ECDC: 11th Rapid Risk Assessment (RRA) On COVID-19

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While COVID-19 continues to run rampant across wide swaths of the Americas, the level of transmission in Europe has reduced significantly over the past several months.  In the ECDC's last RRA, issued just 5 weeks ago, Europe accounted for 15% of the world's total of COVID cases.

In today's update, that number has dropped to just 10%. 

While encouraging, we've seen time and again how easily the virus can flare back up, even in places (i.e. Hong Kong, New Zealand, Germany) that appeared to have gotten community transmission under control.  

You'll want to download and review the full 37-page PDF, but I've posted the executive summary below.

Rapid Risk Assessment: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – eleventh update: resurgence of cases

Risk assessment
10 Aug 2020
 
Since 31 December 2019 and as of 2 August 2020, 17 841 669 cases of COVID-19 have been reported worldwide, including 685 281 deaths. European Union/European Economic Area (EU/EEA) countries and the United Kingdom (UK) have reported 1 733 550 cases (10% of all cases), including 182 639 deaths (27% of all deaths).

In this update, we analyse the risk of further escalation of COVID-19 in the countries that have reported a recent increase in COVID-19 cases and the risk of further escalation of COVID-19 across all EU/EEA countries and the UK.

Executive summary

The COVID-19 pandemic continues to pose a major public health threat to EU/EEA countries and the UK and to countries worldwide. As cases increased, peaking in early April 2020 in the EU/EEA, many countries implemented a range of response measures which led to a reduction in incidence. As countries regained control of transmission and alleviated the burden on healthcare, many measures were relaxed or removed to allow for a more viable way of life with the virus in circulation. Subsequently, a recent increase in COVID-19 cases has been reported in many EU/EEA countries. While many countries are now testing mild and asymptomatic cases, which has resulted in increased case reports, there is a true resurgence in cases in several countries as a result of physical distancing measures being relaxed.

Further increases in the incidence of COVID-19, and associated hospitalisations and deaths, can be mitigated if sufficient control measures are reinstalled or reinforced in a timely manner. Countries that are now observing an increase in cases, after having lifted their control measures following a temporary improvement in the epidemiological situation, should consider re-instating selected measures through a phased, step-wise and sustainable approach. Assessment of risk at local level is important, taking into consideration the epidemiological situation, local services and lessons learned regarding the impact of previous measures.

Member States implementing comprehensive testing are better able to rapidly detect an increase in cases and identify groups at high risk of disease. Alongside a tailored local testing strategy, the speed of contact tracing is important to reduce transmission, and efforts should be made to shorten the time needed for each step in the testing, notification, and contact tracing process.

Given that there are now dedicated COVID-19 surveillance systems, extensive public health measures in place, and ongoing testing and contact tracing of the population, countries should be better prepared to prevent and control any resurgence in cases.

In general, response strategies should be guided by continuous monitoring and assessment of the epidemiological situation. They should be based on sustainable public health measures to protect vulnerable groups and decrease transmission in the community and should include extensive testing and contact tracing, followed by isolation and treatment of identified cases and quarantining of contacts. In addition to the preparedness and response strategies implemented by national authorities, adapted human behaviour is the key to tackling this pandemic. As the COVID-19 pandemic continues, it is natural for people to become fatigued and reduce compliance with public health measures. Risk communication efforts should be tailored to changes in the local situation and continuous messaging is needed to remind the population that the SARS-CoV-2 virus will remain in circulation within the community and that they should take everyday measures to reduce potential exposure, such as practising cough and respiratory etiquette, physical distancing and hand hygiene, wearing face masks, reducing the number of contacts and staying home when ill.

What is new in this update?

• Updated epidemiological situation and response measures implemented in the EU/EEA countries and the UK.
• Updated testing strategies, contact tracing, and general and targeted measures to minimise the risk of COVID-19 resurgence.
• Various risk profiles, based on the changes countries are observing in their reported cases, hospitalisations, testing methodologies, and test positivity rates in response to the relaxing or removing of measures.

What are the risks being assessed in this update?

In this update, we analyse the risk of further escalation of COVID-19 in the countries that have reported a recent increase in COVID-19 cases and the risk of further escalation of COVID-19 across all EU/EEA countries and the UK.

In countries where there is a strong indication of increasing transmission, locally or nationally, as demonstrated by a recent increase in cases and an increase in hospitalisations, the risk of further escalation of COVID-19 is high. For those countries, the risk is very high if they do not implement or reinforce multiple measures, including physical distancing and contact tracing, if they have sufficient testing capacity.

In countries where there is evidence that is suggestive of increasing transmission, as demonstrated by a recent increase in cases and no increase in hospitalisations but where there has been an increase in test positivity rates (if they have sufficient testing capacity and intensity of testing has remained stable), the risk of further escalation is high. For those countries, the risk is very high if they do not implement or reinforce multiple measures, including physical distancing and contact tracing.

The risk of further escalation of COVID-19 is moderate to high for countries reporting a recent increase in cases but no increase in hospitalisations or test positivity rates (if they have sufficient testing capacity and intensity of testing has remained stable). Countries that have multiple measures in place should conduct local assessments to better understand the local drivers of the increase in cases and to determine measures to be added or strengthened.

Overall, the risk of further escalation of COVID-19 across all EU/EEA countries and the UK (if they have sufficient contact tracing and testing capacity), is moderate for countries that continue to implement and enforce multiple measures including physical distancing and very high for countries that do not implement or enforce such measures.

Download

Rapid Risk Assessment: Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – eleventh update: resurgence of cases - EN - [PDF-4.1 MB]

New Zealand Reports 1st Domestic Cluster Of COVID-19 in Over 100 Days

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As any paramedic, firefighter, ER nurse or doctor will tell you - no matter how quiet a shift has been - you never utter the `Q' word until you have punched out on the time clock and have safely left the premises.  

Which is why, when I saw the NEJM article three days ago entitled `Successful Elimination of Covid-19 Transmission in New Zealand', I got a bad feeling about it. 

Not that New Zealand doesn't deserve tremendous props for going 100+ days without a domestic COVID case.  They do, and there is much that can be learned from their rapid and comprehensive pandemic response that has kept their COVID tally to 1,570 cases and just 22 deaths.     

But with the virus circulating globally, maintaining any country's virus-free status is a pretty big ask, even for an island nation with a long history of pandemic planning (see Can Island Nations Effectively Quarantine Against Pandemic Flu?).

Overnight, via a press conference,  New Zealand's Prime Minister Jacinda Ardern announced that four members of a family in Auckland have tested positive for COVID-19, and that for now, the source of their infection is unknown. 

(Click Image for Video - 49 mins)

Auckland will go into a level 3 lockdown for the next 72 hours, while contact tracing and testing are ramped up, while the rest of the country will go to level 2 (details below).  

Given their past successes, New Zealand will likely get a handle on this latest outbreak in pretty short order.  But it is a reminder that while getting to zero cases is extraordinarily difficult in a pandemic  - staying there is nearly impossible. 

A transcript of the PM's statement follows:

11 AUGUST 2020
PM comments on Auckland COVID-19 case

After 102 days we have our first cases of Covid-19 outside of a Managed Isolation or Quarantine facility in New Zealand.

Shortly I will ask Dr Bloomfield to set out the details of the case.

While we have all worked incredibly hard to prevent this scenario, we have also planned and prepared for it.

We have a resurgence plan that we will now activate.

That plan is based on everything we have learned to date, and what we have observed of resurgence overseas.

Those plans are based though on what we know, so I will pass to Dr Bloomfield who will set those details out. Then I will set out the initial decisions that have been made in response, and what it means for everyone.

[Dr Bloomfield speaks]

As you will have heard, our first cases in the community still leaves questions to be answered, the most important of which is tracing the case back to its origin.

When we’re able to do that, we can be much more certain about tracing and isolating close contacts. When we can’t do that, it means we have to take a precautionary approach.

At this stage, we have not yet been able to determine the source of the case. There is no immediate link to an MIQ facility that we are yet aware of, or to border staff.

Therefore we need to take a much more precautionary approach until we can find the source and access the risk of wider spread.

One of the most important lessons we’ve learned from overseas is the need to go hard and go early to stamp out flare ups to avoid the risk of wider outbreak.

As disruptive as it is, a strong and rapid health response remains the best long term economic response.

In line with our precautionary approach, we will be asking Aucklanders to take swift action with us.

As of 12 noon tomorrow, Wednesday August 12 we will be moving Auckland to level 3 for a period of 3 days, until midnight on Friday.

Three days will give us time to assess the situation and gather information, including contact tracing, so we can find out more about how the case arose and make decisions of how to respond after that.

Let me set out what that means for Aucklanders and the rest of New Zealand.

We are asking people in Auckland to stay home to stop the spread.

This means doing the simple things that you will all be familiar with to prevent picking up the virus or passing it on to others.

First, act as if you have Covid and if the people around you have Covid.

At level 3 you are asked to stay at home in your bubble other than for essential movements such as going to the supermarket or local recreation.

If you are in Auckland, you must work from home unless you are an essential service worker.

All schools and child care facilities in Auckland are closed as of tomorrow morning except for the children of essential service workers.

All public facilities, bars, restaurants and businesses must close by midday tomorrow.

Gatherings of more than 10 people in Auckland are not allowed and are restricted to funerals, tangihanga and wedding services only. In the rest of the country gathering are restricted to 100 people with physical distancing requirements back in place.

Travelling into Auckland is prohibited, unless you normally reside there and need to get home.

If you are currently in Auckland but do not normally reside there you also can leave to go home, but we are asking you to be conscious of your health and if you begin to exhibit any symptoms please get tested.

We are defining the area covered by the level 3 restriction as the geographic boundary of the Auckland super city, which extends from Wellsford in the North to Pukekohe in the south. Police will be issuing further guidance on parameters, including on road blocks, in the morning.

As you will recall, all key services including supermarkets, pharmacies, medical centres will remain open so food and supplies will be continue to be readily available. Food delivery is available at Level 3.

Please do not rush to the supermarket tonight. As everyone will remember from last time, Supermarkets will be open, there will be ample stock on the shelves.

If you operated as an essential service under level 4 and 3 last time then you;; recall reverting to those settings again. If in doubt stay at home tomorrow until you have clarity from your employer.

That then brings me to what we are asking the rest of New Zealand.

We will be moving the rest of the country, outside of Auckland, to level two. This will come into place from midday tomorrow, and run through till midnight on Friday, so the same period of time that we have moved Auckland.

That means social distancing applies, and mass gatherings in that time will need to be limited to 100 people, as will all of the other guidance we are familiar with at level two.

I know that this information will be very difficult to receive. We all had hoped not to find ourselves in this position again, but we had also prepared for it. And as a team, we have also been here before. We know if we have a plan, and stick to it, we can work our way through very difficult and often unknown situations.

Before I finish I want to talk briefly about some of the additional plans we have in place.

As the Director General has set out Auckland regional health will be standing up a mass testing programme across the Auckland region where we will seek to test tens of thousands of people over the coming days in order to understand any potential cases unidentified in the community.

It’s our intention to test everyone who works at the border, and everyone who works in managed isolation facilities with a focus on Auckland.

We will also be undertaking wide testing of those who are symptomatic in Auckland. Please do not visit your GP or a community testing station if you are well.

More details of the location of these CBACS and guidance on who should get a test will be provided in an update tomorrow.

And a final word on mask use. We know now that these can be effective in reducing spread. If you are in Auckland, we ask that you use a mask when you are accessing essential services. For the rest of the country, we advise their use if you’re in a place where social distancing is difficult.

Let me finish by saying this. We have planned for this event.

While this initial 3 day lockdown will mainly affect the Auckland region, I am asking the team of 5 million to stand ready again.

Together we have beaten the virus before and with fast action, and by acting together, we can do so again.

We have come too far to go backwards.

I’m also asking New Zealanders to be strong and be kind.

If you know someone in Auckland, give them a call.

If you are in Auckland, please make sure that your neighbours and ensure they are looked after and supported.

We know what to do. We have done it before. Stay home, stop the spread.

I’ll now take your questions.

EID Journal: H1 Swine Influenza A Virus Antibodies in Human Serum Samples by Age Group

 

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Although a novel coronavirus pandemic has been considered a possibility since the 2003 SARS outbreak, and bats are constantly looked at as potential reservoirs of pandemic viruses, novel influenza (either avian or swine) has been at the top of our watch list for decades. 

Because we've seen very high mortality rates (30%-50%) among humans infected with certain avian flu subtypes (H5N1, H5N6, H7N9, etc.), an avian flu pandemic has been ranked at the #1 threat for years  (see CDC's IRAT (Influenza Risk Assessment Tool)).

But swine influenza viruses - while generally less virulent - have a huge evolutionary advantage over avian flu viruses; they are already adapted to mammalian physiology.  

Additionally, swine influenza viruses fall into three main subtypes,  H1, H2, and H3 . . .  which also happen to be the only three subtypes that have caused human influenza pandemics going back 130 years (see graphic at top of blog).

While swine flu viruses occasionally jump to humans (see CDC FluView: Novel A/H3N2v Case Reported In Hawaii), and the 2009 H1N1 pandemic originated in swine, pigs (which are susceptible to a wide rage of flu viruses) are more likely to contract human flu than the other way around. 

As a result, pigs around the world have become a diverse reservoir of swine, human, and even avian flu viruses.  These viruses spread, and reassort, and evolve - mostly out of our sight - and over time one or more could emerge as a pandemic threat. 

Recently, a swine virus with pandemic potential (EA H1N1 `G4') that we've been following since 2015 made headlines again (see PNAS: Eurasian Avian-like H1N1 Swine Influenza Virus With Pandemic Potential In China), which prompted the CDC, the WHO, and the ECDC to issue revised risk assessments. 

But this is far from the only swine flu threat on our radar.  The CDC's IRAT (Influenza Risk Assessment Tool) lists 3 North American swine viruses as having some pandemic potential (2 added in 2019).

H1N2 variant [A/California/62/2018]  Jul   2019  5.8  5.7 Moderate

H3N2 variant [A/Ohio/13/2017]          Jul   2019  6.6  5.8 Moderate

H3N2 variant [A/Indiana/08/2011]      Dec 2012   6.0  4.5 Moderate

We've also been closely watching a number of other swine influenza reassortants around the world, including:

EID Journal: Human-Origin Influenza A(H3N2) Reassortant Viruses in Swine, Southeast Mexico

JVI: Divergent Human Origin influenza Viruses Detected In Australian Swine Populations

Transbound Emerg Dis: H5N2, H1N2 & Other Reassortants In Mexican Swine

I&ORV: Triple-Reassortant Novel H3 Virus of Human/Swine Origin Established In Danish Pigs

EID Journal: Characterization of a Novel Human Influenza A(H1N2) Virus Variant, Brazil

Globally, surveillance for swine flu viruses - both in pigs, and occasionally jumping to other species (including humans) - is weak, but the evidence suggests human infection probably happens with far more frequency than we hear about. 

Since H1N1 and H3N2 seasonal flu viruses have circulated in humans for decades, and H2N2 was the seasonal flu between 1957 and 1968, one would expect there to be a certain degree cross immunity in the human population to these swine-origin viruses.

And to that point, in 2009 we saw those over 55 - or who received the 1976 swine flu shot - were less impacted by that H1N1 virus pandemic than were younger adults and children.  

But those exposed to `newer' H1N1 viruses had little or no immunity. We saw something similar in 1977, when H1N1 returned after a 20 year absence (suspected to have leaked from a lab in China or Russia).   

It sparked a mini-pandemic - but mostly among children and adolescents. 

As a 22-year old paramedic at the time, I treated a lot of sick kids, but never got sick myself. And no, we didn't have PPEs. I was 3 years old when H1N1 went on hiatus in 1957, and very likely picked up antibodies at an early age.  Studies suggest that the first flu virus you are exposed to makes the biggest impression (see PLoS Path.: Childhood Immune Imprinting to Influenza A).

All of which brings us to a study, published last week in the CDC's EID Journal, that attempts to quantify the amount of immunity (by age group) we likely have against a variety of swine-origin flu viruses that are currently circulating in pigs around the globe. 

This study is limited, both by the narrow geographical location (Belgium) and the limited number of serum samples (n=549) tested. Additionally, only 7 major H1 swine IAV (swIAV) clades and 3 human progenitor IAVs were tested.

But what they did find was that any potential immunity (based on seroprevalence titers > 40) ranged (dependent upon age) from greater than 50% to less than 10%, depending upon the strain being tested. 

This is a lengthy, and often highly technical report that many will find tough sledding. I've only posted some excerpts. Those wishing for a deeper dive into the data and graphics will want to follow the link. 

But the gist is, depending upon the causative strain, another emerging H1 swine flu virus could pose a serious pandemic threat, even though we've been surrounded by (two different) lineages of H1N1 for the past 43 years. 

I'll return with a brief postscript after the break.

 Research
Detection of H1 Swine Influenza A Virus Antibodies in Human Serum Samples by Age 

Elien Vandoorn, Isabel Leroux-Roels, Geert Leroux-Roels, Anna Parys, Amy Vincent, and Kristien Van Reeth
Author affiliations: Ghent University, Merelbeke, Belgium (E. Vandoorn, A. Parys, K. Van Reeth); Ghent University and Ghent University Hospital, Ghent, Belgium (I. Leroux-Roels, G. Leroux-Roels); National Animal Disease Center, Ames, Iowa, USA (A. Vincent)
 
Abstract

Most H1 influenza A viruses (IAVs) of swine are derived from past human viruses. As human population immunity against these IAVs gradually decreases, the risk of reintroduction to humans increases. We examined 549 serum samples from persons 0–97 years of age collected in Belgium during 2017–2018 for hemagglutination inhibiting and virus neutralizing antibodies against 7 major H1 swine IAV (swIAV) clades and 3 human progenitor IAVs. 

Seroprevalence (titers >40) rates were >50% for classical swine and European human-like swIAVs, >24% for North American human-like δ1a and Asian avian-like swIAVs, and <10% for North American human-like δ1b and European avian-like swIAVs, but rates were age-dependent. 

Antibody titers against human-like swIAVs and supposed human precursor IAVs correlated with correlation coefficients of 0.30–0.86. Our serologic findings suggest that European avian-like, clade 1C.2.1, and North American human-like δ1b, clade 1B.2.2.2, H1 swIAVs pose the highest pandemic risk.


Humans and swine are susceptible to influenza A viruses (IAVs) of hemagglutinin (HA) subtypes H1 and H3, which are widespread in both species. Human IAVs frequently are transmitted to swine, after which the HA surface protein generally undergoes slower antigenic evolution (drift) in swine than in humans (1–3). Therefore, swine can be considered a reservoir for past human IAVs. Because antigenic drift variants of human IAVs replace each other over time, younger persons only have been exposed to more recent strains and human population immunity against older human IAVs gradually decreases (4).

Consequently, human-origin swine IAVs (swIAVs) can be reintroduced into the human population after a certain period and cause a pandemic, as illustrated by the influenza A(H1N1)pdm09 virus (pH1N1) (5). The H1 of this swine-origin virus is related to the H1 of human seasonal H1N1 IAVs that circulated in 1918–1950. In 2009, only persons born before the 1950s had cross-reactive antibodies against H1N1 viruses, so a pandemic was possible (6,7).

(SNIP)

Discussion

Our results show that serum antibody responses of immunocompetent persons in Belgium against major H1 swIAV clades depend on the swIAV tested and its relation to human seasonal IAVs and the person’s birth year.

Overall seroprevalences were high (≥50%) for classical swine (1A.3.3.2, 1A.3.3.3) and for European human-like (1B.1.2.1) swIAVs, intermediate (≥24%) for North American human-like δ1a (1B.2.2.1) and Asian avian-like (1C.2.3) swIAVs, and low (<10%) for North American human-like δ1b (1B.2.2.2) and European avian-like (1C.2.1) swIAVs.

Our results are consistent with previous studies that aimed to compare antibody responses in nonswine workers with those in persons with frequent swine contact (7,20–25), although those studies examined only a limited number of swIAV clades or samples. Overall, most previous studies showed lower seroprevalences for Asian avian-like (2%–10%) and European avian-like (0–5%) swIAVs in the general population or in nonswine workers (13,20,22–24). A 2010 study in the United Kingdom also found a lower seroprevalence of 11% for a European human-like (1B.1.2.1) swIAV (24). The major difference between our study and studies conducted before or during the 2009 pandemic is the lower seroprevalence of 3%–15% for classical swine IAVs in previous studies (13,20,22–24).

The circulation of pH1N1 viruses (1A.3.3.2) likely contributes to increased seroprevalence rates against these related classical swine IAVs. In our study, the oldest group, those born during 1920–1926 who are 91–97 years of age, had the highest antibody responses against H1 swIAVs of classical swine (1A.3.3) and avian-like (1C.2) lineages, for which antibody titers were correlated (13,20,21). Responses against human seasonal IAVs and related European and North American δ1a human-like H1 swIAVs (1B) generally were highest in those born during 1977–1996, who are 21–40 years of age, and lowest in those born during 1996–2017, who are 0–20 years of age. Responses against North American δ1b human-like H1 swIAVs (1B.2.2.2) generally were low across all age cohorts. 

(Continue . . . )

Although this study is limited to H1 swine viruses, we've see similar research looking at the community susceptibility to swine H3 viruses (see CIDRAP: Children & Middle-Aged Most Susceptible To H3N2v).

And the unexpected emergence of a swine H2N3 virus in Missouri in 2006 and 2007 is a reminder that H2 viruses - while rarely reported - are still in play (see J.I.D.: Population Serologic Immunity To H2N2 For Pandemic Risk Assessment).

In 2009 we got lucky because the the H1N1pdm virus - while highly transmissible - was less lethal than the pandemic viruses of 1968, 1957, and 1918. This new pandemic virus also supplanted the old H1N1 virus which had recently become  nearly 100% resistant to oseltamivir (Tamiflu). 

While we might get lucky again, this study suggests that some H1Nx swine-origin viruses present a substantially bigger pandemic risk than others.  

 

NOAA Raises Their 2020 Atlantic Hurricane Outlook To `Extremely Active'

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Early last week, in CSU Updated (August) Hurricane Forecast, we saw an aggressive (and worrisome) forecast by Colorado State University’s Tropical Meteorology Project for the remainder of the 2020 Atlantic hurricane season; one that increased their June forecast from 19 named storms to 24.

A couple of days later (Aug. 6th) NOAA issued their own - equally aggressive - mid-season outlook.

Both forecasts suggest the next two to three months will be extremely active, with anywhere from 10 to 15 additional named storms, with 9 to 10 of those becoming hurricanes.  While they can't tell us who will get hit - and hopefully many of these storms will stay out to sea - the odds favor several hurricanes impacting land. 

The release from NOAA follows.  Follow the link to read it in its entirety (or listen to the teleconference).  I'll have more when you return. 

'Extremely active' hurricane season possible for Atlantic Basin

NOAA urges preparedness as we enter peak months for hurricane development
 
Audio file from August 6 media teleconference

 August 6, 2020

Atmospheric and oceanic conditions are primed to fuel storm development in the Atlantic, leading to what could be an “extremely active” season, according to forecasters with NOAA’s Climate Prediction Center, a division of the National Weather Service. Today, the agency released its annual August update to the Atlantic Hurricane Season Outlook, initially issued in May.

The 2020 Atlantic hurricane season has been off to a rapid pace with a record-setting nine named storms so far and has the potential to be one of the busiest on record. Historically, only two named storms form on average by early August, and the ninth named storm typically does not form until October 4. An average season produces 12 named storms, including six hurricanes of which three become major hurricanes (Category 3, 4, or 5).

“This is one of the most active seasonal forecasts that NOAA has produced in its 22-year history of hurricane outlooks. NOAA will continue to provide the best possible science and service to communities across the Nation for the remainder of hurricane season to ensure public readiness and safety,” said U.S. Secretary of Commerce Wilbur Ross. “We encourage all Americans to do their part by getting prepared, remaining vigilant, and being ready to take action when necessary.”

The updated outlook calls for 19-25 named storms (winds of 39 mph or greater), of which 7-11 will become hurricanes (winds of 74 mph or greater), including 3-6 major hurricanes (winds of 111 mph or greater). This update covers the entire six-month hurricane season, which ends Nov. 30, and includes the nine named storms to date.

         (Continue . . . )

 

Although I urge hurricane (and general disaster) preparedness every year in this blog (see #Natlprep: Because Disasters Happen) - this year, perhaps more than any in recent memory - is the year you want to be prepared for the unexpected. 

Not only are supply chains already under strain due to the pandemic - making prepping more difficult - but relief efforts (FEMA, restoration of water & power, etc.) may be slower in coming after any major disaster.  

Hurricane/Tropical Storm Isaias left millions of people in the Carolinas and mid-Atlantic states without power 5 days ago, and hundreds of thousands are still sitting in the dark.  The storm spawned more than 100 tornadoes, and killed at least 13 people.  

While never a strong hurricane, much of this damage occurred after it was downgraded to a tropical storm.  It doesn't take a CAT 5 storm to upend your life. 

The old advice that you should have `72 hours' worth of food and water for your entire family (and pets) is woefully inadequate.  Most agencies now recommend a minimum of 7 to 10 days (see 7 Days Without A Disaster Kit Makes One Weak) and would encourage those who can, to have more. 

The tropics are relatively quiet right now, and may remain so for another week or two. The most active period historically runs from mid-August to mid-October.  

All of which means if you live anywhere in the shaded area of the map (below), or anywhere in the Caribbean, you still have time to prepare for the next storm. Even those who live hundreds of miles further inland can be impacted by flooding and tornadoes, and should be preparing as well. 

From Escambia County Hurricane Preparedness Information

So, if you haven't already done so, plan a visit to NOAA's Weather-Ready Nation 2020's Hurricane Preparedness week web page, and decide what you need to do now to keep you, your family, and your property safe during the months ahead.

While where you live, and your local threat environment, may dictate some changes, my general goals for personal and family preparedness include:

• A battery operated NWS Emergency Radio to find out what was going on, and to get vital instructions from emergency officials
• A decent first-aid kit, so that you can treat injuries
• Enough non-perishable food and water on hand to feed and hydrate your family (including pets) for the duration
• A way to provide light when the grid is down.
• A way to cook safely without electricity
• A way to purify or filter water
• A way to stay cool (fans) or warm when the power is out.
• A small supply of cash to use in case credit/debit machines are not working
• An emergency plan, including meeting places, emergency out-of-state contact numbers, a disaster buddy, and in case you must evacuate, a bug-out bag
• Spare supply of essential prescription medicines that you or your family may need
• A way to entertain yourself, or your kids, during a prolonged blackout

Riding out a disaster often boils down to unscheduled camping - for days, or sometimes weeks - in your home, at a friends house, in a community shelter, or possibly even in your backyard.

For some recent blogs specifically on preparing for hurricanes you may wish to revisit:

Hurricane Preparedness Week: Day 7 - Complete A Written Plan

Hurricane Preparedness Week: Day 6 - Help Your Neighbors

Hurricane Preparedness Week: Day 5 - Strengthen Your Home

Hurricane Preparedness Week: Day 4 - Get An Insurance Check-up

Hurricane Preparedness Week: Day 3 - Assemble Disaster Supplies

Hurricane Preparedness Week: Day 2 - Develop An Evacuation Plan

National Hurricane Preparedness Week: Day 1 - Determine Your Risk

Hurricane Preparedness Week 2020

CDC Updated (Aug 6th) COVID-19 Forecasts: Cumulative Deaths & Hospitalizations

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The CDC continues to expand, and hopefully improve, their (4 week) forecasts for COVID-19 deaths and hospitalizations. The CDC's Forecasts of COVID-19 Deaths this week incorporates a record 34 different modeling groups, and last week added a new feature; forecasts of new deaths in addition to forecasts of total deaths.

Their 4 week hospitalization forecast - which is newer, and less robust than the deaths forecast - utilizes just 8 modeling groups, and continues to produce a wider range of results.

All of these models are based on different assumptions about social distancing, disease transmission rates, and local compliance with recommended control measures, and therefore often come up with widely varying `solutions'.

While important gauges of the intensity and trajectory of the pandemic, deaths and hospitalizations don't begin to tell the full story of the impact of COVID-19. We continue to see reports of very slow return to usual health, and studies showing potentially permanent heart and lung damage among some `recovered' COVID cases. There are also concerns over the diseases's impact on pregnant women and their unborn child, and reports of lingering neurological manifestations among survivors.

Our first stop today, the CDC's forecast on COVID-19 Deaths:

COVID-19 Forecasts: Deaths

Updated Aug. 6, 2020

Observed and forecasted new and total reported COVID-19 deaths as of August 3, 2020.

Interpretation of Forecasts of New and Total Deaths
This week CDC received forecasts of national COVID-19 deaths over the next 4 weeks from 34 modeling groups. Those forecasts predict:

• The number of new COVID-19 deaths reported each week (32 forecasts), which indicates how reported deaths are likely to increase or decrease in the coming weeks
• The total number of COVID-19 deaths reported by the end of each week (33 forecasts), which helps us understand the likely overall impact of the pandemic in the coming weeks

Of the 34 modeling groups, 31 provided forecasts of both new and total deaths, one provided forecasts of new deaths only, and two provided forecasts of total deaths only. 

• This week’s national ensemble forecast predicts that weekly reports of new COVID-19 deaths may decrease over the next 4 weeks, with 4,500 to 10,600 new deaths reported during the week ending August 29. The ensemble forecast predicts that 175,000 to 190,000 total COVID-19 deaths will be reported by August 29.
• State-level ensemble forecasts predict that the number of reported new deaths per week may increase over the next four weeks in Hawaii and Puerto Rico and may decrease in Florida, Mississippi, New Mexico, the Northern Mariana Islands, Ohio, Texas, Vermont, and the Virgin Islands.

National Forecast

• The top row of the figure shows the number of new COVID-19 deaths reported in the United States each week from May 30 through August 1 and forecasted new deaths over the next four weeks, through August 29.
• The bottom row of the figure shows the number of total COVID-19 deaths in the United States each week from May 30 through August 1 and the forecasted number of total COVID-19 deaths over the next four weeks, through August 29. 

Models make various assumptions about the levels of social distancing and other interventions, which may not reflect recent changes in behavior. See model descriptions below for details.

State Forecasts

State-level forecasts figures show observed and forecasted state-level new and cumulative COVID-19 deaths in the US. Each state forecast uses a different scale, due to differences in the numbers of COVID-19 deaths occurring in each state.

Forecasts fall into one of two categories:

• The Auquan, CMU, DDS, Columbia-UNC, ERDC, ESG, Geneva, GT-DeepCOVID, ISU, Karlen, LANL, LNQ, LSHTM, MIT-CovAlliance, MIT-ORC, MOBS, Oliver Wyman, NotreDame-Mobility, QJHong, RPI-UW, STH, UA, UCM, UM, UMass-MB, USC, and UT forecasts assume that existing control measures will remain in place during the prediction period.
• The Columbia, COVID19Sim, GT-CHHS, IHME, JCB, JHU, NotreDame-FRED, PSI, UCLA, and YYG forecasts make different assumptions about how levels of social distancing will change in the future. 

Download state forecasts pdf icon[29 pages]1

Download forecast data excel icon[1 sheet]

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Our second stop is this week's hospitalization forecast.

COVID-19 Forecasts: Hospitalizations
Updated Aug. 5, 2020

Interpretation of Forecasts of New Hospitalizations

• This week, three national forecasts predict a likely increase in the number of new hospitalizations per day over the next four weeks, two forecasts predict a likely decline, and three forecasts are either uncertain about the direction of the trend or predict stable numbers. For August 31, the forecasts estimate 2,000 to 12,000 new COVID-19 hospitalizations per day.
• State-level forecasts also show a high degree of variability, which results from multiple factors. Hospitalization forecasts use different sources of data for COVID-19 cases or deaths, with different limitations, and make different assumptions about social distancing.

National Forecast

• The eight national forecasts show the predicted number of new COVID-19 hospitalizations per day for the next four weeks in the United States.
• The forecasts make different assumptions about hospitalization rates and levels of social distancing and other interventions and use different methods to estimate the number of new hospitalizations. See models below for details.

State Forecasts

Nine state-level models predicting the number of new hospitalizations were submitted this week. These forecasts show the predicted number of new COVID-19 hospitalizations per day for the next four weeks in each state. Each state forecast uses a different scale, due to differences in the number of new COVID-19 cases occurring per day in each state.

Download state forecasts pdf icon[1 MB, 7 pages]1

Download forecast data excel icon[2 MB]

Additional forecast data and information on forecast submission are available at the COVID-19 Forecasting Hubexternal icon.

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JAMA: Comparing Viral Shedding Among Asymptomatic & Symptomatic Patients With SARS-CoV-2 Infection

 

Photo Credit PHIL

#15,405

Despite initial resistance from some in the scientific community, it is now generally accepted that asymptomatic and presymptomatic COVID-19 cases can transmit the (SARS-2-CoV) pandemic virus. How often that occurs, however, is still a topic of debate. 

The assumption has been that asymptomatic and presymptomatic cases likely shed far less virus than their symptomatic counterparts, and therefore pose less of a threat to the community. 

But a new study, published this week in JAMA, challenges that assumption.

In a study of 303 SARS-CoV-2 positive cases in South Korea (110 or 36.3% asymptomatic at time of isolation), they discovered that inferred viral loads (via cycle threshold (Ct) values from RT-PCR tests) were comparable among symptomatic and asymptomatic cases. 

Furthermore, asymptomatic cases continued to test positive for the virus for nearly as long as symptomatic patients (avg 17 vs. 19 days).

While this doesn't exactly prove that asymptomatic carriers transmit the virus as readily as symptomatic cases, it weakens the argument against it. And since asymptomatic cases are more likely (than obviously ill individuals) to have contact with others, that probably increases their impact on community spread as well.

The full report can be read at the link below. 

Original Investigation
August 6, 2020

Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients With SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea

Seungjae Lee, MD1; Tark Kim, MD2; Eunjung Lee, MD1; et alCheolgu Lee, MD3; Hojung Kim, MD4; Heejeong Rhee, MD5; Se Yoon Park, MD1; Hyo-Ju Son, MD1; Shinae Yu, MD6; Jung Wan Park, MD6; Eun Ju Choo, MD2; Suyeon Park, MS7; Mark Loeb, MD8; Tae Hyong Kim, MD1
Author Affiliations Article Information
JAMA Intern Med. Published online August 6, 2020. doi:10.1001/jamainternmed.2020.3862
COVID-19 Resource Center

Key Points

Question 

Are there viral load differences between asymptomatic and symptomatic patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection?

Findings

In this cohort study that included 303 patients with SARS-CoV-2 infection isolated in a community treatment center in the Republic of Korea, 110 (36.3%) were asymptomatic at the time of isolation and 21 of these (19.1%) developed symptoms during isolation. The cycle threshold values of reverse transcription–polymerase chain reaction for SARS-CoV-2 in asymptomatic patients were similar to those in symptomatic patients.

Meaning

Many individuals with SARS-CoV-2 infection remained asymptomatic for a prolonged period, and viral load was similar to that in symptomatic patients; therefore, isolation of infected persons should be performed regardless of symptoms.

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