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The Health 202: Some social distancing policies worked better than others to stem covid-19

with Paulina Firozi

New research suggests there would have been 35 times as many covid-19 cases in the United States without widespread lockdowns.

That would have translated to far more deaths than the current count of at least 90,000 and a large-scale overwhelming of the country’s hospitals.

The study from University of Kentucky researchers underscores that social distancing measures enforced by mayors and governors — while hugely detrimental to the economy — were effective in dramatically slowing the spread of covid-19, the disease caused by the novel coronavirus.

Stay-at-home orders, combined with the closing of nonessential businesses such as restaurants and gyms, reduced the daily growth rate of cases by about half once they’d been in place for a little more than two weeks, the study concludes. Because cases of the virus typically grow exponentially — with one person passing it to several others — that translated to many fewer cases by April 27, the end of the time period studied by the researchers.

“The heavy-handed measures that none of us much like actually really did have a meaningful effect on disease,” Aaron Yelowitz, an economics professor at the University of Kentucky and co-author of the research, told me.

“It slowed the spread, it helped hospitals not get overwhelmed, and it bought us time to develop a more robust testing and contact tracing system,” Yelowitz added.

Yet other lockdown policies seemed to have little or no effect on the virus’s spread.

The researchers didn’t find evidence that closing schools or banning mass gatherings helped to slow transmissions. The data on school closures was closer to statistical significance than the findings on mass gatherings, but still insufficient to draw a conclusion.

Yelowitz doesn’t infer from the data that schools should have remained open. Instead, he thinks parents just traded one type of social setting for another.

He guesses that when schools were closed — which largely took place a week or two before the statewide lockdowns — parents simply took their kids to playgrounds and other social gathering spots. The question of school closures is one that needs much more study,Yelowitz believes, as policymakers seek better information about how kids can spread the virus and what that means for the fall semester.

Yelowitz also believes the bans on mass gatherings didn’t result in reduced social interactions because people could have gone to restaurants or bars instead of attending sports games or concerts.

All this raises further questions about what social distancing measures should look like this summer and into the fall.

And it provides some reassurance that at least the lockdowns worked, even as they gutted economic activity.

Hospitals were equipped to handle seriously ill patients, despite dire initial predictions that the U.S, health-care system would be overwhelmed. Some hospitals even spent considerable resources preparing for an onslaught that never materialized, the Wall Street Journal’s Jim Carlton reports.

Now politicians — and Americans — seem to have reached their maximum tolerance for staying at home. After largely obeying the stay-at-home orders in March and April, people are increasingly venturing out, cellphone data shows.

Governors across the political map are moving full speed ahead on reopening. As of today, all 50 states have started lifting their shutdowns, despite widely varying trends in their number of cases, deaths and tests performed.

Connecticut, one of the final states to ease its shutdown, is allowing restaurants to offer outdoor seating, retail stores to let customers inside, and outdoor museums and zoos to resume operations, my colleague Marisa Iati reports. Hair salons and barbershops were also slated to start reopening today until Gov. Ned Lamont (D) pushed back the date to June 1.

Even in New York, the hardest-hit state in the nation, upstate areas are starting to resume activity. Yesterday Gov. Andrew Cuomo (D) said the state’s outbreak has slowed to levels similar to when it began there. On Monday, 105 people died of the virus in the state — a figure comparable to daily deaths at the end of March.

“We’re basically back to where we started before this tragedy descended upon us,” Cuomo said at a news conference.

Ahh, oof and ouch

AHH: A 60-page document of reopening guidelines from the Centers for Disease Control and Prevention was posted on the agency website over the weekend without fanfare.

The guidance on reopening schools, childcare facilities, restaurants and mass transit was released after weeks of delay and an internal debate over whether the details were too strict, Laura Meckler and Rachel Weiner report. The White House had initially shelved the guidelines, saying they were “overly specific.” 

It says schools, for example, must place desks six feet apart, stagger student arrivals and require daily temperature screenings, among other guidelines.

“The guidelines arrive amid mixed messages from authorities over how and how quickly to reopen the life of the nation,” Laura and Rachel write. “… Inside the administration, the most contentious element of the CDC document was guidance over houses of worship, and the posted document eliminates that section. An administration official, speaking on the condition of anonymity because he was not authorized to discuss the matter, said additional guidance on religious gatherings may be coming.”

OOF: Vaccine experts warn Moderna did not produce the information necessary to know how impressive or not its vaccine candidate may be. 

The biotech company announced this week, to much fanfare, that it was seeing promising early results from its first human safety tests. 

Several vaccine experts asked by STAT concluded that, based on the information made available by the Cambridge, Mass.-based company, there’s really no way to know how impressive — or not — the vaccine may be,” Stat News’s Helen Branswell reports

“While Moderna blitzed the media, it revealed very little information — and most of what it did disclose were words, not data. That’s important: If you ask scientists to read a journal article, they will scour data tables, not corporate statements. With science, numbers speak much louder than words.”

“Even the figures the company did release don’t mean much on their own, because critical information — effectively the key to interpreting them — was withheld,” Helen adds.

In an op-ed in The Post, a former Harvard Medical School professor called Moderna’s announcement an example of “publication by press release.” 

“The Moderna announcement described a safety trial of its vaccine based on eight healthy participants. The claim was that in all eight people, the vaccine raised the levels of neutralizing antibodies equivalent to those found in convalescent serum of those who recovered from covid-19,” wrote William Haseltine, founder of Harvard’s cancer and HIV/AIDS research departments. 

“What to make of that claim? Hard to say, because we have no sense of what those levels were. This is the equivalent of a chief executive of a public company announcing a favorable earnings report without supplying supporting financial data, which the Securities and Exchange Commission would never allow.”

OUCH: Most elderly covid-19 patients who were put on ventilators in a pair of New York hospitals did not make it. 

That’s according to a new sweeping study published yesterday in the Lancet. Its findings are “broadly consistent with clinical findings from China and Europe, and confirmed that advanced age is the greatest risk factor for a severe outcome, particularly if accompanied by chronic underlying diseases, such as hypertension, diabetes, heart disease and obesity,” Joel Achenbach and Ariana Eunjung Cha report.

The research looked at 257 critically ill adults admitted at two hospitals in northern Manhattan from March 2 and April 1. It found 39 percent died by April 28. Another 37 percent remained hospitalized. But more than 80 percent of people over 80 who went on a ventilator died. 

Max O’Donnell, the senior author of the study and a pulmonologist at Columbia University Irving Medical Center, told The Post the numbers should be shared with elderly patients and their families trying to decide whether to opt for the invasive procedure. 

The administration’s response

Trump dismissed a study about hydroxychloroquine from his own government as a “Trump-enemy statement.” 

The day after the president announced he is taking the controversial anti-malarial drug to prevent transmission of the coronavirus, Trump disparaged a study of the drug he has aggressively promoted. The study found the drug had no benefit and was linked to higher rates of death for Veterans Affairs patients hospitalized with the coronavirus.

“The only negative I’ve heard was the study where they gave it — was it the VA?” Trump said, referring to the Department of Veterans Affairs. “With, you know, people that aren’t big Trump fans gave it.”

“This idea that there was this study undercutting the utility of the drug Trump has been championing for two months clearly stuck with the president,” Philip Bump writes. Later, Trump said about the study: “If you look at the one survey, the only bad survey, they were giving it to people that were in very bad shape. They were very old. Almost dead.” He described the research as “a Trump-enemy statement.” 

Again, hours later, he called it a “false study.” 

“Again, there’s no evidence at all that the study was spurred by opposition to Trump. What’s more, there’s no evidence that the study was structured in a way that the results would reflect poorly on the medications. It is also not the case that this was the only study that failed to demonstrate efficacy of the medication,” Philip writes. “However, Trump has decided the result is indicative of how opposition to his repeated promotion of hydroxychloroquine is somehow politically motivated. Because for this president, anyone who doesn’t agree with Trump completely almost necessarily opposes him entirely.”

The CEO of Phlow says the company will use a new federal contract to develop a “rapid surge” capability for developing generic drugs in short supply.

The Trump administration recently awarded a $354 million contract to a Virginia-based startup as part of a push to ramp up U.S. drug manufacturing.

During the initial four years, the company will develop the capability to quickly manufacture critically needed medicines and their ingredients and build advanced manufacturing facilities to produce drugs that are in short supply, Eric Edwards, Phlow’s chief executive, told David J. Lynch, Jeanne Whalen and Laurie McGinley.

“The company promises higher yields, less waste and more affordable medicines as a result of its continuous chemical process,” they write. “Initial planning began about a year ago, Edwards said. Once the coronavirus materialized, he said he warned administration officials in early February of inevitable drug shortfalls.”

“Over the past two decades, most U.S. generic drug production has shifted offshore, notably to sites in China and India,” our colleagues write. “That dependence on foreign suppliers became controversial as the coronavirus pandemic raged, when both countries limited their exports and supplies in the United States ran short.”

The World Health Organization’s annual meeting was overshadowed by the latest ultimatum Trump sent to the U.N. body. 

In a letter sent to the WHO — published in a late-night Monday tweet — Trump said he would permanently cut U.S. funding to the organization and “reconsider” the nation’s membership in the WHO if it does not “commit to major substantive improvements” in the next 30 days.

The WHO meeting was meant to rally an international coronavirus response. Instead it “amplified the discord between the United States and China, leaving the U.N. agency caught in the middle and struggling to lead amid the crisis,” Emily Rauhala, Teo Armus and Gerry Shih report. 

“The four-page letter came the same day Chinese President Xi Jinping addressed the assembly by video link. Xi skimmed over China’s handling of the initial outbreak late last year and emphasized its commitment to the global pandemic fight, pledging $2 billion,” they add. 

In a statement, the WHO said it was “considering the contents” of Trump’s letter, which did not specify what changes the U.S. president wanted in order to restore funding to the organization. 

Trump announced in April that the United States — the largest single donor to the WHO — would suspend its payments “while a review is conducted.” 

“The letter restated some of these concerns and added new ones — including some that do not hold up to scrutiny,” Emily, Teo and Gerry report. “Trump’s first claim, for instance, is that the WHO ‘ignored credible reports of the virus spreading in Wuhan in early December 2019 or even earlier.’ He cites as evidence information published by the Lancet. But Richard Horton, chief editor of the publication, said Tuesday that the journal did not publish its first reports on the coronavirus until late January.” 

Coronavirus latest

Here are a few more stories to catch up on this morning: 

On the front lines:
  • Asian American health-care workers across the country have reported a sharp uptick in racist verbal abuse and physical attacks, Tracy Jan reports.
More on the administration’s response:
  • Trump has expressed opposition to extending a weekly $600 boost beyond the end of July in unemployment insurance for laid-off workers, Seung Min Kim reports.
Good to know: 
  • Scientists from the Korean Centers for Disease Control and Prevention found evidence that patients who test positive for the virus after they have recovered can’t transmit any lingering infection, Bloomberg News reports.
  • Greenhouse gas emissions plunged 17 percent in early April amid the pandemic, as people stayed home and travel by car and plane fell. But scientists warn the emissions could rebound as economies reopen, Chris Mooney, Brady Dennis and John Muyskens report.
In other news: 
  • Johnson & Johnson announced it will discontinue sales of its talc-based baby powder in North America after facing thousands of lawsuits from consumers who say the product causes cancer, the New York Times’s Tiffany Hsu and Roni Caryn Rabin report.

 

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