From CDC & Johns Hopkins
Updates Thursday 5/21/2020
Researchers: Nearly Half of Accounts Tweeting About Coronavirus Are Likely Bots (NPR) Nearly half of the Twitter accounts spreading messages on the social media platform about the coronavirus pandemic are likely bots, researchers at Carnegie Mellon University said Wednesday. Researchers culled through more than 200 million tweets discussing the virus since January and found that about 45% were sent by accounts that behave more like computerized robots than humans.
PITFALLS OF IMMUNITY PASSPORTS The concept of “immunity passports” based on COVID-19 antibody testing has been the subject of much discussion. The authors of a recent Nature commentary argue against the use of such passports for both practical and ethical reasons. On the practical side, little is known about the durability of immunity in individuals who recover from SARS-CoV-2 infection, and the scale at which serological testing would need to be conducted for such a program would be enormous. Rather than focus resources and efforts on a system of immunity passports, the authors recommend that governments should instead redouble efforts on testing, contact tracing, and vaccine development. Although the WHO has recommended against the use of immunity passports, some countries are still reportedly considering them as an option to bolster efforts to relax community mitigation measures. For example, Estonia has reportedly started testing digital immunity passports, which would enable individuals to temporarily share their “immune status” with a third party through a smartphone app, although it is unclear how this status would be determined. Chile is reportedly planning to offer “virus-free” certificates to certify that an individual has recovered from COVID-19. One health official maintained this would certify that the individual was fully recovered and has completed the associated isolation period; the certificates will not serve the same purpose as an immunity passport.
Testing of residents
If testing capacity allows, facility-wide PPS of all residents should be considered in facilities with suspected or confirmed cases of COVID-19. Early experience from nursing homes with COVID-19 cases suggests that when residents with COVID-19 are identified, there are often asymptomatic residents with SARS-CoV-2 present as well. PPS of all residents in the facility can identify infected residents who can be cohorted on a pre-specified unit or transferred to a COVID-specific facility. If undertaking facility-wide PPS, facility leadership should be prepared for the potential to identify multiple asymptomatic residents with SARS-CoV-2 infection and make plans to cohort them.
If testing capacity is not sufficient for facility-wide PPS, performing PPS on units with symptomatic residents should be prioritized.
If testing capacity is not sufficient for unit-wide PPS, testing should be prioritized for symptomatic residents and other high-risk residents, such as those who are admitted from a hospital or other facility, roommates of symptomatic residents, or those who leave the facility regularly for dialysis or other services.
Testing of nursing home HCP
If testing capacity allows, PPS of all HCP should be considered in facilities with suspected or confirmed cases of COVID-19. Early experience suggests that, despite HCP symptom screening, when COVID-19 cases are identified in a nursing home, there are often HCP with asymptomatic SARS-CoV-2 infection present as well. HCP likely contribute to introduction and further spread of SARS-CoV-2 within nursing homes.
CDC recommends HCP with COVID-19 be excluded from work. Facility leadership and local and state health departments should have a plan for meeting staffing needs to provide safe care to residents while infected HCP are excluded from work. If the facility is in Crisis Capacity and facing staffing shortages, see CDC guidance on Strategies to Mitigate Healthcare Personnel Staffing Shortages for additional considerations.
Retesting of residents
Retest any resident who develops symptoms consistent with COVID-19.
Retest all residents who previously tested negative at some frequency shortly (e.g., 3 days) after the initial PPS, and then weekly to detect those with newly developed infection; consider continuing retesting until PPSs do not identify new cases.
If testing capacity is not sufficient for retesting all residents, retest those who frequently leave the facility for dialysis or other services and those with known exposure to infected residents (such as roommates) or HCP.
Use retesting to inform decisions about when residents with COVID-19 can be moved out of COVID-19 wards. See CDC guidance on Discontinuation of Transmission-Based Precautions and Disposition of Patients with COVID-19 in Healthcare Settings for additional information.
Retesting of nursing home HCP
Retest any HCP who develop symptoms consistent with COVID-19.
Retest to inform decisions about when HCP with COVID-19 can return to work. See CDC guidance on Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19 for additional details.
Consider retesting HCP at some frequency based on community prevalence of infections (e.g., once a week).
If testing capacity is not sufficient for retesting all HCP, consider retesting HCP who are known to work at other healthcare facilities with cases of COVID-19.
From Johns Hopkin 5/11/2020
CONTACT TRACER TRAINING The Johns Hopkins University Bloomberg School of Public Health and Bloomberg Philanthropies, in partnership with New York state launched an online course to train contact tracers. University faculty teach the basics of interviewing COVID-19 cases, identifying their close contacts, and providing them advice and support for quarantine. The course aims to provide the tools needed for future contact tracers to support COVID-19 response efforts that are critical to the country’s ability to safely relax social distancing measures. New York’s professional contact tracers will be required to complete the course, but anyone may take it for free. The course is available via the Coursera platform starting today.
DOWNSTREAM EFFECTS A study published in the US CDC’s Morbidity and Mortality Weekly Report looked at the effects of the COVID-19 pandemic on routine childhood immunizations in the United States. Based on data from the federal Vaccines for Children Program and the CDC’s Vaccine Tracking System and Vaccine Safety Datalink, the authors found a significant decrease in the number of childhood immunizations administered compared to previous years, potentially driven by concerns that children could be exposed to SARS-CoV-2 during their doctor visits. The authors note, “[t]he decline began the week after the national emergency declaration.” Among children aged 2-18 years, the number of measles-containing vaccinations (e.g., MMR) fell from more than 2,000 per week to only several hundred over a 2-week period and has remained at that level from mid-March through at least mid-April. The decrease was less dramatic for children under 2 years old, and the number of vaccines for this age group has steadily rebounded, up to nearly 1,500 vaccinations by mid-April. The study evaluates only national-level data, and analysis of state and local variations in coverage will be needed to better characterize the local impact. The authors warn that interruptions and delays to childhood immunizations could “indicate that U.S. children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” particularly as social distancing measures are relaxed and children resume social interaction.
ANTIGEN DIAGNOSTIC TEST EUA The US FDA issued the first Emergency Use Authorization (EUA) for an antigen-based diagnostic test for SARS-CoV-2. Previously, the diagnostic tests used for SARS-CoV-2 were all PCR-based, which detects the presence of viral RNA. The new tests detect “fragments of proteins known as antigens found on or within the virus” and are capable of providing results more rapidly. They do have a higher probability of returning false negative results, so negative antigen tests “may need to be confirmed with a PCR test.” The positive results for the antigen tests are highly accurate, however, and the tests cost less to manufacture.
The Johns Hopkins CSSE Dashboard is is reporting 1.33 million US cases and 79,825 deaths as of 1:30pm on May 11.
In summary, existing limited data on antibody responses to SARS-CoV-2 and related coronaviruses, as well as one small animal model study, suggest that recovery from COVID-19 might confer immunity against reinfection, at least temporarily. However, the immune response to COVID-19 is not yet fully understood and definitive data on postinfection immunity are lacking. Amidst the uncertainty of this public health crisis, thoughtful and rigorous science will be essential to inform public health policy, planning, and practice.
After Six New Cases, Wuhan Plans to Test all 11 Million Residents for Coronavirus
The ‘Biggest Challenge’ Won’t Come Until After a Coronavirus Vaccine is Found (Politico) Meeting the overwhelming demand for a successful coronavirus vaccine will require a historic amount of coordination by scientists, drugmakers and the government. The nation’s supply chain isn’t anywhere close to ready for such an effort.
The Coalition for Epidemic Preparedness Innovation (CEPI) announced additional funding to support a promising candidate vaccine against SARS-CoV-2. The vaccine, developed by Novavax, aims to initiate a Phase 1 clinical trial later this month. The new funding will include US$384 million to support Phase 1 and 2 clinical trials as well as “large-scale manufacture” of the vaccine. CEPI previously provided US$4 million to support the vaccine’s development and initial testing, but the recent announcement is orders of magnitude greater than that. Additionally, the funding will support efforts to provide manufacturing partners around the world with the necessary technology to facilitate globally distributed production, if the vaccine proves to be safe and effective.