This week brings some interesting developments on the COVID-19 front, and some scenarios from our school subscribers. We hope you enjoy the newsletter. As always, feel free to send questions and comments to us here.
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A new study from Italy, published in the Journal of the American Medical Association (JAMA) on Sept 14th, examined the rate of asymptomatic children with COVID-19, compared to adults. They sampled children and adults who presented to an Italian hospital for non-COVID-19 complaints and found that only 1% of children and 9% of adults without symptoms of COVID-19 tested positive. This is strikingly different from prior estimates which have suggested up to 80% of adults and 15% of children might be asymptomatic carriers. Overall, this is a good sign and suggests that children may not be as big a contributor to asymptomatic spread as we once thought.
What Symptoms Suggest COVID-19?
Recently one of our schools asked if there is a cluster of symptoms highly suggestive of COVID-19. The question was asked so that a school could take immediate action when sending a student or teacher home with these symptoms, before having a COVID test result. We have previously discussed that contact tracing and most Dept of Health recommendations do not begin until there is a positive test. So what is a school to do while waiting for a test result?
In most cases, a notification of parents of children in the class is helpful. However, one study published last month, suggests that there is a common progression of symptoms for COVID-19 that is reliably different form other infections, like the flu, in adults. Though this study does not address children, it does shed some light on the answer to this question. It suggests the most common progression of symptoms is: fever -> cough -> sore throat, headache, muscle aches -> nausea & vomiting -> diarrhea. The article diagram is viewable here. This suggests that a person progressing through these steps has a higher likelihood of COVID-19. In that setting, a school may consider closing a classroom before a test result has returned.
Will Immunity Last?
A new study published in Nature Medicine examined immunity to 4 different types of coronaviruses which cause respiratory disease (colds) in humans. They tracked the infection rates in 10 men in Amsterdam who had blood samples drawn every 3 months over 10 years. They found that reinfection with similar or identical strains of coronavirus occurred commonly within 12 months, and sometimes as soon as 6 months. Though they were not testing for SARS-CoV-2 which causes COVID-19, the wide variety in genetic types among the 4 different coronaviruses they tested suggests that SARS-CoV-2 may behave similarly and that we may be susceptible to re-infection at 12 months when immunity appears to wane. Though this small sample size is not sufficient to draw any conclusions about the long-term performance of a vaccine, it does suggest that we may be living with COVID-19 for the foreseeable future, and that other mitigation strategies, like seasonal mask use, may need to continue even after vaccination.
More discussion continues around rapid and standard (PCR) testing. We have discussed this previously in our newsletters, but it bears repeating. Rapid testing is helpful for screening large populations regularly. However, to date, it continues to have higher rates of false negatives and false positives. These false results may have significant consequences depending on the population, like nursing home patients who are congregated together when they are found to be positive. For schools, false negative results are of more consequence since a student or teacher with a false negative result has the opportunity to return and infect others in the classroom. This is the reason why standard testing (PCR) is still recommended. Accuracy is important, even if the test results may be delayed. Any inconvenience to a single student or family does not outweigh the consequences of infecting an entire classroom. Continued vigilance, on behalf of the school and parents, is important. We understand the frustration of symptom screening and frequent testing and we are hopeful that a vaccine will provide some reprieve.
In last week’s newsletter we discussed Astra Zenica, a pharmaceutical company, temporarily halting its phase three trial in order to investigate a potential adverse outcome in a volunteer. This week the trial resumed in the UK. The trial has not restarted in the U.S.. No formal published data is available regarding the case, but this is not unusual. There is increasing pressure from external sources asking for “transparency” and release of more information in real-time, but we do not anticipate any further release of information until this phase of the trial is complete.
In other vaccine news, the director of the CDC, Dr. Robert Redfield, noted that a vaccine is unlikely to be available to the general public until mid to late 2021. He did note that limited supplies may be available later this year but those doses would be prioritized to first responders and patients at highest risk. Though there is disagreement from the White House about the timeline, it is important to remember that teachers were added to the list of essential workers several weeks ago. This will likely give them priority access to the vaccine once it is available.
Is The MMR Protective?
Earlier this summer, the American Society for Microbiology announced that physicians were discussing a new theory in the fight against COVID-19. The theory states that the Measles, Mumps, and Rubella vaccine (MMR) might be protective against COVID-19. The idea is that the live attenuated or weakened virus, presented in a vaccine, stimulates the immune system and decreases the ability of other viruses to cause infection. In addition, the theory put forward the idea that the similarities between the viruses in the MMR and SARS-CoV-2 proteins would also help the immune system recognize and defend against SARS-CoV-2. This theory was posed as one reason why children seem to be less effected by the SARS-CoV-2 virus, due to their proximity to the MMR vaccine. Adults do not typically receive any further doses of the vaccine.
Since then, animal models were tested and this month a global trial to test whether the MMR vaccine protects front-line health-care workers against COVID-19 was approved. It will be interesting to see the results in a few months since the vaccine is known to be safe and is readily available globally. If successful, this will be one more tool to combat COVID-19 and similar infections.
A New Therapy
Drug manufacturer Eli Lilly is testing an antibody as a treatment against COVID-19. It was found in the blood of an early COVID survivor and has been cloned. Since then it has progressed to human testing. Eli Lilly and Regeneron are both testing monoclonal antibodies against COVID-19. A recent announcement from Eli Lilly claims that their treatment reduced the infection rate in nursing home patients from 6% to 1% and is presumed to have an effect lasting up to 3 months per treatment. Once the data is publicly available for review, if confirmed, this will be yet another proven therapy to combat COVID-19, especially in high risk patients. More information about the Eli Lilly and Regeneron therapies can be found here.
A Marathon, Not A Sprint.
With the possibility of a vaccine being for the general public being delayed until mid 2021, and the continued presence of the virus in our communities, it is easy to be discouraged. Masks, hand sanitizer, air filtration, and other mitigation strategies will continue to help keep us safe, in addition to vigilance. At Admin EM, we are committed to running this race with you. However, it is important to remember that this is a marathon. Each day brings new science, new debates, and new questions. Maintaining a consistent focus on personal safety and the safety of therapies (medications, vaccines, etc) is important. We will make it through this season, and until we can look back and reflect on our perseverance, we will be beside you the entire way.
Things are going to be this way for a while. But we are here to walk this with you.