medical Center. “It’s public money, so you do have to pay attention to the needs of all.”

But other experts said that BARDA’s shift away from lung treatments made sense, given that vaccines or broad-based antiviral drugs would do the most to stop the global spread of the virus, and experimental treatments like stem-cell therapies are far from proved.

“It’s not unreasonable, what they are doing,” said Dr. Luciana Borio, who oversaw public health preparedness for the National Security Council in Mr. Trump’s White House and had been the acting chief scientist at the Food and Drug Administration under former President Barack Obama. “It’s important to bring discipline to the process because the resources are finite, both financial and human.”

In interviews, six company executives and academic researchers who had begun the application process with BARDA said they had not heard back from the agency, or had been told their research area was not a priority. An executive for one biotech company, who did not want to be named because he did not want to jeopardize future federal contracts, said the company had been in the final stages of negotiating a deal with the agency when it suspended applications. That partnership is now on hold.

ImageWestlake Legal Group merlin_172488117_c657594e-be1a-4899-8323-d04b6b68181c-articleLarge Coronavirus Attacks the Lungs. A Federal Agency Just Halted Funding for New Lung Treatments. your-feed-healthcare Ventilators (Medical) Vaccination and Immunization United States Politics and Government Trump, Donald J Tests (Medical) Research national institutes of health Lungs Health and Human Services Department Drugs (Pharmaceuticals) Dexamethasone (Drug) Coronavirus (2019-nCoV) Clinical Trials Biomedical Advanced Research and Development Authority
Credit…Pool photo by Shawn Thew

The change in policy was posted without fanfare June 3 on a government website, and was not announced in a statement. The agency said it would no longer accept proposals involving “immunomodulators or therapeutics targeting lung repair. This area of interest is suspended until further notice.” It also said it was suspending applications for companies developing preventive treatments.

In a statement, a spokeswoman for the Department of Health and Human Services, Elleen Kane, said, “To make the most of potential partners’ time and efforts and to communicate clearly about investment areas, we are only leaving open areas of interest that are of highest priority for H.H.S. right now.”

She said the agency was setting up a clinical trial network to test multiple treatments, a better approach than “supporting expensive clinical trials for each product separately.” However, BARDA has not yet announced any such trials, and Ms. Kane said, “How such a clinical trial would be run is in early planning stages.”

The government funding is prized by companies because it helps them get through the so-called valley of death — the phase when a product has shown promise, but can fail because of a lack of investment in late-stage clinical trials and manufacturing. Many vaccines and treatments for infectious diseases like Ebola and the coronavirus don’t have a viable commercial market, so companies rely instead on federal funding.

In the case of the coronavirus, Congress has allocated more than $6.5 billion to BARDA to develop vaccines, treatments and other products to address the pandemic. The goal is to speed them through development by financing clinical trials and ramping up manufacturing at the same time, a financial risk that companies normally don’t take because they don’t know if their products will work.

Many of the companies hoping for support from BARDA were developing treatments that seek to dampen the immune system, calming the “cytokine storm” that can wreak havoc on patients with severe Covid-19.

“It seems that BARDA is shutting the door on that whole area of medicine,” said Dr. Joanne Kurtzberg, a stem cell researcher at Duke University.

She had asked the agency in early April to support a small clinical trial on the use of stem cells in patients with Covid-19 who had acute respiratory distress syndrome and said she had received only an acknowledgment that her proposal had been received.

The shift is the latest move by a low-profile federal agency that has increasingly found itself in the spotlight as the coronavirus pandemic enters its sixth month. In April, the head of BARDA, Dr. Rick Bright, announced that he had been ousted from his position in a dispute over an unproven coronavirus treatment pushed by President Trump, and said that top administration officials had repeatedly pressured him to steer millions of dollars in contracts to the clients of a well-connected consultant.

Credit…Shannon Stapleton/Reuters

Representatives for academic researchers and smaller biotech companies contend that BARDA should disperse money to a wider variety of projects. Clinical trials for treatments, rather than vaccines, can move more quickly because the course of Covid-19 is relatively short, compared with testing a vaccine on thousands of healthy volunteers, and waiting for them to get infected. Like a vaccine, an effective drug that renders the virus less deadly could allow society to return to normal more quickly.

They also noted that many of the biggest pharmaceutical breakthroughs — like the polio vaccine or immunotherapy for cancer — originated in academic medical centers or biotech start-ups, not from large drug companies. H.H.S. said in its statement that it was working with companies of all sizes.


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  • Frequently Asked Questions and Advice

    Updated June 16, 2020

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • Will protests set off a second viral wave of coronavirus?

      Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.

    • My state is reopening. Is it safe to go out?

      States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.


“We think failing to focus on lung repair is not wise,” said Janet Marchibroda, the president of the Alliance for Cell Therapy Now, a coalition of academic institutions, biotech companies and health systems that favor more research into cell therapies. “The majority of patients who are in hospitals are dying because of lung injury.”

The coronavirus outbreak has killed more than 118,000 people in the United States, and those who die often succumb to respiratory failure after the lungs become unable to provide the body with enough oxygen. In some cases, people’s immune systems go into overdrive and cause critical damage.

On Tuesday, scientists at the University of Oxford reported that a cheap, commonly used steroid, dexamethasone, reduced deaths of patients on ventilators by a third, a hopeful discovery. An experimental drug, remdesivir, has been shown to have moderate success in speeding patients’ recovery in early trials.

But others say additional treatments will be needed, because no one drug will work in all patients. BARDA has already announced deals with some companies that are testing existing drugs in patients with severe Covid-19, including $25.1 million to Genentech for its rheumatoid arthritis drug Actemra, and $16.4 million to Regeneron for its drug, Kevzara, another remedy for rheumatoid arthritis.

Researchers and companies are also testing stem cell therapies, which are also believed to dampen the immune system. One company, Mesoblast, is testing its stem cell product in patients with severe Covid-19 as part of a clinical trial supported by an arm of the National Institutes of Health.

Another company, Athersys, has also begun testing stem cells in infected patients with acute respiratory distress syndrome, a condition that can be caused by other viruses or illnesses. A previous small trial of patients with A.R.D.S. that tested Athersys’s stem cells produced positive results, and the company said in March that BARDA had designated its product to be a “highly relevant” treatment for Covid-19. A spokesman for Athersys declined to comment on the status of the application.

The chief executive of another company, CytoSorbents Corporation, said its BARDA application to finance a randomized clinical trial was now in limbo. The company makes a device, the CytoSorb, which aims to filter out the excess cytokines that are secreted by the immune system when it becomes overactive. Although the Food and Drug Administration granted emergency authorization for the device to be used in Covid-19 patients, the company’s chief executive, Dr. Phillip Chan, said the CytoSorb should undergo testing in a rigorous clinical trial.

“We are at war with Covid-19, with no cure, and a critical need to continue funding and support of the most promising therapeutic options,” he said in an email.

Credit…Anna Moneymaker/The New York Times

Other federal agencies are planning clinical trials that will include treatments to calm the immune system. In an interview, Dr. Francis S. Collins, the director of the National Institutes of Health, said a public-private partnership known as ACTIV — Accelerating Covid-19 Therapeutic Interventions and Vaccines — had evaluated more than 400 possible therapeutic interventions for the coronavirus and distilled them to six promising candidates for clinical trials that could be funded through President Trump’s “Operation Warp Speed” initiative.

“Among the highest priorities,” Dr. Collins said, are immune modulators and anticoagulants, used to prevent troublesome blood clots that are sometimes associated with Covid-19. The goal, he said, is to find treatments “as soon as possible for the people who are really sick.”

He said officials were in the “very advanced stages” of planning studies that would get underway in the coming weeks.

But some researchers said that while N.I.H trials were welcome, BARDA’s assistance was critical because it provided money to scale up manufacturing and help smaller companies and researchers bring their products to market.

“There’s not other government funding that really fills that gap,” said Dr. Kurtzberg, of Duke University.

Sheryl Gay Stolberg contributed reporting.

Real Estate, and Personal Injury Lawyers. Contact us at: https://westlakelegal.com 

Remdesivir Coronavirus Trial: Federal Scientists Finally Publish Data

Westlake Legal Group 23virus-remdesivir-facebookJumbo Remdesivir Coronavirus Trial: Federal Scientists Finally Publish Data United States Research Remdesivir (Drug) New England Journal of Medicine National Institute of Allergy and Infectious Diseases Kalil, Andre Gilead Sciences Inc Food and Drug Administration Drugs (Pharmaceuticals) Coronavirus (2019-nCoV)

Nearly a month after federal scientists claimed that an experimental drug had helped patients severely ill with the coronavirus, the research has been published.

The drug, remdesivir, was quickly authorized by the Food and Drug Administration for treatment of coronavirus patients, and hospitals rushed to obtain supplies.

But until now, researchers and physicians had not seen the actual data. And remdesivir, made by Gilead Sciences, has a spotty history. It was originally intended to treat hepatitis, but it failed to. It was tested against Ebola, but results were lackluster.

So far, remdesivir has not been officially approved for any purpose. The F.D.A.’s emergency use authorization was not a formal approval.

The long-awaited study, sponsored by the National Institute of Allergy and Infectious Diseases, appeared on The New England Journal of Medicine website on Friday evening. It confirms the essence of the government’s assertions: Remdesivir shortened recovery time from 15 days to 11 days in hospitalized patients. The study defined recovery as “either discharge from the hospital or hospitalization.”

The trial was rigorous, randomly assigning 1,063 seriously ill patients to receive either remdesivir or a placebo. Those who received the drug not only recovered faster but also did not have serious adverse events more often than those who were given the placebo.

It was an international trial, although most sites were in the United States. Patients were assessed daily, and those administering the evaluations did not know whether a patient had been given remdesivir or the placebo.

A monitoring board reviewed the data at specified intervals and called for a halt to the study when there was clear evidence that the drug was effective.

On April 29, N.I.A.I.D. issued a news release stating as much. But infectious disease doctors were frustrated, because they did not have access to the findings, which might have affected how patients were treated.

“For God’s sake, this is a pandemic — we need some data,” said Dr. Judith Feinberg, vice chair of research at West Virginia University School of Medicine.

Publication of the paper has brought some relief. Doctors had been wondering, for instance, whether they should give remdesivir to patients with the most serious Covid-19 cases or to those who weren’t as sick, especially if there were not enough to go around.

Dr. Andre Kalil of the University of Nebraska, a principal investigator of the study, noted that not only do sicker patients fare as well on remdesivir, but their average time to recovery is also slightly faster.

He added that Hispanics, black people and white patients all derived equal benefit from the drug, as did men and women as well as adults in every age group.

The results were the same for patients regardless of whether they had received the drug treatment before or after 10 days of symptoms, said Dr. Helen Chu, of the University of Washington, who was also an investigator of the study.


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  • Frequently Asked Questions and Advice

    Updated May 20, 2020

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


The study’s designers changed the outcome measures after the study had began, but they did not have access to the current data. Some critics questioned whether the change had altered the study’s conclusions, but a subsequent analysis determined that it did not.

The disease had a more protracted course than the investigators had realized, federal officials said, and the original endpoints — the measures of success — were unworkable.

The best outcome would have been a decline in the death rate among patients given remdesivir, but there were only hints that this had occurred.

Despite generally positive results, the researchers caution that the drug is far from ideal.

“Given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient,” they concluded.

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Moderna Vaccine Trial: How Upbeat Coronavirus News Fueled a Stock Surge

When the biotech company Moderna announced early on Monday morning positive results from a small, preliminary trial of its coronavirus vaccine, the company’s chief medical officer described the news as a “triumphant day for us.”

Moderna’s stock price jumped as much as 30 percent. Its announcement helped lift the stock market and was widely reported by news organizations, including The New York Times.

Nine hours after its initial news release — and after the markets closed — the company announced a stock offering with the aim of raising more than $1 billion to help bankroll vaccine development. That offering had not been mentioned in Moderna’s briefings of investors and journalists that morning, and the company chairman later said it was decided on only that afternoon.

By Tuesday, a backlash was underway. The company had not released any more data, so scientists could not evaluate its claim. The government agency leading the trial, the National Institute of Allergy and Infectious Diseases, had made no comment on the results. And the stock sale stirred concerns about whether the company had sought to jack up the price of its stock offering with the news.

The Moderna episode is a case study in how the coronavirus pandemic and the desperate hunt for treatments and vaccines are shaking up the financial markets and the way that researchers, regulators, drug companies, biotech investors and journalists do their jobs.

Drug companies accustomed to releasing early data to attract investors and satisfy regulators suddenly find themselves accused of revealing too much, or not enough, by a new, broader audience. Journalists may be scolded for hyping early findings, while those who ignore sketchy data may be blamed for missing the news.

Scientists who take the traditional time to gather and analyze their data for publication in mainstream journals are criticized for sitting on lifesaving information. Upstart websites beat the journals and break the usual rules by publishing unvetted studies, some of dubious quality. And President Trump uses his bully pulpit to promote unproven treatments.

“You have these wild swings, based on incomplete information,” said David Maris, managing director of Phalanx Investment Partners, and a longtime analyst covering the pharmaceutical industry. “It’s a crazy, speculative environment, because the pandemic has caused people to want to believe that there’s going to be a miracle cure in a miracle time frame.”

Moderna’s chairman, Noubar Afeyan, defended the decision to open a stock sale hours after releasing limited data. He said the company’s board had been considering an offering before Monday’s announcement, but finalized the decision only late in the day.

“It was based on our looking at the data and concluding that we needed to have our own resources going into develop this vaccine and not simply wait for government grants,” he said. Moderna has a deal to receive up to $483 million from the U.S. government to pursue a vaccine.

While corporations and scientists are under incredible pressure to develop a vaccine and raise money for research and manufacturing, vaccine companies are also vying for attention from investors amid a crowded field and are seeking to lift their stock prices in a global recession.

Nearly all are trying to compress the timetable for developing vaccines that normally takes years, sometimes decades, into a year or so — and still ensure that the vaccines will be safe and effective.

At the same time, a torrent of information is blasting from medical journals as well as company and university news releases. Articles are posted on so-called preprint websites of studies that have not been peer-reviewed by experts, unlike articles in mainstream medical and science journals. Clinicaltrials.gov, which lists medical studies, showed that 1,673 were underway for Covid-19, the disease caused by the coronavirus, as of May 23.

News outlets are rushing to stay on top of new findings, and to feed a public hungry for any advances in potential treatments or vaccine candidates that hold promise against the highly infectious virus. Some news organizations would prefer to maintain traditional practice and ignore early results of medical studies, waiting for peer-reviewed data but they are also competing to report on the latest studies.

Still, concerns arise routinely about the quality of rapidly posted data and the motivations behind announcements.

“Why does any company release early data?” Mr. Maris asked. “Clearly there is an appetite for it. People want to know that we are making progress. Having a vaccine is the clearest way to a full reopening and putting this behind us.”

Moderna’s preliminary results were promising. Its vaccine, the first to be tested in humans, appeared safe and stimulated antibody production in the first 45 study participants. And of eight who have undergone further testing so far, all produced so-called neutralizing antibodies, which can stop the virus from invading cells, and should prevent illness.

But there were no details — no charts, no graphs, no numbers, nothing published in a journal.

ImageWestlake Legal Group 22VIRUS-UPROAR2-articleLarge Moderna Vaccine Trial: How Upbeat Coronavirus News Fueled a Stock Surge your-feed-healthcare Vaccination and Immunization Stocks and Bonds Science and Technology Research Remdesivir (Drug) News and News Media Moderna Inc medRxiv Gilead Sciences Inc Coronavirus (2019-nCoV) Clinical Trials Biotechnology and Bioengineering bioRxiv Academic and Scientific Journals
Credit…Doug Mills/The New York Times

Releasing sparse data is not unusual in the biotech world, where companies often present early trial results months before they are published in journals. Publicly traded companies are required to disclose material information that might lead an investor to buy or sell shares. The company said federal researchers who are conducting the trial would be responsible for submitting the data to be reviewed and published.

Mr. Maris said that he would leave it to regulators to decide if the company had acted inappropriately in not announcing the stock sale sooner, and said that investors should have been told earlier that the company was considering a stock offering. “There’s something wrong with that,” he said.

Moderna, based in Cambridge, Mass., went public in 2018 and has been a favorite of biotech investors, given its focus on the hot area of immuno-oncology and its partnerships with companies like Merck and AstraZeneca, and with the Vaccine Research Center at the National Institute of Allergy and Infectious Diseases.

Its technology, based on genetic material called messenger RNA or mRNA, is considered highly promising.

“Messenger RNA is one of the hot new platforms,” Dr. Anthony Fauci, director of the infectious disease institute, said in an interview on Thursday, adding that it can be adapted quickly to produce new vaccines and scaled up easily.

Although Moderna has other vaccines in its pipeline, none have come to market, and the viability of its mRNA vaccine-making platform — the basis of the company — is on the line. It is a front-runner in the coronavirus vaccine race, and its stock has risen more than 250 percent since the beginning of the year. It closed at $69 a share on Friday afternoon, down 26 percent from a high Monday of $87.

Dr. Afeyan acknowledged that companies were now subject to far more intense scrutiny with so much riding on the outcome of drug development.

Credit…Victor Boyko/Getty Images

“People are basically saying, you know, one shouldn’t do this,” Dr. Afeyan said. “And if you don’t put out data, people will say, why are you withholding the data? People are trading without knowing the data. So it’s a tough situation to be doing science in, and we have no choice because we’re trying to develop a vaccine.”

With so many different interests demanding the latest information — including governments around the world — the company couldn’t withhold it from the public, he said. “As a public company, if we have it, we cannot give this to them and hide it from other people.”

Dr. Fauci said that whilecompanies often release partial data, “My own preference, and what my group will do, will be to wait until we get the data solid and then publish it in a paper saying, ‘In the first phase this is what we saw.’”

Still, he considers Moderna’s preliminary results encouraging. The levels of neutralizing antibodies in the eight people tested for them appeared high enough to be protective, Dr. Fauci said. But he emphasized that eight is a small number.

“I have to underscore it’s still limited,” he said, “and that’s the reason why I just withhold my enthusiasm, but I still have some cautious optimism.”


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  • Frequently Asked Questions and Advice

    Updated May 20, 2020

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • Is ‘Covid toe’ a symptom of the disease?

      There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

    • Should I wear a mask?

      The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • How can I help?

      Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.


Dr. Fauci said the big question remained: Will the vaccine work?

“When you’re developing a vaccine,” he said, “nothing is guaranteed.”

Moderna is not the only company that has failed to release detailed scientific data. Little has been known about another closely watched product, remdesivir, an experimental treatment for Covid-19 developed by the drugmaker Gilead.

On April 29, Gilead announced that it was “aware of positive data” about remdesivir’s performance in a federal trial. A few hours later, from the Oval Office, Dr. Fauci said the drug could modestly speed recovery in patients. Although he said it was not a “knockout,” Dr. Fauci — his agency ran that trial, too — said the drug could become the standard of care.

A few days afterward, the Food and Drug Administration granted emergency authorization to use remdesivir to treat Covid-19.

Weeks passed with no detailed data about the clinical trial being published, even though doctors were administering the drug with little information to guide them.

“It was a highly conflicted statement from a highly respected and deservedly respected scientist,” said Gary Schwitzer, the publisher of HealthNewsReview.Org, a watchdog publication that argues for more accurate science journalism. “So it brings you back to, what do we believe? Whom do we believe?”

Dr. Fauci said he and his research team decided to report some results when the study was stopped after an independent safety board found that the treated patients were recovering faster than those receiving placebos. For ethical reasons, all patients had to be offered the drug.

The information would likely have leaked out — especially given that, two weeks earlier, information from another remdesivir trial had been disclosed to the news site STAT, sending Gilead’s stock up.

Dr. Fauci announced that patients treated with remdesivir recovered in 11 days, compared with 15 days for those getting placebos.

Credit…Mike Blake/Reuters

The fast pace of research has caught many news organizations off guard, prompting case-by-case discussions on tight deadlines to decide whether — and how — to cover scientific news even when the quality of studies wouldn’t normally meet their standards.

Scientific articles normally take months to go through peer review. But now, many papers are being published on preprint servers, where scientists are posting research before it is accepted by a journal. The site medRxiv, which was founded last June, had 10 million views in April and has posted nearly 3,100 papers related to Covid-19 since January. A similar site, bioRxiv, has posted about 760 papers on the virus.

“People recognized that there was an urgent need to disseminate information,” said Dr. Harlan Krumholz, a cardiologist and health care researcher at Yale University, and a co-founder of medRxiv. which is pronounced “med archive.” “People recognized that even weeks matter in this moment when we don’t know very much.”

Asked about criticism that sites like medRxiv encourage the rash publication of bad science, Dr. Krumholz said these conversations were healthy and noted that articles in peer-reviewed journals could also be flawed. Submissions go through basic vetting to ensure the research is legitimate.

“Engage in whether it’s good science or not,” he said. “Let’s engage in the consequences of this.”

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These are the most dog-friendly neighborhoods in the DMV

Westlake Legal Group girl-playing-with-dog These are the most dog-friendly neighborhoods in the DMV Walking Research rankings pets pet care pet neighborhoods homes Family families dogs dog walking dog caring apartments Animals
© standret / stock.adobe.com

When walking around Northern Virginia neighborhoods, chances are pretty high you’re going to see a few furry friends strutting along the streets with their owners in tow. And, while the DMV is a primarily green region with plenty of space for Fido to roam, according to new research compiled by local apartment complex The Waycroft, some neighborhoods are better than others for raising your pets. 

The winning location? The Ballston neighborhood of Arlington, due to its abundance of parks within walking distance, easy access to pet services and high number of dog-friendly apartments. Following behind Ballston for second and third place is Old Town Alexandria and Dupont Circle in the District, respectively. 

The Ballston-based complex recently decided to analyze Yelp data and dog-friendly apartment listings in 47 DMV neighborhoods, while using several dog-friendly factors, to reach conclusive results. The factors considered included the number of animal-friendly apartments, number of pet services, number of pet stores, number of veterinarians, number of dog-friendly establishments and number of parks in the designated region. 

For a full list of the top 10 dog-friendly neighborhoods, see below. 

Westlake Legal Group dog-friednly-neighborhoods-rankings These are the most dog-friendly neighborhoods in the DMV Walking Research rankings pets pet care pet neighborhoods homes Family families dogs dog walking dog caring apartments Animals
Photo courtesy of the Waycroft

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What to Know About Hydroxychloroquine

Westlake Legal Group what-to-know-about-hydroxychloroquine What to Know About Hydroxychloroquine Trump, Donald J Rumors and Misinformation Rheumatoid Arthritis Research Preventive Medicine Malaria Lupus Erythematosus Hydroxychloroquine (Drug) hospitals Food and Drug Administration Drugs (Pharmaceuticals) Coronavirus (2019-nCoV) Clinical Trials Azithromycin (Drug)

President Trump revealed on Monday that he had been taking an anti-malaria drug as a preventive measure against the coronavirus, the same medicine that he has been promoting for two months with scant evidence of its efficacy and despite several warnings of dangerous side effects.

The drug, hydroxychloroquine, has been invoked by Mr. Trump repeatedly since March during White House briefings on the coronavirus pandemic despite the reservations of doctors and scientists, including some advising the president. He even called the drug, which has been promoted by some conservative pundits, a “game changer.”

Mr. Trump said he started taking the once-a-day pill about a week and a half ago. It was not immediately clear if Mr. Trump began the regimen in response to two White House staff members’ testing positive for the virus — one of the president’s personal valets and Katie Miller, the spokeswoman for Vice President Mike Pence.

And last week, a federal agency head who had been involved in developing a coronavirus vaccine testified to Congress that he had been removed from the post because he had pressed for a rigorous vetting of hydroxychloroquine. The official, Rick Bright, who led the Biomedical Advanced Research and Development Authority, also said he was pressured to direct money toward hydroxychloroquine.

Here is what we know about the drug:

What is hydroxychloroquine?

Hydroxychloroquine is a prescription medicine that was approved decades ago to treat malaria. It is also used to treat autoimmune diseases like rheumatoid arthritis and lupus. It is sometimes referred to by its brand name, Plaquenil, and is closely related to chloroquine, which is also used to treat malaria.

Why has hydroxychloroquine been considered as a possible treatment for the coronavirus?

There are several reasons. A promising laboratory study, with cultured cells, found that chloroquine could block the coronavirus from invading cells, which it must do to replicate and cause illness. However, drugs that conquer viruses in test tubes or petri dishes do not always work in the human body, and studies of hydroxychloroquine have found that it failed to prevent or treat influenza and other viral illnesses.

Reports from doctors in China and France have said that hydroxychloroquine, sometimes combined with the antibiotic azithromycin, seemed to help patients. But those studies were small and did not use proper control groups — patients carefully selected to match those in the experimental group but who are not given the drug being tested. Research involving few patients and no controls cannot determine whether a drug works. And the French study has since been discredited: The scientific group that oversees the journal where it was published said the study did not meet its standards.

A study from China did include a control group and suggested that hydroxychloroquine might help patients with mild cases of Covid-19, the disease caused by the coronavirus. But that study had limitations: It was also small, with a total of 62 patients, and they were given various other drugs as well as hydroxychloroquine. The doctors evaluating the results knew which patients were being treated, and that information could have influenced their judgment. Even if the findings hold up, they will apply only to people who are mildly ill. And the researchers themselves said more studies were needed.

Another reason the drug has been considered for coronavirus patients is that it can rein in an overactive immune system, which is why it is used to treat lupus and rheumatoid arthritis. In some severe cases of Covid-19, the immune system seems to go into overdrive and cause inflammation that can damage the lungs and other organs. Doctors hope hydroxychloroquine might calm the condition, sometimes called a cytokine storm, but so far there is no proof that it has that effect.

Can hydroxychloroquine protect you from catching the virus?

There is no evidence that hydroxychloroquine can prevent coronavirus infection. However, researchers at the University of Minnesota and the Henry Ford Health System in Detroit are testing the drug in people who live with coronavirus patients to see whether it can protect them.

ImageWestlake Legal Group merlin_172297569_68105811-ae9c-4c75-bedb-6270158c4ff1-articleLarge What to Know About Hydroxychloroquine Trump, Donald J Rumors and Misinformation Rheumatoid Arthritis Research Preventive Medicine Malaria Lupus Erythematosus Hydroxychloroquine (Drug) hospitals Food and Drug Administration Drugs (Pharmaceuticals) Coronavirus (2019-nCoV) Clinical Trials Azithromycin (Drug)
Credit…Narinder Nanu/Agence France-Presse — Getty Images

Is hydroxychloroquine approved by the Food and Drug Administration?

Yes, but for malaria, lupus and rheumatoid arthritis, not for Covid-19. For decades, doctors have been legally allowed to prescribe it for any condition they think it might help, a practice called off-label use.

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In late March, the F.D.A. granted emergency approval to allow hospitals to use hydroxychloroquine from the national stockpile to treat patients who would not otherwise qualify for a clinical trial. Under the approval, patients and their families will receive information about the drug, and hospitals have to track information about the patients who received the drug, including their health condition and serious side effects. But that F.D.A. authorization for emergency use is not equivalent to meeting federal requirements, including scientific evidence through trials, that would deem hydroxychloroquine a proven treatment against the virus.

Is hydroxychloroquine being given to coronavirus patients now?

Yes. Early on in the epidemic, many hospitals began giving it to patients because there was no proven treatment, and they hoped it would help. Clinical trials with control groups have begun across the world. A nationwide trial began on April 2 in the United States; it had planned to enroll 510 patients at 44 medical centers.

Researchers say those studies are essential to find out whether the drug works against the coronavirus. If it does not, time and money can be redirected to other potential treatments.

Is there any danger in taking hydroxychloroquine?

Like every drug, it can have side effects. It is not safe for people who have abnormalities in their heart rhythms, eye problems involving the retina, or liver or kidney disease. Other possible side effects include nausea, diarrhea, mood changes and skin rashes.

The leaders of three professional societies in cardiology warned on April 8 in the journal Circulation that hydroxychloroquine and azithromycin could each cause dangerous disruptions in heart rhythm, and they wrote, “There are very limited data evaluating the safety of combination therapy.”

Over all, it is considered relatively safe for people who do not have underlying illnesses that the drug is known to worsen. But it is not known whether hydroxychloroquine is safe for severely ill Covid-19 patients, who may have organ damage from the virus.

If I can get hydroxychloroquine, should I take it to prevent coronavirus infection?

No, especially not without consulting a doctor who knows your medical history and what other medications you are taking. There is no proof that it works. And if it is being sold on the street or via the internet, it may be fake or unsafe.

An Arizona man in his 60s died in March after swallowing an aquarium cleaning product that had chloroquine on its label. He and his wife, who became critically ill, had thought the product would protect them from the virus.

At this point, the best way to avoid infection is to practice the social-distancing and quarantine measures recommended by public health authorities. The Centers for Disease Control and Prevention also recommends that people wear cloth masks in public and wash their hands regularly.

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