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November 10, 2020 - Brief Issue 117

The Coronavirus Daily Brief is a daily news and analysis roundup edited by New America’s International Security Program and Arizona State University.

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Top Headlines

Interim Results Suggest Pfizer Vaccine More Than 90% Effective (Health & Science)

FDA Approves First Monoclonal Antibody Treatment (Health & Science)

Recent Studies Cast Doubt on “Cytokine Storm” Hypothesis (Health & Science)

Europe Running Low on ICU Beds, Staff (Around the World)

U.K. Redundancies Hit Record High (Around the World)

Brazil Unexpectedly Suspends Sinovac Covid-19 Vaccine Trial (Around the World)

Jordan Holds Parliamentary Election Amid Coronavirus Outbreak (Around the World)

China’s Wildlife Crime Prosecutions on the Rise (Around the World)

Biden Promises More Forceful Pandemic Response, Announces Task Force (U.S. Government & Politics)

HUD Secretary Ben Carson Tests Positive for Coronavirus (U.S. Government & Politics)

Stocks Surge on Vaccine and Election News (U.S. Economy)

McDonald's Sales Recovering From Pandemic Impact (U.S. Society)

Health & Science

There have been 10,110,552 coronavirus cases in the United States, and 238,251 people have died (Johns Hopkins). Around 3,928,845 people have recovered, and the United States has conducted 153,965,479 tests. Worldwide, there have been 50,913,451 confirmed cases of coronavirus, with 1,263,089 deaths. At least 33,289,404 people have recovered from the virus. 

Interim Results Suggest Pfizer Vaccine More Than 90% Effective

An interim analysis of Pfizer’s Covid-19 vaccine found that the vaccine is more than 90% effective – a better outcome than expected (NYT, CNN, Politico). The analysis looked at data from the first 94 confirmed Covid cases in the more than 43,000 volunteers and found that fewer than 10% of infections occurred in those that had received the vaccine.

“I can’t imagine better news on the vaccine front,” said Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh. Other scientists welcomed the news but were quick to point out that the data is still incomplete. The results were communicated via a press release, and data from the ongoing study has not yet been released. The clinical trial will not conclude until at least 164 cases of Covid-19 are confirmed among participants, at which point the full safety and efficacy data will be reviewed.

Pfizer said on Monday that it can produce 50 million doses by the end of the year and 1.3 billion by the end of 2021. The company expects to seek emergency authorization of the vaccine at the end of the month and plans to supply the U.S. government with 100 million doses by March.

FDA Approves First Monoclonal Antibody Treatment

On Monday, the U.S. Food and Drug Administration (FDA) issued emergency approval for Eli Lilly’s monoclonal antibody treatment (CNN, CNBC). The drug, which is called bamlanivimab, targets a protein on the surface of the SARS-CoV-2 virus and prevents entry into human cells. The FDA authorization was based on a study published in the New England Journal of Medicine which found that the treatment lowered hospitalization rates and improved symptoms in patients with mild to moderate Covid-19 symptoms.

Bamlanivimab is now authorized for use in patients 12 years and older who have a positive Covid-19 test and are at high risk for progressing to severe disease. This designation includes individuals 65 years of age and older and those who have certain chronic medical conditions.

Recent Studies Cast Doubt on “Cytokine Storm” Hypothesis

Scientists are still working to understand why some people experience severe effects from Covid-19 while others have a relatively mild disease. One idea is that of the “cytokine storm” – an extreme immune response wherein the virus is cleared but inflammation from cytokines and other immune system components causes extensive damage to tissues and organs.

Most studies of the so-called cytokine storm have focused on one particular cytokine called interleukin-6, or IL-6. High levels of IL-6 have been reported in patients who have died from Covid-19. In the early months of the pandemic, a patient in China and a patient in Italy, both of whom experienced severe symptoms, were treated with IL-6 inhibitors. Both patients recovered. Since then, it has become common to treat patients with drugs that inhibit IL-6.

However, recent studies have found little evidence of efficacy for IL-6 inhibitors, casting doubt on the cytokine storm hypothesis (NYT). Multiple studies examining the effects of the commonly used IL-6 inhibitor tocilizumab found no improvement in clinical status or reduction in mortality in hospitalized Covid-19 patients.

Some scientists have pointed out that IL-6 is far from the only cause of inflammation during the immune response. In fact, hundreds of cytokines are deployed in response to infection, which is one reason it may be difficult to tease out what role, if any, the “cytokine storm” might have in Covid-19. Other inflammatory inhibitors, such as the broad immunosuppressant dexamethasone, may be helpful in reducing patient mortality, and it remains possible that IL-6 inhibitors could be helpful in patients with less severe disease. 

U.K. to Provide Vitamin D Supplements for People Vulnerable to Covid-19

United Kingdom health ministers are making plans to deliver a free, four-month supply of Vitamin D to two million people who are considered at high-risk for Covid-19, including those in care homes (Telegraph). Several studies have found links between low Vitamin D levels and severe Covid-19 symptoms, and other studies suggest that adequate Vitamin D levels may help reduce Covid-19 complications and mortality. The U.K. plans to conduct a clinical trial to further investigate the efficacy of Vitamin D treatment. The move to provide vulnerable individuals with Vitamin D supplements comes shortly after officials in Scotland announced a similar plan.

Nasal Spray May Provide Protective Effects Against Covid-19

A study released as a pre-print on Thursday discusses preliminary results for a new potential defense against Covid-19 (NYT). Researchers at Columbia University developed a nasal spray designed to block absorption of SARS-CoV-2, the virus that causes Covid-19, into airways and lungs. The spray contains a molecule that specifically binds to the SARS-CoV-2 “spike” protein, which the virus uses to attach to cells. With the blocking molecule in place, the virus can no longer cause infections.

The study, which has not yet been peer reviewed, tested the effects of the spray on ferrets. In the study, six ferrets were treated with the spray and six were treated with a placebo spray. These ferrets were then exposed to untreated ferrets that had deliberately been exposed to SARS-CoV-2 two days prior. After 24 hours together, all of the ferrets in the placebo group had become infected, while none of the ferrets who received the spray were infected.

The research group described the spray as “stable” and “nontoxic.” Unlike a vaccine, it does not require refrigeration, making it easier to transport and store. The group hopes the spray, which is effective for about 24 hours, could be used as a daily preventative measure, allowing people to participate in their everyday activities and perhaps even safely interact with infected family members.

The spray requires more development before it would be ready for medical use – it would need to go through all four stages of a clinical trial, and it is unclear how readily the product would scale for mass production. However, scientists are enthusiastic about its potential. Dr. Peter Hotez, a disease expert at Baylor College of Medicine who was not involved in the study, called the therapy “really promising.” The authors of the study hope to begin trials in humans soon and are considering applying for additional funding through the federal government’s Operation Warp Speed program.

Clinics and Laboratories Face Shortages of Common Medical Equipment

As production of Covid-19 tests ramps up, clinics and laboratories report shortages of medical equipment for other tests (WSJ). Common items such as swabs and testing chemicals are being redirected for Covid tests, forcing some doctors to ration tests for other conditions such as strep throat, fungal infections, and urinary tract infections.

According to a survey by the American Society for Microbiology and the Association of Supply Chain Management, approximately 30% of laboratories are experiencing shortages of equipment needed to detect bacterial infections, and 50% said they lacked sufficient supplies to test for routine fungal infections. Administrators say they anticipate the shortages to worsen in the coming months as flu season coincides with rapidly increasing Covid-19 cases.

Utah Governor Declares State of Emergency; Issues Mask Order

Utah Governor Gary Herbert declared a two-week state of emergency late Sunday night amid rapidly rising Covid-19 cases and hospitalizations (WaPo). In a video posted to Twitter and sent to Utah residents via an emergency cell phone alert, the governor expressed grave concern for thin-stretched hospitals and overwhelmed medical professionals. In the video, Governor Herbert issued a mask mandate and other restrictions designed to keep Utah residents safe. Utah reported a record high of 437 Covid-19 hospitalizations on Sunday and has experienced steep increases in case counts over the past several weeks.

N.Y.C. Mayor: The City is Dangerously Close to a Second Wave

New York City Mayor Bill de Blasio warned on Monday that New York City was facing “immense” challenges as case numbers in the city tick upward (NYT). New York has been reopening slowly, hoping to avoid a repeat of the situation in early spring when cases, hospitalizations and deaths spiked in the city.

Mayor de Blasio has reportedly been discussing possible tactics with city health officials, including shutdowns of nonessential businesses. The mayor urged “everyone to participate” in mitigation efforts like social distancing and wearing masks. Otherwise, he said, “it could mean even having to shut down parts of our economy again.” Renewed shutdowns would require approval from the governor. For now, de Blasio and city health officials continue to monitor important metrics, such as hospitalization rates and percent positive test results, as they weigh the possibility of imposing stricter measures.

Health Experts Concerned About Impact of Thanksgiving Break for College Students

As colleges prepare to send students off campus for Thanksgiving, some health officials are concerned about the possibility of students carrying the virus back to their hometowns (NYT). Many colleges are opting to offer only online instruction after the Fall break, meaning that most students will travel back to their homes and remain there until the Spring semester.

Epidemiologists recommend that travelers isolate themselves for at least a week and get a negative Covid-19 test result a minimum of three days before traveling. Upon arrival, travelers should again isolate until another negative test result is confirmed. Those who do not receive a test should quarantine for at least 14 days before and after traveling.

Most universities, however, do not require testing prior to students’ departure. The American College Health Association issued guidance last week asking colleges to encourage students to get tested before traveling, but the association did not call for mandatory testing. Dr. David Paltiel, a professor of health policy and management at the Yale School of Public Health, criticized the lack of a consistent plan across college campuses and said that colleges have “a responsibility not to unleash little ticking time bombs.” Dr. Paltiel believes testing should be mandatory for students traveling away from campus.

Bonus Read: "A National Covid-19 Vaccine Confidence Project: Job No. 1 for President-Elect Biden," (STAT)

Around the World

Europe

Europe Running Low on ICU Beds, Staff

As cases continue to surge across Europe, Intensive Care Units (ICU) are reaching capacity and hospitals are struggling to find healthcare workers trained to provide care to critically ill patients. In France, the coronavirus tracking app shows the intensive care capacity currently taken up by Covid-19 patients as 92% and rising (AP). In Italy, ambulances are parked outside of hospitals that don’t have enough beds for incoming patients. Patients from France and the Netherlands are being evacuated to German ICUs, but German doctors say their capacity is also dwindling. In the past two weeks alone the number of coronavirus patients treated in ICUs in Germany has almost tripled, from 943 to 2,546. In Portugal, there are more cases now than there were during the springtime peak: In the seven months from early March through the end of September, Portugal officially counted more than 75,500 cases of COVID-19. In the month of October alone, it counted almost 66,000. On Monday, there were 391 coronavirus patients in Portuguese ICUs. “There’s no end in sight,” said Fernando Maltez at the infectious disease ward he oversees at Lisbon’s Curry Cabral Hospital, where 20 ICU beds set aside for coronavirus patients are now all occupied. “No health service in the world ... can withstand a deluge of cases that just keeps coming.”

Most hospital administrators across the continent agree with Maltez and are now warning that adding more beds won’t do much good as they don’t have enough doctors and nurses to staff them. For example, in France, more than 7,000 health care workers have been trained in intensive care techniques since last Spring. But Health Minister Olivier Veran says it's still not enough: “If the mobilization is well and truly there, it is not infinite,” he said last week, when the ICU units were filled to 85% capacity. “It is not enough.” And while Germany may have more ICU beds than other countries, they lack the staff. “But a bed, a ventilator and a monitor doesn’t mean the patient can be cared for. When it comes to nurses and specialist staff, Germany is far behind,” said Dr. Uwe Janssens, who heads Germany’s Interdisciplinary Association for Intensive Care and Emergency Medicine. “We have a lot of beds but we don’t have enough staff for them.”

U.K. Redundancies Hit Record High

British employers made a record number of employees redundant, a form of job loss, in the third quarter as the jobless rate jumped, according to official data (Reuters). A record 314,000 workers were made redundant between July 1 and Sept. 30, which was 181,000 more than in the second quarter, according to the Office for National Statistics (BBC). The unemployment rate rose to 4.8%, the highest rate since Nov. 2016. Last week, the Bank of England forecast that Britain’s unemployment rate would reach 6.3% by the end of the year. 

Americas

Brazil Unexpectedly Suspends Sinovac Covid-19 Vaccine Trial

Brazil’s health regulator has suspended a clinical trial of China’s Sinovac coronavirus vaccine citing a severe adverse event, surprising trial organizers. The health regulator, Anvisa, said on Monday that the adverse event occurred on Oct. 29 but did not specify whether it took place in Brazil or somewhere else (BBC). It also did not say how long the suspension would last. Dimas Covas, the head of Sao Paulo’s medical research institute Butantan which is conducting the Sinovac trial, said the regulator’s decision was related to a death but added he found it strange “because it’s a death unrelated to the vaccine.” Covas explained to local broadcaster TV Cultura, “As there are more than 10,000 volunteers at this moment, deaths can occur... It’s a death that has no relation with the vaccine and as such it is not the moment to interrupt the trials” (Reuters). The trial is one of three large late-stage trials currently in progress for the Sinovac vaccine and faced some opposition in Brazil as President Jair Bolsonaro dismissed it as lacking credibility. 

Middle East

Jordan Holds Parliamentary Election Amid Coronavirus Outbreak

On Tuesday, Jordanians began to vote to elect a new parliament even as the country struggles to contain its coronavirus outbreak (AP). Poll workers distributed gloves, masks, and pens and enforced social distancing and any voters who are currently in quarantine will be allowed to cast ballots at the end of the day. Voters will elect 130 members of the lower house of parliament, with 15 seats reserved for women, nine for Chrisitans, and three for minority Chechens and Cicassians. Jordan, with a population of around 10 million, reported 5,665 new cases of coronavirus on Monday. The government has imposed periodic lockdowns and curfews since the beginning of the pandemic.

Asia

China’s Wildlife Crime Prosecutions on the Rise

China prosecuted more than 15,000 people for wildlife-related crimes in the first nine months of this year, up 66% from 2019, according to state prosecutors (Reuters). The increase in prosecutions is largely due to authorities enforcing a trafficking ban that was imposed after the Covid-19 outbreak, which was traced back to a market selling wildlife products. Scientists believe that the novel coronavirus originated in horseshoe bats but infected humans through an intermediary species, perhaps pangolins. In February, China’s legislature passed a resolution that promised to ban the sale and consumption of wild animals, however new legislation is expected to exempt the fur and traditional Chinese medicine trades. China’s wildlife trade is lucrative and poorly regulated, and prosecutors warn that now a large proportion of it has moved online, with traders using e-commerce platforms to sell wild animals and exotic pets. 

U.S. Government & Politics

Biden Promises More Forceful Pandemic Response, Announces Task Force

On Monday, President Elect Joe Biden announced the membership of his Coronavirus Task Force and promised a more forceful response to the pandemic (WSJ, WaPo, NYT). The task force will be co-chaired by Vivek H. Murthy, who was the surgeon general during the Obama administration; David Kessler, who was an FDA commissioner under Presidents George H.W. Bush and Bill Clinton; and Marcella Nunez-Smith, the associate dean for health equity research at Yale’s School of Medicine. Biden stated, “Dealing with the coronavirus pandemic is one of the most important battles our administration will face, and I will be informed by science and by experts.” The Washington Post writes, “The 13-member task force also includes former Trump administration officials, including Rick Bright, former head of the Biomedical Advanced Research and Development Authority, who, after being demoted, spoke out against the administration’s approach to the pandemic. Luciana Borio, director for medical and biodefense preparedness on Trump’s National Security Council until 2019, is also on the panel.” It also includes numerous doctors and health experts including Ezekiel Emanuel, Atul Gawande, Michael T. Osterholm, Eric Goosby, Celine R. Gounder, Julie Morita, Loyce Pace, Robert Rodriguez, Rebecca Katz, and Beth Cameron. The task force will have its hands full with the pandemic surging across the United States and expected to continue its spread in the months before the administration takes office (NYT).

HUD Secretary Ben Carson Tests Positive for Coronavirus

On Monday, Fox News reported that Housing and Urban Development Secretary Ben Carson tested positive for coronavirus (Fox). Carson, 69, was appointed to the White House’s Coronavirus Task Force. The report comes as the White House wrestles with its third outbreak of coronavirus in recent months in which White House Chief of Staff Mark Meadows tested positive. A previous outbreak was centered on the Vice President’s staff while in an earlier outbreak, President Trump himself caught the virus.

U.S. Economy

Stocks Surge on Vaccine and Election News

U.S. stocks surged on news of the positive results of Pfizer’s vaccine study and President Elect Joe Biden’s victory (WSJ, WaPo). The Wall Street Journal reports, “The Dow Jones Industrial Average climbed almost 1400 points, or 4.8%, in afternoon trading. The blue-chip index set its first intraday record since February and came within about 70 points of the 30000 mark before paring some gains. The S&P 500 surged 3.3%, also putting it in record territory.” The news of a possible vaccine caused the stocks of industries devastated by the pandemic to rise, including the stock prices for Carnival (37%), American Airlines (17%), and Kohl’s (16%). In contrast, the Journal notes that “the pandemic’s winning stocks, such as big tech companies, lagged behind the rest of the market, a reversal of fortunes that some investors said was among the most stark they had seen.” Among these companies were Netflix, Clorox, and Zoom, all of which saw declines. 

U.S. Society

McDonald's Sales Recovering From Pandemic Impact

McDonald’s sales are recovering from the impact of the pandemic, according to data on third quarter sales released by the company on Monday (WSJ). According to the data, sales declined 2.2% from third quarter sales last year. However, as the Wall Street Journal notes, this was a “slightly better result than analysts had expected and a sizable improvement from a 23.9% drop in the second quarter. Sales improved as countries allowed restaurants to open again during the summer and autumn after initial lockdowns, McDonald’s said.”

High School Basketball Resumes Despite Health Expert Warnings

High School sports leagues are resuming their games, including basketball, despite health expert warnings that basketball poses risks for spreading coronavirus (WSJ). Basketball is the most popular indoor sport among high schoolers, and the Wall Street Journal reports, “most state high school activities associations plan to go ahead with normal seasons, or continue with some tweaks.” Yet health experts are warning against resuming play. An Oct. 30 letter signed by four officials with Kansas City and Wynadotte County’s Health Department, “strongly recommends that you do not allow indoor sports or activities such as basketball or wrestling, based upon the level of community transmission and consequently, the risks involved.” Yet Piper High School in the county plans to host games regardless. Piper High athletic director Doug Key asserted, “If we would play here in Wyandotte County, we still have a gathering limit and we wouldn’t be able to have fans or cheerleaders.” At least one study suggests that such sports may be safe. The Journal writes, “A study by University of Wisconsin researchers—which had been featured on the National Federation of State High School Associations website—asserts that high school sports in Wisconsin haven’t led to an increase in Covid-19 infections among high school athletes.” But it also notes that the study has not been peer reviewed and has received criticism including from Robert N. Golden, Dean of Wisconsin’s School of Medicine and Public Health, who said the study did not represent the school’s view, saying “we do not believe this report should play a major role in shaping their decisions.” Rex Archer who directs the Kansas City Health Department, stated that he doesn’t believe sports can be played indoors safely.

Bonus Read: “College-Admissions Season Was Already Stressful. Pandemic Made It Chaotic,” (WSJ).

Analysis & Arguments

Patricia Sharpe writes on what she misses about restaurants (Texas Monthly).

Kevin N. Sheth and Serena Spudlich explain what makes vaccines safe and effective (WSJ).

Former FDA Commissioner Scott Gottlieb writes on what Biden can learn from the states in crafting a national pandemic strategy (WSJ).

 Readers can send in tips, critiques, questions, and suggestions to coronavirusbrief@newamerica.org.

The Brief is edited by David Sterman and Emily Schneider with Jessica Scott and Senior Editor Peter Bergen.

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