New Coronavirus News from 26 Aug 2020b

Second wave of coronavirus could hit France in November: government advisor [Reuters, 26 Aug 2020]

PARIS (Reuters) - A second wave of the coronavirus pandemic could hit France in November, a government advisor told local media on Wednesday, as the city of Marseille tightened restrictions to fight the outbreak.

Authorities in Marseille said late on Tuesday that bars and restaurants would have shorter opening times, and they also broadened mandatory mask-wearing in the southern port city between Aug. 26 and Sept. 30.

“There are fears of a second wave in November,” Professor Jean-François Delfraissy, who heads the scientific council that advises the government on the pandemic, told France 2 television on Wednesday.

France has the seventh-highest COVID-19 death toll in the world, and the government is monitoring the figures closely to see if fresh restrictions or lockdown are needed.

Under the new measures, Marseille’s bars and restaurants will have to close from between 11 p.m. and 6 a.m. local time (2100-0400 GMT), having previously been able to stay open until normal closing time at midnight or 1 a.m.

Mandatory mask-wearing will now be compulsory outdoors in public spaces in all districts of the city, having previously only been compulsory in some areas.

The French health ministry reported 3,304 new coronavirus infections on Tuesday, well below daily highs seen last week, though greater numbers of young adults are testing positive.

The number of deaths in France from COVID-19 stands at 30,544 deaths, including 16 in the past 24 hours.

Floods in China, COVID-19, and climate change [The Lancet, 26 Aug 2020]

Authored by Yuming Guo, Yao Wu, Bo Wen, Wenzhong Huang, Ke Ju, Yuan Gao & Shanshan Li

China has made substantial progress regarding COVID-19 control, as the local transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has almost been stopped.
However, a serious natural disaster, flooding, unfortunately threatened the lives and homes of people in 27 provinces across central and southern China in July, 2020. Starting on June 2, 2020, authorities in China issued alerts for heavy rainfall for 41 consecutive days. The average precipitation in areas along the Yangtze River has reached the highest level since 1961. As of August 13, at least 219 people had been killed, 0·82 million people needed emergency assistance, 4·01 million people were evacuated, and 63·46 million people were affected by the flooding. Flooding has destroyed nearly 0·4 million homes and damaged 5 million hectares of farmland. According to the Ministry of Emergency Management of China, it is estimated that direct economic losses exceed US$25 billion.

Floods are among the most frequent natural disasters in China.1

It has been estimated that flooding in China between 1950 and 2018 killed more than 282 737 people and damaged 6 billion hectares of land, and that flooding directly cost approximately $6000 billion between 1990 and 2018. However, the indirect effect of floods was not considered in this estimation of costs. The area of land damaged by flooding each year since 1950 shows an increasing trend, which suggests that the potential impact of floods is also increasing, although mortality directly associated with flooding has been decreasing (appendix p 1).

Climate change could severely alter the risk of floods over large regional and time scales.
Changes in precipitation and temperature are among the most notable climatic characteristics that could increase the risk of floods. Most floods in China, including the ongoing flooding in 2020, are caused by extreme precipitation. The average intensity, quantity, and duration of precipitation in southern China this year are among the highest in China since 1961. Drainage basin conditions and the soil status are both affected by precipitation and temperature and are also associated with the increasing risk of floods.2

Moreover, El Niño Southern Oscillation, Pacific Decadal Oscillation, and atmospheric circulation patterns might influence the volume of precipitation and slow-moving cyclones, which eventually cause severe flooding.3

Health effects could occur directly through contact with flood waters, including drowning and injuries from flood-related events (eg, building collapse and damage, electrocution, fire; appendix p 2). Although deaths directly caused by floods decreased between 1950 and 2018 in China (appendix p 1), the magnitude of the indirect health effects is largely unknown. There are increased risks of aggravation of, and deaths from, cardiovascular disease and diabetes after flooding, possibly due to interrupted health services or social support systems.4

It has been estimated that mortality in populations affected by flooding might increase by up to 50% in the first year after a flood.5

Importantly, floods increase the risk of communicable disease outbreaks and infections (eg, leptospirosis, hepatitis and gastrointestinal disease, cutaneous and respiratory infections), especially in areas with poor hygiene and population displacement.6

Contaminants in floodwater (eg, sewage, human and animal faeces, fertilisers, organic waste, toxic chemicals) could lead to infections of the eye and skin and could increase the risk of exposure to poisonous material. Floods could also indirectly facilitate the transmission of water-borne and vector-borne diseases by expanding the number and range of vector habitats.

It is also not clear how the floods in 2020 are affecting the physical and mental health of those infected with SARS-CoV-2.

Measures should be initiated to reduce the effects of floods.7

Effective flood protection requires both structural and non-structural measures. Structural flood protection measures are considered a leading solution to prevent the effects of flooding worldwide, including flood control levees that prevent flooding of adjacent areas and limit the flow of the river, reservoirs that act as flow balancers, floodways that discharge excess flood water to ensure the safety of dams, diversions of waterways, and many others.8

Non-structural flood protection measures are considered a good complement to structural flood protection measures and can be divided into three categories: avoiding inappropriate use of floodplains and modifying susceptibility to flood damage (eg, via development policies); enhancing preparedness and resilience to flooding (eg, education, flood insurance, tax adjustments); and non-structural flood protection measures that aim to compensate for the drawbacks of structural measures (eg, increasing vegetative cover to reduce erosion).9

These non-structural flood protection measures focus on changing human behaviour. For individuals, there are many ways to prevent and mitigate flood hazards, such as monitoring the news and their surroundings, elevating electrical appliances, preparing adequate supplies (eg, drinking water, cash, food), finding places to evacuate to, and planning travel routes to allow rapid evacuation.

According to the contribution of Working Group II to the Intergovernmental Panel on Climate Change's Fifth Assessment Report, global flood risk will increase in the future. In a high-end climate scenario, with high population growth and high greenhouse gas emissions, flooding is projected to affect an average of 2·4 million additional people and cost an additional 3 billion Euros per year. In this scenario, at an average global temperature increase of 4°C, the largest increases in flood risks would be in the USA, Asia, and Europe. By the end of the current century, China is projected to be affected the most by flooding, with 40 million people affected and 110 billion Euros of damage per year.10

Without immediate and unprecedented measures, climate change will result in more heavy flooding, leading to great health and economic impacts, particularly in the context of COVID-19. The world needs to prepare now to mitigate and handle future flooding.

We declare no competing interests.

References
1.Han W Liang C Jiang B Ma W Zhang Y
Major natural disasters in China, 1985–2014: occurrence and damages.
Int J Environ Res Public Health. 2016; 13: 1118-1131

2.Bates BC Kundzewicz ZW Wu S Palutikof JP
Climate change and water. Technical paper of the Intergovernmental Panel on Climate Change.
IPCC Secretariat, Geneva2008

3.Ward P Kummu M Lall U
Flood frequencies and durations and their response to El Niño Southern Oscillation: global analysis.
J Hydrol. 2016; 539: 358-378

4.Ryan B Franklin RC Burkle Jr, FM et al.
Identifying and describing the impact of cyclone, storm and flood related disasters on treatment management, care and exacerbations of non-communicable diseases and the implications for public health.
PLoS Curr. 2015; 7 (ecurrents.dis.62e9286d152de04799644dcca47d9288.)

5.Fundter DQ Jonkman B Beerman S et al.
Health impacts of large-scale floods: governmental decision-making and resilience of the citizens.
Prehosp Disaster Med. 2008; 23: s70-s73

6.Paterson DL Wright H Harris PNA
Health risks of flood disasters.
Clin Infect Dis. 2018; 67: 1450-1454

7.Wei K Ouyang C Duan H et al.
Reflections on the catastrophic 2020 Yangtze River Basin flooding in southern China.
The Innovation. 2020; (published online Aug 6.)
https://doi.org/10.1016/j.xinn.2020.100038

8.Kim K Han D Kim D et al.
Combination of structural measures for flood prevention in Anyangcheon River Basin, South Korea.
Water. 2019; 11: 2268-2283

9.Kundzewicz ZW
Non-structural flood protection and sustainability.
Water Int. 2002; 27: 3-13

Policy Lessons from Our Covid Experience | NEJM [nejm.org, 26 Aug 2020]

by Gail R. Wilensky,

As of August 24, 2020, nearly 5.7 million cases of Covid-19 had been reported in the United States, with more than 176,000 deaths. Although there is debate about the accuracy of these specific numbers — many people with mild symptoms are never tested for Covid, for example, and especially early in the epidemic, the difference between dying from Covid and dying with Covid may not have been accurately captured — the increase in excess mortality rates reported by the Centers for Disease Control and Prevention is consistent with a significant loss of life associated with the disease.

At the same time, the Covid-19 pandemic has led to staggering economic losses in the United States. Closing down the economy has had a devastating impact on the American people, even though the closure was imposed to save lives. The longest economic expansion on record abruptly ended in February, and the country officially entered a recession late that month.

The U.S. unemployment rate in February was 3.5% — a half-century low. By March, it was 4.4%, and by April, 14.7%, with 20.5 million people losing their jobs and more than 20% of the labor force filing for unemployment benefits. Experts predicted that the unemployment rate would approach 20% in May; instead, it was reported as 13.3%, although there’s debate about whether this figure reflected some workers’ self-classification as only temporarily laid off. The June unemployment rate was even lower — 11.1% — but the economy was still operating with 15 million fewer jobs than it had in February, and there was new concern that the economic impact of the pandemic may linger, given the recent resurgence of new cases.

As the country reopens, it’s important to assess how we can be better prepared to stave off such enormous economic losses during the next wave or the next epidemic. In my view, a few key policy changes will be critical.

First, expertise on pandemic-related policy and strategy should be located closer to the center of power. I believe that the type of pandemic-preparedness office (the Office of Pandemics and Emerging Threats) that now resides only in the Department of Health and Human Services (HHS) also needs to be reestablished as part of the National Security Council (NSC).
Incorporating the office into the NSC doesn’t guarantee that the White House will pay attention to its recommendations, but it helps in commanding the attention of the most senior members of the White House staff. The HHS assistant secretary would continue to serve as the execution arm of the pandemic office.

Since the early 1990s, such an office has repeatedly been established after a national health scare — and then disbanded by the successor administration. The Biodefense and Health Security Office established during the Clinton administration was closed by President George W. Bush, reopened after the anthrax scare, closed by President Barack Obama, and then reopened after the Ebola and Zika scares, at which point the Directorate for Global Health Security and Biodefense was created. The plan prepared in the wake of the Ebola outbreak might have been helpful in preparing a response for the current Covid pandemic, but like his predecessors, former National Security Advisor John Bolton dissolved the office in 2018. Once again, some of the office’s personnel were merged into other NSC units, but the pandemic office itself no longer existed.

Whether as cause or effect of the office’s repeated dissolution or sidelining, neither the defense establishment nor the public seems to appreciate that disease threats are as serious to the country’s security as are wars with our traditional enemies. For example, another airborne disease, smallpox, caused 300 million to 500 million deaths worldwide — more than all 20th-century wars combined.

Second, in planning for unknown future epidemics, federal pandemic-preparedness officials must decide what constitutes a prudent level of supply stockpiling, with an understanding of the inevitable trade-offs between perceived readiness and the cost of equipment and supplies that we hope never to use. They should develop strategies for deploying supplies on an as-needed basis. And they should plan ways to provide surge capacity for beds, operating rooms, and trained personnel, which may involve calling on the National Guard, among other resources. Designation of particular people who will be accountable for these activities will be key to their success.

Third, when an outbreak occurs, determinations about policy and financial responses should be based on accurate epidemiologic knowledge. It is important to establish as quickly as possible who is most vulnerable to a new disease and to respond selectively, with targeted measures directed toward the most vulnerable populations. Older people, particularly those with underlying conditions and compromised immune systems, are especially vulnerable to Covid-19. Some 50,000 deaths from Covid had occurred in nursing homes and other senior care facilities by mid-June. But older people are not always the ones at greatest risk. The “Spanish flu” in 1918 was especially dangerous to infants and 20-to-40-year-olds. We need to understand who is contracting the disease and experiencing serious consequences in order to craft an appropriate and differentiated response.

In a recent study, John Birge and others claim that the economic cost of the U.S. Covid shutdown could have been reduced by 33 to 40% if neighborhoods had been selected for closure more strategically, in line with the infection risk for local residents and workers.1 The authors’ rationale is that living areas are frequently different from the places with the highest concentration of jobs and that it may be possible to keep jobs open as long as many of the employees live in unaffected areas. To calculate the number of people at risk in a given area, however, we need to know who comes into contact with an infected person and be able to track their travel histories. Such work can be done with the type of contact tracing being done in Hong Kong, Germany, and elsewhere, but it may require that people provide detailed information to the authorities, including turning over their cell phones or providing details about their contacts in phone interviews. Many Americans are unlikely to be willing to do so.

Fourth, pandemic-control policies must have logically consistent components. The decision to shut down the U.S. borders to limit the entry of people carrying Covid-19, for example, required thousands of U.S. citizens to quickly reenter the United States, but no plans appeared to have been made for the safe reentry of large numbers of people through a limited number of entry ports. As a result, hundreds of people were crowded into inadequate spaces trying to get through customs and immigration. If any of them were carrying the virus, the crowding would have exacerbated the spread, with serious consequences for public health.

Finally, beyond public policy, individual citizens clearly need to accept responsibility for acting in ways appropriate to fighting pandemics. Though much remains unknown about Covid-19, there is increasing evidence about the efficacy of mask wearing. The refusal of some people to wear face coverings when indoors or to maintain reasonable social distances outdoors increases the burden on all of us. When a safe and effective vaccine becomes available, it will also be incumbent on all who are of an appropriate age and have no contraindications to get vaccinated.

Only time will tell whether the country will be better able to respond to the next health crisis. A key focus now needs to be on reopening the economy in a smart and sensible way. While the economy was shut down, the government provided critical short-term assistance, but I believe we need to ensure that future support is designed to encourage people to return to work as soon as they can do so with relative safety. A stimulus bill was under discussion in Congress but stalled when Congress went into their August recess on July 31. The president signed an executive order on August 10 to provide $400 weekly to unemployed Americans, but it is judged to be on shaky legal grounds. The additional federal spending related to the pandemic has added a huge long-term debt burden to the country. Replacing many Americans’ usual work income with federal funding is not a viable long-term strategy.

China cashes in on America's coronavirus lockdown [Fox Business, 26 Aug 2020]

By Jonathan Garber

China's tech shipments surged 37% in the three months through June

China’s economy is getting a boost from soaring demand for tech products that make it easier and more efficient for Americans to work from home during the COVID-19 pandemic, according to economists at one Wall Street bank.

Tech shipments from China soared 37% from a year earlier in the April-through-June quarter, contributing 2.4 percentage points to the country’s overall export growth of 2%, wrote William Deng and Tao Wang, Hong Kong-based economists at investment bank UBS.

“Export shipments of automatic data processing units and parts, which include computers, tablets, monitors and parts, have seen a significant upswing since April,” according to Deng and Wang, who said Korea and Taiwan are also seeing “significant acceleration.”

Purchases by the U.S. surged 7.8% even as the total volume of imports into the world's largest economy shrank 20%.

COVID-19, which originated in Wuhan, China, has infected more than 23.9 million people worldwide and killed 820,000, with the U.S. faring worse than any other country. Shelter-in-place orders aimed at slowing the spread of the virus have forced employees around the world to work from home, when possible.

Because the outbreak originated in China, production in the country, and elsewhere in North Asia, was able to resume sooner -- and capture market share despite facing tariffs imposed by President Trump during the trade war that led up to a partial agreement in January.

Tech demand could remain strong through the end of the year. A survey conducted in June by Singapore-based UBS analyst Alicia Chen found 44% of respondents plan to purchase a new PC in the next six months, up from 40% in February.

However, UBS warns that some customers may put off purchase decisions until economic uncertainty caused by the pandemic fades.

Another headwind for Chinese exports is supply chain disruptions that will be caused by Trump’s latest Huawei ban, which will impact the tech giant and a number of suppliers beginning on Sept. 15.

“Huawei is the biggest player in the information and technology industry in China,” wrote Deng and Wang. “Although in the medium and long term, there is scope for other players to step up, significant constraints on Huawei will likely result in near-term negative disruptions to the tech industry in China and the supply chain.”

All things considered, the UBS economists say China’s tech shipments will remain robust in the third quarter before seeing some possible Huawei-related disruptions at the end of the year.

The strength of the economic recovery will dictate conditions in 2021.

Exports accounted for more than 18% of China’s gross domestic product last year, and are helping the country's economy emerge from its COVID-19 recession faster than any other nation.

Hong Kong-based economists at JPMorgan Chase & Co. expect the Chinese economy to expand 2.5% this year, making it the only major financial system to see growth.

Economic growth will return to the “pre-virus path in the second half of 2020, while in most countries, GDP will still be significantly below pre-virus levels by end-2021,” wrote bank economists led by Haibin Zhu.

Bolton says US coronavirus response has been 'one mistake after another' [CNN, 26 Aug 2020]

By Paul LeBlanc

Washington (CNN)Former White House national security adviser John Bolton on Wednesday torched the Trump administration's response to the coronavirus pandemic, leveling that that the lack of a national strategy has prompted "one mistake after another."

"They've made a complete mess of it, and it's been a tragedy for Americans, those who have died and their families, the economic consequences," Bolton told CNN's Jake Tapper on "The Lead."

"To this day, the administration does not have a coronavirus strategy. Now, they may yet get the benefit of it. Recent polls apparently show concern with the virus diminishing as a political matter, so they may be able to tough their way through it. But it's just been one mistake after another."

His comments come in the middle of the Republican National Convention where the Trump campaign has sought to gloss over the President's delayed response to the pandemic that has now claimed at least 178,000 American lives, according to Johns Hopkins University.

The party wanted to take that issue "head on," according to event organizers. In a video, the RNC misrepresented Trump's attitude toward the virus, repeating a flurry of falsehoods about the US response even as the country remains the world's leader in total cases and deaths.

But the lack of acknowledgment about the reality of the pandemic isn't the only item that's brought scrutiny to the Republican's convention.

On Tuesday evening, Mary Ann Mendoza, whose police officer son was killed by a drunk driver, was abruptly removed from the program after she retweeted a thread promoting an anti-Semitic conspiracy theory with ties to the fringe conspiracy theory, QAnon.

"Do yourself a favor and read this thread," Mendoza had tweeted in reference to a string of conspiratorial tweets about a Jewish plan to control the world. She later deleted the tweet and claimed that she hadn't read "every post within the thread."

Still, her initial placement in the program highlights the extent to which the Trump campaign has leaned into its fringe support in the final months of the 2020 presidential campaign.

Asked about the episode Wednesday, Bolton offered that he's "worried about Trump."

"That's what worries me. I think the Republican Party after this election is going to have a very serious conversation about the direction we want to go in. It will be immediate if Trump loses.
But it's going to happen even if he wins. I wish we just had a figure in the conservative movement today like William F. Buckley Jr., who used to be able to enter into these debates and say, 'This is just simply not acceptable for responsible conservatives to believe in.'"

"But since there is not philosophy that governs this administration, that's how these extremists creep in," he continued.

"It is disturbing."

China's Coronavirus Lockdown In Xinjiang Is Severe — And Controversial : Goats and Soda [NPR, 26 Aug 2020]

by EMILY FENG

Across China, life has largely returned to normal. Domestic travel is picking back up as a coronavirus pandemic brought under control recedes from memory. Businesses and factories have reopened.

Except in Xinjiang. A sweeping, western region nearly four times the size of California, Xinjiang remains largely cut off from the rest of the country and its some 22 million residents under heavy lockdown, an effort officials say is needed to contain a cluster of more than 800 officially diagnosed cases.

In mid-July, officials declared a "wartime mode" for the region. Community officials continue to go door to door, sealing doors with paper strips, tape and in some cases metal bars, to prevent residents from leaving their homes.

The region has effectively been penned off from the rest of the country, meaning scant information about the lockdown has emerged. In July, Xinjiang's train stations were closed, intercity bus routes canceled, and centralized quarantine imposed on residents returning to the region.

"It has been more than a week since we last had a case, but that does not mean we should relax," said Tang Shan, a Communist Party official who oversees Xinjiang's Ganquanbao district, an industrial zone just outside the region's capital of Urumqi. "We still ask our residents and the society at large, including our government organs, to work together in order to maintain the success we have achieved so far."

The monthlong lockdown has angered residents, thousands of whom took to social media this week to complain about what they said are heavy-handed quarantine and testing policies out of sync with the severity of the outbreak. The region's last new COVID-19 case was diagnosed on Aug. 17.

"The government has used an ax where a scalpel was needed," said a 21-year-old resident of Urumqi, where the vast majority of cases have occurred. He asked to remain anonymous because of potential legal retribution for talking to foreign media. "I just want government officials to refrain from lazy policymaking and combat the outbreak with scientific, reasonable measures."

Xinjiang is home to about 11 million Uighurs, a Turkic ethnic minority. Since 2017, local authorities with backing from the country's leader, Xi Jinping, have extralegally detained or imprisoned hundreds of thousands of Uighurs and other historically Muslim ethnic minorities.
Those not detained live under heavy government surveillance and a web of restrictions that forbid most religious activities and travel.

Darren Byler, a researcher at the University of Colorado, Boulder who has written extensively about Xinjiang, notes the region had already adopted particularly intrusive methods to lock down cities during the epidemic's start in January. Under a campaign called a "million police enter ten million homes," a combination of community officials and auxiliary police kept close tabs on each household and ensured that people did not leave their place of shelter.

"In some cases, the orders to shelter in place during the initial lockdown and the current lockdown were delivered with little to no warning, so some people were forced to stay in their place of work apart from their families and without supplies," said Byler.

Xinjiang's police state has mobilized over the last month to contain the latest coronavirus outbreak. Urumqi residents told NPR that they had been given mandatory tests for the coronavirus as many as three times in the last month and their temperature taken by local officials three times a day.

This past weekend, frustration from Xinjiang residents spilled over to social media, as the hashtag "Xinjiang refugees" briefly began trending on China's Twitter-like platform, Weibo.
Most of the posts were soon deleted, and several accounts suspended. Videos shared on the platform by frustrated residents show Xinjiang residents cuffed to window bars and balcony railings outside their homes, a punishment for violating home quarantine rules.

"I want to strongly emphasize to everyone to now open your front door. Those who are discovered [outside their homes] by neighborhood officials will be reported to the nearest police station," read a warning sent to a chat group of residents in Urumqi's Tianshan district, according to screenshots sent to NPR by one of the group's participants.

The policy is similar to strict lockdown policies adopted for weeks at a time in other Chinese cities such as Wuhan and in coastal Zhejiang province during the height of the epidemic. To feed trapped residents, community officials and volunteers rallied to deliver daily essentials to each household several times a week.

With comparatively less-developed community services, residents in Xinjiang said they have been left hungry in their own homes. One woman in Kashgar, a former Silk Road oasis town, said she had been sealed into her house with a random assortment of groceries sent by community officials once a week — usually basic vegetables such as potatoes, carrots and cabbage.

Four Uighur residents told NPR they had also been forced to drink a brown, herbal Chinese traditional medicine packaged by a company called Beijing Donghuayuan Medical. China's state news agency has said asymptomatic cases in Xinjiang were given an "herbal concoction" to prevent symptoms from appearing and that participation in traditional Chinese medicine treatment had "reached one hundred percent" in Xinjiang, though there is no medical evidence proving its efficacy against the virus.

On Monday, the regional government softened its lockdown policy slightly, allowing residents living in compounds with no cases to leave their homes so long as they are wearing a mask.

To further quell public outrage this week, state media also published the mobile phone numbers for about a dozen senior officials and party members at the provincial and city level, encouraging irate residents to reach out directly with recommendations.

"There has been an endless queue of complaints coming in," said Ye Hailong, a county-level Urumqi official.

On Monday, the Xinjiang regional government softened its stance and said it would allow residents without diagnosed cases in their compounds to leave their homes.

But when asked when Xinjiang's "wartime mode" would be entirely lifted, officials declined to offer a specific date. "Our lockdown policies have to follow the timeline of the epidemic and when the epidemic ends," said Chen Xinjian, an Urumqi district official.

Woman may have caught coronavirus in airplane toilet, researchers say [CNN, 26 Aug 2020]

By Maggie Fox

(CNN)Researchers say they have evidence that a woman caught coronavirus on a flight -- perhaps in the jet's restroom.

The 28-year-old woman was among about 300 South Koreans evacuated from Italy at the height of the coronavirus pandemic in Milan last March, the researchers wrote in the US Centers for Disease Control and Prevention's journal Emerging Infectious Diseases.

"On the flight from Milan, Italy, to South Korea, she wore an N95 mask, except when she used a toilet," they wrote.

"The toilet was shared by passengers sitting nearby, including an asymptomatic patient. She was seated three rows away from the asymptomatic patient," they added.

The South Korean officials who organized the flight had put into effect full infection control measures and tested everyone before they boarded. All the passengers and crew were quarantined when they got to South Korea, as well. Six passengers tested positive soon after arrival in South Korea.

The 28-year-old woman developed symptoms eight days after she got home and was hospitalized.

"Given that she did not go outside and had self-quarantined for three weeks alone at her home in Italy before the flight and did not use public transportation to get to the airport, it is highly likely that her infection was transmitted in the flight via indirect contact with an asymptomatic patient," the researchers at Soonchunhyang University College of Medicine in Seoul wrote.

There has been very little evidence about whether people can catch coronavirus on a flight, although many airlines have policies leaving more space for passengers, are cleaning aircraft more frequently, and are encouraging passengers to stay in their seats and not move about the aircraft. Evidence already shows aircraft ventilation systems clean the air quickly and thoroughly.

"This study was one of the earliest to assess asymptomatic transmission of COVID-19 on an aircraft. Previous studies of inflight transmission of other respiratory infectious diseases, such as influenza and severe acute respiratory syndrome, revealed that sitting near a person with a respiratory infectious disease is a major risk factor for transmission similar to our own findings," the researchers wrote.

The researchers said the officials organizing the flight took many precautions.

"When the passengers arrived at the Milan airport, medical staff performed physical examinations, medical interviews, and body temperature checks outside the airport before boarding, and 11 symptomatic passengers were removed from the flight," they wrote.

Passengers got N95 respirators -- masks shown to protect the wearer for viral infections -- and were kept six feet apart before boarding.

"Most passengers wore the N95 respirators except at mealtimes and when using the toilet during the flight. After an 11-hour flight, 299 asymptomatic passengers arrived in South Korea and were immediately quarantined for two weeks at a government quarantine facility in which the passengers were completely isolated from one another. Medical staff examined them twice daily for elevated body temperature and symptoms of COVID-19."

Researchers in Germany reported earlier this month that two people may have become infected before, during or after a flight from Tel Aviv to Frankfurt in March.

They were seated near the back of the aircraft, directly across the aisle from seven passengers who later turned out to have been infected.

One Meeting in Boston Seeded Tens of Thousands of Infections, Study Finds [The New York Times, 26 Aug 2020]

By Carl Zimmer

A February meeting of biotech executives became a coronavirus “superspreading” event with a transmission chain across the globe.

On Feb. 26, 175 executives at the biotech company Biogen gathered at a Boston hotel for the first night of a conference. At the time, the coronavirus seemed a faraway problem, limited mostly to China.

But the virus was right there at the conference, spreading from person to person. A new study suggests that the meeting turned into a superspreading event, seeding infections that would affect tens of thousands of people across the United States and in countries as far as Singapore and Australia.

The study, which the authors posted online on Tuesday and has not yet been published in a scientific journal, gives an unprecedented look at how far the coronavirus can spread given the right opportunities.

“It’s a really valuable study,” said Dr. Joshua Schiffer, a physician and mathematical modeling expert who studies infectious diseases at the Fred Hutchinson Cancer Research Center in Seattle and was not involved in the research.

Dr. Schiffer said that the new genetic evidence fit well with what epidemiologists and disease modelers have been learning about the coronavirus. The Biogen conference, he said, was just one of many similar events that amplified and spread the virus in its early months. “I don’t think it’s a fluke at all,” he said.

The results came out of a project that began in early March at the Broad Institute of Harvard and M.I.T., a research center specializing in large-scale genome sequencing. As a wave of Covid-19 patients crashed into Massachusetts General Hospital, the Broad researchers analyzed the genetic material of the viruses infecting the patients’ cells. The scientists also looked at samples from the Massachusetts Department of Public Health, which ran tests around Boston at homeless shelters and nursing homes. All told, the scientists analyzed the viral genomes of 772 people with Covid-19 between January and May.

The researchers then compared all of these genomes to trace where each virus came from.

When a virus replicates, its descendants inherit its genetic material. If a random mutation pops up in one of its genes, it will also get passed down to later descendants. The vast majority of such mutations don’t change how the virus behaves. But researchers can use them to track the spread of an epidemic.

“It’s kind of like a fingerprint we can use to follow viruses around,” said Bronwyn MacInnis, a genomic epidemiologist at the Broad Institute.

The first confirmed case of the coronavirus in Boston turned up on Jan. 29. The patient had traveled from Wuhan, China, and his virus carried distinctive mutations found in Wuhan. But Dr. MacInnis and her colleagues didn’t find any other viruses in Boston from later months with the same genetic fingerprint. It’s likely that the patient’s isolation prevented the virus from spreading.

But as February rolled on, the researchers determined, at least 80 other people arrived in Boston with the virus. Undiagnosed, they spread it to others.

Most of the viral lineages in Boston have a genetic fingerprint linking them to earlier cases in Europe, the study found. Some travelers brought the virus directly from Europe in February and March, whereas others may have picked up the European lineage elsewhere in the northeastern United States.

Dr. MacInnis and her colleagues took a detailed look at a few key places to see how the virus swept through the city. At Massachusetts General Hospital, for example, they found that coronaviruses in patients did not share many of the same mutations. That was a relief, because it meant that the hospital was not a breeding ground where a single virus could spread quickly from patient to patient.

But that’s exactly what happened in a skilled nursing home where 85 percent of patients and 37 percent of the staff were infected. The researchers identified three different virus lineages in the home, but one of them accounted for 90 percent of the infections.

Such superspreading events are a hallmark of the coronavirus. When an infected person shows up in the right place — generally inside, with poor ventilation and close contact with other people — the virus can infect a lot of people in very little time. These unfortunate events don’t happen often, and so most people who get infected with the coronavirus don’t pass it on to anyone else.

The virus that raged through the nursing home didn’t spread beyond its walls, as far as Dr. MacInnis and her colleagues could tell. But when the virus showed up at the Biogen conference, the story turned out very differently.

The researchers were able to sequence 28 viral genomes from people at the meeting. All of them shared the same mutation, called C2416T. The only known samples with that mutation from before the Biogen event came from two people in France on Feb. 29.

It’s possible that a single person came to the meeting from Europe carrying the C2416T mutation. It’s also possible that the virus carrying this mutation had already been in Boston for a week or two, and someone brought it into the meeting.

As the attendees spent hours together in close quarters, in poorly ventilated rooms, without wearing masks, the virus thrived. While replicating inside the cells of one meeting attendee, the virus gained a second mutation, called G26233T. Everyone who was subsequently infected by that person carried the double-mutant virus.

From the meeting, the researchers concluded, this lineage spread into the surrounding community. In a Boston homeless shelter, for example, researchers found 51 viral samples with the C2416T mutation, and 54 with both mutations.

“We had no idea it would be associated with the conference,” Dr. MacInnis said. “It came as a complete surprise.”

The researchers estimated that roughly 20,000 people in the Boston area could have acquired the conference virus.

New York saw a similar pattern, according to Matthew Maurano, a computational biologist at N.Y.U. Langone Health. After many viral strains arrived from Europe in February, a few came to dominate the city. “A lot of lineages die off, and some spread enormously,” Dr. Maurano said.

The Boston double-mutant spread particularly far. Researchers identified this lineage in samples collected later in Virginia, North Carolina and Michigan. Overseas, it turned up in Europe, Asia and Australia.

Dr. Jacob Lemieux, a co-author of the new study and an infectious disease physician at Massachusetts General Hospital, said it was impossible at the moment to determine how many people acquired the virus in the months after the Biogen conference. But it would be in the tens of thousands.

Six months after the conference, Dr. MacInnis said that it should serve as a warning to anyone who thinks life can return to an unmasked version of normal before the virus is brought under control.

“One bad decision can affect a lot of people,” she said. “And the ones who suffer the most from that reality are the most vulnerable among us.”

Germany Bans Prostitution During Pandemic. Sex Workers Say That Creates New Dangers [NPR, 26 Aug 2020]

BY ROB SCHMITZ

Among the twisting alleys of the St. Pauli district in Hamburg is the Reeperbahn, Germany's busiest red-light district. One stretch, Herbertstrasse, is blocked off to women who aren't sex workers. This part of Hamburg is nicknamed in German "die sündigste Meile," or "the most sinful mile." But for the first time in two centuries, this mile is less sinful than ever, thanks to the coronavirus pandemic.

Usually, "you can get whatever you want if you go on the right street," says Natalie, a Hamburg brothel manager. NPR is using only her first name to protect her identity as a figure in a controversial industry that's come under increased police scrutiny. But now, "it's a ghost town," Natalie says. "It's like a Western movie."

Prostitution is legal and regulated in Germany, but lawmakers banned it in March to prevent the spread of the coronavirus. At the start of the summer, as this country and the rest of Europe began to reopen their economies, Germany's prostitution ban remained in place. That has angered sex workers and brothel owners and managers such as Natalie, who say the prohibition has not only meant a sudden loss of income, but, more importantly, it has put the workers' lives in danger.

Natalie rents her brothel from a landlord and leases rooms to dozens of sex workers who charge their clients hourly rates. This economic chain, estimated to include as many as half a million sex workers and billions of dollars in revenue nationwide, was broken when the authorities shut the brothels. The workers responded over the summer with protests in Cologne, Berlin and Hamburg, demanding that the government let them go back to work, but Germany's government hasn't budged.

"If we only had one single [coronavirus] case among sex workers, it could potentially, during one day, reach more than 60 other people who would then spread it themselves," says Martin Helfrich, spokesman for Hamburg's Ministry of Social and Health Issues, the agency in charge of regulating the city's sex work industry.

He says the nature of sex work is justification for banning it during the pandemic. Contact tracing — which Germany has excelled at — is also difficult in an industry in which documenting clients' personal details is "expected to be flawed, since who wants to leave the correct contact details of his house and his wife with a prostitute?" Helfrich adds.

The city of Hamburg has stepped in to help by sending welfare checks to registered sex workers and even renting a hotel to house those with nowhere to live during the pandemic. But it has also overseen strict enforcement of the ban, issuing fines of more than $6,000 to sex workers caught working. (In Hamburg, there are no fines for their clients.) This has left workers such as Emily Adaire vulnerable.

Adaire, who identifies as a transgender female, asked NPR to use her professional name for fear of revealing her work to her family and the police.

She says she now earns a quarter of what she made before the shutdown by working in online porn and by defying the ban by meeting a handful of regular clients who she knows aren't police officers. But one client, she says, used the threat of a police fine to take advantage of her.

"He demanded more stuff than usual for a quite low price, and I accepted," Adaire says. "I was like, 'OK, I can do it.' And then afterwards, he was not fully satisfied and he demanded back one-third of the cash."

She says she didn't know what to do. "And usually I don't do that because I think, 'OK, I got naked for you. I had sex with you. And it doesn't meet your expectations. I'm sorry, but I can't do anything about it,' " she says. "And then I was like, 'OK, you can just call the police on me.'
And he was also a bit angry and I was a bit scared. So I just walked home and cried a bit."

Alina Prophet, who works at a community center for sex workers that is mostly funded by the city of Hamburg, says the ban means the workers are now just as vulnerable as their counterparts in much of the world where prostitution is illegal.

"If they work now, they work in worse conditions because they can't do it officially," she says.
"They can't call the police afterwards, if something bad happens to them."

Some of the most vulnerable among them are the many sex workers in Germany who aren't registered and are typically from Romania, Bulgaria and other parts of Eastern Europe.
"They've lost the place where they stayed because the brothels closed, and now many have left, some have returned home, and some are staying at a client's place and are now in dependent relationships," Prophet says.

To help implement measures against the spread of the coronavirus, brothel owners and managers such as Natalie collaborating with sex workers came up with a hygiene plan they've shared with health authorities. "It's very smart because it goes from A to Z," Natalie says. "Even the people who were concerned at first, they were like, 'Oh yeah. That makes sense.' "

The plan calls for sex workers and their clients to wear masks at all times except for during oral sex. "When it comes to oral sex, the face of the sex worker and the face of the client needs to be 90 centimeters away from each other," Natalie says. "We are Germans. We always stick to rules, and we do that even in the bedroom."

Natalie says nobody understands the importance of hygiene like sex workers. The city of Hamburg has hinted it will lift the ban on Sept. 1, but a recent spike in coronavirus cases in Germany may prevent that.