Posted on by Dr. Francis Collins
With the holiday season fast approaching and coronavirus disease 2019 (COVID-19) surging in most parts of the country, millions of Americans—including me and my family—will break with tradition this year to celebrate in ways that we hope will help to keep us all safe and healthy. Granted, this may present some difficult emotional and logistical challenges, but I’m confident that the American can-do spirit will rise to meet those challenges.
I also recognize that this will be hard for many of us. Celebrating holidays alone or with your immediate household members can sound rather dreary. After all, who wants to roast and carve a turkey for just a few people? But, if you look at it another way, the pandemic does offer opportunities to make this holiday a season to remember in new and different ways. Here are a couple of ideas that you may want to consider:
Send Gifts. Although COVID-19 has changed our lives in many ways, sending cards or gifts remains a relatively easy way to let loved ones know that you’re thinking of them. Who wouldn’t want to receive some home-baked goodies, a basket of fresh fruit, or a festive wreath? If you enjoy knitting, candle making, or other ways of crafting gifts for the holidays, now’s the time to start planning for Thanksgiving through the New Year.
Make Videos. When I’m visiting family, there is often music involved—with guitar, piano, and maybe some singing. But, this year, I’ll have to be content with video recording a few songs and sending them to others by text or email. Come to think of it, the kids and the grandkids might enjoy these songs just as much—or even more—if they can watch them at a time and place that works best for them. (On the other hand, some of them might roll their eyes and decide not to open that video file!) If you don’t play a guitar or like to sing, you can still make your own holiday-themed videos. Maybe share a dance routine, a demonstration of athletic skill, or even some stand-up comedy. The key is to have fun and let your imagination run free.
Share a Meal Remotely. Most of our end-of-the-year holidays involve the family sitting around a table overflowing with delicious food. With all of the videoconferencing platforms now available, it is easy to set aside a block of time to share a meal and good conversation remotely with friends and family members, whether they live nearby or across the country. Rather than one cook slaving over a hot stove or a certain person monopolizing the dinner table conversation, everyone gets a chance to cook and share their stories via their smartphone, tablet, or laptop. You can compare your culinary creations, swap recipes, and try to remember to leave room for dessert. If you have a tradition of playing games or giving thanks for your many blessings, you can still do many of these activities remotely.
Take an After-Dinner Walk. Due to the physical demands and psychological impacts of the COVID-19 pandemic, it’s been difficult for many of us to stay physically active. The key is making exercise a daily priority, and the holidays are no different. After your holiday meal, go on a virtual group walk through your respective neighborhoods to work off the food. Thanks to your smartphone’s camera, you can share your time outdoors and all of the interesting sights along the way. (Yes, the new playground in the local park looks fantastic, and the neighbors really did just paint their house purple!)
Stay Safe. If you plan to go ahead and join a holiday gathering in person, it’s important to remain vigilant, even when interacting with dear friends and loved ones. The greatest risk for spread of COVID-19 right now is these family gatherings. Remember there are risks associated with travel and with interacting with people who’ve not been tested for the coronavirus prior to the event, especially if they reside in a COVID hot spot—which is almost everywhere these days. Try to keep any family gatherings brief and relatively small, about five people or less. If the weather permits, hold the get-together outdoors.
To protect yourself and your loved ones, both now and over the holidays, please follow these 3 W’s:
• Wear a mask when you are out in public and when you are indoors with people who are not part of your immediate household. The only exception is while eating or drinking!
• Watch your distance, staying at least 6 feet away from people who are not part of your immediate household.
• Wash your hands thoroughly and frequently.
Making all of these adjustments is a lot to consider when you’re trying to have a good time and there are children and older adults in the mix. That’s why I and my wife Diane decided the best plan for us this holiday season is to stay home in Maryland and forgo our traditional trips to family in Michigan and North Carolina. Not only did we want to reduce the risk of possibly contracting COVID-19 from—or transmitting it to—our faraway loved ones, we want to do everything we can to protect our local friends and co-workers from the coronavirus.
While this holiday season is likely to be memorable in ways that we never could have imagined, I’m confident that, thanks to the rapid advances being made by medical research, we ultimately will get the COVID-19 pandemic under control so we can once again give everyone we love a big hug in person. Until then, please stay safe. Wishing each of you a wonderful and healthful holiday season, starting with a Happy Thanksgiving!
Coronavirus (COVID) (NIH)
Your Health: Holiday Celebrations and Small Gatherings (Centers for Disease Control and Prevention, Atlanta)
Your Health: Personal and Social Activities (CDC)
Posted on by Dr. Francis Collins
The coronavirus disease 2019 (COVID-19) pandemic has already claimed the lives of more than 230,000 Americans, the population of a mid-sized U.S. city. As we look ahead to winter and the coming flu season, the question weighing on the minds of most folks is: Can we pull together to contain the spread of this virus and limit its growing death toll?
I believe that we can, but only if each of us gets fully engaged with the public health recommendations. We need all Americans to do the right thing and wear a mask in public to protect themselves and their communities from spreading the virus. Driving home this point is a powerful new study that models just how critical this simple, low-cost step will be this winter and through the course of this pandemic .
Right now, it’s estimated that about half of Americans always wear a mask in public. According to the new study, published in Nature Medicine, if this incomplete rate of mask-wearing continues and social distancing guidelines are not adhered to, the total number of COVID-19 deaths in the United States could soar to more than 1 million by the end of February.
However, the model doesn’t accept that we’ll actually end up at this daunting number. It anticipates that once COVID mortality reaches a daily threshold of 8 deaths per 1 million citizens, U.S. states would re-instate limits on social and economic activity—as much of Europe is now doing. If so, the model predicts that by March, such state-sanctioned measures would cut the projected number of deaths in half to about 510,000—though that would still add another 280,000 lives lost to this devastating virus.
The authors, led by Christopher Murray, Institute of Health Metrics and Evaluations, University of Washington School of Medicine, Seattle, show that we can do better than that. But doing better will require action by all of us. If 95 percent of people in the U.S. began wearing masks in public right now, the death toll would drop by March from the projected 510,000 to about 380,000.
In other words, if most Americans pulled together to do the right thing and wore a mask in public, this simple, selfless act would save more than 130,000 lives in the next few months alone. If mask-wearers increased to just 85 percent, the model predicts it would save about 96,000 lives across the country.
What’s important here aren’t the precise numbers. It’s the realization that, under any scenario, this pandemic is far from over, and, together, we have it within our power to shape what happens next. If more people make the decision to wear masks in public today, it could help to delay—or possibly even prevent—the need for future shutdowns. As such, the widespread use of face coverings has the potential to protect lives while also minimizing further damage to the economy and American livelihoods. It’s a point that NIH’s Anthony Fauci and colleagues presented quite well in a recent commentary in JAMA .
As we anxiously await the approved vaccines for COVID-19 and other advances in its prevention and treatment, the life-saving potential of face coverings simply can’t be overstated. I know that many people are tired of this message, and, unfortunately, mask-wearing has been tangled up in political perspectives at this time of deep divisions in our country.
But think about it in the same way you think about putting on your seat belt—a minor inconvenience that can save lives. I’m careful to wear a mask outside my home every time I’m out and about. But, ultimately, saving lives and livelihoods as we head into these winter months will require a collective effort from all of us.
To do so, each of us needs to follow these three W’s: Wear a mask. Watch your distance (stay 6 feet apart). Wash your hands often.
 Modeling COVID-19 scenarios for the United States. IHME COVID-19 Forecasting Team. Nat Med. 2020 Oct 23.
 Preventing the spread of SARS-CoV-2 with masks and other “low-tech” interventions. Lerner AM, Folkers, GK, Fauci AS. JAMA. 2020 October 26.
Coronavirus (COVID-19) (NIH)
Institute for Health Metrics and Evaluations (University of Washington School of Medicine, Seattle)
Posted In: News
Tags: community spread, coronavirus, COVID-19, COVID-19 deaths, COVID-19 prevention, face coverings, face mask, fauci, handwashing, Institute of Health Metrics and Evaluations, mask, mask wearing, novel coronavirus, pandemic, public health, public health modeling, SARS-CoV-2, social distancing
Posted on by Dr. Francis Collins
A key metric in seeking to end the COVID-19 pandemic is the likely duration of acquired immunity, which is how long people infected with SARS-CoV-2, the novel coronavirus that causes COVID-19, are protected against reinfection. The hope is that acquired immunity from natural infection—or from vaccines—will be long-lasting, but data to confirm that’s indeed the case won’t be in for many months or years.
In the meantime, a useful place to look for clues is in long-term data on reinfections with other seasonal coronaviruses. Could the behavior of less life-threatening members of the coronavirus family give us some insight into what to expect from SARS-CoV-2?
A new study, published in the journal Nature Medicine, has taken exactly this approach. The researchers examined blood samples collected continuously from 10 healthy individuals since the 1980s for evidence of infections—and reinfections—with four common coronaviruses. Unfortunately, it’s not particularly encouraging news. The new data show that immunity to other coronaviruses tends to be short-lived, with reinfections happening quite often about 12 months later and, in some cases, even sooner.
Prior to the discovery of SARS-CoV-2, six coronaviruses were known to infect humans. Four are responsible for relatively benign respiratory illnesses that regularly circulate to cause the condition we recognize as the common cold. The other two are more dangerous and, fortunately, less common: SARS-CoV-1, the virus responsible for outbreaks of Severe Acute Respiratory Syndrome (SARS), which ended in 2004; and MERS-CoV, the virus that causes the now rare Middle East Respiratory Syndrome (MERS).
In the new study, a team led by Lia van der Hoek, University of Amsterdam, the Netherlands, set out to get a handle on reinfections with the four common coronaviruses: HCoV-NL63, HCoV-229E, HCoV-OC43, and HCoV-HKU1. This task isn’t as straightforward as it might sound. That’s because, like SARS-CoV-2, infections with such viruses don’t always produce symptoms that are easily tracked. So, the researchers looked instead to blood samples from 10 healthy individuals enrolled for decades in the Amsterdam Cohort Studies on HIV-1 Infection and AIDS.
To detect coronavirus reinfections, they measured increases in antibodies to a particular portion of the nucleocapsid of each coronavirus. The nucleocapsid is a protein shell that encapsulates a coronavirus’ genetic material and serves as important targets for antibodies. An increase in antibodies targeting the nucleocapsid indicated that a person was fighting a new infection with one of the four coronaviruses.
All told, the researchers examined a total of 513 blood samples collected at regular intervals—every 3 to 6 months. In those samples, the team’s analyses uncovered 3 to 17 coronavirus infections per study participant over more than 35 years. Reinfections occurred every 6 to 105 months. But reinfections happened most frequently about a year after a previous infection.
Not surprisingly, they also found that blood samples collected in the Netherlands during the summer months—June, July, August, and September—had the lowest rate of infections for all four seasonal coronaviruses, indicating a higher frequency of infections in winter in temperate countries. While it remains to be seen, it’s possible that SARS-CoV-2 ultimately may share the same seasonal pattern after the pandemic.
These findings show that annual reinfections are a common occurrence for all other common coronaviruses. That’s consistent with evidence that antibodies against SARS-CoV-2 decrease within two months of infection . It also suggests that similar patterns of reinfection may emerge for SARS-CoV-2 in the coming months and years.
At least three caveats ought to be kept in mind when interpreting these data. First, the researchers tracked antibody levels but didn’t have access to information about actual illness. It’s possible that a rise in antibodies to a particular coronavirus might have provided exactly the response needed to convert a significant respiratory illness to a mild case of the sniffles or no illness at all.
Second, sustained immunity to viruses will always be disrupted if the virus is undergoing mutational changes and presenting a new set of antigens to the host; the degree to which that might have contributed to reinfections is not known. And, third, the role of cell-based immunity in fighting off coronavirus infections is likely to be significant, but wasn’t studied in this retrospective analysis.
To prepare for COVID-19 this winter, it’s essential to understand how likely a person who has recovered from the illness will be re-infected and potentially spread the virus to other people. While much more study is needed, the evidence suggests it will be prudent to proceed carefully and with caution when it comes to long-term immunity, whether achieved through naturally acquired infections or vaccination.
While we await a COVID-19 vaccine, the best way to protect yourself, your family, and your community is to take simple steps all of us can do today: maintain social distancing, wear a mask, avoid crowded indoor gatherings, and wash your hands.
 Seasonal coronavirus protective immunity is short-lasting. Edridge AWD, Kaczorowska J, Hoste ACR, Bakker M, Klein M, Loens K, Jebbink MF, Matser A, Kinsella CM, Rueda P, Ieven M, Goossens H, Prins M, Sastre P, Deijs M, van der Hoek L. Nat Med. 2020 Sep 14. doi: 10.1038/s41591-020-1083-1. [Published online ahead of print.]
 Rapid decay of anti-SARS-CoV-2 antibodies in persons with mild Covid-19. Ibarrondo FJ, Fulcher JA, Goodman-Meza D, Elliott J, Hofmann C, Hausner MA, Ferbas KG, Tobin NH, Aldrovandi GM, Yang OO. N Engl J Med. 2020 Sep 10;383(11):1085-1087.
Coronavirus (COVID-19) (NIH)
Lia van der hoek (University of Amsterdam, the Netherlands)
Posted In: News
Tags: acquired immunity, Amsterdam Cohort Studies on HIV-1 Infection and AIDS, antibodies, cohort, common cold, coronavirus, COVID-19, COVID-19 reinfection, handwashing, longitudinal study, mask, MERS, Netherlands, novel coronavirus, nucleocapsid, pandemic, protective immunity, SARS, SARS-CoV-2, seasonal coronaviruses, social distancing, vaccine
Posted on by Dr. Francis Collins
The alarming spread of coronavirus disease 2019 (COVID-19) last winter presented a profound threat to nations around the world. Many government leaders responded by shutting down all non-essential activities, implementing policies that public health officials were hopeful could slow the highly infectious SARS-CoV-2, the novel coronavirus that causes COVID-19.
But the shutdown has come at a heavy cost for the U.S. and global economies. It’s also taken a heavy personal toll on many of us, disrupting our daily routines—getting children off to school, commuting to the office or lab, getting together with friends and family, meeting face to face to plan projects, eating out, going to the gym—and causing lots of uncertainty and frustration.
As difficult as the shutdowns have been, new research shows that without these public health measures, things would have been much, much worse. According to a study published recently in Nature , the implementation of containment and mitigation strategies across the globe prevented or delayed about 530 million coronavirus infections across six countries—China, South Korea, Iran, Italy, France, and the United States. Take a moment to absorb that number—530 million. Right now, there are 8.8 million cases documented across the globe.
Estimates of the benefits of anti-contagion policies have drawn from epidemiological models that simulate the spread of COVID-19 in various ways, depending on assumptions built into each model. But models are sophisticated ways of guessing. Back when decisions about staying at home had to be made, no one knew for sure if, or how well, such approaches to limit physical contact would work. What’s more, the only real historical precedent was the 1918 Spanish flu pandemic in a very different, much-less interconnected world.
That made it essential to evaluate the pros and cons of these public health strategies within a society. As many people have rightfully asked: are the health benefits really worth the pain?
Recognizing a pressing need to answer this question, an international team of scientists dropped everything that they were doing to find out. Led by Solomon Hsiang, director of the University of California, Berkeley’s Global Policy Laboratory and Chancellor’s Professor at the Goldman School of Public Policy, a research group of 15 researchers from China, France, South Korea, New Zealand, Singapore, and the United States evaluated 1,717 policies implemented in all six countries between January 2020, when the virus began its global rise, and April 6, 2020.
The team relied on econometric methods that use statistics and math to uncover meaningful patterns hiding in mountains of data. As the name implies, these techniques are used routinely by economists to understand, in a before-and-after way, how certain events affect economic growth.
In this look-back study, scientists compare observations before and after an event they couldn’t control, such as a natural disaster or disease outbreak. In the case of COVID-19, these researchers compared public health datasets in multiple localities (e.g., states or cities) within each of the six countries before and several weeks after lockdowns. For each data sample from a given locality, the time period right before a policy deployment was the experimental “control” for the same locality several weeks after it received one or more shutdown policy “treatments.”
Hsiang and his colleagues measured the effects of all the different policies put into place at local, regional, and national levels. These included travel restrictions, business and school closures, shelter-in-place orders, and other actions that didn’t involve any type of medical treatment for COVID-19.
Because SARS-CoV-2 is a new virus, the researchers knew that early in the pandemic, everyone was susceptible, and the outbreak would grow exponentially. The scientists could then use a statistical method designed to estimate how the daily growth rate of infections changed over time within a location after different combinations of large-scale policies were put into place.
The result? Early in the pandemic, coronavirus infection rates grew 38 percent each day, on average, across the six countries: translating to a two-day doubling time. Applying all policies at once slowed the daily COVID-19 infection rate by 31 percentage points! Policies having the clearest benefit were business closures and lockdowns, whereas travel restrictions and bans on social gatherings had mixed results. Without more data, the analysis can’t specify why, but the way different countries enacted those policies might be one reason.
As we continue to try to understand and thwart this new virus and its damage to so many aspects of our personal and professional lives, these new findings add context, comfort, and guidance about the present circumstances. They tell us that individual sacrifices from staying home and canceled events contributed collectively to a huge, positive impact on the world.
Now, as various communities start cautiously to open up, we should continue to practice social distancing, mask wearing, and handwashing. This is not the time to say that the risk has passed. We are all tired of the virus and its consequences for our personal lives, but the virus doesn’t care. It’s still out there. Stay safe, everyone!
 The effect of large-scale anti-contagion policies on the COVID-19 pandemic. Hsiang S, Allen D, Annan-Phan S, et al. Nature. 2020 June 8 [published online ahead of print].
Global Policy Lab: Effect of Anti-Contagion Policies (University of California, Berkeley)
Video: How much have policies to slow COVID-19 worked? (UC Berkeley)
Hsiang Lab (UC Berkeley)
“Global Policy Lab Rallies for COVID-19 Research,” COVID-19 News, Goldman School of Public Policy, June 5, 2020.
Posted In: News
Tags: China, COVID-19, disease prevention, econometrics, epidemiological modeling, epidemiology, France, global health, global policy, Iran, Italy, New Zealand, novel coronavirus, pandemic, public health, SARS-CoV-2, shutdown policies, Singapore, social distancing, South Korea, virology
Posted on by Dr. Francis Collins
We’ve learned so much about coronavirus disease 2019 (COVID-19), but there’s still much more that we need to learn in order to defeat this devastating pandemic. Among the critical questions: why do some young people who appear healthy and have no history of chronic disease get very sick from the virus? And why do some people in their 80s or 90s seemingly just shrug off the infection? There’s something going on biologically, but we don’t yet have the answers.
We do, however, have some resources that will enable us to examine lots of data in search of biological clues. One of them is NIH’s All of Us Research Program, which is seeking the help of 1 million people to build one of the most diverse health databases in our nation’s history. Two years after its national launch, the program already has enrolled nearly 350,000 diverse participants from across the United States.
As its name suggests, All of Us is open to all people over age 18 in communities all around the country. An important strength of the effort has been welcoming participants from all backgrounds. Indeed, about 75 percent of people who have volunteered for the program come from groups that have traditionally been underrepresented in medical research. That includes people from many racial and ethnic minority groups, as well as those of many different ages, socioeconomic backgrounds, and geographic locations, including remote and rural areas.
Because of COVID-19 and the need for physical distancing to curb the spread of the potentially deadly virus, All of Us has been forced to halt temporarily all in-person appointments. But program leaders, including Josh Denny, chief executive officer of All of Us, and Kelly Gebo, the program’s chief medical and scientific officer, saw an opportunity to roll up their sleeves and help during this unprecedented public health challenge. In fact, Gebo reports that they’d already been hearing from many of their participant partners that they wanted to be a part of the solution to the COVID-19 pandemic.
To rise to this challenge, the All of Us Research Program has just announced three initiatives to assist the scientific community in seeking new insights into COVID-19. The program will:
• Test blood samples from 10,000 or more participants for the presence of SARS-CoV-2 antibodies, indicating prior infection. The testing will start on samples collected in March 2020 and work backward until positive tests are no longer found. This will show the prevalence of novel coronavirus exposure among All of Us participants from across the country, allowing researchers to sift through the data and assess the varying rates and timing of infections across regions and communities.
• Rapidly collect relevant information from more than 200,000 participants who have shared their electronic health records. A number of those participants have already either been diagnosed with COVID-19 or sought health care for related symptoms. The program is working to standardize this information. It will help researchers look for patterns and learn more about COVID-19 symptoms and associated health problems, as well as the effects of different medicines and treatments.
• Deploy a new online survey to understand better the effects of the COVID-19 pandemic on participants’ physical and mental health. This 20- to 30-minute survey is designed both for participants who have been ill with COVID-19 and those who have not knowingly been infected. Questions will be included on COVID-19 symptoms, stress, social distancing and the economic impacts of the pandemic. Participants are invited to take the survey each month until the pandemic ends, so researchers can study the effects of COVID-19 over time and begin to better understand how and why COVID-19 affects people differently.
As this data becomes available, researchers will look for new leads to inform our efforts to bring greater precision to the diagnosis, treatment, and prevention of COVID-19, including for those communities that have been hit the hardest. Another hope is that what is learned about COVID-19 through All of Us and other NIH-supported research will provide us with the knowledge and tools we need to avert future pandemics,
In case you’re wondering, I happen to be among the thousands of people who’ve already volunteered to take part in All of Us. If you’d like to get involved too, new participants are always welcome to join.
Coronavirus (COVID-19) (NIH)
Join All of Us (NIH)