Coronavirus Newsletter Links - September

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Further evolution of information on Covid, now that we are in month six of reporting. August is a slower month, with academics, and others going on holiday, but still a lot out there. One thing that we are going to see more of is the development of the virus. There is a broad debate on whether we are getting better at dealing with the virus, or whether the virus is becoming less lethal… but something is happening - https://www.aljazeera.com/news/2020/08/mutated-coronavirus-deadly-expert-suggests-200818040211070.html

We are also seeing some normalisation in the reporting of deaths. This has been a loaded political issue in many countries, much like ‘face masks’ but this is the first time we have reported that deaths in the UK have gone down by 5,000! Certainly deaths above average are still staggering though - https://www.cebm.net/covid-19/covid-19-florence-nightingales-daigrams-for-deaths/ [sp]. There is still excellent work being done on the tactics and strategy of dealing with the pandemic, and also useful tools being designed. If you have a favourite that you would like to be included in the September edition please contact the editor This email address is being protected from spambots. You need JavaScript enabled to view it. 

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Top Tips –

The CDC ‘Train’ programme aggregates a lot of different learning opportunities together, aimed at the US it offers a variety of programmes on Covid response or track and trace. http://www.phf.org/resourcestools/Pages/Coronavirus_Disease_2019_COVID_19_Training.aspx

‘Turning research into practice’ is the aim of TRIP, and it is a great resource for numerous health responders… or the curious. https://www.tripdatabase.com/search?criteria=%22covid+19%22+OR+%22novel+coronavirus%22&page=2&idList=

Some nice infographics from the South China Morning Post, which can provide data on how SARS-COV-2 started and how it has developed in China. https://multimedia.scmp.com/infographics/news/china/article/3047038/wuhan-virus/index.html

The always excellent TRACIE/ASPR have their latest edition of ‘Exchange’ out, with lots of interesting papers. The current version is here - https://files.asprtracie.hhs.gov/documents/aspr-tracie-the-exchange-issue11-final-508.pdf but it is worth signing up for their weekly email.

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Protection

A paper modelling the value of cheap face coverings for Covid 19. https://www.nature.com/articles/s41467-020-17922-x

Updated guidance from the CDC on how should wear PPE and how you should wear it as an ensemble– ie making sure that mask and eye wear don’t compete. https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html

Handy flowchart for which Emergency Use Authorization (EUA) applies to which respirator and provides links to information on performance factors - https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/considerations-selecting-respirators-your-health-care-facility

WHO catalogue for PPE, diagnostics and pretty much everything else that can be ordered globally via the Covid Supply Portal. https://www.who.int/publications/i/item/emergency-global-supply-chain-system-(covid-19)-catalogue

Some nice posters and other information resources (videos etc) from NETEC on PPE reuse and safe donning/doffing. https://repository.netecweb.org/exhibits/show/ppe-cons/ppe-cons

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Mitigation/Decon

Despite assertions that airtravel is safe, there is a lot of evidence that this might not be the case as individuals don’t follow the rules, and airlines don’t assert them. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2769383 and https://www.bbc.co.uk/news/uk-wales-53966897

Evaluation of decon techniques for the reuse of N95 respirators. https://c19hcc.org/resources/catalog-data/419/link

CDC information on the re-use of N95s when there is a shortage -  https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html

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Diagnostics

Antibody tests are going to be hugely variable as they rely on a strong response, which can vary in patients - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769741

Evaluation of ten point-of-care-style LFAs and two laboratory-based enzyme-linked immunosorbent assays. Turns out that antibodies peak at 20 days and that LFAs require training… https://www.nature.com/articles/s41587-020-0659-0  

Unsure which type of testing is right for you? Then this tool is designed to provide some clarity depending on whether you are a health professional, business/academic owner or member of the public. https://c19hcc.org/resources/catalog-data/460/link

FDA has some nice information on detection and identification tools https://www.fda.gov/medical-devices/coronavirus-covid-19-and-medical-devices/faqs-testing-sars-cov-2. I’d recommend their review of serological tests (LFA, ELISA etc), which is clear and easy to understand - https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/eua-authorized-serology-test-performance

Different approaches to testing across Europe and the UK captured in this document. As you prepare for the Winter Covid season, what testing methodology might work better? https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-population-wide-testing-country-experiences.pdf

We featured the Netherlands waste water epidemiology in the August issue. The CDC has now provided guidance for states and regions that want to do the same. Spoiler alert… it works really well. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/wastewater-surveillance.html and a webinar on the same - https://cste.sharefile.com/share/view/s552abc13bbc436d8

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Therapeutics

The latest on some of the vaccines that target SARS-COV-2. https://www.nature.com/articles/s41591-020-1048-4

Insights into the therapeutic effects of tocilizumab, and potential target cell populations for treating COVID-19-related cytokine storms - https://www.nature.com/articles/s41467-020-17834-w and also the value of it in late stage patients - https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30277-0/fulltext

Short, five day, doses of remdesivir had greater effect than longer 10 day doses. It suggests a complicated relationship with the virus. https://jamanetwork.com/journals/jama/fullarticle/2769871

BCG vaccine providing some protection against SARS-COV-2? Maybe… https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32863070

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Strategy

Greater clarity on ‘at risk’ groups. Diabetics  and black people are definitely the worse, but Native Americans and Asians are also higher than whites. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2769369 also https://www.kff.org/disparities-policy/issue-brief/racial-disparities-covid-19-key-findings-available-data-analysis/

Carnegie Mellon does a great Covidcast, looking visually at a wide variety of data points. Interesting to watch it bloom in various US cities. https://covidcast.cmu.edu/?sensor=doctor-visits-smoothed_adj_cli&level=county&date=20200828&signalType=value&encoding=color&region=42003

Precision for Covid has lots of really interesting graphs based on all kinds of data, that will allow you to see how social distancing, based on mobile phone data, helped prevent, or had no impact, on the spread of the virus. We’re focussing on their one for Africa as there are very few sites that do - https://precisionforcovid.org/africa but it’s all worth an explore.

DHS S&T developed a “master question list” that summarizes what is known, what additional information is needed, and who may be working to address such fundamental questions as, “What is the infectious dose?” https://www.dhs.gov/sites/default/files/publications/mql_sarscov_082520.pdf

Information and comparison on mental health and economic distress over a range of countries. The US does not come out of mental health well. https://www.commonwealthfund.org/publications/issue-briefs/2020/aug/americans-mental-health-and-economic-consequences-COVID19

WHO report card from 1 Feb to 30 June. Quite a lot of back slapping… and then a request for more funding. If it doesn’t become forthcoming it seems likely there’ll be increased deaths in some countries. https://www.who.int/publications/m/item/who-covid-19-preparedness-and-response-progress-report---1-february-to-30-june-2020

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Tactics

It’s not here yet, but there seems to be little doubt that a vaccine will be available shortly. The US National Governors Association provides planning considerations for mass distribution of one. https://www.nga.org/memos/covid-19-vaccine-considerations-mass-distribution/

Centre for Medicaid has come out with a great document filled with best practice for nursing homes. If you have one, or if you have a family member in one, then this is the thing you should be waving around! https://www.cms.gov/files/document/covid-toolkit-states-mitigate-covid-19-nursing-homes.pdf

Pub or no pub [other gatherings are availablehttps://covid19risk.biosci.gatech.edu/">https://covid19risk.biosci.gatech.edu/

A US EMS system designed to map and record resource shortages. A handy system that other countries should think about - https://nemsis.org/ems-covid-resource-reporting-tool/

When should clinicians repeat PCR testing? https://www.ncbi.nlm.nih.gov/research/coronavirus/publication/32863359

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