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Compounding crises undermine ethical, equitable COVID-19 response

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh The strongest cyclone ever recorded in [ ... ]

WHO to create a COVID-19 Intellectual Property Pool

The WHO embraced a proposal by Costa Rica to develop a voluntary mechanism that would pool patents and regulatory testing data to develop drugs, vaccines and diagnostics for COVID-19. Modelled after the Medicines Patent Pool by UNITAID for HIV/AIDS medical products, the COVID IP Pool would serve as a repository that target governments, industry, universities and non-profit organizations in order to ensure equitable access to resulting medical products, something that the Access to COVID-19 Tools (ACT) Accelerator announced last month does not sufficiently address.

The WHO has until May 29 to finalize the framework for the voluntary pool. The US has expressed reservations, while it has been accused of “pandemic chauvinism” because it refused to attend the launch of the WHO ACT Accelerator and is alleged to have offered to buy a German vaccine developer, while the CEO of Sanofi said that the U.S. may get priority access to COVID-19 vaccine, even though the company is headquartered in France.

Covid-19 has exposed the limits of the pharmaceutical market model

As the global search for Coronavirus treatments and vaccines intensify, two articles this week highlight the limitations of the existing drug development models. Health Policy Watch featured an interview with the Director General of a trade association representing the leading pharmaceutical companies. Among the “old-new tensions between profit and public needs” that were discussed was the “concern” by the pharmaceutical industry that the newly adopted World Health Assembly resolution referenced WTO flexibilities that allow countries to override patents to ensure access to vaccines, therapeutics and diagnostics.

The STAT article, meanwhile, points to failures of the existing market model that do not sufficiently incentivize investment into new treatments and vaccines for neglected diseases and pandemic preparedness despite warnings. Building on an extensive body of research, the author advocates for a new economic model of drug development that does not rely on market mechanisms. That would include more open and transparent research and development practices that address the “rapid global expansion of intellectual property” as well as more expansive government initiatives to address collective challenges (particularly given the significant role of government-funded research).

The 15 drugs being tested to treat COVID-19 and how they work

Even under the most optimistic projections, developing new treatments and vaccines for COVID-19 will require far greater time and resources than would be required for repurposed existing therapeutic compounds. An article in Nature this week provides an overview of the 15 leading candidates of existing drugs that are being studied as treatments for COVID-19. These can be divided into two categories: those that target the viral replication cycle, and those that aim to control the symptoms of the disease. They include:

Chloroquine/hydroxychloroquine (primarily used to treat malaria)
Lpinavir and ritonavir (HIV/AIDS)
Nafamostat and camostat (pancreatitis)
Famotidine (heartburn)
Umifenovir (influenza virus A and B)
Nitazoxanide (anti-infective)
Ivermectin (anti-parasitic)
Corticosteroids (cytokine storm, acute respiratory distress syndrome)
Tocilizumab and sarilumab (cytokine storm, ARDS)
Bevacizumab (oncology)
Fluvoxamine (antidepressant)

Contact tracing apps: balancing privacy and public health

Traditional public health contact tracing systems require significant time and resources, as one projection by Johns Hopkins University estimates a workforce of 100,000-300,000 would be needed to contain COVID-19 in the U.S. alone at a cost of $12 billion. As a result, health systems are increasingly turning to mobile contact tracing apps that are pitched as a way to reduce these costs by automating the process of logging people’s contacts should they became infected in the future. Despite their promise, there are outstanding challenges, including marginalizing vulnerable populations that may not have smartphones.

There are also privacy concerns that has led civil liberties advocates to raise warnings about potential abuses, including by authoritarian countries during and after the pandemic. The CSIS also urges policy makers that digital tools such as contact tracing apps are not “silver bullet” substitutes for investment in fundamental pandemic response capabilities. That message was echoed by health authorities in Iceland, where Rakning-19 yielded very little benefit compared to traditional public health systems, despite its high uptake of 40% of the population.

Machine learning applications

In Nature Machine Intelligence, authors report on machine learning tools applying pattern classification to identify three biomarkers associated with COVID-19 mortalities.

Another paper in Nature examine real-time tracking of self-reported symptoms to predict potential cases of COVID-19. The smartphone app allowed the authors to develop a model that was 80% accurate and showed that loss of smell and taste were additional symptoms indicative of COVID-19. While this study used simple statistical regression analysis, another paper in pre-print used machine learning algorithms on a smaller Brazilian dataset that achieved better performance of 92% specificity and 95% sensitivity.

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh

The strongest cyclone ever recorded in the Bay of Bangal (with maximum sustained winds up to 265km/h) is expected to hit India and Bangladesh on Wednesday. Millions of people are being forced to evacuate north-east India, while only 12,000 shelters have been prepared in Bangladesh to house the nearly five million people in the expected path of Cyclone Amphan. The impact is likely to be hardest on those living in low-lying flood prone coastal areas, as the Needs Assessment Working Group of Bangladesh estimates that up to 14.2 million people in coastal districts are likely to be affected, displacing 1.4 million people and damaging up to 600,000 houses.

Vulnerable communities affected by COVID-19 outbreaks and lockdown will also likely be impacted, including the approximately 1.2 million Rohingya refugees that live in over-crowded camps in Cox’s Bazar in Bangladesh. In collaboration with humanitarian partners, including UNICEF and UNHCR, the IOM is constructing a COVID-19 treatment centre in Cox’s Bazar along with cyclone preparedness effort (alerting the community, reinforcing critical infrastructure and prepositioning emergency items before the cyclone makes landfall).

COVID needs in Humanitarian Emergency Settings

The UN High Commissioner for Refugees made an appeal for US$745 million for preparedness and response to outbreaks of COVID-19 among the more than 71 million refugees and forcibly displaced people that remain acutely vulnerable. While no major outbreaks have been reported in large refugee and IDP settlements, UNHCR is rapidly scaling up efforts in 134 refugee-hosting countries that are reporting local transmission. There is also widespread evidence of deep economic impacts on refugees, as 70% of refugees surveyed admitted to skipping meals, and this is most acute among refugee women.

Médecins Sans Frontières has outlined five key priorities for the international community in order to protect migrants and vulnerable populations in humanitarian response locations. These include:

Ensuring COVID-19 is not used as an excuse to enforce restrictive migration control policies and evade international obligations towards refugees, asylum seekers and migrants;
Governments must not use COVID-19 emergency measures to target refugees, asylum seekers and migrants, and measures should be proportionate and limited in duration, respect human dignity, and based on scientific evidence and not applied arbitrarily;
Lockdowns and mass quarantining cannot be cut-and-pasted or discriminatorily applied;
Direct humanitarian evacuation corridors for displaced people at risk (including people above 60 years and those with respiratory conditions, diabetes, or other health complications); and
Safeguarding access to healthcare for all (ensuring border closures do not prevent the mobility of people, essential supplies and aid workers, particularly in humanitarian response locations).

EU is Creating Humanitarian Air Bridges to enable the COVID-19 Response

The European Commission has allocated 10 million Euro to support a humanitarian air bridge amid travel shutdowns. In the absence of commercial air travel, the air bridge will allow humanitarian staff and supplies to be delivered across 30 routes deemed important for the COVID-19 response, with the first flight launched last week from France to the Central African Republic with 60 humanitarian workers and 13 metric tons of humanitarian cargo.

Build Back Better After COVID-19

The International Recovery Platform developed a toolkit of existing guidelines and tools to support countries and communities when they are ready to recover from the COVID-19 pandemic crisis. It supports recovering communities to “build back better” towards more resilient health systems, economies, and more just societies. The Compendium of Tools and Guidelines are organized according to four categories: Health Sector Recovery; Private Sector and Livelihood Recovery; Inclusive Recovery; and Disaster Recovery Governance. The IRP is a joint initiative of UN, international finance institutions, national and local governments, and NGOs engaged in disaster recovery and sustainable development.

A paper commissioned by the Swedish International Development Cooperation Agency provides analysis and guidance on to inform the design, implementation and adaptation of conflict sensitive humanitarian and development responses to COVID-19.

Lancet Papers Decry the lack of Ethical global leadership on health inequities around COVID-19

A paper in the Lancet calls for greater ethical global leadership on health inequities during the COVID-19 pandemic. The authors reference widespread reports of the disproportionate impact of the pandemic on vulnerable communities around the world, while pointing to “unconscionable stockpiling by wealthy countries” and even attempts to extract profits from the crisis through economic speculation.

Another paper in the same issue highlights how social inequalities in health profoundly, and unevenly, impacting COVID-19 morbidity and mortality. Among the social determinants of health, the authors identify emerging findings on the correlation of the pandemic with poverty (including homelessness), physical environment, and race or ethnicity. The paper also notes how physical distancing measures are significantly more difficult for vulnerable and marginalized populations, while school closures have increased food insecurity for children living in poverty, exacerbating physical and mental health. The authors urge policymakers to emphasize the mitigation of social determinants, including improving housing and reducing overcrowding as well as improving access to health services and income support. The paper also calls on social determinants of health to be an essential part of pandemic research priorities, public health goals, and policy implementation.

Preventing a COVID-19 Related Global Food Crisis

The Food and Agriculture Organization made an appeal for US$350 million to scale up efforts to address hunger and livelihood-boosting efforts in contexts vulnerable to food crisis. As part of the broader UN Global Humanitarian COVID-19 Plan, the appeal will include supporting farmers’ access to fields, seeds and other inputs to plant or buy feed for their animals in order to avoid the cascading impacts of missing planting seasons such as drops in output. The FAO also advocates proactive efforts for stronger emergency livelihoods interventions to avoid famines.
The WEF also reports how the pandemic has amplified the risk of worldwide food-price spikes, urging greater coordination across governments to avert disruptions to food supply chains, including through food protectionism. While lockdowns have led to a collapse in demand for discretionary goods and services, the opposite is true of food as panic buying and food hoarding has proliferated. On the supply side, global grain stockpiles could be quickly depleted as the virus disrupts production and distribution, compounded by the worst locust outbreak in 70 years that have left countries in East Africa acutely vulnerable. In Kenya, for example, the price of staple foods has risen by 60% since last year.
ICRISAT published a new report that outlines four key strategies to protect the lives and livelihoods of farming communities in Eastern and Southern Africa. These include:
1. Diversification of farming systems for improved resilience and profitability (including technologies suitable for sustainable intensification);
2. Enhancing access to seed at scale of grain legumes and dryland cereals (through community seed banks that also supports grain aggregation);
3. Building capacity of partners to promote technologies in a participatory manner (including governments, community organizations, local leaders and women); and
4. Gender integration and empowerment to engage actively in agribusinesses (including livelihood-strengthening activities like climate-smart agriculture)

CommunityFirst COVID-19 Roadmap

This week, SeeChange Initiative and Ilisaqsivik Society, in partnership with the Association of Médicos Sin Fronteras in Latin America, and the Dahdaleh Institute, launched the CommunityFirst COVID-19 Roadmap, a planning tool to empower communities in developing local strategies to organize, prepare and respond to COVID-19. The Roadmap is available in English, Spanish and Inuktitut, and also includes an Emergency Readiness Checklist. Last month, the Executive Director of SeeChange and a Steering Committee member of the CommunityFirst Roadmap published an article in the Lancet on local efforts among Inuit communities to address COVID-19 and TB. The role of community-based responses to the pandemic was also highlighted in STAT.

Webinar Resources

COVID-19 in Humanitarian Setting: Magnifying Gender Inequalities? (JHU)
- Wednesday, May 20, 2020 (8-9am EST)
Digital Solutions to Covid-19 and Urban Challenges in Sub-Saharan Africa (CSIS)
- Thursday, May 21, 2020 (9-10am EST)
Humanitarian Operations During Covid-19: A Conversation with UNHCR (CSIS)
- Monday, June 8, 2020 (9:30-10:15am EST)

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The growing pandemic funding gap

The gap between donor commitments and the funding needed to respond to the pandemic continues to grow. As the UN Office for the Coordination of Humanitarian Affairs tripled its appeal last week to US$6.7 billion, they admit to only receiving US$1 billion towards its initial request for US$2 billion. That includes a mere $65 million contribution from the U.S. that a senator described as “unconscionable,” while the Washington Post reports the US$3 trillion COVID-19 bill introduced by Democrats this past week contains no funding for international assistance. Germany and France likewise agreed to support a 500 billion Euro aid package to support E.U. countries with recovery from the pandemic.

NGOs such as the International Rescue Committee argue that much of the aid is stuck within multilateral channels, as humanitarian funding to front-line NGOs accounts for only 2% of commitments under the UN Global Humanitarian Response Plan.

The global economy is shrinking, and 130 million people may be pushed into extreme poverty

Global economic output is expected to drop by 3.5% in 2020, and by US$8.5 trillion over the next two years as a result of the pandemic. The UN World Economic Situation and Prospects report warns that an additional 34 million people could fall below the extreme poverty line by the end of this year. The UN Department of Economic and Social Affairs did “not anticipate (the global economy) would dive as quickly as it did” amidst the sharpest economic contraction since the Great Depression. The report projects that by 2030, an estimated 130 million will be pushed into extreme poverty. Africa is expected to absorb 56% of the rise in poverty, in part due to limited economic and social protection measures as well as debt burdens.

In the World Economic Forum’s weforum.org, the Dean of the Wharton Business School projects that COVID-19 would also reverse trends in globalization and urbanization. The resulting compression of the global economy, he predicts, will be further impacted by reduction in international cooperation and increased likelihood of international conflict.

250 million Africans could be infected, with up to 190,000 dead by years’ end

Modelling by the WHO predicts that nearly a quarter of a billion people across 47 African countries will be infected with the Coronavirus, with as many as 190,000 projected mortalities by year’s end, according to a study to be published in BMJ Global Health. While African countries may experience fewer severe cases and deaths per capita due to younger populations and lower obesity rates, health system capacity gaps and disruptions in maternal and child health could result in additional deaths.=

ODI calls for increased solidarity to support developing countries

The Overseas Development Institute estimates that the economic impacts of the pandemic to sub-Saharan Africa remain uncertain but will likely exceed $100 billion. While many countries have imposed stringent measures to contain the spread of the virus, there are immediate and long-term concerns about the lag in economic and social protection measures as governments face major liquidity and fiscal constraints. Since much of the global economic dislocation stems from decisions to protect citizens in wealthier countries, the ODI calls for increased international solidarity to support developing countries. That can include special drawing rights to address capital outflows, moratoria on debt service repayments, development finance to provide liquidity to protect employment, as well as non-concessional lending and economic resource packages as aid.

Rising Inequity Gap

The IMF warns that COVID-19 could widen the inequality gap between rich and poor across and within countries, urging policymakers to put in place risk-sharing and social assistance mechanisms to protect the most vulnerable from economic impacts. Using past pandemics as a guide, the analysis shows net increases in Gini coefficient (a measure of inequity within a country) after five years as well as long-term impacts due to job loss and other shocks to income (e.g. lower remittances). To minimize long-term damage (or “scarring”) to the livelihoods of vulnerable communities – and improve resilience to future shocks (including the effects of climate change), the IMF urges countries to consider a range of measures including:

Access to sick leave, unemployment benefits, and health benefits;
A “New Deal,” particularly in countries where the employment sector is largely informal and where social protection systems are limited; and
Expanding social assistance systems, introducing new transfers, boosting public work programs, and progressive tax measures.

“Nothing lays bare inequality and discrimination like a disaster”

In a forceful address on the human rights dimensions of the COVID-19 pandemic, the UN Special Representative for Disaster Risk Reduction highlighted the disproportionate impact on marginalized and vulnerable populations, amplifying social inequities, forced displacement as well as gender- based violence. The central message was that the international community “must do more.” This includes treating persons at risk as people with human rights and not just as beneficiaries of humanitarian actions, who are consulted in decision-making relevant to their lives, and to foster greater resilience by focusing on the drivers of disaster risk, including poverty, lack of international solidarity and pandemic preparedness, and increasing frequency and magnitude of extreme weather events.

‘Donor states can and must do more’

According to a Devex survey of development professionals, two thirds say donors are not doing enough to respond to the Coronavirus. The UN estimates that US$500 billion will be needed to address the pandemic in developing countries, as Oxfam urged 30 donors of the OECD Development Assistance Committee to contribute $300 billion. In addition to more funding, development experts point to three other steps donors should take:

Simplified funding mechanisms for a faster response;
Clarity and transparency on decisions; and
Looking beyond the immediate needs, including longer-term impacts of COVID-19 and what preparation is needed now to respond to those.

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“Impartial, independent, and comprehensive evaluation”

For the first time in the WHO’s history, its annual World Health Assembly (WHA) was entirely virtual. With a focus almost entirely on the Coronavirus pandemic, the condensed two-day meeting was preceded by three weeks of intense negotiations.

The most significant outcome this year was the adoption of a COVID-19 resolution that was proposed by the European Union and supported by 120 countries that contained three major elements (A73/CONF/1), including an “impartial, independent, and comprehensive evaluation (of the) international health response to COVID-19.” In the closing remarks, the WHO Director General affirmed that the review would take place “as soon as possible.”

Rising geopolitical tensions shape emergent Global Health institutions and practices

The WHA opened with a failed motion to grant Taiwan Observer status, underscoring growing tensions in part arising from accusations by the U.S. (and shared by other Western and Pacific Asian countries) that China was not transparent in the early days of the pandemic.

In a letter, the U.S. President threatened to permanently eliminate the funding that was temporarily withdrawn from the WHO, suggesting the U.S. would pursue bilateral aid channels including US$500 million to 40 ‘at risk’ countries. The President of China addressed the Assembly directly pledging US$2 billion over the next two years to support COVID-19 response efforts in developing countries, and an ambition to establish China as a “global humanitarian response capital and hub.” Focusing on African countries in particular, President Xi referenced debt suspension initiatives, building “green corridors” to accelerate delivery of essential goods as well as partnering with 30 major hospitals in Africa to build a China Centres for Disease Control headquarters on the continent.

‘No monopolies on access’ to COVID treatments and vaccines in a pandemic

The negotiations on access to treatments and future vaccines were far more divisive. Led by Costa Rica, developing countries and civil society organizations expressed particular concern about ensuring equitable access, including to COVID-related knowledge, lessons learned, experience, and best practices. The WHO Secretariat will have until May 29 to develop a framework for a voluntary COIVD-19 Intellectual Property Pool for patents and clinical trial data, while the EU-led resolution also references WTO TRIPS flexibilities allowing countries to override patents to ensure access.

COVID is a ‘wake-up call to our global fragility’

In his address to the World Health Assembly, the UN Secretary General called for greater unity and solidarity along three dimensions: a coordinated and comprehensive health response guided by the WHO and focusing on developing countries; policies to address the social and economic dimensions of the COVID crisis; and a response and recovery plan based on equity, inclusion and sustainability centred on human rights. Given the unprecedented nature of the pandemic, some civil society organizations such as South Centre expressed disappointment in the lack of ambition of the COVID-19 resolution. Knowledge Ecology International (KEI) likewise referred to the “typical watered down, lawyered ambiguity” of the final draft that fails to limit legal monopolies that could affect access (they noted that other proposals like Canada’s would have called for “universal and non-exclusive and open-licensing” that referenced data sharing and more expansive mandate beyond existing mechanisms).

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Soaring drug prices could bar access to future coronavirus treatments (Guardian)
- COVID-19 exposes drug supply gaps as Canada explores local ‘Made in Canada’ solutions (CTV News)
To deliver a COVID-19 vaccine equitably, we must start planning now (Devex)
- U.S. taxpayer funding contributed to research for a remdesivir patent that will likely remain inaccessible to many people due to the $4,500 price tag by Gilead (STAT)
Protect against market exclusivity in the fight against COVID-19 (Nature Medicine)
- Compulsory Licensing: A Cure for Distributing the Cure? (CSIS)
Mobile apps that allow real-time tracking of self-reported symptoms are effective in predicting infections, according to a new study in Nature Medicine
- COVID-19 and digital inequalities: Reciprocal impacts and mitigation strategies (Computers in Human Behavior)

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A new WHO study projects that up to 190,000 people in Africa could die and an additional 29-44 million could get infected by the Coronavirus in the first year if containment measures fail.
Harvard Professor Joseph Nye – one of the world’s leading scholars on global governance- examines the “abysmal failure of leadership” from the U.S. and China, urging that more global solidarity and recognition of mutual interest is essential to address the pandemic
In collaboration with DIGHR, the Ilisaqsivik Society, and Médecins Sans Frontières (Latin), SeeChange Initiative is launching a Community Roadmap planning tool today to support communities organize, prepare and respond to COVID-19. See:
- CommunityFirst COVID-19 Emergency Readiness Checklist
- What the Covid-19 pandemic is teaching us about community (STAT)
In a commentary, Nobel Peace Prize laureate, Kailash Satyarthi, highlights the compassionate work of community and civil-society groups working with vulnerable populations, urging G20 to increase international aid and coordination through UN agencies like WHO, UNICEF and UNOCHA.
A study in Lancet Global Health projects an additional 0.25-1.2 million children under 5 could die indirectly in the next six months as a result of the pandemic though disruption of health systems and decreased access to food. This would be the first increase in global child mortality since World War II. The researchers from Johns Hopkins also estimate that indirect maternal deaths could rise from 8% to 38%.
An analysis by the New York Times reveals spikes in fatalities across Latin America (including Brazil, Ecuador and Peru) that exceed the worst pandemic trajectories in Europe and the U.S. The Brazilian president, when asked about the death toll, replied “So what? What do you want me to do?”.
Amazon indigenous leaders warn of the potentially devastating effects of COVID-19 (New Humanitarian), where “no specific attention has been given to indigenous communities”.In Brazil, the potential effects highlight the lack of government support with food and health services. The former health minister of Ecuador, meanwhile, warns that “everyone is at risk” if marginalized communities are not able to afford basic health services, while officials in Mexico suggest that thousands of deaths are not being reported, obscuring the true toll of the COVID-19 epidemic.
China, South Korea and Japan are experiencing a resurgence in COVID cases, as the WHO and public health experts warn against lifting containment measures too early (CNBC)
- Authorities in Wuhan plan to test all 11 million residents over the next ten days after discovering new infections for the first time since its lockdown was lifted, prioritizing vulnerable groups and high-density areas (BBC)
Exceptionally heavy seasonal rains across East Africa since late April have resulted in widespread floods that caused a heavy loss of life and property, compounding the risks to human health and food security from the COVID-19 pandemic and the most serious desert locust invasion in decades. (WMO)
COVID19 epitomises why a “One Health” approach – which recognises the fundamental interconnectedness of humans, animals, and their shared environment- is key to ensuring the healthy and sustainable future of the planet. coChairs of the Lancet One Health Commission are calling for a COVID-19 One Health Research Coalition (Lancet)

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World leaders pledge $8 billion for research into vaccine and therapies as well as equitable and timely distribution (Coronavirus Global Response Summit)

The absence of the U.S., India and Russia points to possible fractures in global health diplomacy (Washington Post)

Vaccine could be available as early as 9-24 months (Gates Foundation)

A vaccine likely won’t be available until the end of 2021 due to Phase 2 and 3 clinical trials to ensure safety and efficacy, according to the chair of the WHO Global Outbreak Alert and Response Network (CNBC)

Nature: Multiple vaccines are in competition: how will scientists choose the best?

Rapid review for the anti-coronavirus effect of remdesivir (Drug Discoveries & Therapeutics)

Video: How does Gilead’s drug remdesivir work against coronavirus? (STAT)

Gilead to charge up to US$4,500 for experimental COVID-19 treatment remdesivir (Institute for Clinical and Economic Research)

WHO to engage U.S. and Gilead as data on safety and efficacy emerge to ensure wider availability of remdesivir (CNBC)

GAVI Vaccine Alliance proposes an Advanced Market Commitment program for COVID-19 vaccine (GAVI)

Internet of Things has been deployed in innovative ways to provide information and monitoring during the COVID-19 epidemic, including automated and transparent treatment (Journal of Diabetes & Metabolic Syndrome)

Emerging technologies to combat COVID-19 pandemic (J of Clinical and Experimental Hepatology)

Going Viral: how to boost the spread of coronavirus science on social media (Nature)

COVID-19 has reinforced the importance of preprints as a means for rapid research dissemination (Nature Biotechnology)

Tool: Google releases an AI-powered COVID-19 Research Explorer to assist researchers with complex queries

UK researchers create antibody test claiming 100% sensitivity, 99.8% specificity and results in 35 minutes (UK Standard)

U.S. Food and Drug Administration tighten standards for antibody testing following false specificity and sensitivity claims (WSJ)

Ethical and practical challenges of COVID-19 human vaccine trials (STAT)

Human Challenge Studies to Accelerate Coronavirus Vaccine Licensure (Journal of Infections Diseases)

WHO to issue ethical guidelines this month to inform human challenge trials amidst reports of deliberate infection of healthy human volunteers to test vaccine candidates (SCMP)

Frontier technologies for COVID-19 need better governance (WEF)

Unproven herbal remedy, ‘Madagascar Tonic’, touted by some African governments despite warnings from health officials (Globe & Mail; The Economist)

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Several countries have made adjustments to their official figures over the last couple days, including China adding over 1,300 uncounted deaths from Wuhan. The broader challenge is that most models of the pandemic are based on prior figures from China and may need to be revised to reflect these significant adjustments.

The U.S. CDC revising its case and death counts to reflect both confirmed and probable cases and deaths. With more than 675,000 total cases, the U.S. has more cases than the next four highest reporting countries combined, while accounting for almost 20% of all reported COVID-related deaths globally.

Revelations of significantly higher rates of transmission and deaths in elderly care facilities contributed to Canada becoming the 15^th country to report at least 1,000 deaths, as total cases spiked by 30% this week to over 30,000. While the Canadian government announced that control and border measures will remain for months to come, the U.S. President yesterday outlined a Federal Plan to open up the country to widespread criticism by public health experts and government officials across the country.

Total confirmed cases worldwide increased to 2.2 million, as the number of COVID-19 related deaths approach 150,000 as of Friday morning.

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On Monday, the Center for Health Security published a National Plan for Contact Tracing in the U.S. that estimates an“army” of 100,000 additional workers would be required. Meanwhile, healthcare workers have been disproportionately affected by the Coronavirus, and in multiple hospitals have been asked to work while possibly infected. There are also reports that the U.S. government is exploring surveillance measures adopted by some countries (including China and Israel) that may violate civil liberties, while troops are also reportedly being readied to assist with COVID public health measures.

Meanwhile, the U.S. CDC and Public Health Agency of Canada shifted its messaging by recommending face coverings in public where other social distancing steps are hard to maintain.

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During this unprecedented global pandemic, U.S. President Trump announced his intention to suspend funding to the WHO over accusations of mismanagement. The move has been roundly criticized by many governments and the EU, global health experts as well as the UN Secretary General. The U.S., meanwhile, has raised questions about its own handling of the pandemic, as it remains the epicentre with almost a third of all worldwide cases (644,806) and over 20% of all COVID-related deaths. The five worst affected countries (U.S., Spain, Italy, Germany, France) account for over 60% of all cases and almost 80% of deaths globally.

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April 9 marks the 100th day since the WHO was notified of the first case of “pneumonia of unknown cause” in Wuhan, China.

As of April 12 at 10am EST, the total worldwide deaths from COVID-19 has surpassed 110,000, as confirmed cases approach 1.8 million. The actual number of dead and infected worldwide are believed to be much higher, but testing shortages, different counting practices and concealment by some governments limit detection and reporting.

The U.S. is the current global epicentre with over 530,000 confirmed cases and over 20,000 deaths, while the five worst affected countries (U.S., Spain, Italy, Germany, France) account for over 60% of all cases and almost 80% of deaths globally.

Community transmission is spreading, and the rapid increase of cases across low- and middle-income countries has become a critical global issue, as over 20 developing countries are reporting more than 1,000 cases. The number of African cases increased approximately by 40% over the past week, with all 55 countries reporting cases and 8 African countries seeing exponential rise. South Africa’s border controls and lockdown over the past two weeks have significantly reduced the number of new cases.

The economic fallout from the global pandemic could push 500 million people into poverty (8% of global population), according to a UN University report. This would be the first time that poverty has increased globally in over thirty years. The World Bank and IMF have scaled up and accelerated efforts to provide emergency funding to countries, while the UN Office for the Coordination for Humanitarian Affairs (OCHA) issued a US$2 billion appeal for a Coordinated Global Humanitarian Response Plan, which as of April 8, is only 20% funded.

As governments confront the dual challenge of containing the viral pandemic and economic crisis, public health experts warn countries that premature re-opening could lead to a second wave of outbreaks, echoed as well by modelling projections in a recent Lancet paper. Oxfam has urged world leaders to contribute to the $2.5 trillion economic rescue plan set out by the UN to “keep poor countries and poor communities afloat.” Mounting job losses and disruptions to global supply chains are also expected to result in chronic food shortages, as countries are urged to keep trade open and to protect farmers.

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Short-term forecasts of COVID-19 deaths in multiple countries

Imperial College London, 8 April 2020

https://sangeetabhatia03.github.io/covid19-short-term-forecasts/index.html

This weekly report by Imperial College London presents forecasts of transmission and mortality estimates over the coming week for 42 countries with active transmission, accounting for the impact of control measures. The caveat with these forecasts is that accuracy varies with the quality of surveillance and reporting, i.e. presenting likely underestimates for countries with poor reporting. That said, based on transmissibility estimates, the COVID-19 epidemic is expected to demonstrate:

Stabilizing patterns in 14 countries (including Italy, Iran, Iraq, South Korea);
Slow-growth transmission (1<Rt<2) in Spain and Netherlands; and
Rapidly growing transmission (Rt>2) across 26 countries (including Algeria, Brazil, Canada, China, Egypt, France, Germany, India, Japan, Peru, Turkey, U.K. and U.S.).

Based on central forecasting trends, reported deaths in the coming week are expected to be:

Relatively small (<100) and large (100-1000) in 29 countries;
Large (1,000-5,000) in 8 countries (including Algeria, Brazil, Germany, Iran, and Turkey); and
Very large (5,000+) in 5 countries (France, Italy, Spain, U.K. and U.S).

New COVID-19 forecasts for Europe: Italy & Spain have passed the peak of their epidemics; UK, early in its epidemic, faces a fast-mounting death toll

Institute for Health Metrics and Evaluation, 7 April 2020

http://www.healthdata.org/news-release/new-covid-19-forecasts-europe-italy-spain-have-passed-peak-their-epidemics-uk-early-its

New COVID-19 forecast from IHME found that among European nations, the peak daily death rate from the pandemic will occur during the third week of April, with the pandemic spreading from Southern Europe. According to current trajectories, 151,680 COVID-19 deaths could occur during the “first wave” of the pandemic in Europe, while the U.S. is expected to face 81,766 deaths. Declines in deaths are now occurring in Italy and Spain as most regions in the two countries have passed their peaks in the number of deaths, while other nations are approaching their peaks and still others facing peak mortality later in April. The death toll in many countries is compounded by demand for hospital resources well in excess of what is available. Predicted peaks in daily COVID-19 deaths appear to be highly variable among EEA countries, likely reflecting the equally variable ways that the novel coronavirus initially spread and then continued to affect Europe.

Projecting hospital utilization during the COVID-19 outbreaks in the United States

Moghadas et al, National Academy of Sciences, 3 April 2020

https://www.pnas.org/content/117/16/9122

Findings

Without isolation and with R0 = 2.5, treatment of critically ill patients at the outbreak peak would require 3.8x more ICU beds than exist in the U.S. (or 2x if R0 = 2). With self-isolation by 20% of cases within 24 hours of symptom onset, the outbreak trajectory would delay and flatten, and the number of ICU beds needed at the peak would reduce by 48.4% (or 73.5% if R0 = 2).

Interpretation

Hand washing and self-isolation is shown to significantly contribute to reducing the rate of spread of COVID-19, and therefore reducing the number of ICU beds needed at any one time. This could facilitate emergency mobilization to expand mobilization of critical care capacity to handle the burgeoning outbreak.

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WHO to create a COVID-19 Intellectual Property Pool

Covid-19 has exposed the limits of the pharmaceutical market model

The 15 drugs being tested to treat COVID-19 and how they work

Chloroquine/hydroxychloroquine (primarily used to treat malaria)
Lpinavir and ritonavir (HIV/AIDS)
Nafamostat and camostat (pancreatitis)
Famotidine (heartburn)
Umifenovir (influenza virus A and B)
Nitazoxanide (anti-infective)
Ivermectin (anti-parasitic)
Corticosteroids (cytokine storm, acute respiratory distress syndrome)
Tocilizumab and sarilumab (cytokine storm, ARDS)
Bevacizumab (oncology)
Fluvoxamine (antidepressant)

Contact tracing apps: balancing privacy and public health

Machine learning applications

In Nature Machine Intelligence, authors report on machine learning tools applying pattern classification to identify three biomarkers associated with COVID-19 mortalities.

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