Why the US is experiencing a coronavirus plateau

News Network
June 9, 2020

Washington, Jun 9: When epidemiologists talked about "flattening the curve," they probably didn't mean it this way: the US hit its peak coronavirus caseload in April, but since that time the graph has been on a seemingly unending plateau.

That's unlike several other hard-hit countries which have successfully pushed down their numbers of new cases, including Spain and Italy, which now have bell-shaped curves.

Experts say the prolonged nature of the US epidemic is the result of the cumulative impact of regional outbreaks, as the virus that started out primarily on the coasts and in major cities moves inward.

Layered on top of that are the effects of lifting lockdowns in parts of the country that are experiencing rising cases, as well as a lapse in compliance with social distancing guidelines because of economic hardship, and in some cases a belief that the threat is overstated.

"The US is a large country both in geography and population, and the virus is at very different stages in different parts of the country," Tom Frieden, a former director of the Centers for Disease Control and Prevention told AFP.

The US saw more than 35,000 new cases for several days in April. While that figure has declined, it has still been exceeding 20,000 regularly in recent days.

By contrast, Italy was regularly hitting more than 5,000 cases per day in March but is currently experiencing figures in the low hundreds.

"We did not act quickly and robustly enough to stop the virus spreading initially, and data indicate that it travelled from initial hotspots along major transport routes into other urban and rural areas," added Frieden, now CEO of the non-profit Resolve to Save Lives.

To wit: the East Coast states of New York, New Jersey and Massachusetts accounted for about 50 percent of all cases until about a month or so ago -- but now the geographic footprint of the US epidemic has shifted to the Midwest and southeast, including Florida.

Another key problem, said Jennifer Nuzzo, an epidemiologist at Johns Hopkins, is that the United States is still not doing enough testing, contact tracing and isolation.

After coming late to the testing party -- for reasons ranging from technical issues to regulatory hurdles -- the US has now conducted more COVID-19 tests than any other country.

It even has one of the highest per capita rates per country of 62 per 1,000 people, according to the website ourworldindata.org -- better than Germany (52 per 1,000) and South Korea (20 per 1,000).

But according to Nuzzo, these numbers are misleading, because "the amount of testing that a country should do should be scaled to the size of its epidemic.

"The United States has the largest epidemic in the world so obviously we need to do a lot more testing than any other country."

For Johns Hopkins, the more important metric is the positivity rate -- that is, out of all tests conducted, how many came back positive for COVID-19.

As of June 7, the United States had an average daily positivity rate of 14 percent, well above the World Health Organization guideline of 5 percent over two weeks before social distancing guidelines should be relaxed.

By contrast, Germany, which has tested far fewer people in relation to its population, has a positivity rate of 5 percent.

Even if testing were scaled up, carrying out tests in of itself does very little good without the next steps -- finding out who was exposed and then asking them to isolate.

Here also, too many US states are lagging woefully behind.

Texas, which is experiencing a surge in cases after relaxing its lockdown, is a case in point. The state targeted hiring a modest 4,000 tracers by June, but according to local reports is still more than a thousand shy of even that goal.

Opt-in app based efforts have also been slow to get off the ground.

Then there is the fact that some people are growing tired of lockdowns, while others don't have the economic luxury of being able to stay home for prolonged periods.

The government sent some 160 million Americans a single stimulus check of up to $1,200 back in April but it's not clear whether more will be forthcoming.

Still others, particularly in so-called red states under Republican leadership, have chafed under restrictions and mask-wearing guidelines that they see as an affront to their personal freedom.

"The US is kind of on the extreme of the individual liberty side," Sten Vermund, dean of the Yale School of Public Health, told AFP.

Part of this has to do with mixed messaging from Republican leaders, including President Donald Trump, said Nuzzo.

"We have had at the highest political level an assertion that this is a situation that's been overblown, and that maybe certain protective behaviors are not necessary," she said.

More recently, tens of thousands of people across the country have taken to the streets to protest the killing on an unarmed black man by police, risking coronavirus infection to demonstrate against the public health threat of racialized state violence.

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Agencies
May 31,2020

Minneapolis, May 31: The full Minnesota National Guard was activated for the first time since World War Two after four nights of civil unrest that has spread to other U.S. cities following the death of George Floyd, a black man shown on video gasping for breath as a white Minneapolis policeman knelt on his neck.

Minnesota Governor Tim Walz said the deployment was necessary because outside agitators were using protests over Monday’s death of George Floyd to sow chaos and that he expected Saturday night’s demonstrations to be the fiercest so far.

From Minneapolis to several other major cities including New York, Atlanta and Washington, protesters clashed with police late on Friday in a rising tide of anger over the treatment of minorities by law enforcement.

“We are under assault,” Walz, a first-term governor elected from Minnesota’s Democratic-Farmer-Labor Party, told a briefing on Saturday. “Order needs to be restored. ... We will use our full strength of goodness and righteousness to make sure this ends.”

He said he believed a “tightly controlled” group of outsiders, including white supremacists and drug cartel members, were instigating some of the violence in Minnesota’s largest city, but he did not give specific evidence of this when asked by reporters.

As many as 80% of those arrested were from outside the state, Walz said. But detention records show just eight non-Minnesota residents have been booked into the Hennepin County Jail since Tuesday, and it was unclear whether all of them were arrested in connection with the Minneapolis unrest.

The Republican Trump administration suggested civil disturbances were being orchestrated from the political left.

“In many places, it appears the violence is planned, organized and driven by anarchic and left extremist groups - far-left extremist groups ... many of whom travel from outside the state to promote violence,” U.S. Attorney William Barr said in a statement.

In an extraordinary move, the Pentagon said it put military units on a four-hour alert to be ready if requested by Walz to help keep the peace.

Activists staged another round of protests on Saturday in at least a dozen major U.S. cities coast to coast, including Seattle, Los Angeles, Chicago, Cleveland, Dallas, Atlanta, New York and Atlanta.

In the nation’s capital, hundreds of demonstrators assembled near the Justice Department headquarters, then marched toward the U.S. Capitol, chanting, “Black lives matter,” and “I can’t breathe,” a rallying cry echoing Floyd’s dying words.

Many later ended up near the White House, where they faced off with shield-carrying police, some mounted on horseback.

The streets of Minneapolis were largely quiet during daylight on Saturday, though several National Guard armoured personnel carriers were seen rolling through town.

On Friday, in defiance of a newly imposed curfew, Minneapolis protesters took to the streets for a fourth night - albeit in smaller numbers than before - despite the announcement hours earlier of murder charges filed against Derek Chauvin, the policeman seen in video footage kneeling on Floyd’s neck.

Three other officers fired from the police department with Chauvin on Tuesday are also under criminal investigation in the case, prosecutors said.

The video of Floyd’s arrest - captured by an onlooker’s cellphone as he repeatedly groaned, “please, I can’t breathe” before becoming motionless - triggered an outpouring of rage that civil rights activists said has long simmered in Minneapolis and cities across the country over persistent racial bias in the U.S. criminal justice system.

‘PAINS ME SO MUCH’

The mood was sombre on Saturday in the Minneapolis neighbourhood of Lyndale, where dozens of people surveyed the damage while sweeping up broken glass and debris.

“It pains me so much,” said Luke Kallstrom, 27, a financial analyst, standing in the threshold of a fire-gutted post office. “This does not honour the man who was wrongfully taken away from us.”

Some of Friday’s most chaotic scenes were in the New York City borough of Brooklyn, where police armed with batons and pepper spray made more than 200 arrests in sometimes violent clashes. Several officers were injured, police said.

In Washington, President Donald Trump said on Saturday that if protesters who gathered the night before in Lafayette Square, across from the White House, had breached the fence, “they would have been greeted with the most vicious dogs, and most ominous weapons, I have ever seen.”

CHAOS IN ATLANTA

In Atlanta, Bernice King, the youngest daughter of slain civil rights icon Martin Luther King Jr., urged people to go home on Friday night after more than 1,000 protesters marched to the state capitol and blocked traffic on an interstate highway.

The demonstration turned violent at points. Fires burned near the CNN Center, the network’s headquarters, and windows were smashed at its lobby. Several vehicles were torched, including at least one police car.

Rapper Killer Mike, in an impassioned speech flanked by the city’s mayor and police chief, also implored angry residents to stay indoors and to mobilize to win at the ballot box.

“But it is not time to burn down your own home.”

Floyd, a Houston native who had worked security for nightclubs, was arrested on suspicion of trying to pass counterfeit money at a store to buy cigarettes on Monday evening. Police said he was unarmed. An employee who called for help had told a police dispatcher that the suspect appeared to be intoxicated.

In a striking coincidence, Floyd and Chauvin had both worked security at the same Latin nightclub in Minneapolis, though it was unlikely they ever interacted, former owner Maya Santamaria, who sold the El Nuevo Rodeo club in January, told Reuters.

Santamaria said Floyd worked inside the club on certain nights, supporting other staff with security. She said Chauvin, who worked outside the club as an off-duty cop for 16 years, had a reputation for roughing up customers, but she considered him responsible and a friend.

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News Network
June 4,2020

Jun 4: A malaria drug President Donald Trump took to try to prevent COVID-19 proved ineffective for that in the first large, high-quality study to test it in people in close contact with someone with the disease.

Results published Wednesday by the New England Journal of Medicine show that hydroxychloroquine was no better than placebo pills at preventing illness from the coronavirus.

The drug did not seem to cause serious harm, though -- about 40% on it had side effects, mostly mild stomach problems.

 “We were disappointed. We would have liked for this to work,” said the study leader, Dr. David Boulware, an infectious disease specialist at the University of Minnesota.

“But our objective was to answer the question and to conduct a high-quality study,” because the evidence on the drug so far has been inconclusive, he said.

Hydroxychloroquine and a similar drug, chloroquine, have been the subject of much debate since Trump started promoting them in March.

Hydroxychloroquine has long been used for malaria, lupus, and rheumatoid arthritis, but no large studies have shown it or chloroquine to be safe or effective for much sicker patients with coronavirus, and some studies have suggested the drugs may do harm.

Trump took a two-week course of hydroxychloroquine, along with zinc and Vitamin D, after two staffers tested positive for COVID-19, and had no ill effects, according to results of his latest physical released by his doctor Wednesday.

Federal regulators have warned against hydroxychloroquine's use except in hospitals and formal studies because of the risk of side effects, especially heart rhythm problems.

Boulware's study involved 821 people in the United States and Canada living with someone diagnosed with COVID-19 or at high risk of getting it because of their job -- doctors, nurses, ambulance workers who had significant exposure to a sick patient while not wearing full protective gear.

They were randomly assigned to get either the nutrient folate as a placebo or hydroxychloroquine for five days, starting within four days of their exposure. Neither they nor others involved in the research knew who was getting which pills.

After 14 days in the study, 12 per cent on the drug developed COVID-19 symptoms versus 14 per cent in the placebo group, but the difference is so small it could have occurred by chance, Boulware said.

“There's basically no effect. It does not prevent infection,” he said of the drug. Even if it were to give some slim advantage, “we'd want a much larger effect” to justify its use and risk of side effects for preventing illness, he said.

Results were no different among a subgroup of participants who were taking zinc or vitamin C, which some people believe might help make hydroxychloroquine more effective or fight the coronavirus.

There are some big caveats: The study enrolled people through the Internet and social media, relying on them to report their own symptoms rather than having them tracked in a formal way by doctors.

Participants were not all tested for the coronavirus but were diagnosed as COVID-19 cases based on symptoms in many cases. And not all took their medicines as directed.

The results “are more provocative than definitive,” and the drug may yet have prevention benefits if tried sooner or in a different way, Dr. Myron Cohen of the University of North Carolina at Chapel Hill wrote in a commentary in the journal.

Others were glad to see a study that had a comparison group and good scientific methods after so many weaker reports on hydroxychloroquine.

“This fits with everything else we've seen so far which suggests that it's not beneficial," said Dr. Peter Bach, director of a health policy center at Memorial Sloan Kettering Cancer Center in New York.

This study was in younger relatively healthy people, but the results “would make me very discouraged about trying to use this in older people” who are most vulnerable to serious illness from the coronavirus, Bach said.

“If it does work, it doesn't work very well.” Dr. Dan Culver, a lung specialist at the Cleveland Clinic, said there's still a chance that giving the drug sooner than four days after someone's exposure to the virus may help prevent illness.

But the study “takes 'home run' off the table” as far as hopes for the drug, he said.

The study was mostly funded by David Baszucki, founder of Roblox, a California-based game software company, and other private donors and the Minnesota university.

Boulware also is leading a study testing hydroxychloroquine for treating COVID-19. The study is finished and results are being analyzed now.

On Tuesday, the journal Lancet posted an “expression of concern” about a study it published earlier this month of nearly 15,000 COVID-19 patients on the malaria drugs that tied their use to a higher risk of dying in the hospital or developing a heartbeat problem.

Scientists have raised serious questions about the database used for that study, and its authors have launched an independent audit.

That work had a big impact: the World Health Organization suspended use of hydroxychloroquine in a study it is leading, and French officials stopped the drug's use in hospitals. On Wednesday, the WHO said experts who reviewed safety information decided that its study could resume.

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Agencies
June 7,2020

Boston, Jun 7: Dozens of scientists doing research funded by Mark Zuckerberg say Facebook should not be letting President Donald Trump use of the social media platform to spread both misinformation and incendiary statements.

The researchers, including 60 professors at leading US research institutions, wrote a letter to the Facebook CEO on Saturday asking that he consider stricter policies on misinformation and incendiary language that harms people," especially during the current turmoil over racial injustice.

The letter calls the spread of deliberate misinformation and divisive language the researchers' goal of using technology to prevent and eradicate disease, improving childhood education and reform the criminal justice system.

The researchers' mission "is antithetical to some of the stances that Facebook has been taking, so we're encouraging them to be more on the side of truth and on the right side of history as we've said in the letter, said Debora Marks of Harvard Medical School, one of three professors who organized the letter.

The other organisers are Martin Kampmann of the University of California-San Francisco and Jason Shepherd of the University of Utah.

All have grants from a Chan Zuckerberg Initiative program working to prevent, cure and treat neurodegenerative disorders including Alzheimer's and Parkinson's disease. The initiative is run by Zuckerberg and his wife, Priscilla Chan.

They said the letter had more than 160 signatories. Shepherd said about 10% are employees of Chan Zuckerberg foundations.

The letter objects specifically to Zuckerberg's decision not to at least flag as a violation of Facebook's community standards Trump's post that stated when the looting starts, the shooting starts after unrest in Minneapolis over the videotaped killing of George Floyd, a black man, by a white police officer.

The letter's authors called the post a clear statement of inciting violence.

Twitter had both flagged and demoted a Trump tweet using the same language.

The Associated Press emailed the Chan Zuckerberg Initiative press office for comment. It did not immediately respond.

Some Facebook employees have publicly objected to Zuckerberg's refusal to take down or label misleading or incendiary posts by Trump or other politicians. But Zuckerberg who controls a majority of voting shares in the company has so far refused.

On Friday, Zuckerberg said in a post that he would review potential options for handling violating or partially-violating content aside from the binary leave-it-up or take-it-down decisions I know many of you think we should have labeled the President's posts in some way last week, he wrote.

"Our current policy is that if content is actually inciting violence, then the right mitigation is to take that content down not let people continue seeing it behind a flag. There is no exception to this policy for politicians or newsworthiness.

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