Top US infectious disease expert Fauci urges caution on China and Russia Covid-19 vaccines

‘America’s top infectious diseases official has raised concerns over the safety of Covid-19 vaccines being developed by China and Russia as the world scrambles for answers to a pandemic the WHO warned will be felt for decades. Several Chinese companies are at the forefront of the race to develop an immunity to the disease and Russia has set a target date of September to roll out its own vaccine. But US infectious disease expert Anthony Fauci said it was unlikely his country would use any vaccine developed in either country, where regulatory systems are far more opaque than they are in the West.’

Read here (Straits Times, August 3, 2020)

WHO warns of long road ahead, may never be a ‘silver bullet’

‘The World Health Organisation warned on Monday that there might never be a “silver bullet” for Covid-19 in the form of a perfect vaccine, and that the road to normality will be long, with some countries requiring a reset of strategy. WHO director general Tedros Adhanom Ghebreyesus and WHO emergencies head Mike Ryan exhorted nations to rigorously enforce health measures such as mask-wearing, social distancing, handwashing, contact tracing and testing. “For now, stopping outbreaks comes down to the basics of public health and disease control. The message to people and governments is clear: ‘Do it all’,” Tedros told a virtual news briefing from the UN body’s headquarters in Geneva.’

Read here (South China Morning Post, August 3, 2020)

Unmasking the masks facts and fallacies: Lecture on masks by Dato' Dr Amar Singh

This is highly relevant current information on Covid-19 transmission and the use of face masks including reusable cloth masks and emerging ones.

Watch here (Youtube, August 1, 2020)

Coronavirus: Just 0.3% of cases in Singapore admitted to ICU

‘While Covid-19 cases in Singapore have surged past 50,000, only a tiny fraction of those who fell ill - just 128, or 0.3 per cent - have been admitted to the intensive care unit (ICU) as of Monday. Experts said years of investment in healthcare, as well as a well thought out and executed strategy to keep infection numbers low, have helped to ensure the Republic has one of the world's lowest ICU admission - and fatality - rates from Covid-19.’

Read here (Straits Times, July 31, 2020)

What the D614G mutation means for Covid-19 spread, fatality, treatment, and vaccine

‘We are facing the global shift of the SARS-CoV-2 variant — from D614 to G614. The G614 variant is more infectious in laboratory settings; whether it means increased viral spread in humans is unconfirmed. Current evidence says that the G614 variant is not any deadlier than D614. And so, treatment options should not be any more different. Both the D614 and G614 variants should react similarly to vaccines, studies suggest, as the mutation does not change the immunogenic part of the spike protein; that is, the receptor-binding domain (RBD).’

[This is a survey of literature by a young post-grad Malaysian. It gives a rounded picture of the D614G mutation without using too much jargon. Must counter check the accuracy of what's stated against the originals.] 

Read here (Medium, July 31, 2020)

New evidence suggests young children spread Covid-19 more efficiently than adults

Two new studies, though from different parts of the world, have arrived at the same conclusion: that young children not only transmit SARS-CoV-2 efficiently, but may be major drivers of the pandemic as well. The first, which was published in JAMA yesterday, reports findings from a pediatric hospital in Chicago, Illinois. The second, a preprint manuscript awaiting peer review, was conducted in the mountainous province of Trento, Italy.

Read here (Forbes, July 31, 2020)

Careless young people driving some Covid-19 spikes, says WHO

‘The World Health Organisation (WHO) on Thursday (July 30) warned that spikes in coronavirus transmission in a number of countries were being driven by young people "letting down their guard". "Young people are not invincible," WHO chief Tedros Adhanom Ghebreyesus told a virtual news conference in Geneva.

‘WHO's technical lead for Covid-19 Maria Van Kerkhove lamented in particular that nightclubs in a number of places had become "amplifiers" of transmission. "We are asking for all people, including young people, to be your own risk manager" and avoid behaviours that could easily increase transmission of the disease.’

Read here (Straits Times, July 31, 2020)

One more reason to wear a mask: You’ll get less sick from Covid-19

‘It’s likely that face masks, by blocking even some of the virus-carrying droplets you inhale, can reduce your risk of falling seriously ill from COVID-19, according to Monica Gandhi, MD, an infectious disease specialist at UC San Francisco.

‘These epidemiological observations are among the evidence that Gandhi and colleagues cite in a paper in the Journal of General Internal Medicine, in which they propose that masks can lead to milder or asymptomatic infections by cutting down on the dose of virus people take in...

‘To Gandhi, these case studies [comparing situations at cruise ships, seafood processing centres, etc] suggest that if more people wore masks, we could see less serious illness from COVID-19 and a higher proportion of asymptomatic cases, currently estimated to be around 40 percent of cases by the Centers for Disease Control and Prevention. Milder infections would ease the burden on the health care system, save lives, and even nudge us closer to herd immunity before a vaccine becomes available, said Gandhi.’

Read here (The University of California, San Francisco, July 31, 2020)

‘We could see this tsunami of people coming’: Inside the secret world of intensive care

“When dealing with patients at the extremes of life,” writes Aoife Abbey, a doctor at University Hospital Coventry in her memoir The Seven Signs of Life, “there is an onus on doctors to be alert for the time when the burden of treatment outweighs the expected benefit for a patient. It is imperative that medicine knows when it is time to work with death, if it is to work at all. Intensive care, perhaps more than any other speciality, is defined by this specific sort of responsibility.”

‘During these months of treating Covid-19 patients, Abbey has seen patients come in with severe acute respiratory failure. Some patients stood to benefit from intensive care, while for others the escalation of treatments, including invasive forms of ventilation, were not deemed to be in their best interest. The established ethical frameworks used to make these kinds of decisions have remained the same when treating patients with Covid-19.’

Read here (The Guardian, July 30, 2020)

Only governments can prevent Covid-19 recessions becoming depressions

‘In March, French economists Emmanuel Saez and Gabriel Zucman, both at Berkeley, proposed that governments help ease pain and disruption with payer-of-last-resort programmes, with adversely affected businesses reporting unavoidable monthly overhead and maintenance costs to qualify for government aid.

‘Such a payer-of-last-resort programme would reduce hardship for workers and businesses. It could enable businesses to temporarily suspend or scale down operations, to limit haemorrhage and avoid insolvency, and to pick up quickly as conditions improve. It would maintain ‘cash flow’ for families and businesses, minimising Covid-19 shocks’ adverse secondary impacts on demand (e.g., due to fired workers spending less on consumption), while enabling more rapid recovery as demand resumes.’

Read here (ksjomo.org, July 30, 2020)

Here's what the science actually says about kids and Covid-19

‘As school districts across the United States decide whether to welcome kids back into the classroom for in-person education this fall, administrators find themselves weighing a complex set of variables. There’s the risk of children, teachers and staffers getting sick or spreading the disease, on the one hand. But on the other, there’s evidence that being out of school can degrade children’s long-term learning prospects and mental health; make it harder for many to get the food they need; and make it difficult for parents to work—especially mothers, who are often expected to handle a disproportionate amount of childcare duties. Millions of students, meanwhile, lack access to high-speed broadband internet and other technological resources required to get the most out of remote learning, making it an inadequate substitute for many.’

Read here (Time Magazine, July 29, 2020)

Moderna aims to price coronavirus vaccine at $50-$60 per course: FT

‘Moderna Inc is planning to price its coronavirus vaccine at $50 to $60 per course, at least $11 more than another vaccine from Pfizer Inc and BioNTech, the Financial Times reported on Tuesday, citing unnamed sources. Moderna’s proposed price for a two-dose course sold to governments compares with $39 for two doses under a deal that Pfizer Inc and German partner BioNTech struck with the U.S. government.’

Read here (Reuters, July 29, 2020)

Aliens and reptilians: The odd beliefs of Stella Immanuel, doctor in US viral video retweeted by Trump

‘A Houston doctor who praised hydroxychloroquine as a miracle coronavirus cure in a viral video retweeted by President Donald Trump blames gynaecological problems on sex with evil spirits and believes the US government is run by “reptilians”. Stella Immanuel’s viral speech has drawn attention to a little-known group calling themselves “America’s Frontline Doctors” who appear to exist to promote the common antimalarial drug in the fight against Covid-19.’

Read here (South China Morning Post, July 29, 2020)

Vietnam let down its guard, and cases surged

It’s a familiar story in Asia: Vietnam seemed like a miracle, where months went by without a single coronavirus death or even local transmission. 

 

The economy reopened, travel restarted and residents began leaving their masks at home. But over the weekend, the country announced that the virus was lurking after all — and spreading. Experts do not know the source. 

 

It followed a pattern in places that seemed to have done everything right: Japan, China, Australia and South Korea all recorded spikes on Wednesday. And the mystery is worrying medical experts and residents alike. 

 

Details: Shortly after a 57-year-old man from Danang tested positive, clusters emerged in five hospitals. By Wednesday, the virus had spread north to Hanoi, south to Ho Chi Minh City, to two provinces in the country’s center and even the remote Central Highlands. 

 

Quotable: “In my opinion, this outbreak is more dangerous than the previous one because it is happening at the same time in many places,” said the dean of public health at Quang Trung University.

Read here (New York Times, June 29, 2020)

Fight pandemic, not windmills of the mind

‘Reversing emergency expansionary measures too soon risks aborting recovery and may even trigger new recessions. Even an assets fund manager has acknowledged, “Like a course of antibiotics, an economic relief package is most efficacious when administered to completion”.

‘When President Franklin Delano Roosevelt tried to balance the budget in 1937 after securing re-election, the ensuing downturn ended the recovery, only revived after deficit spending resumed in 1939. Also, countries that abandoned fiscal expansion for consolidation from 2009 had worse recovery records than others.’

Read here (IPS News, July 28, 2020)

Covid-19: Getting our SOPs right - Amar Singh HSS and Lim Swee Im

This article discusses a number of issues on SOPs pertaining to Malaysia today:

• How can we best monitor our pandemic when our numbers are low?
• How ready are our testing capabilities for a second and subsequent waves?
• How good are our safe physical distancing measures?
• Optimising masks in Covid-19 prevention
• There is no way for the poor (B40) to comply with this ruling without a government mandated free programme
• Mask etiquette and our leaders

Read here (The Malay Mail, July 27, 2020)

Covid-19 vaccines may cause mild side effects, experts say, stressing need for education, not alarm

‘While the world awaits the results of large clinical trials of Covid-19 vaccines, experts say the data so far suggest one important possibility: The vaccines may carry a bit of a kick. In vaccine parlance, they appear to be “reactogenic,” meaning they have induced short-term discomfort in a percentage of the people who have received them in clinical trials. This kind of discomfort includes headache, sore arms, fatigue, chills, and fever.

‘At least two manufacturers, Cambridge, Mass.-based Moderna and CanSino, a Chinese vaccine maker, stopped testing the highest doses of their Covid-19 vaccines because of the number of severe adverse events recorded among participants in their clinical trials.’

Read here (STAT, July 27, 2020)

False and misleading claims about vaccines debunked

‘In the week that Oxford University announced promising results from its coronavirus vaccine trial, we're looking at claims on social media about vaccines and misleading statements about their safety.

‘The anti-vaccination movement has gained traction online in recent years, and campaigners opposed to vaccination have moved their focus to making claims relating to the coronavirus.’

Read here (BBC, July 26, 2020)

Child malnutrition and Covid-19: The time to act is now

‘The Lancet recently published a call to action co-authored by the directors of UNICEF, the Food and Agriculture Organization, the World Food Programme, and the WHO. The statement addresses the growing threat of childhood malnutrition due to downstream effects of the COVID-19 pandemic and associated response policies and operations, particularly in low- and middle-income countries. The statement listed 5 “urgent actions” to support children's right to adequate nutrition during the pandemic. Specifically, the authors call on national governments and private donors to support efforts to ensure access to nutritious, safe, and affordable diets; maternal and child health; early detection and treatment for child wasting; nutritious school meals for vulnerable children; and safe access to food and essential services. These priorities must be integrated more completely into the COVID-19 response.’ -- Center for Health Security, John Hopkins University

Read here (The Lancet, July 27, 2020)

What we know – and what we don’t know – about stopping the spread of the coronavirus

What's successful: (1) Fast action (2) Well-timed lockdowns (3) Travel restrictions (4) Face masks and coverings. What we still don’t know about the virus’ spread: (1) Mass gatherings (2) Super-spreaders (3) Indoor locations (4) Schools 

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

Governments losing support for their handling of Covid-19: Survey

‘Governments are fast losing support for their handling of the coronavirus outbreak from a public that widely believes death and infection figures to be higher than statistics show, a survey of six countries [US, Britain, France, Sweden, Japan and Germany] revealed on Saturday (July 25).’

Read here (Straits Times, July 25, 2020)

US CDC: One-third of COVID-19 patients who aren't hospitalised have long-term illness

‘The Centers for Disease Control and Prevention acknowledged Friday that a significant number of COVID-19 patients do not recover quickly, and instead experience ongoing symptoms, such as fatigue and cough. As many as a third of patients who were never sick enough to be hospitalised are not back to their usual health up to three weeks after their diagnosis, the report found.

"COVID-19 can result in prolonged illness even among persons with milder outpatient illness, including young adults," the report's authors wrote. The acknowledgement is welcome news to patients who call themselves "long-haulers" — suffering from debilitating symptoms weeks and even months after their initial infection.

"This report is monumental for all of us who have been struggling with fear of the unknown, lack of recognition and many times, a lack of belief and proper care from medical professionals during our prolonged recovery from COVID-19," Kate Porter, who is on day 129 of her recovery, wrote in an email to NBC News.

Read here (MSNBC, July 25, 2020)

The Covid-19 pandemic is forcing a rethink in macroeconomics: It is not yet clear where it will lead

 ‘In the form it is known today, macroeconomics began in 1936 with the publication of John Maynard Keynes’s “The General Theory of Employment, Interest and Money”. Its subsequent history can be divided into three eras. The era of policy which was guided by Keynes’s ideas began in the 1940s. By the 1970s it had encountered problems that it could not solve and so, in the 1980s, the monetarist era, most commonly associated with the work of Milton Friedman, began. In the 1990s and 2000s economists combined insights from both approaches. But now, in the wreckage left behind by the coronavirus pandemic, a new era is beginning. What does it hold?...

‘The rethink of economics is an opportunity. There now exists a growing consensus that tight labour markets could give workers more bargaining power without the need for a big expansion of redistribution. A level-headed reassessment of public debt could lead to the green public investment necessary to fight climate change. And governments could unleash a new era of finance, involving more innovation, cheaper financial intermediation and, perhaps, a monetary policy that is not constrained by the presence of physical cash. What is clear is that the old economic paradigm is looking tired. One way or another, change is coming.’

Read here (The Economist, July 25, 2020)

Lancet says scapegoating China for pandemic ‘not constructive’

‘Prestigious scientific journal The Lancet has praised aspects of China’s response to Covid-19, while pushing back against political rhetoric blaming the country for the pandemic.

‘An editorial published on Friday for the journal’s latest edition acknowledged that China had been “widely criticised for its role and responsibilities during the pandemic because of censorship, transparency, and human rights concerns”, but said the rest of the world could still learn from its disease control successes.’

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

Download The Lancet editorial PDF here

US CDC report on symptom duration and risk factors for delayed return to usual health

Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network — United States, March–June 2020

Read here (US CDC, July 24, 2020)

Finland’s cautious lockdown vs Sweden’s laidback approach

‘Despite being neighbours with some social similarities, Finland and Sweden adopted vastly different methods in confronting the coronavirus pandemic. Their differing ways of confronting this virulent disease resulted in a wide gap in the number of infections and deaths in both Scandinavian countries. Finland opted for a cautious lockdown; it has reported over 7,300 infections and more than 300 deaths. In contrast, Sweden embraced a laidback attitude; it has now over 78,500 confirmed infections and nearly 5,700 deaths.’

Read here (Aliran, July 24, 2020)

Viral loads: Review points to PCR-testing inadequacies and need to prioritise early case detection

A review of 79 studies on viral loads in people — specifically, SARS-CoV-2, SARS-CoV-1 and MERS-CoV — has shown that (1) ‘viral RNA can persist in and be shed from the body for long periods of time (more than 80 days in some cases)’ although ‘SARS-CoV-2 only remains viable and infectious for approximately one week after the onset of symptoms’ (2) ‘Viral load was at its highest approximately 3-5 days after the onset of symptoms, and there was a positive correlation between prolonged viral shedding and disease severity. Older patients also experienced prolonged viral shedding compared to younger patients, even when accounting for disease severity...

‘While there are fewer studies on the kinetics of viral load for asymptomatic infections, viral shedding appeared to be of a shorter duration, and overall viral load appeared to be lower compared to symptomatic cases.’ 

The authors conclude that (1) ‘PCR testing is likely not a good tool for evaluating patient recovery, because viral RNA is detectable long after the end of the infectious period’. (2) ‘Early case detection and isolation should be prioritised in order to maximise control efforts during the time when patients are the most infectious.’ -- Center for Health Security, John Hopkins University

https://www.medrxiv.org/content/10.1101/2020.07.25.20162107v2.full.pdf

Read here (Medrxiv, July 25, 2020)

Malaysians ignoring SOPs at own peril: R0 at 1.36 on July 23

Health director-general Datuk Dr Noor Hisham Abdullah said the infectivity rate, or R0 (R-naught), was at 1.36 in the country. He said this was an increase from the rate of 0.3 after the Movement Control Order (MCO) and Conditional MCO were enforced.

"If our R0 continues to increase, we worry that more people will be infected. Right now, it is at 1.36, but once it goes above 1.6, there is a risk that cases may spike in the near future," he said at a press conference yesterday. Dr Noor Hisham said before the MCO was implemented, the R0 was 3.55, which meant that one person could infect 3.55 people.

Read here (New Straits Times, July 24, 2020)

German sniffer dogs show promise at detecting coronavirus

‘Scientists at the University of Veterinary Medicine Hanover have found that trained sniffer dogs could be used to detect COVID-19 in human samples with a relatively high rate of accuracy, a study published on Thursday revealed... The animals were able to positively detect SARS-CoV-2 infected secretions with an 83% success rate, and control secretions at a rate of 96%. The overall detection rate, combining both, was 94%.’

Read here (DW, July 23, 2020)

Covid-19 compounds developing country debt burdens

‘Covid-19 is expected to take a heavy human and economic toll on developing countries, not only because of contagion in the face of weak health systems, but also containment measures which have precipitated recessions, destroying and diminishing the livelihoods of many.

‘The unique, but varied and changing nature of the pandemic and efforts to contain contagion, and the specific challenges of relief, revival and reorientation imply that neither ‘one size fits all’ nor other formulaic solutions, e.g., to address financial crisis, are appropriate.

‘Policy measures will not only need to address the specificities of the Covid-19 crises, but must also take into consideration the legacy of earlier problems, including the burdens of accumulated debt and debt-servicing.’

Read here (IPS News, July 23, 2020)

The world needs a 'people's vaccine' for coronavirus, not a big-pharma monopoly: Helen Clark and Winnie Byanyima

‘Current distribution plans for the Oxford vaccine are an alarming reminder of what happens when you leave a public resource in the hands of a single company. Around 300m doses have been promised for developing countries by the end of this year – a welcome step, but one that pales in comparison with the 400m doses that will go to the US and UK. The Netherlands, Italy, France and Germany have secured another 400m doses between them. The EU and other rich nations are also pushing their way to the front of the queue. Many middle-income countries, such as those in Latin America, where the scale of the outbreak is frightening, may be completely locked out of these arrangements.’

Read here (The Guardian, July 23, 2020)

Inside the global quest to trace the origins of Covid-19 — and predict where it will go next

‘It has been 100 years since an infectious disease pushed the entire world’s population into hiding to the extent that COVID-19 has. And the primary approaches we take to combatting emerging microbes today are likewise centuries old: quarantine, hygiene and social distancing. We may never learn exactly where SARS-CoV-2 came from, and it’s clearly too late to prevent it from becoming a global tragedy. But extraordinary advances in scientific knowledge have given us new tools, like genetic sequencing, for a more comprehensive understanding of this virus than anyone could have imagined even a decade or two ago. These are already providing clues about how emerging viruses like SARS-CoV-2 operate and, most important, how they can be thwarted with more effective drugs and vaccines.’

Read here (Time Magazine, July 23, 2020)

Donald Trump willing to work with China on coronavirus vaccine for US

‘Remarks comes day after study shows candidate developed by CanSino and China’s military research unit is safe and induces immune response. US president has resumed daily Covid-19 press briefings as US cases continue to climb... Besides declaring support for masks as a way to fight the pandemic, he admonished young people against crowding bars and spreading the disease. It all marked a delayed recognition by Trump that the economic reopening he has been championing since April – and more importantly, his re-election – were imperilled by spiking cases nationwide.‘

Read here (South China Morning Post, July 22, 2020)

Dr Anthony Fauci warns the coronavirus won’t ever be eradicated

‘White House coronavirus advisor Dr. Anthony Fauci said Wednesday it is unlikely the coronavirus will ever be eradicated. While the virus will not disappear, it’s possible world leaders and public health officials could work to bring the virus down to “low levels,” the director of the National Institute of Allergy and Infectious Diseases said during an interview with the TB Alliance.

“I think with a combination of good public health measures, a degree of global herd immunity and a good vaccine, which I do hope and feel cautiously optimistic that we will get, I think when we put all three of those together, we will get control of this, whether it’s this year or next year. I’m not certain,” he said.’

Read here (CNBC, July 22, 2020)

The hunt for the origins of SARS-CoV-2 will look beyond China: The virus may have been born in South-East Asia

‘John Bell, a professor of medicine at the University of Oxford, says everyone thought there would be a flood of cases in Vietnam because the country is right across the border from China. Yet Vietnam has reported only 300 in a population of 100m, and no deaths. The country did not have a great lockdown either, he adds. Nobody could work out what was going on.

‘One explanation, he suggests, is that Vietnam’s population is not as immunologically “naive” as has been assumed. The circulation of other sars-like viruses could have conferred a generalised immunity to such pathogens.’

Read here (The Economist, July 22, 2020)

Trials for three Covid-19 vaccines show promise but much more work still needed, say experts

‘The global fight against Covid-19 received a boost on Monday with the release of encouraging findings from human trials of three coronavirus vaccines, including a closely watched one being developed by Oxford University. The results showed that the vaccines being tested did not cause any dangerous side effects, and that they could coax a protective response from the human body. But experts said that while the results were encouraging, much more work is still needed to plug remaining gaps in knowledge before a vaccine can be made commercially available.’

Read here (Straits Times, July 22, 2020)

Meet the generation changed by lockdown

“We should not trivialize [teenagers’] stressors or grief in the context of the larger issues playing out during this pandemic,” Beth Marshall, associate director of the Johns Hopkins Center for Adolescent Health, said during a Johns Hopkins faculty roundtable in May. “Their grief over what they are experiencing — or not getting to experience — is real.” But out of stagnation often comes transformation.

‘To be a teenager is to be in a state of constant growth and transition; to form values, priorities and plans that will affect your life for years to come. And for a generation of young adults who have seen their lives upended by a global pandemic and then witnessed their communities lit up by grassroots activism, this year might prove crucial in determining how they see the world and their home country as they grow up and gain power.’

Read here (Huffington Post, July 22, 2020)

Dengue fever, second wave: What are the hurdles Singapore faces in its coronavirus fight?

(1) Clearing the Covid-19 disease from worker dormitories remains the biggest challenge. ‘The testing in dorms is now in the “final stretch”, with 232,000 cases confirmed as recovered or virus-free as of July 16.’
(2) Singapore’s second challenge comes from imported cases, although the city state has limited this risk by shutting its borders.
(3) Singapore also faces the risk of a resurgence in infections triggered by a failure to comply with safe-distancing rules, which remain in place despite the lockdown being lifted.
(4) The fourth challenge is the simultaneous onset of dengue fever in Singapore, which has seen some 19,000 cases so far this year.

Read here (South China Morning Post, July 22, 2020)

How cultural differences help Asian countries beat Covid-19, while US struggles

‘Confucianism, a cultural force in East Asia that advocates duty to society over individual needs, has been cited to explain Asian responses to COVID-19 and lack of cohesion in the United States, according to March 31 blog post by the Wilson Center policy forum.

‘Ethnic Malay cultures in Malaysia and Indonesia promote banding together against common threats, [Alan] Chong [associate professor at the S. Rajaratnam School of International Studies] said. Within a week of Malaysia declaring its lockdown, some 95% of the population had complied with the order, said Ibrahim Suffian, program director with the polling group Merdeka Center in Kuala Lumpur.

Read here (VOA, July 22, 2020)

EU leaders reach recovery deal after marathon summit

‘Tempers were often frayed during the negotiations. The "frugal four", Sweden, Denmark, Austria and the Netherlands, along with Finland had opposed extending €500bn in grants. The group originally set €375bn as the limit. Other members, such as Spain and Italy, did not want to go below €400bn. At one point French President Emmanuel Macron reportedly banged his fists on the table, as he told the "frugal four" they were putting the European project in danger...

‘Another issue was over linking aid to the "rule of law". Hungary and Poland both threatened to veto the package if it adopted a policy of withholding funds from nations deemed to fall short of democratic principles.’

Read here (BBC, July 21, 2020)

Household contacts over 6 times more likely to become infected: South Korea study

‘A recent study by researchers in South Korea, published in the US CDC’s Emerging Infectious Diseases journal, found that SARS-CoV-2 transmission was far more common in household settings compared to public settings. Based on analysis of more than 59,000 contacts of more than 5,700 COVID-19 “index patients,” the researchers found that household contacts were more than 6 times more likely to become infected than non-household contacts. The study identified cases in 11.8% of household contacts, compared to only 1.9% of non-household contacts.

‘Notably, households with an “index patient” aged 10-19 years were at even higher risk for transmission—cases identified in 18.6% of household contacts, compared to 11.8% in households with “index patients” of other ages. The lowest transmission risk among household contacts was for “index patients” aged 0-9 years. In these households, cases were identified in only 5.3% of household contacts; however, this was still greater than the overall risk for non-household contacts. This indicates that children who are infected at school could transmit the infection at home more easily than in other settings, particularly for older children, which would put other family members at increased risk.‘

Source: Newsletter, Center for Health Security, John Hopkins University.

Read here (EID Journal, 2020)

Is America’s second corona wave a political hoax?

There is a bunch of information in this article that is not consistent with what is widely believed by the established scientific community or reported by mainstream media. A must-read to see how other seemingly highly-educated people think and influence others.

Read here (Global Research, July 21, 2020)

The people with hidden immunity against Covid-19

‘While the latest research suggests that antibodies against Covid-19 could be lost in just three months, a new hope has appeared on the horizon: the enigmatic T cell... T cells are a kind of immune cell, whose main purpose is to identify and kill invading pathogens or infected cells. It does this using proteins on its surface, which can bind to proteins on the surface of these imposters... Several studies have shown that people infected with Covid-19 tend to have T cells that can target the virus, regardless of whether they have experienced symptoms...

‘Most bizarrely of all, when researchers tested blood samples taken years before the pandemic started, they found T cells which were specifically tailored to detect proteins on the surface of Covid-19. This suggests that some people already had a pre-existing degree of resistance against the virus before it ever infected a human. And it appears to be surprisingly prevalent: 40-60% of unexposed individuals had these cells.’

Read here (BBC, July 20, 2020)

Protein treatment trial ‘a breakthrough’

‘The preliminary results of a clinical trial suggest a new treatment for Covid-19 dramatically reduces the number of patients needing intensive care, according to the UK company that developed it. The treatment from Southampton-based biotech Synairgen uses a protein called interferon beta which the body produces when it gets a viral infection... The initial findings suggest the treatment cut the odds of a Covid-19 patient in hospital developing severe disease - such as requiring ventilation - by 79%.’

Read here (BBC, July 20, 2020

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

‘Now [Richard] 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)

UN makes record $10.3bn appeal for pandemic fight: Up to 265m people could face starvation by end-2020

‘The United Nations is making an appeal for $10.3 billion (£8.2 billion) to help fight the coronavirus pandemic, its largest ever fundraising call. The UN says up to 265 million people could face starvation by the end of the year because of the impact of Covid-19. The money will be for used for low income and fragile countries.’

Read here (BBC, July 17, 2020)

Press releases by RECOVERY (Randomised Evaluation of Covid-19 Therapy) Trial, University of Oxford

This UK national clinical trial, conducted by researchers at the University of Oxford in concert with other relevant institutions, aims to identify treatments that may be beneficial for people hospitalised with suspected or confirmed COVID-19... A range of potential treatments have been suggested for COVID-19 but nobody knows if any of them will turn out to be more effective in helping people recover than the usual standard of hospital care which all patients will receive. The RECOVERY Trial is aimed at evaluating the efficacy of such treatments. It has made a series of press statements from end-March 2020. This link takes you to them.

Read here (RECOVERY Trial website)

The new stability

‘I look for hope and find none, but I am not allowed to admit to total free fall. “Stronger together” say the screen savers on every screen in the hospital, the banners on the sides of the shuttle bus. What I’ll see in the coming weeks is just how much this isn’t true, how so many of our sickest patients are Black or Brown like you, “essential” and yet unprotected. I will see a 46-year-old Black man, infected with SARS-CoV-2, die instead from having a police officer kneel on his neck. I will see those who protest police brutality, though masked and mostly peaceful, tear-gassed and shot with rubber bullets. I will see unregulated corporate bailouts, record unemployment, record housing insecurity. I will see political polarization recast common-sense public health policy as liberal propaganda. I will see your death multiplied by 10,000, by 100,000, all those bodies, mothers and fathers, daughters and sons. I wish I could tell you how sorry I am, for my fear, for our nation, for what happens next.’

Read here (New England Journal of Medicine, July 17, 2020)

Anger in Japan as US army bases report mounting Covid-19 outbreak

‘An escalating Covid-19 outbreak at American bases in Okinawa has seen 136 US military personnel and dependents infected so far, with the governor of the southern Japanese island complaining that United States officials have refused to provide details of infections among service members...

‘The question of quarantine regulations for US troops and their family members is a particularly contentious one, with local media reporting that Tokyo has little control over the US nationals who fly into Japan, even if they are arriving at commercial airports. The SOFA [Status of Forces Agreement between Japan and the US] permits service personnel to sidestep testing that is presently mandatory for all other arrivals from overseas.’

Read here (South China Morning Post, July 16, 2020)

Vulnerable: The law, policy and ethics of Covid-19

The contents of this 649-page book ‘confronts the vulnerabilities that have been revealed by the pandemic and its consequences. It examines vulnerabilities for people who have been harmed or will be harmed by the virus directly and those harmed by measures taken to slow its relentless march; vulnerabilities exposed in our institutions, governance, and legal structures; and vulnerabilities in other countries and at the global level where persistent injustices affect us all. Covid-19 has forced us to not only reflect on how we govern and how we set policy priorities, but also to ensure that pandemic preparedness, precautions, and recovery include all individuals, not just some.’

Most of its contents are focussed on Canada, however, there are articles about other places. The last 100 pages e.g. is on “Global health and governance”. Even while being Canada-centric, many of the issues are relevant to other countries albeit developed ones.

Download here (uO Research, University of Ottawa, 2020)

Swiftly waning Covid-19 immunity poses vaccination challenge

‘Emerging evidence that the body's immune defence against Covid-19 may be short-lived makes it even harder for vaccine developers to come up with shots fully able to protect people in future waves of infection, scientists said on Tuesday.

‘Preliminary studies in China, Germany, Britain and elsewhere have found that patients infected with the novel coronavirus make protective antibodies as part of their immune system's defences, but these appear to last only a few months.’

Read here (Malaysiakini, July 15, 2020)

COVAX: Ensuring global equitable access to COVID-19 vaccines

‘The WHO and other international groups, such as CEPI and GAVI, have established the COVID-19 Vaccines Global Access (COVAX) Facility to encourage and coordinate donations from high-income countries in order to support the distribution of vaccine doses to lower-income countries. Low- and middle-income countries (LMICs) may not be able to purchase sufficient vaccine on their own or compete against wealthier countries to secure access to early doses without external support...

According to a GAVI press release of July 15: ‘Seventy-five countries submit expressions of interest to COVAX Facility, joining up to 90 further countries which could be supported by the COVAX Advance Market Commitment (AMC). The COVAX Facility, and the AMC within it, is designed to guarantee rapid, fair and equitable access to COVID-19 vaccines for every country in the world, rich and poor, to make rapid progress towards slowing the pandemic. Interest from governments representing more than 60% of the world’s population offers ‘tremendous vote of confidence’ in the effort to ensure truly global access to COVID-19 vaccines, once developed.’

Read here (GAVI, July 15, 2020) and here

Ignoring effects of Covid-19 on women could cost $5tn, warns Melinda Gates

‘The failure of leaders to take into account the disproportionate impact of Covid-19 on women, and their roles in lessening its harm, will mean a long, slow recovery that could cost the world economy trillions of dollars, Melinda Gates has warned. Even a four-year delay in programmes that promote gender equality, such as advancing women’s digital and financial inclusion, would wipe a potential $5tn (£4tn) from global GDP by 2030. “As policymakers work to protect and rebuild economies, their response must account for the disproportionate impact of Covid-19 on women, and the unique roles women will have to play in mitigating the pandemic’s harm,” Gates said in a paper published on Wednesday.’

Read here (The Guardian, July 15, 2020)

Training for the pandemic economy

‘But we can learn from the failure of earlier programs. Their record reveals that training works best when it is closely connected to a real job or occupation. Program design should be informed by detailed government forecasts of the types of jobs that are coming and which skills they will require. Similarly, training works best when firms and industries collaborate on program design, because employers are a source of information about the skills that will be needed. At the implementation stage, on-the-job training – apprenticeships, in other words – is essential, and not only for blue-collar jobs. Although we think of apprentices as machinists and plumbers, increasingly they are nursing assistants and insurance underwriters.

‘Here, Europe has a leg up, owing to strong trade unions that can cooperate with employers’ associations in organizing apprenticeships, and because worker-firm attachments are relatively strong. In the US, progress will be harder...’

Read here (Project Syndicate, July 13, 2020)

A new understanding of herd immunity

‘Gabriela Gomes studies chaos. Specifically, patterns in nonlinear dynamics... So with all its apparently chaotic eccentricities, the coronavirus was an ideal challenge for Gomes, a professor at the University of Strathclyde, in Glasgow, Scotland... Based on data from several countries in Europe, she said, her results show a herd-immunity threshold much lower than that of other models. “We just keep running the models, and it keeps coming back at less than 20 percent,” Gomes said. “It’s very striking.”

‘If that proves correct, it would be life-altering news. It wouldn’t mean that the virus is gone. But by Gomes’s estimates, if roughly one out of every five people in a given population is immune to the virus, that seems to be enough to slow its spread to a level where each infectious person is infecting an average of less than one other person. The number of infections would steadily decline...

There are two more arguments in the story, citing levels from 20 to 70 percent... The conclusion, as stated in the subhead: ‘The portion of the population that needs to get sick is not fixed. We can change it.’

Read here (The Atlantic, July 13, 2020)

Airborne transmission of SARS-CoV-2: Theoretical considerations and available evidence

‘All told, current understanding about SARS-CoV-2 transmission is still limited. There are no perfect experimental data proving or disproving droplet vs aerosol-based transmission of SARS-CoV-2. The balance of evidence, however, seems inconsistent with aerosol-based transmission of SARS-CoV-2 particularly in well-ventilated spaces. What this means in practice is that keeping 6-feet apart from other people and wearing medical masks, high-quality cloth masks, or face shields when it is not possible to be 6-feet apart (for both source control and respiratory protection) should be adequate to minimize the spread of SARS-CoV-2 (in addition to frequent hand hygiene, environmental cleaning, and optimizing indoor ventilation).’

Read here (JAMA Network, July 13, 2020)

Health workers silenced, exposed and attacked

‘Governments must be held accountable for the deaths of health and essential workers who they have failed to protect from COVID-19, Amnesty International said today, as it released a new report documenting the experiences of health workers around the world.

‘The organization’s analysis of available data has revealed that more than 3000 health workers are known to have died from COVID-19 worldwide - a figure which is likely to be a significant underestimate.

‘Alarmingly, Amnesty International documented cases where health workers who raise safety concerns in the context of the COVID-19 response have faced retaliation, ranging from arrest and detention to threats and dismissal.’

Read here (Amnesty International, July 13, 2020)

Russian university completes clinical trials of Covid-19 vaccine

Russia has become the first country to have completed clinical trials of a Covid-19 vaccine candidate, after Sechenov University said that it had concluded its study. According to Sechenov University Center for Clinical Research on Medications head and chief researcher Elena Smolyarchuk, study data showed the vaccine candidate’s effectiveness, reported Russian news agency TASS. Smolyarchuk was quoted by the news agency as saying: “The research has been completed and it proved that the vaccine is safe. The volunteers will be discharged on 15 July and 20 July.”

Read here (Clinical Trials Arena, July 13, 2020)

Merck CEO Ken Frazier discusses a Covid cure, racism, and why leaders need to walk the talk

‘As chairman and CEO of the leading vaccine producer in the world, pharmaceutical giant Merck & Co., Ken Frazier has one of the highest-profile positions in global business.

‘But Frazier, who is leading one of the firms on a charge to develop a COVID-19 vaccine, is unique in another way: He is just one of four Black CEOs leading a Fortune 500 company. Frazier is also outspoken, having resigned from President Trump’s American Manufacturing Council to make a clear statement against “hatred, bigotry and group supremacy” that surfaced in protests at Charlottesville, Virginia.

‘In the video [with transcript] below, Frazier provides insights into this turbulent period of American history with Tsedal Neeley (@tsedal), the Naylor Fitzhugh Professor of Business Administration at Harvard Business School. Topics ranged from corporate America’s role in hiring more African Americans to the experience of being raised just one generation away from slavery.’

View/read here (Harvard Business School, July 13, 2020)

China and Kazakhstan try to smooth over ‘deadly pneumonia’ row

‘Chinese ambassador reaffirms ties in phone call to Kazakh health minister. WHO says many cases in the Central Asian nation were likely Covid-19 but just not diagnosed correctly.’

Read here (South China Morning Post, July 11, 2020)

Why steroids are a Covid-19 game changer

This video provides clear information on how Covid-19 affects our bodies adversely, e.g. via inflammation and over-reaction of the immune system (cytokine storm); why anti-viral remdesivir and drug hydroxychloroquine have been found to be relatively ineffective; and how a low-cost steroid dexamethasone produced quite dramatic positive results in severely affected patients. Although well-produced, this video is a means by the producers Real Science to advertise services like Nebula and CuriosityStream.

View here (Real Science, July 11, 2020)

Why has the pandemic spared the Buddhist parts of South-East Asia?

‘Vietnam is the standout: with 97m people, it claims no deaths from covid-19. Thailand, with 70m, has seen just 58 fatalities and no local transmission in over 40 days. Impoverished Myanmar claims just six deaths from 317 cases, while Cambodia (141 confirmed cases) and tiny Laos (19 cases) also have no deaths apiece and no local transmission since April. Compare that with the nearby archipelagic nations of Indonesia (some 68,100 cases and 3,400 deaths) and the Philippines (50,400 cases and 1,300 deaths), where the pandemic still rages.’

Read here (The Economist, July 11, 2020)

WHO’s Covid-19 inquiry is a shrewd move in a sea of disinformation

‘In the week in which the US formally announced its intention to quit the WHO, the organisation’s announcement of the two figures who will lead its review of the pandemic and its response feels significant.

‘Given Trump’s record of denigrating female leaders, and of racist dog-whistles, it is striking that the review will be chaired by two highly regarded and independent-minded women leaders, one of them from Africa – Ellen Johnson Sirleaf, a Nobel laureate and the former president of Liberia, and Helen Clark, former prime minister of New Zealand.’

Read here (The Guardian, July 10, 2020)

Covid-19: Are we being misled again by Big Pharma?

This Third World Network article examines the parallels between the production, marketing and distribution strategies of (1) antiviral medicine oseltamivir (Tamiflu) by Roche for H1N1 in the years 2005 and 2009 and (2) remdesivir by Gilead Sciences for Covid-19 during this pandemic.

Read here (Third World Network, July 10, 2020)

WHO promises ‘honest evaluation’ of how world handled COVID-19

The World Health Organization (WHO) said on Thursday it was setting up an independent panel to review its handling of the COVID-19 pandemic and the response by governments. The announcement follows strong criticism by U.S. President Donald Trump’s administration of the global agency’s role in the crisis - though the WHO said the review was not linked to the United States. Former New Zealand prime minister Helen Clark and former Liberian president Ellen Johnson Sirleaf have agreed to head the panel, WHO Director-General Tedros Adhanom Ghebreyesus said.

Read here (Reuters, July 9, 2020)

Will medical tourism survive Covid-19?

‘Treatment in Asia is up to 90% cheaper than private healthcare in the US. According to the MHTC [Malaysia Healthcare Travel Council], a coronary artery bypass graft that would cost $92 000 in the US, costs less than $10 000 in India, for example. Coupled with a steep reduction in the cost of long haul air travel, the region has successfully broadened the appeal of medical tourism beyond just the most affluent customers.

‘But all that was before the pandemic. The uncertainty of covid-19, lockdowns, border restrictions, and social distancing has stalled international travel. The UN World Tourism Organisation estimates that the travel industry could decline by 60% to 80% by the end of 2020, calling it the “worst crisis that international tourism has faced since records began.” It says Asia and the Pacific have been the regions hardest hit, with a loss of 33 million tourists.’

Read here (BMJ, July 10, 2020)

Coronavirus: Sweden has become the world's cautionary tale

‘Sweden's grim result - more death and nearly equal economic damage - suggests that the supposed choice between lives and pay cheques is a false one: A failure to impose social distancing can cost lives and jobs at the same time.’

Read here (Straits Times, July 8, 2020)

School openings across globe suggest ways to keep coronavirus at bay, despite outbreaks

“Outbreaks in schools are inevitable,” says Otto Helve, a pediatric infectious disease specialist at the Finnish Institute for Health and Welfare. “But there is good news.” So far, with some changes to schools’ daily routines, he says, the benefits of attending school seem to outweigh the risks—at least where community infection rates are low and officials are standing by to identify and isolate cases and close contacts.

This article discusses the following:

• How likely are children to catch and transmit the virus?
• Should children play together?
• Should kids wear masks?
• What should schools do when someone tests positive?
• Do schools spread the virus to the wider community?
• What lies ahead?

Read here (Science Magazine, July 7, 2020)

Once-model states suffer response fatigue as Covid-19 surges in India

‘The city of Bangalore... was a model for the response to Covid-19 in India just last week. But infections have doubled in the first six days of July, crossing 10,000. With about 1,000 new infections a day, the famed tech city is now gripped by confusion about bed availability, disappearing medical staff, and falling rates of testing...

‘The neighbouring state of Kerala, which received international praise for its early and rigorous response to the pandemic that began with its - and India's - first case on January 30, is also showing signs of response fatigue.’

Read here (Straits Times, July 7, 2020)

This is not a normal mental-health disaster

‘The full extent of the fallout will not come into focus for some time. Psychological disorders can be slow to develop, and as a result, the Textbook of Disaster Psychiatry, which Morganstein helped write, warns that demand for mental-health care may spike even as a pandemic subsides. “If history is any indicator,” Morganstein says of COVID-19, “we should expect a significant tail of mental-health effects, and those could be extraordinary.” Taylor worries that the virus will cause significant upticks in obsessive-compulsive disorder, agoraphobia, and germaphobia, not to mention possible neuropsychiatric effects, such as chronic fatigue syndrome...

‘In 2013, reflecting on the tenth anniversary of the SARS pandemic, newspapers in Hong Kong described a city scarred by plague. When COVID-19 arrived there seven years later, they did so again. SARS had traumatized that city, but it had also prepared it. Face masks had become commonplace. People used tissues to press elevator buttons. Public spaces were sanitized and resanitized. In New York City, COVID-19 has killed more than 22,600 people; in Hong Kong, a metropolis of nearly the same size, it has killed seven. The city has learned from its scars.’

[Joshua Morganstein is the chair of the American Psychiatric Association’s Committee on the Psychiatric Dimensions of Disaster; Steven Taylor is a psychiatrist at the University of British Columbia and the author of The Psychology of Pandemics]

Read here (The Atlantic, July 7, 2020)

Will universities learn from lockdowns?

‘Like many businesses, universities are struggling with how to reopen and are adopting a range of strategies. For example, the University of Cambridge in the United Kingdom has announced that its lectures will be online-only until at least the summer of 2021. Others, including Stanford University, are offering a mix of in-person and online classes, as well as spreading out their academic year so that fewer students will be on campus at any time.

‘Make no mistake: COVID-19 represents a massive economic hit to higher education. Dorm rooms are unoccupied, sports stadiums remain empty, and students push back against paying full tuition fees. For many colleges and universities, the drop in revenue from foreign students, especially Chinese, is likely to be painful; numerous smaller and less-endowed schools may close.’

Read here (Project Syndicate, July 6, 2020)

The coronavirus may not have originated in China, says Oxford professor

‘The coronavirus may have been lying dormant across the world until emerging under favourable environmental conditions, rather than originating in China, an expert has claimed.

‘Dr Tom Jefferson, from the Centre for Evidence-Based Medicine (CEBM) at Oxford University, has pointed to a string of recent discoveries of the virus’s presence around the world before it emerged in Asia as growing evidence of its true origin as a global organism that was waiting for favourable conditions to finally emerge.

‘Traces of COVID-19 have been found in sewage samples from Spain, Italy and Brazil which pre-date its discovery in China. A preprint study, which has not been peer reviewed, claims to have found the presence of SARS-CoV-2 genomes in a Barcelona sewage sample from 12 March 2019.’

Read here (BBC Science Focus, July 6, 2020)

Lessons for Covid-19 from the early days of AIDS

‘Thirty-six years ago, we were, like today, in the midst of a new and still somewhat mysterious global pandemic. In the U.S. alone, more than one million people were infected with HIV, and 12,000 had already died of AIDS. At the time, we were just beginning to understand how the virus worked. But that didn’t stop some leaders from making wildly optimistic claims about an AIDS vaccine being delivered within two years.

‘Now, with COVID-19, we are in a remarkably similar spot: 2.7 million people have been infected across the U.S., and 128,000 have died of the disease. Despite our limited understanding of how the novel coronavirus works and what it does to the human body, many are putting what I consider a disproportionate amount of faith in the possibility of a COVID-19 vaccine by 2021. My feelings today echo my feelings a third of a century ago: yes, a vaccine may be possible, but it is by no means a certainty.’

Read here (Scientific American, July 6, 2020)

239 experts with 1 big claim: The coronavirus is airborne

‘The World Health Organization has long held that the coronavirus is spread primarily by large respiratory droplets that, once expelled by infected people in coughs and sneezes, fall quickly to the floor. But in an open letter to the WHO, 239 scientists in 32 countries have outlined the evidence showing that smaller particles can infect people, and are calling for the agency to revise its recommendations. The researchers plan to publish their letter in a scientific journal next week.’

Read here (New York Times, July 4, 2020)

The national humiliation we need

‘What’s the core problem? Damon Linker is on to a piece of it: “It amounts to a refusal on the part of lots of Americans to think in terms of the social whole — of what’s best for the community, of the common or public good. Each of us thinks we know what’s best for ourselves.”

‘I’d add that this individualism, atomism and selfishness is downstream from a deeper crisis of legitimacy. In 1970, in a moment like our own, Irving Kristol wrote, “In the same way as men cannot for long tolerate a sense of spiritual meaninglessness in their individual lives, so they cannot for long accept a society in which power, privilege, and property are not distributed according to some morally meaningful criteria”.’

Read here (New York Times, July 2, 2020)

Rethink food security and nutrition following Covid-19 pandemic

‘The Covid-19 crisis has had several unexpected effects, including renewed attention to food security concerns. Earlier understandings of food security in terms of production self-sufficiency have given way to importing supplies since late 20th century promotion of trade liberalization.

‘Food systems need to be repurposed to better produce and supply safe and nutritious food. Ensuring that food systems improve nutrition is not just a matter of increasing production. The entire ‘nutrition value chain’ — from farm to fork, from production to consumption — needs to be considered to ensure the food system better feeds the population.

‘Food systems have to improve production practices, post-harvest processing and consumption behaviour. Resource use and abuse as well as environmental damage due to food production and consumption need to be addressed to ensure sustainable food systems.’

Read here (IPS News, July 2, 2020)

Coronavirus autopsies: A story of 38 brains, 87 lungs and 42 hearts

‘Given widespread reports about neurological symptoms related to the coronavirus, Fowkes [an associate professor of pathology who is part of a team at Mount Sinai Health that has performed autopsies on 67 covid-19 patients] said, she expected to find virus or inflammation — or both — in the brain. But there was very little. When it comes to the heart, many physicians warned for months about a cardiac complication they suspected was myocarditis, an inflammation or hardening of the heart muscle walls — but autopsy investigators were stunned that they could find no evidence of the condition.

‘Another unexpected finding, pathologists said, is that oxygen deprivation of the brain and the formation of blood clots may start early in the disease process. That could have major implications for how people with covid-19 are treated at home, even if they never need to be hospitalized.’

Read here (Washington Post, July 2, 2020)

Microbiologist shows how well masks work in gross but effective demonstration

Dr Davis's conclusion is a simple one: "Masks as a political / social litmus test or used to shame those who won't (or disabled folks who truly can't!) wear them is a travesty. We wash hands after using the bathroom and wipe noses on tissues. Masks / face shields need to be just another normalized act of hygiene.

Read here (Distractify, July 1, 2020)

Priorities for the Covid-19 economy: Joseph Stiglitz

‘Because Covid-19 looks likely to remain with us for the long term, we have time to ensure that our spending reflects our priorities. When the pandemic arrived, American society was riven by racial and economic inequities, declining health standards, and a destructive dependence on fossil fuels. Now that government spending is being unleashed on a massive scale, the public has a right to demand that companies receiving help contribute to social and racial justice, improved health, and the shift to a greener, more knowledge-based economy. These values should be reflected not only in how we allocate public money, but also in the conditions that we impose on its recipients.’

Read here (Project Syndicate, July 1, 2020)

US buys up world stock of key Covid-19 drug remdesivir

‘The US has bought up virtually all the stocks for the next three months of one of the two drugs proven to work against Covid-19, leaving none for the UK, Europe or most of the rest of the world. Experts and campaigners are alarmed both by the US unilateral action on remdesivir and the wider implications, for instance in the event of a vaccine becoming available. The Trump administration has already shown that it is prepared to outbid and outmanoeuvre all other countries to secure the medical supplies it needs for the US.’

Read here (The Guardian, June 30, 2020)

Stealth infections

‘From the Black Death to polio, the most dangerous pathogens have moved silently, transmitted by apparently healthy people...

‘It isn’t ‘pandemics’ per se that we need to fear. The concept of being ‘overdue for a pandemic’ actually makes little sense. Pandemics aren’t cyclical, nor are they necessary products of global warming. We are vulnerable to pandemic outbreaks because of our interconnected world, not because there is some mysterious mechanism in the world that’s going to produce them. It takes precise conditions, what we can call ‘disease factories’, to produce pandemics, and these conditions don’t exist until we create them. The 2009 H1N1 influenza pandemic was the product of a disease factory: it most likely sprang out of a giant pig farm in the Mexican state of Veracruz, owned in part by Smithfield Foods, a giant US pig-raising and meat-packing conglomerate.’

Read here (Aeon, June 30, 2020)

The vaccine race

’Rarely has the fate of the world depended on an international competition like the one for a Covid-19 vaccine. It's a race against time, it's a race to save lives, it's a race for glory. Trials are underway. Who develops a vaccine first? Who gets to take it first? How much will vaccines cost? And will they be effective enough, or safe enough?’

Read here (Politico, June 30, 2020)

‘You have to take action’: One hospital cleaner’s journey through the pandemic

‘Two years ago, Ernesta decided she wanted to improve things for the cleaners at Lewisham hospital. She believed they deserved better pay and better treatment. She joined the union, persuaded her colleagues to join, too, and they began to organise themselves. In a long campaign to improve their working lives – a campaign that has persevered through a pandemic – the cleaners have won various battles, but they still have more to fight. In the past three months, their vulnerability has also been made distressingly clear. Cleaners from all over the country have died from Covid-19 – two of those who died worked down the road from Lewisham at St George’s hospital in Tooting. The pandemic has revealed what was always obvious to Ernesta: a hospital can’t function without its cleaners. They are as vital to its purpose as any of the other frontline staff, and equally at risk.’

Read here (The Guardian, June 30, 2020)

Remdesivir, the first coronavirus drug, gets a price tag

‘Remdesivir will be sold for US$520 (S$724) per vial, or US$3,120 per treatment course, to hospitals for treatment of patients with private insurance, according to the Department of Health and Human Services and Gilead Sciences, the drug's manufacturer.’

Read here (Straits Times, June 30, 2020)

New rules: Malaysians to pay RM30-RM150 for Covid-19 test upon return abroad; foreigners pay RM60-RM250

‘Malaysians returning from overseas will have to pay a range of RM30 to RM150 to be tested for Covid-19 upon entering the country from today onwards, while non-citizens will pay higher fees depending on the type of tests conducted, new rules issued by the government said.

‘In the regulations made on June 26 by Health Minister Datuk Seri Dr Adham Baba, any Malaysian or foreigner entering Malaysia will be required to pay the specified fee depending on the type of Covid-19 detection tests taken "before proceeding for immigration clearance at any point of entry", with the type of tests used to be decided by the health director-general.’

Read here (The Malay Mail, June 29, 2020)

Coronavirus traces found in March 2019 sewage sample, Spanish study shows

‘Spanish virologists have found traces of the novel coronavirus in a sample of Barcelona waste water collected in March 2019, nine months before the Covid-19 disease was identified in China, the University of Barcelona said on Friday (June 26). The discovery of virus genome presence so early in Spain, if confirmed, would imply the disease may have appeared much earlier than the scientific community thought.’

Read here (Straits Times, June 27, 2020)

India's female Corona-warriors: Underpaid and unappreciated

‘Asha workers connect their communities with the public health system. While technically volunteers, they perform crucial tasks, including recording data about births, deaths, marriages and child immunisations; providing information about nutrition, sanitation, maternal and child health; accompanying pregnant women and sick children to health care centres; and helping treat diarrhoea, fevers and tuberculosis.

‘The Covid-19 outbreak added to their duties. Ashas are now expected to educate people about precautions against infection, monitor quarantined households, trace contacts of infected people and help with testing. They have no holidays.’

Read here (Straits Times, June 27, 2020)

Covid-19 vaccines: EU prioritises preferential access, paying lip-service to global solidarity

‘The European Commission has released an “EU Strategy for COVID-19 vaccines” that is premised on sealing advance purchase agreements with vaccine producers to secure production of vaccines in the European Union and sufficient supplies for its Member States. Launched on 17th June 2020, the EU Strategy marks a major shift from earlier calls for global collaboration and solidarity in ensuring affordable equitable access to vaccines globally.’

Read here (Third World Network, June 26, 2020)

Persuasive words are not enough

‘The scientific community is losing the battle against this digital leviathan of misinformation. A well-reasoned and highly placed op-ed on this topic is not going to move the needle, no matter how well it is crafted to adhere to the best practices in science communication. Neither is a perfect trade book, television appearance, or speaking tour by a scientific leader. The only way to win this fight is to harness the same sophisticated tools in the name of science that are being used to tear science down.’

Read here (Science Magazine, June 26, 2020)

Care homes and Covid-19 deaths: An opportunity to cut down mortality rates

‘The impact of COVID-19 on care home residents has been very different internationally, with some countries reporting no deaths (or infections) in care homes, such as Hong Kong, Jordan and Malta, and two countries reporting that over 80% of COVID-19 deaths were of care home residents. Without including the three countries with zero deaths, and with the caveat that the definitions used vary, on average the share of all COVID-19 deaths that were care home residents is 47% (based on 26 countries).’

Read here (International Long-term Care Policy Network, June 26, 2020)

Seamen struck by cruel waves of Covid-19

‘During this Covid-19 pandemic, the performance of healthcare workers, the police, soldiers and e-hailing drivers has been really outstanding. The people appreciate their sacrifices and would always remember their courage for standing at the front lines in the fight against the pandemic. But there is another group of people who have also been working tirelessly, moving cargo safely from one country to another while people stayed at home to stay safe. Sadly, not many people are aware of their plight. That’s because we are at sea. That’s right, there are thousands of sailors stranded onboard vessels now.’

Read here (The Star, June 25, 2020)

How the coronavirus may deliver a shock to the US dollar: Stephen Roach

‘America is leading the charge into protectionism, deglobalisation and decoupling. Its share of world foreign-exchange reserves has fallen from a little over 70 per cent in 2000 to a little less than 60 per cent today. Its Covid-19 containment has been an abysmal failure. And its history of systemic racism and police violence has sparked a transformative wave of civil unrest.

‘Against this background, especially when compared with other major economies, it seems reasonable to conclude that hyperextended saving and current-account imbalances will finally have actionable consequences for the dollar and/or US interest rates.

‘To the extent that the inflation response lags, and the Federal Reserve maintains its extraordinarily accommodative monetary-policy stance, the bulk of the concession should occur through the currency rather than interest rates. Hence, I foresee a 35 per cent drop in the broad dollar index over the next two to three years.’

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

Vaccine alliance finds manufacturing capacity for 4 billion doses of coronavirus vaccines

‘An influential foundation focused on preparation and response to epidemics that is backing nine potential coronavirus vaccines has identified manufacturers with capacity to produce four billion doses a year, the group's top manufacturing expert told Reuters. The Coalition for Epidemic Preparedness Innovation (CEPI) plans to have two or three manufacturing plants for each vaccine, James Robinson, a long-time biopharma executive leading CEPI'S vast manufacturing push, said in an interview. "Right now, we know we can do the two billion doses that we have as kind of our minimum target" by the end of 2021, he said.’

Read here (Straits Times, June 25, 2020)

CDC head estimates US coronavirus cases might be 10 times higher than data show

‘In a press briefing on June 25, Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention (CDC), said that the current official count of COVID-19 cases in the U.S. may actually be a drastic underestimate.

‘Redfield said the new, much-higher estimate, is based on growing data from antibody testing, which picks up the presence of immune cells that react to SARS-CoV-2, the virus that causes COVID-19. People will test positive for antibodies to the virus if they have been infected—whether or not they ever got sick or even developed symptoms.’

Read here (Time Magazine, June 25, 2020)

Australia calls military in after virus surge

‘Australia's military was called in Wednesday to help tackle a coronavirus outbreak in Melbourne -- a surge in infections that has rattled the country's second-most populous city. Victoria has recorded double-digit increases in new daily cases for more than a week -- mostly in the state capital Melbourne -- representing a sizeable spike in cases in a country that has otherwise successfully curbed Covid-19.’

Read here (Today Online, June 24, 2020)

What’s at risk: An 18-month view of a post-Covid world

 ‘As the world continues to grapple with the effects of COVID-19, no part of society seems to be left unscathed. Fears are surmounting around the economy’s health, and dramatic changes in life as we know it are also underway.

‘In today’s graphic, we use data from a World Economic Forum survey of 347 risk analysts on how they rank the likelihood of major risks we face in the aftermath of the pandemic. What are the most likely risks for the world over the next year and a half?’

Read here (Visual Capitalist, June 24, 2020)

Human challenge trials with live coronavirus aren’t the answer to a Covid-19 vaccine

‘With vaccines already a target of widespread misinformation campaigns, the death of a single volunteer would likely cause even greater damage. From a public health perspective, it would be especially disastrous if it both slowed the race to develop a coronavirus vaccine and fueled the anti-vaccination movement. There are other ethical considerations. An important principle in human challenge studies is that subjects must give their informed consent in order to take part. That means they should be provided with all the relevant information about the risk they are considering. But that is impossible for such a new disease.’

Read here (STAT News, June 23, 2020)

To date (July 19, 2020), the 1DaySooner campaign has attracted nearly 33,000 volunteers from 140 countries. Read here

The long-term effects of Covid-19 infection

‘Some scientists suspect that Covid-19 causes respiratory failure and death not through damage to the lungs, but the brain – and other symptoms include headaches, strokes and seizures... For Julie Helms, it started with a handful of patients admitted to her intensive care unit at Strasbourg University Hospital in northeast France in early March 2020. Within days, every single patient in the ICU had Covid-19 – and it was not just their breathing difficulties that alarmed her. “They were extremely agitated, and many had neurological problems – mainly confusion and delirium,” she says. “We are used to having some patients in the ICU who are agitated and require sedation, but this was completely abnormal. It has been very scary, especially because many of the people we treated were very young – many in their 30s and 40s, even an 18-year-old.”

‘Helms and her colleagues published a small study in the New England Journal of Medicine documenting the neurological symptoms in their Covid-19 patients, ranging from cognitive difficulties to confusion. All are signs of “encephalopathy” (the general term for damage to the brain) – a trend that researchers in Wuhan had noticed in coronavirus patients there in February.’

Read here (BBC, June 23, 2020)

Fauci: Coronavirus vaccine could be available by end of 2020

‘Dr Anthony Fauci, the nation’s top infectious disease expert, told Congress Tuesday that he’s “cautiously optimistic” about the development of a coronavirus vaccine, saying that he believes one could be available as soon as the end of this year, or the beginning of 2021.’

Read here (Vox, June 23, 2020)

People have stopped going to the doctor. Most seem just fine

‘As stay-at-home orders ease and cities reopen for business, many doctors and hospital administrators are calling for a quick return of health care to pre-pandemic levels. For months now, routine care has been postponed. Elective procedures — big moneymakers — were halted so that hospitals could divert resources to treating Covid-19 patients. Routine clinic visits were canceled or replaced by online sessions. This has resulted in grievous financial losses for hospitals and clinics. Medical practices have closed. Hospitals have been forced to furlough employees or cut pay.

‘Most patients, on the other hand, at least those with stable chronic conditions, seem to have done OK. In a recent survey, only one in 10 respondents said their health or a family member’s health had worsened as a result of delayed care. Eighty-six percent said their health had stayed about the same.’

Read here (New York Times, June 22, 2020)

The politics of the mask

‘The years since Donald Trump’s election have been marked by a resurgence of violent street-level political confrontations. Fascists and their opponents have squared off in numerous cities, while recent protests against racist police violence have grown into a powerful movement. Cities across the country are now in open rebellion.

‘This new political instability coincides with the tenth anniversary of the publication of critical theorist AK Thompson’s Black Bloc, White Riot: Anti-Globalization and the Genealogy of Dissent (2010), which advanced a provocative thesis regarding the intimate bond between political violence and the white middle class. In Thompson’s account, the black bloc – a demonstration tactic in which masks and sartorial uniformity are used to facilitate participation in confrontational skirmishes – was both seductive and disquieting to white middle-class audiences because it forced them to confront the limits of their own political efficacy. Today, as activists confront the question of violence once again – and COVID-19 universally necessitates the wearing of masks in public – the polarizing debates that inspired the book have reignited, and Thompson’s analysis has implications that reach far beyond the case study that prompted it.

‘In this interview, the writer pushes Thompson to clarify his positions and extend his analysis to consider the forms of street-level political violence we confront today.’

https://socialistproject.ca/2020/06/the-politics-of-the-mask/

Read here (The Bullet, June 22, 2020)

Gilead to start testing an inhaled version of remdesivir, making it available to vastly more patients

‘The biotech giant that developed the first effective coronavirus treatment is now looking to expand its impact. Gilead Sciences CEO Daniel O'Day said Monday that the company would start testing an inhaled version of the antiviral drug remdesivir in August. Currently, the drug is given as an intravenous infusion. If remdesivir is effective when given through a nebulizer, that "could have significant implications in helping to stem the tide of the pandemic," O'Day wrote in an open letter.’

Read here (Business Insider, June 22, 2020)

Antibody levels in recovered COVID-19 patients decline quickly, Chinese study finds

‘Levels of an antibody found in recovered COVID-19 patients fell sharply in two to three months after infection for both symptomatic and asymptomatic patients, according to a Chinese study, raising questions about the length of any immunity against the novel coronavirus. The research, published in Nature Medicine on Jun 18, highlights the risks of using COVID-19 "immunity passports" and supports the prolonged use of public health interventions such as social distancing and isolating high-risk groups, researchers said.’

Read here (Channel News Asia, June 22, 2020)

Asymptomatic patients may shed virus for longer than others, study says

‘Asymptomatic coronavirus patients could shed the virus for longer than those with symptoms, according to a new study in southwest China. “The emergence of these silent spreaders … has caused difficulties in the control of the epidemic,” the researchers led by Huang Ailong, from Chongqing Medical University, wrote in a peer-reviewed paper in Nature Medicine on Thursday. Huang’s team found that the median duration of viral shedding among the 37 asymptomatic patients in the Chongqing study was 19 days – a third longer than the patients with mild symptoms.’

Read here (South China Morning Post, June 22, 2020)

Fearing second Covid-19 wave, Europe aims to train ‘army’ of medics

‘Europeans are enjoying the gradual easing of coronavirus lockdown measures, but in hospitals, they are already preparing for the next wave of infections. Some intensive care specialists are trying to hire more permanent staff. Others want to create a reservist "army" of medical professionals ready to be deployed wherever needed to work in wards with seriously ill patients. European countries have been giving medics crash courses in how to deal with Covid-19 patients, and are now looking at ways to retrain staff to avoid shortages of key workers if there is a second wave of the novel coronavirus.’

Read here (Straits Times, June 22, 2020)

Trust in governments surges during pandemic, survey shows

‘Trust in governments surges during pandemic, survey shows Times of uncertainty often drive people to governments. And during the Covid-19 pandemic, many governments seem to be delivering. Trust in governments surged to an all-time high around the world, according to the 2020 Edelman Trust Barometer Spring Update report released last week.’

Read here (Straits Tines, June 22, 2020)

Thailand had the world's first coronavirus case outside China. Here's how it avoided disaster

‘James Wise, a former Australian ambassador to the country and author of Thailand: History, Politics and the Rule of Law, said the Village Health volunteers were "enormously important". "The key factor is they were well prepared for it," Mr Wise said... "[The volunteers] work closely with the local communities and then once coronavirus comes along you've got an army of foot soldiers who can be quickly briefed on the coronavirus and then can go out into the communities, spread information, dispel misinformation and check people's symptoms. And that's what they did".’

Read here (ABC News, June 22, 2020)

Covid-19 has led to a pandemic of plastic pollution

‘Whether on the foreshore of the Thames or the deserted beaches of Soko, the planet is awash with pandemic plastic. Data are hard to come by but, for example, consumption of single-use plastic may have grown by 250-300% in America since the coronavirus took hold, says Antonis Mavropoulos of the International Solid Waste Association (ISWA), which represents recycling bodies in 102 countries. Much of that increase is down to demand for products designed to keep covid-19 at bay, including masks, visors and gloves. According to a forecast from Grand View Research, the global disposable-mask market will grow from an estimated $800m in 2019 to $166bn in 2020.’

Read here (The Economist, June 22, 2020)

A plague of willful ignorance

‘We aren’t a nation of know-nothings; many, probably most Americans are willing to listen to experts and act responsibly. But there’s a belligerent faction within our society that refuses to acknowledge inconvenient or uncomfortable facts, preferring to believe that experts are somehow conspiring against them... Trump hasn’t just failed to rise to the policy challenge posed by Covid-19. He has, with his words and actions — notably his refusal to wear a mask — encouraged and empowered America’s anti-rational streak.’

Read here (New York Times, June 22, 2020)

The essential but invisible trade: TRAFFIC sounds alarm over sustainability of wild plants used to treat Covid-19

‘Wild plant species used in herbal treatments of Covid-19 are set to come under heightened harvesting pressure, both as a result of increased demand and because of more people turning to wild harvesting as an alternative source of income during times of high unemployment and economic crisis. The future availability of plant ingredients to support human health—through medicines, food and well-being products—is dependent on prioritising the conservation and sustainable use of their source species in the long-term.’

Read here (Traffic, June 18, 2020)

New Covid-19 tracing tool appears on smartphones

‘A Covid-19 tracing software tool has appeared in the settings of both Android phones and iPhones as part of an update of their operating systems. The "exposure notification" tool is switched off by default, and is not a tracing app itself. It enables an app to run in the background while still using Bluetooth. This lets the app measure the distance between two handsets - and then alert the phone owner if someone near them later tests positive for Covid-19.’

Read here (BBC, June 20, 2020)

How Uruguay has coped with Covid-19

‘By June 18th Uruguay had reported 849 confirmed cases and 24 deaths from covid-19, the lowest number as a share of population of any country in South America. Uruguay has administered 55,215 tests, a regional record... Luis Lacalle Pou, the centre-right president, was swift but not strict. On March 13th he declared an emergency and shut the borders. Like the populist leaders of Brazil and Mexico, he is at pains to shield the economy. Unlike them, he does not make light of the disease...

‘The government calls its policy libertad responsable (responsible liberty). It shut down schools, cinemas and shopping malls. It urged people to work from home, wear face masks and keep their distance from each other, but did not confine them to their houses. Mr Lacalle Pou “was not going to imprison people”, says an adviser.’

Read here (The Economist, June 20, 2020)

Coronavirus: China’s belt and road partners call for more cooperation on public health

‘Senior officials from 25 nations involved with China’s multibillion-dollar Belt and Road Initiative have issued a joint statement calling for great cooperation on public health as the world continues to battle the Covid-19 pandemic. Ensuring fair access to health products and services should be the world’s top priority, the minister-level officials said in a communique released by China’s foreign ministry on Friday following an international videoconference. They also called for greater investment in “sound and resilient” health infrastructure – including the construction of regional storage centres for medical supplies – and committed to improving the availability and affordability of “products of reliable quality”, especially vaccines, drugs and other essential items.’

Read here (South China Morning Post, June 20, 2020)

Coronavirus antibody tests have a mathematical pitfall

‘...such [antibody] tests have been proposed as a way for individuals to find out if they have already been infected with the novel coronavirus. But a mathematical wrinkle makes these tests—and in fact, all screening tests—hard to interpret: even with a very accurate test, the fewer people in a population who have a condition, the more likely it is that an individual's positive result is wrong. If it is, people might think they have the antibodies (and thus may have immunity), when in fact they do not.

‘A positive screening test result for other diseases usually prompts follow-up testing to confirm a diagnosis. But for COVID-19 screening, such follow-up has been rare because testing resources are scarce or because other testing methods are prioritized for the sickest patients. Here's a look at the massive impact infection rates can have on the predictive value of these tests for individuals.’

Read here (Scientific American, July 2020, pre-published in June 19, 2020)

World in ‘new and dangerous phase’ of Covid-19 pandemic: WHO

‘The coronavirus pandemic is now in a “new and dangerous phase”, the World Health Organisation (WHO) said on Friday (June 19), with the disease accelerating at the same time as people tire of lockdowns. WHO chief Tedros Adhanom Ghebreyesus urged nations and citizens to remain extremely vigilant, as the number of cases reported to the UN health agency hit a new peak. “The pandemic is accelerating. More than 150,000 new cases of Covid-19 were reported to WHO yesterday – the most in a single day so far,” Tedros told a virtual press conference.’

Read here (Straits Times, June 19, 2020)

In this coronavirus wave, China tries something new: Restraint

‘The city of Beijing has tested 1.1 million people in less than a week and has halted many flights, but has not imposed the citywide lockdowns used in provincial outbreaks...

‘The brunt of the government’s measures has been borne by food traders at markets that were sealed off after cases were found, and by the residents of more than four dozen apartment complexes placed under lockdown. But in many other Beijing neighborhoods, the shops, restaurants and even hair salons are still operating. Traffic is a little lighter than usual, but plenty of cars are still on the road. City sidewalks remain busy.’

Read here (New York Times, June 19, 2020)

US Department of Homeland Security develops DIY method to decontaminate masks with a multicooker

‘A household appliance, which may be sitting inside your kitchen cabinet, can now be used as a powerful tool in the fight to control COVID-19. Researchers with the Department of Homeland Security (DHS) Science and Technology Directorate (S&T) developed a do-it-yourself solution to decontaminate personal protective equipment (PPE) using a programmable multicooker...

‘Moist heat decontamination is achieved by treating masks with 149°F steam for 30 minutes. Key steps include placing the mask(s) in a paper bag, filling the multicooker with a half inch of water and setting the bag on a rack inside of it. S&T verified these conditions inactivate the virus below detectable limits in culture media and simulated saliva, while the masks still meet performance specifications after five treatments...

Read here (US DHS, June 19, 2020)

Full instructions, a video, fact sheet and FAQ about the process are available on the HHS S&T website. View video and download PDFs here

What is the true death toll of the pandemic?

‘At least another 130,000 people worldwide have died during the coronavirus pandemic on top of 440,000 officially recorded deaths from the virus, according to BBC research. A review of preliminary mortality data from 27 countries shows that in many places the number of overall deaths during the pandemic has been higher than normal, even when accounting for the virus.’

Read here (BBC, June 19, 2020)

Race for virus vaccine could leave poor countries behind

‘As the race for a vaccine against the new coronavirus intensifies, rich countries are rushing to place advance orders for the inevitably limited supply to guarantee their citizens get immunised first, leaving significant questions about whether developing countries will get any vaccine before the pandemic ends.

‘Earlier this month, the United Nations, International Red Cross and Red Crescent, and others said it was a "moral imperative" that everyone have access to a "people's vaccine". But such grand declarations are unenforceable and without a detailed strategy, the allocation of vaccines could be messy.’

Read here (Aljazeera, June 18, 2020)