No images? Click here Click here to subscribe to the daily brief. September 10, 2020 - Brief Issue 91 The Coronavirus Daily Brief is a daily news and analysis roundup edited by New America’s International Security Program and Arizona State University. Subscribe or listen here to get the top weekly stories as a podcast. Top Headlines U.S. Sees Positive Trend in Reduced Countrywide Coronavirus Cases, Deaths, and COVID-19 Hospitalizations; More Than 500,000 American Children Have Been Infected by the Coronavirus Since the Start of the Pandemic (Health & Science) Following Standard Safety Protocols, AstraZeneca Halts Global Vaccine Trials to Investigate Single Adverse Reaction Among Thousands (Health & Science) New Research Points to ACE2 Receptors in Brain That Cause Neurological Symptoms in COVID-19 Patients (Health & Science) New Case Study From China Finds Recycled Air During a Bus Trip Contributed to Coronavirus Super-Spread (Health & Science) JAMA: Children with COVID-19 and Children with Flu Have Similar Rates of Severe Illness; Cell: Children with Rare Multisystem Inflammatory Syndrome Have Different Immune Profile (Health & Science) Puzzled Austrians Receive U.S. Stimulus Checks (Around the World) U.K. Health Secretary Decries Asymptomatic Testing (Around the World) Berlusconi Facing “Hellish” COVID-19 Infection (Around the World) Jakarta Reimposes Lockdown as Healthcare System Nears Collapse (Around the World) Woodward Book: Trump Says He Knew Coronavirus Was Deadly But Claimed Otherwise Publicly; Biden: Trump “Lied to the American People” (U.S. Government & Politics) HHS Official Tried to Muzzle Fauci on Coronavirus Threat to Children (U.S. Government & Politics) Cuomo: New York City to Allow Inside Dining at 25% Capacity by September 30 (U.S. Government & Politics) NPR Poll: Half of Respondents Report Job, Wage, or Work Hour Loss During Pandemic (U.S. Economy) New York City Homeless Shelter Population Lowest in Six Years (U.S. Society) Health & Science There have been 6,363,276 coronavirus cases in the United States, and 190,873 people have died (Johns Hopkins). Around 2,387,479 people have recovered, and the United States has conducted 84,558,560 tests. Worldwide, there have been 27,891,274 confirmed cases of coronavirus, with 904,192 deaths. At least 18,794,016 people have recovered from the virus. Following Standard Safety Protocols, AstraZeneca Halts Global Vaccine Trials to Investigate Single Adverse Reaction Among Thousands In a widely covered story, AstraZeneca halted its global Phase III coronavirus vaccine trial Tuesday—with some 17,000 participants in the United Kingdom, Brazil, and South Africa, and seeking to enroll 30,000 in the United States—because of a single participant. A woman in the U.K., who received the vaccine rather than a placebo, had symptoms that could indicate a serious neurological disease called transverse myelitis, although the diagnosis is not confirmed, as AstraZeneca’s CEO Pascal Soriot told investors in a private call Wednesday (STAT). Soriot said that the patient is improving and may be discharged from the hospital as early as Wednesday. It is not clear whether the vaccine caused the participant’s condition, which is not confirmed as transverse myelitis: AstraZeneca halted the trial in order to allow an independent board to investigate the possible linkage (NYT). Transverse myelitis is an inflammation of the spinal cord that can cause muscle weakness, pain, bladder problems, and paralysis; it can be caused by viral infections and in rare cases vaccines. “I rarely see single adverse events like this leading to news stories. That underscores to me the heightened sense of concern about safety and how the vaccine trial process is poorly understood,” commented Jon Cohen of Science magazine (Twitter). Intensive press coverage (Axios, Bloomberg, CNN, Fox, FT, NPR, WSJ) comes on the heels of a pledge by AstraZeneca and eight other leading coronavirus vaccine developers that they would not shortcut the Phase III trials, and amid concerns that President Trump’s repeated suggestions that a vaccine will be ready before the November election, contrary to health officials’ views, may lead to political pressure to approve vaccine that has not been thoroughly vetted, as we covered in Tuesday’s brief (Politico, STAT). Soriot also confirmed that AstraZeneca halted the trial once before in July when a participant showed neurological symptoms that could have been transverse myelitis: on further investigation, the case was diagnosed as multiple sclerosis and assessed as unrelated to the trial vaccine (STAT). AstraZeneca’s actions do not indicate that the vaccine is unsafe; rather, they show that the trial is proceeding as it should, according to standard practice, and the question of safety has yet to be determined (Axios, Conversation, MIT Technology Review, Nature, Reuters). The purpose of the large Phase III trials, which typically involve several thousand participants, is to find rare adverse reactions that would be unlikely to show up in the much smaller Phase I and II trials, which typically enroll dozens up to a few hundred participants. A “clinical hold, as has been placed on AstraZeneca as of yesterday, because of a single serious adverse event is not at all unprecedented,” Francis Collins, the director of the National Institutes of Health (NIH), told a Senate panel Wednesday. “This certainly happens in any large-scale trial where you have tens of thousands of people invested in taking part, some of them may get ill and you always have to try to figure out: Is that because of the vaccine, or were they going to get that illness anyway?” (STAT). Moreover, “the clinical hold shows that there are functioning checks and balances, in spite of political pressure,” said vaccine researcher Marie-Paule Kieny at INSERM, the French national health research institute in Paris (Nature). If the illness is confirmed as transverse myelitis, it may be hard to determine whether or not the vaccine caused it. “Unfortunately, it might end up being very difficult to come to a conclusion, especially if this is a single case,” writes drug researcher Derek Lowe (In the Pipeline). “But the adverse events themselves (especially the serious ones) can be extremely rare, and the only way to get a statistical foothold on them is to have a very large controlled patient population under study. The Oxford/AstraZeneca trial is enrolling nearly 30,000 people, and the problem is that that may still not be enough for a definite answer on something like this.” Director of the Scripps Research Translational Institute Eric Topol commented, “This will likely (hopefully) not turn out to be any signal of trouble at all. But it reinforces the principal concern for safety for such programs that will ultimately be implemented in tens of millions of healthy people” (Twitter). New Research Points to ACE2 Receptors in Brain That Cause Neurological Symptoms in COVID-19 Patients As we’ve noted in several previous briefs, the SARS-CoV-2 virus binds to the ACE2 receptor, which is found on many types of cells, including in the lungs, kidneys, and intestines. In earlier stages of the pandemic, it was thought that the brain might be an unlikely target for the virus because it is not full of ACE2 receptors. However, the number of available ACE2 proteins in the brain is sufficient for brain infection. The novel coronavirus deprives brain cells of oxygen, which causes them to die. Scientists have also found that the virus depletes synapses between neurons. In Iwasaki’s team’s
research on mice, one group of mice had ACE2 receptors in the brain, and the other group had ACE2 receptors in the lungs. Once infected with the virus, the mice with brain receptors “rapidly lost weight and died within six days. The lung-infected mice did neither.” According to the Times analysis, the virus might be able to enter the brain through the olfactory bulb, through the eyes, or the bloodstream, but it’s not fully clear. JAMA: Children with COVID-19 and Children with Flu Have Similar Rates of Severe Illness; Cell: Children with Rare Multisystem Inflammatory Syndrome Have Different Immune Profile Researchers at Children’s National Hospital in Washington D.C., found children with COVID-19 and children with the seasonal flu have similar rates of severe illness, as they reported in a study published in JAMA Tuesday (CIDRAP, JAMA). After comparing 315 children diagnosed with COVID-19 and 1,402 children diagnosed with the flu, the researchers found that 17 percent of COVID-19 patients compared to 21 percent of flu patients were hospitalized; 6 percent of COVID-19 patients and 7 percent of flu patients were admitted to the ICU; and 3 percent of COVID-19 patients versus 2 percent of flu patients needed mechanical ventilation. (This comparison between flu and COVID-19 does not hold true for adults, however [JAMA]). The majority of children with COVID-19 recover with few symptoms, but in the weeks after they contract COVID-19, a small percentage go on to develop multisystem inflammatory syndrome (MIS-C), a rare but serious illness. In over 500,000 confirmed COVID-19 cases in children in the United States, less than 0.2 percent developed MIS-C (Conversation). As of September 3, the Centers for Disease Control and Prevention (CDC) reports 792 confirmed MISC cases, and, tragically, 16 children have died. The causes of the syndrome are still poorly understood, but it appears to result from hyperinflammation, similar to a childhood illness called Kawasaki disease, although MIS-C can affect many organ systems and lead to shock. MIS-C tends to affect children who are slightly older, with an average age of about eight, while Kawasaki disease is more common in children younger than five. A new systematic review of MIS-C published Friday in a Lancet journal reports that the syndrome can appear even in children who had asymptomatic cases of COVID-19, and half of the children with MIS-C had no underlying conditions (EClinicalMedicine). The authors found that MIS-C can quickly weaken the heart, but do not yet know if children will suffer long-term damage. Meanwhile, researchers at the Karolinska Institute in Stockholm found that children with MIS-C had no antibodies to the two coronaviruses that cause the common cold, unlike children with Kawasaki’s disease and children with mild COVID-19, they reported in a pre-proof study accepted by Cell last week (Nature, Cell). This difference may play a role in how and why MIS-C develops in some cases and not in others.
Around the World Europe Puzzled Austrians Receive U.S. Stimulus Checks Confused Austrians have successfully deposited U.S. stimulus checks evidently sent in error, the Washington Post reported on Wednesday. While the total number of cashed checks is unclear, three local bank branches in Austria reported clearing about 200 of the checks in recent months. Although it is likely at least some of those bank customers are United States citizens living abroad and thus meet the criteria for the stimulus benefit, a spokeswoman for Austria’s Oberbank said that local customers had brought the checks to the bank presuming they were attempted targets of fraud only to discover that the U.S. government had inexplicably sent them authentic $1,200 checks. At least some customers appear to have had worked in the U.S. in the past, with an official at Sparkasse bank reporting that Austrians who had recently returned from the U.S. after serving as au pairs were among the recipients. A 73-year-old man who received a check along with his wife told Austrian public broadcaster ORF that he worked briefly in the U.S. in the 1960s (WaPo) and draws a small pension from that period of employment. This is not the first time U.S. stimulus checks have been reported abroad. Last month, NPR reported that checks have been sent to non-U.S. citizens in at least 129 countries (NPR). U.K. Health Secretary Decries Asymptomatic Testing British Health Secretary Matt Hancock has said “inappropriate” testing of asymptomatic people has led to shortages in coronavirus test kits, drawing criticism that the government is sending mixed messages on who should get tested. “In the last couple of weeks we have seen an increase in demand, including an increase in demand for people who are not eligible for tests, and people who don't have symptoms," said Hancock, citing a school that had sent an entire grade to testing centers as well as returning vacationers. "We have seen an increase of about 25 percent of people who are coming forward that don't have symptoms and aren't eligible. They don't have a reason for it,” he added. Members of the Labor opposition party have expressed bewilderment at Hancock’s comments, arguing that it contradicts the government’s abundantly cautious messaging that had previously advised tests to anyone in doubt about their status. "It beggars belief that after weeks of encouraging people to have a test if feeling unwell, ministers are seeking to blame people for simply doing what they were advised,” said shadow health secretary Jonathan Ashworth (BBC). Berlusconi Facing “Hellish” COVID-19 Infection Former Italian Prime Minister Silvio Berlusconi said on Wednesday he is facing a “hellish” case of COVID-19 after being diagnosed last Thursday. “[The virus] is very bad,” he said in a phone call to a fellow candidate from his Forza Italia party. “I’m giving it my all, I hope to make it and to get back on track.” Berlusconi’s girlfriend Marta Fascina, his daughters Marina and Barbara and his son Luigi have also all recently been diagnosed with the virus. His doctor, Alberto Zangrillo, said the former prime minister’s condition is improving. Zangrillo previously stoked controversy in May when he said that the coronavirus “no longer exists clinically.” Berlusconi also assured his party’s candidates and supporters in six regional elections taking place this month that he is “by their side” (Guardian). Bonus Read: “Summer Jet-Setters Turned Sardinia Into a Virus Hot Spot,” (NYT). Asia-Pacific Jakarta Reimposes Lockdown as Healthcare System Nears Collapse The governor of Indonesia’s capital city of Jakarta, announced Wednesday that lockdown conditions will return to the Indonesian capital as health officials warn that the city’s healthcare system is on the brink of collapse. All non-essential business premises will be shuttered to the public while offices will return to a work-at-home policy. Governor Anies Baswedan said that the city is poised to fill all 4,053 of its COVID-19 isolation beds by next week. “There is little choice for Jakarta but to pull the emergency brake immediately,” he said. In the meantime, Anies added, the city will enlist private hospitals to increase the number of beds by 20 percent in order to buy an extra month of time before full capacity is reached. Jakarta, Indonesia’s hardest-hit city, saw its daily new cases count rise above 1,000 at the end of August. A total of 1,334 people have died in Jakarta, which is home to 9.6 million people (Jakarta Globe). North Korean Children Train for Mass Games Amid Pandemic Images from Pyongyang have emerged of hundreds of children evidently preparing in close quarters for North Korea’s semi-regular Mass Games gymnastics performances even as the rest of North Korea appears to be in varying states of social distancing. Photos apparently taken on Wednesday show large groups of children practicing gymnastics in matching uniforms at Pyongyang’s central Kim Il Sung Square, while video footage dated September 5 shows children wearing gymnastics uniforms inside the Mayday Stadium, where the Mass Games are usually held. While the children are not social distancing, some are wearing masks. The training is presumed to be in preparation for the 75th Anniversary of the founding of the ruling Workers’ Party of Korea on October 10. It has not been made clear by the North Korean regime whether elaborate public ceremonies, which normally coincide with such important political anniversaries, will take place this year owing to the pandemic (NK News). The public health situation in North Korea is unclear. While it has not yet officially announced a diagnosis of coronavirus infection, leader Kim Jong Un in July publicly declared a “maximum emergency” due to a suspected case in Kaesong near the demilitarized zone bordering South Korea. Reports from the secretive nation suggest the government has since undertaken a far more cautious approach than it had before, implementing temperature checks in public places while greatly reducing incoming ship traffic. The World Health Organization (WHO) in August, however, reported that none of the 2,767 people tested in North Korea had the infection. However, South Korea’s Minister of Unification Lee In-young told lawmakers in Seoul days after the WHO made its statement that a COVID-19 outbreak of some degree in North Korea is likely, declining to elaborate further in a non-classified setting (NK News). Philippine Government Investigates Senator Over Alleged Quarantine Breach On Wednesday, the Philippine Department of Justice reopened a criminal investigation into an alleged quarantine breach by Senator Koko Pimentel in March on the same day his coronavirus test came back positive. Pimentel, who was President of the Senate from 2016 to 2018, had been under a legally-imposed quarantine at home in Manila with flu-like symptoms when he joined his wife at a hospital for the delivery of their baby. While still at the hospital, he received a phone call from the Research Institute for Tropical Medicine informing him that he had tested positive for the coronavirus. The hospital’s chief later denounced Pimentel for his visit, referring to his actions in the midst of a public health crisis as an “admonition.” The initial criminal investigation into Pimentel, an ally of President Rodrigo Duterte, was closed in July. The Philippines has reported 245,000 cases of the coronavirus, with the daily new case count currently more than 3,000 (The Rappler) U.S. Government & Politics Woodward Book: Trump Says He Knew Coronavirus Was Deadly But Claimed Otherwise Publicly; Biden: Trump “Lied to the American People” President Trump knew even before the first known coronavirus-related death in the United States that the virus would be deadly, but continued to downplay and dismiss the threat, according to interviews conducted with Trump for famed journalist Bob Woodward’s forthcoming book Rage (CNN, Politico, WSJ, NYT, WaPo, FOX). In one of 18 interviews with Trump, which Woodward recorded, Trump called the virus “more deadly than even your strenuous flus” and told Woodward “this is deadly stuff” on February 7. Meanwhile, around the same time, Trump was saying publicly that the virus was “going to disappear.” On March 9, despite having privately called the virus deadlier than the worst strains of flu, Trump tweeted a comparison between coronavirus and a regular flu season, stating, “Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!” In a March 19 interview, Trump stated, “I wanted to always play it down” and “I still like playing it down, because I don't want to create a panic.” According to the book, Trump received a briefing on January 28 that said the virus would be the “biggest national security threat” of his presidency and Woodward writes that Trump’s head “popped up” at that statement. Woodward also writes that Matthew Pottinger, Deputy to National Security Adviser Robert O’Brien, compared the impact to the 1918 flu that killed more than 600,000 Americans. The revelations drew criticism of the administration from Democratic presidential candidate Joe Biden (CNN). At a campaign event in Michigan, Biden stated, “It was much more deadly than the flu. He knew and purposely played it down. Worse, he lied to the American people.” Biden added, “He had the information. He knew how dangerous it was. And while this deadly disease ripped through our nation, he failed to do his job on purpose.” The White House has attempted to downplay the story, with White House Press Secretary Kayleigh McEnany saying “the president has never lied to the American public on Covid” and arguing, “The president was expressing calm and his actions reflect that.” HHS Official Tried to Muzzle Fauci on Coronavirus Threat to Children Paul Alexander, a senior adviser to Health and Human Services Assistant Secretary for Public Affairs Michael Caputo, attempted to prevent White House Coronavirus Task Force Member Anthony Fauci from discussing coronavirus’ threat to children publicly, according to a report Wednesday in Politico (Politico). Politico writes, “Emails obtained by POLITICO show Paul Alexander — a senior adviser to Michael Caputo, HHS’s assistant secretary for public affairs — instructing press officers and others at the National Institutes of Health about what Fauci should say during media interviews. The Trump adviser weighed in on Fauci’s planned responses to outlets including Bloomberg News, BuzzFeed, Huffington Post and the science journal Cell.” Some of Alexander’s messages were sent this week, according to the report. In an August 27 email, Alexander wrote, “I continue to have an issue with kids getting tested and repeatedly and even university students in a widespread manner…and I disagree with Dr. Fauci on this. Vehemently.” In one email, he wrote, “Can you ensure Dr. Fauci indicates masks are for the teachers in schools. Not for children.” In a statement attributed to Caputo, HHS said, “Dr. Alexander advises me on pandemic policy and he has been encouraged to share his opinions with other scientists.” Cuomo: New York City to Allow Inside Dining at 25% Capacity by September 30 On Wednesday, New York Governor Andrew Cuomo announced that New York City restaurants would be allowed to resume inside service at 25 percent capacity beginning on September 30 (Fox, WSJ, NYT). New York City Mayor Bill de Blasio stated that a 2 percent positivity rate in any of the city’s five boroughs would be a trigger for a reassessment. The decision comes as the pandemic has hit the restaurant industry particularly hard and as the approaching cold weather months threaten to further impact the industry, which has relied upon patio and outdoor dining to continue business. However, Cuomo did state there would be “no bar service.” In the rest of New York State, most restaurants are allowed to operate indoor dining at 50 percent capacity. Bonus Read: “A Senate Race in Kansas Between Two Doctors Sets the Stage for an Election Hyper-Focused on Health Policy — and on Covid-19,” (STAT). U.S. Economy NPR Poll: Half of Respondents Report Job, Wage, or Work Hour Loss During Pandemic On Wednesday, a poll conducted by the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health with NPR of residents of America’s four largest cities, found that half of respondents “have experienced the loss of a job or a reduction in wages or work hours in their household since the start of the coronavirus outbreak” (NPR). NPR reports, “Many of these problems are concentrated among Black and Latino households in the four cities” with Houston reporting particularly high numbers with 77% of Latino households and 81% of Black households reporting serious financial difficulties. However, majorities of Black and Latino households in all four cities (Houston, New York City, Los Angeles, and Chicago) reported the same. Coronavirus Misinformation Impacting Wall Street Research Misinformation regarding the coronavirus is impacting research on Wall Street, according to a Wednesday CNN report (CNN). An early August note sent by the research firm Fundstrat Global Advisors to investors included citations to tweets by James Todaro, an ophthalmologist, that presented an inaccurate and overly rosy picture of the pandemic. Such research notes shaped decisions over assessments of the market, so many analysts express concern over the appearance of misinformation in them. One hedge fund manager told CNN, “There should be a difference between Wall Street research and what's available on the internet. It's just that simple.” Bonus Read: “Business Vacancies Rise on New York City’s Broadway,” (WSJ). U.S. Society New York City Homeless Shelter Population Lowest in Six Years Amid the coronavirus pandemic, the population of New York City’s homeless shelters has dropped to its lowest level in six years (WSJ). The system on average housed 54,770 people in August, according to New York City’s Department of Homeless Services. The Wall Street Journal notes that the decline is driven by lower numbers of families living in shelters, while the number of single adults in shelters reached a record high over the summer. The Journal writes, “City officials said they primarily attribute the drop in the overall shelter population to their work securing permanent housing for people in shelters. City officials and advocacy groups also said the decline is likely in part because of a citywide eviction moratorium effective through October 1, which has helped keep people housed.” However, many remain concerned about the potential for a future uptick, especially if eviction moratoriums are ended. Ingrid Gould Ellen, faculty director at New York University’s Furman Center which conducted a study of the economic impact of the virus on households, told the Journal, “There’s a sense that very soon, whether it’s this month or next month, we’re going to see people really unable to pay their rent.” Concerts Held During Pandemic Raise Legal Questions The music industry is beginning to experiment again with potential ways to hold in-person concerts, but with the experiments come substantial legal questions, according to a Wednesday report in the Wall Street Journal (WSJ). The Journal notes that the number of in-person shows is a “drop in the bucket” compared to the 50,000 shows that “Concert giants Live Nation Entertainment and AEG Presents alone normally put on” annually. However, the experimentation that is happening is raising questions about who is responsible for attendee safety, whether insurance will cover lawsuits, and whether fans can win lawsuits.” These questions have contributed to the slowness of the emergence of shows. As the Journal writes, “Despite desperately needing ticket sales—Live Nation’s revenue dropped 98% in the second quarter—the biggest concert promoters have proceeded slowly and emphasized safety.” Analysis & Arguments Michael Brendan Dougherty warns of a coming bout of coronavirus-driven polarization (National Review). Ed Yong writes that the U.S. is making the same mistakes in its coronavirus response that it made before, entering a pandemic spiral (Atlantic). Clio Chang writes on the purgatory like experience of seeking unemployment benefits during the pandemic (New Republic). Ewen Callaway discusses whether or not the coronavirus mutating is something to be concerned with (Nature).
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