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Covid-19 patients

In vivo antiviral host transcriptional response to SARS-CoV-2 by viral load, sex, and age

Authors: Lieberman NAP

Publication date: 08 September 2020

Journal: PLOS Biology

DOI: 10.1371/journal.pbio.3000849

Despite limited genomic diversity, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown a wide range of clinical manifestations in different patient populations. The mechanisms behind these host differences are still unclear. Here, we examined host response gene expression across infection status, viral load, age, and sex among shotgun RNA sequencing profiles of nasopharyngeal (NP) swabs from 430 individuals with PCR-confirmed SARS-CoV-2 and 54 negative controls. SARS-CoV-2 induced a strong antiviral response with up-regulation of antiviral factors such as OAS1-3 and IFIT1-3 and T helper type 1 (Th1) chemokines CXCL9/10/11, as well as a reduction in transcription of ribosomal proteins. SARS-CoV-2 culture in human airway epithelial (HAE) cultures replicated the in vivo antiviral host response 7 days post infection, with no induction of interferon-stimulated genes after 3 days. Patient-matched longitudinal specimens (mean elapsed time = 6.3 days) demonstrated reduction in interferon-induced transcription, recovery of transcription of ribosomal proteins, and initiation of wound healing and humoral immune responses. Expression of interferon-responsive genes, including ACE2, increased as a function of viral load, while transcripts for B cell–specific proteins and neutrophil chemokines were elevated in patients with lower viral load. Older individuals had reduced expression of the Th1 chemokines CXCL9/10/11 and their cognate receptor CXCR3, as well as CD8A and granzyme B, suggesting deficiencies in trafficking and/or function of cytotoxic T cells and natural killer (NK) cells. Relative to females, males had reduced B cell–specific and NK cell–specific transcripts and an increase in inhibitors of nuclear factor kappa-B (NF-κB) signaling, possibly inappropriately throttling antiviral responses. Collectively, our data demonstrate that host responses to SARS-CoV-2 are dependent on viral load and infection time course, with observed differences due to age and sex that may contribute to disease severity.

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RECOVERY trial will evaluate REGN-COV2 investigational antibody cocktail in the UK

Publication date: 14 September 2020

Source: UK Research and Innovation

One of the world’s largest efforts to find effective COVID-19 treatments will evaluate the impact of REGN-COV2 on mortality, hospital stays, and the need for ventilation.

The University of Oxford and its partner Regeneron Pharmaceuticals, Inc. (NASDAQ: REGN) today announced that RECOVERY (Randomised Evaluation of COVid-19 thERapY), one of the world’s largest randomised clinical trials of potential COVID-19 treatments, will evaluate Regeneron’s investigational anti-viral antibody cocktail, REGN-COV2.

The Phase 3 open-label trial in patients hospitalised with COVID-19 will compare the effects of adding REGN-COV2 to the usual standard-of-care versus standard-of-care on its own.

Professor Fiona Watt, Executive Chair of the Medical Research Council, part of UKRI, said: “With our support, the RECOVERY trial has previously found the most clinically effective treatment for COVID-19 so far, dexamethasone.

"The same UK-wide trial will now test a new treatment designed specifically to combat the virus that causes the disease. Monoclonal, or targeted, antibodies are already used to treat cancer and autoimmune diseases. The new trial will tell us whether antibodies that attack the virus can be an effective treatment for Covid-19.”

Peter Horby, Professor of Emerging Infectious Diseases and Global Health, Nuffield Department of Medicine, University of Oxford and chief investigator of the trial, said: “We have already discovered that one treatment, dexamethasone, benefits COVID-19 patients, but the death rate remains too high so we must keep searching for others. The RECOVERY trial was specifically designed so that when promising investigational drugs such as REGN-COV2 became available they can be tested quickly.

"We are looking forward to seeing whether REGN-COV2 is safe and effective in the context of a large-scale randomised clinical trial; this is the only way to be certain about whether it works as a treatment for COVID-19.”

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Early viral clearance among Covid-19 patients when gargling with povideon-iodine and essential oils: a pilot clinical trial

Authors: Mohamed NA et al

Publication date: 09 September 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.09.07.20180448

Background: Gargling had been reported to have significant roles in the prevention and treatment of respiratory tract infections. The purpose of this study was to assess the ability of regular gargling to eliminate SARS-CoV-2 in the oropharynx and nasopharynx. Methodology: This pilot, open labeled, randomized, parallel study compared the effect of 30 seconds, 3 times/day gargling using 1% povidone-iodine (PVP-I), essential oils and tap water on SARS-CoV-2 viral clearance among COVID-19 patients in a tertiary hospital in Kuala Lumpur. Progress was monitored by day 4,6 and 12 PCR (Ct value), gargling and symptoms diary as well as clinical observations. Results: Five confirmed Stage 1 COVID-19 patients were recruited for each arm. The age range was from 22 to 56 years old. The majority were males. Two respondents had co-morbidities, which were asthma and obesity. Viral clearance was achieved at day 6 in 100%, 80%, 20% and 0% for 1% PVP-I, essential oils, tap water and control group respectively. Analysis of 1% PVP-I group versus control group showed significant p-value for comparison of PCR results on Day 4, Day 6 and Day 12. Conclusions: This preliminary study showed that gargling with 1% PVP-I and essential oils show great potential to be part of the treatment and management of Stage 1 COVID-19. Larger studies are required to ascertain the benefit of gargling for different stages of COVID-19 patients.

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COVID-19 and the Path to Immunity

Authors: David S Stephen MD and M Juliana McElrath PhD

Publication date: 11 September 2020

Journal: JAMA

DOI: 10.1001/jama.2020.16656

The emergence of adaptive immunity in response to the novel Betacoronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), occurs within the first 7 to 10 days of infection.1-3 Understanding the key features and evolution of B-cell– and T-cell–mediated adaptive immunity to SARS-CoV-2 is essential in forecasting coronavirus disease 2019 (COVID-19) outcomes and for developing effective strategies to control the pandemic. Ascertaining long-term B-cell and T-cell immunological memory against SARS-CoV-2 is also critical to understanding durable protection.

A robust memory B-cell and plasmablast expansion is detected early in infection,2,4 with secretion of serum IgM and IgA antibodies by day 5 to 7 and IgG by day 7 to 10 from the onset of symptoms. In general, serum IgM and IgA titers decline after approximately 28 days (Figure), and IgG titers peak at approximately 49 days. Simultaneously, SARS-CoV-2 activates T cells in the first week of infection, and virus-specific memory CD4+ cells and CD8+ T cells reportedly peak within 2 weeks but remain detectable at lower levels for 100 or more days of observation. Grifoni et al1 and others5,6 have identified SARS-CoV-2–specific memory CD4+ T cells in up to 100% and CD8+ T cells in approximately 70% of patients recovering from COVID-19. Although severe COVID-19 is characterized by high-viral titers, dysregulated innate inflammatory cytokine and chemokine responses and prolonged lymphopenia, antibody-dependent enhancement or dominant CD4+ TH2-type cytokines (eg, IL-4, IL-5, IL-13) do not appear to contribute to acute COVID-19 severity.

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Evolution of immunity to SARS-CoV-2

Authors: Wheatly AK et al

Publication date: 11 September 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.09.09.20191205

The durability of infection-induced SARS-CoV-2 immunity has major implications for public health mitigation and vaccine development. Animal studies and the scarcity of confirmed re-infection suggests immune protection is likely, although the durability of this protection is debated. Lasting immunity following acute viral infection requires maintenance of both serum antibody and antigen-specific memory B and T lymphocytes and is notoriously pathogen specific, ranging from life-long for smallpox or measles4, to highly transient for common cold coronaviruses (CCC). Neutralising antibody responses are a likely correlate of protective immunity and exclusively recognise the viral spike (S) protein, predominantly targeting the receptor binding domain (RBD) within the S1 sub-domain. Multiple reports describe waning of S-specific antibodies in the first 2-3 months following infection. However, extrapolation of early linear trends in decay might be overly pessimistic, with several groups reporting that serum neutralisation is stable over time in a proportion of convalescent subjects. While SARS-CoV-2 specific B and T cell responses are readily induced by infection, the longitudinal dynamics of these key memory populations remains poorly resolved. Here we comprehensively profiled antibody, B and T cell dynamics over time in a cohort recovered from mild-moderate COVID-19. We find that binding and neutralising antibody responses, together with individual serum clonotypes, decay over the first 4 months post-infection, as expected, with a similar decline in S-specific CD4+ and circulating T follicular helper (cTFH) frequencies. In contrast, S-specific IgG+ memory B cells (MBC) consistently accumulate over time, eventually comprising a significant fraction of circulating MBC. Modelling of the concomitant immune kinetics predicts maintenance of serological neutralising activity above a titre of 1:40 in 50% of convalescent subjects to 74 days, with probable additive protection from B and T cells. Overall, our study suggests SARS-CoV-2 immunity after infection is likely to be transiently protective at a population level. SARS-CoV-2 vaccines may require greater immunogenicity and durability than natural infection to drive long-term protection.

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Cross-reactive antibody responses against SARS-CoV-2 and seasonal common cold coronaviruses

Authors: Klompus S et al

Publication date: 09 September 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.09.01.20182220

Beyond SARS-CoV-2, six more coronaviruses infect humans (hCoVs), four of which cause only mild symptoms (seasonal/common cold hCoVs). Previous exposures to seasonal hCoVs may elicit immunological memory that could benefit the course of SARS-CoV-2 infections. While cross-reactive T cells epitopes of SARS-CoV-2 and seasonal hCoVs have been reported in individuals unexposed to SARS-CoV-2, potential antibody-based cross-reactivity is incompletely understood. Here, we have probed for high resolution antibody binding against all hCoVs represented as 1,539 peptides with a phage-displayed antigen library. We detected broad serum antibody responses against peptides of seasonal hCoVs in up to 75% of individuals. Recovered COVID-19 patients exhibited distinct antibody repertoires targeting variable SARS-CoV-2 epitopes, and could be accurately classified from unexposed individuals (AUC=0.96). Up to 50% of recovered patients also mounted antibody responses against unique epitopes of seasonal hCoV-OC43, that were not detectable in unexposed individuals. These results indicate substantial interindividual variability and antibody cross-reactivity between hCoVs from the direction of SARS-CoV-2 infections towards seasonal hCoVs. Our accurate high throughput assay allows profiling preexisting antibody responses against seasonal hCoVs cost-effectively and could inform on their protective nature against SARS-CoV-2.

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Social Impacts

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Authors: Maringe C PhD

Publication date: 20 July 2020

Journal: The Lancet Oncology

DOI: 10.1016/S1470-2045(20)30388-0

Background: Since a national lockdown was introduced across the UK in March, 2020, in response to the COVID-19 pandemic, cancer screening has been suspended, routine diagnostic work deferred, and only urgent symptomatic cases prioritised for diagnostic intervention. In this study, we estimated the impact of delays in diagnosis on cancer survival outcomes in four major tumour types.

Methods: In this national population-based modelling study, we used linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15–84 years, diagnosed with breast, colorectal, and oesophageal cancer between Jan 1, 2010, and Dec 31, 2010, with follow-up data until Dec 31, 2014, and diagnosed with lung cancer between Jan 1, 2012, and Dec 31, 2012, with follow-up data until Dec 31, 2015. We use a routes-to-diagnosis framework to estimate the impact of diagnostic delays over a 12-month period from the commencement of physical distancing measures, on March 16, 2020, up to 1, 3, and 5 years after diagnosis. To model the subsequent impact of diagnostic delays on survival, we reallocated patients who were on screening and routine referral pathways to urgent and emergency pathways that are associated with more advanced stage of disease at diagnosis. We considered three reallocation scenarios representing the best to worst case scenarios and reflect actual changes in the diagnostic pathway being seen in the NHS, as of March 16, 2020, and estimated the impact on net survival at 1, 3, and 5 years after diagnosis to calculate the additional deaths that can be attributed to cancer, and the total years of life lost (YLLs) compared with pre-pandemic data.

Findings: We collected data for 32 583 patients with breast cancer, 24 975 with colorectal cancer, 6744 with oesophageal cancer, and 29 305 with lung cancer. Across the three different scenarios, compared with pre-pandemic figures, we estimate a 7·9–9·6% increase in the number of deaths due to breast cancer up to year 5 after diagnosis, corresponding to between 281 (95% CI 266–295) and 344 (329–358) additional deaths. For colorectal cancer, we estimate 1445 (1392–1591) to 1563 (1534–1592) additional deaths, a 15·3–16·6% increase; for lung cancer, 1235 (1220–1254) to 1372 (1343–1401) additional deaths, a 4·8–5·3% increase; and for oesophageal cancer, 330 (324–335) to 342 (336–348) additional deaths, 5·8–6·0% increase up to 5 years after diagnosis. For these four tumour types, these data correspond with 3291–3621 additional deaths across the scenarios within 5 years. The total additional YLLs across these cancers is estimated to be 59 204–63 229 years.

Interpretation: Substantial increases in the number of avoidable cancer deaths in England are to be expected as a result of diagnostic delays due to the COVID-19 pandemic in the UK. Urgent policy interventions are necessary, particularly the need to manage the backlog within routine diagnostic services to mitigate the expected impact of the COVID-19 pandemic on patients with cancer.

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Government and Health Authorities


Impact of false-positives and false-negatives in the UK’s COVID-19 RT-PCR testing programme

Authors: Carl Mayers & Kate Baker

Publication date: 03 June 2020

Source: gov.uk


The UK’s COVID-19 testing programme uses a network of laboratories to detect SARS-CoV-2 in nasopharyngeal swabs. Pillar 1 (those with a clinical need, critical essential workers in the NHS) pillar 2 (essential workers, wider public through NHS portal, care home staff and residents regardless of symptoms) and pillar 4 (national surveillance, such as ONS surveys) of the UK testing programme use reverse-transcription polymerase chain reaction (RT-PCR) tests to detect viral RNA. These RT- PCR tests are carried out across a network of government, commercial and academic labs across the UK to meet the high demand and fast turnaround required.

RT-PCR tests are highly sensitive, but can show false negatives (giving a negative result for a person infected with COVID-19) and false positives (giving a positive result for a person not infected with COVID-19). The RT-PCR assays used for the UK’s COVID-19 testing programme have been verified by PHE, and show over 95% sensitivity and specificity. This means that under laboratory conditions, these RT-PCR tests should never show more than 5% false positives or 5% false negatives.

It is important to remember that laboratory testing verifies the analytical sensitivity and analytical specificity of the RT-PCR tests. They represent idealised testing. In a clinical or community setting there may be inefficient sampling, lab contamination, sample degradation or other sources of error that will lead to increased numbers of false positives or false negatives. The diagnostic sensitivity and diagnostic specificity of a test can only be measured in operational conditions.

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SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020

Authors: Bixler D et al

Publication date: 15 September 2020

Source: The Centers for Disease Control and Prevention

What is already known about this topic?

Symptoms associated with SARS-CoV-2 infection are milder in children compared with adults.

What is added by this report?

Among 121 SARS-CoV-2–associated deaths among persons aged <21 years reported to CDC by July 31, 2020, 12 (10%) were infants and 85 (70%) were aged 10–20 years. Hispanic, non-Hispanic Black and non-Hispanic American Indian/Alaskan Native persons accounted for 94 (78%) of these deaths; 33% of deaths occurred outside of a hospital.

What are the implications for public health practice?

Persons aged <21 years exposed to SARS-CoV-2 should be monitored for complications. Ongoing surveillance for SARS-CoV-2–associated infection, hospitalization, and death among persons aged <21 years should be continued as schools reopen in the United States.

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Clinical study set to trial inhaled Covid-19 vaccines

Publication date: 14 September 2020

Source: National Health Executive

A new clinical study, funded by UKRI and NIHR, has been launched to explore the effects of administering Covid-19 vaccines as inhaled airborne droplets rather than by injection into muscle – similar to how inhaled asthma medications are delivered.

Researchers are set to begin small trials to assess inhalation of two of the UK’s coronavirus vaccines in development, by Imperial College London and Oxford University.

These trials will assess the safety and effectiveness of delivering the vaccines directly to the respiratory tract of human volunteers, inhaled through the mouth.

It is hoped that by directly targeting the cells lining the airways, which are typical points of infection for respiratory viruses, it may be able to induce a more effective immune response. This could potentially lead to accelerating the development of effective vaccines against Covid-19 by exploring additional methods and targets.

Lead researcher Dr Chris Chiu, from the Department of Infectious Disease at Imperial College London, said: “We have evidence that delivering influenza vaccines via a nasal spray can protect people against flu, as well as help to reduce the transmission of the disease.

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Social Impacts

Unprecedented falls in GDP in most G20 economies in second quarter of 2020

Publication date: 14 September 2020

Source: OECD

COVID-19 containment measures weighed heavily on economic activity in the second quarter of 2020, with unprecedented falls in real gross domestic product (GDP) in most G20 countries. For the G20 area as a whole, GDP dropped by a record (minus) 6.9%, significantly larger than the (minus) 1.6% recorded in the first quarter of 2009 at the height of the financial crisis.

China was the only G20 country recording growth (11.5%) in the second quarter of 2020, reflecting the earlier onset of the pandemic in this country and subsequent recovery. GDP contracted by an average of (minus) 11.8% in all other G20 economies in the second quarter of 2020, when the effects of the pandemic began to be more widely felt.

GDP fell most dramatically, by (minus) 25.2%, in India, followed by the United Kingdom (minus 20.4%). GDP also dropped sharply in Mexico (minus 17.1%), South Africa (minus 16.4%), France (minus 13.8%), Italy (minus 12.8%), Canada (minus 11.5%), Turkey (minus 11.0%), Brazil and Germany (minus 9.7% in both countries), the United States (minus 9.1%), Japan (minus 7.9%), Australia (minus 7.0%) and Indonesia (minus 6.9%). The contraction was less pronounced in Korea and Russia (minus 3.2% in both countries).

Year-on-year GDP in the G20 area fell by (minus) 9.1% in the second quarter of 2020, following a contraction of (minus) 1.7% in the previous quarter. Among G20 economies, China recorded the highest annual growth (3.2%), while India recorded the largest annual fall (minus 23.5%).

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A world in disorder

Publication date: 14 September 2020

Source: Global Preparedness Monitoring Board

Never before has the world been so clearly forewarned of the dangers of a devastating pandemic, nor previously had the knowledge, resources and technologies to deal with such a threat. Yet, never before has the world witnessed a pandemic of such widespread and destructive social and economic impact.

The COVID-19 pandemic has revealed a collective failure to take pandemic prevention, preparedness and response seriously and prioritize it accordingly. It has demonstrated the fragility of highly interconnected economies and social systems, and the fragility of trust. It has exploited and exacerbated the fissures within societies and among nations. It has exploited inequalities, reminding us in no uncertain terms that there is no health security without social security. COVID-19 has taken advantage of a world in disorder.

The last century has witnessed numerous developments and innovations that have improved and prolonged lives the world over. But the same advances have also created unprecedented vulnerability to fast moving infectious disease outbreaks by fueling population growth and mobility, disorienting the climate, boosting interdependence, and generating inequality. The destruction of tropical rain forests has increased the opportunities for transmission of viruses from wild animals to humans. We have created a world where a shock anywhere can become a catastrophe everywhere, while growing nationalism and populism undermine our shared peace, prosperity and security. Infectious diseases feed off divisiveness; societal divisions can be deadly.

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Media – Science related


The coronavirus is mutating — does it matter?

Author: Ewen Callaway

Publication date: 08 September 2020

Source: Nature

When COVID-19 spread around the globe this year, David Montefiori wondered how the deadly virus behind the pandemic might be changing as it passed from person to person. Montefiori is a virologist who has spent much of his career studying how chance mutations in HIV help it to evade the immune system. The same thing might happen with SARS-CoV-2, he thought.

In March, Montefiori, who directs an AIDS-vaccine research laboratory at Duke University in Durham, North Carolina, contacted Bette Korber, an expert in HIV evolution and a long-time collaborator. Korber, a computational biologist at the Los Alamos National Laboratory (LANL) in Sante Fe, New Mexico, had already started scouring thousands of coronavirus genetic sequences for mutations that might have changed the virus’s properties as it made its way around the world.

Compared with HIV, SARS-CoV-2 is changing much more slowly as it spreads. But one mutation stood out to Korber. It was in the gene encoding the spike protein, which helps virus particles to penetrate cells. Korber saw the mutation appearing again and again in samples from people with COVID-19. At the 614th amino-acid position of the spike protein, the amino acid aspartate (D, in biochemical shorthand) was regularly being replaced by glycine (G) because of a copying fault that altered a single nucleotide in the virus’s 29,903-letter RNA code. Virologists were calling it the D614G mutation.

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What does a case of Covid-19 really mean?

Authors: Prof Carl Heneghan & Tom Jefferson

Publication date: 14 September 2020

Source: The Spectator

‘What's in a name? That which we call a rose by any other name would smell as sweet,’ wrote the Bard. He was referring to a rose which is a rose, instantly recognised by its fragrance and its appearance. But a case of Covid-19 does not fit the metaphor, because it differs wherever you look.

In the course of our evidence gathering activities, we have gone through a few thousand papers reporting studies on all aspects of Covid-19 spread. We found that not very many defined a case of Covid, which is a sign of sloppiness when that is what you are looking for. Those that did, reported different definitions and ways of ascertaining what they meant by a ‘case’.

Now this may seem a pedantic academic remark, but in reality, it underlines the chaos which has crept into Covid-19 science and decision-making. After watching the briefing by the Chief Medical Officer Chris Whitty on 9th September, where he described his worry about the increase in cases and compared the situation in the UK to other countries, we asked the question: what does a Covid 19 case mean and how do different nations define a case? We looked at the definition of a case given by the World Health Organisation, the US and EU Centres for Disease Control, China, Italy, Spain, France. We only tapped official websites, and what came out was a concoction that did not smell like the Bard’s rose.

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Government Innumeracy

Author: James Ferguson

Publication date: 12 September 2020

Source: Lockdown Sceptics

Are you positive you are ‘positive’?

The UK has a big problem with the false positive rate (FPR) of its COVID-19 tests. The authorities acknowledge no FPR, so positive test results are not corrected for false positives and that is a big problem.

The standard COVID-19 RT-PCR test results have a consistent positive rate of ≤ 2% which also appears to be the likely false positive rate (FPR), rendering the number of official ‘cases’ virtually meaningless. The likely low virus prevalence (~0.02%) is consistent with as few as 1% of the 6,100+ Brits now testing positive each week in the wider community (pillar 2) tests actually having the disease.

We are now asked to believe that a random, probably asymptomatic member of the public is 5x more likely to test ‘positive’ than someone tested in hospital, which seems preposterous given that ~40% of diagnosed infections originated in hospitals.

The high amplification of PCR tests requires them to be subject to black box software algorithms, which the numbers suggest are preset at a 2% positive rate. If so, we will never get ‘cases’ down until and unless we reduce, or better yet cease altogether, randomized testing. Instead the government plans to ramp them up to 10m a day at a cost of £100bn, equivalent to the entire NHS budget.

Government interventions have seriously negative political, economic and health implications yet are entirely predicated on test results that are almost entirely false. Despite the prevalence of virus in the UK having fallen to about 2-in-10,000, the chances of testing ‘positive’ stubbornly remain ~100x higher than that.

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Operation Moonshot: What do the leaked documents say?

Author: Elisabeth Mahase

Publication date: 11 September 2020

Journal: The BMJ

DOI: 10.1136/bmj.m3558

Operation Moonshot is the name of the UK government’s newly proposed covid-19 mass testing scheme. The plan, revealed by The BMJ,1 involves an expansion of testing from the current hundreds of thousands of tests each day to 10 million a day by early 2021. But how does the government propose to do this?

How will testing increase between now and early 2021?

The documents show a proposed three stage rollout. They state that the UK will carry out between 200 000 to 800 000 tests a day between September and December 2020. This might break down to:

200 000 tests a day on people with symptoms,

100 000 a day on people without symptoms in local areas to suppress outbreaks,

250 000 a day on people without symptoms in the NHS and care homes, and

100 000 a day through national prevalence studies.

From December the plans propose increasing daily capacity to between two and four million. This would involve mass testing of all homes in local areas or whole cities when prevalence rises (430 000 tests a day), testing high contact professions such as teachers every week (100 000 a day), and testing people to allow them to enter high risk settings, such as visitors to hospital and care homes.

The plan then states that there would be “full rollout” in early 2021 to 10 million tests a day, to “enable people to return to and maintain normal life.” At this stage, weekly testing would be made available progressively to the whole population to allow people to go to high risk events by using a “digital passport” to show they have tested negative for the virus.

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Covid-19: Government plans to spend £100bn on expanding testing to 10 million a day

Authors: Gareth Lacobucci and Rebecca Coombes

Publication date: 09 September 2020

Source: The BMJ

The UK government has drawn up plans to carry out up to 10 million covid-19 tests a day by early next year as part of a huge £100bn (€110bn; $130bn) expansion of its national testing programme, documents seen by The BMJ show.

The internal correspondence reveals that the government is prepared to almost match what it spends on the NHS in England each year (£130bn) to fund mass testing of the population “to support economic activity and a return to normal life” under its ambitious Operation Moonshot programme.

A briefing memo sent to the first minister and cabinet secretaries in Scotland, seen by The BMJ, says that the UK-wide Moonshot programme is expected to “cost over £100bn to deliver.” If achieved, the programme would allow testing of the entire UK population each week.

A separate PowerPoint presentation prepared for the government by the global management consulting firm Boston Consulting Group, also seen by The BMJ, says the plans had the potential to grow the UK’s testing capacity from the current 350 000 a day to up to 10 million tests a day by early 2021.

Critics have already rounded on the plans as “devoid of any contribution from scientists, clinicians, and public health and testing and screening experts,” and “disregarding the enormous problems with the existing testing and tracing programmes.”

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Taking the UK’s Testing Strategy to the Next Level

Publication date: 17 August 2020

Source: Tony Blair Institute for Global Change

With a safe vaccine still some way off, mass testing – meaning testing the majority of the population, using all possible means at our disposal – remains the only way to restore confidence and allow the UK to live safely alongside Covid-19. This means an evolution in the government’s testing strategy, from one based on targeted testing to one that opens up testing to as many people as possible, as often as possible.

It is the key to reviving our economy and getting the country back to work.

We are therefore asking the government to make establishing a mass-testing regime its core objective.

This means evolving its existing testing strategy from one targeted on those with symptoms to a system that sees people tested often and easily. It is no easy ask. We ourselves are experienced in the challenges of governing, and Covid-19 is the most disruptive event of our lifetimes. To have gone from minimal lab-based testing to an infrastructure that has capacity to test more than 300,000 people per day should be rightly celebrated. The government and Britain’s diagnostics industry deserve much credit for this.

Mass testing is the natural next step, but it requires a giant leap in the focus, resources and support demanded of government. These are set out across five pillars in this paper, which also serves as a plan for boosting testing capacity, including incentivising and onboarding rapid on-the-spot tests. This evolution in testing will not happen overnight and nor should we expect it to. Regular testing should be steadily introduced to those sectors identified as a priority by government, including education and social care, while employers should be supported to participate in mass testing. The need for mass testing has been set out clearly by figures such as Anthony Costello, Paul Romer and Sir Patrick Vallance, as well by organisations like the WHO and today, the CBI.

We know there is a delicate balance to be struck between health and economic concerns. We also know that the two are inextricably linked: an economy in freefall causes immense physical and mental harm and the uncertainty of lockdowns will lead to deep and lasting economic damage. Having the confidence to return to work and for consumers to interact with businesses is now a must, but it can only be achieved by learning to live alongside the virus. Short of a safe vaccine, mass testing is the only way to realise this.

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Scientists Voice Concerns over Russian COVID-19 Vaccine Study

Author: Amanda Heidt

Publication date: 11 September 2020

Source: The Scientist

The first data detailing Russia’s COVID-19 vaccine—nicknamed Sputnik—was published last week (September 4) in The Lancet. Almost immediately, other scientists began to call attention to unlikely patterns in the data, asking for raw numbers to verify the study’s conclusions.

Enrico Bucci, a systems biologist and bioethicist at Temple University, published an open letter on his blog September 7 to draw The Lancet’s attention to suspected data manipulation. While he stresses that the letter is not an allegation, “the presentation of the data raises several concerns which require access to the original data to fully investigate.”

The study reports results of Russia’s Phase 1/2 clinical trial to assess the safety and effectiveness of its vaccine candidate, carried out by Moscow’s Gamaleya Institute. The tests took place between June and July of this year with 76 participants, and researchers trialed two versions of a human adenovirus vector–based immunization, an approach similar to that of the AstraZeneca/University of Oxford joint initiative. The benign virus contains the gene for the SARS-CoV-2 spike protein that when expressed primes the immune system to recognize the virus as a threat.

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KFF Health Tracking Poll - September 2020: Top Issues in 2020 Election, The Role of Misinformation, and Views on A Potential Coronavirus Vaccine

Authors: Liz Hamel, Audrey Kearney, Ashley Kirzinge, Lunna Lopes, Cailey Muñana, and Mollyann Brodie

Publication date: 10 September 2020

Source: Kaiser Family Foundation

Recently, the Centers for Disease Control and Prevention (CDC) issued a notice to states to start preparing to distribute a coronavirus vaccine by November 1st, 2 days before the 2020 election. Most adults (81%), including majorities across partisans, do not think a vaccine for coronavirus will be widely available in the U.S. before the presidential election in November.

Many (62%) are worried that the political pressure from the Trump administration will lead the FDA to rush to approve a coronavirus vaccine without making sure that it is safe and effective – including 85% of Democrats and 61% of independents. Fewer Republicans (35%) express this level of concern. About four in ten adults overall say both the FDA (39%) and the CDC (42%) are paying “too much attention” to politics when it comes to reviewing and approving treatments for coronavirus or issuing guidelines and recommendations.

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Heidi Larson: shifting the conversation about vaccine confidence

Author: Heidi Larson

Publication date: 10 September 2020

Journal: The Lancet

DOI: 10.1016/S0140-6736(20)31612-3

Heidi Larson is no stranger to opposition. Some in the health community took time to recognise the relevance of her work on vaccine hesitancy. Professor of Anthropology, Risk and Decision Science at the Department of Infectious Disease Epidemiology at the UK's London School of Hygiene & Tropical Medicine (LSHTM), Larson is the founder and Director of the Vaccine Confidence Project (VCP). A key research focus of the VCP is developing an early warning system to detect, monitor, and analyse waning public confidence in vaccines. Set up in 2010, the VCP also offers guidance for responding to such concerns and building public engagement to sustain confidence in vaccines and immunisation. “The VCP has contributed to getting an acknowledgment that Houston, we have a problem. Most rewarding has been building a multidisciplinary team around this complex issue. My team keep me motivated, inspired, and challenge me daily”, she says.

Larson's passion to challenge the system came from her father, an Episcopal priest and civil rights advocate. “My Dad once told me, ‘don't believe everything you read, question it!’ Somehow that stuck with me”, she says. Larson grew up in Massachusetts, USA, and after a degree in Visual and Environmental Studies from Harvard University, Harvard's Sheldon Traveling Fellowship took her research to Israel, where she also worked with Save the Children. In 1980, she moved to Nepal with Save the Children and then worked for UNICEF. “Seeing the UN agencies and their development programmes parachute in as if people don't have existing lives, beliefs, their own culture, and social ways really struck me”, she says. During those Nepal years, Larson realised the importance of social context in development work, and returned to academia to complete a PhD in anthropology at the University of California, Berkeley. In 1993, she took a post with UNICEF in the South Pacific for 6 years and oversaw implementation of social mobilisation strategies to support child and adolescent health in 13 Pacific Island countries. She became UNICEF's cross-UN focal point on AIDS and grew interested in engaging with and understanding social behaviours in this work. In 1998, she joined WHO as a Senior Adviser in communicable diseases and tuberculosis programmes, but moved back to UNICEF in 2000 to lead UNICEF's strategic communication on new vaccines and the launch of Gavi, The Vaccine Alliance.

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Not just conspiracy theories: vaccine opponents and pro-ponents add to the COVID-19 ‘infodemic’ on Twitter

Authors: Jamison AM et al

Publication date: 09 September 2020

Source: Harvard Kennedy School

In February 2020, the World Health Organization announced an ‘infodemic’ — a deluge of both accurate and inaccurate health information — that accompanied the global pandemic of COVID-19 as a major challenge to effective health communication. We assessed content from the most active vaccine accounts on Twitter to understand how existing online communities contributed to the ‘infodemic’ during the early stages of the pandemic. While we expected vaccine opponents to share misleading information about COVID-19, we also found vaccine proponents were not immune to spreading less reliable claims. In both groups, the single largest topic of discussion consisted of narratives comparing COVID-19 to other diseases like seasonal influenza, often downplaying the severity of the novel coronavirus. When considering the scope of the ‘infodemic,’ researchers and health communicators must move beyond focusing on known bad actors and the most egregious types of misinformation to scrutinize the full spectrum of information — from both reliable and unreliable sources — that the public is likely to encounter online. 

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Covid-19 vaccine trial participant had serious neurological symptoms, but could be discharged today, AstraZeneca CEO says

Author: Adam Feuerstein

Publication date: 09 September 2020

Source: STAT

The participant who triggered a global shutdown of AstraZeneca’s Phase 3 Covid-19 vaccine trials was a woman in the United Kingdom who experienced neurological symptoms consistent with a rare but serious spinal inflammatory disorder called transverse myelitis, the drug maker’s chief executive, Pascal Soriot, said during a private conference call with investors on Wednesday morning.

The woman’s diagnosis has not been confirmed yet, but she is improving and will likely be discharged from the hospital as early as Wednesday, Soriot said.

The board tasked with overseeing the data and safety components of the AstraZeneca clinical trials confirmed that the participant was injected with the company’s Covid-19 vaccine and not a placebo, Soriot said on the conference call, which was set up by the investment bank J.P. Morgan.

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Media – Reporting


Was Covid-19 spreading freely worldwide BEFORE last Christmas? The evidence keeps stacking up

Author: Peter Andrews

Publication date: 11 September 2020

Source: RT.com

A new study from America indicates that people were falling ill with coronavirus-like symptoms in December 2019, but doctors at the time dismissed it as ordinary flu.

A team of doctors from Los Angeles scouring the hospital records from last winter has discovered a series of smoking gun clues which almost guarantee that Covid-19 was present in America well before Christmas.

Scientists from UCLA have been analysing over 10 million hospital records from December 1, 2019 to February 29, 2020. Comparing that winter to previous ones, they noticed a 50-percent increase in ‘coughing’ as a symptom on admission forms. In addition, 18 more people than would ordinarily be expected were hospitalised with acute respiratory failure.

In fact, the scientists estimate that there may have been 1,000 or more Covid sufferers in LA alone last winter – and presumably those are just the symptomatic minority. At the time, of course, all of this was put down to a moderately bad flu season. Officially, Covid did not turn up in LA until January 22, when a traveller in LAX airport fell ill. He was from Wuhan, and was identified as Covid-positive four days later.

This bombshell fits an emerging body of evidence on an earlier coronavirus timeline. Many people may remember the reports of a strange vaping-related illness that ravaged Americans towards the end of last year. There was a good deal of study on it. Scientists at first thought it was the oils in the e-cigs congealing in people’s lungs, but soon debunked that hypothesis. In hindsight, it is difficult to look past Covid as the real culprit. Pneumonia-like symptoms, ordinarily fit people falling severely ill… it was Covid all over.

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Sweden spared European surge as coronavirus infections stay low

Author: Jon Henley

Publication date: 16 September 2020

Source: The Guardian

While many European countries are seeing new cases surge to levels not seen since the peak of the Covid-19 pandemic, Sweden – whose light-touch approach has made it an international outlier – has one of the continent’s lowest infection rates.

According to the European Centre for Disease Prevention and Control (ECDC), the Scandinavian country’s 14-day cumulative total of new cases was 22.2 per 100,000 inhabitants on Tuesday, against 279 in Spain, 158.5 in France, 118 in the Czech Republic, 77 in Belgium and 59 in the UK, all of which imposed lockdowns this spring.

Twenty-two of the 31 European countries surveyed by the ECDC had higher infection rates. New cases, now reported in Sweden only from Tuesday to Friday, are running at roughly the rate seen in mid-March, while data from the national health agency showed only 1.2% of its 120,000 tests last week came back positive.

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People who refuse to self-isolate could be detained under proposed Victorian law

Author: Paul Sakkal

Publication date: 15 September 2020

Source: The Age

New powers to detain people considered a high risk of negligently spreading COVID-19 are set to be debated in State Parliament this week.

The Victorian government could also enlist protective services officers and WorkSafe inspectors to enforce public health directions under the proposed law, which extends one-off changes made in April for another six months.

People suspected by health authorities of being likely to spread the virus if they are COVID-positive or a close contact of an infected person could be forcibly detained if the bill is passed.

The rules, confirmed to The Age by a state government spokesman, could be applied to conspiracy theorists who refuse to self-isolate or severely drug-affected or mentally impaired people who do not have the capacity to quarantine.

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The cure is worse than the disease: Dr JOHN LEE argues that the coronavirus lockdown could cause more long-term harm than the illness itself

Author: Dr John Lee

Publication date: 13 September 2020

Source: Mail Online

The supposed cure for coronavirus is turning out to be worse than the disease. As analysis by the Mail reveals today, more lives are being wrecked by the official response to Covid than by the virus itself.

In a bizarre paradox, ill-directed efforts at protecting public health are creating a public health disaster.

When the outbreak began, the Government decided to shield the NHS, with the aim of maintaining its capacity for the imminent tidal wave of cases. All resources were focused on this goal.

From March, the treatment of other conditions and illnesses was put in abeyance for three months. And to this day, the NHS has not resumed anything like normal service. But the predicted Covid deluge never materialised.

Even now the fiercely disputed current Covid death toll of 41,628 is barely half the total fatalities of the 1968 flu epidemic in the UK.

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Our right to spend time with loved ones is being cruelly violated by the government

Author: Nicci Gerrard

Publication date: 13 September 2020

Source: The Guardian

Just as I sat down to write this piece, my phone rang. The woman’s voice was thick with distress. She didn’t want her name to be public, didn’t want practical help; she just wanted to tell her story to someone and she didn’t know who would listen and who would care.

Her husband, to whom she has been married for 57 years, has dementia and is in a home. Before lockdown, she visited twice a day, spending hours with him, kissing him, hugging and holding him. He is at a stage of his dementia where it can be hard to have a conversation, but, she says, “he understands affective language” – the language of touch, of physical presence and affection. People with dementia lose so much, but they usually do not lose their deep feelings, their love and need.

In March, the doors shut. When at last she was allowed to see him – at a window, at a distance, wearing a mask – he was blank and confused. On the second visit, he was more responsive. He stood with his arms held out for a hug and beckoned her to come closer. “I kept saying, ‘Darling, I can’t, my darling.’ It was torture, for him and for me. And he might forget, he has dementia, but I – I don’t forget.”

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Fauci: Return to pre-coronavirus normality will be 'well into 2021'

Author: Peter Sullivan

Publication date: 11 September 2020

Source: The Hill

The nation's top infectious disease expert Anthony Fauci said Friday that it will be “well into 2021” before the country returns to a level of normality resembling pre-coronavirus times.

“If you're talking about getting back to a degree of normality which resembles where we were prior to COVID[-19], it's going to be well into 2021, maybe even towards the end of 2021,” Fauci said on MSNBC.

Dr. Fauci discusses distributing the coronavirus vaccine to the public and returning to "normality":

"If you're talking about getting back to a degree of normality, which resembles where we were prior to COVID, it's gonna be well into 2021. Maybe even towards the end of 2021." pic.twitter.com/FHhdWhSsFb

when asked when people will be able to go to a movie theater without wearing masks. Fauci noted a theater is a high-risk environment, given that it is indoors and closed off.

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Big Tech Removes a Video From Prominent Think Tank For Contradicting WHO on Coronavirus

Author: Leah Barkoukis

Publication date: 14 September 2020

Source: Townhall

The Hoover Institution at Stanford University is one of the most prominent think tanks in America, and its fellows are some the most accomplished in their respective fields. But that doesn’t matter to Big Tech. YouTube recently removed a June 23 interview its senior fellow Dr. Scott Atlas did with Hoover because it goes against the World Health Organization’s position on the Wuhan coronavirus.

According to Avik Roy, president of the Foundation for Research on Equal Opportunity, the decision was made because the video “contradicts the World Health Organization or local health authorities’ medical information about COVID-19.”

In the interview’s description it explains that Atlas is not “COVID-19 denier” but that the “one-size-fits-all approach we are currently using is overly authoritarian, inefficient, and not based in science.” Moreover, he argues “an economic shutdown, and all of the attendant issues that go along with it, is a terrible solution.” The transcript is still available here.

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Social Impacts


Publication date: 15 September 2020

Source: Bill & Melinda Gates Foundation

AS WE WRITE, COVID-19 has killed more than 850,000 people. It has plunged the world into a recession that is likely to get worse. And many countries are bracing for another surge in cases.

In past editions of the Goalkeepers Report—almost every time we have opened our mouths or put pen to paper, in fact—we have celebrated decades of historic progress in fighting poverty and disease.

Icons for the Sustainable Development Goals (SDGs) and shown together on a lighter blue background.

But we have to confront the current reality with candor: This progress has now stopped. In this report, we track 18 indicators included in the United Nations’ Sustainable Development Goals (SDGs). In recent years, the world has improved on every single one. This year, on the vast majority, we’ve regressed.

And so this essay has two goals. First, we analyze the damage the pandemic has done and is still doing—to health, to economies, and to virtually everything else. Second, we argue for a collaborative response. There is no such thing as a national solution to a global crisis. All countries must work together to end the pandemic and begin rebuilding economies. The longer it takes us to realize that, the longer it will take (and the more it will cost) to get back on our feet.

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It's Far Too Late to Think Lockdowns Can Make Covid-19 Go Away

Author: Ryan McMaken

Publication date: 12 September 2020

Source: Mises Institute

In the early days of the coronavirus crisis, the rationale given for lockdowns was that it was necessary to stay at home for "fifteen days to slow the spread." The idea was that social distancing was necessary so that hospitals and other healthcare resources would not be overwhelmed.

However, by the summer of 2020, whether by design or not, it became common to hear media pundits, politicians, and even some scientists either imply or outright claim that social distancing could permanently flatten the curve or otherwise somehow cause a drastic reduction in overall covid-19 deaths.

For example, The Hill's Reid Wilson claimed in July: "We know how to stop this virus, it requires social distancing, it requires wearing a mask, and constant hand sanitizers and staying home as much as possible."


Yet this displays a woeful lack of understanding about the purpose and effectiveness of lockdowns. Lockdowns of the sort seen in April and May in this country do nothing at all to "stop this virus." The lockdown strategy only works to completely stop a disease if certain conditions can be met. Specifically, the lockdown must be extremely strict,  and it must be maintained indefinitely—perhaps for years—until a safe and effective vaccine is widely available.

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