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Infection Fatality Ratios for COVID-19 Among Noninstitutionalized Persons 12 and Older: Results of a Random-Sample Prevalence Study – Annals of Internal Medicine

 Our random-sample study estimated 187 802 cumulative infections, to which 180 hospitalizations were added. The average age among all COVID-19 decedents was 76.9 years (SD, 13.1). The overall noninstitutionalized IFR was 0.26%. In order of magnitude, the demographic-stratified IFR varied most by age, race, ethnicity, and sex. Persons younger than 40 years had an IFR of 0.01%; those aged 60 or older had an IFR of 1.71%. Whites had an IFR of 0.18%; non-Whites had an IFR of 0.59%.

By using SARS-CoV-2 population prevalence data, we found that the risk for death among infected persons increased with age. Indiana’s IFR for noninstitutionalized persons older than 60 years is just below 2% (1 in 50). In comparison, the ratio is approximately 2.5 times greater than the estimated IFR for seasonal influenza, 0.8% (1 in 125), among those aged 65 years and older. Of note, the IFR for non-Whites is more than 3 times that for Whites, despite COVID-19 decedents in that group being 5.6 years younger on average.

https://web.archive.org/web/20201003112851/https://www.acpjournals.org/doi/10.7326/M20-5352

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Low-cost measurement of face mask efficacy for filtering expelled droplets during speech – Science Magazine

We noticed that speaking through some masks (particularly the neck gaiter) seemed to disperse the largest droplets into a multitude of smaller droplets (see fig. S5), which explains the apparent increase in droplet count relative to no mask in that case. Considering that smaller particles are airborne longer than large droplets (larger droplets sink faster), the use of such a mask might be counterproductive. Furthermore, the performance of the valved N95 mask is likely affected by the exhalation valve, which opens for strong outwards airflow. While the valve does not compromise the protection of the wearer, it can decrease the protection of persons surrounding the wearer. In comparison, the performance of the fitted, non-valved N95 mask was far superior.

https://web.archive.org/web/20200902201232/https://advances.sciencemag.org/content/6/36/eabd3083

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SAGE Transparency and freedom of information releases – Gov.UK

Transparency and freedom of information releases for SAGE.

https://www.gov.uk/search/transparency-and-freedom-of-information-releases?organisations%5B%5D=scientific-advisory-group-for-emergencies&parent=scientific-advisory-group-for-emergencies

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Electronically integrated, mass-manufactured, microscopic robots – Nature

Fifty years of Moore’s law scaling in microelectronics have brought remarkable opportunities for the rapidly evolving field of microscopic robotics. Electronic, magnetic and optical systems now offer an unprecedented combination of complexity, small size and low cost, and could be readily appropriated for robots that are smaller than the resolution limit of human vision (less than a hundred micrometres). However, a major roadblock exists: there is no micrometre-scale actuator system that seamlessly integrates with semiconductor processing and responds to standard electronic control signals. Here we overcome this barrier by developing a new class of voltage-controllable electrochemical actuators that operate at low voltages (200 microvolts), low power (10 nanowatts) and are completely compatible with silicon processing. To demonstrate their potential, we develop lithographic fabrication-and-release protocols to prototype sub-hundred-micrometre walking robots. Every step in this process is performed in parallel, allowing us to produce over one million robots per four-inch wafer. These results are an important advance towards mass-manufactured, silicon-based, functional robots that are too small to be resolved by the naked eye.

https://www.nature.com/articles/s41586-020-2626-9

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Evidence summary for face mask use by healthy people in the community – HIQA

National and international public health guidance is based on low certainty direct evidence of clinical effectiveness and indirect evidence that supports the plausibility of effectiveness of face masks.

https://www.hiqa.ie/sites/default/files/2020-08/Evidence-summary-face-masks-in-the-community.pdf

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Diagnosing COVID-19 infection: the danger of over-reliance on positive test results – medRxiv

Unlike previous epidemics, in addressing COVID-19 nearly all international health organizations and national health ministries have treated a single positive result from a PCR-based test as confirmation of infection, even in asymptomatic persons without any history of exposure. This is based on a widespread belief that positive results in these tests are highly reliable. However, data on PCR-based tests for similar viruses show that PCR-based testing produces enough false positive results to make positive results highly unreliable over a broad range of real-world scenarios. This has clinical and case management implications, and affects an array of epidemiological statistics, including the asymptomatic ratio, prevalence, and hospitalization and death rates. Steps should be taken to raise awareness of false positives, reduce their frequency, and mitigate their effects. In the interim, positive results in asymptomatic individuals that haven’t been confirmed by a second test should be considered suspect.

https://www.medrxiv.org/content/10.1101/2020.04.26.20080911v3

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Phase III Double-blind, Placebo-controlled Study of AZD1222 for the Prevention of COVID-19 in Adults – ClinicalTrials.gov

Brief Summary:The aim of the study is to assess the safety, efficacy, and immunogenicity of AZD1222 for the prevention of COVID-19.

Actual Study Start Date  :August 28, 2020
Actual Primary Completion Date  :March 5, 2021
Estimated Study Completion Date  :February 14, 2023

https://clinicaltrials.gov/ct2/show/NCT04516746

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16 Possible Factors for Sweden’s High Covid Death Rate among the Nordics –

What accounts for Sweden’s high Covid death rate among the Nordics? One factor could be Sweden’s lighter lockdown. But we suggest 15 other possible factors. Most significant are: (1) the “dry-tinder” situation in Sweden (we suggest that this factor alone accounts for 25 to 50% of Sweden’s Covid death toll); (2) Stockholm’s larger population; (3) Sweden’s higher immigrant population; (4) in Sweden immigrants probably more often work in the elderly care system; (5) Sweden has a greater proportion of people in elderly care; (6) Stockholm’s “sport-break” was a week later than the other three capital cities; (7) Stockholm’s system of elderly care collects especially vulnerable people in nursing homes. Other possible factors are: (8) the Swedish elderly and health care system may have done less to try to cure elderly Covid patients; (9) Sweden may have been relatively understocked in protective equipment and sanitizers; (10) Sweden may have been slower to separate Covid patients in nursing homes; (11) Sweden may have been slower to implement staff testing and changes in protocols and equipage; (12) Sweden elderly care workers may have done more cross-facility work; (13) Sweden might have larger nursing homes; (14) Stockholmers might travel more to the Alpine regions; (15) Sweden might be quicker to count a death “a Covid death.” We give evidence for these other 15 possible factors. It is plausible that Sweden’s lighter lockdown accounts for but a small part of Sweden’s higher Covid death rate.

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3674138

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Coronial autopsies identify the indirect effects of COVID-19 – The Lancet

Review of autopsy reports enabled the determination of the relative contributions of undiagnosed COVID-19 and lockdown restrictions on deaths. Of the 67 autopsies done at our hospital during the first 2 months of lockdown, only two autopsies identified COVID-19 that was undiagnosed before death. More frequently, reduced access to health-care systems associated with lockdown was identified as a probable contributory factor (six cases) or possible contributory factor (eight cases) to death. These causes included potentially preventable out-of-hospital deaths such as acute myocardial infarction and diabetic ketoacidosis, in which patients contacted the health services by telephone and were advised to self-isolate at home rather than attending hospital. Direct reference to financial or work pressures caused by COVID-19 was identified in three of ten cases of suicide.

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30180-8/fulltext

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Exposure to common cold coronaviruses can teach the immune system to recognize SARS-CoV-2 – MedicalXpress

  • Your immune system’s ‘memory’ T cells keep track of the viruses they have seen before.
  • New study led by scientists at La Jolla Institute for Immunology (LJI) shows that memory helper T cells that recognize common cold coronaviruses also recognize matching sites on SARS-CoV-2, the virus that causes COVID-19.
  • Having a strong T cell response, or a better T cell response may give you the opportunity to mount a much quicker and stronger response.
  • 40%-60% of people never exposed to SARS-CoV-2 had T cells that reacted to the virus showing that their immune systems recognized the virus.
  • This finding turned out to be a global phenomenon and was reported in people from the Netherlands, Germany, the United Kingdom and Singapore.
  • This discovery suggests that fighting off a common cold coronavirus can induce cross-reactive T cell memory against SARS-CoV-2.

https://medicalxpress.com/news/2020-08-exposure-common-cold-coronaviruses-immune.html

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The Melbourne Experiment – Monash University

The Melbourne Experiment is a landmark interdisciplinary research collaboration studying the effects of COVID-19 on the functions of a city and an international model for post-COVID-19 urban recovery and renewal. 

Bringing together research expertise across Monash University, the Melbourne Experiment examines key activities and elements of the urban environment before, during and after the COVID-19 shutdown.

The Melbourne Experiment will use its findings to contribute to new approaches for urban renewal, emphasising innovation, sustainability and social cohesion alongside economic prosperity to help meet the United Nations 2030 Sustainable Development Goals.

As the Australia, New Zealand and Pacific Regional Centre of the UN Sustainable Development Solutions Network, Monash is uniquely placed and motivated to mobilise communities to create a better and more sustainable future, as articulated by the 2030 UN Sustainable Development Goals.

https://web.archive.org/web/20200811192936/https://www.monash.edu/research/the-melbourne-experiment

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Preliminary report on surgical mask induced deoxygenation during major surgery – PubMed (2008)

Abstract
Objectives: This study was undertaken to evaluate whether the surgeons’ oxygen saturation of hemoglobin was affected by the surgical mask or not during major operations.

Methods: Repeated measures, longitudinal and prospective observational study was performed on 53 surgeons using a pulse oximeter pre and postoperatively.

Results: Our study revealed a decrease in the oxygen saturation of arterial pulsations (SpO2) and a slight increase in pulse rates compared to preoperative values in all surgeon groups. The decrease was more prominent in the surgeons aged over 35.

Conclusions: Considering our findings, pulse rates of the surgeon’s increase and SpO2 decrease after the first hour. This early change in SpO2 may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO2, our findings may have a clinical value for the health workers and the surgeons.

https://pubmed.ncbi.nlm.nih.gov/18500410/

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Association of contact to small children with mild course of COVID-19 – medRxiv

It is known that severe COVID-19 cases in small children are rare. If a childhood-related infection would be protective against severe course of COVID-19, it would be expected that adults with intensive and regular contact to small children also may have a mild course of COVID-19 more frequently. To test this hypothesis, a survey among 4,010 recovered COVID-19 patients was conducted in Germany. 1,186 complete answers were collected. 6.9% of these patients reported frequent and regular job-related contact to children below 10 years of age and 23.2% had own small children, which is higher than expected. In the relatively small subgroup with intensive care treatment (n=19), patients without contact to small children were overrepresented. These findings are not well explained by age, gender or BMI distribution of those patients and should be validated in other settings.

https://www.medrxiv.org/content/10.1101/2020.07.20.20157149v1

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The role of chest radiography in confirming covid-19 pneumonia – The BMJ

A normal chest radiograph does not exclude covid-19 pneumonia

No single feature of covid-19 pneumonia on a chest radiograph is specific or diagnostic, but a combination of multifocal peripheral lung changes of ground glass opacity and/or consolidation, which are most commonly bilateral, may be present

Diagnosis might be complicated as covid-19 pneumonia may or may not be visible on chest radiograph; consider other causes for patients’ respiratory symptoms

https://www.bmj.com/content/370/bmj.m2426

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A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes – The Lancet

Lockdowns may reduce the peak of transmission and recovery rates but not the number of critical cases or overall mortality.

Lastly, government actions such as border closures, full lockdowns, and a high rate of COVID-19 testing were not associated with statistically significant reductions in the number of critical cases or overall mortality.

…full lockdowns and early border closures may lessen the peak of transmission, and thus prevent health system overcapacity, which would facilitate increased recovery rates.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30208-X/fulltext

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Particle sizes of infectious aerosols: implications for infection control – The Lancet

Note: Coughing and large droplets are note the issue beause breathing exhales more virus in fine aerosols than coughing. Finer aerosols bypass masks and nose to the lungs. Since masks nebulise particles, the solution is ventilation, not face masks.

The global pandemic of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) has been associated with infections and deaths among health-care workers. There have been conflicting recommendations from health authorities on the use of masks or respirators to protect health-care workers. When I first reviewed personal respiratory protection against tuberculosis for health-care workers more than 20 years ago, there was very little information on infectious aerosols. Since then, colleagues in various disciplines have provided a wealth of data. The purpose of this Viewpoint is to review the scientific literature on the aerosols generated by individuals with respiratory infections, and to discuss how these data inform the optimal use of masks, respirators, and other infection-control measures to protect health-care workers from those aerosols. This is not a review of the literature on the use of surgical masks or respirators, as several have been done already.

https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30323-4/fulltext

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Masking lack of evidence with politics – CEBM

This recent crop of trials added 9,112 participants to the total randomised denominator of 13,259 and showed that masks alone have no significant effect in interrupting the spread of ILI or influenza in the general population, nor in healthcare workers.

The small number of trials and lateness in the pandemic cycle is unlikely to give us reasonably clear answers and guide decision-makers. This abandonment of the scientific modus operandi and lack of foresight has left the field wide open for the play of opinions, radical views and political influence.

https://www.cebm.net/covid-19/masking-lack-of-evidence-with-politics/

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Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19 – International Journal of Infectious Diseases

  • As of May 27, 2020 there are over 1,678,843 confirmed cases of COVID-19 claiming more than 100,000 lives in the Unites States. Currently there is no known effective therapy or vaccine.
  • •According to a protocol-based treatment algorithm, among hospitalized patients, use of hydroxychloroquine alone and in combination with azithromycin was associated with a significant reduction in-hospital mortality compared to not receiving hydroxychloroquine.
  • •Findings of this observational study provide crucial data on experience with hydroxychloroquine therapy, providing necessary interim guidance for COVID-19 therapeutic practice.

https://www.ijidonline.com/article/S1201-9712(20)30534-8/fulltext

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Doctors From Harvard and Yale Medical Schools Support Dr. Zelenko’s Treatment Method (The Zelenko Protocol)

JRC Publishing LLC, New Jersey has published an important book on treatment of COVID-19 virus. The book is based on medical research and treatment conducted by Dr. Roland Derwand, Prof. Martin Scholz and Dr. Zelenko.

The compendium presents treatment process and detailed experiences of COVID-19 patients while undergoing medical care with Dr. Zelenko and his colleagues from around the world. This extensive work, covering 248 pages, offers unparalleled breath of medical research and is the first volume to be published in this field to date. The e-book is available for download and is being distributed free of charge.

https://internetprotocol.co/covid-19/2020/07/21/yale-harvard-professors-support-zelenkos-protocol/

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A country level analysis measuring the impact of government actions, country preparedness and socioeconomic factors on COVID-19 mortality and related health outcomes – The Lancet

Increasing COVID-19 caseloads were associated with countries with higher obesity (adjusted rate ratio [RR]=1.06; 95%CI: 1.01–1.11), median population age (RR=1.10; 95%CI: 1.05–1.15) and longer time to border closures from the first reported case (RR=1.04; 95%CI: 1.01–1.08). Increased mortality per million was significantly associated with higher obesity prevalence (RR=1.12; 95%CI: 1.06–1.19) and per capita gross domestic product (GDP) (RR=1.03; 95%CI: 1.00–1.06). Reduced income dispersion reduced mortality (RR=0.88; 95%CI: 0.83–0.93) and the number of critical cases (RR=0.92; 95% CI: 0.87–0.97). Rapid border closures, full lockdowns, and wide-spread testing were not associated with COVID-19 mortality per million people. However, full lockdowns (RR=2.47: 95%CI: 1.08–5.64) and reduced country vulnerability to biological threats (i.e. high scores on the global health security scale for risk environment) (RR=1.55; 95%CI: 1.13–2.12) were significantly associated with increased patient recovery rates.

https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30208-X/fulltext