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REACT-1 round 6 updated report: high prevalence of SARS-CoV-2 swab positivity with reduced rate of growth in England at the start of November 2020

Authors: Riley S et al

Publication date: 20 November 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.11.18.20233932

Methods: REACT-1 is a series of community surveys of SARS-CoV-2 RT-PCR swab-positivity in England designed to monitor the spread of the epidemic and thus increase situational awareness. Round 6 of REACT-1 commenced swab-collection on 16th October. A prior interim report included data from 16th to 25th October for 85,971 participants. Here, we report data for the entire round on 160,175 participants with swab results obtained up to 2nd November 2020.

Results: Overall weighted prevalence of infection in the community in England was 1.3% or 130 people per 10,000 infected, up from 60 people per 10,000 in the round 5 report (18th September to 5th October 2020), doubling every 24 days on average since the prior round. The corresponding R number was estimated to be 1.2. Prevalence of infection was highest in North West (2.4%, up from 1.2%), followed by Yorkshire and The Humber (2.3% up from 0.84%), West Midlands (1.6% up from 0.60%), North East (1.5% up from 1.1%), East Midlands (1.3% up from 0.56%), London (0.97%, up from 0.54%), South West (0.80% up from 0.33%), South East (0.69% up from 0.29%), and East of England (0.69% up from 0.30%). Rapid growth in the South observed in the first half of round 6 was no longer apparent in the second half of round 6. We also observed a decline in prevalence in Yorkshire and The Humber during this period. Comparing the first and second halves of round 6, there was a suggestion of decline in weighted prevalence in participants aged 5 to 12 years and in those aged 25 to 44 years. While prevalence remained high, in the second half of round 6 there was suggestion of a slight fall then rise that was seen nationally and also separately in both the North and the South.

Conclusion: The impact of the second national lockdown in England is not yet known. We provide here a detailed description of swab-positivity patterns at national, regional and local scales for the period immediately preceding lockdown, against which future trends in prevalence can be evaluated.

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Post-lockdown SARS-CoV-2 nucleic acid screening in nearly ten million residents of Wuhan, China

Authors: Cao S et al

Publication date: 20 November 2020

Source: Nature

DOI: 10.1038/s41467-020-19802-w

Stringent COVID-19 control measures were imposed in Wuhan between January 23 and April 8, 2020. Estimates of the prevalence of infection following the release of restrictions could inform post-lockdown pandemic management. Here, we describe a city-wide SARS-CoV-2 nucleic acid screening programme between May 14 and June 1, 2020 in Wuhan. All city residents aged six years or older were eligible and 9,899,828 (92.9%) participated. No new symptomatic cases and 300 asymptomatic cases (detection rate 0.303/10,000, 95% CI 0.270–0.339/10,000) were identified. There were no positive tests amongst 1,174 close contacts of asymptomatic cases. 107 of 34,424 previously recovered COVID-19 patients tested positive again (re-positive rate 0.31%, 95% CI 0.423–0.574%). The prevalence of SARS-CoV-2 infection in Wuhan was therefore very low five to eight weeks after the end of lockdown.

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Household Transmission of SARS-COV-2: Insights from a Population-based Serological Survey

Authors: Bi et al

Publication date: 04 November 2020

Journal: medRxiv

DOI: 10.1101/2020.11.04.20225573

Conclusions and Relevance: The risk of infection from exposure to a single infected household member was four-times that of extra-household exposures over the first wave of the pandemic. Young children had a lower risk from infection from household members. Asymptomatic infections are far less likely to transmit than symptomatic ones but do cause infections. While the small households in Geneva limit the contribution of household spread, household transmission likely plays a greater role in other settings.

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Covid-19 patients

UK report on 15,983 patients critically ill with COVID-19

Institution: Intensive Care National Audit & Research Centre (ICNARC)

Publication date: 13 November 2020


Obesity, old age and frailty are the true risk factors for COVID-19 mortality and not chronic disease or ethnicity

Authors: Philipose Z etal

Publication date: 18 November 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.08.12.20156257

Background: Coronavirus-19 (COVID-19) mortality in hospitalised patients is strongly associated with old age, nursing home residence, male sex and obesity, with a more controversial association with ethnicity and chronic diseases, in particular diabetes mellitus. Further complicating the evaluation of the independent impacts of these risk factors is the failure to control for frailty in the published studies thus far. Aim: To determine the true risk factors for mortality in patients confirmed to have COVID-19 in Croydon needing hospital admission and to evaluate the independence of these risk factors in this group after adjusting for body mass index (BMI) and frailty. Methods: This observational study retrospectively reviewed hospital electronic medical records of 466 consecutive patients who were admitted to Croydon University Hospital confirmed positive by rapid PCR test from 11th March 2020 to 9th April 2020. Statistical analysis was performed by multiple unconditional and univariate logistic regression. Results: After multivariate analysis, male sex [OR 1.44 (CI 0.92-2.40)], age (per year) [OR 1.07 (CI 1.05-1.09)], morbid obesity (BMI > 40 kg/m2 vs reference BMI 18.5-24.9 kg/m2 ) [OR 14.8 (CI 5.25-41.8)], and nursing home residence (OR 3.01 (CI 1.56-5.79) were independently associated with COVID-19 mortality with no statistically significant association found with chronic diseases or ethnicity. In the non-nursing home population, after adjusting for age and sex, the odds ratio for type 2 diabetes mellitus (T2DM) as a risk factor was 1.64 (CI 1.03-2.61, p = 0.03) and was and was attenuated to 1.30 (CI 0.78-2.18)) after controlling for BMI; the association of mortality with male sex was strengthened [OR 1.66 (CI 0.96-2.87)] and that for ethnic minority patients was weakened [South Asians [from OR 1.30 (CI 0.67-2.53)) to OR 1.21 (CI 0.60-2.46)]; African Caribbeans [from OR 1.24 (CI 0.65-2.34) to OR 1.16 (CI 0.58-2.30)]. There was a borderline but potentially large protective effect (p= 0.09) in patients who were on anticoagulation drugs prior to admission [OR 0.56 (CI 0.28-1.11)]. Conclusion: No significant effect of ethnicity and chronic diseases as independent risk factors on COVID-19 mortality was found whereas male sex, high BMI, old age, and frailty were found to be independent risk factors. BMI was related to mortality risk throughout its range from underweight to severely obese. It is likely that chronic diseases are epiphenomena of the effects of ageing and visceral adiposity on the immune system. Routine prophylactic treatment with anticoagulant drugs in the high risk COVID-19 population warrants further prompt investigation.

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Multi-organ impairment in low-risk individuals with long COVID

Authors: Dennis A et al

Publication date: 16 October 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.10.14.20212555

In a young, low-risk population with ongoing symptoms, almost 70% of individuals have impairment in one or more organs four months after initial symptoms of SARS-CoV-2 infection. There are implications not only for burden of long COVID but also public health approaches which have assumed low risk in young people with no comorbidities.

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Covid-19 Mortality: A Matter of Vulnerability Among Nations Facing Limited Margins of Adaptation

Authors: De Larochelambert Q et al

Publication date: 19 November 2020

Journal: Frontiers in Public Health

DOI: 10.3389/fpubh.2020.604339

Context: The human development territories have been severely constrained under the Covid-19 pandemic. A common dynamics has been observed, but its propagation has not been homogeneous over each continent. We aimed at characterizing the non-viral parameters that were most associated with death rate.

Methods: We tested major indices from five domains (demography, public health, economy, politics, environment) and their potential associations with Covid-19 mortality during the first 8 months of 2020, through a Principal Component Analysis and a correlation matrix with a Pearson correlation test. Data of all countries, or states in federal countries, showing at least 10 fatality cases, were retrieved from official public sites. For countries that have not yet finished the first epidemic phase, a prospective model has been computed to provide options of death rates evolution.

Results: Higher Covid death rates are observed in the [25/65°] latitude and in the [−35/−125°] longitude ranges. The national criteria most associated with death rate are life expectancy and its slowdown, public health context (metabolic and non-communicable diseases (NCD) burden vs. infectious diseases prevalence), economy (growth national product, financial support), and environment (temperature, ultra-violet index). Stringency of the measures settled to fight pandemia, including lockdown, did not appear to be linked with death rate.

Conclusion: Countries that already experienced a stagnation or regression of life expectancy, with high income and NCD rates, had the highest price to pay. This burden was not alleviated by more stringent public decisions. Inherent factors have predetermined the Covid-19 mortality: understanding them may improve prevention strategies by increasing population resilience through better physical fitness and immunity.

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Covid-19 and children

Assessment of 135 794 Pediatric Patients Tested for Severe Acute Respiratory Syndrome Coronavirus 2 Across the United States

Authors: L Charles Bailey, Hanieh Razzaghi and Evanette K Burrows

Publication date: 23 November 2020

Journal: JAMA Pediatrics

DOI: 10.1001/jamapediatrics.2020.5052

Conclusions and Relevance: In this large cohort study of US pediatric patients, SARS-CoV-2 infection rates were low, and clinical manifestations were typically mild. Black, Hispanic, and Asian race/ethnicity; adolescence and young adulthood; and nonrespiratory chronic medical conditions were associated with identified infection. Kawasaki disease diagnosis is not an effective proxy for multisystem inflammatory syndrome of childhood.

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COVID-19 and the Impact on Children's Mental Health

Authors: Waddell C et al

Publication date: November 2020

Source: Children’s Health Policy Centre, Faculty of Health Sciences, Simon Fraser University

The COVID-19 public health crisis has created significant challenges for children in British Columbia. These challenges have included most children facing restrictions in their contacts with family members and friends, as well as temporary school closures. Many children are also part of families that have experienced economic hardships. Beyond the social, educational and economic costs, there will also be mental health consequences. This rapid review therefore aimed to determine how the pandemic and its associated challenges may affect the mental health of BC’s children, including those who may be disproportionately harmed. The overarching goal was to inform and assist policymakers to support all children in BC during COVID-19 — and beyond.

Our systematic review identified one relevant original study on the mental health consequences of previous pandemics and five systematic reviews on the mental health consequences of natural disasters for children. The findings showed dramatic increases in rates of anxiety, posttraumatic stress, depression and behavioural challenges compared to rates typically found in the general population of children. Other literature suggests that some groups may also be disproportionately affected, including children from socioeconomically disadvantaged families and those who have faced extreme or cumulative adversities. Racism may contribute to Asian-Canadian children facing added hardships. Indigenous children may also be particularly disadvantaged given the cumulative adversities associated with the legacies of colonialism. As well, children with neuro-diverse special needs such as autism spectrum disorder, fetal alcohol spectrum disorder, developmental delays or other disabilities may have greater mental health needs during the pandemic.

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Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of aggregate data from randomised controlled trials

Authors: Jolliffe D et al

Publication date: 24 November 2020

Journal: medRxiv preprint

DOI: 10.1101/2020.07.14.20152728

Objectives: To assess the overall effect of vitamin D supplementation on risk of acute respiratory infection (ARI), and to identify factors modifying this effect. Design: We conducted a systematic review and meta-analysis of data from randomised controlled trials (RCTs) of vitamin D for ARI prevention using a random effects model. Pre-specified sub-group analyses were done to determine whether effects of vitamin D on risk of ARI varied according to baseline 25-hydroxyvitamin D (25[OH]D) concentration or dosing regimen. Data Sources: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, ClinicalTrials.gov and the International Standard RCT Number (ISRCTN) registry from inception to May 2020. Eligibility Criteria for Selecting Studies: Double-blind RCTs of supplementation with vitamin D or calcidiol, of any duration, were eligible if they were approved by a Research Ethics Committee and if ARI incidence was collected prospectively and pre-specified as an efficacy outcome. Results: We identified 40 eligible RCTs (total 30,956 participants, aged 0 to 95 years). Data were obtained for 29,841 (96.5%) of 30,909 participants in 39 studies. For the primary comparison of vitamin D supplementation vs. placebo, the intervention reduced risk of ARI overall (Odds Ratio [OR] 0.89, 95% CI 0.81 to 0.98; P for heterogeneity 0.009). No statistically significant effect of vitamin D was seen for any of the sub-groups defined by baseline 25(OH)D concentration. However, protective effects were seen for trials in which vitamin D was given using a daily dosing regimen (OR 0.75, 95% CI 0.61 to 0.93); at daily dose equivalents of 400-1000 IU (OR 0.70, 95% CI 0.55 to 0.89); and for a duration of ≤12 months (OR 0.82, 95% CI 0.72 to 0.94). Vitamin D did not influence the proportion of participants experiencing at least one serious adverse event (OR 0.94, 95% CI 0.81 to 1.08). Risk of bias within individual studies was assessed as being low for all but two trials. A funnel plot showed asymmetry, suggesting that small trials showing non-protective effects of vitamin D may have been omitted from the meta-analysis. Conclusions: Vitamin D supplementation was safe and reduced risk of ARI, despite evidence of significant heterogeneity across trials. The overall effect size may have been over-estimated due to publication bias. Protection was associated with administration of daily doses of 400-1000 IU vitamin D for up to 12 months. The relevance of these findings to COVID-19 is not known and requires investigation.

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Zinc and SARSCoV2: A molecular modeling study of Zn interactions with RNAdependent RNApolymerase and 3Clike proteinase enzymes

Authors: Ali Pormohammad, Nadia K Monych and Raymond J Turner

Publication date: 18 November 2020

Journal: International Journal of Molecular Medicine

DOI: 10.3892/ijmm.2020.4790

RNA‑dependent RNA‑polymerase (RdRp) and 3C‑like proteinase (3CLpro) are two main enzymes that play a key role in the replication of SARS‑CoV‑2. Zinc (Zn) has strong immunogenic properties and is known to bind to a number of proteins, modulating their activities. Zn also has a history of use in viral infection control. Thus, the present study models potential Zn binding to RdRp and the 3CLpro. Through molecular modeling, the Zn binding sites in the aforementioned two important enzymes of viral replication were found to be conserved between severe acute respiratory syndrome (SARS)‑coronavirus (CoV) and SARS‑CoV‑2. The location of these sites may influence the enzymatic activity of 3CLpro and RdRp in coronavirus disease 2019 (COVID‑19). Since Zn has established immune health benefits, is readily available, non‑expensive and a safe food supplement, with the comparisons presented here between SARS‑CoV and COVID‑19, the present study proposes that Zn could help ameliorate the disease process of COVID‑19 infection.

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Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers

Authors: Jain A et al

Publication date: 19 November 2020

Journal: Nature Scientific Reports

DOI: 10.1038/s41598-020-77093-z

COVID-19 is characterized by marked variability in clinical severity. Vitamin D had recently been reviewed as one of the factors that may affect the severity in COVID-19. The objective of current study is to analyze the vitamin D level in COVID-19 patients and its impact on the disease severity. After approval from Ethics Committee, M.L.B Medical College the current study was undertaken as continuous prospective observational study of 6 weeks. Participants were COVID-19 patients of age group 30–60 years admitted during the study period of 6 weeks. Study included either asymptomatic COVID-19 patients (Group A) or severely ill patients requiring ICU admission (Group B). Serum concentration of 25 (OH)D, were measured along with serum IL-6; TNFα and serum ferritin. Standard statistical analysis was performed to analyze the differences. Current Study enrolled 154 patients, 91 in Group A and 63 patients in Group B. The mean level of vitamin D (in ng/mL) was 27.89 ± 6.21 in Group A and 14.35 ± 5.79 in Group B, the difference was highly significant. The prevalence of vitamin D deficiency was 32.96% and 96.82% respectively in Group A and Group B. Out of total 154 patients, 90 patients were found to be deficient in vitamin D (Group A: 29; Group B: 61). Serum level of inflammatory markers was found to be higher in vitamin D deficient COVID-19 patients viz. IL-6 level (in pg/mL) 19.34 ± 6.17 vs 12.18 ± 4.29; Serum ferritin 319.17 ± 38.21 ng/mL vs 186.83 ± 20.18 ng/mL; TNFα level (in pg/mL) 13.26 ± 5.64 vs 11.87 ± 3.15. The fatality rate was high in vitamin D deficient (21% vs 3.1%). Vitamin D level is markedly low in severe COVID-19 patients. Inflammatory response is high in vitamin D deficient COVID-19 patients. This all translates into increased mortality in vitamin D deficient COVID-19 patients. As per the flexible approach in the current COVID-19 pandemic authors recommend mass administration of vitamin D supplements to population at risk for COVID-19.

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Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study)

Authors: Rastogi A et al

Publication date: 12 November 2020

Journal: BMJ Postgraduate Medical Journal

DOI: 10.1136/postgradmedj-2020-139065

Background: Vitamin D has an immunomodulatory role but the effect of therapeutic vitamin D supplementation in SARS-CoV-2 infection is not known.

Aim: Effect of high dose, oral cholecalciferol supplementation on SARS-CoV-2 viral clearance.

Participants: Asymptomatic or mildly symptomatic SARS-CoV-2 RNA positive vitamin D deficient (25(OH)D<20 ng/ml) individuals.

Intervention: Participants were randomised to receive daily 60 000 IU of cholecalciferol (oral nano-liquid droplets) for 7 days with therapeutic target 25(OH)D>50 ng/ml (intervention group) or placebo (control group). Patients requiring invasive ventilation or with significant comorbidities were excluded. 25(OH)D levels were assessed at day 7, and cholecalciferol supplementation was continued for those with 25(OH)D <50 ng/ml in the intervention arm. SARS-CoV-2 RNA and inflammatory markers fibrinogen, D-dimer, procalcitonin and (CRP), ferritin were measured periodically.

Outcome measure: Proportion of patients with SARS-CoV-2 RNA negative before day-21 and change in inflammatory markers.

Results: Forty SARS-CoV-2 RNA positive individuals were randomised to intervention (n=16) or control (n=24) group. Baseline serum 25(OH)D was 8.6 (7.1 to 13.1) and 9.54 (8.1 to 12.5) ng/ml (p=0.730), in the intervention and control group, respectively. 10 out of 16 patients could achieve 25(OH)D>50 ng/ml by day-7 and another two by day-14 [day-14 25(OH)D levels 51.7 (48.9 to 59.5) ng/ml and 15.2 (12.7 to 19.5) ng/ml (p<0.001) in intervention and control group, respectively]. 10 (62.5%) participants in the intervention group and 5 (20.8%) participants in the control arm (p<0.018) became SARS-CoV-2 RNA negative. Fibrinogen levels significantly decreased with cholecalciferol supplementation (intergroup difference 0.70 ng/ml; P=0.007) unlike other inflammatory biomarkers.

Conclusion: Greater proportion of vitamin D-deficient individuals with SARS-CoV-2 infection turned SARS-CoV-2 RNA negative with a significant decrease in fibrinogen on high-dose cholecalciferol supplementation.

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Robust and Specific Secretory IgA Against SARS-CoV-2 Detected in Human Milk

Authors: Fox A et al

Publication date: 20 November 2020

Journal: iScience

DOI: 10.1016/j.isci.2020.101735

The SARS-CoV-2 immune response in human milk has not yet been examined, although protecting infants and young children from COVID-19 is critical for limiting community transmission and preventing serious illness and death. Here, milk samples from eight COVID-19-recovered and seven COVID-19-suspected donors were tested for antibody (Ab) binding to the SARS-CoV-2 Spike protein. All samples exhibited significant specific IgA reactivity to the full Spike, whereas 80% exhibited significant IgA and secretory (s)Ab binding to the Receptor-Binding Domain (RBD). Additionally, 67% samples exhibited IgG and/or IgM binding to RBD. IgA and sAb titers were highly correlated, indicating most IgA to be sIgA. Overall, these data indicate that a robust sIgA-dominant SARS-CoV-2 Ab response in human milk after infection should be expected in a significant majority of individuals. Further research is highly warranted to determine Ab functionality and the potential for exploiting extracted milk sIgA for therapeutic use.

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Covid-19: Screening without scrutiny, spending taxpayers’ billions

Author: Kamran Abbasi

Publication date: 19 November 2020

Journal: The BMJ

DOI: BMJ 2020;371:m4487

Mass testing is a euphemism for population screening. A range of experts who care about screening for the right reasons, in the right contexts, with the right tests, and with the correct follow-up, are in no doubt.

Mike Gill and Muir Gray (who was knighted for his work on national screening programmes) insist the Liverpool mass testing pilot must be stopped.1 It is screening by the back door, bypassing appraisal by the UK’s National Screening Committee. The lateral flow test being used is of doubtful value, with a high false negative rate. Although the false positive rate is small it is still a problem in a low prevalence setting.

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Non-pharmaceutical interventions

A room with a green view: the importance of nearby nature for mental health during the COVID‐19 pandemic

Authors: Soga M et al

Publication date: 17 November 2020

Journal: Ecological Applications

DOI: 10.1002/eap.2248

The COVID‐19 pandemic and its global response have resulted in unprecedented and rapid changes to most people’s day‐to‐day lives. To slow the spread of the virus, governments have implemented the practice of physical distancing (“social distancing”), which includes isolation within the home with limited time spent outdoors. During this extraordinary time, nature around the home may play a key role in mitigating against adverse mental health outcomes due to the pandemic and the measures taken to address it. To assess whether this is the case, we conducted an online questionnaire survey (n = 3,000) in Tokyo, Japan, to quantify the association between five mental health outcomes (depression, life satisfaction, subjective happiness, self‐esteem, and loneliness) and two measures of nature experiences (frequency of greenspace use and green view through windows from home). Accounting for sociodemographic and lifestyle variables, we found that the frequency of greenspace use and the existence of green window views from within the home was associated with increased levels of self‐esteem, life satisfaction, and subjective happiness and decreased levels of depression, anxiety, and loneliness. Our findings suggest that a regular dose of nature can contribute to the improvement of a wide range of mental health outcomes. With the recent escalation in the prevalence of mental health disorders, and the possible negative impacts of the COVID‐19 pandemic on public mental health, our findings have major implications for policy, suggesting that urban nature has great potential to be used as a “nature‐based solution” for improved public health.

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Physical interventions to interrupt or reduce the spread of respiratory viruses

Authors: Jefferson T et al

Publication date: 12 November 2020

Journal: Cochrane Library

DOI: 10.1002/14651858.CD006207.pub5

The high risk of bias in the trials, variation in outcome measurement, and relatively low compliance with the interventions during the studies hamper drawing firm conclusions and generalising the findings to the current COVID‐19 pandemic.

There is uncertainty about the effects of face masks. The low‐moderate certainty of the evidence means our confidence in the effect estimate is limited, and that the true effect may be different from the observed estimate of the effect. The pooled results of randomised trials did not show a clear reduction in respiratory viral infection with the use of medical/surgical masks during seasonal influenza. There were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection. Hand hygiene is likely to modestly reduce the burden of respiratory illness. Harms associated with physical interventions were under‐investigated.

There is a need for large, well‐designed RCTs addressing the effectiveness of many of these interventions in multiple settings and populations, especially in those most at risk of ARIs.

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Modelling the impact of the mandatory use of face coverings on public transport and in retail outlets in the UK on COVID‐19‐related infections, hospital admissions and mortality

Authors: Heald AH et al

Publication date: 18 October 2020

Journal: The International Journal of Clinical Practice

DOI: 10.1111/ijcp.13768

Conclusion: We have illustrated that the policy on mandatory use of face coverings in retail outlets/on public transport may have been very well followed, but may be of limited value in reducing hospital admissions and deaths, at least at the time that it was introduced, unless infections begin to rise faster than currently seen. The impact appears small compared with all other sources of risk, thereby raising questions regarding the effectiveness of the policy.

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Social impacts

Psychological Distress and COVID-19–Related Stressors Reported in a Longitudinal Cohort of US Adults in April and July 2020

Authors: McGinty EE et al

Publication date: 23 Novmber 2020

Journal: JAMA

DOI: 10.1001/jama.2020.21231

Serious psychological distress was reported by 13.6% of US adults in April 2020 vs 3.9% in 2018.1 How psychological distress has changed over the course of the coronavirus disease 2019 (COVID-19) pandemic is unknown.

Discussion: Reported prevalence of serious psychological distress among US adults was 13.6% in April 2020 and 13% in July 2020. Persistent distress increases risk of psychiatric disorders, which the Kessler 6 scale predicts.3 High prevalence at both time points suggests that the pandemic’s longer-term disruptions are important drivers of distress. More than 60% of adults with serious distress reported that pandemic-related disruptions to education, employment, and finances negatively affected their mental health. These stressors may be particularly salient to young adults, about a quarter of whom reported serious distress in both April and July. Thirty-five percent of adults with serious distress cited inability to obtain health care as a contributing factor, highlighting the need to facilitate safe and affordable health care access during the pandemic and beyond.4,5

Limitations of the study include potential sampling and response biases. AmeriSpeak uses best-practice probability-based recruitment to minimize sampling bias,6 and survey weights incorporated nonresponse adjustments.

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Harms of public health interventions against covid-19 must not be ignored

Authors: Itai Bavli, Brent Sutton and Sandro Galea

Publication date: 02 November 2020

Journal: The BMJ

DOI: 10.1136/bmj.m4074

The harmful consequences of public health choices should be explicitly considered and transparently reported to limit their damage, say Itai Bavli and colleagues

The SARS-CoV-2 pandemic has posed an unprecedented challenge for governments. Questions regarding the most effective interventions to reduce the spread of the virus—for example, more testing, requirements to wear face masks, and stricter and longer lockdowns—become widely discussed in the popular and scientific press, informed largely by models that aimed to predict the health benefits of proposed interventions. Central to all these studies is recognition that inaction, or delayed action, will put millions of people unnecessarily at risk of serious illness or death.

However, interventions to limit the spread of the coronavirus also carry negative health effects, which have yet to be considered systematically. Despite increasing evidence on the unintended, adverse effects of public health interventions such as social distancing and lockdown measures, there are few signs that policy decisions are being informed by a serious assessment and weighing of their harms on health. Instead, much of the discussion has become politicised, especially in the US, where President Trump’s provocative statements sparked debates along party lines about the necessity for policies to control covid-19. This politicisation, often fuelled by misinformation, has distracted from a much needed dispassionate discussion on the harms and benefits of potential public health measures against covid-19.

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Government and Health Authorities


Implementation of a Pooled Surveillance Testing Program for Asymptomatic SARS-CoV-2 Infections on a College Campus — Duke University, Durham, North Carolina, August 2–October 11, 2020

Authors: Denny TN et al

Publication date: 20 November 2020

Source: Centers for Disease Control and Prevention

What is already known about this topic?

SARS-CoV-2 can rapidly spread through university settings. Pooling specimens can enable large-scale testing while minimizing needed resources.

What is added by this report?

In fall 2020, Duke University’s COVID-19 prevention strategy included risk reduction behaviors, frequent testing using pooled SARS-CoV-2 polymerase chain reaction testing, and contact tracing. Among 10,265 students who received testing 68,913 times, 84 had positive results. One half of infections were asymptomatic, and some had high viral loads.

What are the implications for public health practice?

SARS-CoV-2 transmission was limited in this congregate setting by integration of prevention strategies that included identification of asymptomatic infections through frequent testing. Pooled testing reduced the need for resources while allowing high throughput with high sensitivity and rapid turnaround of results.

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Infection rates

Coronavirus (COVID-19) Infection Survey, UK: 20 November 2020

Publication date: 20 November 2020

Source: Office for National Statistics (UK)

Estimates for England, Wales, Northern Ireland and Scotland. This survey is being delivered in partnership with University of Oxford, University of Manchester, Public Health England and Wellcome Trust.

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Q&A: Talking about the ‘race’ for a coronavirus vaccine could reduce public confidence

Author: Richard Gray

Publication date: 16 November 2020

Source: Horizon. The EU Research & Innovation Magazines

Efforts to achieve herd immunity against Covid-19 with a vaccine could be hampered by low levels of confidence in immunisation programs in some European countries, warns Professor Heidi Larson, director of the Vaccine Confidence Project and an anthropologist at the London School of Hygiene & Tropical Medicine, in the UK.

Surveys conducted by the project during the pandemic suggest many people are still unsure about the safety of potential Covid-19 vaccines and how effective they will be. Prof. Larson believes a more open and honest discussion is needed with the public to answer questions they might have.

About two decades ago, immunisation programmes in different corners of the world started seeing more people refusing to have vaccines for various reasons, some of which had actually been brewing over weeks, months and even years. It was a growing challenge because individuals, communities and even government leaders were questioning whether to take vaccines.

But they are not simply divided into people who are pro-vaccines and those who are against – there are a lot of people in the middle who are not sure, they might take some but not others. The World Health Organization framed this as ‘vaccine hesitancy’. What we didn’t have was any data about how much of a problem it was, so our (vaccine confidence) index is trying to anticipate people’s willingness to take a vaccine by measuring their confidence in (vaccines).

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Media – Science related


Origins, Early Spread of the Pandemic, and One Health Solutions to Future Pandemic Threats

Publication date: 20 November 2020

Source: The Lancet Covid-19 Commission

This Task Force will focus on analyzing data on all leading theories for origin, documenting outbreak investigation and control efforts, and identifying the benefits of a One Health approach in preventing future pandemics.

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Non-pharmaceutical interventions

Breastmilk Harbors Antibodies to SARS-CoV-2

Author: Ashley Yeager

Publication date: 17 November 2020

Source: The Scientist

Milk from lactating moms may hold potent antibodies to counter SARS-CoV-2 infections, according to a new study of 15 women. All of the samples from women who had recovered from COVID-19 and who were breastfeeding babies at the time had antibodies reactive to the virus’s spike protein, researchers report in the November issue of iScience.

Detecting antibodies against the virus in breastmilk indicates that mothers could be passing viral immunity to their babies. Women can “feel pretty comfortable breastfeeding” during the pandemic, Christina Chambers, a perinatal epidemiologist at the University of California, San Diego, who not involved in the new study, tells The Scientist.

To date, there’s no evidence that a mother can transmit SARS-CoV-2 to her baby through breastmilk, Chambers says. She and others have tested breastmilk for SARS-CoV-2 RNA and found a few positive results, but no live virus. Her latest research also suggests that donor milk is safe for babies’ consumption, too, though she hasn’t assessed antibodies in donor milk banks she works with yet.

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AstraZeneca probes 'mistake' behind 90% COVID-19 vaccine efficacy

Author: Nick Paul Taylor

Publication date: 24 November 2020

Source: Fierce Biotech

AstraZeneca is looking into why the accidental use of a half-dose primer vaccine appears to make its COVID-19 regimen more effective. The half-dose was given to some participants due to an error but is now AstraZeneca’s best hope of delivering efficacy comparable to mRNA vaccines.

Most participants in the late-phase analysis received a full dose of AZD1222. The efficacy in that group was 62%, well below the 90%-plus bar set by the Pfizer-BioNTech and Moderna vaccines. A far smaller cohort of subjects received a half-dose primer followed by a full-dose booster. The efficacy in that group was 90%. However, participants were never meant to receive a half-dose primer.

“It was a mistake,” AstraZeneca Executive Vice President Mene Pangalos, Ph.D., told Reuters.

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Brazil will not exempt COVID-19 vaccine makers from liability, deputy minister says

Publication date: 19 November 2020

Source: Reuters

Brazil does not intend to draw up legislation that would exempt makers of COVID-19 vaccines from liability, the country’s deputy health minister Elcio Franco said on Thursday.

Franco said meetings held this week in Brasilia with vaccine developers should lead to non-binding memorandums of understanding on possible future purchases of vaccines against COVID-19.

He said the prices and target populations will be factors in deciding any purchase.

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Social impacts

World leading experts in health, science and economics discuss post-Covid world

Authors: Dr Baine L van Elsland, Roshini Mehta, Stephen Johns

Publication date: 24 November 2020

Source: Imperial College London

The world’s leading experts in health, science and economics discussed the post-COVID-19 world at the inaugural J-IDEA symposium.

Central bankers, Nobel laureates, epidemiologists, public health policymakers and a former Prime Minister came together for the symposium, Shaping the post-COVID-19 world, which marked the first anniversary of the Abdul Latif Jameel Institute for Disease and Emergency Analytics (J-IDEA).

Since the launch in October 2019., the Institute has been largely focussed on analysing the impact of COVID-19 around the world.

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Cost of Lockdowns: A Preliminary Report

Publication date: 18 November 2020

Source: American Institute for Economic Research

In the debate over coronavirus policy, there has been far too little focus on the costs of lockdowns. It’s very common for the proponents of these interventions to write articles and large studies without even mentioning the downsides.

Here is a brief look at the cost of stringencies in the United States, and around the world, including stay-at-home orders, closings of business and schools, restrictions on gatherings, shutting of arts and sports, restrictions on medical services, and interventions in the freedom of movement.

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Media – Reporting


Scientist with conflict of interest leading Lancet COVID-19 Commission task force on virus origins

Author: Sainath Suryanarayanan

Publication date: 24 November 2020

Source: US Right To Know

Last week, U.S. Right to Know reported that an influential statement in The Lancet signed by 27 prominent public health scientists about the origins of SARS-CoV-2 was organized by employees of EcoHealth Alliance, a non-profit group that has received millions of dollars of U.S. taxpayer funding to genetically manipulate coronaviruses with scientists at the Wuhan Institute of Virology (WIV).

The Feb. 18 statement condemned “conspiracy theories” suggesting COVID-19 may have come from a lab, and said scientists “overwhelmingly conclude” the virus originated in wildlife. Emails obtained by USRTK revealed that EcoHealth Alliance President Peter Daszak drafted the letter and orchestrated it to “avoid the appearance of a political statement.”

The Lancet failed to disclose that four other signers of the statement also have positions with EcoHealth Alliance, which has a financial stake in deflecting questions away from the possibility that the virus could have originated in a lab.

Now, The Lancet is handing even more influence to the group that has conflicts of interest on the important public health question of the pandemic origins. On Nov. 23, The Lancet named a new 12-member panel to the The Lancet COVID 19 Commission. The chairman of the new task force to investigate the “Origins, Early Spread of the Pandemic, and One Health Solutions to Future Pandemic Threats” is none other than the EcoHealth Alliance’s Peter Daszak.

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Government controls

Anti-Lockdown Protests All Across Europe

Publication date: 19 November 2020

Source: Off Guardian

As the alleged “second wave” of the Coronavirus “pandemic” is reported to be sweeping across Europe in recent weeks, many governments have enthusiastically embraced their totalitarian side and granted themselves sweeping new “emergency powers” alongside new lockdown measures.

The public has been markedly less co-operative this time around. Rebelling against the seemingly arbitrary limitations which are not supported by either science or common sense. Protests have taken place all across the continent.

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Coronavirus: Inside test-and-trace - how the 'world beater' went wrong

Authors: Nick Triggle, Rachel Schraer and Phil Kemp

Publication date: 20 November 2020

Source: BBC News

Just half of close contacts given to England's NHS Test and Trace are being reached in some areas, a BBC investigation has found.

Six months after Boris Johnson promised a "world beating" system, it can be shown the network is failing in areas with some of the worst infection rates.

The research also found no-one from NHS labs was at a key government meeting with private firms about testing.

But the government said the system was "undoubtedly" curbing Covid spreading.

It added that NHS Test and Trace was dealing with rising numbers of cases and was working hard to "refine and improve" the way it worked.

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Rapid Testing Is Less Accurate Than the Government Wants to Admit

Author: Lisa Song

Publication date: 16 November 2020

Source: ProPublica

The promise of antigen tests emerged like a miracle this summer. With repeated use, the theory went, these rapid and cheap coronavirus tests would identify highly infectious people while giving healthy Americans a green light to return to offices, schools and restaurants. The idea of on-the-spot tests with near-instant results was an appealing alternative to the slow, lab-based testing that couldn’t meet public demand.

By September, the U.S. Department of Health and Human Services had purchased more than 150 million tests for nursing homes and schools, spending more than $760 million. But it soon became clear that antigen testing — named for the viral proteins, or antigens, that the test detects — posed a new set of problems. Unlike lab-based, molecular PCR tests, which detect snippets of the virus’s genetic material, antigen tests are less sensitive because they can only detect samples with a higher viral load. The tests were prone to more false negatives and false positives. As problems emerged, officials were slow to acknowledge the evidence.

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Number 10 cherry-picked 'spurious' Covid data to justify England's second lockdown and may have intended to frighten the public, top Cambridge statistician claims

Author: Connor Boyd

Publication date: 24 November 2020

Source: Mail Online

Number 10 cherry-picked 'spurious' coronavirus data to justify England's second lockdown and may have intended to frightened the public, according to one of Britain's top experts.

Eminent statistician Sir David Spiegelhalter said ministers had 'broken pretty much every code of conduct' by choosing only to show worst-case scenarios, which were often based on out of date data.

The Cambridge professor told MPs today: 'I don't want to ascribe motivation to anyone of course. But if someone was really trying to manipulate the audience and frighten them and persuade them that what was being done was correct, rather than genuinely inform them, then this is the kind of thing they might do.'

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Censoring anti-vaxxers will only reduce trust and encourage conspiracy theories

Author: John Macdonald

Publication date: 24 November 2020

Source: CAPX

First Pfizer, then Moderna and now AstraZeneca – it appears we are on the cusp of a viable vaccine for a mass immunisation programme.

While these developments are hugely welcome, they do come with some important caveats. The next phase of overcoming the pandemic, designing and rolling out vaccinations, could prove the most challenging yet. There might be a light at the end of the tunnel, but finding that doesn’t mean the journey will be straightforward.

Either way, it was refreshing to hear Boris Johnson rule out mandatory vaccinations at his press conference last night. As he said, to pursue such a strategy would be an affront to “the way we do things in this country”. Even if this were not the case, a policy of mandatory vaccinations would be bad public health policy and nigh on impossible to implement.

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Doctors say CDC should warn people the side effects from Covid vaccine shots won’t be ‘a walk in the park’

Author: Berkeley Lovelace Jr

Publication date: 23 November 2020

Source: CNBC

Public health officials and drugmakers must be transparent about the side effects people may experience after getting their first shot of a coronavirus vaccine, doctors urged during a meeting Monday with CDC advisors as states prepare to distribute doses as early as next month.

Dr. Sandra Fryhofer of the American Medical Association noted that both Pfizer’s and Moderna’s Covid-19 vaccines require two doses at varying intervals. As a practicing physician, she said she worries whether her patients will come back for a second dose because of the potentially unpleasant side effects they may experience after the first shot.

“We really need to make patients aware that this is not going to be a walk in the park,” Fryhofer said during a virtual meeting with the Advisory Committee on Immunization Practices, or ACIP, an outside group of medical experts that advise the CDC. She is also a liaison to the committee. “They are going to know they had a vaccine. They are probably not going to feel wonderful. But they’ve got to come back for that second dose.”

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Coronavirus vaccine backlash: COVID breakthrough jab 'mustn't be mandatory' - poll results

Author: Steven Brown

Publication date: 10 November 2020

Source: Daily Express

A CORONAVIRUS vaccine could be rolled out across the country within the next few weeks as the UK continues to battle against the deadly pandemic. But the potentially live-saving drug should not be made mandatory, an Express.co.uk poll has indicated.

Yesterday, pharmaceutical giant Pfizer, alongside German partner BioNTech, announced their experimental coronavirus vaccine was more than 90 percent effective following a large-scale clinical test. This came days after the UK entered a second national lockdown.

While fuelling hopes that life may return to normal soon, an Express.co.uk poll - which ran from 10pm yesterday to 8am today - asked whether the vaccine should be made mandatory across the country.

Out of 2,408 votes, 70 percent (1,645) said the vaccine should not be mandatory.

Just 29 percent (737) said it should, while one percent (26) didn’t know.

One reader said: “There really isn’t enough known about the side effects of this anti-virus.

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Compulsory vaccination – the next step for Covid-19?

Author: Rosalind English

Publication date: 05 November 2020

Source: UK Human Rights Blog

Would you be first in the queue for the Covid-19 vaccine if and when it is rolled out? Or would you prefer to wait and appraise its effects on more pioneering citizens? With nearly a year of widespread media coverage of the coronavirus, it would not be surprising if a large percentage of an already fearful population exercised its right not to be subjected to what would be an assault and battery under English law: medical treatment without consent.

This is a syndrome, and it has a name. It is called “vaccine hesitancy”. The WHO describes this as “the reluctance or refusal to vaccinate despite the availability of vaccines”. Our willingness to avail ourselves of a future COVID vaccine is very much in doubt, and it is in doubt in high places.

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Social Impacts

The REAL cost of Covid-19: RUTH SUNDERLAND's terrifying dossier exploring the full economic damage will make you ask... can we afford to keep the brakes on Britain?

Author: Ruth Sunderland

Publication date: 22 November 2020

Source: Mail Online

They are the figures that should give any government pause for thought — a terrifying reflection of the catastrophic effect on the economy of the pandemic.

This Mail analysis of the financial cost of the virus — to jobs, the economy, businesses and the public finances — could not be more sobering.

It follows our publication on Saturday of medical data which showed that the Government’s grim predictions charting the course of the pandemic were worse than the reality.

An indication of the true state of the shattered public purse will emerge on Wednesday when Chancellor Rishi Sunak conducts his Spending Review.

In the meantime, our dossier shows the crippling scale of the damage already inflicted and sets out how much worse it will become if large swathes of the economy remain trapped in lockdown or overly restrictive tier systems.

It lays bare the immense level of harm done to our financial well-being, and raises serious questions over the handling of the virus by the Government — steered by its scientific advisers.

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What they DON'T tell you about Covid: Fewer beds taken up than last year, deaths a fraction of the grim forecasts, 95% of fatalities had underlying causes... and how the facts can be twisted to strike fear in our hearts

Author: Ross Clark

Publication date: 20 November 2020

Source: Mail Online

With the nation’s health at stake, it was revealed this week that GCHQ staff have been embedded in a cabinet office team in Downing Street to provide Boris Johnson with real-time updates to combat the ‘emerging and changing threat’ posed by Covid-19.

The intelligence analysts will sift through vast amounts of data to ensure the Prime Minister has the most up-to-date information on the spread of the virus.

But what exactly should Mr Johnson be looking for? Here, ROSS CLARK reveals what he should be asking…

The short answer is: not very. In a July report commissioned by Chief Scientific Adviser Sir Patrick Vallance, scientists estimated that there could be 119,000 deaths if a second spike coincided with a peak of winter flu. Yesterday, that figure stood at 54,286 – less than half that.

In fact, the second peak seems to have passed – over the past week there has been an average of 22,287 new infections a day, down from 24,430 the week before.

In mid-September, Sir Patrick made the terrifying claim that the UK could see 50,000 new coronavirus cases a day by mid-October unless more draconian restrictions were introduced. Yet we have never got near that figure.

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The Pandemic's Digital Shadow

Authors: Adrian Shahbaz and Allie Funk

Publication date: October 2020

Source: Freedom House

The coronavirus pandemic is accelerating a dramatic decline in global internet freedom. For the 10th consecutive year, users have experienced an overall deterioration in their rights, and the phenomenon is contributing to a broader crisis for democracy worldwide.

In the COVID-19 era, connectivity is not a convenience, but a necessity. Virtually all human activities—commerce, education, health care, politics, socializing—seem to have moved online. But the digital world presents distinct challenges for human rights and democratic governance. State and nonstate actors in many countries are now exploiting opportunities created by the pandemic to shape online narratives, censor critical speech, and build new technological systems of social control.

Three notable trends punctuated an especially dismal year for internet freedom. First, political leaders used the pandemic as a pretext to limit access to information. Authorities often blocked independent news sites and arrested individuals on spurious charges of spreading false news. In many places, it was state officials and their zealous supporters who actually disseminated false and misleading information with the aim of drowning out accurate content, distracting the public from ineffective policy responses, and scapegoating certain ethnic and religious communities. Some states shut off connectivity for marginalized groups, extending and deepening existing digital divides. In short, governments around the world failed in their obligation to promote a vibrant and reliable online public sphere.