Winter may bring a lot more coronavirus cases, new research finds

Early in the coronavirus pandemic, scientists speculated that warm summer air would dampen its spread.

Then as the virus spread rapidly around the world, racking up more than 27 million cases in the spring and summer, the seasonal impact largely fell out of the public conversation.

But researchers at Johns Hopkins University are coming out with new research that suggests rising temperatures do moderate the spread of the virus—and a big new wave of cases could be coming with the cooler fall air.

“We have made significant inroads in this pandemic, and we can say a lot of that is because of social interventions,” said Dr. Adam Kaplin, assistant Hopkins professor of psychiatry and behavioral sciences and the lead researcher.

The warm weather served as a tail wind for those efforts, he said.

“In the fall and colder months we are going to hit a head wind in the other direction and that will make control much more difficult,” Kaplin said.

The findings were so striking that Kaplin took the unusual step of discussing the work while the research still was under review for publication in a scientific journal.

Maryland and other states, as well as other countries, have been easing restrictions with a drop in cases of COVID-19, the disease caused by the coronavirus. But Kaplin said cases could spike with more virus-friendly cool air even with the same restrictions.

The findings of seasonal variation are not new. The flu, the common cold and other coronaviruses typically moderate during warmer months. This could be due to the direct effects of heat on viruses and because fewer people congregate indoors.

Other recent studies or models on the pandemic coronavirus, from the University of Maryland to Harvard and Princeton universities, have found at least some impact from temperature changes or projected that there would be effects even if they weren’t obvious yet.

A paper published in the Journal of the American Medical Association by the Maryland researchers found, for example, the virus acted in a way “consistent with the behavior of a seasonal respiratory virus,” spreading along with temperature and humidity levels. The College Park researchers said it would be possible to develop a weather model to predict places most likely at higher risk for spread.

Rachel Baker from the Princeton Environmental Institute downplayed how much the weather was a factor, instead pointing to the importance of other measures such as wearing masks and physical distancing.

“I think it is possible that upcoming wintertime conditions could increase transmission, particularly in locations with more severe winters,” she said. “However, if we have effective control measures in place, we should be able to limit large secondary outbreaks.”

Baker said studies suggest the effects would be more clear over time. For now, a lot of the studies face challenges, such as differences in how cases are reported around the world.

Dr. Michael Ryan, executive director of the World Health Organization’s Health Emergencies Programme, was even less sure there would be a visible impact from temperature changes.

“This virus has demonstrated no seasonal pattern as such so far,” he said during an Aug. 10 news conference.

But other studies have raised concerns that a cold winter will lead to more cases if steps aren’t taken now to tamp down cases and keep them low.

That includes Dr. David Rubin at the Children’s Hospital of Philadelphia’s PolicyLab, which has incorporated weather into models it regularly produces. (The model suggests a slight uptick in Baltimore in the fall due to various factors including students returning to college campuses.)

The PolicyLab’s own weather study found a narrow range of springlike temperatures were the safest, 60-65 degrees. The researchers hypothesize that colder weather may facilitate more virus transmission but warmer weather may encourage more social gatherings conducive to spread.

The study, published in July in JAMA Network Open, also found distancing measures were the most effective means of controlling the virus no matter the temperature.

“There is a reason the meatpacking industry was hit so hard by this pandemic,” Rubin said. “They do live in congregate housing, but they also work in freezers. … We need to start now and get a good control of the virus so we don’t go into winter already in a surge.”

Kaplin at Hopkins agreed that measures taken now will matter.

A psychiatrist, Kaplin doesn’t normally do weather-related research, but wanted to sound early alarms to get the public’s attention while there is still time.

The issue became clear to him while in Brazil for his wedding in February, a summer month. He noticed a lower rate of viral transmission compared with the infection rate in the United States during a winter month.

Kaplin enlisted statistician colleagues and used data collected by other Hopkins researchers for their public coronavirus dashboard as well as available government weather data. The researchers got information from 50 countries that had reporting early in their outbreaks, before controls such as mask-wearing and physical distancing. The researchers accounted for population and land area in their calculations and looked for a pattern.

They found from January to April, places such as Singapore with average temperatures in the 80s had much lower rates of viral spread than places such as Turkey with average temperatures in the 20s.

Kaplin didn’t want to weigh in on specific actions to get ahead of another big wave of cases. But he said policymakers likely would have to consider tougher restrictions when the temperature drops just to maintain the same level of spread.

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COVID-19 data shows triple the number of suspected cases and twice the risk for ethnic minorities

There were three times as many suspected COVID-19 cases presented to GPs during the peak of the pandemic than shown in official COVID-19 test results, according to research led by Queen Mary University of London.

The study, published in the British Journal of General Practice, also shows that black, Asian, and minority ethnic (BAME) groups were twice as likely to present with COVID-19, and this is not explained by other factors such as other health conditions, obesity and social deprivation.

Lead author Dr. Sally Hull from Queen Mary University of London said: “Our results suggest that COVID-19 prevalence during the peak of the epidemic was higher than previously thought. The official COVID-19 test statistics are likely to have underrepresented the extent of the epidemic, as many people with COVID-19 would not have been tested, including those with milder symptoms or those who could not access testing centers. Much of the COVID-19 epidemic is being managed in primary care which has had to adjust rapidly to online consultations. We need timely reporting of COVID-19 test results to practices, and diagnostic information from NHS 111, so that practices can provide continuing care to patients with more severe episodes. It’s going to be very important how GPs record and manage cases in their community, as this can provide an early warning system if cases are rising again in an area and if we’re about to see a second wave of infection.”

Attention on COVID-19 initially focused on hospital presentations and intensive care, but little was known about the pattern of early presentations at GP surgeries. Community testing ceased in England on 12 March 2020, hence the extent of asymptomatic and milder symptomatic cases in community settings remains unknown.

The researchers studied anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four east London clinical commissioning groups (Newham, Tower Hamlets, City and Hackney, and Waltham Forest) during the peak of the London epidemic during March and April. Three of the four boroughs had death rates in the top five for London boroughs and 55 percent of the population are from ethnic minorities, hence the area is well placed to examine the over-representation of black and South Asian populations in suspected COVID-19.

The study found that:

  • GPs recorded 8,985 suspected COVID-19 cases between 14 February and 30 April 2020—triple the number who tested positive at government test centers over that period.
  • There was a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. This risk remains even after accounting for other factors, such as multiple health conditions, obesity and social deprivation, which are also strongly associated with increased risk of a suspected COVID-19 diagnosis.
  • The odds of suspected COVID-19 increased with social deprivation, numbers of long-term conditions and BMI.
  • There was a seven-fold increase in risk of suspected COVID-19 for those with dementia, which may reflect the excess risks to older people living in care homes.
  • In contrast with other studies, the current study did not find an excess of male cases, but found that females had a slight increase in risk of suspected COVID-19, which suggest that the known higher risks for men emerge later in the disease trajectory.
  • There was a sharp seasonal decline in upper and lower respiratory infections during the period that saw a rise in suspected COVID-19 cases, which may have been magnified by social distancing.

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New virus cases decline in the US and experts credit masks

The number of Americans newly diagnosed with the coronavirus is falling—a development experts credit at least partly to increased wearing of masks—even as the outbreak continues to claim nearly 1,000 lives in the U.S. each day.

About 43,000 new cases have been reported daily over the past two weeks across the country, down 21 percent since early August, according to data compiled by Johns Hopkins University. While the U.S., India and Brazil still have the highest numbers of new cases in the world, the trend down is encouraging.

“It’s profoundly hopeful news,” said Dr. Monica Gandhi, an infectious-diseases expert at the University of California, San Francisco, who credits the American public’s growing understanding of how the virus spreads, more mask-wearing and, possibly, an increasing level of immunity.

“Hopefully all those factors are coming into play to get this virus under control in this country that’s really been battered by the pandemic,” she said.

The virus is blamed for more than 5.7 million confirmed infections and about 178,000 deaths in the U.S. Worldwide, the death toll is put at more than 810,000, with about 23.7 million cases.

Jeffrey Shaman, a public health expert at Columbia University, said he is skeptical enough people are immune to significantly slow the spread. But he agreed that changes in Americans’ behavior could well be making a difference, recalling the impact that people’s actions had in containing Ebola in West Africa several years ago.

“Ebola stopped for reasons we didn’t anticipate at the time. It was so horrifying that people stopped touching each other,” Shaman said. Something similar may be happening with the coronavirus, he said.

“I know I don’t have nearly the number of contacts that I used to,” Shaman said. “But if we relax that, if we get complacent, will we just see another outbreak?”

The decline in newly reported cases in the U.S. comes even as deaths from the virus remain alarmingly high. Over the past two weeks, state officials have reported an average of 965 deaths a day from COVID-19, down from 1,051 a day in early August.

The percentage of those testing positive for the disease has also declined over the past two weeks, from 7.3% to 6.1%. But that comes as the total number of tests administered has fallen from its August peak of more than 820,000 daily, leveling off in recent weeks at about 690,000 a day.

It’s not clear what will happen to case numbers as more school districts bring students back to classrooms and colleges reopen their campuses. In recent weeks, schools including the University of North Carolina and Notre Dame have moved instruction online after outbreaks on their campuses.

Officials at the University of Tennessee at Knoxville said Monday that four students are facing disciplinary proceedings after three hosted off-campus parties with no mask or other distancing and another left isolation to meet with others despite testing positive for the virus.

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Florida overtakes NY State in coronavirus cases, adds 9,300

Florida surpassed New York over the weekend as the state with the second-most coronavirus cases in the U.S., as more than 9,300 new cases were reported in the Sunshine State on Sunday, accompanied by an additional 78 new deaths.

Florida’s 423,855 coronavirus cases as of Sunday were surpassed only by California’s 453,659 cases. With 39.5 million residents, California has almost double the population of Florida’s 21.4 million inhabitants. California is the nation’s most populous state, followed by Texas, Florida and New York.

New York, once the epicenter of the virus in the U.S., had 411,736 coronavirus cases. The state has 19.4 million residents.

There were 9,344 new cases reported in Florida on Sunday. The number of new cases was lower than other days last week, but caseloads released on Sundays tend to be smaller because of the lack of workers entering data or in labs testing samples.

The statewide median age of coronavirus patients in Florida was 40.

Almost 3.4 million Floridians have been tested for the virus. The new cases tested over the weekend had a positive rate of 11%, according to the Florida Department of Health.

The state health department recorded 781 COVID-19 deaths over the past week for an average of 126 deaths per day on Sunday, down slightly from Saturday’s weekly average of 127 deaths per day. Florida had 5,972 total deaths as of Sunday, according to the Florida Department of Health.

Florida also had 8,951 coronavirus-related hospitalizations as of Sunday.


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Brazil has record week for virus cases

Brazil had its worst week yet of the coronavirus pandemic in terms of new cases, registering 259,105 infections in the seven days through Sunday, according to health ministry figures.

The country also reported its second-highest weekly death toll, with 7,005 people killed, just below the record of 7,285 set the previous week.

Brazil, the country with the second-highest number of infections and deaths worldwide after the United States, has struggled to set a strategy for dealing with the pandemic.

The latest grim figures came as protesters in various cities across the country and as far away as Stockholm, London and Barcelona held demonstrations against Brazilian President Jair Bolsonaro and his handling of the health crisis.

The far-right president has downplayed the new coronavirus as akin to a “little flu,” railed against state authorities’ stay-at-home measures and publicly flouted social distancing guidelines and the face-mask requirement in place in the capital, Brasilia.

At Copacabana beach in Rio de Janeiro, military police clutching riot shields used batons to push back people protesting under the slogan “Stop Bolsonaro,” as well as for Gay Pride day and against racism.

The harsh police reaction against the crowd of around 200 drew more people to protest from their windows, shouting “Get out, Bolsonaro!”

In Brasilia, protesters put up 1,000 crosses on a lawn in front of Congress to pay tribute to COVID-19 victims, with a banner reading “Bolsonaro, stop denying!”

“Brazil is suffering immense pain, a hidden pain that throbs in the face of the incredible numbers of deaths caused by COVID-19,” the organizers said in a statement.

Experts say the real number of infections and deaths in Brazil is probably much higher than the official figures.

The health ministry began this week to test all suspected coronavirus cases in the public health system, but under-testing remains a problem in the country of 212 million people.

And even though the spread of the disease is still not under control, some local authorities are pushing ahead with efforts to reopen their economies.

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Brazil now second in virus deaths, as US states see rising cases

Brazil on Friday claimed the unenviable position of having the second-highest coronavirus death toll worldwide behind the United States, where several states have posted record daily case totals, signaling the crisis is far from over.

US and European stocks ended the week on an upswing after a rout sparked by the US data and fresh evidence of the economic damage caused by virus-related lockdowns, with British GDP shrinking by a record 20.4 percent in April.

Meanwhile, in several European countries, the focus shifted to the courts, and who might eventually be pinned with the blame for the global financial and health crisis.

Brazil’s health ministry recorded 909 deaths in the past 24 hours, putting the total at 41,828—meaning the country of 212 million people has now surpassed Britain’s death toll.

Experts warn the actual number of cases in Latin America’s biggest economy could be many times higher than the confirmed figure of 828,810.

“Some areas are at a critical stage” in Brazil, with intensive care unit occupancy levels of more than 90 percent, World Health Organization emergencies director Mike Ryan told journalists in Geneva.

Brazilian President Jair Bolsonaro, who threatened last week to quit the WHO over “ideological bias,” has dismissed the virus as a “little flu,” and berated state officials for imposing lockdowns.

Latin America is the latest epicenter in the world’s battle with the novel coronavirus, which emerged in China late last year.

The region has recorded more than 1.5 million infections and 76,000 deaths, with no signs the virus is slowing.

In the US, which has confirmed the most COVID-19 deaths—over 114,000—more than a dozen states, including two of the most populous, Texas and Florida, reported their highest-ever daily case totals this week.

“It’s important that we remember that this situation is unprecedented. And that the pandemic has not ended,” Robert Redfield, director of the Centers for Disease Control and Prevention, told a media briefing on Friday.

Nevertheless, US President Donald Trump and many local officials remain determined to get the world’s biggest economy back on track.

The virus and resulting lockdowns have caused a spike in US unemployment—44.2 million people have filed claims for jobless benefits since mid-March.

Worldwide, the pandemic has killed more than 425,000 people and infected more than 7.6 million.

Court action

In Italy, one of the countries hardest hit by the virus, prosecutors questioned Prime Minister Giuseppe Conte over his government’s initial response.

In the country’s northern Lombardy region, an investigation has been launched into why a quarantined “red zone” was not enforced around two towns sooner.

And in Bergamo province, 50 victims’ family members filed complaints this week over how the crisis was handled.

“All investigations are welcome. The citizens have the right to know and we have the right to reply,” Conte said this week.

Elsewhere, British Airways, easyJet and Ryanair launched legal action against the British government over a “flawed” 14-day coronavirus quarantine system introduced this week.

Europe’s reopening

Europe is pushing ahead with its exit from lockdown, with a number of countries preparing to reopen borders on a limited basis on Monday after the EU Commission urged a relaxation of restrictions.

France said it would gradually reopen its borders to non-Schengen countries from July 1.

Greece said it would welcome tourists again, though Britons remain barred—and passengers from Italy, Spain and the Netherlands must undergo tests on arrival.

Germany said it would end land border checks on Monday.

And Italy said it would allow amateur contact sports—including team sports—from June 25.

‘Fight not over’

Yet world health officials have warned that the virus is far from contained.

“The fight is not over,” WHO chief Tedros Adhanom Ghebreyesus said Thursday.

In evidence of the continued threat, eleven residential estates in the southern part of the Chinese capital were locked down due to a fresh cluster of coronavirus cases linked to a nearby meat market, officials said Saturday.

Seven cases have so far been linked to Xinfadi meat market, six of them confirmed on Saturday, officials added. Nine nearby schools and kindergartens have been closed.

China has largely brought domestic infections under control, and the majority of cases in recent months have been among overseas nationals returning home.

In India, experts are warning the worst is far from over.

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