A serological investigation in Southern Italy: was SARS-CoV-2 circulating in late 2019?

In March 2020, the first pandemic caused by a coronavirus was declared by the World Health Organization. Italy was one of the first and most severely affected countries, particularly the northern part of the country. The latest evidence suggests that the virus could have been circulating, at least in Italy, before the first autochthonous SARS-COV-2 case was detected in February 2020. The present study aimed to investigate the presence of antibodies against SARS-CoV-2 in human serum samples collected in the last months of 2019 (September-December) in the Apulia region, Southern Italy. Eight of 455 samples tested proved positive on in-house receptor-binding-domain-based ELISA. Given the month of collection of the positive samples, these findings may indicate early circulation of SARS-CoV-2 in Apulia region in the autumn of 2019. However, it cannot be completely ruled out that the observed sero-reactivity could be an unknown antigen specificity in another virus to which subjects were exposed containing an epitope adventitiously cross-reactive with an epitope of SARS-CoV-2.

Characterization of antibody response in asymptomatic and symptomatic SARS-CoV-2 infection.

SARS-CoV-2 pandemic is causing high morbidity and mortality burden worldwide with unprecedented strain on health care systems. To investigate the time course of the antibody response in relation to the outcome we performed a study in hospitalized COVID-19 patients. As comparison we also investigated the time course of the antibody response in SARS-CoV-2 asymptomatic subjects. Study results show that patients produce a strong antibody response to SARS-CoV-2 with high correlation between different viral antigens (spike protein and nucleoprotein) and among antibody classes (IgA, IgG, and IgM and neutralizing antibodies). The antibody peak is reached by 3 weeks from hospital admission followed by a sharp decrease. No difference was observed in any parameter of the antibody classes, including neutralizing antibodies, between subjects who recovered or with fatal outcome. Only few asymptomatic subjects developed antibodies at detectable levels.

Changes to management of a non-pandemic illness during the COVID-19 pandemic: Case study of invasive management of acute coronary syndrome

The coronavirus 2019 (COVID-19) pandemic requires significant changes to standard operating procedures for non-COVID-19 related illnesses. Balancing the benefit from standard evidence-based treatments with the risks posed by COVID-19 to patients, healthcare workers and to the population at large is difficult due to incomplete and rapidly changing information. In this article, we use management of acute coronary syndromes as a case study to show how these competing risks and benefits can be resolved, albeit incompletely. While the risks due to COVID-19 in patients with acute coronary syndromes is unclear, the benefits of standard management are well established in this condition. As an aid to decision making, we recommend systematic estimation of the risks and benefits for management of any condition where there is likely to be an increase in non-COVID-19 related mortality and morbidity due to changes in routine care.

Designing an Interstate Compact for a Pandemic Testing Board

From the Introduction: Analysts have recently focused their attention on two pathways for the United States to reopen prior to the development of a vaccine for COVID-19 [coronavirus disease 2019]. The first is to accept a series of rolling openings and closings: reopening as infection rates decrease, then reclosing as they rise again due to increased interactions. This approach is generally thought to be enormously costly economically and socially, as people will be kept in their homes and commerce restrained for considerable amounts of time. The second approach is to massively ramp up the production of testing, either through a universal testing regime (which would require capacity to test all 300+ million Americans every week or two) or a system of testing, tracing, and supported isolation (which would require testing 5 million Americans a day, plus tracing those who were in contact with the infected and isolating them). The testing pathway would enable the United States to reopen without having to close repeatedly and it would, as a result, save billions of dollars. The problem is that we do not have the number of tests necessary to pursue a testing pathway to reopening. [...] This paper offers a blueprint for how to design a pandemic testing board via an interstate compact.COVID-19 (Disease);Disaster recovery--Plans;Health--Testing;Public health surveillance;Epidemics

Mitigate/Suppress/Maintain: Local Targets for Victory Over COVID

From the Abstract: There is growing consensus around a strategy centered on testing, tracing, and supported isolation (TTSI) to suppress COVID [coronavirus disease], save lives, and safely reopen the economy. Given the high prevalence the disease has reached in many OECD [Organisation for Economic Co-operation and Development] countries, this requires the expansion of TTSI inputs to scales and with a speed that have little precedent (Siddarth and Weyl, 2020). AAs scarcity of testing supplies is expected to remain during the build-up to a surge, authorities will need to allocate these tests within and across localities to minimize loss of life. This paper documents a preliminary framework that aims to provide such guidance to multiscale geographies, in conjunction with our previous recommendations. Given unfortunate limits in current testing capacity, we describe a testing and tracing regime in which orders of magnitude fewer resources can be used to suppress the disease.COVID-19 (Disease);Health--Testing;Public health surveillance;Disaster recovery--Plans

Preparedness and Unpreparedness: The Military Vs Medicine

From the Abstract: As the COVID-19 [coronavirus disease 2019] pandemic intensified in the spring of 2020, many Americans were shocked to see how quickly hospitals were overwhelmed in affected cities. Our medical and public health infrastructure was clearly not prepared, leading to problems with emergency medical services, acute care hospitals, nursing homes, access to adequate protective equipment, and mortuary capacity. How could this be? For several decades, the United States government has run pandemic simulations and this outcome-- overwhelmed health care systems--has been identified as a possible scenario time and time again. Yet preparations for this eventuality were halting and inadequate at best. In this essay we review the historical and policy contexts of pandemic preparedness to understand why we have been caught off-guard by something we had repeatedly foreseen. We explore the reasons for our current predicament and whether alternative approaches ought to be pursued. It is not that preparedness is impossible: the federal government invests substantial resources in military preparedness, seemingly with good effect. The problem is specific to health care and bears the imprint of our fragmented systems of financing and government oversight.COVID-19 (Disease);Disaster preparedness--Plans;Crisis management;Military readiness;Health planning

Educational Ethics During a Pandemic

From the Abstract: This paper examines districts' and states' distributive choices during March and April 2020 to explore the ethics of educating in a pandemic. Section 2 investigates our revealed preferences around the aims of schooling, concluding that we value schools as providers of care before and even above their roles as deliverers of learning opportunities. Section 3 shifts to policy makers' decisions about schools specifically as providers of academic learning. It finds that school closures under COVID-19 [coronavirus disease 2019] 'intensify' existing ethical dilemmas in education policy and practice, but they generally have not posed novel ethical challenges. In contrast to public health ethics in emergency contexts of scarcity, however, egalitarian rather than utilitarian principles seem to motivate policy makers and educators. This led many districts and states to decide initially to offer no educational services to anyone rather than violate substantive equality of educational opportunity. Section 4 finds similar motivations at work in more recent decisions to eliminate high-stakes grading through adoption of mandatory pass/no credit approaches. The paper concludes that while the pandemic has not changed the nature of existing ethical challenges, it has raised the stakes if we fail to realize our ethical commitments--and demonstrated our capacity to have realized them all along.COVID-19 (Disease);School closings;Education;Epidemics

Roadmap to Pandemic Resilience: Massive Scale Testing, Tracing, and Supported Isolation (TTSI) as the Path to Pandemic Resilience for a Free Society

From the Executive Summary: "We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy. We acknowledge that even this number may not be high enough to protect public health. In that considerably less likely eventuality, we will need to scale-up testing much further. By the time we know if we need to do that, we should be in a better position to know how to do it. In any situation, achieving these numbers depends on testing innovation. [...] This policy roadmap lays out how massive testing plus contact tracing plus social isolation with strong social supports, or TTSI, can rebuild trust in our personal safety and the safety of those we love. This will in turn support a renewal of mobility and mobilization of the economy. This paper is designed to educate the American public about what is emerging as a consensus national strategy."

Digital Tools for COVID-19 Contact Tracing: Identifying and Mitigating the Equity, Privacy, and Civil Liberties Concerns

From the Abstract: Many state governments and public health authorities in the United States are turning to digital tools to assist contact tracing efforts in response to the coronavirus pandemic despite equity, privacy, and civil liberties concerns. The digital divide, pronounced lack of trust in government among certain communities, and privacy risks posed by collecting personal data at scale make effective deployment of digital contact tracing tools challenging. But if governments decide they need to supplement manual contact tracing due to capacity issues, digital tools that use exclusively Bluetooth-based technology may be useful, as long as public health authorities implement proper safeguards. This paper outlines the equity, privacy, and civil liberties risks posed by digital tools as well as safeguards that policymakers can adopt to mitigate these concerns. Further, the paper recommends that policymakers take affirmative steps to address vulnerable populations that are unlikely to be reached by digital apps, partner with developers and community organizations, promote public education campaigns when deploying digital tools, take steps to close the digital divide, and pass comprehensive privacy legislation with effective enforcement mechanisms.COVID-19 (Disease);Public health surveillance;Civil liberties

Pandemic Resilience: Getting it Done

From the Executive Summary: On April 27, the CDC [Centers for Disease Control and Prevention] changed its guidance to support broader use of testing not only for therapeutic purposes, but also for disease control. In the most recent guidance, released May 3, first priority goes to hospitalized patients, first responders with symptoms, and residents in congregate living contexts with symptoms. But there is now also a second priority category that includes asymptomatic individuals from groups experiencing disparate impacts of the disease and 'persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitoring, sentinel surveillance, or 'screening of other asymptomatic individuals according to state and local plans' (bold in original, italics added). The last phrase supports broad testing of contacts of COVID [coronavirus disease]-positive individuals and of essential workers, even when they have mild symptoms or none at all. This Supplement to our Roadmap to Pandemic Resilience offers guidance to help state and local governments develop TTSI (testing, tracing, and supported isolation) programs in support of such testing for purposes of disease control and suppression.Coronaviruses;COVID-19 (Disease);Disaster recovery;Health--Testing;Public health surveillance;Disaster recovery--Plans