Beijing's partial coronavirus lockdown a sign of the world's new normal

‘Party officials in charge of Beijing, including the city's party secretary, Mr Cai Qi, have sounded chagrined about the flare-up. "The lessons run very deep, the situation for epidemic control is very grim, and this has sounded a warning to us," said an official summary of a city leaders' meeting carried by The Beijing Daily on Wednesday.

‘Most Beijing streets flowed with traffic on Wednesday, though less than usual, and the public mood appeared resigned rather than panicked. Restaurants still opened, though the government has ordered them to disinfect and check employees.’

Read here (Straits Times, June 18, 2020)

The end of tourism?

‘Coronavirus has also revealed the danger of overreliance on tourism, demonstrating in brutal fashion what happens when the industry supporting an entire community, at the expense of any other more sustainable activity, collapses. On 7 May, the UN World Tourism Organisation estimated that earnings from international tourism might be down 80% this year against last year’s figure of $1.7tn, and that 120m jobs could be lost. Since tourism relies on the same human mobility that spreads disease, and will be subject to the most stringent and lasting restrictions, it is likely to suffer more than almost any other economic activity.’

Read here (Guardian, June 18, 2020)

An analysis of three Covid-19 outbreaks: How they happened and how they can be avoided

‘A crowded restaurant to celebrate the Chinese New Year; 100 workers infected inside a 19-story building; a group of devout Buddhists travelling by bus for a religious ceremony. These were the scenarios for three outbreaks of Covid-19 that have been carefully documented by the authorities. What happened in each one? What were the risk factors? What lessons can be learned, now that we are trying to get back to normal and return to restaurants, offices and other shared spaces?’

Read here (El Pais, June 18, 2020)

Scathing Covid-19 book from Lancet editor — rushed but useful

‘Since the coronavirus crisis began, Richard Horton, editor-in-chief of leading medical journal The Lancet, has been tearing across the British public sphere. Here he is on the BBC, the national broadcaster, there in the pages of The Guardian newspaper — taking the government to task for failures that have left the United Kingdom with the world’s second-highest per capita COVID-19 death toll so far (Belgium is top). Horton has never shied away from controversy (his journal published the retracted, fraudulent paper by Andrew Wakefield that alleged a non-existent link between vaccines with autism) or crusades (against the Iraq war and for political action on climate change). In coronavirus, he has found a cause that matches his energy: the Lancet journals are pumping out both the latest research and his pointed critiques of government policy; and last month, he reviewed a new book by the Slovenian Marxist philosopher Slavoj Žižek that imagines economic and social worlds after COVID-19.

‘Now Horton has a book of his own. The COVID-19 Catastrophe is a sort of history, diagnosis and prescription, in real time. It is wide ranging, querying the changing role of international cooperation and the fallout of austerity economics, and taking a deeper dive into China’s scientific and political response to the crisis than most Western media have offered. But the book returns again and again to the catastrophe in both the United Kingdom and the United States. It is haunted by the question: how did two of the richest, most powerful and most scientifically advanced countries in the world get it so wrong, and cause such ongoing pain for their citizens?’

Read here (Nature, June 18, 2020)

What to expect when flying now (and in the future)

Air travel is full of opportunities for coronavirus transmission. Touchless check-in, plexiglass shields, temperature checks, back-to-front boarding and planes with empty middle seats are all now part of the flying experience, and the future may bring even more changes. Illustration: Alex Kuzoian

Watch here (Wall Street Journal, June 17, 2020)

Antibody tests don't mean a ton right now. But that could change soon

‘In the study published in medRxiv, a preprint server for posting studies before they are peer-reviewed, a team at the Lindsley F. Kimball Research Institute of the New York Blood Center and Rockefeller University analyzed 370 plasma samples donated from people who recovered from COVID-19 and found some surprising results...

‘Overall, around 88% of the people generated varying levels of antibodies to the virus. But only about 10% of them had high levels that were able to neutralize the lab-based version of the COVID-19 virus—and, on the other side of the spectrum, 17% had almost no antibody response to their infection.’

Read here (Time Magazine, June 16, 2020)

The pandemic broke end-of-life care

‘The first day the palliative-care doctors walked into the ICUs, Thomas [Jane deLima Thomas, the director of palliative care at Brigham and Women’s Hospital and Dana-Farber Cancer Institute] says, “we felt like tourists.” They were dressed in business casual, while their ICU colleagues raced around in scrubs and masks. But the palliative-care team—which includes physicians, nurses, chaplains, and social workers—found ways to integrate themselves. In the early days of the pandemic, when protective gear was scarce, no visitors were allowed. Palliative caregivers, along with ICU nurses, held iPads cocooned in plastic bags so families could say goodbye on Zoom. They were sometimes the only one in the room when a patient died, otherwise alone. I interviewed several members of the Boston-based palliative-care team, and their stories, which have been condensed and edited for clarity, are below...’

Read here (The Atlantic, June 16, 2020)

Hadassah doctors crack the cause of fatal corona blood clots

‘A research team at Hadassah-University Medical Center in Jerusalem’s Ein Kerem discovered that patients who form fatal blood clots have an increased level of alpha defensin protein in their blood... They also say they have a way to treat the cause before it’s too late... At least 30% of patients with coronavirus develop blood clots that block the flow of blood to their kidneys, heart and brain, as well as the lungs, according to international research...

‘Dr. Abd Alrauf Higavi said his team are en route to a solution: administering the drug colchicine to coronavirus patients. Colchicine is an approved drug used in the prevention and treatment of gout attacks, caused by too much uric acid in the blood. Higavi said they have completed testing colchicine on mice and found that it successfully inhibited the release of alpha defensin. Now, they are waiting for the necessary approvals to test it on human coronavirus patients.’

Read here (Jerusalem Post, June 16, 2020)

Dexamethasone proves to be life-saving drug

‘A cheap and widely available drug can help save the lives of patients seriously ill with coronavirus. The low-dose steroid treatment dexamethasone is a major breakthrough in the fight against the deadly virus, UK experts say...

‘It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth. Had the drug had been used to treat patients in the UK from the start of the pandemic, up to 5,000 lives could have been saved, researchers say. And it could be of huge benefit in poorer countries with high numbers of Covid-19 patients.’

Read here (BBC, June 16, 2020)

US in the spring of the pandemic

‘The gnawing anger beneath the pandemic is that democracy itself is being rewired in our absence. The system has failed us, the system is guaranteed to go on failing us, but while we the people are out of the picture, others are making grand, world-altering decisions. The powerful are rewriting the social contract while we watch TV and console ourselves with booze and simple chores.’

Read here (Le Monde Diplomatique, June 2020)

Volunteers sign up to put their lives on the line for a coronavirus vaccine

‘Lehua Gray, a 32-year-old product manager in Austin, wants to risk her life for a coronavirus vaccine. A cloud of potentially deadly microbes would be spritzed up her nose — if she’s allowed to a participate in what’s called a human challenge trial.

‘It’s built on a deceptively simple premise: Researchers inject healthy volunteers with an experimental vaccine and then expose them to a pathogen. If the vaccine prevents volunteers from getting sick, the study can accelerate development of a promising formula.’

Read here (Washington Post, June 15, 2020)

Fact-checking claims coronavirus might have started in August 2019

‘There's been criticism of a study from the US suggesting that the coronavirus could have been present in the Chinese city of Wuhan as early as August last year. The study by Harvard University, which gained significant publicity when it was released earlier this month, has been dismissed by China and had its methodology challenged by independent scientists...

‘The Harvard study has gained a lot of traction in the media, with President Trump, who has been highly critical of China's pandemic response, tweeting a Fox News item highlighting the researchers' findings. The tweet has been viewed more than three million times.’

Read here (BBC, June 15, 2020)

UK readers find the government’s COVID-19 messages more misleading than actual fake news

‘Our research suggests broadcasters may have helped people become fairly confident in spotting egregious examples of fake news. But many participants were confused by more routine political decisions, most strikingly the lockdown measures that can affect people in England differently to Scotland, Wales and Northern Ireland.

‘For broadcasters to more effectively counter misinformation, our research tells us it is not only about boldly questioning what politicians say and holding the government to account. It is about identifying what people are most confused about and finding ways to raise their level of understanding about complex and contentious issues.’

Read here (Nieman Lab, June 15, 2020)

To understand who’s dying of Covid-19, look to social factors like race more than preexisting diseases

‘The Sutter and MIT studies cast doubt on whether individual risk factors are as important as social determinants of health in affecting someone’s chances of contracting severe and even fatal Covid-19. “It should cause us to ask a different set of questions about what puts you at risk of hospitalization or death,” Schwalbe said.

‘More and more evidence is pointing to social determinants of risk, which puts the role of underlying health conditions in a new light. “Comorbidities are still used to blame people for how hard they are hit by Covid-19,” said Philip Alberti, senior director for health equity research at the AAMC. To reduce the U.S. death toll now that many states are seeing a new surge in cases, he said, “our response to this disease” must look beyond the strictly medical.’

Read here (STAT News, June 15, 2020)

A visual guide to the SARS-CoV-2 Coronavirus

‘In the graphics that follow, Scientific American presents detailed explanations, current as of mid-May, into how SARS-CoV-2 sneaks inside human cells, makes copies of itself and bursts out to infiltrate many more cells, widening infection. We show how the immune system would normally attempt to neutralize virus particles and how CoV-2 can block that effort. We explain some of the virus's surprising abilities, such as its capacity to proofread new virus copies as they are being made to prevent mutations that could destroy them. And we show how drugs and vaccines might still be able to overcome the intruders.’

Read here (Scientific American, June 15 web story for July 2020)

Tale of Covid-19 in two Indian cities: Dharavi, Mumbai, a rare success, and Delhi which was “messed up”

‘Asia's largest slum Dharavi was being seen as a 'Covid-engine' that will drive Mumbai in the wrong direction. But with conscious efforts, the slum's Covid doubling rate has come down to 44 days, twice as good as Mumbai’s 22. Delhi sadly is a study in contrast with India’s highest test positivity rates. In episode 496 of ThePrint's #CutTheClutter, Shekhar Gupta talks about the lessons from Dharavi & new plan for Delhi.’

Watch here (Youtube, June 14, 2020)

Sinovac says early data show its Covid-19 vaccine generated immune responses

‘Sinovac Biotech announced preliminary study results on Saturday showing its experimental Covid-19 vaccine generated immune responses in patients and was safe — early data that suggest it might protect people against infections with the novel coronavirus. The Beijing-based drug maker’s vaccine, called CoronaVac, induced neutralizing antibodies in “above 90%” of people who were tested 14 days after receiving two injections, two weeks apart. There were no severe side effects reported, the company said in a statement. The preliminary results were from a 600-patient, placebo-controlled Phase 2 study. Sinovac is also conducting a 143-patient, placebo-controlled Phase 1 study.’

Read here (STAT News, June 14, 2020)

Fears of second wave as new cases emerge at Beijing market

‘A wholesale food market in south-west Beijing is in the spotlight after being linked to a spate of new Covid-19 cases, sparking fears of a second wave of infections... Officials said at a news briefing yesterday that six cases were reported on Friday, all related to the market, which sells meat, seafood, fruit and vegetables. Another man who had shopped there was also reported as a confirmed case on Thursday. In addition, 45 people tested positive from among 517 samples collected at the market, although none showed symptoms of the coronavirus infection.

‘Chinese news outlet Beijing News reported that the virus was detected at Xinfadi market on a chopping board for imported salmon, which had come from Jingshen seafood market, one of the markets ordered shut on Friday. Large supermarket chains such as Carrefour and Japanese restaurants have pulled salmon off the shelves and menus after news that supplies could be contaminated sparked worries across the city.’

Read here (Straits Times, June 14, 2020)

Why is it hard to do what is right?

‘In the fight to contain the spread of coronavirus, Malaysians have split into two camps: the risk-takers and the rule-followers. On one side are carefree people who ignore public health measures; on the other are the anxious ones coming to grips with the reality of life with Covid-19. What a depressing spectacle has been the effect of the recovery movement control order involving public transport and eating out.’

Read here (Free Malaysia Today, June 14, 2020)

Lancet editor spills the beans and the unfolding of a pharmaceutical scandal

‘In a videotaped interview on May 24, 2020, Dr [Philippe] Douste-Blazy provided insight into how a series of negative hydroxychloroquine studies got published in prestigious medical journals. He revealed that at a recent Chatham House top secret, closed door meeting attended by experts only, the editors of both, The Lancet and the New England Journal of Medicine expressed their exasperation citing the pressures put on them by pharmaceutical companies... [Douste-Blazy is a cardiologist and former French Health Minister who served as Under-Secretary General of the United Nations. He was a candidate in 2017 for Director of the World Health Organization]

‘The alarming findings and serious negative impact of the Lancet report led numerous scientists around the globe to scrutinise the report in detail. That scrutiny by legitimate, independent scientists has led to many serious questions about the integrity of the study, the authenticity of the data, and the validity of the methods the authors used... [many details are provided in this story]

Demonisation of favourable HCQ-AZ treatment studies: ‘Since publishing favourable reports about a treatment combination of two cheap, widely prescribed medicines: hydroxychloroquine and the antibiotic azithromycin, as a treatment of choice against Covid-19, Dr [Didier] Raoult has become the subject of intense demonisation by the corporate-influenced medical establishment, the media, and the [sic] who resort to this tactic whenever they lack evidence or legitimate grounds to support public health policies that cause people harm.’

Read here (Health Impact News, received on June 13, 2020)

Understanding Covid-19 risks and vulnerabilities among black communities in America: The lethal force of syndemics

‘Black communities in the United States are bearing the brunt of the Covid-19 pandemic and the underlying conditions that exacerbate its negative consequences. Syndemic theory provides a useful framework for understanding how such interacting epidemics develop under conditions of health and social disparity. Multiple historical and present-day factors have created the syndemic conditions within which black Americans experience the lethal force of Covid-19. These factors include racism and its manifestations (e.g., chattel slavery, mortgage redlining, political gerrymandering, lack of Medicaid expansion, employment discrimination, and health care provider bias). Improving racial disparities in Covid-19 will require that we implement policies that address structural racism at the root of these disparities.’

Read here (Annals of Epidemiology, Volume 47, July 2020, Pages 1-3, via Science Direct)

Treasury Secretary Mnuchin says ‘we can’t shut down the economy again’

Treasury Secretary Mnuchin says ‘we can’t shut down the economy again’

‘[US] Treasury Secretary Steven Mnuchin told CNBC that shutting down the economy for a second time to slow Covid-19 isn’t a viable option. The Treasury secretary’s comments came as Wall Street grew more concerned about a second wave of coronavirus cases in the US. Mnuchin also said he’s prepared to return to Congress to request additional fiscal spending to help juice the economy if needed.’

Read here (CNBC, June 11, 2020)

Religion and science in a time of Covid-19: Allies or adversaries?

‘The current zeitgeist tells us that we must pick a side, as we do in sports or politics; one cannot be an adherent of both. Either choose secular science, which is rational and rigorous; or religion, a matter of personal belief.

‘But perhaps this narrative represents a false dichotomy. Does the tension between science and religion really exist? And in the context of COVID-19, is it inconceivable that a scientist can wholeheartedly pray for a cure for a loved one whilst also working to develop a vaccine?’

Read here (Scientific American, June 11, 2020)

Immunity to the coronavirus remains a mystery. Scientists are trying to crack the case

‘With Covid-19, immunity — whether from an infection or a vaccine — is expected to wane over perhaps a few years; that is what happens with the four human coronaviruses that cause colds. If that pattern extends to this virus, people will gradually become more susceptible to the virus after some amount of time (though they may be less likely to get a severe case). Tracking the levels of the different correlates could provide clues to how long immunity lasts, and when a person becomes vulnerable again. It could also indicate when people might need another dose of the vaccine.’

Read here (STAT News, June 11, 2020)

I'm an ICU doctor treating coronavirus patients. But somehow I'm not angry

‘Sometimes I wonder if my lack of anger means I don’t care enough; if I’ve been worn down by ventilators being turned off, patients dying, families asking for a final call. Perhaps emotions overwhelm and suffocate each other in such a situation, leaving no air for something as indulgent as anger. Perhaps my anger couldn’t compete with the humility of knowing that until early March, I and every doctor I knew had predicted that this virus posed little threat beyond a bad seasonal flu. Like my better judgment, perhaps my anger had lost.’

Read here (The Guardian, June 11, 2020)

Unsung heroines: Who cares for the carers?

Even before Covid-19, the world was facing a care crisis. The plight of often neglected, under-appreciated, under-protected and poorly equipped ‘frontline’ health personnel working to contain the pandemic has drawn attention to the tip of the care crisis iceberg. Oxfam’s annual early 2020 Davos report, Time to Care, estimates that 2.3 billion people will need care by 2030, 200 million more than in 2015, including 100 million more older people and an additional 100 million children aged 6 to 14 years.

Read here (IPS News, June 11, 2020)

How to avoid the virus as the world reopens

‘Three key factors determine risk of exposure: proximity to people; duration of exposure; and how confined the environment is. The greatest peril lies where the three overlap. “The biggest risk is being in close proximity to someone in an indoor space for any extended period of time,” said Jeremy Rossman, honorary senior lecturer in virology at the University of Kent. The perception of risk and the actual scientific risk have sometimes diverged, he noted. “I don’t think that’s been very clearly communicated”.’

Read here (Financial Times, June 10, 2020)

Pandemic exposes systemic staffing problems at US nursing homes - Special report by Reuters

‘In the United States, longstanding problems with staffing shortages and chronic turnover have left nursing homes especially exposed. An estimated 40% of the country’s more than 100,000 COVID-19 deaths are connected to long-term care facilities such as nursing homes or assisted-living centers, according to a Kaiser Family Foundation tally.

‘About a quarter of nursing homes responding to a recent federal survey reported shortages of direct-care staff during at least one of the last two weeks in May, according to a Reuters analysis of survey data from the Centers for Medicare and Medicaid Services.’

Read here (Reuters, June 10, 2020)

Widespread mask-wearing could prevent COVID-19 second waves: Study

‘Population-wide face mask use could push COVID-19 transmission down to controllable levels for national epidemics, and could prevent further waves of the pandemic disease when combined with lockdowns, according to a British study on Wednesday. The research, led by scientists at the Britain’s Cambridge and Greenwich Universities, suggests lockdowns alone will not stop the resurgence of the new SARS-CoV-2 coronavirus, but that even homemade masks can dramatically reduce transmission rates if enough people wear them in public.’

Read here (Reuters, June 10, 2020)

Should we aim for herd immunity like Sweden?

‘One thing is to decide against a Hammer. That’s fine. It happened. We can’t change the past. A very different thing is to know you can Dance to reduce your epidemic dramatically and for quite cheap, but actively decide not to do it. The UK’s government has acknowledged its mistakes and changed course. Pressure is mounting for Sweden to do the same. Tens of thousands of lives are at stake. If the government doesn’t decide to acknowledge its mistakes and correct its course, bodies will keep piling up for nothing.

Summary of the article: ‘Sweden is suffering tremendously in cases and deaths. Yet few people have been infected yet. They are a long way from Herd Immunity. Between 0.5% to 1.5% of infected die from the coronavirus. Left uncontrolled, it can kill between 0.4% and 1% of the entire population. Many more suffer conditions we don’t yet understand. Unfortunately, that death and sickness toll is far from having bought us Herd Immunity anywhere in the world. Only protecting those most at risk sounds great. It’s a fantasy today. Even if Sweden’s economy has remained mostly open, it has still suffered as much as others. From now on, it might start doing worse. Sweden now has regrets. But not enough. It can control the virus without a lockdown if it acknowledges its mistakes and takes the right measures. Other countries, like the US or the Netherlands, are toying with a Herd Immunity strategy. It will only cause more economic loss and death.’

Read here (Medium, June 10, 2020)

‘Epidemic stopped’: Results in from second Chinese city to do mass coronavirus tests

‘In all, 19 asymptomatic cases found among the 650,000 people tested in Mudanjiang, authorities say. Viral cultures reveal low level of infectiousness among those carriers.’

Read here (South China Morning Post, June 10, 2020)

How Singapore’s Covid-19 contact tracing app drew inspiration from a US high school project

‘Two US students developed a prototype app called kTrace in 2014, at the height of the Ebola epidemic. They won a prize but found no backers. But Singapore’s GovTech agency found it and the students shared code and advice to speed up the development of the city state’s TraceTogether app.’

Read here (South China Morning Post, June 10, 2020)

The WHO stumbles, and some scientists see a pattern

‘Even as the World Health Organisation leads the worldwide response to the coronavirus pandemic, the agency is failing to take stock of rapidly evolving research findings and to communicate clearly about them, several scientists warned on Tuesday (June 9). In a news briefing on Monday, a WHO official asserted that transmission of the coronavirus by people without symptoms is "very rare". Following concerted pushback from researchers, officials on Tuesday walked back the claim, saying it was a "misunderstanding".’

Read here (Straits Times, June 10, 2020)

‘Are you immune?’ The new class system that could shape the Covid-19 world

‘...experts predict that if survivors are found to be immune, they could perform a range of jobs and services – such as volunteering in hospitals and nursing homes, caring for coronavirus patients and working in shops and food processing plants – risk-free. And, depending on how authorities, business and society at large respond, they could also be entitled to greater freedoms.’

Read here (The Guardian, June 10, 2020)

How the coronavirus compares with 100 years of deadly events (United States)

‘Only the worst disasters completely upend normal patterns of death, overshadowing, if only briefly, everyday causes like cancer, heart disease and car accidents. Here’s how the devastation brought by the pandemic in 25 cities and regions compares with historical events.’

Read here (New York Times, June 10, 2020)

Economic ghosts block post-lockdown recovery

‘As governments the world over struggle to revive their economies after the debilitating lockdowns they imposed following their failure to undertake adequate precautionary containment measures to curb Covid-19 contagion, neoliberal naysayers are already warning against needed deficit financing for relief and recovery.’

Read here (IPS News, June 9, 2020)

America fails the marshmallow test

Paul Krugman: ‘Why are we failing the test? It’s easy to blame Donald Trump, a man-child who would surely gobble down that first marshmallow, then try to steal marshmallows from other kids. But America’s impatience, its unwillingness to do what it takes to deal with a threat that can’t be beaten with threats of violence, runs much deeper than one man.’

Read here (New York Times, June 9, 2020)

The role of vitamin D in reducing risk of COVID-19: A brief survey of the literature

‘The evidence that higher vitamin D status is causally linked to lower risk of COVID-19 incidence, severity, and death continues to increase. This brief report outlines what has been learned through early June 2020 and provides links to some of the key references.

‘It should be noted that acceptance of the role of vitamin D supplementation will probably not be achieved before reports are published that demonstrate randomized controlled trials of vitamin D supplementation significantly reduced COVID-19 incidence or death. Several RCTs and observational studies regarding vitamin D supplementation and COVID-19 incidence and outcomes are either in the planning stage or in progress. The obvious groups to study are those at highest risk: dark-skinned people living at high latitudes, people in nursing homes or health care facilities; prisoners; factory workers such as in meat-packing facilities in the U.S.; health care workers. A major problem is that the powers that be see vitamin D as a threat to income and profit, so use the Disinformation Playbook to suppress positive information on vitamin D...

‘In a review published in early April, it was proposed that vitamin D supplementation could reduce the risk of COVID-19. Two mechanisms were identified: 1, reduced survival and replication of viruses through vitamin D-stimulated release of cathelicidin and defensins, and 2, reduced risk of the cytokine storm by reducing production of pro-inflammatory cytokines...’

Read here (Orthomolecular Medicine News Service, June 9, 2020)

The effect of large-scale anti-contagion policies on the Covid-19 pandemic

‘...we compile new data on 1,717 local, regional, and national non-pharmaceutical interventions deployed in the ongoing pandemic across localities in China, South Korea, Italy, Iran, France, and the United States (US)... We estimate that across these six countries, interventions prevented or delayed on the order of 62 million confirmed cases, corresponding to averting roughly 530 million total infections. These findings may help inform whether or when these policies should be deployed, intensified, or lifted, and they can support decision-making in the other 180+ countries where COVID-19 has been reported.

Read here (Nature, June 8, 2020)

Asymptomatic spread of coronavirus is ‘very rare,’ WHO says

‘Government responses should focus on detecting and isolating infected people with symptoms, the World Health Organization said. Preliminary evidence from the earliest outbreaks indicated the virus could spread even if people didn’t have symptoms. But the WHO says that while asymptomatic spread can occur, it is “very rare.”

Read here (CNBC, June 8, 2020)

China plans to overhaul health system, but better communication with public is off the radar

Ma Xiaowei, director of the National Health Commission, ‘identified five areas for improvement, including more investment in the public health system, giving the Centres for Disease Control more powers, a public health network to link hospitals to the CDC, a better epidemic monitoring and warning system and fostering medical talent...But Li Dun, a professor and the head of the experts network at Tsinghua University’s Centre for the Study of Contemporary China, said better communication should also be included in the proposed reforms. “Without information disclosure and public participation, the warning system won’t work effectively,” he said.’

Read here (South China Morning Post, June 8, 2020)

Half of Singapore’s coronavirus cases show no symptoms, joint head of task force says

‘Based on our experience, for every symptomatic case you would have at least one asymptomatic case,’ Lawrence Wong said. Wong was explaining the city state’s cautious approach to reopening following a two-month lockdown to curb infections.

Read here (South China Morning Post, June 8, 2020)

From drug dealers to loan sharks: how coronavirus empowers organised crime

‘At the outset, Covid-19 and the lockdown disoriented organised crime and its activities as much as the rest of us. But organised crime is not only adapting to the present, it is preparing to carve a lucrative future out of the crisis... Disruption to supplies, diversion of police resources and collapsing businesses all create opportunities.’

Read here (The Guardian, June 7, 2020)

The coronavirus' next victim? Capitalism

‘The pandemic has deftly illustrated two lessons that we, as a civilization, must learn in order to survive: (1) Science does not care about your political ideology. (2) The economic status quo — namely, free market capitalism — is fatally flawed, in ways that the coronavirus pandemic has brought to light.’

Read here (Salon, June 7, 2020)

‘Fighting Covid-19: China in action’

China's State Council Information Office published on June 7, 2020, a 65-page white paper to ‘keep a record of China’s efforts in its own fight against the virus, to share its experience with the rest of the world, and to clarify its ideas on the global battle.’

Read here (XinHua, June 7, 2020)

Are we underestimating how many people are resistant to Covid-19?

‘One thing seems clear: there are many reasons why one population is more protected than another. Theoretical epidemiologist Sunetra Gupta of the University of Oxford thinks that a key one is immunity that was built up prior to this pandemic. “It’s been my hunch for a very long time that there is a lot of cross-protection from severe disease and death conferred by other circulating, related bugs,” she says...

‘Socioeconomic status, climate, culture and genetic makeup could also shape vulnerability, as could certain childhood vaccines and vitamin D levels. And all of these factors can vary between countries.’

Read here (The Guardian, June 7, 2020)

Wear masks in public says WHO, in update of COVID-19 advice

The WHO's technical lead expert on Covid-19, Maria Van Kerkhove, said in a Reuters interview: "We are advising governments to encourage that the general public wear a mask [in public areas where there is a risk of transmission of COVID-19]. And we specify a fabric mask - that is, a non-medical mask... We have new research findings... We have evidence now that if this is done properly it can provide a barrier ... for potentially infectious droplets."

Read here (Straits Times, June 6, 2020)

What social distancing reveals about East-West differences

‘In short, while the Chinese may not experience social-distancing anxiety as we Americans do, the pandemic seems to have brought out individualistic ways of thinking in some. Of course, divorce rates and rationales can only tell a small part of the sprawling story that is China. Still, might the globalization that has drawn East and West so much closer together physically also, via the pandemic, draw us ever so slightly closer together psychologically as well? It’s possible.’

Read here (Scientific American, June 6, 2020)

Dutch mink cull starts as coronavirus spreads to 10th farm

‘Dutch mink farms have begun a government-ordered cull amid concern that animals infected with coronavirus could transmit the illness to humans. Infected mink have been found on 10 Dutch farms where the ferret-like animals are bred for their fur, according to the country’s Food & Wares Authority. “All mink breeding farms where there is an infection will be cleared, and farms where there are no infections won’t be,” said spokeswoman Frederique Hermie.’

Read here (Reuters, June 6, 2020)

50% asymptomatic carriers. They have lung tissue damage typical of Covid-19 too

‘Another concern, says Topol, is that the virus may be damaging the bodies of asymptomatic in other, silent ways. Among the 331 passengers on the Diamond Princess cruise ship who tested positive but did not have symptoms, 76 people had CT scans of their lungs and nearly half showed signs of lung tissue damage typical of coronavirus infection. “People who are getting infection without symptoms are actually doing a lot of damage to their bodies and they don’t know it,” says Topol. Another small study in South Korea that studied 10 asymptomatic people from a group of 139 COVID-19 patients supports these findings.’

Read here (Time Magazine, June 5, 2020)

Race, ethnicity data to be required with coronavirus tests starting August 1

‘Data on who is being tested “are rarely being reported to CDC in usable format,” Giroir said during a conference call with journalists. “It is critical for us to ensure that there is equitable access to testing, especially for underserved minorities. And without the data we are now requiring, there is simply no way to determine that.”

Read here (Washington Post, June 5, 2020)

The pandemic's first major research scandal erupts

‘The controversy is an unfortunate distraction, says Miguel Hernán, a Harvard epidemiologist and co-investigator on an ongoing trial of hydroxychloroquine in Spain and Latin America. “If you do something as inflammatory as this without a solid foundation, you are going to make a lot of people waste time trying to understand what is going on.” Chaccour says both NEJM and The Lancet should have scrutinized the provenance of Surgisphere's data more closely before publishing the studies. “Here we are in the middle of a pandemic with hundreds of thousands of deaths, and the two most prestigious medical journals have failed us,” he says.’

Read here (Science Magazine, June 5, 2020)

Chinese tech firms pledge more help for street stalls, small vendors after Premier’s comments

Key points: Premier Li Keqiang says the Chinese government will provide more support for street stalls and small businesses as they are the “fire” of China’s economy. Tech platforms like WeChat and JD.com responded to Li’s comments by announcing new initiatives to help smaller retailers.

Read here (South China Morning Post, June 4, 2020)

Trump said he would terminate the US relationship with the WHO. Here's what that means

‘The impacts wouldn’t be felt just abroad. Were the U.S. to leave the WHO, scientists and public health officials in the states would suddenly find themselves cut off from some of the most important global health communication channels. You don’t need to look too far into the past to see how this might play out: In the early days of COVID-19, “not all of the data from China was public. It was shared among the WHO member states initially before it was put out in public bulletins,” says Amanda Glassman, executive vice president of the Center for Global Development, a nonprofit think tank, That information, in theory, should have enabled U.S. health infrastructure to rapidly spring into action, and take steps to mitigate the worst viral outcomes. It didn’t of course, but that failure can hardly be pinned on the WHO.’

Read here (Time Magazine, June 4, 2020)

Death from Covid-19 of 23 health care workers in China

‘As of March 31, none of the 42,600 health care workers who went to Hubei Province to care for patients with Covid-19 were known to have been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).5 The 42,600 workers included one of us, an intensive care physician from Fujian Province who cared for patients with Covid-19 from January 29 to March 23, first in Wuhan Central Hospital, and then in Wuhan Jinyintan Hospital. These data suggest that sufficient precautions with rigorous enforcement can prevent health care workers from becoming infected with SARS-CoV-2 and the subsequent risk of death.’

Read here (New England Journal of Medicine, June 4, 2020)

Alibaba's AI helps detect coronavirus pneumonia within a minute

‘Medical information provider M3 has tapped Alibaba Group Holding's artificial intelligence technology to develop a diagnostic system that can quickly identify COVID-19 pneumonia in CT scan images. The system, which is awaiting approval from the health ministry, holds promise as a supplementary testing tool as Japan struggles to expand capacity for PCR (polymerase chain reaction) tests for the coronavirus.’

Read here (Nikkei, June 4, 2020)

World leaders make historic commitments to provide equal access to vaccines for all

‘The Global Vaccine Summit, hosted by the UK, raises US$ 8.8 billion from 32 donor governments and 12 foundations, corporations and organisations to immunise 300 million children and support the global fight against COVID-19. US$ 567 million also raised for new innovative financing instrument to provide access to COVID-19 vaccines for low- and middle-income countries. Boris Johnson: “Together we rise to fulfil the greatest shared endeavour of our lifetime – the triumph of humanity over disease, now and for the generations that follow.”

Read here (Gavi, June 4, 2020)

What are the long-term health implications of Covid-19?

‘Six months into the Covid-19 pandemic, and with more than 380,000 people dead, the picture we have of Sars-CoV-2 remains opaque and unclear. Thousands of papers and reports have flooded the academic sphere during this period, as scientists have rushed to understand the virus, which, according to the journal Science, “acts like no pathogen humanity has ever seen”...

‘What initially appeared to be a predictable respiratory infection, similar to Sars or Avian flu, Sars-CoV-2 is now known to affect the lungs, brain, eyes, nose, heart, blood vessels, livers, kidneys and intestines — virtually every organ in the human body.’

Read here (The Independent, June 4, 2020)

Social media firms fail to act on Covid-19 fake news

‘Hundreds of posts spreading misinformation about Covid-19 are being left online, according to a report from the Center for Countering Digital Hate. Some 649 posts were reported to Facebook and Twitter, including false cures, anti-vaccination propaganda and conspiracy theories around 5G. 90% remained visible online afterwards without any warnings attached, the report suggests.’

Read here (BBC, June 4, 2020)

Why stock markets are so calm amid global economic turmoil

‘Those numerous analysts who warned of a dead-cat bounce have so far been proved wrong. A survey by CNBC found that a fifth of global Chief Financial Officers think the Dow Jones will continue to rally, without major declines along the way. However, more than half now believe the index will soon crash below its March low of 18.591.

"There's going to be a meaningful correction once people realize this is going to be a U-shaped recovery," Nouriel Roubini, professor of economics at New York University's Stern School of Business, told New Yorker magazine last month. "If you listen carefully to what Fed officials are saying — or even what JPMorgan and Goldman Sachs are saying — initially they were all in the V camp [V-shaped recovery], but now they're all saying, 'well, maybe it's going to be more of a U'."

Read here (DW, June 4, 2020)

Covid-19 can last for several months

I interviewed nine of them [“long-termers” or “long-haulers” who have suffered symptoms for months] for this story, all of whom share commonalities. Most have never been admitted to an ICU or gone on a ventilator, so their cases technically count as “mild.” But their lives have nonetheless been flattened by relentless and rolling waves of symptoms that make it hard to concentrate, exercise, or perform simple physical tasks. Most are young. Most were previously fit and healthy. “It is mild relative to dying in a hospital, but this virus has ruined my life,” LeClerc said. “Even reading a book is challenging and exhausting. What small joys other people are experiencing in lockdown—yoga, bread baking—are beyond the realms of possibility for me.”

Read here (The Atlantic, June 4, 2020)

Regime change didn't disrupt Covid-19 response: Health DG

‘The country’s Covid-19 response was not adversely affected by the change in government, says Health Ministry director-general Dr Noor Hisham Abdullah. “No. Even though there was a change of government, we were still able to carry out our duties, which were to monitor data, look at our strategic planning and do what we needed to do to control and stop the spread of Covid-19.”

Read here (Malaysiakini, June 3, 2020)

Covid-19 could foster boom in aid-dependency: Red Cross

Economic hardships brought about by the Covid-19 pandemic could cause a boom in aid-dependency in countries at conflict, a new survey by the International Committee of the Red Cross (ICRC) showed – prompting the international body to call for social protection programmes to be maintained or extended and to include the most vulnerable.

In a statement issued from Geneva on Wednesday, ICRC said without concerted action from the global community, it expects humanitarian needs to deepen and worsen in the wake of Covid-19.

Read here (Malaysiakini, June 3, 2020)

Scientist defends Sweden’s hotly debated virus strategy

‘Sweden’s chief epidemiologist on Wednesday defended his country’s controversial coronavirus strategy, which avoided a lockdown but resulted in one of the highest per capita COVID-19 death rates in the world... “We still believe that our strategy is good, but there is always room for improvement. ... You can always get better at this job,” [Anders] Tegnell told a news conference in Stockholm.

‘According to the national health agency, Sweden, a nation of 10.2 million people, has seen 4,542 deaths linked to COVID-19, which is far more than its Nordic neighbors and one of the highest per capita death rates in the world. Denmark has had 580 coronavirus deaths, Finland has seen 320 and Norway has had 237, according to a tally by Johns Hopkins University.’

Read here (Associated Press, June 3, 2020)

A pulmonary physician on what it's like to treat Covid-19 patients

‘I did not think much about my risk. Doctors are always at some risk of contracting a disease. However, that changed when I was exposed to a COVID-19-positive patient without my personal protective equipment for a considerable period of time and in close proximity. I questioned my "recklessness" in examining the patient (who did not exhibit any COVID-19 symptoms) and my ability to infect my family and other patients. I felt guilty and foolish for putting myself and my family in such a position. It was not a good day. One of my colleagues had even written a living will, just in case.’ 

Read here (Asia Society, June 3, 2020)

Nearly 26,000 COVID deaths in nursing homes spur inspections

‘Nearly 26,000 nursing home residents have died from COVID-19, the government reported Monday, as federal officials demanded states carry out more inspections and vowed higher fines for facilities with poor infection control.

“This is not a nursing home problem; this is a health system problem,” said Terry Fulmer, president of the John A. Hartford Foundation, which works to improve care for older adults. “Every system produces the outcome it is set up for. If you set up a system where the sickest and frailest people are in locations that are forgotten about and ignored, where the staff is paid less, why should that surprise anyone?”

Read here (Associated Press, June 3, 2020)

China delayed releasing coronavirus info, frustrating WHO

‘Throughout January, the World Health Organization publicly praised China for what it called a speedy response to the new coronavirus. It repeatedly thanked the Chinese government for sharing the genetic map of the virus “immediately,” and said its work and commitment to transparency were “very impressive, and beyond words.”

‘But behind the scenes, it was a much different story, one of significant delays by China and considerable frustration among WHO officials over not getting the information they needed to fight the spread of the deadly virus, The Associated Press has found.’

Read here (Associated Press, June 3, 2020)

Governments and WHO changed Covid-19 policy based on suspect data from tiny US company

‘The World Health Organization and a number of national governments have changed their Covid-19 policies and treatments on the basis of flawed data from a little-known US healthcare analytics company [Surgisphere], also calling into question the integrity of key studies published in some of the world’s most prestigious medical journals [The Lancet and New England Journal of Medicine].

‘Data it claims to have legitimately obtained from more than a thousand hospitals worldwide formed the basis of scientific articles that have led to changes in Covid-19 treatment policies in Latin American countries. It was also behind a decision by the WHO and research institutes around the world to halt trials of the controversial drug hydroxychloroquine. On Wednesday, the WHO announced those trials would now resume.’

Read here (The Guardian, June 3, 2020)

How coronavirus tore through Britain's ethnic minorities

‘In a report released on Tuesday, Public Health England (PHE) acknowledged the disproportionate effect the pandemic has had on Black, Asian and Minority Ethnic (Bame) people, including making us more likely to become critically ill, and to die. Black people are almost four times more likely to die of Covid-19, according to the Office of National Statistics, while Asians are up to twice as likely to die.’

Read here (BBC, June 3, 2020)

Genes may leave some people more vulnerable to severe Covid-19

‘Variations at two spots in the human genome are associated with an increased risk of respiratory failure in patients with Covid-19, the researchers found. One of these spots includes the gene that determines blood types. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study...

‘The coronavirus triggers an overreaction of the immune system in some people, leading to massive inflammation and lung damage — the so-called cytokine storm. It is theoretically possible that genetic variations influence that response.’

Read here (New York Times, June 3, 2020)

‘They let us down’: 5 takeaways on the CDC’s coronavirus response

• Aging data systems left the agency with blind spots
• The CDC clashed with White House aides who viewed them as the ‘deep state’
• The CDC’s culture slowed its response
• Redfield felt he was ‘on an island’ between his agency and the White House
• Confusing guidance left doctors, public officials and others to look elsewhere

Read here (New York Times, June 3, 2020)

The CDC waited ‘its entire existence for this moment’. What went wrong?

‘The technology was old, the data poor, the bureaucracy slow, the guidance confusing, the administration not in agreement... The coronavirus shook the world‘s premier health agency, creating a loss of confidence and hampering the US response to the crisis...

‘The CDC.’s most fabled experts are the disease detectives of its Epidemic Intelligence Service, rapid responders who investigate outbreaks. But more broadly, according to current and former employees and others who worked closely with the agency, the CDC is risk-averse, perfectionist and ill suited to improvising in a quickly evolving crisis — particularly one that shuts down the country and paralyzes the economy.

“It’s not our culture to intervene,” said Dr George Schmid, who worked at the agency off and on for nearly four decades. He described it as increasingly bureaucratic, weighed down by “indescribable, burdensome hierarchy.”

Read here (New York Times, June 3, 2020)

No new virus sufferers, 300 asymptomatic, after Wuhan-wide tests

‘The Chinese city of Wuhan, where the Covid-19 (coronavirus) outbreak began, has found no new cases of people suffering from Covid-19 (coronavirus) after testing almost its entire population, and 300 asymptomatic carriers of the virus, officials said on Tuesday (June 2). Authorities launched the vast testing campaign on May 14, and reached 9.9 million out of 11 million people, after a cluster of new cases raised fears of a second wave of infections.’

Read here (The Star, June 2, 2020)

Distancing and masks cut Covid-19 risk, says largest review of evidence

‘Keeping at least one metre apart and wearing face masks and eye protection are the best ways to cut the risk of Covid-19 infection, according to the largest review to date of studies on coronavirus disease transmission. In a review that pooled evidence from 172 studies in 16 countries, researchers found frequent handwashing and good hygiene are also critical - though even all those measures combined can not give full protection.’ The findings were published in The Lancet journal on Monday.

Read here (Malaysiakini, June 2, 2020)

Experts dispute reports that coronavirus is becoming less lethal

‘Has the novel coronavirus in Italy changed in some significant way? That was the suggestion of a top doctor in northern Italy who reports that patients to his hospital have been showing up with lower levels of the virus in their upper respiratory tracts compared with those two months ago.

‘The comments, which received widespread attention following a Reuters report, prompted vigorous pushback from Michael Ryan, a top official with the World Health Organization, who said Monday during an online news conference that “we need to be exceptionally careful not to create a sense that all of a sudden the virus by its own volition has now decided to be less pathogenic. That is not the case at all.”

Read here (Washington Post, June 2, 2020)

Protesting racism versus risking Covid-19: ‘I wouldn't weigh these crises separately’

‘...But the risks of congregating during a global pandemic shouldn't keep people from protesting racism, according to dozens of public health and disease experts who signed an open letter in support of the protests. "White supremacy is a lethal public health issue that predates and contributes to COVID-19," the letter said...

Dr Elaine Nsoesie, an assistant professor of global health at Boston University: "Data is showing that blacks and Latinos have been disproportionately affected by COVID-19 in many states," said Nsoesie, who was not among the letter's signatories when NPR contacted her. "Racism is one of the reasons this disparity exists." She continued, "Racism is a social determinant of health. It affects the physical and mental health of blacks in the U.S. So I wouldn't weigh these crises separately."

Read here (NPS, June 1, 2020)

Covid-19 significantly impacts health services for noncommunicable diseases

“The results of this survey confirm what we have been hearing from countries for a number of weeks now,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “Many people who need treatment for diseases like cancer, cardiovascular disease and diabetes have not been receiving the health services and medicines they need since the COVID-19 pandemic began. It’s vital that countries find innovative ways to ensure that essential services for NCDs continue, even as they fight COVID-19.”

Read here (WHO, June 1, 2020)

Rapid assessment of service delivery for NCDs during the Covid-19 pandemic (PDF). Download here

New coronavirus losing potency, top Italian doctor says

‘The new coronavirus is losing its potency and has become much less lethal, a senior Italian doctor said on Sunday. “In reality, the virus clinically no longer exists in Italy,” said Alberto Zangrillo, the head of the San Raffaele Hospital in Milan in the northern region of Lombardy, which has borne the brunt of Italy’s coronavirus contagion. “The swabs that were performed over the last 10 days showed a viral load in quantitative terms that was absolutely infinitesimal compared to the ones carried out a month or two months ago,” he told RAI television.’

Read here (Reuters, June 1, 2020)

K number: What is the coronavirus metric that could be crucial as lockdown eases?

‘K sheds light on the variation behind R. “Some [infectious] people might generate a lot of secondary cases because of the event they attend, for example, and other people may not generate many secondary cases at all,” said Dr Adam Kucharski, an expert in the dynamics of infectious diseases at the London School of Hygiene and Tropical Medicine. “K is the statistical value that tells us how much variation there is in that distribution.” But unlike R, K numbers are not intuitive. “The general rule is that the smaller the K value is, the more transmission comes from a smaller number of infectious people,” said Kucharski.’

Read here (The Guardian, June 1, 2020)

India's richest city Mumbai is rapidly turning into the world's next coronavirus catastrophe

‘With more than 37,000 infections and 1,200 deaths, Mumbai accounts for more than a fifth of India's total coronavirus tally and almost a quarter of all deaths. There are no clear signs the situation is improving, with hundreds — if not thousands — testing positive each day. Last week videos were uploaded to social media showing bodies lying on hospital beds next to living COVID-19 patients.’

Read here (ABC News, June 1, 2020)

The FDA-approved drug ivermectin inhibits the replication of SARS-CoV-2 in vitro

• Ivermectin is an inhibitor of the COVID-19 causative virus (SARS-CoV-2) in vitro.
• A single treatment able to effect ~5000-fold reduction in virus at 48 h in cell culture.
• Ivermectin is FDA-approved for parasitic infections, and therefore has a potential for repurposing.
• Ivermectin is widely available, due to its inclusion on the WHO model list of essential medicines.
  
  

Abstract: Although several clinical trials are now underway to test possible therapies, the worldwide response to the COVID-19 outbreak has been largely limited to monitoring/containment. We report here that Ivermectin, an FDA-approved anti-parasitic previously shown to have broad-spectrum anti-viral activity in vitro, is an inhibitor of the causative virus (SARS-CoV-2), with a single addition to Vero-hSLAM cells 2 h post infection with SARS-CoV-2 able to effect ~5000-fold reduction in viral RNA at 48 h. Ivermectin therefore warrants further investigation for possible benefits in humans.

Read here (Science Direct, June 2020)

Nobel laureate Michael Levitt on the lockdowns: “I think it is a huge mistake”

‘Q: What’s your view of the lockdown policy that so many European countries and states in America have introduced?

‘A: I think it is a huge mistake. I think we need smart lockdowns. If we were to do this again, we would probably insist on face masks, hand sanitizers, and some kind of payment that did not involve touching right from the very beginning. This would slow down new outbreaks and I think that for example they found as I understand, that children, even if they’re infected, never infect adults, so why do we not have children at school? Why do we not have people working? England, France, Italy, Sweden, Belgium, Holland, are all reaching levels of saturation that are going to be very, very close to herd immunity — So that’s a good thing. I think the policy of herd immunity is the right policy. I think Britain was on exactly the right track — before they were fed wrong numbers and they made a huge mistake.’

Read here (AIER, May 31, 2020)

Trump terminates US relationship with WHO

US President Donald Trump has announced that he is terminating the country's relationship with the World Health Organization (WHO). The president has accused the WHO of failing to hold Beijing to account over the coronavirus pandemic. "China has total control over the World Health Organization," the president said while announcing measures aimed at punishing Beijing.

Read here (BBC, May 30, 2020)

Is Malaysia in desperate need of a Covid-19 bill?

‘Since the MCO, the government had implemented several measures to combat the impacts of Covid-19, albeit on piecemeal basis. For example, the Companies (Exemption) (No. 2) Order 2020 provided protection for companies from being wound-up for a period of 6 months after receiving a statutory demand, compared to the previous period of 21 days. The EPF Act 1991 had been amended to allow withdrawal by members for the purpose of “sustainable living”. Although these measures are welcomed, a comprehensive Covid-19 Bill is very much needed at this juncture if the issues caused by the MCO are to be sufficiently addressed. After almost 3 months of MCO and CMCO, it is imperative that the Bill covers all bases to assist businesses in rebuilding the economy and our nation.’

Read here (Malay Mail, May 30, 2020)

Coronavirus: the mask of white Australia drops in racist media coverage

Key points: Victims of racism say headlines can incite hate, fear and anger. More needs to be done to stop racism before it happens through education or a more responsible press.

‘Inquiry and curiosity are the best ways to surmount racism, as well-known racism academic and author of US bestseller White Fragility Robin DiAngelo tells me... As DiAngelo says to me: “The default of society is the reproduction of racial inequality, it is the norm. It is not an aberration. It is the default that all our institutions have set up, intentionally, to reproduce racial inequality for the benefit of white people. It was literally coded in law in both our [US and Australia] countries”. I just hope DiAngelo will be completely wrong one day.‘

Read here (South China Morning Post, May 30, 2020)

99% confident that COVID-19 vaccine will work, says Chinese firm

‘Chinese scientists working on a COVID-19 vaccine have told Sky News they are "99%" sure it will be effective. Sinovac, a Beijing-based biotech company, currently has its coronavirus vaccine in stage 2 trials, with more than 1,000 volunteers participating. Sky News is the first British broadcaster to visit its labs.’

Read here (Sky News, May 30, 2020)

Working life has entered a new era: Farewell BC (before coronavirus). Welcome AD (after domestication)

‘Without the Monday-to-Friday commute, the weekend seems a more nebulous concept, as does the 9-to-5 working day. In future employees may work and take breaks when they please, with the company video call the only fixture. The downside, however, is that the rhythm of life has been disrupted and new routines are needed: as Madness, a British pop group, sang about school in “Baggy Trousers”, people are reduced to “trying different ways to make a difference to the days”.’

Read here (The Economist, May 30, 2020)

The mystery of ‘silent spreaders’: An insight to asymptomatic transmission and contact tracing in Singapore’s The Life Church and Missions

‘Investigators resorted to going through the CCTV recordings made at the church that Sunday to search for clues. And they stumbled across something completely unexpected - the woman who'd attended the later service, after the Chinese couple had left, had sat in the seats they had used several hours earlier...

‘Somehow, despite having no symptoms and not feeling ill, the Chinese husband and wife had managed to spread the virus. Maybe they'd had it on their hands and touched the seats, maybe their breath carried the infection and it landed on a surface, it's not clear, but the implications were huge...

‘For Dr Lee, piecing everything together, there was only one possible explanation - that the virus was being passed by people who had it without even realising. This was a revelation that would be relevant the world over because the central message of all public health advice on coronavirus has always been to look out for symptoms in yourself and others.’

Read here (BBC, May 30, 2020)

Gripped by disease, unemployment and outrage at the police, America plunges into crisis

‘America’s persistent political dysfunction and racial inequality were laid bare this week, as the coronavirus death toll hit a tragic new milestone and as the country was served yet another reminder of how black people are killed by law enforcement in disproportionately high numbers. Together, the events present a grim tableau of a nation in crisis — one seared by violence against its citizens, plagued by a deadly disease that remains uncontained and rattled by a devastating blow to its economy.’

Read here (Washington Post, May 30, 2020)

Evidence for limited early spread of Covid-19 within the United States, January–February 2020

‘The first US cases of nontravel–related COVID-19 were confirmed on February 26 and 28, 2020, suggesting that community transmission was occurring by late February... Four separate lines of evidence (syndromic surveillance, virus surveillance, phylogenetic analysis, and retrospectively identified cases) suggest that limited U.S. community transmission likely began in late January or early February 2020, after a single importation from China, followed by multiple importations from Europe. Until late February, COVID-19 incidence was too low to be detected by emergency department syndromic surveillance for COVID-19–like illness... Enhanced syndromic and virus surveillance will be needed to monitor COVID-19 trends for the duration of the pandemic.’

Read here (US CDC, May 29, 2020)

We have different attitudes toward social distancing, and it's straining relationships

‘The coronavirus isn't just threatening our health, it's threatening our relationships as we try to navigate how a socially distanced world should look -- something never done before. And now that states have replaced stay-at-home orders with various guidelines on reopening, there's more room for differing views on social distancing. These conflicts can be an opportunity for growth if we try to understand each other's mindset, according to psychologist Holly Parker, but that depends on both parties' willingness to embrace vulnerability.’

Read here (CNN, May 29, 2020)

Wearing face masks at home cuts Covid-19 spread by 79 percent - study

‘While face masks and frequent disinfection is widely assumed to prevent Covid-19 transmission, a new study has lent weight to the usefulness of these measures in ‘real world’ situations. In a paper published in the journal BMJ Global Health yesterday, researchers found that wearing face masks at home before the primary case showed symptoms slashed the risk of secondary infections by 79 percent. Wearing masks after symptoms appeared had no effect.’

Read here (Malaysiakini, May 29, 2020)

The world is still far from herd immunity for coronavirus, studies show

‘The precise herd immunity threshold for the novel coronavirus is not yet clear; but several experts said they believed it would be higher than 60 per cent... Some countries - notably Sweden, and briefly Britain - have experimented with limited lockdowns in an effort to build up immunity in their populations. But even in these places, recent studies indicate that no more than about 7 per cent -17 per cent of people have been infected so far. In New York City, which has had the largest coronavirus outbreak in the United States, around 20 per cent of the city's residents have been infected by the virus as of early May, according to a survey of people in grocery stores and community centres released by the governor's office.’

Read here (Straits Times, May 29, 2020)

There are coronavirus solutions for resource-poor countries, too

‘No country, let alone poor countries, can afford to risk the health of, or indeed, drive away precious healthcare workers. Rather than put them at risk of infection, and in turn, risk infecting their patients, governments should consider alternatives. In this respect, Rwanda showed leadership. Their whole-of-government approach included: deterring people with suspected COVID-19 infections from coming to health facilities unless seriously unwell; minimising contact between health workers and infected patients; and focusing on prevention and care within communities.

‘The good news is that following decades of investments, many resource-poor countries have fleets of community-based health workers (CHWs). These workers deliver door-to-door services and know their communities well.’

Read here (Aljazeera, May 29, 2020)

Coronavirus may be a blood vessel disease, which explains everything

‘A respiratory virus infecting blood cells and circulating through the body is virtually unheard of. Influenza viruses like H1N1 are not known to do this, and the original SARS virus, a sister coronavirus to the current infection, did not spread past the lung. Other types of viruses, such as Ebola or Dengue, can damage endothelial cells, but they are very different from viruses that typically infect the lungs...

‘An infection of the blood vessels would explain many of the weird tendencies of the novel coronavirus, like the high rates of blood clots... Blood vessel damage could also explain why people with pre-existing conditions like high blood pressure, high cholesterol, diabetes, and heart disease are at a higher risk for severe complications from a virus that’s supposed to just infect the lungs.’

Read here (Medium, May 29, 2020)

A Covid-19 ‘exit’ strategy to end lockdown and reopen the economy | Uri Alon

‘How can we return to work without spurring a second surge of coronavirus infection? Biologist Uri Alon shares a thought-provoking strategy: four days at work followed by 10 days of lockdown, a cycle that would exploit a weakness in the virus's biology and potentially cut its reproductive rate to a manageable level. Learn more about this approach -- which has already been adopted by both companies and countries -- and how it could be a key to reopening the economy responsibly. (This virtual conversation, hosted by head of TED Chris Anderson and science curator David Biello, was recorded on May 20, 2020.)’

Watch here (TED Talk, May 28, 2020)

Coronavirus may never go away, even with a vaccine

‘It is a daunting proposition — a coronavirus-tinged world without a foreseeable end. But experts in epidemiology, disaster planning and vaccine development say embracing that reality is crucial to the next phase of America’s pandemic response. The long-term nature of covid-19, they say, should serve as a call to arms for the public, a road map for the trillions of dollars Congress is spending and a fixed navigational point for the nation’s current, chaotic state-by-state patchwork strategy.’

Read here (Washington Post, May 28, 2020)

Harnessing our humanity — How Washington’s health care workers have risen to the pandemic challenge

‘Given mounting PPE shortages and the rising death toll from Covid-19 among health care workers globally, such scenarios [of protocol modifications -- including the use of bandannas in place of face masks] induce terror and necessitate rethinking of routine standards of care. Should we run to codes of patients with known or suspected Covid-19? Should physicians refuse to intubate a patient unless they have adequate PPE? Should we offer bedside comfort to the elderly patient with possible Covid-19 who becomes increasingly delirious as unrecognizable health care workers speed in and out of the room while TV coverage of the pandemic drones on in the background? The clarion call of the profession — to put our patients’ needs above our own — is far less directive when meeting one patient’s needs may leave us too ill to care for the next.’

Read here (New England Journal of Medicine, May 28, 2020)

Coronavirus: The human cost of virus misinformation

A BBC team tracking coronavirus misinformation has found links to assaults, arsons and deaths. And experts say the potential for indirect harm caused by rumours, conspiracy theories and bad health information could be much bigger.

Read here (BBC, May 27, 2020)

WHO Foundation established to support critical global health needs

‘The Foundation which is legally separate from WHO, will facilitate contributions from the general public, individual major donors and corporate partners to WHO and trusted partners to deliver on high-impact programmes. Its goal is to help broaden WHO’s donor base and work towards more sustainable and predictable funding.  The WHO Foundation will simplify the processing of philanthropic contributions in support of WHO and make such contributions possible on all aspects of health and WHO’s mission.’

Read here (WHO, May 27, 2020)

Seniors with Covid-19 taking ACE inhibitors have lower hospitalisation risk

‘A Yale-led study suggests that older COVID-19 patients taking ACE inhibitors for hypertension have a lower risk of hospitalization for the novel coronavirus... The use of ACE inhibitors was associated with an almost 40% lower risk of COVID-19 hospitalization for the older, Medicare Advantage patients — but there was no significant difference in risk for the younger, commercially insured patients.’

Read here (Yale, May 27, 2020)

Read original Medrxiv pre-print paper here

Listen: It’s a small World Health Organization

‘WHO is funded for about $2.2 to $2.3 billion a year. That’s about the size of one medium-size hospital, and it has to cover 194 countries. The objective of WHO, as stated in its constitution, is the attainment by all peoples of the highest possible level of health. That’s a huge goal, and you’re spreading this budget extremely thin.’

Listen or read here (The Atlantic, May 27, 2020)

Amazon writes its own TV news segments to laud coronavirus pandemic response

‘Several local TV news stations recently broadcast strikingly similar reports that focused on the safety measures the online retail giant has implemented at its warehouses, according to a video compiled by the Courier, part of a progressive media company with ties to groups supporting the Democratic Party. That similarity is because the segments were based on scripts and footage provided by Amazon, journalists who received similar pitches from the company said on Twitter.’

Read here (South China Morning Post, May 27, 2020)

The coronavirus killed the handshake and the hug. What Will replace them?

‘If you feel that personal connections are harder to form when talking to someone six feet away or through a screen on Zoom, you’re not alone. “You’re having to verbalize a lot more things that you would normally express with touch,” Suvilehto says. Hugging someone who needs comforting or placing a hand on their shoulder often feels easier and more natural than finding the right words. Being forced to voice these feelings might turn us into better communicators. “But the other option is that people will just stop communicating about emotions,” Suvilehto says.’

Read here (Time Magazine, May 27, 2020)

Big Pharma chief who developed first Ebola shot breaks silence on Covid-19

‘It's not that we couldn't have done something earlier. The reason that we're announcing these things now is because as we tried to select approaches, we did it with a view that we needed vaccines with three characteristics: No. 1, they have to be vaccines that can be deployed broadly, globally. No. 2, and this is extremely important, these have to be vaccines that we have reasonable confidence could be effective with just a single dose. No. 3, we wanted to develop vaccines that used technology, platforms that have already been proven to work safely and effectively in people.’

Read here (Sydney Morning Herald, May 27, 2020)

Call for clear face masks to be ‘the norm’

‘Standard face masks, which have become widespread as countries try to stop the spread of coronavirus, muffle words and obscure the mouth... Main dans la Main (Hand in Hand), an association which supports deaf and hearing impaired people in Chevrières, northern France, is among the organisations around the world that have created a mask with a transparent window... But one setting where homemade masks are not suitable - but where both PPE and communication are vital - is in hospitals. There is just one company in the US that has secured Food and Drug Administration (FDA) approval to make clear masks for clinical use.’

Read here (BBC, May 26, 2020)

Politics, profits undermine public interest in Covid-19 vaccine race

‘Some pharmaceutical giants, e.g., Glaxo-Smith-Kline and Sanofi, claim they do not expect to profit from the Covid-19 vaccine. But such recent industry promises not to profiteer from making the vaccine globally available are hard to reconcile with the record that drug research and development has long been driven by the prospect of massive profits.

‘Such firms have been urged to make the Open Covid pledge to voluntarily relinquish their IP rights (IPRs), at least until the Covid-19 pandemic is over... Governments can also use ‘compulsory licencing’, permitted by World Trade Organization rules, to enable companies that do not have the IPRs, to make, manufacture and sell generic versions of patented medicines...’

Read here (IPS News, May 26, 2020)

Coronavirus: Why is the US making such a mess of it? Should we be concerned

‘Should the rest of the world be concerned that America is lurching towards a monumental health disaster? Yes, for three reasons... First, the world is so interconnected today that no part of the world can be safe if the epidemic is not brought under control everywhere... Second... the huge negative impact of a poorly controlled epidemic on the US economy will depress global aggregate demand for the rest of 2020 and prolong and deepen the recession that is unfolding... Third, a wounded tiger is most dangerous, especially when it has the largest military force on the planet...’

Read here (Aliran, May 26, 2020)

A third of Americans now show signs of clinical anxiety or depression, Census Bureau finds amid coronavirus pandemic

‘When asked questions normally used to screen patients for mental health problems, 24 percent showed clinically significant symptoms of major depressive disorder and 30 percent showed symptoms of generalized anxiety disorder. The findings suggest a huge jump from before the pandemic. For example, on one question about depressed mood, the percentage reporting such symptoms was double that found in a 2014 national survey.’

Read here (Washington Post, May 26, 2020)

WHO temporarily pauses hydroxychloroquine study due to safety concerns

‘The World Health Organization has temporarily halted studying hydroxychloroquine as a potential Covid-19 treatment due to safety concerns, WHO Director-General Tedros Adhanom Ghebreyesus said during a media briefing in Geneva on Monday.

‘The decision was made after an observational study published Friday in the medical journal The Lancet described how seriously ill Covid-19 patients who were treated with hydroxychloroquine and chloroquine were more likely to die. Tedros said that an independent executive group is now reviewing the use of hydroxychloroquine in WHO's Solidarity Trial. The executive group represents 10 of the participating countries in the trial.’

Read here (CNN, May 25, 2020)

Do not discriminate against migrant workers, Health DG warns

‘With Covid-19 infection clusters emerging in three immigration detention centres, Datuk Dr Noor Hisham Abdullah has said that negative sentiments against detainees must not be amplified and must not be a catalyst for discrimination in saving lives. The Health director-general said that the whole of government and whole community approach should work together to fight the virus.’

Read here (The Star, May 25, 2020)

Take a shot, isolate at hotel: Chinese volunteer 048 describes Covid-19 vaccine trial

‘We were treated pretty well, says one of 108 participants in trial in Wuhan, whose results were published on Friday. The potential vaccine has since become the world’s first to enter a second phase of human testing, according to WHO.’

Read here (South China Morning Post, May 25, 2020)

China must raise its soft power game, especially at a time Trump’s America is losing friends

‘Research published last week comparing American and German views on China, globalisation and international cooperation showed surprising differences: the number of Germans valuing close relations with the United States tumbled between 2019 and 2020 from 50 per cent to 37 per cent, an obvious casualty of the quixotic aggression of an “America first” White House. At the same time, Germans valuing close relations with China climbed from a meagre 24 per cent to 36 per cent – now equal to those valuing close links with the US. Are we seeing a shift in soft power?’

Read here (South China Morning Post, May 24, 2020)

Coronavirus: 'Baffling' observations from the front line

“It felt in some ways like we were trying to prepare for the D-Day landings," says Barbara Miles, clinical director of intensive care at Glasgow Royal Infirmary, "with three weeks to get ready and not a great deal of knowledge about what we would be facing". But what arrived in the UK as winter turned into spring took even the most experienced ICU specialists by surprise. Most people infected with the coronavirus have only mild symptoms, or sometimes none at all. But in many thousands of patients who fall critically ill, Covid-19 is a disease of alarming complexity.’

Read here (BBC, May 23, 2020)

Covid-19 patients no longer infectious 11 days after getting sick, research shows

‘After 11 days of getting sick, Covid-19 patients no longer pose a risk of spreading the disease - which means they can be safely discharged. Singapore now discharges patients only after two swab tests are negative for the virus. But a local study has shown that while the patients might test positive, it "does not equate to infectiousness or viable virus". That's because the test detects parts of the virus' genome, but is unable to show if they are just fragments of the virus, or if an intact virus is no longer viable and can't infect anyone.’

Read here (Straits Times, May 23, 2020)

Coronavirus is the practice run for schools. But soon comes climate change

‘By finding ways to continue learning through the pandemic, the education system will be better equipped for a future marked by severe weather emergencies... Schools are still scrambling simply to cope with the immediate coronavirus crisis and meet students’ basic needs, but the next school year could present opportunities to rethink how remote learning happens... One big step forward would be universal broadband access... Another is making sure teachers receive training on distance learning, through programs that prepare them for the profession as well as through ongoing professional development... Education systems will also have to adjust how they assess students and schools. Measures like seat time and attendance just won’t work the same way in a world facing so much disruption.’

Read here (Huffington Post, May 23, 2020)

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of Covid-19: A multinational registry analysis

‘Hydroxychloroquine or chloroquine, often in combination with a second-generation macrolide, are being widely used for treatment of COVID-19, despite no conclusive evidence of their benefit. Although generally safe when used for approved indications such as autoimmune disease or malaria, the safety and benefit of these treatment regimens are poorly evaluated in COVID-19.

’We were unable to confirm a benefit of hydroxychloroquine or chloroquine, when used alone or with a macrolide, on in-hospital outcomes for COVID-19. Each of these drug regimens was associated with decreased in-hospital survival and an increased frequency of ventricular arrhythmias when used for treatment of COVID-19.’

Read here (The Lancet, May 22, 2020)

The world needs Covid-19 vaccines. It may also be overestimating their power

‘In the public imagination, vaccines are often seen effectively as cure-alls, like inoculations against measles. Rather than those vaccines, however, the Covid-19 vaccines in development may be more like those that protect against influenza — reducing the risk of contracting the disease, and of experiencing severe symptoms should infection occur, a number of experts told STAT.’

Read here (STAT News, May 22, 2020)

First human trial of COVID-19 vaccine finds it is safe and induces rapid immune response

‘These results represent an important milestone. The trial demonstrates that a single dose of the new adenovirus type 5 vectored COVID-19 (Ad5-nCoV) vaccine produces virus-specific antibodies and T cells in 14 days, making it a potential candidate for further investigation,’ says Professor Wei Chen from the Beijing Institute of Biotechnology in Beijing, China, who is responsible for the study. ‘However, these results should be interpreted cautiously. The challenges in the development of a COVD-19 vaccine are unprecedented, and the ability to trigger these immune responses does not necessarily indicate that the vaccine will protect humans from COVID-19. This result shows a promising vision for the development of COVID-19 vaccines, but we are still a long way from this vaccine being available to all.’

Read here (Science Daily, May 22, 2020)

This is the original report in The Lancet. Read here (The Lancet, May 22, 2020)

Look into my eyes: Communication in the era of face masks

‘Wallraven's research at Korea University in Seoul focuses on facial expressions. "The greatest source of non-verbal information comes from our mouths," he said, explaining that facial expressions, especially in the lower part of the face, reveal nuances in the spoken word. But face masks hide much of these facial expressions. This makes it difficult to put things that are being said into the right context, which may lead to uncertainty, Wallraven said. "Is that person smiling or grinning sarcastically? You just can't tell."

Read here (DW, May 22, 2020)

Why we might not get a coronavirus vaccine

‘When the prime minister, Boris Johnson, told a No 10 press briefing that a vaccine was “by no means guaranteed”, his chief scientific adviser, Patrick Vallance, agreed, but added: “I’d be surprised if we didn’t end up with something.” Many scientists share that view... In all likelihood, a coronavirus vaccine will not be 100% effective.’

Read here (The Guardian, May 22, 2020)

Is everyone depressed?

‘For people whose response to the pandemic turns from acute anxiety into general malaise, Jarvis recommends facing the numbness head-on. It’s treatable, and not necessarily with medication. First, she says, create regimens of simple tasks that give structure to the day. The approach is working for Falcone, the acupuncturist. He starts every day with 30 minutes of stretching, no matter what. Then he walks his dog, makes coffee, and sits down to teach massage via Zoom. Deb Hawkins, the tech analyst, sent me a list of things she’s doing to help others and stay busy: She donated money to a couple of worthy causes, and made an appointment to give blood. She has created a small social bubble and signed up for an online ballet class. She says her sense of self is returning.’

Read here (The Atlantic, May 22, 2020)

8 ways Covid will transform the economy and disrupt every business

‘In this report, we look at eight major trends underway in the world, and pinpoint the possibilities for savvy business operators, investors and innovators. We all know how much our lives have changed, and how we’re not likely to go back to our old ways. We’ll be more cautious but we also may be more creative. As history likes to remind us, with unprecedented times come unprecedented opportunities.’

Read here (RBC Thought Leadership, May 22, 2020)

How fear, groupthink drove unnecessary global lockdowns

‘New York City reached over a 25% infection rate and yet 99.98% of all people in the city under 45 survived, making it comparable to death rates by normal accidents. But of course the whole linchpin of the lockdown argument is that it would have been even worse without such a step. Sweden never closed down borders, primary schools, restaurants, or businesses, and never mandated masks, yet 99.998% of all their people under 60 have survived and their hospitals were never overburdened. Why did we lock down the majority of the population who were never at significant risk? What will be the collateral damage? That is what this series will explore.’

Read here (Real Clear Politics, May 21, 2020)

As the US and China clash, what can other countries do?

Keypoints: Neighbours and partners must work to rebuild cross-border trade and boost supply chains as a leadership gap widens during the coronavirus pandemic. Lessons can be drawn from the efforts of Asian countries, which signed their own FTAs as a backup plan to global trade when WTO negotiations stalled at the start of the 2000s.

Read here (South China Morning Post, May 21, 2020)

Will coronavirus change Germans’ love of cash?

“Covid-19 has probably changed German payment behaviour faster than any single technology ever has,” says Georg Hauer, general manager of the Germany-Austria-Switzerland region at N26, a Berlin-based online banking start-up. For many Germans, using cash isn't just a personal preference; it's a cultural value that they've grown up with — and one tied closely to a national value with centuries-old roots.

Read here (BBC, May 21, 2020)

The West has lost its way, but China may not be the beneficiary, says historian Wang Gungwu

‘It did not help that the US as the leader of that West has made serious mistakes as the world’s sole superpower, including that of letting rampant capitalism dictate the globalisation process. The negative reaction among those in the US who turned against its liberal ideals has left the country’s allies in confusion and thus opened Western hegemony to question. But even if the West should be in relative decline, that does not mean that China will be the beneficiary. Much will depend on whether China’s alternative perspective is credible and attractive to those who are now more sceptical of what the West stands for.’

Read here (South China Morning Post, May 21, 2020)

Why are Africa's coronavirus successes being overlooked?

‘Take the two African countries I have called home – Senegal and Ghana... Senegal is in a good position because its Covid-19 response planning began in earnest in January, as soon as the first international alert on the virus went out... As a result, this nation of 16 million people has had only 30 deaths... Ghana, with a population of 30 million, has a similar death toll to Senegal, partly because of an extensive system of contact tracing, utilising a large number of community health workers and volunteers, and other innovative techniques such as “pool testing”, in which multiple blood samples are tested and then followed up as individual tests only if a positive result is found. The advantages in this approach are now being studied by the World Health Organization.’

Read here (The Guardian, May 21, 2020)

Doctors race to understand new illness afflicting children

‘They named the new illness paediatric multisystem inflammatory syndrome (PMIS) or multisystem inflammatory syndrome in children (MIS-C) - the name is still evolving - described its symptoms, and prescribed a course of treatment. Each case would require a team of specialists and the facilities of a well-resourced city-based children's hospital.

"We should know in a couple of weeks how wide the spectrum is. We've literally been hearing about cases every day, but we're not gathering systematic data. It's all word of mouth from Zoom conferences and webinars," Dr Levin said on May 12, writing a few days later to say that data-collection processes had already improved.’

Read here (Al Jazeera, May 21, 2020)

How the pandemic is changing shopping

‘Across the country, stores are reopening to a changed reality. Retailers that have spent years trying to get customers to linger, in hopes they’ll buy more than they need, are reimagining their stores for a grab-and-go future filled with deliberate purchases. Gone, they say, are the days of trying on makeup or playing with toys in the aisles. The focus now is on making shopping faster, easier and safer to accommodate long-term shifts in consumer expectations and habits.’

Read here (Washington Post, May 21, 2020)

Why you might be missing your commute

“You can’t disentangle home and work anymore, and that’s not always easy,” says Jon Jachimowicz, an assistant professor in the Organizational Behavior Unit at Harvard Business School. A new study, co-authored by Jachimowicz, examines the function of the commute as a psychological threshold between home and work.

According to the study, the daily commute offers an opportunity for people to engage in “role-clarifying prospection”, meaning it gives them time and space to think about the upcoming work role. “Through role-clarifying prospection, employees mentally shift their attention from what they are experiencing in the present - thoughts pertaining to their commute, or thoughts unrelated to their past or future role - to what they will be experiencing when they arrive at work, namely, thoughts pertaining to their workday,” the authors write.

Read here (BBC, May 21, 2020)