"It took 12 weeks for the world to reach 400,000 cases of #covid19. Over the weekend there were more than 400,000 cases around the world”, says @DrTedros at @WHO presser. “The outbreak is accelerating and we’ve clearly not reached the peak of the pandemic.”
@DrTedros@WHO WHO experts are traveling to China this weekend "to prepare scientific plans with their Chinese counterparts for identifying the zoonotic source of #covid19”, says @DrTedros.
@DrTedros@WHO Experts will develop scope and terms of reference of WHO-led international mission. "The mission objective is to advance the understanding of animal hosts for #covid19 and ascertain how the disease jumped between animals to humans”, says @drtedros.
1. It’s easy. Wearing a mask is a really small thing we can all do. If it curbs spread even a little bit (so if it brings down R even a little) - and there is plenty evidence it does - then it gives us a bit more leeway in opening other parts of society, like opening schools etc.
2. It sends a signal. Wearing masks was part of what we did to curb the spread of #covid19 and even if numbers are low now, nothing has changed fundamentally. The virus is still here. Telling people they don‘t have to wear masks suggests it‘s over. It isn‘t.
I’ve been following the research on experimental therapies to treat #covid19 from the beginning and in the last month the three biggest results came from just one trial: Recovery in the UK. Why is that? My story here and quick thread to come: sciencemag.org/news/2020/07/o…
The UK trial has delivered robust negative results on hydroxychloroquine (a malaria medication) and lopinavir/ritonavir (an HIV medication) and a robust positive result on dexamethasone (a steroid). Caveat: Only the dexamethasone results have been published as a preprint so far.
How did it get those results so fast:
- simple design focusing on mortality
- enrolment and data collection kept easy
- supported by a national health service
- UK explicitly prioritized the trial over others, urging doctors to enrol patients
- UK had a lot of #covid19 cases
“Six months ago none of us could have imagined how our world and our lives would be thrown into turmoil by this new virus”, says @DrTedros at start of @WHO#covid19 presser. "The pandemic has brought out the best and the worst of humanity.”
@DrTedros@WHO “All over the world we have seen heartwarming acts of resilience, inventiveness, solidarity and kindness”, says @drtedros. "But we have also seen concerning signs of stigma, misinformation and the politicization of the #covid19 pandemic.“
@DrTedros@WHO "The single-most important intervention for breaking chains of transmission is not necessarily high-tech and can be carried out by a broad range of professionals. It’s tracing and quarantining contacts”, says @DrTedros.
Lots of debate in Germany about a huge #covid19 outbreak with 1500+ cases linked to a Tönnies meat processing plant in Gütersloh. A lot of important things being discussed, but it feels a bit like main takeaways are getting buried. Big picture:
1. The virus is still here and it‘s not going anywhere. As soon as we give it an opportunity to start spreading again, it will do so. The uncomfortable truth is: We may get tired, but the virus doesn’t.
2. We increasingly understand settings that carry the highest risk for spreading #covid19 widely. We need to do what we can to prevent infections in these places and investigate every case where that fails, like Tönnies, to understand why it failed.
Big news yesterday was the announcement by UK scientists that the steroid dexamethasone reduced deaths in ventilated #covid19 patients by a third. It was the kind of good news we all sorely needed. A little thread after a night‘s rest (and story is here sciencemag.org/news/2020/06/c…)
First of all: Everyone wants to see full results. Announcing top-line results with no data, no publication to back it up is a huge problem and obviously not normal. Practically everyone I talked to pointed this out, @BhadeliaMD and @ashishkjha to name just two here.
I asked the investigators, of course. „There is this tension between having the final details and the final decimal points nailed down, and having what is actually a clear-cut and practical message in the public domain“, @MartinLandray told me.
This analysis of #covid19 clusters in Japan in the first two and a half months of the epidemic there presents some really interesting data. It reinforces many points I and others have made in the last weeks re clusters and superspreading events wwwnc.cdc.gov/eid/article/26…
The researchers identified 61 clusters where five or more people were infected at once (they did not count onward transmission from these people that happened later):
largest cluster was more than 100 cases, most were 5-10 cases.
The places where they found clusters:
18 healthcare facilities
10 care facilities such as nursing homes or daycare centers
10 restaurants or bars
7 music events, such as concerts or karaoke parties
2 ceremonial functions
1 transport-related (airplane)
Data is starting to come out from big trials testing hydroxychloroquine as experimental therapy to fight #covid19. So where are we at on the question of whether it works? It’s not looking good. At all. Here is my @NewsfromScience story. Thread to follow. sciencemag.org/news/2020/06/t…
@NewsfromScience The earliest data on chloroquine (CQ) and hydroxychloroquine (HCQ) came from test tube experiments showing the compounds can keep cells from being infected by #SARSCoV2. But high dose needed and the therapeutic window (the margin between an effective and a toxic dose) is small.
@NewsfromScience So from the beginning CQ and HCQ were seen as long shots by most researchers. For instance, Susanne Herold told me back in March: “Researchers have tried this drug on virus after virus, and it never works out in humans. The dose needed is just too high.” (sciencemag.org/news/2020/03/w…)
“Although the situation in Europe is improving, globally it is worsening”, say @DrTedros at regular #covid19@WHO presser. More than 100,000 new cases were reported on 9 of the last 10 days, he notes. Yesterday was the highest number on a single day so far: 136,000.
@DrTedros@WHO "Almost 75% of yesterday’s cases come from 10 countries, mostly in the Americas and South Asia”, says @DrTedros. Most countries in African region are still seeing increase in cases. "We also see increasing numbers of #Covid19 cases in parts of Eastern Europe and central Asia."
@DrTedros@WHO Overall almost 7 million #covid19 cases now reported to @WHO and almost 400,000 deaths. But some countries are also seeing very positive signs, says @drtedros. "In these countries, the biggest threat now is complacency”, he says, noting that most people are still susceptible.
After results this week from @boulware_dr showing no benefit from hydroxychloroquine given as post-exposure prophylaxis, now similarly disappointing results from UK’s Recovery trial using it for treatment and the drug has been pulled from that trial. bbc.com/news/health-52…
@boulware_dr Question now is how other ongoing trials (like @WHO’s Solidarity trials) will react. But it sure looks like we are getting very close to the end of the hydroxychloroquine saga. Here’s hoping it will free up researchers to concentrate on more promising drugs.
@boulware_dr@WHO In a statement the chief investigators of the Recovery trial said 1542 patients had been randomized to hydroxychloroquine in the trial. They compared their outcomes with those of 3132 patients randomised to usual care alone. They found:
“WHO is continuing to respond to the new #Ebola outbreak in the city of Mbandaka”, says @DrTedros at start of regular #covid19 presser at @WHO. 8 cases have been detected, 4 of them have died. Today, close to 50 responders and 3600 doses of #Ebola vaccine arrived in Mbandaka.
@DrTedros@WHO Latest #Ebola case attended the burial of the first case, but was detected in Bikoro, a town 150 km from Mbandaka, says @drtedros. "This means that two health zones are now affected.” Virus is being sequenced to find out whether there is a link to previous outbreak.
@DrTedros@WHO "More than 100,000 cases of #Covid19 have been reported to WHO for each of the past 5 days”, says @drtedros. "We are especially worried about Central and South America, where many countries are witnessing accelerating epidemic.”
„Each violation of our Constitution and our civic peace gets absorbed, rationalized, and accepted by people who once upon a time knew better“. Read this smart piece by @anneapplebaum about the „collaborationisms“ we are witnessing in the US. theatlantic.com/magazine/archi…
The piece is powerful because it dissects the part of Trumpism that has most shocked and vexed me and many of my colleagues and friends: Why do people who know better and who have little to fear enable, aide and abet him?
One of the saddest, most infuriating things about reporting on this pandemic has been watching country after country fail to learn: from experts, from the past, from each other. Watching US politics and reading this piece makes me feel something very similar.
It argues for focussing efforts to fight #covid19 on preventing superspreading events: „Forget about maintaining — or, if infections resurge, resuming — sweeping measures designed to stem the virus’s spread in all forms. Just focus on stopping the superspreading.“
Also cautious on Japan‘s cluster strategy: „We believe that despite Japan’s success so far, Hong Kong’s suppression strategy, which includes testing and contact-tracing as well, is preferable in the long run, if only because it’s better preparation for any future outbreaks.“
“We now have more than 6 million cases of #Covid19 across the world and have lost more than 370,000 people to the virus“, says @drtedros at start of regular @WHO presser on #covid19.
@DrTedros@WHO Mentions the new #Ebola outbreak near Mbandaka that the government of the Democratic Republic of Congo announced today. "WHO will continue supporting DRC in tackling Ebola, as well as responding to #covid19 and the world’s largest measles outbreak”, says @DrTedros.
@DrTedros@WHO “During the #covid19 pandemic, we have seen that mass gatherings have the potential to act as super spreading events”, says @DrTedros. Points to updated guidance to "help organisations determine how and when mass gatherings can safely resume”. (here: who.int/publications-d…)
For the new episode of our (German) @pandemiapodcast I spoke with @tzimmer_history about the origins of @WHO and how the cholera pandemics in the 19th century led nations to start collaborating in the fight against infectious diseases.
Zimmer made very clear that this move was fundamentally an act of self-interest and not driven by a sense of global solidarity. In some ways it has stayed that way. Trump‘s move to cut ties with @WHO is not just unconscionable, it’s also against the interests of the US.
It is yet another move that may play well in some quarters but ultimately will lessen US influence on decisions that will end up impacting the US any way. Surely if we have learnt anything these last months it’s that pathogens don‘t respect borders.
Scientists had long argued that the outbreak in Italy likely did not descend from earlier cluster in Bavaria. But it is clearer now that the two first Washington cases (both in Snohomish County) also weren‘t connected, as @trvrb conceded in a great thread
The larger point here is that, as @AdamJKucharski and others have pointed out, this pattern of introductions that die out is exactly what you would expect of a virus with overdispersed (‚very patchy’) transmission, since most infected people do not infect anyone else.
“The pandemic has given us a glimpse of what our world could look like”, says @drtedros at start of #covid19 presser. “Our air and water can be clearer, our streets can be quieter and safer, and many of us have found new ways to work while spending more time with our families"
@DrTedros@WHO As societies reopen, says @drtedros, "the question we must answer is whether we will just return to the way things were, or whether we will learn the lessons the #covid19 pandemic is teaching us about our relationship with our planet."
Regular @WHO presser on #covid19 starting with @drtedros marking #AfricaDay. "Africa is the least affected region globally”, he says: 1,5 % of the world’s reported #covid19 cases, 0,1% of the world’s deaths. “Of course those numbers don’t paint the whole picture."
@WHO@DrTedros He notes that testing is still ramping up in some places on the continent and that #covid19 cases may be missed. Still: "Africa appears to have so far been spared the scale of outbreaks we have seen in other regions”, says @drtedros.
@WHO@DrTedros "Countries across Africa have garnered a great deal of experience from tackling infectious diseases like polio, measles, Ebola, yellow fever, influenza and many more”, says @DrTedros.
Another new and really interesting paper on #SarsCoV2 clusters and superspreading by @gmleunghku, @bencowling88 and others: “we estimated that approximately 20% of cases were responsible for 80% of all #SARSCoV2 transmission in Hong Kong”
“Overall, the majority (51.9%; 539/1,038) of #SARSCoV2 infections in Hong Kong have been associated with at least one of 135 known clusters. The median cluster size was two and the largest involved 106 local cases.”
That large cluster “traced back to multiple social exposures among a collection of bars across Hong Kong. Evidence suggested this “bar and band” cluster originated in Lan Kwai Fong among a few staff and customers before being spread to additional venues by a number of musicians”
Haven’t had a chance to look closely at this preprint about #covid19 in Israel, but interesting to see that their model "indicates that #SARSCoV2 transmission dynamics were driven by an extremely high level of viral superspreading”. Looks like evidence is accumulating.
"if we assume almost complete case reporting, our phylodynamic analysis indicates that between 5-9% of infections are responsible for 80% of secondary infections; with lower assumed levels of case reporting, between 1-5% of infections would be responsible for this 80%"
"Our results suggest that superspreading events are a main feature of #SARSCoV2 spread, suggesting that focused measures to reduce contacts of select individuals/social events could dramatically mitigate viral spread."
Early results on use of convalescent plasma in US are out as a preprint and look promising: Increased survival in study comparing 39 #covid19 patients with retrospectively matched controls. RCT needed, of course, but this will increase demand for CP. medrxiv.org/content/10.110…
“Interestingly, these data suggest that the survival effect of convalescent plasma may begin to manifest more than 1 week after transfusion. If this observation is borne out in subsequent studies, it could indicate that convalescent plasma prevents longer-term complications...”
“We did not observe significant benefit of convalescent plasma in intubated patients, consistent with past literature demonstrating that passive antibody transfer therapies are most efficacious early in disease.
However, the number of intubated patients in this study is small...”