For the Harvard Chan community: Find the latest updates, guidance, useful information, and resources about Coronavirus Disease 2019 (COVID-19) here.
In the wake of an outbreak of coronavirus that began in China in late December 2019, Harvard T.H. Chan School of Public Health experts have been speaking to a variety of media outlets. We’ll be updating this article on a regular basis. Here’s a selection of stories from April 2020 in which they offer comments and context:
April 30: Public Health Calls for Solidarity, Not Warfare (Foreign Affairs)
To protect public health during the COVID-19 pandemic, governments are imposing measures ranging from the mandatory wearing of masks to quarantines to curfews, and sometimes using tactics such as arrests, fines, and intimidation to enforce those measures. But Natalia Linos and Mary Bassett, executive director and director, respectively, of the FXB Center for Health and Human Rights at Harvard University, argued against heavy-handed methods. They called instead for a civilian health workforce that could monitor compliance with restrictive measures but also help out by distributing masks, food, and other essentials.
April 30: Tracking the coronavirus through crowdsourcing (Harvard Gazette)
A new crowdsourcing app, How We Feel, is gathering data on the spread of COVID-19. The app was launched as part of a collaboration involving Pinterest and researchers from Harvard and other institutions. One of the collaborators is Xihong Lin, professor of biostatistics.
April 30: What to know about the efforts in Massachusetts to require masks in public (Boston.com)
As of May 6, Massachusetts will require everyone in the state to wear masks in public if they can’t remain six feet away from other people, in order to curb the spread of COVID-19. Some cities and towns, such as Brookline, Cambridge, and Somerville, are already requiring masks everywhere, all the time. Experts say that risk of infection is low in uncrowded outdoor areas. But epidemiologist William Hanage said that requiring face masks in all outside settings can reduce the chance that someone will move into a crowded area without a mask. And research professor of public health Barry Bloom said he is a “big believer” in masks, because they can help reduce the amount of virus particles that can get into a person’s lungs.
April 30: Is It Safe To Send Your Mom Flowers For Mother’s Day 2020? Here’s What To Know (Elite Daily)
There’s no evidence of coronavirus being transmitted on flowers, says preparedness fellow Rachael Piltch-Loeb. But if you’re sending your mother flowers on Mother’s Day, it would be safest if mom washes her hands before and after opening the packaging and arranging the flowers, she said.
April 30: What Roles Do Children Play in Spreading COVID-19? (WebMD)
Most children who get COVID-19 get very few symptoms or none at all, but they could be passing the virus on to others. Data hints at the possibility that young children don’t play a large role in transmitting the virus, while adolescents may be more likely to pass it on, said epidemiologist William Hanage. But he added that it’s still “extremely premature” to draw any firm conclusions about whether age plays a role in how the coronavirus is transmitted.
April 30: Opinion: How the invisible hand of the free market screwed up coronavirus testing in the U.S. — and how to fix it (Project Syndicate)
Widespread testing is “the first line of defense” during disease outbreaks, according to this article co-authored by doctoral candidate Sachin Silva. The authors argued that the world needs a global coordinating platform to ensure the rapid development, production, and deployment of diagnostics during outbreaks such as COVID-19.
April 30: On eve of reopening, Texas COVID-19 cases remain high and tests still lag Abbott’s benchmarks (Dallas Morning News)
Texas was planning to start reopening its economy on May 1 even though the state hadn’t met two important benchmarks set by the governor and a top adviser — 30,000 coronavirus tests a day, and a 14-day decline in new cases. Experts warned that, without enough testing, the state may not be able to keep up with new infections. “If you have a hurricane that’s coming, you want to make sure you have our weather satellites up in the air and ready to go to track your hurricane,” said health policy researcher Thomas Tsai. “You don’t wait for the hurricane to come to launch your satellites.”
April 30: COVID-19 Is Not the Flu (National Review)
Experts agree that the coronavirus, which killed about 60,000 Americans in six weeks, is much more lethal than the seasonal flu. And after the first wave of disease passes, more waves are expected, said epidemiologist Marc Lipsitch. He hopes that a combination of strategies — widespread testing for infections, tracing the contacts of those infected, wearing masks, washing hands, and social distancing — will help keep the disease at bay in the coming months while enabling the economy to function with less disruption.
Most U.S. adults would prefer to wait for a further reduction in COVID-19 cases before their states return to normal day-to-day activities, according to a new poll. Experts say widespread testing and contact tracing is key to reopening economies. Although the White House has been saying that there’s enough testing, HGHI director Ashish Jha said many more tests — 3.5 million a week, at minimum — are necessary before reopening.
April 30: Rural areas face pandemic risk as country’s urban areas reopen (Roll Call)
The COVID-19 pandemic is likely to spread into rural areas, where older populations with higher rates of chronic illnesses are particularly vulnerable, and where hospitals have long faced declines, according to experts. Those at risk include people living in nursing homes as well as those living in crowded conditions in areas without a lot of housing options and low wages. “It takes only one person to set off a household,” said social epidemiologist Nancy Krieger.
As of April 30, hospitalizations for the coronavirus in Massachusetts were stuck at roughly 3,800 for about two weeks. Although it’s a good sign that the numbers are plateauing, “we still have a long ways to go” until hospitalizations and daily deaths decline for a sustained period, said health policy researcher Thomas Tsai. “I think that’s why the governor and a lot of municipalities are doing the right thing by still being cautious.” As for social distancing, he said it’s “not an on/off switch. We need to think about this as a dial. We may have to dial it up, or dial it down depending on what the case counts are, what the hospitalization rates are, what the fatality rates are.”
April 30: Poll: Many Americans feel lonely and anxious during pandemic (Associated Press)
The coronavirus pandemic is significantly impacting people’s mental health and stress levels, according to a new survey. Psychiatric epidemiologist Karestan Koenen said that physical distancing, the lack of predictability, economic upheaval, and the inability to mourn the death of loved ones in traditional ways all are factors in the toll on our mental health. “We can’t do all the normal stuff,” she said. “It feels like we’re more alone.”
April 30: There May Be a Dangerous Shortcut to a Coronavirus Vaccine (New York Times)
One idea for hastening the development of a coronavirus vaccine is known as human challenge — when volunteers are deliberately infected with the virus to test vaccines. This opinion piece discussed the ethics of such trials, and mentioned a recent article co-authored by epidemiologist Marc Lipsitch that argued that while human-challenge trials are risky, they could speed the vaccine development process by months. Wrote Lipsitch and his co-authors, “Every week that vaccine rollout is delayed will be accompanied by many thousands of deaths globally. If the use of human challenge helped to make the vaccine available before the epidemic has completely passed, the savings in human lives could be in the thousands or conceivably millions.”
April 30: Cuomo, Bloomberg detail plan to trace Covid-19 contacts (Politico)
Under a new effort in New York, thousands of state workers and others will be deployed to help trace the movements of people who’ve come into contact with individuals with COVID-19. Some public health experts, like epidemiologist Marc Lipsitch, have cautioned that a major contact tracing effort could divert resources from other efforts to fight COVID-19. Lipsitch said he believes that contact tracing “in this current setting, is going to be a fairly modest contributor [to reopenings].”
April 30: Expert report predicts up to two more years of pandemic misery (CNN)
A team of pandemic experts has predicted in a new report that the new coronavirus is likely to keep spreading for another 18-24 months in the U.S. They urged officials to stop telling people that the pandemic is on the wane, and instead to prepare for a long period of intense effort to quell upcoming waves of disease. Epidemiologist Marc Lipsitch, co-author of the report, expressed surprise that many states are lifting restrictions aimed at curbing the spread of COVID-19. “I think … it’s an experiment that likely will cost lives, especially in places that do it without careful controls to try to figure out when to try to slow things down again,” he said.
As some states begin to reopen their economies, and more people move around and come into contact with others, coronavirus infections may resurge. And if people travel, infection could spread to other states. These potential ripple effects could also occur if universities, employers, or sports leagues decide to reopen. If universities bring students back — reasoning that, overall, they’re less impacted by COVID-19 — “and young people start transmitting among themselves but largely asymptomatically or with mild symptoms, if you don’t look deep enough at the question, you might say, ‘Great, we’re building up herd immunity,’” said epidemiologist Michael Mina. “But then those young people will inevitably start seeding outbreaks to the wider community, and anyone else can be at risk.”
Most of the nearly 330 million people in the U.S. remain at risk for infection from the coronavirus — which means that, as communities begin to allow businesses to reopen, they must be ready to control new outbreaks. The way to do that, said public health research professor Barry Bloom, is to have a robust testing system. “We’re going to have to find those people who are infected, and not just wait for them to come to us,” he said. The bottom line is, it’s testing, testing, testing — so we know where the epidemic is before we can relax any stringencies in a stepwise fashion.”
April 30: Coronavirus antibody tests explained: what are they and do they work? (The Guardian)
Antibody tests can show if a person has been exposed to COVID-19, and possibly if they have become immune to the disease. There is hope that these tests could help indicate that it’s safe for certain people to return safely to their jobs. But some early tests have been unreliable. And it’s not known what amount of antibodies is necessary to confer immunity. Epidemiologist Michael Mina said that once scientists figure this out, an ideal antibody test would “give you value — similar to how people are used to getting a cholesterol value, or a sugar level” — that confirms safety from future infection.
April 29: What Makes an Office Building “Healthy” (Harvard Business Review)
Bringing employees back to office buildings amid the coronavirus pandemic will require a focus on making those buildings “healthy” in order to minimize risk of disease transmission as much as possible, wrote Joseph Allen, assistant professor of exposure assessment science, and John Macomber, co-authors of the 2020 book “Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.” They offered a framework for how employers can safely repopulate their offices.
April 29: A wider lens on the impact of COVID-19 (Every Child Thrives)
David Williams, Florence Sprague Norman and Laura Smart Norman Professor of Public Health, discussed COVID-19’s disproportionate impact on communities of color in this interview. “The coronavirus did not create racial inequities in health,” said Williams. “It has just uncovered and revealed them. These disparities have long existed in the U.S., and persist across leading causes of death, from the cradle to the grave.”
April 29: As death toll rises, more details emerge about Turlock Nursing and Rehabilitation Center (Modesto Bee)
This article chronicled a rash of COVID-19 deaths and infections at a nursing home in California. It quoted from an article co-authored by health policy expert Michael Barnett, which said that nursing home residents are older and typically have chronic illnesses, making them susceptible to COVID-19 complications that can lead to death. “Unlike a hospital, a nursing home is someone’s home,” Barnett and his co-author wrote. “Often, residents live in close quarters with one another. So it can be quite challenging to move or quarantine residents once they are sick.”
April 29: Why summer likely won’t save us from the coronavirus (Vox)
Although some are hoping that sunnier, warmer, and more humid weather will destroy the coronavirus, as it does with other viruses, experts say that’s unlikely to happen, given that places with such weather have had growing numbers of COVID-19 cases. This Vox story quoted from an article on the website of the Center for Communicable Disease Dynamics (CCDD) written by epidemiologist Marc Lipsitch, CCDD director. “For the novel coronavirus SARS-CoV-2, we have reason to expect that like other betacoronaviruses, it may transmit somewhat more efficiently in winter than summer, though we don’t know the mechanism(s) responsible,” he wrote. “The size of the change is expected to be modest, and not enough to stop transmission on its own.”
April 29: End of Trump’s social distancing policy spurs fears of virus rebound (Politico)
The Trump administration is ending its national campaign to get people to stay home to limit the spread of the coronavirus, leaving it up to states to figure out their own plans. Experts worry that the lack of national guidelines could drive a resurgence of COVID-19 or prolong the current outbreak. In response to President Trump’s statements that he expects warmer temperatures and sunny days in summer to contain the spread of the virus, HGHI director Ashish Jha said, “It might help on the margins. But we shouldn’t expect big help from temperature.”
About 15,000 more people died in the U.S. between March 1 and April 4 than would have been expected at that time — a figure roughly 1.5 to 2 times higher than the reported number of COVID-19 deaths at the time. The gap suggests that many more people died from COVID-19 than have been reported in official counts. “As we gain more detailed information on the causes of death, we will learn more about whether COVID-19 caused them directly, or whether the many disruptions, both to health care, and economic disruption, could have caused many of the excess deaths,” said Ellen Meara, professor of health economics and policy.
Public health research professor Barry Bloom wrote that scientists in China, the U.S., and other countries are working together to provide the best scientific evidence they can to beat COVID-19. “It’s the international sharing of scientific knowledge and values that will ultimately defeat this disease,” he wrote.
April 29: As death toll passes 60,000, Trump’s team searches for an exit strategy (Politico)
Although the White House is focused on rebuilding the pandemic-ravaged U.S. economy, experts say that there is still much to do to contain the coronavirus. COVID-19 could resurge in the fall, possibly combining with the seasonal flu to create an even more serious public health emergency, and businesses may be forced to close again. HGHI director Ashish Jha said that winning the war on the coronavirus over the next few months will be less about finding a way out of the crisis than about the Trump administration continuing to stay in the fight. “The virus is not cunning — it doesn’t change strategies,” he said. “It’s not that hard. We have just not been interested in trying to execute on it.”
Governments that are beginning to lift coronavirus-related lockdowns are considering allowing people to form “social bubbles”—small groups of people that can spend time together, as long as they agree to socialize only with each other. But experts warned that social bubbles could still be significant sources of infection. “I think approaches like this to refine distancing are an important part of how we move past the initial surge and get into the space beyond it that will define the rest of the pandemic,” said epidemiologist William Hanage. “I also think that there are multiple reasons to be cautious, from the obvious fact that some people will be more at risk, for example, the elderly, and should not participate, to the fact that some people may be more at risk of already being infected themselves, people working in health care for instance.”
April 29: Op-ed: We need the real CDC back, and we need it now (STAT)
HGHI director Ashish Jha wrote that, since the beginning of the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) — the premier public health agency in the world — “has been inexplicably absent, and Americans are suffering and dying for it.” He added, “Real CDC leadership — clear, science-based guidance, effective coordination of states, and public transparency of data — is absolutely essential for confronting and getting clear of this crisis.”
April 29: A terrible price: The deadly racial disparities of COVID-19 in America (New York Times)
Around the U.S., areas with large populations of black people have experienced disproportionate death rates from COVID-19. A complex mix of factors explains the disparities, such as underlying health conditions that are more common and more deadly in black Americans, and that make them more vulnerable to COVID-19. Experts say that socioeconomic disparities and entrenched racism are at the root of the problem. For instance, social scientist David Williams said it’s possible that implicit bias among health care workers is higher than usual because of the stress of dealing with COVID-19. “I worry about what it means in terms of the life-or-death decisions in the context of coronavirus,” he said. He also cautioned against suggestions that individual behavior is leading to higher COVID-19 deaths among African Americans. He attributed the disparities to “societal policies, driven by institutional racism.”
April 29: CRISPR-based diagnostic chips perform thousands of tests simultaneously to detect viruses (Broad Institute)
A new diagnostic platform developed at the Broad Institute uses CRISPR-based detection technology and microfluidic chips to run thousands of tests at the same time to check for viruses, with same-day results. One chip can range from detecting a single type of virus in more than 1,000 samples to searching a small number of samples for more than 160 viruses, including the coronavirus that causes COVID-19. Pardis Sabeti, professor of immunology and infectious diseases, was co-senior author of a paper in Nature that described the technology. “The current pandemic has only underscored that rapid and sensitive tools are critical for diagnosing, surveilling, and characterizing an infection within a population,” she said.
There’s not much data available for mathematical forecasts of the COVID-19 pandemic because the disease is only a few months old — and that makes it difficult for experts to predict how various policies could affect the severity of the outbreak, said Caroline Buckee, associate professor of epidemiology and associate director of the Center for Communicable Disease Dynamics. “The reality is that we all want answers,” she said. “How many hospital beds do I need? When can we start rolling back physical distancing interventions? And people put out models, but they can be misapplied if they’re read too literally. That’s a tension between the reality of the uncertainty in the science and the public’s need to have some sense of what’s going to happen.”
April 29: American idols: New action figures, toys immortalize heroes of the coronavirus pandemic (USA Today)
A new line of action figures and toys from Mattel feature doctors, nurses, emergency medical technicians, grocery workers, and delivery workers — people on the front lines of the COVID-19 pandemic. Net proceeds from sales of the toys will go to #FirstRespondersFirst, an initiative to support health care first responders that was launched in March by Harvard Chan School, Thrive Global, and the CAA Foundation, the philanthropic arm of talent firm the Creative Arts Agency.
With Americans eating most meals at home because of the COVID-19 pandemic, diets could improve — or not, depending on what people choose to cook, and on their access to healthy food, say experts. Many variables make it difficult to predict how the pandemic will change how Americans eat. But one thing is clear, said Walter Willett, professor of epidemiology and nutrition: “The epidemic is likely affecting diets, and our diets are likely affecting who dies” — because major risk factors for being hospitalized for COVID-19 include diet-related conditions, such as obesity, hypertension, and type 2 diabetes.
April 28: Cautioning against ‘letting up,’ Baker extends business closures, stay-at-home advisory to May 18 (Boston Globe)
Massachusetts Gov. Charlie Baker announced that business closures in the state will be extended at least until May 18 to limit the spread of COVID-19. Howard Koh said, “You need to see sustained declines — sustained irrefutable declines — in cases, deaths” before reopening. “He [Gov. Baker] is being very careful and following the data very closely. The data and science are clearly helping him make that decision.”
April 28: Is the Healthiest Building in the World Worth the Rent? (Harvard Business Working Knowledge)
In this podcast, healthy buildings expert Joseph Allen and John Macomber of Harvard Business School spoke about the importance of healthy buildings in a post-COVID-19 world. Allen and Macomber are co-authors of the new book, “Healthy Buildings: How Indoor Spaces Drive Performance and Productivity.”
April 28: How Contagious? Likely Before You Know You’re Sick (WebMD)
Experts say it’s likely that people are transmitting COVID-19 before they feel sick, but it’s not clear how long before. Epidemiologist William Hanage said that infected people with no symptoms may be just as contagious as those with symptoms, such as a dry cough, fever, and aches. As for when people are no longer contagious, epidemiologist Michael Mina said, “A good rule of thumb for this virus … is to wait for about 2 weeks after symptom onset before assuming that you’re most likely not transmissible.”
April 28: UK on track for one of Europe’s worst virus death tolls (Reuters)
Recent data showed that COVID-19 deaths in Britain topped 24,000, giving it one of the worst coronavirus death tolls in Europe. “The United Kingdom is going to be right up there among the worst-hit nations in the initial surge,” said epidemiologist William Hanage. “With the most optimistic views of the amount of immunity that might be being generated, it would still not be close to having enough to be able to return to normal. The crucial part of the next stage is to have enough testing and early warning systems to avoid ending up back where the UK is now.”
April 28: Trump guidance puts burden on states to reach Covid-19 testing targets (The Guardian)
With the Trump administration placing most of the burden on states to ramp up testing for COVID-19, experts say current testing levels are still far from where they need to be. HGHI director Ashish Jha said that the U.S. should be performing a “bare minimum” of 500,000 tests per day — a threshold it has not reached yet. “Identifying who’s infected, who’s not is like public health, disease control 101,” said Jha. “Without that, you’ve got nothing. If you can’t test people for the virus, you cannot figure out who’s infected, you can’t keep them away from susceptible people, you can’t run your economy.”
April 28: The Immunity Numbers Are Too Low (The Atlantic)
Initial results from antibody surveys — tests that can show if a person has had COVID-19 — suggest that there are still too many Americans vulnerable to infection. Even if someone does have antibodies to COVID-19, it’s not clear if that makes them immune, or if they were immune, how long it would last. And many antibody tests on the market are unreliable. Further, current antibody surveys are revealing that potential immunity to COVID-19 can vary widely from location to location. So although the pandemic is global, “it is made up of hyperlocal epidemics that are differentially impacting communities,” said immunologist Yonatan Grad. “At some point, we’re going to need to think about How do we all get to the same place?”
April 28: Virus Test Shortages Undermine Drive to Restart U.S. Economy (Bloomberg)
States across the U.S. have been competing with each other for much-needed coronavirus testing and supplies. Experts say that while U.S. testing capacity has improved, it still has a long way to go. On April 27, the White House announced a plan to provide enough tests to all 50 states for at least 2% of their residents. HGHI director Ashish Jha said the announcement suggests that the administration is “taking testing seriously,” but it should have been doing so in February. “I see this as the first step in the White House finally recognizing what every public health officials has known for months. But I worry it’s too little too late.”
April 28: Governor’s testing claims clash with healthcare industry reality in Florida (Miami Herald)
Gov. Ron DeSantis of Florida says that the state has enough COVID-19 testing capacity to keep people safe as businesses start to reopen. But healthcare operators and public health experts questioned his claims. Epidemiologist Michael Mina noted that testing needs will be different in communities and states across the U.S. — the higher the case rate in a particular place, the more surveillance and testing will be needed. “Most of us working on the safest ways to open up the economy again place significant amounts of testing front and center to prevent significant outbreaks and monitor them,” he said.
April 28: We’ve reached the coronavirus plateau. So when will the numbers begin to decline? (Boston Globe)
Although the COVID-19 pandemic in Massachusetts appears to be plateauing, experts don’t know when the number of cases will start to go down. Some, like epidemiologist William Hanage, say that the plateau might be longer than expected in the U.S., because social distancing restrictions here have not been as stringent as in Wuhan, China, where the pandemic began. “If [new infections] are stopped very quickly by very intense actions and quarantines as was the case in Wuhan, then you expect new cases to fall rapidly,” he said. “However if less intense interventions are put in place the virus can continue to transmit, just more slowly. This can lead to a long plateau in which cases decline, but over a longer time period.”
April 28: Northeastern model shows Boston’s coronavirus outbreak began much earlier than previously thought (Boston Globe)
In early March, Boston public health officials knew of a handful of COVID-19 cases in the city. But thousands may have been infected in January and February, according to a new model from Northeastern University researchers. Immunologist Sarah Fortune said the greatest lesson from the finding is that “we need proactive public health. We need to remember this moment and invest in surveillance, not just reactive public health.”
Health experts say that social problems stemming from poverty, such as unstable housing, food insecurity, and lack of transportation, are key reasons that people of color are being disproportionately sickened and killed by COVID-19. They hope the virus will lead to increased funding to tackle poverty and boost health. “The question is how do we generate the political will to do those things that would work and would create a more productive workforce for the American economy?” said social scientist David Williams.
April 28: Governors tiptoe toward reopening across the country (The Hill)
Governors considering lifting coronavirus restrictions are trying to balance public health with the health of the economy. Complicating matters is the lack of adequate testing, which is necessary to monitor cases and prevent outbreaks. “I don’t think we necessarily have gotten testing and surveillance efforts where they need to be to … prevent large outbreaks from happening, especially if you look across the whole of the United States,” said epidemiologist Michael Mina. “I expect we will see more cases, though, once we open back up. We know the vast majority of the population are not immune.” He said it will take a few weeks to how the reopenings impact the spread of disease.
April 27: App helps scientists track COVID-19 symptoms (KHOU-11, Houston)
Andrew Chan, professor in the Department of Immunology and Infectious Diseases, discussed the new free research app he helped create, called the COVID Symptom Tracker. The app records users’ COVID-19 symptoms, so that scientists can learn more about how the disease is spreading and pinpoint hotspots. “Anybody in the public can download [the app] to their phone, which allows them to report how they’re feeling, if they’re well or if they feel sick, and also if they’ve been feeling sick, whether they’ve been evaluated for COVID-19,” said Chan. “We can then use this information to deliver back in real-time information about how communities are currently feeling and whether there might be potential hotspots of the disease.”
April 27: This is what waking from an economic ‘coma’ might look like (CNN)
In this video, immunologist Yonatan Grad was one of several experts commenting on what it will be like when COVID-19 restrictions begin to lift and the U.S. economy restarts. “The ability to do extensive testing, as we’ve heard again and again, remains a challenge in many places,” he said, adding, “If we are not prepared for resurgence, I fear even worse damage to businesses and the economy.”
April 27: An unexpected side effect of COVID-19: more guns (Undark)
Available data suggest that the COVID-19 outbreak has prompted an unprecedented interest gun ownership—many among first-time buyers. Experts say the interest likely stems from people’s concern about protecting themselves and their homes if basic services, such as law enforcement, are disrupted by the pandemic. Public health experts caution that the pandemic could increase the well-documented risks of having a gun in one’s home. David Hemenway, professor of health policy, said that guns purchased for self-defense are usually not stored as safely as guns purchased for hunting, and tend to be “much more accessible to people in the family and people you don’t want to have them.”
April 27: Pence to visit Mayo Clinic to learn about testing ‘moonshot’ (AP)
Minnesota’s Mayo Clinic is partnering with the state and the University of Minnesota on creating a coronavirus testing “moonshot” to quickly boost the state’s testing capacity to 20,000 tests per day. Across all states, Minnesota currently ranks among the lowest in per-capita testing. “If Minnesota can increase its capacity to 20,000 tests per day, that would be a very meaningful increase in its testing capacity,” said health policy researcher Thomas Tsai. But test numbers are only part of the solution, he said. “The most important piece is the strategy around testing — not waiting for people to show up. You have to do active contact tracing and active outreach into the community.”
In an interview with Jim Braude of WBGH’s “Greater Boston,” immunologist Sarah Fortune said that COVID-19 antibodies will likely provide some level of protection against reinfection.
April 27: How air pollution exacerbates Covid-19 (BBC)
Recent research from Harvard Chan School found that air pollution can worsen the impact of COVID-19. Other research even suggests that air pollution particles may act as vehicles for viral transmission. “The evidence we have is pretty clear that people who have been living in places that are more polluted over time, that they are more likely to die from coronavirus,” said C-CHANGE interim director Aaron Bernstein. “For every small increment in air pollution, there’s a substantial increase in death.” Doctoral student Xiao Wu, who led the Harvard Chan study with Rachel Nethery, assistant professor of biostatistics, said that the link between air pollution and COVID-19 impact is like due to the higher risk of existing respiratory and heart diseases in areas with higher pollution.
April 27: How the U.S. should invest in public health before reopening the economy (Fortune)
In this commentary, Harvard Chan School Dean Michelle Williams and Wayne Koff, CEO of the Human Vaccines Project, listed the public health investments needed to safely reopen the economy during the coronavirus pandemic.
April 27: Can We Track COVID-19 and Protect Privacy at the Same Time? (New Yorker)
Researchers led by epidemiologist Caroline Buckee are using cell phone data to study people’s mobility patterns, in order to help control COVID-19—without violating people’s privacy. Buckee described her work as “absolutely exhausting, often quite emotional, and completely all-consuming.”
A new state-by-state analysis from the Harvard Global Health Institute (HGHI) and STAT found that more than half of U.S. states would need far more testing if they are considering lifting coronavirus restrictions after May 1. The analysis is aimed at providing a guide for individual states as to how much they need to ramp up testing. “You can’t just take the national number and scale it to states by their population,” said HGHI director Ashish Jha. “You have to base it on the size of the outbreak in the state.” New York and New Jersey topped the list in terms of how many more tests they’d need each day—100,000 more and 68,000 more, respectively.
April 27: Can We Use COVID-19 To Transition Towards A Greener, Healthier Future? – Climate Experts Weigh In (Health Policy Watch)
Experts at a recent Harvard webinar said that the COVID-19 pandemic, despite its devastation, presents a ‘shock’ that could propel the planet to a greener future. Panelists included C-CHANGE interim director Aaron Bernstein, and Gina McCarthy, professor of the practice of public health and chair of the C-CHANGE Board of Advisors.
April 26: Can antibody tests help end the coronavirus pandemic? (New York Times)
Antibody tests show if someone has been infected with COVID-19. But recent research suggests they’re often inaccurate, and it’s not clear if having antibodies means that a person is immune to the disease. Epidemiologist William Hanage said that while results of antibody tests should not be used to make public health decisions, they can be used to estimate the size and nature of the epidemic.
Health policy MPH student Aaron Troy wrote about the illustrated, accessible COVID-19 guide for the autistic community that he helped create with fellow members of Students Against COVID-19, a student-led initiative to tackle the disease by supporting communities and spreading information. The group was started by Harvard Chan School students.
Experts say that although Florida is “flattening the curve” of COVID-19 infection—keeping cases low enough so that they don’t overwhelm hospitals—keeping it that way will require expanding testing to identify, trace, and isolate people who are infected. “Can we please get more testing? I would urge people to be looking for more testing,” said epidemiologist William Hanage.
April 25: More Questions Than Answers About the Racial & Ethnic Skew in COVID-19 Deaths (City Limits)
In New York City, blacks and Latinos comprise a larger share of COVID-19 deaths than they do of the city’s population. Experts say that the disparity is driven by high poverty rates in these groups, which increase their likelihood of having underlying health conditions—such as diabetes, obesity, and hypertension—that make them more vulnerable to COVID-19. Mary Bassett, FXB director and former New York City health commissioner, noted that “diabetes is a chronic disease related to income; it has social roots. Processed food tends to be cheaper than healthier options.” Josiemer Mattei, Donald and Sue Pritzker Associate Professor of Nutrition, commented on a trend of higher death rates among New York City Latinos compared to non-Latino whites. “We do not have a clear understanding of the situation around minority populations,” she said. “So far we can speculate, mainly based on pre-existing inequities that may be driving the disparate numbers of COVID-19 among Latinos now.
April 25: In a Crowded City, Leaders Struggle to Separate the Sick From the Well (New York Times)
It’s been difficult to contain the spread of COVID-19 in Chelsea, Mass., where many families live in cramped housing. The city is home to many immigrants, and is the epicenter of the coronavirus crisis in Massachusetts. Separating the sick from the well is crucial to slowing the spread of disease. That’s what China did in Wuhan, where the coronavirus outbreak originated. But Xihong Lin, professor of biostatistics, who studied the response in Wuhan—which included enforced quarantines—said that, in the U.S., sick people can only be encouraged to separate from family voluntarily. “Western countries are different from Asian countries,” she said. “One cannot force people to do things.”
April 25: Minorities hit hard by coronavirus in U.S., but Nebraska isn’t tracking by race, ethnicity (Star Herald)
COVID-19 cases in Nebraska aren’t routinely being tracked by race or ethnicity. Data from other states shows that people of color are being disproportionately affected by the virus, and it’s likely that the same thing is happening in Nebraska, say experts. Commenting on why race or ethnicity data may be lacking, social scientist David Williams said, “At drive-thru sites, people crack windows open and provide information to someone who writes it down on a clipboard. My suspicion is it is sometimes not asked. Those collecting the data don’t see it as a priority and aren’t asking it.”
April 24: The Scariest Pandemic Timeline (The Atlantic)
Many public health experts are worried that even if COVID-19 numbers decrease this summer, the virus will resurge in the fall—and that, combined with the regular flu season, it could strain hospital capacity even more than it did this spring. “It’s going to be a very difficult fall and winter this year coming up,” said HGHI director Ashish Jha. Most experts say the best path forward is to significantly ramp up COVID-19 testing and contact tracing to keep infections down as much as possible, and to keep up social distancing—which could also help reduce the spread of flu. “Some of these things will hopefully work their way into our more normal, day-to-day lives, and we’ll be able to do ‘social distancing light’ in a way that will help us reduce the transmission,” said Stephen Kissler, research fellow in the Department of Immunology and Infectious Diseases.
April 24: Mental health in Africa amid pandemic (Harvard Gazette)
Experts from Kenya and South Africa discussed the particular mental health challenges faced by their countries—such as a lack of caregivers and unequal access to health care—as they grapple with the coronavirus pandemic. The event was part of Harvard Chan School’s online mental health series, hosted by psychiatric epidemiologist Karestan Koenen and Bizu Gelaye, assistant professor in the Department of Epidemiology.
April 24: After America reopens, a healthy roadmap for theater (Harvard Gazette)
Healthy buildings expert Joseph Allen is working with Diane Paulus, director of the American Repertory Theater (A.R.T.), on how the A.R.T. and other theaters can continue to provide great art and keep audiences, performers, and theater staffers safe in spite of the COVID-19 crisis. The collaboration began before the pandemic in preparation for the A.R.T.’s move to Harvard’s Allston campus, with the goal of creating a structure that’s healthy in terms of ventilation and materials and that will also adapt to a variety of public uses. In planning the new theater space, Allen said, “we have to recognize there is no ‘zero risk.’ We are working to minimize risk. The goal is to give people hope.” Allen also discussed the collaboration in a WBUR story.
April 24: A five-layered defense for workplace reopening (Harvard Gazette)
Healthy buildings expert Joseph Allen offered a relatively low-cost, five-step approach for employers and building managers considering how to safely reopen their establishments as COVID-19 restrictions begin to lift. The steps, in order, include keeping employees home; bringing back only key employees; using healthy-building strategies such as increasing the flow of outside air and using portable air purifiers; having people work staggered shifts so buildings are less dense; and using personal protective equipment such as masks. He warned, though, that even taking one or more of these steps can’t ensure complete protection. “Everyone has to be really clear,” he said. “There’s no such thing as zero risk.”
Although there’s “anxiety and anxiousness” about lifting COVID-19 restrictions, epidemiologist Michael Mina said that doing so “has to be dealt with in a very organized and carefully thought out fashion so that we don’t find ourselves with large outbreaks happening again.” Once cases of COVID-19 get down to a more manageable number, contact tracing will become a crucial aspect of epidemic detection and control, he said.
April 24: Independent doctors feel coronavirus pressure (Orlando Sentinel)
Many medical practices across the U.S. have seen their business fall off as a result of the COVID-19 pandemic. Patients are avoiding doctors’ offices because of worry about infection, elective surgeries have been canceled, and some specialties, such as orthopedics, have almost been brought to a halt. Health policy expert Michael Barnett said that it will take a while for primary care practices to build patient volumes back up, because the virus isn’t going away. “What I fear might happen is that a lot of primary care practices are going to go out of business and the only way that they will stay afloat is by being basically part of a health-care system,” he said. He said this could “raise prices and just further exacerbate health-care spending issues that have been plaguing us for decades.”
April 24: Governments Move to Bolster Aid as Global Coronavirus Deaths Top 187,000 (Wall Street Journal)
This article offered a snapshot of coronavirus infections and deaths around the world, and various governments’ efforts to control the pandemic while minimizing its economic fallout. Epidemiologist William Hanage noted that some serological tests—blood tests that check for antibodies to the coronavirus and may shed light on whether a person has become immune—may be unreliable or generate false positives. A preliminary study from serological tests in New York showing that the state’s death rate is roughly .5% “passes the smell test in a way that some of these other serological surveys have not, in the sense that it indicates the highest signal of infection in the place where we know where the most hospitalizations have been occurring.”
Experts are cautioning officials and the general public not too put too much weight on so-called “serological surveys”—studies that aim to determine how widely the coronavirus has spread by testing people’s blood for antibodies to the virus, to see if they’ve been previously infected. While these studies are “going to be really crucial to the decisions we make next,” according to epidemiologist Michael Mina, there are problems. Many of the serological tests on the market haven’t been validated, and some serological studies may not be rigorous enough. In addition, some of the studies may have used questionable methods, said epidemiologist William Hanage.
April 23: Locked and Loaded Against COVID-19 (The Crimson)
Firearms sales in the U.S. have jumped since the COVID-19 pandemic began. Experts say the climate of uncertainty has led to the spike. David Hemenway said his chief concern is the potential increase in first-time gun owners. “Whether you have four, five, or ten guns in your home probably doesn’t matter a lot,” he said. “The question is zero or one.” He advised gun owners to be sure to lock guns in safes, store them unloaded, and store ammunition separately.
April 23: ‘The Mystery of Death’ (Mississippi Today)
The death of 38-year-old Shalondra Rollins from COVID-19 in Mississippi is an example of how the black community has been hit hard by the disease. Although blacks represent less than 40% of the state’s population, they represented 53% of COVID-19 cases and 63% of the related deaths through April 22. A number of factors put blacks at higher risk—for example, they’re more likely than whites to live in poverty, be unemployed, work in jobs without an option to work from home, and live in close proximity to others. They also have less access to health care and receive lower quality care when they do use the medical system. Social scientist David Williams said, “There are two hundred black people who die every day in this country who wouldn’t die if there were no white-black differences in mortality.”
April 23: What will it take to massively scale up COVID-19 testing to the level we need? (Fast Company)
As of April 23, the U.S. was testing around 150,000 people per day for the coronavirus. But experts say many more tests are needed. The Harvard Global Health Institute has estimated that the U.S. should run, at minimum, 500,000 to 700,000 tests per day by mid-May. “You want to identify enough of the people who are infected quickly enough so that they don’t spread the infection much further, and you can keep the disease at bay,” said HGHI director Ashish Jha. Some states have struggled to find enough test kits, while others have shortages of the swabs needed for testing. “I say to policy people, you realize we’ve shut our entire economy down because we don’t have enough swabs—how is this not just a travesty?”
April 23: What we can (and can’t) take away from New York’s antibody testing results (NBC News)
Preliminary data from New York’s state health department found that almost 14% of people tested for the coronavirus had antibodies to COVID-19, the disease it causes. Although the finding suggests that the state’s mortality rate may be lower than previously thought, experts said it’s still too early to draw any firm conclusions about what the data means. They said that getting a clear picture of the true number of coronavirus cases is complicated, and it’s also not known whether having antibodies confers sufficient immunity to the coronavirus, or for how long. “There’s a risk of really serious misinterpretation here,” said epidemiologist William Hanage. “But the most basic conclusion—that quite a large number of people may have been infected and are not turning up in the official case counts—that’s extremely plausible and something we have been suspecting all along.”
April 23: PolitiFact: Did other countries that reopened see an increase in coronavirus infections? Yes (Politifact)
This article rated as “true” New York Gov. Andrew Cuomo’s recent claim that other countries experienced an uptick in coronavirus cases after relaxing lockdown orders for people, schools, businesses and borders. Areas that have seen a resurgence include Singapore, Hong Kong, and Hakkaido, Japan. “We are definitely seeing rises in cases in those places,” said research fellow Stephen Kissler.
The COVID-19 pandemic and the resulting school closures are causing trauma for students. Research associate Archana Basu said the remote teaching going on now is less “home schooling” than it is “crisis schooling.” She said that although it’s challenging to learn during a stressful time, it’s still important to try, partly because schoolwork can provide routine and structure—which can help a student’s emotional wellbeing.
April 22: Coronavirus deaths in Mass. are likely far higher than what’s been reported. Here’s why (Boston Globe)
A Boston Globe analysis suggests that coronavirus-related deaths are being undercounted in Massachusetts. A spike in deaths in March 2020 was much higher than the number of March fatalities attributed to COVID-19 in official counts. “We are absolutely undercounting COVID-19 deaths, there is not a doubt in my mind about that,” said Michael Mina. “And if we undercount deaths, we deflate fatality rates.” The number of people who died at home jumped sharply—up 32% in March compared to the 20-year March average. Those numbers may stem in part from people’s fears of going to the hospital or doctor’s office for treatment of non-COVID issues such as heart problems, and are dying from them at home, Mina said.
To reopen the economy during the COVID-19 pandemic, planning could address known risks, such as people being in close proximity and in large groups, and building characteristics such as room layouts that allow the separation of people, said Harvey Fineberg, president of the Gordon and Betty Moore Foundation and former dean of Harvard Chan School, at a recent forum organized by the School and the New England Journal of Medicine. He predicted that, as the economy gets rolling, handshakes will be a waning custom and people will wear face masks. “In my opinion life in the time of coronavirus is not never going to be quite the same as life prior to the coronavirus,” he said. Another panelist, Caroline Buckee, associate professor of epidemiology, said that more testing—both diagnostic tests to see who’s infected and antibody testing to determine the extent of the epidemic—is crucial to reopening. “I wouldn’t be considering opening up society until I had testing in place. Period,” she said.
April 22: ICE has tested a tiny fraction of its detainees for COVID-19. Most of them were positive (Miami Herald)
According to the most recently available data, U.S. Immigration and Customs Enforcement (ICE) has tested only 1.32% of its detainees for COVID-19—and at least 60% of that group has tested positive for the virus. A lawsuit was filed in Miami federal court on April 13 claiming that U.S. immigration officials are violating federal guidelines by grouping inmates together by the hundreds if they have COVID-19 symptoms or have been exposed to the coronavirus. “By cohorting people, all you are doing is spreading it among everyone, including people that may not have it,” said HGHI director Ashish Jha. “And because we are not testing, there is no way of knowing.”
Children and teens infected with the coronavirus mostly have only mild COVID-19 symptoms. But it’s still possible that they can pass the virus on to others, and until this question is resolved, it’s likely that schools will remain, and should remain, closed, said epidemiologist William Hanage.
April 22: What’s the best case scenario for the coronavirus pandemic? (Boston Globe)
In this “Op-Talk,” epidemiologist Marc Lipsitch and Boston Globe opinion editor Bina Venkataraman discussed possible scenarios for how the COVID-19 pandemic could end.
April 22: Asymptomatic coronavirus cases roil best-laid plans for reopening (Washington Times)
The challenge in attempting to reopen state economies will be trying to find people with asymptomatic COVID-19 who might be inadvertently spreading the virus, according to experts. The White House coronavirus task force is advocating that testing be targeted to places such as inner cities and nursing homes where there are high-risk populations. “Obviously, looking for people who are vulnerable individuals is really important,” said epidemiologist William Hanage. “That means health care facilities, nursing homes, assembly-line conditions, things like that.” He added that there may be ways to use digital apps to track people’s movements and alert people if they’ve been potentially exposed to someone infected with COVID-19.
April 22: Op-ed: Is there coronavirus in your car? Here’s how you can protect yourself. (USA Today)
Keeping your car windows open a crack is an easy way to minimize the risk of COVID-19 transmission when you’re driving, according to an opinion piece co-authored by Harvard Chan School’s Joseph Allen and John Spengler, Akira Yamaguchi Professor of Environmental Health and Human Habitation, and Portland State University’s Richard Corsi. Evidence suggests that it’s common for people to be sick with COVID-19 and not realize it, and shed virus. In the enclosed space of a car, virus can quickly accumulate. Opening the windows will circulate the air and dilute the concentration of viral particles, the authors wrote.
April 22: Why the number of asymptomatic coronavirus cases matters (Boston Globe)
Recent testing efforts in Boston and Chelsea showed that a hefty percentage of people—roughly 40% to 50%—had COVID-19 and didn’t know it, and never experienced any symptoms. The high number of asymptomatic cases suggests that there are many undetected coronavirus cases, and that people are unwittingly spreading the disease. “This makes stamping out transmission basically impossible,” said immunologist Sarah Fortune. On the positive side, if there are many more COVID-19 cases than previously thought, it could mean that communities with high infection rates might be over the worst of the pandemic, she said.
Experts say there’s a link between the global coronavirus pandemic and worsening climate change. As climate change pushes animals into new habitats, it allows “for what we call ‘spillover’ of a pathogen from an animal to another animal, or from an animal to a person,” said C-CHANGE interim director Aaron Bernstein in this Q&A. He noted that “people’s long-term exposure to air pollution over many, many years is damaging their lungs, making them more likely to die and get sicker from COVID.” He added, “Those things we need to do—preventing deforestation, addressing the root causes of climate change and air pollution—have health benefits that go well beyond pandemics.” Bernstein was also quoted in a Popular Science article on the connection between air pollution exposure and risk of death from COVID-19.
There’s a good benchmark for a community to tell if it’s doing enough testing for COVID-19: if roughly 10% or lower of tests come back positive, according to epidemiologist William Hanage. He said if a high percentage of the tests come back positive, it means there’s not enough testing to find all the infected people in a community. “The lower the percentage of tests you’re doing that come back positive, the better,” he said. Although testing has increased in recent weeks, the U.S. is not yet near the 10% benchmark.
April 22: Op-ed: It’s Too Soon to Reopen States. The Coronavirus Is Not Under Control. (New York Times)
This article discussed some of the disease models for COVID-19, explained that strong social distancing policies are key to declines in the infection rate, and said that loosening restrictions now would likely lead to a rise in cases. Epidemiologist Marc Lipsitch and global health expert Ashish Jha were both quoted.
April 22: Special Report: Former Labradoodle breeder tapped to lead U.S. pandemic task force (Reuters )
Critics say that much of the responsibility for America’s halting response to the COVID-19 pandemic lies with the Department of Health and Human Services. Alex Azar, HHS secretary, oversaw an agency that was slow to alert the public to the magnitude of the crisis and to produce a widely available test. Azar initially put his chief of staff, a former Labradoodle breeder, in charge of a task force to manage the pandemic response. But after problems mounted, Vice President Mike Pence took over at the end of February. HGHI director Ashish Jha said that the White House should have taken a stronger role over the task force. “It’s very clear that Azar wasn’t able to marshal the forces across the government like he needed to,” he said.
April 21: How can reporters stay safe while getting the story during COVID-19? (Center for Health Journalism)
Jack Dennerlein, adjunct professor of ergonomics and safety, offered strategies that journalists can use to stay safe while doing in-person reporting on the COVID-19 pandemic. They can interview sources on the phone even if they’re in the same space, turning away from each other to talk or talking on opposite sides of a window. Photographers can use telephoto lenses to shoot from long distances or take pictures through windows. Broadcast journalists can use boom mics to maintain distance while getting audio. All equipment should be disinfected after and during the reporting process. Journalists should wear face masks and gloves and wash their hands frequently. In spite of the risks, Dennerlein acknowledged that “the role that the press plays in informing the general public on public health issues is crucial to fighting the disease.”
Interviewed by Jim Braude on WGBH News’ “Greater Boston,” HGHI director Ashish Jha said that the U.S. is nowhere near ready to control the spread of COVID-19 because it is not doing enough testing. He said that the country needs to be testing, at minimum, 500,000 people every day—more than three times the current level. Any state that lifts coronavirus restrictions before ramping up testing should expect see a resurgence of cases, he said. He called the federal government’s efforts to institute nationwide COVID-19 testing “a fiasco.”
April 21: Columbia construction workers ordered to return to sites as COVID cases peak in NYC (Columbia Spectator)
Construction workers have been asked to return to work at Columbia University in New York, although both the workers and experts have raised concerns about the workers’ risks of contracting COVID-19. Ergonomics and safety expert Jack Dennerlein said that since workers come and go quickly on job sites, “what that means is that you’re going to be exposed to more workers and more likely to contract COVID-19.” He said it may be hard to practice social distancing on construction sites. In addition, construction workers face high risks of respiratory issues because of their high exposure to particulate matter, dust, and chemicals, and their high rates of smoking, according to Dennerlein and Glorian Sorensen, professor of social and behavioral sciences. “I can’t say that it’s safe [to resume working], but if they are going back, then [the priority] is making sure these situations are set up to maximize safety, such as regular and consistent breaks, social distancing norms and wearing masks, and having sick leave policies in place,” said Sorensen.
April 21: Need to Report Coronavirus Symptoms? There’s an App for That (NBC Boston)
Through the “How We Feel” app, people can report how they’re feeling in about 30 seconds. The information helps researchers get up-to-date information on COVID-19 and identify potential hotspots. The app was developed by a team including researchers from Harvard Chan School.
April 21: As Covid-19 rips through black communities, African American leaders demand inclusion on response teams (Mississippi Today)
African American leaders in Mississippi are expressing concern about the lack of black representation on the state’s COVID-19-related task forces. They are worried that the virus’ disproportionate impact on blacks will be attributed to that community’s higher rates of chronic conditions such as diabetes and hypertension, without the root causes being addressed. Researchers have noted that blacks are at greater risk of dying from COVID-19 than whites for the same underlying reasons that they have higher rates of other diseases—disparities that stem from poverty and wealth inequity, residential segregation, underfunded education, and systemic racism. “Race matters for health,” said social scientist David Williams.
April 21: A Herd Immunity Strategy Could Actually Work in Youthful India (Bloomberg)
Some experts have suggested that countries with younger populations, such as India, should allow their populations to become infected with COVID-19 in a controlled way in order to achieve “herd immunity”—when enough of the population has developed immunity so that the disease stops spreading. The move would be risky because it could overwhelm hospitals. And although younger people generally face less risk from COVID-19, that may not be the case in a country like India, where high levels of air pollution, hypertension, and diabetes could raise their mortality risk. In addition, it’s unclear how much of the population would need to be immune to achieve herd immunity. “My view is there are a number of questions about whether it can work,” said epidemiologist Marc Lipsitch. “The main questions being how much immunity do we need in the population, and how much immunity does each person get as a result of infection.”
April 21: In two states, a vast testing gap shows what it means to have no national strategy (Washington Post)
A wide difference in the per capita testing rate for COVID-19 between Rhode Island and Kentucky shows the challenges posed by the state-by-state testing strategy in the U.S., say experts. Some states with more resources have made progress in tracking the virus, while others are struggling to catch up. “This is what you get when you get a 50-state strategy on fighting a pandemic,” said HGHI director Ashish Jha. “Pandemics affect all of us equally. We don’t have a country where every state is supposed to be self-sufficient on all issues related to pandemic preparedness.”
Federal estimates from early April showed that, if all social distancing measures were abandoned, more than 300,000 Americans could die from COVID-19. The model, from the Department of Health and Human Services, is a type that provides a baseline against which to weigh various measures to stop the spread of disease. “Models like this are also tools to discriminate between possible futures and guide your decisions in figuring out which you would like to avoid and how best you might avoid them,” said epidemiologist William Hanage. Other experts, like HGHI director Ashish Jha, called the government’s model “way too optimistic. He said the model’s fatality rate was too low and didn’t account for hospitals being overwhelmed.
States that start reopening for business without significantly expanding testing for COVID-19 could risk a second wave of the pandemic, according to experts. Epidemiologist Caroline Buckee said that, in addition to people who show up at the hospital to get tested, there are many more mild and asymptomatic cases in the community. “And those are the people that are spreading the disease,” she said. Immunologist Eric Rubin said it’s important to learn if people who’ve recovered from COVID-19 can still spread the disease. “What we really need is some epidemiological data to tell us, ‘Are people who have left the hospital going on to transmit the disease?’” he said. “That’s kind of the shoe leather epidemiology, contact tracing, following what happens to the context of those patients, which takes some manpower.”
One of the things that went wrong with the U.S. response to the COVID-19 pandemic was testing, say experts. At first the federal government initially didn’t recognize the coronavirus as a problem, then was slow to ramp up testing, said epidemiologist Michael Mina. The initial tests provided by the Centers for Disease Control and Prevention were flawed. And there’s still not enough testing capacity to make it safe to reopen schools and businesses. Mina said that serological testing, which measures antibodies in the blood, will be key to showing how many people have been infected with COVID-19. “Using antibodies — those are going to be the watershed moments,” he said. “That will tell us about the prevalence, and the true mortality. And that will help paint the picture of what we do next as a society.”
April 21: Harvard prof advising Netanyahu: Don’t ease lockdown without solid fallback plan (Times of Israel)
Epidemiologist Marc Lipsitch has advised Prime Minister Benjamin Netanyahu that it’s important to have plans in place before loosening COVID-19 restrictions in Israel, in case the country has to quickly reimpose them if cases rebound. “There need to be clear plans for how you impose restrictions, if it turns out to be that cases are going up faster than anticipated,” said Lipsitch.
April 21: With COVID-19 looming, NM hospitals tossed masks and other protective gear (Searchlight New Mexico)
At least two major hospitals in New Mexico threw out gowns, masks, hand sanitizer, and other supplies in late January and early February, even though warnings were sounding at the time about a possible COVID-19 epidemic that would likely require such supplies. Hospitals routinely toss such items when they’re past their printed expiration dates so that they won’t fail inspections. Experts didn’t blame the hospitals, but said that the wasteful behavior reflected the government’s uncoordinated response to COVID-19. “There was by no means a unanimous call that every hospital should clutch on to every single one of these [N95 masks] as long as possible,” said health policy expert Michael Barnett, but added, “in hindsight, it certainly seems foolish.”
A report from more than 45 economists, social scientists, lawyers and ethicists, titled “Roadmap to Pandemic Resilience,” argues that the U.S. needs to dramatically scale up testing, tracing, and supported isolation during the coronavirus pandemic in order to safely restart the American economy. Lead author of the report was Danielle Allen, James Bryant Conant University Professor at Harvard University and director of Harvard’s Edmond J. Safra Center for Ethics. Meredith Rosenthal, C. Boyden Gray Professor of Health Economics and Policy, was a co-author.
April 20: Covid-19 Vaccine Is 12 to 18 Months Away, Harvard’s Jha Says (Bloomberg)
Given that a COVID-19 vaccine is 12-18 months away, HGHI director Ashish Jha said that a three-pronged strategy is necessary to open the economy and keep it open. “You want to see a sustained period of declining cases, so you know that the transmission in the community is heading in the right direction,” he said. “Second, you want to have a very substantial testing, tracing, and isolation infrastructure, because as soon as you open, the transmissions will go up. … And third, you want to make sure your health care system is ready, because even if you do everything else perfectly, there is a chance that you’ll get a large surge of cases and your health care system will have to take care of very sick patients.”
April 20: Why COVID-19 Raises the Stakes for Building Health (Harvard Business Working Knowledge)
A new book co-authored by healthy buildings expert Joseph Allen and John Macomber of Harvard Business School focuses on how healthy indoor spaces can keep people from getting sick and help enhance cognitive performance. In the coronavirus era, healthy buildings with good air quality will be more important than ever, according to the authors.
April 20: Coronavirus is largely spread by people without symptoms. Here’s what that could mean for reopening the economy. (Philadelphia Inquirer)
Evidence suggests that much, if not most, of the spread of COVID-19 is from people who are asymptomatic, and that the disease is contagious for up to a few weeks after any symptoms end—meaning that stopping the spread will be tough. Inadequate testing in the U.S. means that it’s difficult to estimate true rates of transmission, death, and immunity, said epidemiologist Michael Mina. Antibody tests could help determine who’s had COVID-19, and possibly developed immunity, but it’s unclear how accurate the tests are, because they’re basically unregulated. “The FDA has really swung the pendulum, in my opinion too much,” said Mina. “Things are getting [to market] that probably shouldn’t be.”
April 20: It’s Not Too Late to Go on Offense Against the Coronavirus (New Yorker )
Jim Yong Kim—physician and anthropologist and former professor at Harvard Chan School—wrote that the only way to fight COVID-19 is to mount a five-part public health attack, including social distancing, contact tracing, testing, isolation, and treatment. He cited research co-authored by biostatistician Xihong Lin that showed that when Wuhan, China began using these weapons, the transmission rate dropped.
April 20: Harvard doc: RI farther on path to reopening than Mass (WPRI)
Rhode Island is in good shape in terms of testing capacity for COVID-19, according to HGHI director Ashish Jha. Jha and colleagues think that testing needs to be done at a rate of 152 tests per 100,000 people. Rhode Island has reportedly been conducting an average of 195 daily tests per 100,000 residents. “Rhode Island is the only state I know of that meets that testing threshold,” Jha said. He said that sufficient testing needs to be paired with at least two weeks of declining coronavirus cases, strong contact tracing, and adequate hospital capacity in order for the state to safely lift physical distancing restrictions.
April 20: Pressure builds on White House to increase tests (The Hill)
Experts say the U.S. needs to at least triple its testing capacity for the coronavirus, from the current 150,000 tests per day to between 500,000 to 700,000 per day. Although the White House has claimed that the country is already producing enough tests to begin reopening the economy, public health experts disagreed. “What you need is a federal government that’s deeply engaged, helping states,” said HGHI director Ashish Jha. “Right now, we have a federal government that keeps giving the wrong message to the American people. They keep saying ‘We don’t need any more testing, we don’t need any more testing.’ That’s just wrong.”
Although public health experts have expressed approval regarding Trump administration guidelines for lifting COVID-19 restrictions state by state, they say that the president’s guidance at press conferences and on Twitter has been unclear. “At each step, he does defer to the scientific experts, but his messages are often very mixed as everyone will agree,” said Howard Koh. “All that does is confuse the public.”
As of April 19, Kansas was testing about six out of every 1,000 residents in the state for COVID-19—the lowest testing rates among all U.S. states. Experts say that if Kansas lifts restrictions aimed at curbing the spread of disease before testing is significantly ramped up, it could lead to a resurgence of infections. “You can’t just relax physical distancing interventions in the absence of knowing where you are in the epidemic,” said epidemiologist Caroline Buckee. “You’d lead to enormous resurgence and a lot of deaths.”
There is a high level of interest in antibody tests, which screen blood for previous COVID-19 infection and can potentially identify people who’ve developed immunity to the disease. But experts caution that some of the tests haven’t been validated and some can provide false results. Even accurate positive tests can’t guarantee that a person is immune or specify how long immunity may last. “We don’t have nearly the immunological or biological data at this point to say that if someone has a strong enough immune response that they are protected from symptoms … that they cannot be transmitters,” said epidemiologist Michael Mina.
April 20: Kemp reopens some businesses, despite warnings COVID-19 still a threat (Atlanta Journal Constitution)
Georgia Gov. Brian Kemp decided to allow certain businesses in the state to reopen although experts say the move will spark new COVID-19 infections. “It’s a very big risk,” said epidemiologist Marc Lipsitch. “If you open up enough, it’s almost for certain the virus will hit Georgia again. It’s just waiting for more susceptible people and more contacts. That’s how viruses work.”
April 19: Impossible for UK to meet Covid-19 testing targets, scientists say (The Guardian)
Experts say that the UK’s stated goal of 100,000 COVID-19 tests per day is an unreachable target. “The data I’ve been seeing suggests there’s not anywhere near enough testing,” said epidemiologist William Hanage.
April 19: Infectious Disease Expert Weighs In On U.S. Coronavirus Testing (NPR)
Public health research professor Barry Bloom said that the Trump administration’s plan to reopen the country gradually in the wake of COVID-19 closures makes sense. But he said the lack of testing for the disease “is truly an embarrassment and has slowed down the response at every level … we have no idea how many people are walking around with COVID infection but are not sick and are capable of transmitting that. And the only way to find that out is to do a great deal of testing.”
April 18: Experts worry politics will guide voters’ virus precautions (AP)
People’s political views may be guiding their opinions about restrictive measures aimed at curbing the spread of the coronavirus. The partisan lens is dangerous because it can cause confusion about public health advice and could lead to more disease and death, experts say. “From a public health point of view, you want a unified position from government regarding what’s the best way to protect people,” said Robert Blendon, professor of health policy and political analysis.
April 17: Return to normal demands unprecedented surge in testing, experts warn (Atlanta Journal Constitution)
For Georgia to reopen its economy without causing more COVID-19 deaths, there should be a much wider expansion of testing in the state, say public health experts. Howard Koh said the state must perform tests on as many people as possible to keep the death rate down. “Every state has to step up and make this a sustained priority for the indefinite future,” he said.
April 17: There is No Public Health Rationale for a Categorical Ban on Asylum Seekers (Just Security)
Although the Trump administration closed U.S. borders to asylum seekers on March 20 because of COVID-19, experts say that people fleeing persecution are protected under U.S. and international law and should not be denied entry because of the pandemic. Monik Jiménez, assistant professor in the Department of Epidemiology, said it’s clear that the decision was based on political motivations, not on a public health rationale.
April 17: Health officials give warning of 2nd wave (Lawrence Eagle-Tribune)
Experts are cautioning against easing COVID-19-related physical restrictions in order to avoid a second wave of infections. “We’re not even at the peak yet in Massachusetts, and the rates of infections are still going up,” said Howard Koh. “So any discussions about reopening the economy can’t even begin until we’re on the other side of the curve.” He said expanding testing is key to determining how many people have been infected.
April 17: Model Shows New Coronavirus Projections For Mass.: ‘We’re Feeling the Uphill’ (NBC Boston)
Experts are trying to predict the number of COVID-19 cases and deaths in Massachusetts, but estimates have ranged widely. That’s because predictions are based on information that keeps changing, such as whether or not people are sticking with social distancing measures. “Models are not destiny,” said epidemiologist William Hanage. “They are a possible future, and they can be used to explore the expected impact of making changes to avoid some of the worst futures that we have.”
April 17: Why It’s Difficult To Assess The Coronavirus Mortality Rate (WBUR’s “Here & Now”)
It’s difficult to know how many people are dying from COVID-19, mostly because of the lack of adequate testing for the disease, according to epidemiologist Marc Lipsitch. In addition, mortality rates may differ across U.S. regions because different populations have different distributions of risk factors, such as age, hypertension, and obesity, Lipsitch said. He said that early reports that the antiviral drug remdesivir may be helping COVID-19 patients are encouraging, but cautioned that the drug “is not a solution to the pandemic.”
April 17: A Harvard Epidemiologist’s Reminder of Our Common Humanity (The Crimson)
Social epidemiologist Nancy Krieger was featured in this Q&A about how the coronavirus pandemic has revealed the social determinants that drive health inequities, and what can be done to alleviate those inequities.
April 17: Harvard professors caution that widespread testing still needed (USA Today)
Reacting to President Trump’s plan to reopen the country after COVID-19 restrictions, two Harvard Chan School experts — Barry Bloom, public health research professor, and epidemiologist William Hanage — said the gradual nature of the plan is “thoughtful.” But Hanage said that the “glaring problem” with the plan is that it doesn’t address the fact that widespread testing for COVID-19 is still needed. “Figuring out what’s actually going on in the community is the key part of dealing with this pandemic, and we’re still early on in this pandemic,” he said.
April 17: Trump gives governors 3-phase plan to reopen economy (Associated Press)
New guidelines from the Trump administration are aimed at easing restrictions in U.S. regions with low transmission of COVID-19, while moving more slowly in areas that are harder hit. Some lawmakers and public health experts said that the guidelines are reasonable, but others expressed concern that opening up parts of the country too soon could result in disease resurgence. Epidemiologist Marc Lipsitch said that the White House may be taking too rosy a view on COVID-19 trends. “I would not declare a peak almost anywhere in the U.S. yet,” he said. He recommended “working to enhance surveillance and testing so if we do hit a peak, it will be possible to identify it with greater certainty.”
April 16: ‘Stop Corona’ music video (YouTube)
A new rap video called “Stop Corona” includes advice—to a beat—about ways to stop the spread of COVID-19. The video was produced by former Harvard Chan School student John Clarke, director of occupational medicine at Cornell Health.
April 16: Defunding WHO: Why The President’s Decision Makes America Less Safe (Health Affairs)
In this blog, global health expert Ashish Jha argued that President Trump’s plan to stop funding the World Health Organization (WHO) in the midst of the COVID-19 pandemic “will certainly make us all less safe.” Trump accused the agency of mismanaging the COVID-19 outbreak in its early stages. While acknowledging that WHO “gave unearned, excessive praise to China in its early response to the outbreak,” Jha said that the agency plays a critical role in fighting COVID-19 around the world. “WHO is not perfect,” he wrote. “But despite their mistakes (which are less dramatic than the President has made them out to be), they are key to ending this pandemic.”
April 16: ‘No fast track’ to normal when it comes to reopening economies (PRI’s “The World”)
Governments and health experts are struggling to determine when it’s safe to ease physical restrictions put in place in response to the coronavirus. Epidemiologist Caroline Buckee said that the pandemic is playing out differently across the globe, in terms of how much testing is being done and how well health systems are able to care for the sick, which will influence decisions in different places. She said it’s crucial to get a clearer picture of how many people have been infected and how people without symptoms are spreading the virus. Contact tracing will also be key to preventing the resurgence of disease, she said.
This op-ed called for reusable head-to-toe protection for health care workers to protect them from COVID-19. The article noted that, initially during China’s outbreak, infection rates among health care workers were three times higher than that of the general public. But there were no further reports of infected workers after they started wearing full safety gear, the article said, citing a recent presentation by Xihong Lin, professor of biostatistics.
April 16: Op-ed: No matter how you crunch the numbers, this pandemic is only just getting started (The Guardian)
Although there has been talk of COVID-19 “peaking” in various countries, these might only be initial surges out of many peaks to come—because most of the population is not yet immune to the disease, wrote epidemiologist William Hanage in this opinion piece. To achieve population-wide immunity in the absence of a vaccine, a large percentage of the population would have to be infected with COVID-19—which would mean thousands more deaths, according to Hanage. He acknowledged that keeping countries locked down “is going to be a mammoth strain on the economy. But the deaths of many thousands of people would be too: it is simply not possible to thoroughly insulate an economy from the impact of a pandemic of this kind.”
April 16: Crucibles of Leadership: From Conflict to Collaboration (Harvard Ash Center)
Howard Koh was one of four experts who participated in a virtual discussion session on conflict resolution and teamwork, as part of Bloomberg Philanthropies’ Coronavirus Local Response Initiative to support mayors as they manage COVID-19.
April 16: Video: Road Map to Reopening (U.S. Chamber of Commerce Foundation)
In this video conversation, epidemiologist William Hanage discussed many aspects of the COVID-19 pandemic, including the need for more testing, contact tracing, research on immunity, and digital disease tracking. He also talked about the importance of continuing to wear masks in public places, but cautioned that mask-wearing is not a silver bullet to prevent transmission.
April 16: Insomnia in a pandemic (Harvard Gazette)
There are some simple ways to avoid sleep problems during the COVID-19 pandemic, according to sleep expert Donn Posner, president of Sleepwell Associates and an adjunct professor at Stanford University School of Medicine. Speaking at an online event—part of a Harvard Chan School weekly forum on the emotional and psychological effects of the COVID-19 pandemic—Posner recommended avoiding napping or sleeping late on weekends, keeping a normal sleep-wake rhythm, and making sure to get sunlight, exercise, eat regular meals, and avoid stimulants before bed.
April 16: Coronavirus surge in Massachusetts will last a while due to flattened curve, MGH doc says (Boston Herald)
Physical distancing restrictions in Massachusetts are helping ensure that the state won’t have an unmanageable spike in COVID-19 cases, according to emergency preparedness expert Paul Biddinger. Still, he expects that the surge of patients will last a while. He said the state is about six weeks away from a gradual downturn in new cases.
April 16: White House guidelines for reopening garner mixed reviews (The Hill)
Health experts and governors gave mixed reviews to President Trump’s plan to reopen the country after COVID-19 restrictions. HGHI director Ashish Jha called the plan a “measured approach,” but expressed concern that the plan doesn’t include specific criteria for testing and would allow governors to move from one phase to another if cases drop consistently for 14 days. “That’s a huge problem,” he said.
April 16: Big Brother Wants To Track Your Location And Health Data. And That’s Not All Bad. (Kaiser Health News)
Collecting personal data via mobile devices will be key in helping the U.S. track the coronavirus and slow its spread, say health and technology experts. Academics, data firms, and technology companies are involved in various efforts to gather such data—for instance, they’re using location information from smartphones to map people’s compliance with social distancing. They’re also using symptom trackers to help find virus hot spots, such as the COVID Symptom Tracker app that Andrew Chan, an immunologist and cancer epidemiologist, helped develop.
April 16: No country has beaten the coronavirus yet (Vox)
Countries that began to relax restrictions aimed at slowing the spread of COVID-19, such as China, Singapore, and South Korea, have experienced an uptick in new cases. Epidemiologist William Hanage said that the if the U.S. lifts restrictions, it too could see cases surge. “This might just offer a glimpse of our future, because it is very hard to believe that the initial surge [of infections] will generate population immunity sufficient to do very much to blunt it in the future.”
April 16: What Can Antibody Testing Really Tell Us About COVID? (WebMD)
Tests that check for immune responses to COVID-19, called serology tests, will be essential as the U.S. moves forward, according to experts. The tests can confirm how many people were actually infected and thus how dangerous the virus is, said epidemiologist Michael Mina. The tests can also guide policymakers who want to know how many people have the disease and how many have immunity, so that they can decide when it’s safe to ease physical distancing, said epidemiologist Marc Lipsitch.
April 16: Public health expert: ‘Marshall Plan’ needed to redress coronavirus race disparities (Chicago Sun-Times)
Recent data showing the disproportionate death rate from COVID-19 among people of color reflects “longstanding policies that have created pervasive social and economic inequalities in the United States,” said social scientist David Williams. He called the coronavirus “a call to action. It gives us a chance to make a commitment to do better than we have done in the past. Call it a ‘Marshall Plan’ for disadvantaged communities.” Williams was also quoted about COVID-19-related health disparities in a Daily Memphian article.
April 16: What scientists know about Covid-19 immunity can help us fight the pandemic (Quartz)
Learning more about how the body mounts an immune response to COVID-19 will help scientists design the right tools — tests, treatments, and vaccines — to help manage its spread. For example, serology tests that look for antibodies to COVID-19 in the blood could help shed light on whether a person has immunity to the disease. “Serology surveys will be very important in understanding the extent of population immunity, and the extent to which immunity wanes over time,” said immunologist Yonatan Grad.
April 16: Feeling more anxious and stressed? You’re not alone (Harvard Gazette)
Psychiatric epidemiologist Karestan Koenen said that the COVID-19 pandemic is taking a mental health toll on Americans. People may face depression and anxiety because of social distancing’s physical isolation, fears over the potential for illness, death, job loss and bankruptcy, and other concerns. To help children deal with the crisis, she recommended that parents keep regular routines, answer questions honestly, and limit media exposure. And parents should manage their own stress. “Kids take their lead from their parents,” she said. “By managing your stress, you’re helping your kids manage their stress.”
April 16: Op-ed: Covid-19 is ravaging nursing homes. We’re getting what we paid for. (Washington Post)
Thousands of Americans are dying from COVID-19 in nursing homes and long-term care facilities. The situation could become much worse, though, wrote health policy expert Michael Barnett and Harvard Medical School’s David Grabowski. They said that the nursing home industry as a whole “is potentially facing a financial catastrophe” because it relies on a tenuous business model that COVID-19 could upend. The authors recommended policy change to reform the problematic payment system that nursing homes rely on.
This article highlighted Harvard Chan School’s collaboration with tech company Thrive Global and the CAA Foundation to help first responders on the frontlines of the COVID-19 pandemic through a fundraising initiative called #FirstRespondersFirst. The aim is to provide essential supplies, equipment, and resources such as accommodations, child care, food, and mental health support for frontline health care workers. A number of other businesses have joined the effort, including Dutch Bros Coffee, Johnson & Johnson, Americares, Direct Relief, World Central Kitchen, Bright Horizons, Cisco, IHG Hotels & Resorts, Marriott International, and Modelo.
April 16: COVID-19, Data, and Health Justice (The Commonwealth Fund)
In this blog, social epidemiologist Nancy Krieger argued that there’s not enough health data in the U.S. to shed light on how COVID-19 affects different populations and social groups. For accurate guidance on the risks faced by different groups, testing and mortality data should include information on age, race, ethnicity, socioeconomic position, gender, work status, insurance status, sickness benefits, housing status, incarceration, citizenship status, sexual orientation, gender identity, and exposure to domestic violence. “To ensure that COVID-19 work is grounded in health justice, we must generate and publicly report data on how it affects different populations and social groups and use a health equity lens to examine how the pandemic is exacerbating inequities,” she wrote.
It’s important for health care workers treating COVID-19 patients to wear N95 masks — which can keep out at least 95% of airborne particles — to minimize their risk of infection. But many health care workers are not receiving the proper training in how to wear the masks, which require a tight seal to work properly, wrote Joseph Allen, assistant professor of exposure assessment science, and David Christiani, Elkan Blout Professor of Environmental Genetics. “Simply delivering more respirators and personal protective equipment to the front lines is not enough to solve the crisis that health care workers face,” they wrote. “We need to stop sending them into the health care equivalent of burning buildings without making sure they know how to properly use this protective equipment.”
April 16: How coronavirus antibody tests will help (Axios)
Experts say it’s crucial to conduct blood tests, called serological tests, that can determine whether a person has had COVID-19. The tests check for antibodies to the disease and can suggest if a person has become immune. But Ashish Jha cautioned against placing too much weight on the tests. “People just think this is the solution, that this is finally the thing, that everybody is going to have immunity passports … and I am very skeptical of this for a variety of reasons,” he said. Simply having antibodies doesn’t necessarily mean you’re immune, or how strong the immunity might be, say experts. And it’s unknown how well the tests will work.
April 16: Grocery Blues: Supermarket Shopping In The Time Of COVID (Connecticut Public Radio)
Joseph Allen was one of several guests on The Colin McEnroe Show for a discussion about grocery shopping during the COVID-19 pandemic. Allen said that the risk of being infected from the virus on food packaging is “small and manageable,” and that there are simple steps people can take to minimize risk, such as washing your hands after touching packaging. (Segment with Allen starts at 22:17)
A number of colleges and universities are considering the possibility of extending COVID-19 closures through the fall semester. Visiting scientist Eric Feigl-Ding, an epidemiologist and health economist, said it makes sense for the colleges to plan ahead. “I think colleges should definitely make plans for delaying start dates and for intermittent closings and reopenings, because epidemiology modeling suggests we may have to go into open and close waves until potentially even 2022.”
April 15: So what have you been up to? (Harvard Gazette)
In this article, Harvard faculty and staff talked about what how they’ve been spending their time in social isolation during the COVID-19 pandemic. One of them was epidemiologist William Hanage. “I tried to reread “La Peste” [“The Plague”], given the subject matter and the way Camus has influenced my thinking ever since my best friend introduced me to his work,” said Hanage. “But I never made it past the first page. I have a framed photo of Camus above my desk in my office. Not sure when I will lay eyes on it again.”
April 15: Avoid Twitter’s swamp of misinformation by following these epidemiology experts (DigitalTrends)
Ashish Jha said he doubts the U.S. could safely reopen by May 1 without experiencing an uptick in cases of COVID-19. “The number one issue in my mind about when to reopen is really about how do we reopen in a way that lets us stay open,” he said. “We could reopen tomorrow. But if we did, we’d have to shut down again very, very quickly. So what we need to see is substantially declining case rates.” He said that he was more optimistic that some loosening of restrictions could take place in mid-May or June.
April 15: When will California emerge from the coronavirus crisis? What models can – and can’t – predict (The Guardian)
Various models have made very different estimates of COVID-19’s impact on California, and some have been off the mark in their predictions. For example, a model used by California state officials predicted that a median of 10,711 people would be hospitalized with COVID-19 on April 12 — when in reality 5,048, less than half the predicted number, were hospitalized on that day. Epidemiologist William Hanage said “that doesn’t mean the modeling is wrong.” He said that California’s model “has a mechanism within it that’s trying to account for the impact of different interventions, like shelter-in-place.” He added, “The way to use models is to think of them as a guide. They are possible futures — futures that can change based on the choices we make.”
President Trump has criticized the World Health Organization’s handling of the COVID-19 outbreak, blaming the agency for the crisis in the U.S. and threatening to cut off the agency’s funding. But some global health experts said that although WHO made some missteps, it’s not to blame for the U.S. government’s lack of preparation. Global health expert Ashish Jha said that with COVID-19 spreading around the world, countries “failing in their response have decided WHO is the culprit.” Media reports have suggested that the Trump administration knew about the outbreak early in 2020, if not sooner, but failed to act. “WHO is not responsible for America not heeding the warnings of its own scientists and security apparatus — for two months,” said Jha. “That’s laughable.”
Blood tests to detect whether a person has ever had COVID-19 — serology tests — are crucial to helping determine if it’s safe for Americans to resume their everyday activities, because they could reveal if someone has developed immunity to the virus. Some experts said, however, that relaxed rules from the Food and Drug Administration are allowing unreliable tests on the market. But the tests are sorely needed, said epidemiologist Marc Lipsitch. “What we really, really need is serologic studies to figure out what proportion of the population has [immunity],” he said. “And then there’s the further question of how protective that immune response is.”
April 15: How to get better COVID-19 infection data without universal testing (Boston Globe)
Many experts have called for frequent testing of the entire U.S. population in order to shed more light on the number and severity of COVID-19 infections, but there are not enough supplies, infrastructure, and human resources to get the job done. In this op-ed, David Bloom, the Clarence James Gamble Professor of Economics and Demography, and David Canning, Richard Saltonstall Professor of Population Sciences and Professor of Economics and International Health, recommended instead that COVID-19 tests be conducted on a representative sample of the population. In Massachusetts, a random sample of 5,000 residents out of the total population of nearly 7 million would be large enough to determine the prevalence of COVID-19 infection within a margin of error of 1.5 percentage points, they wrote. “The information yielded by testing such a sample would contribute decisively to our epidemiological projections and related policies to prevent and control the spread of this too-often deadly virus,” they wrote.
April 14: Virus models predict possible outcomes. We can fight to stop the worst ones. (Washington Post)
Models can be helpful in predicting possible paths of the COVID-19 pandemic—but those paths can vary widely depending on the data and assumptions they’re based on, according to this opinion piece by epidemiologists William Hanage and Helen Jenkins. Some models “change at least as quickly as the weather does,” they wrote, cautioning that “models are not destiny.” They added, “Debating the merits of different models rather than taking prompt action to slow the relentless march of the coronavirus is a deadly mistake.”
April 14: COVID-19 targets communities of color (Harvard Gazette)
Communities of color are being disproportionately affected by COVID-19, according to recent data. Social and economic inequalities, excess exposure to environmental hazards, lack of access to healthy foods and green space, and lack of access to health care have contributed to health disparities—such as high rates of chronic conditions—that put minorities at greater risk of death from COVID-19 than whites, experts say. Another risk faced by African Americans is that many work in service jobs that can’t be done from home, putting them in harm’s way from the pandemic, said social scientist David Williams.
April 14: COVID-19 may not go away in warmer weather as do colds (Harvard Gazette)
Experts don’t expect COVID-19 to subside in the summer. Even though the common cold—which is also caused by coronaviruses—wanes in the summer, that’s because a large proportion of the population develops immunity by spring. But with the new coronavirus, SARS-CoV-2, much of the population will likely remain vulnerable through the warmer months, so transmission could continue. Epidemiologist Marc Lipsitch said that even if there is some amount of seasonal decline in COVID-19, it wouldn’t be enough to make the disease go away in the summer in the absence of intervention. Ashish Jha said that social distancing should be eased only gradually to ensure there isn’t a resurgence of illness.
April 14: Managing Crises in the Short and Long Term (Harvard Business Review)
In this podcast, Eric McNulty, associate director of the National Preparedness Leadership Initiative, discussed the common traps that leaders fall into during crises, and shared how the best leaders excel by thinking longer-term and trusting their teams with operational details. He said that companies that put people ahead of the bottom line tend to fare better through crises. McNulty also offers expertise on crisis leadership in an on-demand webinar from MIT Sloan Management Review titled “Leading Through a Crisis Day-by-Day.”
April 14: The Fierce Urgency Of Now: Closing Glaring Gaps In US Surveillance Data On COVID-19 (Health Affairs)
There are significant gaps in data about COVID-19, according to this blog co-authored by social epidemiologist Nancy Krieger, FXB director Mary Bassett, epidemiologist William Hanage, and colleagues. They argued that it’s crucial to improve data collection to inform who currently needs help, to help estimate the likely spread and impact of COVID-19, and to assess the racial/ethnic, economic, and gender inequities associated with the disease. They recommended the adoption of a short digital form for COVID-19 testing and surveillance — to replace a long form that is currently in use — with data being reported in real time.
April 14: Why Did The World Shut Down For COVID-19 But Not Ebola, SARS Or Swine Flu? (FiveThrityEight)
Previous modern viruses — such as Ebola, SARS, MERS, and swine flu — were tragedies but didn’t cause the huge level of societal and economic disruption that COVID-19 is causing. SARS and MERS didn’t cause the same level of devastation mostly because they’re not as transmissible as COVID-19 and don’t spread presymptomatically. Swine flu spread easily but wasn’t as deadly as COVID-19. And Ebola was deadly but harder to contract. “If you want to see illnesses which are controllable, they all have transmission very much tied to symptoms, and this includes SARS and Ebola,” said epidemiologist William Hanage.
April 14: Ending coronavirus lockdowns will be a dangerous process of trial and error (Science)
Opening up society after worldwide lockdowns aimed at curbing the spread of COVID-19 will take a long time and will be marked by trial and error, say experts. “How to relax the lockdown is not something around which there is a scientific consensus,” said epidemiologist Caroline Buckee. Governments can use various tools to keep the virus in check, including isolating patients and tracing their contacts, restricting their borders, and social distancing—but there are challenges with all of these methods, experts say. As authorities around the world choose different paths forward, it will shed light on what works and what doesn’t, said epidemiologist Marc Lipsitch. “I think there’s going to be a lot of experimentation, not on purpose, but because of politics and local situations,” he said. “Hopefully the world will learn from that.”
April 14: UK coronavirus death toll could be far higher than previously shown (Reuters)
The true death toll from COVID-19 in the United Kingdom is likely about 15% higher than the toll previously published by the government, according to broader official data that includes deaths in places such as nursing homes. “I am not remotely surprised there would be an undercounting,” said epidemiologist William Hanage. “The UK Hospital death toll that you are seeing — the one on the news each night — is a composite of things that have been trickling in over a period of time. It is not an exact number and does not include the numbers dying in places such as nursing homes.” He added, “The UK response [to COVID-19] was fractured and it was too late, and allowed a large number of people to become infected who didn’t need to become infected.”
April 14: Our Pandemic Summer (The Atlantic)
In order to suppress the coronavirus until a vaccine is developed, regular life cannot fully return, according to experts. There are ongoing challenges, including a lack of tests, medical supplies, ventilators, and respiratory therapists; diminished ranks of health care workers, because they’re falling ill from COVID-19; and a lack of data about what percentage of the U.S. population has been infected. Experts quoted in this article said they weren’t comfortable with the return of crowded public spaces anytime soon. “It’s hard for me to imagine anyone going to Fenway Park and sitting with 30,000 fans,” said Ashish Jha. “This isn’t going to look like a normal summer in America.” Serology tests—which check for antibodies to COVID-19—could signal if someone has been infected, but can’t definitely confirm if the person is immune to reinfection or won’t go on to infect others. Epidemiologist Michael Mina said he worries “that a lot of employers are just assuming that having antibodies or having been infected means you’re good to get back to work.” Research fellow Stephen Kissler said that, over the coming months, we need “to normalize COVID in the public psyche, and reinforce that this will be a part of our day-to-day lives.”
April 14: ‘Unbelievable’ Timing: As Coronavirus Rages, Trump Disregards Advice to Tighten Clean Air Rules (New York Times)
Public health experts say that a Trump administration decision not to tighten regulations on fine particulate (PM2.5) air pollution disregards clear scientific evidence that such pollution harms health, particularly for people with COVID-19. Previous studies have suggested that PM2.5 pollution contributes to tens of thousands of premature deaths each year. A recent Harvard Chan School study found that a small increase in long-term exposure to fine particulate air pollution, or PM2.5, leads to a large increase in the COVID-19 death rate. Biostatistician Francesca Dominici, study co-author, said she was “disappointed but not surprised” by the administration’s move. She said that “it is an unwise decision in light of the pandemic. There has been a constant tactic over the last few years by the administration to dismiss science in general.”
On-and-off periods of social distancing will likely be needed into 2022 to ensure that hospitals have enough capacity for future COVID-19 patients in need of critical care, according to a new modeling study from Harvard Chan School researchers. Even if one 8- to 12-week period of social distancing is successful in “flattening the curve” — keeping the infection rate low enough so that hospitals aren’t overwhelmed — many people will remain susceptible to COVID-19, and there could be a resurgence of infection among this group in the absence of other interventions. “I think social distancing interventions of some sort are going to have to continue, hopefully lightened and in conjunction with other interventions,” said epidemiologist Marc Lipsitch, co-senior author of the study.
April 14: We Need a Reality Check on the Coronavirus Vaccine (Elemental)
Experts said they don’t know yet whether people who recover from COVID-19 develop a strong immunity to the disease or how long such immunity would last. They also said that developing a vaccine could take months — if it can be developed at all. “There are a lot of very smart people working very hard to come up with a vaccine,” said immunologist Yonatan Grad. He said it’s “likely” that one will be developed, “but it’s not a given.”
April 14: The interwoven threads of inequality and health (New Yorker)
In this Q&A, social epidemiologist Nancy Krieger discussed how the COVID-19 pandemic is highlighting health inequities that have existed in the U.S. for many years. She commented on preliminary data showing that African Americans are dying from COVID-19 at higher rates than whites, even though they make up a smaller percentage of the population. A variety of factors put people of color at greater risk, she said — such as living in crowded conditions, working in service jobs that put them in close proximity to others, having pre-existing health conditions that increase the risk of COVID-19, and lacking access to health care and health insurance.
April 13: What Good Leadership Looks Like During This Pandemic (Harvard Business Review)
Acting with urgency, communicating with transparency, responding productively to missteps, and constantly updating strategies are key attributes of good leadership during the COVID-19 crisis, wrote Michaela Kerrissey, assistant professor of management, and Harvard Business School’s Amy Edmondson. Two leaders got things right, they said: Adam Silver, commissioner of the National Basketball Association, who suspended the league’s season on March 11; and Jacinda Ardern, prime minister of New Zealand, who led an early and bold response to the pandemic and has communicated about it clearly, honestly, and compassionately.
April 13: Massachusetts Recruits 1,000 ‘Contact Tracers’ To Battle COVID-19 (WBUR)
Among the 1,000 “contact tracers” being recruited by Massachusetts — people who will help reach everyone in the state who may have COVID-19 so they can be tested and moved into isolation or treatment if needed — are student volunteers from Harvard Chan School who are working with local boards of health. Stacey King, director of practice, said that the contact tracer may be the first person to let someone know that they may be infected with COVID-19, and that it will be challenging to build trust while asking people about their symptoms, who they’ve been in contact with, their recent activities, and the health of members of their family. “Especially when people are under so much stress right now, I think it will be one of the hardest things that we experience,” she said.
April 13: Op-ed: A better way to grapple with benefit-cost trade-offs in a pandemic (The Hill)
In this op-ed, co-author James Hammitt, professor of economics and decision sciences and director of the Harvard Center for Risk Analysis, argued that a standard benefit-cost analysis is not sufficient in making difficult decisions during the coronavirus pandemic — for example, decisions about rationing medical supplies. The authors wrote that such analyses should take into account a variety of factors that matter to people, including longevity, income, and health.
April 13: Tensions skyrocket as COVID-19 fears grip Arizona detention center (Arizona Center for Investigative Reporting)
Experts are concerned that COVID-19 is spreading in the nation’s immigration detention centers. Detainees at some facilities are reporting that they’re being held in close quarters where they can’t practice social distancing, that communal spaces are not properly sanitized, there’s a lack of soap and personal protective equipment, they’re not always cared for when they fall ill, and that detention center authorities are not always forthcoming about the spread of disease. “An outbreak of COVID-19 in a rural detention center could be disastrous,” wrote Ashish Jha in a federal court document on April 8. He recommended that officials pause immigration court proceedings and release as many detainees as possible.
April 13: Florida should social distance until a vaccine exists — even if it’s next year, surgeon general says (Tampa Bay Times)
Florida Surgeon General Scott Rivkees said on April 13 that Floridians should continue with social distancing and wearing face masks for up to a year, until there’s a vaccine for COVID-19, although it’s unclear if Florida Gov. Ron DeSantis agrees with that strategy. Epidemiologist Marc Lipsitch said that governors should strongly consider the advice of public health experts, especially when so many agree on the importance of taking strong measures to slow the spread of the virus. “As a general matter, public health is a type of expertise,” he said. “Most governors don’t have (that) expertise. They should seek out the people who do have the expertise, otherwise they’re not getting the best advice.”
April 13: How Long Does It Take To Recover From COVID-19? (NPR)
Recovering from COVID-19 can be an up-and-down experience. Both symptoms and severity can vary widely. Some people start to feel better after a few days, only to feel sick again. The Centers for Disease Control and Prevention say that people with COVID-19 can stop isolating themselves after being fever-free for 72 hours, after their respiratory symptoms have improved, and at least seven days from the onset of initial symptoms. After returning to work or public spaces, recovered patients should still avoid groups and wash their hands frequently. It’s unclear how long people are infectious after recovering, and also unclear if they become immune to reinfection and how long any immunity lasts. “Based on immunity to SARS [and] MERS, and seasonal coronaviruses, a reasonable expectation is that most, and maybe nearly all, people who been infected with SARS-CoV-2 will have immunity for a year or more,” said epidemiologist Marc Lipsitch. This immunity will likely protect people “at least against severe disease and against shedding a lot of virus that would make them highly contagious.”
Experts expressed doubt about a disease model from the University of Washington’s Institute for Health Metrics and Evaluation (IMHE), cited by the White House, that predicts that COVID-19 deaths will stop this summer. The model suggests that social distancing will only have to last until the end of May because strategies such as mass screening, testing, and contact tracing will be put into place and will keep the disease from spreading. Epidemiologist William Hanage said, “Unfortunately, there is no way that amount of control could happen by the summer. Even in the best scenario, we assume there will be flare-ups, and we will have to remain extremely vigilant.” Ashish Jha said it’s unrealistic to think that the epidemic will somehow be over for the next few months. “We know that’s not true,” he said. “We know that the number of cases will continue. The virus is not going away.” Health policy researcher Thomas Tsai said the model is useful but added that “it’s still just a model of what the world could look like. And there are a lot of parameters that the best models can’t account for.”
April 13: Keep parks open. The benefits of fresh air outweigh the risks of infection. (Washington Post)
In this opinion article, three professors — epidemiologist Marc Lipsitch and Joseph Allen, both of Harvard Chan School, and Harvard University’s William “Ned” Friedman, director of the Arnold Arboretum — argued that public green spaces such as parks, botanical gardens, and arboreta need to stay open during the COVID-19 pandemic. Closing such spaces because of overcrowding and disregard for social distancing “should be a temporary, last-resort measure for disease control” because “the benefits of getting outside vastly outweigh the risk of getting infected in a park,” they wrote.
April 13: Who Is Immune to the Coronavirus? (New York Times)
In this opinion piece, epidemiologist Marc Lipsitch wrote that there are many uncertainties about how the human immune system responds to COVID-19 and what that means for the spread of disease. In the absence of clear data, scientists can use current knowledge about how the immune system works and about viruses related to COVID-19 to develop models as to how immunity may develop for COVID-19 patients. One “educated guess,” said Lipsitch, is that most people will develop some sort of immune response after infection, some better than others, and that the protection could last about a year. But many questions need to be answered, including how many cases of COVID-19 there are, what an immune response means for a person’s risk of getting reinfected or their contagiousness to others, and whether or not infections are leading to “herd immunity”—when enough people develop immunity so that the virus can be contained.
April 12: Why wasn’t California more prepared for the coronavirus? (Desert Sun)
Although California was preparing to deal with pandemics in the 2000s, those plans petered out after the recession hit in 2008. According to models of hospital surge capacity developed by Ashish Jha, researchers at Harvard Chan School, and the news site ProPublica, most communities in California will face severe shortages unless local authorities manage to curb the spread of disease. Jha said that having the capacity to deal with a surge of disease involves planning. “If you had planned for it for years and know … how to turn a convention center into a hospital, know how you are going to get the extra staff, you can get through it,” he said. “When you haven’t done any of that planning it is much, much harder — and that’s what we are experiencing right now.”
April 11: The only way this ends: herd immunity (Boston Globe)
The only way the COVID-19 pandemic will end will be when a high percentage of the population develops immunity — so-called “herd immunity” — either through a vaccine or through exposure to the disease, according to experts. In this opinion piece, writer Jeff Howe discussed disease models from epidemiologist Marc Lipsitch and immunologist Yonatan Grad which show that intermittent periods of social distancing may be the best option to control the pandemic. This on-again, off-again approach would protect hospitals from being overwhelmed with sick patients, buy them time to gather adequate medical supplies, and allow the population to slowly gain immunity, the article said.
April 11: Social distancing is working, but when will things return to normal, and what will that look like? (Boston Globe)
It’s possible that social distancing measures aimed at slowing the spread of COVID-19 could be eased sometime in May, according to epidemiologists. But easing these measures won’t include allowing large-scale gatherings, and people will likely still have to take precautions such as frequent hand-washing and maintaining physical distance from each other in places like stores and restaurants. The key to easing restrictions will be implementing much more testing, say experts. “The more we know about the prevalence of the virus, the closer we’ll get to being able to reopen,” said epidemiologist Michael Mina. Health policy researcher Thomas Tsai said his best estimate for when businesses can reopen would be early summer, and that large gatherings should be allowed only if there’s a thorough testing and quarantine regime in place. “We know there’s a high chance that there could be another recurrence,” he said. “We need to be very careful about how we proceed, and dial up our responses as they’re needed.”
Decades of air pollution have had negative health impacts on Americans with conditions such as hypertension and asthma. Those diseases have now been associated with severe cases of COVID-19, according to a pre-print study from Harvard Chan School—and minority populations are bearing the brunt of the harm. Evidence suggests the reason for this is that black and Hispanic people are often exposed to more air pollution than other groups because of socioeconomic disparities. Biostatistician Rachel Nethery, co-author of the pre-print, said the study found that race was “the largest effect, hugely statistically significant. It was pretty shocking.” Minorities’ unequal access to health care may also be playing a role, said social epidemiologist Nancy Krieger. “That makes quite the whammy.”
April 10: Obama: In trying times, truth first (Harvard Gazette)
A virtual seminar offered advice for municipal leaders on how to handle the COVID-19 pandemic, featuring speakers including former President Barack Obama, former New York City Mayor Michael Bloomberg, and Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention. One speaker was Kimberlyn Leary, an associate professor in the Department of Health Policy and Management. She noted that recent data shows that people of all ages and from all walks of life are facing new or worsened mental health issues because of the pandemic. She said that city leaders could help by promoting available resources, acknowledging the difficulties, and expanding services when possible.
April 10: Relearning ways to grieve (Harvard Gazette)
Hugs are out and funerals have gone virtual during the COVID-19 pandemic. In an April 8th online forum, experts spoke about learning new ways to mourn. “Losses are ubiquitous in a world closed down by the virus,” said Christy Denckla, research associate in epidemiology. “The scope of this loss is truly global and unprecedented.” She said that the sense of bereavement and dislocation has been compounded by job losses and the cancellation of events such as graduations and sports matches. Columbia University psychiatry professor Katherine Shear spoke about the problems that can occur when coping mechanisms — processing grief and resuming a changed life — are disrupted. She offered approaches to help clinicians, family members, and the bereaved navigate grief during our changed reality.
April 10: This Is Exactly How to Wear a Homemade Mask Safely (Self)
The Centers for Disease Control and Prevention is now recommending that everyone wear a homemade face mask when they are in public places where it’s hard to maintain social distancing, such as grocery stores and pharmacies, in order to curb the spread of COVID-19. According to epidemiologist Marc Lipsitch, the general consensus is that the main benefit of homemade masks is that they can keep a sick person from spreading germs—which can happen without them knowing it, because evidence suggests that COVID-19 can be spread even when people don’t have symptoms. Although there isn’t strong evidence that homemade masks can adequately protect the wearer, Lipsitch said that wearing them is “a common-sense precaution [that] should be at least partially protective.” He added that homemade masks can also remind us not to touch our faces, and serve as a visible reminder of the need for good hygiene.
April 10: Testing, Treatment And Vaccines: Unpacking Efforts To Contain The Coronavirus (WBUR’s “On Point”)
Eric Rubin, immunologist and NEJM editor, and Harvey Fineberg, former president of the National Academy of Medicine and former dean of Harvard Chan School, discussed efforts to contain the coronavirus. They spoke about the prospects, and the timeline, for a successful vaccine; the need to expand testing; adopting a wartime strategy for combating coronavirus; the wisdom of instituting a “smart quarantine”; and the sacrifices medical workers are making every day.
In this radio interview, epidemiologist Michael Mina discussed COVID-19 testing—both testing for the virus itself and serologic testing, a blood test that can determine whether a person has previously been infected by checking for antibodies to the virus. Mina said Massachusetts now has almost enough tests for the virus, but not enough swabs to take samples from patients, because of a global shortage. As for the antibody tests, he said they won’t be widely available for at least another month or more.
April 10: Routine Healthcare Is Falling Through The COVID-19 Cracks (Science Friday)
Health policy expert Michael Barnett spoke about how the COVID-19 pandemic is affecting patients and clinics. He discussed telemedicine and virtual health services, the economics of private doctors’ offices, and shortages of regular medications.
April 10: Finding community during a pandemic (Science)
Postdoctoral fellow Arpit Sharma wrote about feeling worried after COVID-19 arrived in Boston and Harvard instituted mandatory work-from-home policies. “My lab mates and I think of our workspace as a home away from home, where we enjoy interacting at lab meetings and over coffee. I felt a pit in my stomach as I realized all that was over for now. I was afraid of feeling isolated.” But after participating in virtual seminars and connecting with colleagues online, he wrote, “I feel more connected than ever. … I now realize that I am part of a global research community that can thrive online.” He said that the tough times have provided “an opportunity to rethink how we interact with one another, in ways that will benefit the scientific community in the long term.”
April 9: Harvard health scholar shares insights on pandemic (Martha’s Vineyard Times)
In this Q&A, Jennifer Leaning, professor of the practice of health and human rights, discussed a range of topics about the coronavirus, such as the United States’ lack of preparedness. She noted that the U.S. disbanded its pandemic task force in 2018 and so was blindsided by the coronavirus. “I would say it’s a failure of judgment, a failure of vision, a failure of will that we’re in this situation,” she said. She spoke about the importance of protecting health care workers from infection, because if they get sick they could be out of commission for weeks, which could lead to a shortage of people to care for patients. She said that if hospitals do become overwhelmed, it could lead to a triage situation in which “you have to decide who you do not take care of even though they’re very sick and that is brutal. That is war surgery. … I fervently hope that we don’t get to that point.”
A computer simulation from Belgian researchers seems to suggest that droplets spread by exhalations, coughs, or sneezes from runners, walkers, or cyclists can potentially infect people behind them. The simulation went viral. But experts are questioning the simulation’s findings, which have not been vetted because no specifics were published about it. “On the epidemiology side — where the droplets are is much less relevant than the amount of transmission that occurs via this route,” said epidemiologist William Hanage. “Advice on physical distancing is really about reducing the risk of transmission rather than eliminating it altogether.” He added, “The amount of transmission from this route, even if it is possible, will be dwarfed by that from others.”
April 9: Hope for managing hospital admissions of COVID-19 cases (Harvard Gazette)
Social distancing measures may have worked well enough so that Massachusetts General Hospital will be able to avoid being overwhelmed with COVID-19 patients. Emergency preparedness expert Paul Biddinger said that recent modeling suggests that the pandemic’s peak will stretch but not overwhelm the hospital. “We are cautiously optimistic that, with the numbers we are anticipating, we will have enough ventilators and we will have enough Intensive Care Unit spaces,” he said.
Hospitals in Massachusetts have been furloughing employees, cutting pay, and withholding salaries for health care workers. Leonard Marcus, founding co-director of the National Preparedness Leadership Initiative (NPLI), said that even though hospitals are busy with coronavirus patients, they’re losing money on medical procedures that would normally be generating revenue. “If we look at a hospital like any business that has to pay its people at the end of the day and meet its financial obligations, this is an absolute nightmare,” he said. He said it’s unclear which hospitals will emerge unscathed when the pandemic ends.
April 9: COVID-19 models vary widely. What that means for leaders under pressure. (Christian Science Monitor)
Leaders around the U.S. have been making life-disrupting decisions in order to navigate the coronavirus crisis, but in doing so they’ve had to take into account widely varying disease models. The reason for the differing models is that there’s uncertainty around questions such as COVID-19 transmission and fatality rates, and because of variations in social distancing measures in different parts of the U.S. “I think we should use all data to inform our views, but we shouldn’t be overconfident in the results from any one data set or even any combination of data sets,” said epidemiologist Marc Lipsitch.
April 9: Racial Disparities, No Surprise, Now What? (NY 1)
COVID-19 is affecting communities of color disproportionately. Experts say it’s because of entrenched racial health disparities that have led to higher rates of diseases such diabetes, high blood pressure, obesity, and asthma in minority populations. FXB director Mary Bassett said that black and Hispanic communities face greater risk of exposure to COVID-19 because they often live in crowded conditions, have to travel on crowded public transportation to work, and have roles as essential workers in which they may not be able to keep six feet away from others. They also are more likely to lack health insurance. She recommended gathering data on COVID-19 disparities in order to help direct resources to where they’re needed most; conducting clinical trials for potential COVID-19 drugs in hospitals serving marginalized communities; and having employers house their essential workers in hotels near their work to minimize their commuting time and potential disease exposure.
April 9: The Young Americans Most Vulnerable To COVID-19 Are People Of Color And The Working Class (FiveThirtyEight)
It’s known that older people are vulnerable to COVID-19, but so are younger people, particularly people of color and poorer Americans, because they’re more likely to have underlying health conditions such as heart disease or diabetes. These medical conditions are often the result of socioeconomic disparities such as poverty, racial segregation, differences in employment and education opportunities, limited access to fresh food, and lack of access to health care, say experts. Social scientist David Williams said that those who are most disadvantaged will likely be hit hardest by the pandemic—they may lose their jobs as businesses close, making it even harder for them to see a doctor if they get sick. “The people being most hurt by this epidemic are the very people who at the beginning of this epidemic were the most vulnerable,” he said.
Some leaders have suggested the rapid pursuit of “herd immunity” as a way to help slow the spread of the coronavirus. Herd immunity occurs when a certain fraction of the population becomes immune to a particular disease so that person-to-person transmission is unlikely or even impossible. For COVID-19, experts think herd protection could be achieved if 50% to 66% of the population were immune. But experts say that, without an available vaccine, the only way to achieve herd immunity quickly would be for many people to become infected. “What really matters is how you get to herd immunity,” said epidemiologist William Hanage. “And it will be impossible to get there without a large number of deaths.” He said it’s unclear how many people who’ve recovered from COVID-19 are immune. “We don’t even know how much immunity the disease generates and how long it lasts,” he added.
April 9: Harvard School of Public Health Students Join Workforce During Pandemic (The Crimson)
Harvard Chan School students are volunteering with both the Massachusetts Department of Public Health and Harvard University Health Services (HUHS) to help fight the COVID-19 pandemic. They’re helping the state with contact tracing efforts and helping HUHS with health communication and promotion. Doctoral students Christina Alonso and Eric Coles are co-leading the student volunteer workforce for the state. Coles said he hopes student support for local boards of health will help decrease hospitalizations. Lucas Buyon, president of the Harvard Chan Student Association—which is organizing the effort to help HUHS—said that more than 200 students responded to an initial call for volunteers in the first 72 hours.
Even though the number of confirmed cases of COVID-19 appears to be slowing in some states, epidemiologists said it’s still too soon to stop social distancing. Visiting scientist Eric Feigl-Ding noted that the possible decrease is only significant if there’s enough testing to show the actual number of cases. He said that the numbers will hold more significance if they slow for at least a week, and that social distancing is “even more important” right now. Using the example of battling a wildfire, he said, “If you are super aggressive and put out a raging wildfire before it starts, people will think, ‘Oh, you overreacted. Nothing happened.’ Well, nothing happened because you were aggressive.”
April 8: Consistent, transparent messaging from leaders needed in coronavirus crisis, expert says (Boston Herald)
During the COVID-19 pandemic, it’s crucial that federal, state, and local leaders provide messaging for the public that’s consistent and transparent, according to leadership and preparedness expert Leonard Marcus. He noted that the federal government has been inconsistent in its messaging on certain orders and advisories, and that states are also pursuing different courses of action regarding the pandemic. “The concern … is that the public could be confused,” said Marcus—for instance, about who should wear masks and under what circumstances.
April 8: Op-ed: A second, hidden pandemic will follow covid-19. We need to plan for it. (Washington Post)
As COVID-19 blankets the U.S., most routine doctors’ appointments and elective surgeries have been canceled—which could lead Americans’ health to deteriorate during the course of the pandemic, wrote health policy expert Michael Barnett in this opinion piece. He predicted that a “second, hidden pandemic” will follow the coronavirus, because people will stop dieting and exercising, avoid filling prescriptions out of fear of pharmacies or inability to pay, and suffer from mental health issues because of the worsening economy and being stuck at home. He urged: “If you have a medical concern, reach out to your doctors. … Though we may not be battling covid-19 in the intensive care unit, primary care doctors are supporting the front-line medical troops by keeping everything else out of the emergency room.”
April 8: Coronavirus ‘is the Big One … I hope never to see bigger’: Harvard epidemiologist (USA Today)
In a wide-ranging Q&A, epidemiologist Marc Lipsitch discussed the coronavirus—its trajectory, the impact of social distancing on disease spread, when the U.S. can open up again, testing for COVID-19, and immunity. He said the key to easing social distancing measures and getting people back to work and school will be using serologic testing—testing for antibodies to COVID-19—to determine if people have developed immunity. Then scientists will have to determine how much protection immunity confers, and whether it varies from person to person. He also predicted that increasing fatigue with social distancing will prompt some regions of the U.S. to ease restrictions, which may in turn prompt a resurgence of infections. “There are ways to avoid that, but they all involve this very long and destructive process of social distancing,” he said. “It’s easy to say as the public health person, this is what we need to do for public health. But I’m acutely aware that there are also other considerations, and I don’t see a really good answer.”
April 8: Ashish Jha: ‘India needs extensive ramp-up of testing… lockdown isn’t a cure, just reduces burden’ (India Express)
India is considering next steps after a lockdown to tamp down the spread of COVID-19. In a Q&A, HGHI director Ashish Jha said that easing the lockdown isn’t a good idea unless there is widespread testing so that the country can determine where disease hotspots are. “If you open up without good data of how much disease there is in your community, what will happen is that the disease is going to come right back,” he said. “Lockdown doesn’t cure the disease. It just reduces the burden.”
April 8: Op-ed: To Get Our Economy Moving, Focus On Testing For Coronavirus (Forbes)
What will it take to open up the U.S. again without a resurgence of COVID-19? Ashish Jha wrote, “The single most important tool we’ll need is an extensive testing infrastructure. … Without adequate testing, we don’t know how many are infected, where the virus is spreading or where the hotspots are. We’re on a battlefield wearing blindfolds.” He said that without enough testing, sweeping social distancing measures are necessary. “While the price of social distancing is high, the price of reopening without the right testing infrastructure would be higher,” he wrote.
April 8: Even as deaths mount, officials see signs pandemic’s toll may not match worst fears (Washington Post)
Although 1,800 people in the U.S. died from COVID-19 on April 7—the highest daily death toll so far—the number of new hospitalizations in New York, the state hardest hit by the virus, was starting to plateau. Some computer models suggested that the overall death toll from the disease in the U.S. will be lower than originally thought. But experts warned that the nation should not let up on social distancing anytime soon, because doing so could prompt infections to spike. They also said that states beyond New York could soon experience a surge in disease. “The pandemic is only just getting its boots on in other places,” said epidemiologist William Hanage. He said he is “incredibly anxious” about smaller communities around the nation, which have fewer resources than cities “and probably won’t be testing until too late.” Hanage was also quoted in another Washington Post article that explained that disease models frequently change, and that different models can produce different results.
April 7: 5 Reasons COVID-19 Will Impact the Fight to End Extreme Poverty (Global Citizen)
The COVID-19 pandemic is expected to devastate the world’s most vulnerable people. FXB executive director Natalia Linos said that in order to achieve the United Nations’ Global Goals by 2030, there should be a worldwide conversation about how COVID-19 will impact inequality and poverty. “Unless governments do something explicitly to focus on the poor, we would be silly to think that wouldn’t impact achieving goal one — solidarity and global commitment to fight poverty — which I think already is going to require a lot,” she said. “Now there’s this additional challenge.”
April 7: How masks and buildings can be barriers to the coronavirus (Harvard Gazette)
In this Q&A, healthy buildings expert Joseph Allen discussed ways to minimize the spread of COVID-19—through wearing face masks; lowering the density in office buildings; making sure that fresh air circulates in homes workplaces, and stores; and following cleanliness precautions around those who are infected. Asked about the role of aerosols—the fine particles that can be expelled when people cough or even just breathe—in the spread of COVID-19, Allen said he thinks they are a frequent form of transmission.
April 7: Florida argues Medicaid expansion hurts state. Experts say right now, it could help. (Miami Herald)
Florida has so far opted out of expanding Medicaid under the Affordable Care Act, primarily because of concern about the impact on the state’s budget. But some public officials and public health experts are now calling for the expansion of Medicaid, the public health insurance program for low-income people, because during the COVID-19 pandemic more people need medical care, safety net hospitals need reinforcement, and thousands of people in Florida have fallen into low-income brackets. Health economist Benjamin Sommers called the lack of expansion in states like Florida “pretty galling.” Sommers argued in a recent New England Journal of Medicine article that expanding Medicaid in the 14 states that haven’t done so yet would not harm state budgets.
April 7: The reasons why the U.S. isn’t on track to open up (Politico)
The U.S. is testing nearly 700,000 people every week for COVID-19, but experts say that’s still not enough. In addition, labs across the country have a large backlog of patient samples. And some are questioning the accuracy of new antibody tests that could potentially tell if someone has been infected with the coronavirus. Experts say that significantly increasing the amount of testing, curbing the spread of new infections, and boosting health care capacity are all necessary before social distancing measures can be eased. “There are going to be a lot of places, if not everywhere in the U.S., that are still not meeting those criteria by the end of this month,” said epidemiologist Marc Lipsitch.
April 7: Defeating COVID-19 Might Turn On Survival of the Fittest (Voice of America)
COVID-19 will be defeated forever only when enough people develop immunity to it so that it can no longer spread easily from person to person, according to experts. This so-called “herd immunity” can happen in one of two ways. A vaccine—the preferred way—is at least a year away. The other way happens naturally, when a large percentage of the population becomes infected and develops antibodies to the disease that protect from reinfection. The problem with the second way is that many will die in the process. In addition, it’s unknown what percentage of the population needs to become infected to provide herd immunity. Even for those who have developed immunity, “we don’t know how effective it is or how long it will last,” said William Hanage. He said that, until a vaccine is available, repeated rounds of physical distancing may be needed.
April 7: How Scientists Track Us to Help Tame Covid-19 (Bloomberg Quint)
Researchers are using anonymized data from social media companies to determine whether people are complying with government policies around the globe aimed at slowing the spread of COVID-19. For example, the COVID-19 Mobility Data Network is using data sets from Facebook that show the location of people’s cell phones to study the effects of social-distancing advisories. “We have no idea what they actually do in terms of subsequent epidemiology of disease,” said epidemiologist Caroline Buckee, who leads the effort. “Policy makers want to know things like, ‘Which of these policies actually work? And how long are we going to have to do them?”
April 7: New Research Links Air Pollution to Higher Coronavirus Death Rates (New York Times)
People with COVID-19 who live in U.S. regions with high levels of air pollution are more likely to die from the disease than people who live in less polluted areas, according to a new nationwide study from Harvard Chan School researchers. The study found that a small increase in long-term exposure to fine particulate air pollution, or PM2.5, leads to a large increase in the COVID-19 death rate. Study co-author Francesca Dominici said the study suggests that counties with higher pollution levels “will be the ones that have higher numbers of hospitalizations, higher numbers of deaths and where many of the resources should be concentrated.”
April 6: Epidemiologist says COVID-19 may be more infectious than thought (Harvard Gazette)
Given the difficulty in keeping COVID-19 from spreading in settings such as hospitals, cruise ships, and nursing homes, epidemiologist Michael Mina thinks that the virus is more transmissible than previously thought. He recommended moving people out of nursing homes if possible, and stepping up surveillance at the facilities, such as by testing employees every few days. He also said that additional testing for the virus is needed everywhere, and that scientists need serological tests to show how many people have been infected and recovered. “We have to get to an order-of-magnitude-understanding of how many people have actually been infected,” he said. “We really don’t know if we’ve been 10 times off or 100 times off in terms of cases. Personally, I lean more toward to 50 to 100 times off, and that we’ve actually had much wider spread of this virus than testing … numbers are giving us at the moment.”
April 6: N.Y. Hospitals ‘Redline’ While Virus Cases Hint at a Plateau (Bloomberg)
Data suggests that cases of COVID-19 are beginning to level off in New York, but experts cautioned that social distancing policies need to stay in place to avoid a resurgence of infections. Among the state’s 20 million residents, 130,000 have been diagnosed, and undiagnosed cases could mean that as many as 1 million were infected, said epidemiologist Marc Lipsitch. But even that number, representing roughly 5% of the population, would be too low for herd immunity to offer protection. “It’s premature to say whether we have reached the peak of the first wave [of infections], or the overall peak,” he said. If cases are peaking, “it means social distancing is working, because cases are going down before herd immunity has kicked in. But then people are still vulnerable. That’s the fundamental dilemma of social distancing. The better it works, the more susceptible people remain in the population.”
Facebook has stepped up efforts to share anonymized data about people’s movement patterns with COVID-19 researchers, in order to better understand the spread of disease and the effectiveness of social distancing measures. “Measuring the impact of social distancing policies is absolutely critical at this stage, and aggregated data of this kind provides insights that protect individual privacy but are actionable for policymakers and researchers building predictive models,” said epidemiologist Caroline Buckee.
A new smartphone app—the COVID Symptom Tracker—is helping track the onset and progression of COVID-19 symptoms of millions across the U.S., with the goal of shedding light on the nature of the disease, identifying those at risk sooner, pinpointing virus hot spots, and helping slow the spread of disease. Immunologist and cancer epidemiologist Andrew Chan is the lead U.S. researcher for the multi-institutional project.
April 6: With Coronavirus Infections Linked to Religious Gatherings, Debate Rages over Worship (Religion News Service )
Most houses of worship across the U.S. have stopped holding large gatherings to limit the spread of COVID-19, but some continue to meet, prompting lawmakers, religious leaders, and health experts to consider whether religious freedom means the freedom to risk people’s health. Epidemiologist Michael Mina said he thinks worship services should be curtailed during the pandemic. “Every extra person who shows up in the hospital puts everyone else at risk,” he said. “I’m in support of limiting those kinds of congregation (meetings) from happening because the ramifications extend well beyond those individuals.”
New recommendations that everyone should wear a face mask to limit the spread of COVID-19 are based on growing evidence suggesting that the disease can be transmitted by people who don’t feel sick, and by tiny droplets that spread when people are speaking. “The number one benefit [of a mask] is that it prevents someone who is sick from infecting others,” said Joseph Allen. He said it can also offer some level of protection to the wearer. “We’ve seen the scale and scope of this virus. It’s unprecedented, and we’re realizing that we have to throw everything we can at it,” he said.
April 6: HIV, Ebola, SARS and now COVID-19: Why some scientists fear deadly outbreaks are on the rise (Los Angeles Times )
Practices such as deforestation and poaching—which lead to increased contact between wild animals and human populations—are one of the driving forces behind a surge in dangerous new infectious diseases that have made the leap from animals to humans, such as Ebola, SARS, swine flu, and HIV, according to experts. COVID-19 may have originated in bats, scientists believe. “The evidence is clear; we’re driving disease emergence through less sustainable use of nature,” said C-CHANGE interim director Aaron Bernstein. “It’s happening more often, and it’s mostly happening because of spillover of pathogens from animals to people.”
April 6: The covid-19 crisis is going to get much worse when it hits rural areas (Washington Post)
“It’s only a matter of time before the virus attacks small, often forgotten towns and rural counties. And that’s where this disease will hit hardest,” wrote Dean Michelle Williams, Bizu Gelaye, assistant professor in the Department of Epidemiology, and Emily M. Broad Leib of Harvard Law School in an opinion piece about the spread of COVID-19. They wrote that rural communities could fare worse than urban and suburban areas because they have older populations with poorer overall health; because many rural hospitals have closed and others are in dire financial straits; and rural counties don’t have many intensive care beds and may not have enough health care workers to care for an influx of patients. The authors recommended expanding telemedicine and social safety net programs to alleviate the burden on rural health systems.
Tests that can show if a person has had COVID-19—serologic or antibody tests—will help determine the proportion of the population that was infected and, hopefully, who has developed immunity to the disease. “The key is whether those antibodies actually protect against infection; we still don’t know that,” said epidemiologist Caroline Buckee. Immunologist Sarah Fortune said that serologic testing will help determine if there’s enough “herd immunity” in the population—in other words, if enough people are immune so that there wouldn’t be another huge resurgence of disease.
April 6: How to beat the coronavirus and return to a new normal (USA Today)
Aggressive social distancing will help ensure that the coronavirus doesn’t overwhelm hospital systems across the U.S., but if we let up, the virus will come “roaring back,” wrote Joseph Allen and Harvard’s Juliette Kayyem, former assistant secretary at the Department of Homeland Security, in this opinion piece. They wrote that a broad consensus has been reached by many experts about what to do over the next two months to keep the virus at bay: keep up with social distancing, produce test kits and medical resources, then manage the virus through a variety of measures until a vaccine is available. They stressed the importance of having a national plan and national mobilization, not state-by-state ad-hoc approaches. “We cannot half-ass it; this is an ‘all-in’ moment in history if there ever was one,” they wrote. “We cannot think about this in terms of weeks; it took two months for each successful country or region to get this under control. We must act now.”
April 5: No COVID-19 testing at home yet but quicker options coming (Associated Press)
Although some companies have developed home-testing kits for the coronavirus, U.S. regulators haven’t approved any of them for use. Testing can still only be done at hospitals, clinics, or drive-through sites, with a doctor’s order. Testing has ramped up across the nation, and some newer and quicker tests are being used, but more are still needed. “We have this massive epidemic on our hands and if we really want to control it through testing we need to have it more readily available and on a repeated basis — potentially every week to know who is truly positive and negative,” said epidemiologist Michael Mina.
April 5: We are fighting a 21st-century disease with 20th-century weapons (The Guardian)
To fight subsequent waves of COVID-19 and future pandemics, there should be a unified and comprehensive health data system that can link information about patients’ risk factors with information about the spread of disease, wrote David Hunter.
A new federal tracking system developed by the Centers for Disease Control and Prevention, COVIDView, will track the coronavirus in the U.S. and provide weekly updates. “I think the information will be valuable,” said epidemiologist Marc Lipsitch. But he and others said the CDC should have developed the system much sooner, and that it doesn’t provide everything it should, such as daily instead of weekly updates. “We’re in the middle of the greatest pandemic in a century,” said Ashish Jha. “So I think what they’re doing is fine and it is helpful. But we need something much more than that. The pandemic doesn’t take the weekend off.”
April 4: Experts: Uneven Stay-at-Home Orders Could Mean Wider Pandemic (Voice of America)
As of April 4, 12 states had not issued stay-at-home orders to stem the spread of the coronavirus, but public health experts said that if social distancing measures are delayed in some parts of the U.S., the nationwide death toll could rise. Immunologist Yonatan Grad said that while isolation may have protected rural areas to some degree so far, that won’t last. “It just takes more time to show up there,” he said. “But it will.” He noted that there’s a lag of several weeks between when cases start to appear and when a surge of disease hits. “The sooner you’re able to slow the spread of the virus, the more you’re able to flatten the curve and mitigate the risk to your health care infrastructure,” he said.
April 3: Mask on? Mask off? (Vox’s “Today, Explained”)
In this podcast, Joseph Allen, assistant professor of exposure assessment science, said it’s important for the general public to wear cloth face masks to help prevent the spread of COVID-19—but to reserve N95 respirator masks for frontline health workers. He also discussed the inconsistent messaging about masks from federal officials, and how even though Americans aren’t used to wearing masks, it can begin to feel more natural over time. “Norms can change pretty quick, and I think that’s what you’re seeing with other countries in terms of mask-wearing,” he said. He added that masks don’t substitute for other important measures to stop the spread of infection, such as washing hands, staying at least six feet away from people, and staying home except to pick up necessities.
With coronavirus deaths in the U.S. estimated at 100,000 to 250,000 and possibly higher, the U.S. faces a large-scale collective trauma. Aside from having to process so much death, social distancing means that our traditional ways of mourning the dead—attending funerals, dropping off meals at loved ones’ homes, or sitting shiva—are not available to us. “Many of the ways we as individuals, and communities and societies, cope with grief, we will not be permitted to do,” said psychiatric epidemiologist Karestan Koenen. Although saying goodbye to loved ones and comforting those in mourning in person is impossible right now, Koenen said it’s important to find alternatives if we’re going to move ahead.
Commenting on U.S. missteps in addressing the threat posed by the coronavirus, epidemiologist Marc Lipsitch said that actions taken in January—screening people coming off of planes from Wuhan and then banning foreigners who’d spent time in China—was a good idea, but “the problem is those measures became the centerpiece rather than a minor aspect of the response. So we wasted a lot of time not getting prepared in those weeks of late January, early February and much of February, in fact.” Lipsitch said that social distancing is showing signs of working in some parts of the country, but warned against lifting those restrictions too soon. “We’ve grabbed a life raft, and we need to climb out of the water and catch our breath and start making plans for how we’re going to solve the problem,” he said. “But how to get to dry land is really unclear this point.”
April 3: Harvard to help track the virus (Harvard Gazette)
Hundreds of students at Harvard Chan School are volunteering to assist with the COVID-19 response. Working with local boards of health across Massachusetts through the Academic Health Department Consortium, they’re helping with case interviewing and contact tracing, communication efforts, and social media. They’re also assisting Harvard University Health Services by fielding questions from the Harvard community, tracking the latest official health recommendations, and helping with health promotion. Dean Michelle Williams called the students’ efforts “an incredible learning opportunity for all of us, in addition to the contribution we want to make.” Lucas Buyon, PhD ’23, president of the Harvard Chan Student Association, said, “There’s suddenly been a burst of activism from the student body as we’ve realized we’re all public health professionals, and we can do something about this, we can use our skills to help everyone.” The article also quoted Eric Coles, DrPH ’20, who is helping coordinate the volunteer workforce.
April 3: Fox News’ Jesse Watters Said Travel Bans ‘More Critical In Saving Lives’ Than COVID Testing. He’s Wrong. (Kaiser Health News)
There is little evidence that the Trump administration’s restrictions on some international travelers have restrained COVID-19, according to experts. They said that such restrictions can work only as part of a more comprehensive response that includes widespread testing, isolating people who may have been exposed to infection, and ramping up emergency preparedness. Epidemiologist William Hanage said that the Trump travel ban was the wrong approach at the wrong time. “When the travel ban was put in place, the risk of importation from China was quite small,” he said.
April 3: What to know about the risks of restaurant takeout and delivery — and how to minimize them (Washington Post)
There aren’t definitive answers on whether there’s risk of spreading COVID-19 through restaurant takeout or food delivery, but experts offered advice on minimizing potential risk for customers, crews who prepare the food, and delivery drivers. This article referenced Joseph Allen, who wrote in a recent Washington Post op-ed that the risk of getting COVID-19 from grocery shopping or food delivery is low. Epidemiologist William Hanage was also quoted on whether or not COVID-19 can be transmitted by people who don’t adequately wash their hands after using the bathroom. “We can reasonably surmise that some transmissible virus happens from a stool, but we have no evidence to suggest that it is a major route of transmission,” he said. “My judgment would be that the role of this in transmission is dwarfed by the contribution that is made by people who don’t even realize they are infected yet.”
Public health experts say it could take many months until life returns to normal in the wake of COVID-19. Although cases are expected to peak in mid-April in many parts of the U.S., lifting social distancing restrictions too soon could lead to a resurgence of the virus, they say. In the meantime, much needs to be done to fight the pandemic, including expanding testing, creating the infrastructure needed to trace contacts of cases and monitor them in quarantine, expanding hospital capacity, and providing more protective equipment for health workers. “We let things get out of hand,” said epidemiologist Michael Mina. “So now the place that we’re left in is we have to absolutely beat this down with a hammer and get to near zero cases.”
April 2: Preparedness Spending Exploded After 9/11. Is That Helping Now? (Undark)
After 9/11, the federal government poured money into bolstering the nation’s public health systems. Without that investment, the current problems with the response to COVID-19, such as a lack of tests for the virus and shortages of hospital beds and medical supplies and equipment, might be even worse, according to experts. Howard Koh, Harvey V. Fineberg Professor of the Practice of Public Health Leadership, said that it’s a mistake to question whether those funds were over-allocated to, for example, bioterrorism preparation, rather than pandemic planning. “One doesn’t want to be a Monday morning quarterback on that,” he said.
April 2: Why it can be so hard to tell if you have Covid-19 (Vox)
Major symptoms of COVID-19 are fever, coughing, and shortness of breath. But some people experience very different symptoms, such as vomiting and loss of taste and smell, and some experience no symptoms. The variation from person to person has “really put us behind in our ability to identify people with COVID infections, and probably resulted in a lot of people walking around with COVID and not knowing it,” said immunologist and cancer epidemiologist Andrew Chan. Chan is collaborating with colleagues on a COVID Symptom Tracker app that can provide information about the nature of the disease, who’s getting infected, and how best to limit its spread. Chan explained why the app can help: “If it’s just one person that feels this way, we don’t know what to make of that,” he said. “But if many people are feeling the same way with subtle symptoms then that is something that’s really worth sitting up and taking notice about.”
April 2: In coronavirus fight, oft-criticized Facebook data aids U.S. cities, states (Reuters)
Health researchers from Harvard and other universities are tracking the effectiveness of social distancing policies by using anonymized mobile location data from Facebook. The researchers—part of the COVID-19 Mobility Data Network—have found, for example, that mobility dropped in New York on weekends but rose again during the week, when some people returned to work. Epidemiologist Caroline Buckee said that the data can also show “if at first people stop moving but then begin to travel further once fatigue sets in.” She said that matching changes in mobility with later hospitalizations can help determine when it makes sense to relax social distancing policies.
April 2: As coronavirus cases surge in Florida, fears mount that action came too late (Washington Post)
Although Floridians are now under a stay-at-home order to curb the spread of COVID-19, experts say it might not have been issued soon enough. Epidemiologist William Hanage said he is “very worried” about what might happen in the state. “My concern for Florida is rooted in the fact it has a population that skews old,” he said. “There have been reasonably large opportunities for super spreading events. And I don’t think there is very good evidence that the transmission of covid-19 is slowed in any meaningful way by warmer temperatures.”
Environmental experts are criticizing Trump administration policy changes they say will lead to more air pollution. Under one new policy, environmental monitoring and reporting requirements won’t be enforced during the COVID-19 pandemic; under another, fuel economy and emission standards will be weakened. Critics say the changes will not only increase the greenhouse gas emissions that lead to climate change, but will also put people with lung conditions at higher risk of harm from COVID-19, a respiratory illness. “Burning fossil fuels is killing millions of people around the world every year, through air pollutants,” said C-CHANGE interim director Aaron Bernstein. “Air pollutants can increase the risk of people getting sick from viral infections like COVID, as well as bacterial infections.”
April 2: You need to wear a mask. Here’s how (Washington Post)
In this opinion piece, Joseph Allen recommended that people start wearing masks when they go out. He wrote that masks provide four public health benefits: they help prevent the user from infecting others, they protect the user from others who might be sick, they serve as a reminder not to touch your face, and they serve as a social cue that COVID-19 poses a real threat. Allen explained the right way to use masks. He also cautioned that wearing a mask doesn’t replace other important measures such as hand-washing, social distancing, covering your cough, and cleaning surfaces.
April 1: Here are rules doctors can follow when they decide who gets care and who dies (Washington Post)
Even the most favorable scenarios suggest that, when COVID-19 hits its peak in the U.S., the nation will have roughly 20,000 intensive-care-unit beds available—but will need nearly twice that many. There won’t be enough ventilators either. In this Perspective piece, Daniel Wikler, Mary B. Saltonstall Professor of Ethics and Population Health, wrote that clinicians, epidemiologists, patient advocates, and ethicists generally agree that if difficult choices must be made about which patients to save, the goal is to save the most lives possible. Often that may mean prioritizing health care workers, police officers and others who help maintain civil order, because they all help save lives. It may also mean prioritizing the young or those who seem likeliest to survive the disease, he wrote.
April 1: Former Harvard Dean Says U.S. Can Defeat the Coronavirus In 10 Weeks (CBS Boston)
If we take six steps, we can beat the coronavirus by early June, according to Harvey Fineberg, former dean of Harvard Chan School. In a New England Journal of Medicine editorial, Fineberg, who is helping the federal government with its COVID-19 response, recommended:
- The president should put one commander in charge of mobilizing all needed assets to fight the pandemic.
- The country should make millions of tests to use over the next two weeks to determine the scope of the disease.
- The nation should supply health care workers with all the protective gear, ventilators, and other supplies they need.
- The population should be separated into five groups—those infected, those presumed to be infected, those exposed, those not known to have been exposed, and those who have recovered from infection—and treated accordingly.
- The public should be inspired and mobilized to maintain social distancing, help each other, and use their skills to develop solutions to the pandemic.
- Research about COVID-19 should continue at a fast pace so that the fight against the disease can be guided by science.
April 1: NL Interview: Harvard researchers on myths and realities of the coronavirus pandemic (News Laundry)
In this podcast, Bhargav Krishna, DrPH ’21, talked about the possible outcomes of the COVID-19 pandemic, particularly in India. Discussion topics included the accuracy of pandemic prediction models, the importance of collecting as much data as possible on infections and deaths, the dangers of COVID-19 for those with underlying conditions, the possibility of the virus mutating into a deadlier strain, and when a vaccine might be available.
April 1: How Scientists Predict How Many People Will Get COVID-19 (Medscape)
To model the course of an epidemic, epidemiologists consider information such as how contagious a virus is, how long people are infectious, the number of people currently infected, and the population susceptible to infection. But there’s still much information about the coronavirus that’s unknown to modelers—such as how long asymptomatic people can shed virus, whether the virus is seasonal, and what role children play in transmission. One big question is how long immunity will last for people who recover from COVID-19. “That continues to be an unknown that will really have big implications for what will happen in the longer term with this virus,” said Yonatan Grad.
April 1: Coronavirus: If we are in a war against COVID-19 then we need to know where the enemy is (The Conversation)
David Hunter wrote about what’s desperately needed in the battle against COVID-19 in Britain: more protective gear for health workers, more hospital beds, more ventilators, and more testing. He also argued that the fight against the pandemic should be led by someone like an army general or a captain of industry—“someone … whose expertise is commissioning, or commandeering supplies, and delivering … supplies under fire.”
April 1: Everyone Thinks They’re Right About Masks (The Atlantic)
Does the coronavirus travel through the air? If so, how far can it travel? Experts say the answers to these questions are complicated and studies are inconclusive. To find answers, “you’d have to expose animals to different quantities of airborne viruses, see if they get infected, and relate that to measures of the virus [in places] where people are infected,” said epidemiologist William Hanage. “This is the type of stuff people will work on for years, but no one is going to find out for the moment.” As for whether people should be wearing masks, Hanage said they could potentially stop those with COVID-19 from infecting others, but data is limited. “We’re trying to build the plane while we’re flying it,” he said. “We’re having to make decisions with quite massive consequences in the absence of secure data. It’s a nightmare for your average cautious public-health professional.”
If the U.S. had instituted earlier coronavirus testing and lockdowns, “we clearly would have had a very different situation,” said Ashish Jha on April 1. In an appearance on CNN’s “New Day,” he said, “I don’t know any public health expert who does not believe that if we had gotten our testing together, if we had gotten our hospitals ready, if we had communicated and gotten a lot of our lockdown orders going much earlier,” we would have had “a different situation,” he said. “We clearly would have.” He also said that many states across the U.S. are still not doing enough testing.
Nurses on the front lines of the COVID-19 pandemic are in harm’s way because of a shortage of personal protective equipment, according to the Massachusetts Nurses Association. The group called for a statewide inventory. Howard Koh said it’s important to coordinate the distribution of such equipment. “Hospital A could be overwhelmed, but hospital B nearby may not have that level of volume. So if those hospitals can work together and communicate and coordinate, that’s hugely important for a statewide response,” he said. He added, “My concern is we’re going to see more of those front-line people, our nurses, our doctors, our respiratory therapists, the critical team that we need to keep people alive, are the very people who are going to be too sick to give the care that’s needed.”
A backlog of COVID-19 tests in the U.S. has made it difficult to achieve timely quarantining of patients and to gain an accurate picture of how many are infected. Epidemiologist Caroline Buckee said that until the U.S. health care system is able to test patients widely, it will be impossible to understand the full scope of the virus and to effectively address it.
April 1: University community rallies to deal with COVID-19 crisis (Harvard Gazette)
Harvard faculty, students, researchers, and staff are helping with the response to the COVID-19 pandemic in a variety of ways. Dean Michelle Williams discussed Harvard Chan School’s efforts, which include a partnership with Thrive Global and the CAA Foundation to support frontline health care workers; COVID-19 online resources for employers and employees, from the Center for Work, Health, and Well-Being; an online mental health series to help cope with the pandemic; and efforts to get students and alumni involved with the COVID-19 response through the Massachusetts Department of Public Health.
A vaccine is the best hope for bringing the COVID-19 pandemic to a permanent conclusion—but there won’t be one available for at least a year or more. In the meantime, wrote Marc Lipsitch and Yonatan Grad in this opinion piece, “we should be working overtime” on a number of fronts. They stressed the need to control the spread of disease through continued social distancing, massive testing, and ensuring that healthcare workers have personal protective equipment. They also urged support for finding treatments for COVID-19, increasing healthcare capacity, and accelerating work on a vaccine. Comparing the intense measures being used to slow the spread of the virus to a life raft, and dry land to the pandemic’s end, they wrote that “we must think clearly and understand that getting through the first phase of this pandemic only gets us into the life raft, not to dry land.”
April 1: What we need to know before we can end social distancing (Washington Post)
To know if it’s wise to pull back on social distancing, it’s crucial to gather data on what works and what doesn’t in slowing the spread of COVID-19, wrote health policy expert Michael Barnett, epidemiologist Caroline Buckee, and Yonatan Grad in this opinion piece. They recommended comparing outcomes from states across the U.S., which implemented social distancing measures at different times. They also recommended studying whether people followed lockdown orders, whether children contribute to transmission of COVID-19, and whether closing bars and restaurants has a big impact on infection rates. With epidemiological models predicting another outbreak in the fall, finding answers to these questions is key to deciding on the best strategies to use in the months ahead. “If we can combine data on covid-19 cases and the effectiveness of specific social distancing policies, we can develop clear guidelines on what and when to lock down, and how and when to emerge again,” they wrote.
A number of factors will influence when various parts of the U.S. will be hit with the coronavirus—and how hard they’ll be hit—such as the age and health of the population, the area’s connection to other regions, and how densely people live. It also matters how aggressively local officials implement physical distancing policies. That’s why experts are urging leaders in areas without much spread of the virus to start physical distancing measures now. “The effects will be seen weeks down the road,” said epidemiologist Caroline Buckee. For those who think their communities don’t need such measures, she said, “that is extremely naïve. Everywhere should be taking social distancing very seriously, because nowhere is immune to this virus.”