The Search Continues: Coronavirus Vaccination Not “One-Size Fits All”

A number of the leading COVID-19 vaccines, including the first to market, rely on new platforms. These are technologies that have been developed over years, even decades, to target not just a single disease, but to take advantage of a key scientific development to affect a range of (current and future) clinical needs. Messenger RNA, which underpins the first two vaccine candidates is one such example – developed for other purposes and now deployed to combat a previously unknown virus.

At the Massachusetts General Hospital (MGH) Vaccine and Immunotherapy Center (VIC), we have been developing a self-assembling vaccine (SAV) platform that activates the immune system to attack specific targets. The core of the platform is a protein adapted from the bacterium that causes tuberculosis (called the protein core) and that powerfully displays fragments of proteins to the immune system. In our Self-Assembling Vaccine platform, any protein sequence from a new virus can be readily attached to the protein core to quickly make a vaccine. In 2014, for example, using Lassa virus, we went from viral sequence through pre-clinical testing in only 120 days. (Suffice it to say, that is fast!)

Knowledge of the immune response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2 or COVID-19) infection has been accumulating at an almost unimaginable pace. Dr. Patrick Reeves and his team at VIC, in collaboration with Voltron Therapeutics Inc., have developed a method for sifting through the knowledge and identifying the regions of the novel SARS-CoV-2 virus that the immune system targets most strongly. Each individual’s immune response is different, as indicated by the varying degree of illness that people experience once exposed to COVID-19. For this reason, rather than selecting a few precise sequences of the virus, Dr. Reeves and his colleagues chose an array of viral regions that appear again and again in different experiments. While a given individual may or may not respond well to a specific sequence within the region, most people’s immune systems will identify something within the pattern or grouping to which it will react in order to protect the person from the foreign invader – in this case, the coronavirus.

Will we need to vaccinate the whole world every year?

This next line of vaccines, like the SAV platform being developed by VIC, will prove to be very important. While the early reports and press releases from Pfizer, Moderna, and Astra-Zeneca are impressive and exciting, many unanswered questions remain. The first centers around durability of the immune response. More specifically, will we need to vaccinate the whole world every year? Unlike the front-running candidates, which are focused on stimulating antibodies in response to vaccine exposure, the SAV platform is aimed at training the T-cells (sometimes called memory cells) that are thought to provide longer lived immunity. T-cells are part of the adaptive immune system or active immune response; they recognize foreign substances, including infections, that they were exposed to in the past and then produce antibodies to attack the foreign body – kind-of like a precursor to or director of antibody production.

Regardless, second generation vaccines, like the one being developed at VIC, are critical for the overarching response

Next, there is the question of access and distribution of vaccines that require ultra-low temperature storage and multiple doses. Plus, safety concerns may emerge as follow up continues with ongoing trials. While rare and hopefully not serious, untoward side effects or adverse reactions could limit the number of people who should otherwise receive the vaccine. Progress thus far has happened at record speed; therefore, we dare to hope that the frontrunners will be enough to suppress or eliminate COVID-19 worldwide. Regardless, second generation vaccines, like the one being developed at VIC, are critical for the overarching response. In addition, the SAV platform can be applied to emerging infectious and other diseases where the immune system needs to be targeted, including coronaviruses in general, viral and bacterial infections, the next pandemic, and even cancer.

Written By Mark Poznansky, MD, PhD, FCRP, FIDSA  

Edited By Jacki Hart, MD

Vaccines in Development: Which are Ready for Prime Time?

Vaccine development for COVID-19 is a fast-moving topic. Private industry, academics, and government agencies are working together at rapid speed to generate viable options for billions of people throughout the world without sacrificing safety or introducing unforeseen risk. The goal, as with any vaccine, is to stimulate your immune system to make antibodies against the SARS-COV-2 virus, thereby protecting you from getting sick with coronavirus. The urgency to control the spread has translated into testing of well-known, theoretical, and brand-new technologies. Brilliant minds are hard at work, around the clock, to not only design and test vaccines, but to also determine systems for distribution and administration to help abate the global crisis

There are hundreds of vaccines in the pipeline in various stages of investigation, including 54 (as of this writing) that have advanced to the stage of being tested on people and 10 in late stage (known as Phase III) clinical testing. As of November 2020, there are two that stand out as close to acceptable levels of effectiveness and safety; therefore, plans for mass production, distribution and administration are also underway.

Pfizer and Moderna Both use mRNA Technology

The news that has grabbed recent worldwide attention include announcements by Moderna and Pfizer/BioNTech that Phase III clinical trials of their mRNA vaccine candidates show nearly 95% effectiveness. Many drained global citizens are starting to imagine solutions for this pandemic. Dr. Anthony Fauci, Director of the United States (U.S.) National Institute of Allergy and Infectious Diseases (NIAID) went so far as to claim that “it’s not going to be a pandemic for a lot longer because I believe the vaccines are going to turn that around.”

There are many caveats and precautions to keep in mind, however, not only with vaccine development and confirmation of efficacy and safety, but also with distribution and administration of the shots.

Vaccine Safety & Effectiveness

While these encouraging results bring us closer to a solution, it’s important to understand what they mean. In clinical trials, such as those conducted by scientists at Pfizer and Moderna, there are two groups of people, neither of whom have been previously infected with COVID-19. Participants are randomly assigned to receive injection of either placebo (consisting of saline water) or the experimental vaccine candidate. The participants, doctors, and healthcare providers administering the injection do not know who received vaccine and who received placebo; this is called a randomized, controlled, blinded clinical trial. In medicine, we refer to that design as the “gold standard” of research because we can rely on the results being scientifically valid, rather than the positive effects being from nothing more than luck or chance. Those who received the experimental vaccine in both the Pfizer and the Moderna studies were 90 to 95% less likely to develop coronavirus than those who received placebo injections. For example, in the Pfizer investigation, 170 people, out of almost 44,000 recipients have contracted the virus to date; 162 of them had received placebo, while only 8 had received the vaccine. 

This is promising and exciting. After many months of being sequestered and feeling secluded, we have legitimate reason to feel hope.

After many months of being sequestered and feeling secluded, we have legitimate reason to feel hope.

Now, Pfizer/BioNTech submitted an application for Emergency Use Authorization (EUA) to the U.S. Food and Drug Administration (FDA). The company will continue ongoing research to assess long term immunity (meaning – for how long the vaccine can protect you from contracting the virus), potential negative effects that might occur over time, and ability to confer immunity following exposure to the virus. The last question will explore whether the vaccine is protective if you receive it after you’ve been around someone who has COVID-19. One important element already determined is that it takes roughly 28 days following the second dose of the Pfizer mRNA vaccine until antibodies develop – a crucial step toward conferring immunity. 

Moderna also announced progress on their vaccine, which is based on a similar genetic platform and suggests excellent rates of potential protection.

Vaccine Distribution & Administration

As rates of infection in parts of America and Europe approach their highest levels, everyone eagerly awaits the release of this vaccine. Once authorized by the FDA, public distribution will be complicated and will limit return to our pre-pandemic lives, as will outstanding questions about safety and effectiveness. 

Widespread vaccination in America is still many months away. We must remain vigilant, continue to do everything in our individual and collective power to slow the spread of the virus. Wearing masks, physically distancing, avoiding social gatherings, and practicing hygiene remain the mainstay for stopping the spread of COVID-19 and saving lives. This will be the case for a significant period of time, even after a vaccine is available. Dr. Fauci estimates that high-risk Americans and healthcare workers will be among the first recipients of the vaccine. Ambitious estimates suggest that a sizeable proportion of the U.S. population will receive the vaccine by mid to late spring. But, Dr. Fauci warns, such a “guesstimate” assumes that everything proceeds without setbacks, mistakes, or unanticipated risks.

But, Dr. Fauci warns, such a “guesstimate” assumes that everything proceeds without setbacks, mistakes, or unanticipated risks

Concerns have also been raised about how Pfizer will manufacture and ship the vaccine to hospitals and pharmacies across the globe. Pfizer is manufacturing the vaccine in Kalamazoo Michigan and in Belgium; for Americans, the majority of vaccine doses will come from the Great Lakes state. It is up to federal and state governments, however, to decide to whom to appropriate the doses and the number to request. As mentioned, the vaccine preparation uses mRNA that, once inside your body, enters cells and is coded to produce a protein that mimics spikes on the outside of the coronavirus. These spike proteins “trick” your immune system into responding to this foreign entity as if it were coronavirus. 

The mRNA needs to be kept at temperatures well below zero (more specifically, negative 70 degrees Celsius, which is equivalent to negative 94 degrees Fahrenheit); otherwise, the vaccine will denature (fall apart) and be rendered ineffective and unusable. Pfizer has designed reusable boxes filled with dry ice to keep the vials of vaccine cold enough, and shipping companies, including UPS and FedEx, have designed special compartments to send and deliver the vaccine vials. These special containers hold between 1000 and 5000 vials. 

One potential advantage of the Moderna candidate, which relies on similar mRNA and, therefore, still requires cold storage, is that the temperatures needed for this vaccine to stay stable up to 30 days resemble standard refrigerators and freezers available in pharmacies and hospitals.

Many details are yet to be determined, including that Pfizer reports the plan to ship 50 million doses in December. Twenty-five million of those vials are slated for distribution in the U.S., while the other 25 million will go to other countries. That means that 12.5 million Americans can be vaccinated during this first round, since each person receives two doses, three weeks apart. 

12.5 million Americans can be vaccinated during this first round, since each person receives two doses, three weeks apart. 

Meanwhile, the Bill & Melinda Gates Foundation is at the forefront of global distribution, working with international partners to both quickly develop the second generation of vaccines more suitable for low and moderate income countries and prepare systems for distribution. GAVI, Vaccine Alliance and Coalition for Epidemic Preparedness Innovations (CEPI) are co-leading the efforts of the Access to COVID-19 Tools (ACT) Accelerator to ensure equitable access to COVID-19 tests, treatments, and vaccines. As Melinda Gates says “COVID-19 anywhere is COVID-19 everywhere.”

As Melinda Gates says “COVID-19 anywhere is COVID-19 everywhere.

Distribution Within States’ Purview; But Dollars Fall Short

In the U.S., the logistics of vaccinating and tracking millions of citizens will be left largely to state governments. The Centers for Disease Control and Prevention (CDC) in the U.S. has committed to providing 340 million dollars to the states for these distribution efforts; however, local health departments anticipate much higher costs and have requested another 8.4 billion dollars from the U.S. Congress to adequately and appropriately fulfill this duty. Comprehensive online systems are necessary to keep track of who has received vaccinations. Insufficient funding will slow down the rate of vaccination, especially among citizens who are hard to reach, as well as the process of following who has received their first and second doses. States with large rural populations pose particular challenges for the administration of the vaccine due to the cold storage requirements.

States with large rural populations pose particular challenges for the administration of the vaccine due to the cold storage requirements.

Each of Us Has a Role in Curbing COVID-19

Another problem involves potential resistance to taking the vaccine. There is a worldwide movement of anti-vaxxers, which is based on false data and amplified by social media. Plus, others feel some degree of skepticism because of the speed with which the vaccines are being developed. 

But, as Kavita Patel, MD, a prominent physician and public health expert, points out “vaccines don’t save lives; vaccinations do.” 

Kavita Patel, MD, a prominent physician and public health expert, points out “vaccines don’t save lives; vaccinations do.”

Lessons from the Past

When Elvis Presley was vaccinated on national television in 1956, the polio immunization rate among teens skyrocketed and incidents of polio went down by 90% in just four years. History shows that when prominent Americans, especially from marginalized or high-risk communities, use their platforms to lead by example, people pay attention and heed their advice. Nowadays, those messages can reach far and wide through social media influencers, when first vetted by public health experts. 

Many questions remain unanswered and unexpected challenges will arise along the way. The aim is for scientists and authorities to work hand-in-hand to mitigate polarization and to not only produce safe, effective vaccines but also readily distribute and administer them as swiftly, efficiently, and equitably as possible. 

In the meantime, our job as citizens remains to limit the spread of COVID-19 even after the vaccine is available and distribution has begun. This virus will circulate in the population for a long time to come. Like a mantra, we say again and again:  wear masks, physically distance, avoid social gatherings, and practice hygiene. Plus, while availability of testing has improved, progress is still needed for widespread application in the U.S. and receipt of rapid results. As we face the last quarter of the year since COVID-19 was identified, we still need to set testing as a top priority by enhancing supplies and, perhaps, the possibility of self-administered home testing. 

Written By Rohan Prabhu & Jacki Hart, MD

Isolated Elderly and Stir-Crazy Teens Form Real Bonds, Virtually

My Covid Story

Older adults are at high risk for severe consequences from COVID-19. While this necessitates self-isolation to help mitigate spread and reduce their chances of contraction, the ensuing seclusion is not without its own health risks. The National Academy of Sciences discovered that social isolation and loneliness increase the risk of anxiety, depression, and even premature death in the elderly. Not everyone who is socially isolated (defined as lack of social connections) is lonely and not everyone who feels lonely is socially isolated. Elderly individuals are at higher risk for loneliness and/or social isolation because of factors like living alone, losing friends and family, having a chronic illness, or experiencing hearing loss.

Whether experienced together or separately, loneliness and social isolation are referred to as “poor social relationships,” which increase the risk of heart disease by 29%, stroke by 32%, and dementia by 50%. Among people with heart failure specifically, loneliness was linked to a 4-fold increase in the risk of death, a 68% increased chance of hospitalization, and a 57% rise in emergency department visits.

Disrupted Routines Replaced with Distanced Connections

Many elderly individuals have limited social contact, often restricted to places of worship or community centers. Even routine public encounters in local businesses like grocery stores, pharmacies, or coffee shops are no longer available to the same extent, due to protections set in place against COVID-19. In addition, those who lack close friends or family, or who had relied on care from either paid caregivers or voluntary services, as well as those who were already isolated, are at an increased risk of loneliness and associated health concerns.

Seeking to alleviate the physical and emotional isolation of at-risk seniors, Rabbi Marcia Plumb of Congregation Mishkan Tefila in Brookline, Massachusetts developed the Silverlining Buddy program to replicate volunteer and visiting programs that existed prior to COVID-19. This virtual program is an intergenerational collaboration, managed by Wendy Handler, designed to foster relationships between seniors and college students or young professionals. Understanding the difficulty that technology can present for some seniors, Rabbi Plumb conceived the program as an old fashioned, basic pairing of individuals through telephone contact. With the support of Combined Jewish Philanthropies (CJP), a non-profit organization in Boston, they are expanding the program to use Zoom or other technologies.

The program has successfully matched more than 100 buddy pairs

The program has successfully matched more than 100 buddy pairs, based on community needs and availability. Young adult volunteers undergo basic training and then typically connect with their senior buddies at least once a week. They discuss a myriad of topics ranging from personal life stories to politics to the science behind COVID-19. While the program was initially designed to help reduce loneliness among older adults, Ms. Handler says the program has shifted into more of an equal relationship where the young volunteers get just as much out of the experience as the older adults.

Unexpected Life Parallels

Rosalie, a senior buddy, became involved in the program through her synagogue; she thought it would be fun to talk to someone from a younger generation. She and her buddy, Nikki, a college junior, have a lot in common. Both grew up in Brooklyn, New York. Both had family members who were Holocaust survivors, and they share similar political views. Conversations between Rosalie and Nikki run the gamut from their personal lives, including gardening (a hobby of Rosalie’s) and travel to politics and science. They even exchange recommendations for good books and show each other photos over facetime. Rosalie likes hearing about changes in Brooklyn and she also now appreciates how the pandemic has imposed limitations on the younger generation still in college too. Rosalie says that she and Nikki never run out of topics and that her young companion asks thoughtful questions that make her reflect. “It’s comforting to talk to [Nikki] and hear about her life,” Rosalie said. “I think [the Silverlining Buddy System] is a very interesting and fun concept and perhaps, even after COVID, it would be good to keep it up.” 

Nikki became involved in the program through Companions to Elders, a community service program she helps coordinate for her university. Nikki relays that “[the experience] has made me insert more perspective into my day to day life, because it’s so easy to get absorbed into the bubble of college, when I’m at college, or of my childhood bedroom which I’ve been trapped in for six months! Leaving that world to talk to someone who is pretty far out of that environment gives me more perspective. Takes me out of my head.”

Leaving that world to talk to someone who is pretty far out of that environment gives me more perspective. Takes me out of my head.”

Emma, another student buddy, is a college senior majoring in biology. She said that volunteering has given her the opportunity to empathize with someone older and wiser, and helped broaden her view of the world. “If Marylin (her buddy), who has lived through many ups and downs in history still has hope that we’ll go back to normal day to day life, and is still enjoying each day; I think that just shows that we all should be thankful for what we can do and what we do have during this time.”

The Silver Lining Buddy System offers a unique opportunity that provides a meaningful connection during a time when many of us are feeling disconnected. It should serve as a role model to spawn similar programs. 

Written & Reported by Giovi Hersch
Edited by Dr. Jacki Hart

White House Touts Old Therapy for New Virus

Convalescent plasma (CP) is not a new therapy, but it’s gotten new attention. For illness that has progressed to respiratory distress, physicians in hospitals have prescribed convalescent plasma for COVID-19 patients, along with other treatments like steroids and antiviral medications that are generally well established for this clinical scenario from similar infectious agents. Because of both theoretical benefit and observational success, studies have begun to emerge about the application of convalescent plasma for COVID-19 specifically. With early encouraging results suggesting improved survival rates for tens of thousands of individuals, the White House administration urged the United States (U.S.) Food and Drug Administration (FDA) to establish emergency use authorization (EUA). Despite the preliminary success, this move remains controversial because the usual degree of research scrutiny has not been applied to convalescent plasma for COVID-19. Studies are ongoing.

Proponents say convalescent plasma has been around for a long time for similar purposes, what could be the harm? (Well – think hydroxychloroquine…) Skeptics say the move is premature. The middle ground would have been to continue in the previous capacity of FDA investigational (also called compassionate) use. That allows doctors to make informed clinical decisions to use CP when the patients’ circumstances warrant, with documentation and agreement that the patient is aware of the experimental nature of the therapy, and with meticulous tracking of many details that would become clinically relevant and inform well-substantiated application of the treatment as we move forward. 

Now, some experts worry that the EUA might jeopardize research. Having the medication readily available for this purpose may translate to fewer people enrolling in studies since doctors can obtain the drug for patients without requesting the added demands of participating in a clinical trial. Given the positive publicity about convalescent plasma, patients may not take the chance of being assigned to a placebo group and, thus, not receive the therapy. The EUA may also lead to diminished tracking which helps delineate important details regarding the treatment, like dosing and timing of administration as well as potential risks, side effects, and negative reactions.

How does Convalescent Plasma Work?

The idea of convalescent plasma is to gather blood from patients who have recovered from the infection and, thus, developed antibodies that might confer immunity to someone who currently has the illness. In theory, the antibody-rich blood product should help patients recover faster from COVID-19. Since there is no confirmed effective treatment for COVID-19, the idea of boosting patients’ immune response to the virus seems worthwhile.

The therapy has been around since early in the 20th century and has been used successfully for other viruses, including hepatitis, mumps, measles, rabies, polio, and the 1918 influenza pandemic. More recently, it’s even been used for H1N1 flu, Ebola, and previous coronavirus outbreaks like Severe Acute Respiratory Syndrome -1 (SARS-1) and Middle Eastern Respiratory Syndrome (MERS). However, it remains unclear whether convalescent plasma adds benefit to standard treatment. The way to determine this involves studies using a rigorous design known as randomized controlled clinical trials (RCTs) for hospitalized patients with COVID-19.

Without such scientific analysis, many questions remain unresolved about the proper way to administer the therapy

Without such scientific analysis, many questions remain unresolved about the proper way to administer the therapy – including exactly who will benefit, at what stage of the COVID-19 infection, and what dose confers protection. 

Data from Chinese researchers suggests benefits like xray resolution of lung infections from COVID-19, a reduced viral load, and improved survival. However, the data is extremely limited, including that that study was discontinued due to low rates of enrollment and lack of added clinical benefit from convalescent plasma. There are several assessments going on currently in the U.S., including through the University of North Carolina (UNC) and an expanded (again, called compassionate) use program led by the Mayo Clinic in Minnesota. The latter is from where much of the information about CP use in COVID-19 patients has been derived to date. 

In the meantime, under what appears to be possible pressure from the White House Administration, and against the advice of some prominent experts, the FDA issued the EUA on August 23rd, 2020 for convalescent plasma. 

Given the change in FDA status, there has been a surging interest from hospitals continuing to struggle with high numbers of people with COVID-19. This has translated to accelerated demand for convalescent plasma. Blood banks around the country are shipping CP to states like Florida, Texas, Tennessee, Mississippi, Missouri, and California. Organizations leading these efforts include the Red Cross and America’s Blood Centers.

If you’ve recovered from coronavirus and test positive for COVID-19 antibodies, you might be eligible to donate convalescent plasma; the FDA explains.

If you’ve recovered from coronavirus and test positive for COVID-19 antibodies, you might be eligible to donate convalescent plasma; the FDA explains. Even one donor can benefit three to four patients with matching blood types. 

Written By Rohan Prabhu & Jacki Hart, MD

While Hard, Societal Sacrifices Are Measurably Paying Off

The SARS-COV-2 (COVID-19) pandemic has infiltrated almost all aspects of our lives, bringing much of normal societal flow to a grinding halt. Social distancing has restricted contact with others, business closures have reversed economic growth, and other safety and prevention measures have resulted in an abrupt and dramatic change to daily life. Despite these drastic actions, there are still nearly 13 million confirmed cases worldwide and well over 3 million in the United States (U.S.) alone, at the time of this writing. The vast number of COVID-19 infections and, worse, deaths from the virus, begs the question, have the steps we’ve taken made any difference? Is that measurable and, if so, how? Answers to these questions are crucial for a number of reasons. First, the changes we’ve been collectively making are hard. So, knowing whether these steps are saving lives and reducing infections can be motivating. Similarly, some leaders have sown doubt, causing a certain percentage of citizens to ignore scientific recommendations and raising wonder about whether the collective inconvenience, job loss, diminished learning, and isolation are worthwhile or not?

knowing whether these steps are saving lives and reducing infections can be motivating

To address this concern and curb the public skepticism, researchers from the University of Berkeley recently analyzed data to assess the effectiveness of a variety of protective measures across six major epicenters of COVID-19 including the U.S., Iran, France, China, South Korea, and Italy. Gathering 1,717 points of information from the six countries, the researchers assessed the significance of the effect by comparing the growth rate of COVID-19 just prior to the intervention (or interventions) to the change in growth rate soon after the implementation of one or more policies including, but not limited to:

If Nothing Had Been Done, 530 Million People Infected Worldwide

Without any policy action at all, the researchers estimated that the growth rate of COVID-19 infection would have been 43% higher per day across the six countries studied. This would have translated to 14 times more identified COVID-19 infections (i.e. nearly 5 million more cases) in the US alone as of the first week in April. In total, the study predicted that without intervention, there would have been 62 million more confirmed cases (again, as of early April) in the six countries, corresponding to 530 million total infections across the world.

Fig. 4 | Estimated cumulative confirmed COVID-19 infections with and without anti-contagion policies.

The current total of confirmed cases, close to 13 million, pale in comparison to these predicted values if no measures had been implemented in these 6 countries. It is clear that policy measures “significantly and substantially slowed the pandemic” spread. 

A similar study published in Health Affairs, discovered comparable trends in reduced growth rate of infection in the U.S. after implementation of shelter in place orders (SIPO). Following policies until the end of April, the Health Affairs researchers projected that without SIPO, there would have been 10 million more cases across the U.S. and without additional measures of event bans and closures (discussed below), there would have been 35 million more cases. Since two independent studies produced parallel results, we can feel confident about the accuracy of the estimated number of cases averted and lives saved as predicted by these statistical models. In other words, our collective actions and sacrifices, both as individuals and society at large, have mattered and have saved lives.

our collective actions and sacrifices, both as individuals and society at large, have mattered and have saved lives

If Nothing Had Been Done, 530 Million People Infected Worldwide

Both analyses went even further to try to uncover whether specific policies were most influential in mitigating spread of the disease compared with others. According to UC Berkeley and Health Affairs authors, social distancing has been especially impactful for slowing the spread of the virus; but, perhaps, school closures have not had as large an effect. Home isolation and social distancing, per the UC Berkeley analysis, reduced the growth rate of cases of coronavirus by 

-11.31% and -21.81% respectively. The study in Health Affairs also found that the SIPO provided the largest decrease in growth rate of -8% after only 21 days of implementation and that that result, in scientific terms, was statistically significant (p<0.01) – meaning the decline in spreading COVID-19 was definitely from the changed behavior, and not simply luck or chance. Additional actions that have also been emotionally draining and economically difficult, like business closure and quarantining those who test positive for COVID-19, have also effectively slowed the spread of COVID-19. The UC Berkeley experts report that these two actions resulted in a decrease in the rate of COVID-19 growth in the U.S. by -5.35% and -5.92% respectively, and even more in other countries like Italy (-11.40% and -6.06%, respectively). Neither of these studies examine the economic or psychological impact of these various preventative measures, which should be the subject of future research. However, this data makes it clear that while many of these protective measures are costly, challenging, and often unenjoyable, they have successfully stopped the spread of COVID-19.

What Can We Glean?

Both studies make it clear that their reports cannot determine definitively which protective measures are necessary, and which may be obsolete. Rather, these studies aim to shed light on the success of particular measures to slow the spread of COVID-19 and highlight how, all together, worldwide collective efforts have made a massive difference in combating the virus. These results prove that measures such as social distancing and home isolation have significantly slowed the spread of COVID-19, despite some dissenting opinions. In addition, while school closure and cancellation of large gatherings did not show significance or decreases in growth rate, both studies emphasize that these findings should not be interpreted as being unnecessary, nor does the data claim any stake on whether they be applied or avoided for future disease prevention.

The results of these analyses should be comforting since most of the preventative measures have produced what they intended.

The results of these analyses should be comforting since most of the preventative measures have produced what they intended. Through these measures, nations across the world were able to unite to implement meaningful action to slow the spread of COVID-19 and were able to prevent upwards of 530 million global infections. Dr. Kendon Bell, one of the UC Berkeley researchers, stated that as a global population, “we should be very proud” of our teamwork and collective actions to address the pandemic. 

These studies lay the foundation for effective statistical analysis of virus prevention and provide a template for what actions should be considered when facing the next pandemic. Our collaborative efforts to practice social distancing, in particular, and other measures have paid off. We have successfully cared for and protected one another. Let’s continue.

Written & Reported by Robert Shepard; Edited by Dr. Jacki Hart

Will 21-Year-Olds Learn to Take the Pandemic Seriously?

Doug, a 21-year old college student in Boulder, Colorado (CO), tested positive for COVID-19. Unlike others who have had much more serious cases, Doug was lucky. He only showed symptoms for a single day and, thankfully, never entered a hospital or emergency room. In fact, Doug assumed, at first, that he had the flu. 

Reflecting on his experience, Doug describes his main lessons from his quick brush with coronavirus. Doug learned, in large part, that his peers tend to take COVID-19 for granted. In fact, many in his friend group wound up testing positive, including the person from whom Doug contracted the virus. But few have taken it seriously enough to alter their habits and behaviors. 

Despite having had a smooth, easy course without complications, Doug now recognizes how contagious the virus is and tries to communicate with his friends the importance of wearing masks and taking other precautionary measures. Doug bases his newfound caution on the fact that he was exposed to the virus when in the same room with one or more who later tested positive. In fact, as Doug recounts, he was never in direct contact with an infectious person, just in the general vicinity

Even before having any symptoms, Doug sought testing because of this exposure. He found it difficult to locate a site; then, serendipitously, he developed symptoms one day later, which lasted less than 24 hours. Doug was quarantining from the time that he learned of the exposure. Three days after his symptoms began, his test results came back positive. His housemates and several friends, who had also been at that party, all tested positive; but no one had more than short-lived, mild symptoms.

While quarantining with housemates, their community came through with support. Other friends without COVID-19 delivered groceries and other supplies. The day that Doug shared his story with Covid-Recovery.org, he was scheduled to get his follow up test back the next day. He was anxious to know the results because he had stayed out of work for nearly a month. 

few his age seem to be taking the virus seriously enough.

When probed about the opinions of COVID-19 held by his peers, Doug described stories similar to what is shown in popular media: few his age seem to be taking the virus seriously enough. Those in Boulder, CO are still holding house parties, and while they wear masks when entering shops and bars, which are mandated, they’re not participating in strict social distancing. Doug believes that people his age might be convinced to change their behavior if their return to college was in jeopardy. Universities, like all schools throughout the country, are making a range of decisions based on the risks within their regions and many other factors. Part of the problem is that the delay between the risky behaviors that might spread the infection and any rise in rates could preclude students from connecting their actions and the schools’ decisions or altered policies. 

As far as Doug’s own behaviors — even though his case was mild, he carries an important message for people of all ages: listen to your doctors and wear your masks! 

Written & Reported by Robert Shepard
Edited by Dr. Jacki Hart

COVID-19 Testing Overview

While not foolproof, testing is an important tool to help each country, state, and region safely re-open. The data shows us that countries most successful at keeping down the numbers of COVID-19 infections and deaths have applied testing, contact tracing, and robust preventive practices. Together, these measures can help guide us to return, step by step, toward some normalcy in our economic and social lives. The use of testing coupled with key preventive approaches can also help avoid a second surge of millions of additional COVID-19 cases and 100,000s of deaths.

While there are new approaches coming soon, viral testing is generally performed via nasal swab. The sample is sent to the laboratory where a polymerase chain reaction through what’s called (PCR) test is performed to detect genetic material of the virus itself. Contact tracing involves a process to notify those who have been in contact with someone who tested positive for the COVID-19 virus. Contact tracing can also be applied for those who have been exposed to someone who has typical COVID-19 symptoms, but doesn’t get tested and, therefore, carries a presumed COVID-19 diagnosis. Antibody testing (also called serologic testing) is a blood test that checks whether someone has developed immunity to (protection from) COVID-19 at least temporarily. While the antibodies may not be present forever, or the COVID-19 virus might mutate (change) over time, there is scientific evidence suggesting that characteristics of the virus allow for antibodies, if they develop, to help fend off reinfection for a period of time — possibly up to 1 to 3 years. Since COVID-19 is newly discovered and hasn’t been infecting people for very long, more research will emerge as the virus is further studied and better understood.

The amount of testing being conducted varies from country to country, and from state to state. This impacts steps taken in the opening of regions across the globe. Interestingly, there is a form of testing that is talked about less often but may also be applied to guide recovery: Fecal Testing.

Not at Risk; Or So Luiz Thought

My Covid Story:

My name is Luiz. I am 38 years old, young, healthy, physical therapist and Pilates instructor. Because of my profession, I make exercises every day. And because I was not high-risk patient, I was thinking the COVID-19 for me could be like a ‘big’ flu. IT WASN’T! The COVID-19 started with a sore throat, muscles pain and fever like a common flu. I took medicine against fever and it is gone. But the fever came back every day stronger until the medicine didn’t make more effect and the fever stayed continuously between 38-40°C [100.4-104°F].

After 9 days with symptoms, I went to the doctor and I tested positive for COVID-19. In the total it was 12 consecutive days of fever. I also had diarrhea, a lot of vomit, smell and taste lost, nose burning, abdominal pain, muscles pain, heavy eyes, headache, cough and difficulty breathing. I had shortness breath but because my oxygen saturation was 98%, I didn’t need oxygen mask… After 14 days with [treatment from my doctor including LOTS of fluids], the disease, the fever was going out and the symptoms started to decrease. Now I am ok; but I would like to advice you stay home, wash your hands and face all the time, use mask and gloves and hear all the recommendations from healthcare workers. They want to help you!

Swab Testing

Using a long swab that is mildly uncomfortable when placed through your nasal passages, the clinician (e.g. nurse, doctor, or physician assistant) performing the test (wearing protective equipment or PPE) will twist the swab for 10 to 15 seconds (roughly 5 times) in order to get an adequate sample for the lab to look for the COVID-19 virus under the microscope.

Continue reading

COVID-19 Symptoms & Course

Roughly 81% of people infected with COVID-19 will experience symptoms considered to be mild to moderate that fully resolve at home. With that said, you may feel truly awful during this time which generally lasts up to 14 days with fluctuating symptoms. Many describe an overwhelming feeling of being rundown, whole body aches and pains, gastrointestinal symptoms like diarrhea or nausea, and fevers that can go up and down, but tend to climb quite high. Others say they feel “beat up” with “weird” symptoms that may include loss of taste and smell and lack of appetite. Some additional COVID-19 symptoms include headache, cough and sore throat. It’s important to note that while fever is considered a hallmark of the virus, it is not present in everyone infected. 

Cough, too, happens in most (roughly 2 out of 3) but not all people with COVID-19. Shortness of breath is often an indicator that the condition is progressing from mild or moderate to severe; you should be seen and tested.

Once infected, the riskiest time tends to be roughly one week after the start of symptoms – more specifically, between days 5 and 8 after getting sick. At that point, shortness of breath can set in and rapidly worsen. If you are gasping for air, coughing up blood, or experiencing chest pain, you must seek medical care emergently.
Symptom
Likelihood
Fever and/ or chills
83%-99%
Cough
67% (range 59%-82%)
Shortness of Breath
31%-40%
Muscle aches and pains
15% (11%-35%)
Fatigue
70%
Loss of smell and/or taste; loss of appetite
70%; 40%-84%
Stomach symptoms like diarrhea, nausea, vomiting
10%

Clusters

Interestingly, symptoms tend to cluster. For example, fatigue and loss of smell often go hand in hand, and that combination can herald a milder illness. Similarly, headache, stomach symptoms, and confusion are frequently seen grouped together in older, frailer patients or those who have comorbid risk factors like diabetes. With that said, nothing about COVID-19 is yet fully predictable because there is so much left to learn. The more data and info that we gather, from testing, tracing, and tracking, the more we understand and can help protect everyone.

COVID-19 Risks

About 14% of people who contract COVID-19 develop serious symptoms that require hospitalization and for the remaining 5%, COVID-19 becomes life threatening. We (i.e. the medical community) are still learning much about the symptoms and risks for COVID-19 and its complications that can include severe shortness of breath, heart inflammation, and the potential need for a respiratory machine (called mechanical ventilator) to support breathing.

There does appear to be greater risk to catch the virus and to develop complications if you:

Lingering Syndromes

While COVID-19 symptoms typically last up to 14 days, there are post-viral syndromes that can continue for weeks or even months, particularly for those who have experienced a prolonged course or required hospitalization. Some individuals describe a sensation of pins and needles, ringing in their ears (called tinnitus), lingering breathlessness, dizziness, joint pain and swelling (especially of one’s hands), confusion, and emotional lability. If you’ve “recovered” from COVID-19 (meaning that you’re past the most acute phase and you’ve even now tested negative for the virus), but have persistent symptoms, you are not “crazy” and you are definitely not alone. The data suggests that roughly 5% of those recovering from COVID-19 experience these ongoing symptoms that can ebb and flow for a prolonged period. Loss of taste or smell, emerging as hallmark symptoms of COVID-19, tend to last for 2 to 4 weeks, for example. But, as some patients share, there are even stranger symptoms that can appear well past the infectious stage:

For example, Jonny never knew that he had COVID-19 until unusual bruises appeared on his toes.

Known now as COVID-toes, this happens from inflammation of the small blood vessels in the skin, called chilblains or pernio. Jonny says he feels no pain but has had some mild itching. Because this unexpected finding is fairly common — in conjunction with other COVID symptoms, as part of a post-viral syndrome, or the one and only manifestation of the virus – an international registry has been set up by a dermatologist at Massachusetts General Hospital in Boston. To date, patients from 21 countries have reported COVID-toes specifically. Dr. Esther Freeman reports that there are many other skin manifestations being reported including hives and measle-like rashes.

*Most data to date have suggested that males are at higher risk for complications from COVID-19 than females; however, recent data from Massachusetts specifically suggests the opposite in that state. More needs to be understood before drawing definitive conclusions either way.