Coronavirus cases surge past 40 million infections worldwide

Concerning coronavirus trend? US sees big spike in new cases

Fox News correspondent Jonathan Serrie has the latest from Atlanta on ‘Special Report’

LONDON – The number of confirmed COVID-19 cases throughout the world has surpassed 40 million, but experts say that is only the tip of the iceberg when it comes to the true impact of the pandemic.

The milestone was hit Monday morning, according to Johns Hopkins University, which collates reports from around the world.

The actual worldwide tally of COVID-19 cases is likely to be far higher, as testing has been variable, many people have had no symptoms and some governments have concealed the true number of cases. To date, more than 1.1 million confirmed virus deaths have been reported, although experts also believe that number is an undercount.

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The U.S., India, and Brazil are reporting by far the highest numbers of cases — 8.1 million, 7.5 million, and 5.2 million respectively — although the global increase in recent weeks has been driven by a surge in Europe, which has seen more than 240,000 confirmed virus deaths in the pandemic so far.

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Last week, the World Health Organization said Europe had reported a record weekly high of nearly 700,000 cases and said the region was responsible for about a third of cases globally. Britain, France, Russia and Spain account for about half of all new cases in the region, and countries like Belgium and the Czech Republic are facing more intense outbreaks now than they did in the spring.

WHO said the new measures being taken across Europe are “absolutely essential” in stopping COVID-19 from overwhelming its hospitals. Those include new requirements on mask-wearing in Italy and Switzerland, closing schools in Northern Ireland and the Czech Republic, closing restaurants and bars in Belgium, implementing a 9 p.m. curfew in France and having targeted limited lockdowns in parts of the U.K.

The agency said several European cities could soon see their intensive care units overwhelmed and warned that governments and citizens should take all necessary measures to slow the spread of the virus, including bolstering testing and contact tracing, wearing face masks, and following social distancing measures.

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WHO has previously estimated about 1 in 10 of the world's population — about 780 million people — have been infected with COVID-19, more than 20 times the official number of cases. That suggests the vast majority of the world's population is still susceptible to the virus.

Some researchers have argued that allowing COVID-19 to spread in populations that are not obviously vulnerable will help build up herd immunity and is a more realistic way to stop the pandemic instead of the restrictive lockdowns that have proved economically devastating.

A man walks past anti-lockdown graffiti in Manchester, England, Monday, Oct. 19, 2020 as the row over Greater Manchester region’s coronavirus status continues. Britain’s government says discussions about implementing stricter restrictions in Greater Manchester must be completed Monday because the public health threat caused by rising COVID-19 infections is serious and getting worse. (Peter Byrne/PA via AP)

But WHO Director-General Tedros Adhanom Ghebreyesus has warned against the belief that herd immunity might be a viable strategy to pursue, saying this kind of protection needs to be achieved by vaccination, not by deliberately exposing people to a potentially fatal disease.

“Allowing a dangerous virus that we don’t fully understand to run free is simply unethical,” Tedros said last week.

The U.N. health agency said it hopes there might be enough data to determine if any of the COVID-19 vaccines now being tested are effective by the end of the year. But it warned that first-generation vaccines are unlikely to provide complete protection and that it could take at least two years to bring the pandemic under control.

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Bacteria virus combo may be cause of neonatal brain infections in Uganda

A newly identified bacteria and a common virus may be the underlying cause of infection-induced hydrocephalus in Uganda, according to an international team of researchers.

“Thirteen years ago, while visiting Uganda and seeing a stream of kids with hydrocephalus after infection I asked the doctors, ‘What is the biggest problem you have that you can’t solve?'” said Steven J. Schiff, Brush Chair Professor of Engineering and professor of engineering science and mechanics, neurosurgery and physics, Penn State. “‘Why don’t you figure out what makes these kids sick?’ was the reply.”

By that time, the doctors at CURE Children’s Hospital of Uganda, had seen more than a thousand infants with infection-caused hydrocephalus and were unable to culture a single thing in the laboratory. They have now seen over 8,000 similar children in this one, small Ugandan hospital.

“Hydrocephalus is the most common childhood neurosurgical condition that we see in the population that we serve,” said Edith Mbabazi-Kabachelor, director of research, CURE Children’s Hospital of Uganda. “If hydrocephalus is left untreated in children less than two years old, the progressive increase in head size will lead to further brain damage, resulting in the majority of these children dying, and those that survive being left with severe cognitive and physical disability.”

Severe systemic bacterial infection during the first four weeks of life accounts for an estimated 680,000 to 750,000 yearly neonatal deaths worldwide. Hydrocephalus is the most common brain disorder in childhood and the largest single cause of childhood hydrocephalus is neonatal infection, accounting for an estimated 160,000 yearly cases, said Schiff.

Over a 5-year study in Uganda, supported by the U.S. National Institutes of Health, using advanced genomic techniques the team uncovered the major bacterial and viral underpinnings of these infections, the researchers report today (Sept. 30) in Science Translational Medicine.

Schiff and his team have studied this problem for more than 10 years, but in the last five years, they took a different approach, using DNA and RNA sequencing techniques to identify the causative agents. The researchers looked at blood and cerebrospinal fluid drawn from 100 cases of post-infectious hydrocephalus and control patients without infection in Uganda. There were 64 infants with post-infectious hydrocephalus and 36 with non-post-infectious hydrocephalus. All infants were under three months old. The researchers prepared the samples in two ways—fresh-frozen and preserved—and they sent samples to two different laboratories in the U.S., where samples were analyzed with different techniques. This was to ensure valid and reproducible results.

“We found this weird bacteria dominating,” said Schiff.

The bacteria was a previously unidentified strain of Paenibacillus thiaminolyticus, now named Mbale after the city where the CURE Children’s Hospital is located.

“The initial link between hydrocephalus and Paenibacillus was made through high-throughput sequencing and PCR analyses at the Center for Infection and Immunity in the Mailman School of Public Health at Columbia University, a renowned center led by W. Ian Lipkin,” said Schiff.

High-throughput sequencing allows sequencing of more than one DNA molecule at the same time, and PCR analysis multiplies existing DNA samples so that they are easier to analyze and identify.

“You build a field of dreams—in this case a platform for pathogen discovery—and wait for the right partner and the right project,” said W. Ian Lipkin, John Snow Professor of Epidemiology and director, Center for Infection and Immunity, Mailman School of Public Health, and professor of pathology and neurology, College of Physicians & Surgeons, Columbia University. “Steven Schiff is a remarkable investigator and this is such a project. It stands out for impact amongst hundreds we’ve done over a period of more than 30 years. Our team is delighted to have had an opportunity to help implicate an agent and contribute to control of this devastating disorder.”

The researchers managed to grow the difficult-to-culture new bacterial strain at Penn State, and tested it on mice. While the common variants of Paenibacillus are harmless, the Mbale strain was lethal to the mice.

The researchers found the new bacterial strain in the cerebrospinal fluid of the infection-induced hydrocephalic children and then only in the youngest patients.

“While we tested infants up to three months old, we mostly identified the cause of infections in those less than six weeks of age,” said Schiff. “If we didn’t study them really early in life, then the infection had already burned out. Between 6 and 12 weeks there were very few positive results.”

Schiff was not satisfied with finding the proposed bacterial cause of the problem, he said. He reasoned that other diseases had both a bacterial and viral component and so the team looked for viral, fungal and parasitic genetic material. They found cytomegalovirus (CMV) in the cerebrospinal fluid of the infection-caused hydrocephalic infants, but not in that of the other hydrocephalus patients.

CMV is a common virus found around the world. The virus causes minor symptoms, if any, in most adults, although babies may be born with congenital CMV or acquire it early in life and be significantly harmed by neurological damage. The researchers only found CMV in the cerebrospinal fluid of babies with post-infection hydrocephalus.

While the researchers believe they have found the source of the infections that cause the high prevalence of hydrocephalus, they do not know where the babies encounter the new bacteria. According to Schiff, the bacteria may be soil- or water-born and more work is necessary to find the bacterial source.

The researchers are creating predictive models that, coupled with data they are now analyzing from thousands of infants and satellite-acquired rainfall to predict optimal treatment for individual locations. The researchers said they do not know if this particular bacterial virus combination exists outside this area of Uganda. However, the same strategy of using DNA and RNA to diagnose previously unknown causes of similar infections can be used in many other regions in the developing world where similar cases are seen.

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Elevated clotting factor V levels linked to worse outcomes in severe COVID-19 infections

Patients hospitalized with severe COVID-19 infections who have high levels of the blood clotting protein factor V are at elevated risk for serious injury from blood clots such as deep vein thrombosis or pulmonary embolism, investigators at Massachusetts General Hospital (MGH) have found.

On the other hand, critically ill patients with COVID-19 and low levels of factor V appear to be at increased risk for death from a coagulopathy that resembles disseminated intravascular coagulation (DIC), a devastating, often fatal abnormality in which blood clots form in small vessels throughout the body, leading to exhaustion of clotting factors and proteins that control coagulation, report Elizabeth M. Van Cott, MD, investigator in the deparment of pathology at MGH and colleagues.

Their findings, based on studies of patients with COVID-19 in MGH intensive care units (ICUs), point to disturbances in factor V activity as both a potential cause of blood clotting disorders with COVID-19, and to potential methods for identifying at-risk patients with the goal of selecting the proper anticoagulation therapy.

The study results are published online in the American Journal of Hematology.

“Aside from COVID-19, I’ve never seen anything else cause markedly elevated factor V, and I’ve been doing this for 25 years,” Van Cott says.

Patients with severe COVID-19 disease caused by the SARS-CoV-2 virus can develop blood clots in medical lines (intravenous lines, catheters, etc), and in arteries, lungs, and extremities, including the toes. Yet the mechanisms underlying coagulation disorders in patients with COVID-19 are still unknown.

In March 2020, in the early days of the COVID-19 pandemic in Massachusetts, Van Cott and colleagues found that a blood sample from a patient with severe COVID-19 on a ventilator contained factor V levels high above the normal reference range. Four days later, this patient developed a saddle pulmonary embolism, a potentially fatal blood clot occurring at the junction of the left and right pulmonary arteries.

This pointed the investigators to activity of factor V as well as factor VIII and factor X, two other major clotting factors. They studied the levels of these clotting factors and other parameters in a group of 102 consecutive patients with COVID-19, and compared the results with those of current critically ill patients without COVID-19, and with historical controls.

They found that factor V levels were significantly elevated among patients with COVID-19 compared with controls, and that the association between high factor V activity and COVID-19 was the strongest among all clinical parameters studied.

In all, 33 percent of patients with factor V activity well above the reference range had either deep vein thrombosis or a pulmonary embolism, compared with only 13 percent of patients with lower levels. Death rates were significantly higher for patients with lower levels of factor V (30 percent vs. 12 percent), with evidence that this was due to a clinical decline toward a DIC-like state.

Van Cott and colleagues also found that the clinical decline toward DIC was foreshadowed by a measurable change in the shape or “waveform” of a plot charting light absorbance against the time it takes blood to coagulate (waveform of the activated partial thromboplastin time, or aPTT).

“The waveform can actually be a useful tool to help assess patients as to whether their clinical course is declining toward DIC or not,” Van Cott explains. “The lab tests that usually diagnose DIC were not helpful in these cases.”

Importantly, the MGH investigators note that factor V elevation in COVID-19 could cause misdiagnosis of some patients, because under normal circumstances factor V levels are low in the presence of liver dysfunction or DIC. Physicians might therefore mistakenly assume that patients instead have a deficiency in vitamin K.

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