U.K. authorizes Oxford-AstraZeneca coronavirus vaccine

LONDON —
Britain on Wednesday became the first country to authorize a coronavirus vaccine from the University of Oxford and the British-Swedish pharmaceutical firm AstraZeneca, adding a second shot to the fight against a surging outbreak here driven by a highly infectious variant of the virus.
The Oxford-AstraZeneca doses are cheaper than other coronavirus vaccines and easier to transport, as they can be stored at normal fridge temperatures.
Health Minister Matt Hancock praised the homegrown vaccine as a "game-changer" and said clinical trials have proved it to be safe and effective — but he did not put to rest questions about how effective.
Researchers from the Oxford-AstraZeneca team earlier this month published interim results that showed their vaccine was 62 percent effective for volunteers given two full doses and 90 percent effective for a smaller subgroup who received a half dose followed by a full dose. The scientists said they were studying why the different regimens produced such different results.
Britain’s Medicines and Healthcare products Regulatory Agency authorized the vaccine at two full doses for people 18 and older, concluding the results of the half-dose regimen could not yet be supported.
British regulators also noted data is limited on how well the vaccine works in those over 65, who are among the most vulnerable to the virus but who represented less than 6 percent of the clinical trial participants. Still, the regulators okayed use in older populations. Health officials stressed that the vaccine has been shown to greatly reduce severe illness from covid-19, the disease the virus causes, which will cut the number of hospitalizations and deaths.
Moncef Slaoui, the head of the White House’s Operation Warp Speed, said at a Wednesday briefing that he anticipates the AstraZeneca vaccine gaining U.S. authorization in April, based on successful completion of Phase 3 clinical trials in the United States.
He said that he has “no doubt the vaccine is very effective against severe disease” but that the “biggest question mark is efficacy in the elderly population that needs to be further documented.”
The Pfizer-BioNTech and Moderna vaccines already rolled out in the United States use a different technology and had simpler trial designs, showing them to be 95 percent effective.
Britain has injected some 600,000 people with the Pfizer vaccine since becoming the first Western country to roll out mass inoculations. But experts say the government must ramp up quickly, to inoculate 2 million people a week — 10 times the current rate — to beat back the pandemic.
The National Health Service will start inoculating with the AstraZeneca vaccine on Monday, with nursing home residents, health-care workers and people over 80 at the front of the line. There are plans to deliver the vaccine in mass immunization centers, such as sporting arenas and convention halls.
The urgency is especially great with a new variant of the virus spreading rapidly. Researchers have found no indication the variant is deadlier, but it appears to be 50 percent more transmissible.
Britain recorded more than 53,000 cases on Tuesday — the highest in a single day. British hospitals have more coronavirus patients than when the first wave gripped the country in April.
As of Thursday, 8 in 10 people in England will be under the highest tier of restrictions. Wales, Scotland and Northern Ireland have enacted tight restrictions, as well.
Hancock said having both the Pfizer and AstraZeneca vaccines means the government now has “a very high degree of confidence that we can be out of this by spring.”
Hancock said that in the interest of injecting as many people as possible, as quickly as possible, it would be sufficient to give a first dose of the AstraZeneca vaccine and allow more than the usual 21 days between shots.
“In the data, the scientists and the regulators have found the immunity comes from around two weeks after the first dose, and then the second dose should be taken up to 12 weeks later to give you that long-term protection,” Hancock said.
“This means we can spend the first three months vaccinating people with the first doses, getting them that immunity, getting people protection quicker than we possibly could have done otherwise,” he said.
Britain bet the house on the AstraZeneca vaccine, ordering 100 million doses, compared with 40 million doses of the Pfizer vaccine and 7 million doses of Moderna, which the United Kingdom has not yet reviewed for emergency authorization.
AstraZeneca says it can deliver about 2 million doses a week initially. It has pledged 40 million doses by the end of March. The company has manufacturing facilities in Britain.
June Raine, chief executive of the British regulator, said “no corners were cut” in the rapid review of the vaccine, even though it was developed at Oxford and backed by the British government. Raine said it has “the potential to save many lives.”
Prime Minister Boris Johnson said the approval of the new vaccine was “truly fantastic news — and a triumph for British science.”
British scientists noted that the vaccine could help protect not only Britons but also many in the developing world.
Regulators in India will meet Friday to consider whether to grant emergency approval. Serum Institute of India, one of the world’s biggest vaccine manufacturers, has nearly 50 million doses ready and plans to produce 300 million by July. Half of the production will be used in India.
The vaccine uses a harmless cold virus that typically infects chimpanzees to deliver to the body’s cells the genetic code of the spike protein that dots the outside of the coronavirus. That teaches the body’s immune system to block the real virus.
At a briefing announcing the approval of the vaccine, Wei Shen Lim, a respiratory physician and chair of the Joint Committee on Vaccination and Immunization, said, “The data shared with us, and I am not sure it is entirely in the public domain, calculated the vaccine efficacy between Day 22 of Dose 1 to the time of Dose 2 being given, the figure is around 70 percent.”
Lim added, “But I don’t think I should be revealing any more than that at this point in time.”
In an AstraZeneca news release on Wednesday, the company said that “the primary efficacy endpoint based on a pooled analysis showed that the vaccine was 70.4 percent.”
“Today is an important day for millions of people in the U.K. who will get access to this new vaccine,” said Pascal Soriot, chief executive of AstraZeneca. “It has been shown to be effective, well-tolerated, simple to administer and is supplied by AstraZeneca at no profit.”
He said scientists believe the AstraZeneca vaccine will be effective against the new variant detected in Britain.
Public health officials say there is much to recommend the new vaccine, as it costs less than $4 a dose, is relatively easy to manufacture at huge scale and does not require special handling.
The British government has not released how much it is paying for vaccines. A spokesman for the Department for Business, Energy and Industrial Strategy said the prices are “commercially sensitive so can’t be disclosed by us.” But U.S. figures suggest that the Pfizer vaccine may be five times as expensive as AstraZeneca’s.
The Pfizer vaccine must also be kept in special freezers and dry ice at extremely low temperatures.
The British health secretary conceded that the Pfizer requirements “made it more challenging to get out, especially to some of the smaller care homes, and those limitations aren’t there for this Oxford-AstraZeneca vaccine.”
Approval of the vaccine provides “a ray of hope at the end of a very challenging year,” said Lawrence Young, a professor of molecular oncology at Warwick Medical School. “It also comes at a time when we have just recorded the largest daily increase in the number of infections in the U.K. and when the NHS is struggling with the number of hospitalizations. And all this on the backdrop of a more infectious variant of the virus.”
Andrew Pollard, director of the Oxford Vaccine Group, told the BBC that the pandemic this year was “like being in a blizzard.”
“We’ve been really struggling uphill through snow drifts with this icy wind in our faces, and I think this morning we do have some respite with this good news and the warmth that that brings,” he said.


Find information about COVID-19 variants and how they differ from the main outbreak.

COVID-19 variants appear to transmit faster and are fueling outbreaks from the U.K. to South Africa. The U.K. variant of the COVID-19 virus, which contains 17 mutations, appears to be a more highly transmissible form of the virus and is showing up in at least 19 countries around the world.  The South Africa variant is being seen in 4 other countries. Both variants seem to be more contagious but there is no evidence that they cause more severe illness. Documents that discuss long-covid or the flu are irrelevant.

Find articles discussing the question of COVID-19 variant transmissibility.

CDC: Covid-19 death toll is twice as high among people of color under age 65 as for white Americans

The coronavirus proved substantially deadlier to people of color under the age of 65 than to their white counterparts in the early days of the pandemic, an in-depth analysis released Friday found.
The report from the Centers for Disease Control and Prevention is the agency’s most comprehensive analysis of the demographics of those who died of covid-19, the disease caused by the novel coronavirus. Researchers analyzed data for about 52,000 confirmed deaths between mid-February and mid-April.
Most of the people who died were older than 65, and most had underlying medical conditions. But researchers obtained more complete data on race, ethnicity and underlying conditions for a subset of about 10,000 people. Most of those deaths occurred in New York City, New Jersey and Washington state, three areas hardest hit at the dawn of the pandemic.
What was notable was the higher death toll among some racial and ethnic groups, researchers said.
The study found stark differences in the age at which people from different racial and ethnic groups died of covid-19. Among white people, the median age was 81, while for Hispanics it was 71, and for all nonwhite, non-Hispanic people it was 72.
Researchers found that the virus exacted a vastly steeper toll on people of color who were younger than 65. About 35 percent of Hispanic people who died of covid-19 were under 65, and about 29.5 percent of nonwhite, non-Hispanics who died were under 65. By comparison, 13.2 percent of deaths among white people were in those younger than 65.
The percentage of deaths among Hispanic and nonwhite people exceeded their representation in the U.S. population. That suggests rates of coronavirus transmission are higher among younger members of those groups than among their white counterparts and may reflect their greater presence in front-line jobs that don’t allow them to work from home. It could also suggest they are more likely to live in crowded or multigenerational homes where it is difficult to maintain social distancing.
Authorities on health disparities say racial differences arise from social and structural inequities that leave some racial and ethnic groups around the world acutely vulnerable to the most devastating effects of the coronavirus. Those differences have helped fuel protests for racial justice that have swept the nation.
Among those older than 65 who died of covid-19, nearly 41 percent were white and non-Hispanic, 21 percent were Hispanic and 32 percent were nonwhite and non-Hispanic.
The CDC report found that diabetes was common among those younger than 65 who died. Nearly half of the deaths in people under 65 were in people with diabetes. Overall, 35 percent of patients under age 65 hospitalized with covid-19 had diabetes.
The CDC recently broadened its warning about the groups at risk of developing severe complications from covid-19. Officials said even younger people who are obese or have other health conditions, such as diabetes, can become severely ill if they contract the virus.
A CDC study last month found that people with underlying medical conditions such as heart disease and diabetes were hospitalized six times as often as otherwise healthy individuals infected with the coronavirus during the first four months of the pandemic and they died 12 times as often.
In the report released Friday, nearly 1 in 12 deaths in people under 65 took place at home or in an emergency department, suggesting they may not have had access to health care, may have delayed seeking care or may have been delayed in getting diagnosed.


California, Colorado confirm infections with U.K. coronavirus variant

The coronavirus variant that has pummeled Britain was identified Wednesday in Southern California, the second confirmed infection in the United States of what scientists believe to be a more contagious strain of the pathogen.
The news broke just hours after Colorado officials revealed they are investigating their second suspected infection involving the variant, and as federal officials pledged to ramp up their monitoring of coronavirus mutations.
The California case involved a 30-year-old man who was tested Wednesday, officials said. He had no known travel history. The same is true of the two people involved in the Colorado cases. That suggests the variant, believed by scientists to be more transmissible but not more likely to sicken or kill, is freely circulating in some communities in the United States.
“Because there is no travel history, we believe this is not an isolated case in San Diego County, and there are probably other cases of the same strain in San Diego County,” County Supervisor Nathan Fletcher said at a news conference.
The rapid-fire developments in two states underscored the need to improve the country’s scattered surveillance of the coronavirus, which jumped from an unknown animal into the human species late last year and appears to be evolving as it adapts to its new host.
“Just an hour or so ago we were informed that this new variant, this new strain that we’ve identified obviously from the United Kingdom … has been identified here in the state of California, in Southern California,” Gov. Gavin Newsom said on a Facebook Live broadcast.
Federal health officials said that a new surveillance system, created by the Centers for Disease Control and Prevention in November to track new variants of the coronavirus, will eventually be able to analyze as many as 3,500 virus genomes per week to look for mutations of interest — a capability scientists say is essential to identify and protect against new strains with mutations that might evade testing and be impervious to vaccines or certain treatments.
In a statement released Wednesday in response to questions about the pace of the program, the CDC did not offer a timetable, saying it “has been working on the surveillance for several months and has some components in place. This is the time to accelerate the process to better help public health and safety.”
Both the U.K. variant and one spreading rapidly in South Africa are believed by scientists to carry mutations that enhance transmissibility for reasons not clearly understood. However, they are not thought to change the severity of the illness, or pose any issues for the efficacy of the newly developed coronavirus vaccines. They also do not appear able to cause reinfections in people who have already survived a recent bout with the virus.
But a more transmissible virus means more infections, an unwelcome development amid the cold-weather surge of cases, hospitalizations and deaths in the United States and many other countries trying to survive this brutal pandemic winter.
The variants “could lead to more cases and put even more strain on our heavily burdened health-care systems,” said Henry Walke, head of the CDC’s response to covid-19, the disease caused by the virus.
The United Kingdom variant, named B.1.1.7, has been identified in at least 19 countries. Walke said that no one knows how widely it has actually spread in the United States or globally. The South Africa variant has been seen in a total of four countries, but not in the United States so far.
He and others said the identification of the variant in this country should spur people to follow guidelines designed to limit the virus’s spread.
“If there was a reason to work really hard on stopping community transmission, we have an even better reason now, because we’re up against a more formidable enemy,” said Francis Collins, director of the National Institutes of Health. “Things are getting bad enough already, just from the previous viral strain.”
Colorado authorities echoed those admonitions on Wednesday as they described their scrutiny of a second case they described as “highly suspicious.”
Both infected individuals are members of the National Guard who were deployed Dec. 23 to the Good Samaritan Society assisted-living facility in Simla, Colo., in Elbert County, where all 26 residents tested positive for the familiar strain of the virus and four died, officials said.
The facility confirmed that an “allied health worker” tested positive with the new variant strain of the virus and said the state health department had been on site to test employees.
“We look forward to beginning vaccinations at this location next week,” said Randy Fitzgerald, regional vice president of the Good Samaritan Society.
State epidemiologist Rachel Herlihy said the new variant has not been detected among the facility’s residents. She said the two National Guard personnel were among six deployed to boost staffing and were not the cause of the outbreak, which began much earlier.
Herlihy added that it was not clear where the two people might have been exposed. Both are in isolation and recovering, officials said.
The fact that the individual with the confirmed infection, described as a man in his 20s, had no known travel history “logically implies that there’s more spread throughout the state,” said Anuj Mehta, a pulmonary and critical care physician at Denver Health who has been involved in the state’s pandemic response.
“We have to assume he got it from community spread,” Mehta said. “That could mean two other people had it, or it could mean 200 other people had it. Time will tell how widespread it is.”
Most mutations have no practical consequence. Since all viruses mutate, there are many variants of the coronavirus, known as SARS-CoV-2. But one mutation that appeared early this year is now seen in all new coronavirus cases, and many scientists say it enhanced infectivity. Now the United Kingdom and South Africa variants are seizing the attention of scientists and public health officials.
“We expect to see new variants emerge over time,” Walke said.
The U.K. variant, which contains 17 mutations, including some affecting the spike protein on the exterior of the virus, first appeared there in September  and has become dominant across the country, leading to a lockdown in London and southern England and travel bans by other countries hoping to prevent its importation.
Officials in the United States, where surveillance of viral sequences is spotty, say they are not surprised it has been detected in this country.
“I would have been amazed if this variant was not present in the U.S. given that it’s been bouncing around in the U.K. since September and people do go back and forth,” Collins said.
At least one epidemiologist said it is unlikely the new variant is a driving force in the disease surges in Los Angeles and other locations. Although the United States is sequencing only a small  fraction of cases — and missing many infections because people are asymptomatic — the new strain would probably have been picked up if it had spread at that scale, said John Brownstein, an epidemiologist and chief innovation officer of Boston Children’s Hospital.
But given the paucity of sequencing, finding one or two cases in Colorado suggests there are several hundred that have been missed, he said.
“It could drive a future surge, especially given the challenges with the vaccine rollout,” Brownstein said. He added that greater numbers of infections also translate to additional opportunities for the virus to mutate in potentially problematic ways. “The sheer amount of transmission allows more chances for it to mutate,” he said.
Among those problems could be reduced effectiveness of monoclonal antibodies, as mutations may affect how they neutralize the virus, said Jesse Goodman, who directs the COMPASS program at Georgetown University, which focuses on science-based public health policy. Some monoclonal antibody treatments, such as the one President Trump received when he had covid-19 and hailed as a cure, contain more than one antibody, making resistance less likely to develop.
Goodman said that although preliminary evidence suggests the changes in the new variant are unlikely to reduce the vaccines’ effectiveness, that may not be true of future mutations. Still, the messenger RNA platform used in two newly authorized vaccines is comparatively easy to modify to handle mutant strains, he said.
“We are still learning every day about this virus,” Goodman said. “We don’t know when or how often we may need to make changes in a coronavirus vaccine.”
Bruce Gellin, president of global immunization at the Sabin Vaccine Institute, said the shifts in the coronavirus reflect a pattern that mimics what goes on with influenza, where scientists routinely monitor changes in the strain.
With other coronaviruses — such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), the current strain of the novel coronavirus and now the new variant — scientists are constantly playing catch up, said Gellin, who advocates a Manhattan Project-type approach to produce a universal vaccine that could protect against any strain of the coronavirus or flu.
“We need to have an approach that will prevent these problems before they show up, rather than quash after they arrive,” he said.


Britain finds 2 cases of coronavirus variant linked to South Africa; travel resumes across English Channel

siobhan.ogrady@washpost.com

Britain has found two cases of a coronavirus variant linked to South Africa, Health Secretary Matt Hancock said Wednesday, both of which are tied to contact with recent arrivals from that country.
Hancock announced new restrictions on visitors from South Africa and called on anyone who has recently been to that country or been in contact with a recent arrival from there to quarantine immediately, describing the measures as temporary while officials seek to better understand the variant.
“This virus is highly concerning because it is yet more transmissible and appears to have mutated further than the new variant that’s been discovered in the U.K.,” he said at a news conference.
South African officials announced last week that their scientists had detected a new variant that appeared to be fueling a rapid rise in infections there.
The appearance of the South African variant in Britain comes as its officials are already grappling with a worsening coronavirus outbreak linked to a different variant recently discovered in England.
Experts have cautioned that both variants need additional study as scientists seek to better understand the mutations and what effect — if any — they will have on vaccines.
British authorities are tightening restrictions in response to the increase in cases. By Dec. 26, about 24 million people will face Britain’s toughest coronavirus rules, under which all nonessential businesses are required to close.
Many countries in Europe and elsewhere closed their borders to British travelers in recent days to try to limit the spread of the variant discovered in England. Some also placed restrictions on people traveling from South Africa.
France banned freight across the English Channel, one of Europe’s busiest travel corridors, for 48 hours. On Wednesday, ferry passengers began to trickle back into France from Britain, after a late-night agreement between the countries to allow some people back into France, provided they could show negative coronavirus test results.
It will take days, however, to move the thousands of freight trucks stranded on the British side of the English Channel as all the drivers are tested.
British Home Secretary Priti Patel tweeted Wednesday that mass testing has begun and that the “priority is to get lorries moving.”
Housing Secretary Robert Jenrick estimated that at least 4,000 trucks were parked around the Kent region and said the military would manage testing sites, including one at Manston airport, where many of the trucks are located.
Patel urged people to avoid traveling to Kent because of major congestion, saying that an increase in travelers “will slow things down.”
TV footage showed angry truck drivers scuffling with police and honking their horns in protest after being stranded for days, often far from even the most basic sanitation facilities. Many face the prospect of missing Christmas with their families.
In interviews with local television, truckers picketing the port town of Dover said there was no movement, no apparent testing and no hygiene facilities for them.
“What we’ve got this morning is very, very angry truckers in Dover,” Rod McKenzie of the Road Haulage Association told the BBC. “They’re tired, frustrated, desperately want to get home for Christmas.”
Kent police tweeted Wednesday that they have responded to “disturbances in Dover and Manston this morning involving individuals hoping to cross the Channel” and made one arrest.
In his morning television appearances, Jenrick said there were no shortages of food at supermarkets and urged everyone to avoid panic-buying. Many locations have reported empty supermarket shelves.
And Britain’s main supermarket chains, Tesco and Sainsbury’s, warned Monday that some fresh food could run out if freight did not start moving soon. Late Tuesday, Tesco announced the rationing of certain products in an email to customers, including toilet paper, rice, soap and eggs, to ensure there would be enough for everyone.
Britain’s newspapers, meanwhile, were filled with images of thousands of trucks lined up in Manston.
Concern over the new variants comes as Britain is attempting to negotiate the terms of its future relations with the European Union and as much of the country is enduring a harsh new lockdown coinciding with the Christmas holiday season.
As many European countries rushed to impose new rules on travelers from Britain, the European Commission on Tuesday urged European Union member states to coordinate their response and lift bans on flights, trains and freight, citing “the need to ensure essential travel and avoid supply chain disruptions.”
Some countries chose to maintain or expand their prohibitions anyway, while others eased their restrictions but requested polymerase chain reaction, or PCR, coronavirus tests for new arrivals.
India has suspended flights from Britain until the end of the year. Meanwhile, it plans to track down all passengers who arrived from Britain in the past month. Officials across India have been asked to track and monitor the health of the passengers for the next two weeks.
About a dozen passengers from Britain have tested positive for the coronavirus on arrival in four Indian cities in recent days, according to local media reports. Their samples are being examined for the variant detected in England, and they are being kept in quarantine pending the results.

siobhan.ogrady@washpost.com


U.S. ranks 43rd worldwide in sequencing to check for coronavirus variants like the one found in the U.K.

The United States has the most coronavirus cases in the world — but in sequencing cases to check for genetic changes, it lags at an astoundingly low rate. Of the more than 18 million cases officially reported in the United States, just 51,212, or 0.3 percent, have been genetically analyzed for variants, according to the latest data from the GISAID Initiative, which provides a global database of coronavirus genomes. Worldwide, the United States ranks 43rd in percentage of cases sequenced among countries with more than 100 reported infections. Britain, by contrast, is No. 8, having analyzed 7.4 percent of its more than 2 million documented cases, according to the Covid-19 Genomics UK (COG-UK) Consortium. Britain’s relatively high rate probably contributed to its detection of a highly transmissible variant circulating in southern England since September. “It makes sense that it was detected first in the U.K. because they have probably the world’s best surveillance program,” Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security, told The Washington Post. Australia, which has reported more than 28,200 coronavirus cases, has sequenced 58.6 percent, the highest rate worldwide. New Zealand ranks second, with 48.6 percent of the country’s more than 2,100 cases analyzed. Taiwan, Denmark and Iceland also make the top five. South Africa, which globally falls at 42, just ahead of the United States, announced Dec. 18 that it had detected a similar variant after a surge in cases there. South Africa is battling the worst outbreak in Africa. The U.S. Centers for Disease Control and Prevention has not documented any cases of the British variant in the United States — but experts, even at the CDC, say it’s probably already here. “Given the small fraction of U.S. infections that have been sequenced, the variant could already be in the United States without having been detected,” the CDC wrote on its website.


A mysterious blood-clotting complication is killing coronavirus patients

Craig Coopersmith was up early that morning as usual and typed his daily inquiry into his phone. “Good morning, Team Covid,” he wrote, asking for updates from the ICU team leaders working across 10 hospitals in the Emory University health system in Atlanta.
One doctor replied that one of his patients had a strange blood problem. Despite being put on anticoagulants, the patient was still developing clots. A second said she’d seen something similar. And a third. Soon, every person on the text chat had reported the same thing.
“That’s when we knew we had a huge problem,” said Coopersmith, a critical-care surgeon. As he checked with his counterparts at other medical centers, he became increasingly alarmed: “It was in as many as 20, 30 or 40 percent of their patients.”
One month ago when the country went into lockdown to prepare for the first wave of coronavirus cases, many doctors felt confident they knew what they were dealing with. Based on early reports, covid-19 appeared to be a standard variety respiratory virus, albeit a contagious and lethal one with no vaccine and no treatment. They’ve since seen how covid-19 attacks not only the lungs, but also the kidneys, heart, intestines, liver and brain.
Increasingly, doctors also are reporting bizarre, unsettling cases that don’t seem to follow any of the textbooks they’ve trained on. They describe patients with startlingly low oxygen levels — so low that they would normally be unconscious or near death — talking and swiping on their phones. Asymptomatic pregnant women suddenly in cardiac arrest. Patients who by all conventional measures seem to have mild disease deteriorating within minutes and dying at home.
With no clear patterns in terms of age or chronic conditions, some scientists hypothesize that at least some of these abnormalities may be explained by severe changes in patients’ blood.
The concern is so acute some doctor groups have raised the controversial possibility of giving preventive blood thinners to everyone with covid-19 — even those well enough to endure their illness at home.
Blood clots, in which the red liquid turns gel-like, appear to be the opposite of what occurs in Ebola, Dengue, Lassa and other hemorrhagic fevers that lead to uncontrolled bleeding. But they actually are part of the same phenomenon — and can have similarly devastating consequences.
Autopsies have shown some people’s lungs fill with hundreds of microclots. Errant blood clots of a larger size can break off and travel to the brain or heart, causing a stroke or heart attack. On Saturday, Broadway actor Nick Cordero, 41, had his right leg amputated after being infected with the novel coronavirus and suffering from clots that blocked blood from getting to his toes.
Lewis Kaplan, a University of Pennsylvania physician and head of the Society of Critical Care Medicine, said every year doctors treat people with clotting complications, from those with cancer to victims of severe trauma, “and they don’t clot like this.”
“The problem we are having is that while we understand that there is a clot, we don’t yet understand why there is a clot,” Kaplan said. “We don’t know. And therefore, we are scared.”
The first sign something was going haywire was in legs, which were turning blue and swelling. Even patients on blood thinners in the ICU were developing clots — which is not unusual in one or two patients in one unit but is for so many at the same time. Next came the clogging of the dialysis machines, which filter impurities in blood when kidneys are failing and jammed several times a day.
“There was a universal understanding that this was different,” Coopersmith said.
Then came the autopsies. When they opened up some deceased patients’ lungs, they expected to find evidence of pneumonia and damage to the tiny air sacs that exchange oxygen and carbon dioxide between the lungs and the bloodstream. Instead, they found tiny clots all over.
Zoom meetings were convened in some of the largest medical centers nationwide. Tufts. Yale-New Haven. The University of Pennsylvania. Brigham and Women’s. Columbia-Presbyterian. Theories were shared. Treatments debated.
Although there was no consensus on the biology of why this was happening and what could be done about it, many came to believe the clots might be responsible for a significant share of U.S. deaths from covid-19 — possibly explaining why so many people are dying at home.
In hindsight, there were hints blood problems had been an issue in China and Italy as well, but it was more of a footnote in studies and on information-sharing calls that had focused on the disease’s destruction of the lungs.
“It crept up on us. We weren’t hearing a tremendous amount about this internationally,” said Greg Piazza, a cardiovascular specialist at Brigham and Women’s who has begun a study of bleeding complications of covid-19.
Helen W. Boucher, an infectious-disease specialist at Tufts Medical Center, said there’s no reason to think anything is different about the virus in the United States. More likely, she said, the problem was more obvious to American doctors because of the unique demographics of U.S. patients, including large percentages with heart disease and obesity that make them more vulnerable to the ravages of blood clots. She also noted small but important differences in the monitoring and treatment of patients in ICUs in this country that would make clots easier to detect.
“Part of this is by virtue of the fact that we have such incredible intensive care facilities,” she said.
The body’s cardiovascular system often is described as a network of one-way streets that connect the heart to other organs. Blood is the transport system, responsible for moving nutrients to the cells and waste away from them. A common cold or a cut on the finger can lead to changes that help repair the damage, but when the body undergoes a more significant trauma, the blood can overreact, leading to an imbalance that can cause excessive clots or bleeding — and sometimes both.
Scientists call this “hemostatic derangement.” In math, a derangement is a permutation in which no element is in its original position.
Harlan Krumholz, a cardiac specialist at the Yale-New Haven Hospital Center, said no one knows whether blood complications are a result of a direct assault on blood vessels, or a hyperactive inflammatory response to the virus by the patient’s immune system.
“One of the theories is that once the body is so engaged in a fight against an invader, the body starts consuming the clotting factors, which can result in either blood clots or bleeding. In Ebola, the balance was more toward bleeding. In covid-19, it’s more blood clots,” he said.
A study published in JAMA on Wednesday found that a large number of covid-19 patients admitted to New York State’s largest health system came in with blood test readings that indicated clotting problems.
And a Dutch study published April 10 in the journal Thrombosis Research provided more evidence the issue is widespread, finding 38 percent of 184 covid-19 patients in an intensive care unit had blood that clotted abnormally. The researchers called it “a conservative estimation” because many of the patients were still hospitalized and at risk of further complications.
Early data from China on a sample of 183 patients showed more than 70 percent of patients who died of covid-19 had small clots develop throughout their bloodstream.Although acute respiratory distress syndrome still appears to be the leading cause of death in covid-19 patients, blood complications are not far behind, said Behnood Bikdeli, a fourth-year fellow at Columbia University Irving Medical Center, who helped anchor a paper about the blood clots in the Journal of The American College of Cardiology.
“My guess is it’s one of the top three causes of demise and deterioration in covid-19 patients,” he said.
That recognition is prompting many hospitals to change the way they think about the disease and manage it. When the novel coronavirus first hit, the Centers for Disease Control and Prevention and others put people with asthma at the top of their lists of those who might be the most vulnerable. But European researchers writing in the journal Lancet noted it was “striking” how underrepresented asthma patients had been. Earlier this month, when New York state released data about the top chronic health problems of those who died of covid-19, asthma was not among them. Instead, they were almost all cardiovascular conditions.
Some medical centers have begun giving all hospitalized covid-19 patients small doses of blood thinners as preventive measures, and many are adjusting doses upward for the most seriously ill. The challenge is the more you give, the greater the danger of upsetting the balance in the other direction and having the patient bleed to death.
Another big mystery the doctors hope the blood issue will shed light on is why some maternity patients are collapsing during or after giving birth.
A paper published in the American Journal of Obstetrics & Gynecology MFM in late March detailed how two women with no prior symptoms of covid-19 ended up in intensive care. The first was a 38-year-old patient of New York-Presbyterian/Columbia University Irving Medical Center in Manhattan who spiked a fever of 101.3 while undergoing a C-section delivery and began bleeding profusely. The second woman, 33, also underwent a C-section but the next day developed a cough that progressed to respiratory distress. Her heart beat irregularly and her blood pressure jumped to as high as 200/90.
Several physician-researchers said the relationship between covid-19, clotting and pregnant women is “an area of interest.” Women in childbirth can experience clotting and bleeding complications because of the involvement of the blood-rich placenta, but it’s possible covid-19 may be triggering additional cases by making some women’s bodies “lose balance.”
“There’s lots of speculation,” Krumholz said. “That’s one of the frustrating things about this virus. We’re in a lot of darkness still.”
Read more:
After deaths of two of their own in New Jersey town, some EMTs go AWOL while others soldier on
Sandy Brown lost her husband and son to the coronavirus. As multiple families face multiple deaths, experts call for isolating sick away from families.
A funeral, a birthday party, hugs and covid-19: CDC traces Chicago coronavirus outbreak to family gatherings
Who’s favored, who’s not if there’s a ventilator shortage


The Health 202: Coronavirus keeps spreading. But at least we've learned more about it.

with Paulina Firozi
Coronavirus infections are swelling in the United States, which hit 5 million cases over the weekend.
But so is the body of research on how the novel coronavirus spreads and affects people.
Dozens of studies have now been published in top medical journals, providing critical information to public health officials and medical professionals attempting to get a handle on the virus. More understanding of the virus is critical, as its aggressive spread around the country confounds President Trump’s efforts toward an economic rebound and threatens to keep schools and workplaces shuttered through the fall.
There’s a lot left to learn. But some of the blanks are starting to be filled in, now that researchers around the world have had six months to study it (check out The Post's database of questions and answers about the pandemic).
Here are some things we learned about the virus over the summer — and some questions that persist:
Researchers are still trying to discover whether people without visible symptoms spread the virus at similar rates as those with symptoms. There’s been a considerable amount of confusion around this question, particularly after the World Health Organization appeared to suggest the virus isn’t spread asymptomatically — and then walked back its pronouncement the next day.
It seems clear that asymptomatic transmission does occur. People with no symptoms carry the same level of virus in their nose, throat and lungs as those with symptoms, according to a South Korean study of 303 people published last week in JAMA Internal Medicine.
The study was the first to distinguish between patients who didn’t develop symptoms initially and those who did develop symptoms later on — which can cause some confusion when looking at asymptomatic spread. Based on their observations, the researchers estimated that 30 percent of infected people never develop symptoms.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week he thinks the figure is closer to 40 percent.
“The good news about covid-19 is that about 40 percent of the population have no symptoms when they get infected,” Fauci said, but he added that asymptomatic people "are propagating the outbreak, which means that you’re going to infect someone, who will infect someone, who then will have a serious consequence.”
There is some very early, tentative evidence suggesting a segment of the world’s population may have partial protection thanks to the immune system's “memory” T cells, which are trained to recognize specific
People may derive this protection from standard childhood vaccinations or from previous infections by other coronaviruses, such as those that cause the common cold, my colleague Ariana Eunjung Cha reported.
“This might potentially explain why some people seem to fend off the virus and may be less susceptible to becoming severely ill,” National Institutes of Health Director Francis Collins remarked in a blog post last week.
“On a population level, such findings, if validated, could be far-reaching,” Ariana wrote. “ … In communities in Boston, Barcelona, Wuhan and other major cities, the proportion of people estimated to have antibodies and therefore presumably be immune has mostly been in the single digits. But if others had partial protection from T cells, that would raise a community’s immunity level much higher.”
The head of the Centers for Disease Control and Prevention estimated in June that there were roughly 10 times more coronavirus infections in the United States than had been confirmed through testing.
There were just 2.4 million confirmed cases when CDC Director Robert Redfield made that estimate — which, if accurate, would have translated to 24 million cases at the time. Confirmed cases have since doubled, to more than 5 million — meaning the virus may have swept through tens of millions of people.
Redfield based his estimate on the results of antibody tests, which examine a person’s blood for indicators that the body fought off an infection, Lena H. Sun and Joel Achenbach wrote.
Scientists initially thought the virus easily spread on surfaces, similar to how other viruses operate. That’s why much of the initial public health advice centered around hand-washing and disinfecting surfaces.
Now public health experts think SARS-CoV-2 is primarily spread through person-to-person contact.
In May, the CDC updated guidance on its “How COVID-19 Spreads” website to say that “the virus spreads easily between people.” The agency also acknowledged the virus may spread other ways, such as through touching contaminated objects or surfaces, but clarified “this is not thought to be the main way the virus spreads.”
“The virus travels through the droplets a person produces when talking or coughing,” Ben Guarino and Joel wrote. “An individual does not need to feel sick or show symptoms to spread the submicroscopic virus. Close contact means within about six feet, the distance at which a sneeze flings heavy droplets. Example after example have shown the microbe’s affinity for density. The virus has spread easily in nursing homes, prisons, cruise ships and meatpacking plants — places where many people are living or working in proximity.”
Children only rarely get seriously ill or die of covid-19, the disease the virus causes; data on hospitalizations and deaths make that clear. But whether — and to what extent — they can spread the virus to others asymptomatically is still murky.
Studies are also conflicting on whether the age of children affects their likelihood of spreading the virus. One study conducted at a Chicago hospital found children younger than 5 with mild to moderate cases of covid-19 had much higher levels of virus in their noses than older children and adults — suggesting they could be more infectious, Ariana, Haisten Willis and Chelsea Janes reported.
But a study out of South Korea examining household transmission seemed to
The lungs appear most susceptible to the virus. Researchers have also found the pathogen in
But researchers have been surprised to discover little inflammation on the brain, despite previous reports about
Putin declared victory in the vaccine race, saying his own daughter has already been inoculated with it, The Post's Isabelle Khurshudyan and Carolyn Y. Johnson report.
“Officials have pledged to vaccinate millions of people, including teachers and front-line health-care workers, with the experimental coronavirus vaccine developed by the Gamaleya Institute in Moscow this month, raising global alarm that the country is jumping dangerously ahead of critical, large scale testing that is essential to determine if it is safe and effective,” they write.
Naturally:
“Of course, what counts most is for us to be able to ensure the unconditional safety of the use of this vaccine and its efficiency in the future. I hope that this will be accomplished,” Putin said at a meeting with government members Tuesday.
“The aggressive strategy from a country eager to declare a victory amid one of the worst outbreaks in the world has been criticized by outside scientists who worry that
The Trump administration is circulating a proposal that would enable border officials to block individuals from entering the country from Mexico if they are suspected to be infected, Chelsea Janes, Brady Dennis, Nick Miroff and Josh Dawsey report.
“It is unclear whether the Trump administration has the legal authority to block citizens and permanent residents from returning to their own country, but one official said the administration is weighing a public health emergency declaration that would let the White House keep out potentially infected Americans,” they add. “Medical experts have warned the administration that such restrictions would make little difference in controlling the pandemic, because widespread community transmission already is occurring in the United States.”
The administration has already cited the pandemic to enforce a system of expelling most migrants taken into custody at the border and returning them to Mexico.
The New York Times, which first reported the administration’s discussions, reported that the draft regulation does not detail how long the individual would be required to stay outside the country.
The Times adds, “The rule appears to apply to all points of entry into the United States, including at airports and along both the northern and southern borders. In particular, the draft could impact the border with Mexico, where many American citizens and legal residents cross back and forth frequently.”
Immigration and Customs Enforcement says it wants to expel migrant children to prevent the spread of the coronavirus. But the children sent home have already tested negative.
“Court documents, and information given by Immigration and Customs Enforcement to congressional staff last week, reveal that the Trump administration has agreed to test every child in its custody before sending them back to their home countries under the expulsion policy,” Dara Lind and Lomi Kriel report for ProPublica. “ICE’s comprehensive testing appears to undermine the rationale for the mass expulsion policy: that it is necessary to ‘prevent the introduction’ of COVID-19 into the United States.”
The administration has cited the ongoing pandemic as the reason it is sidestepping protections that are meant to direct migrant children to the Department of Health and Human Services. Citing a law that allows the Centers for Disease Control and Prevention to exclude an individual if they may introduce diseases into the United States, the CDC began blocking anyone without documentation from entering the country in March.
It’s not clear, Dara and Lomi add, when the testing requirements began.
Lee Gelernt of the ACLU, which is representing children in legal challenges to the policy, told ProPublica that the administration’s “claim that they need to summarily expel children because of COVID was always a pretext. … If they are now actually testing and know the children do not have COVID, then the policy is that much more unjustified.”
Jeff Jeans, a conservative Republican from Sedona, Ariz., will explain how he opposed the Affordable Care Act until he was diagnosed with throat cancer and was able to get insurance coverage despite that preexisting condition, Matt Viser reports.
The list of speakers also includes “a former Trump voter from Pennsylvania who is supporting Biden, a paramedic and immigrant from Mexico City on the front lines of the pandemic in Florida, a bus driver from Atlanta and an autoworker from Lake Orion, Mich.,” he adds.
Hillary Clinton, the party’s 2016 presidential nominee, and Sen. Bernie Sanders (I-Vt.) will also be among the marquee speakers during the four-night convention, which will be mostly virtual and streamed online across numerous social media platforms and on television. Former president Barack Obama, former first lady Michelle Obama and Sen. Elizabeth Warren (D-Mass.) are also set to speak, though Warren will be slotted into the vice presidential speaking slot if she’s chosen as Biden’s running mate.
During his landmark visit, the Health and Human Services secrretary pointed to the U.S. support for Taiwan in “security, commerce, health care and shared common values” and praised its strategy for addressing the novel coronavirus, Gerry Shih reports. U.S. and Taiwanese officials also signed an accord meant to signal cooperation on disease control and drug development.
The Chinese government wasn't pleased.
“China claims Taiwan, a self-ruled island backed militarily by Washington, as its territory, and it objects strenuously to Taiwan’s participation in international bodies like the World Health Organization and to any official exchanges that lend Taiwan the appearance of sovereign nation status," Gerry writes.
Azar’s visit was also an opportunity for the U.S. and Taiwan to compare notes on their responses to the pandemic.
“The gap between the democracies is stark: Taiwan, population 23 million, has reported fewer than 500 novel coronavirus cases and seven deaths as of Sunday. The United States, population 328 million, has reported 5 million cases and more than 162,000 deaths,” Emily Rauhala reports.
Chuang Yin-ching, an infectious-disease specialist with the Taiwan Centers for Disease Control, told The Post about learning about the coronavirus. He held a news conference in mid-January to warn the world, days after listening to local health officials in Wuhan, China, describe the mysterious new virus.
“Taiwan took immediate action. The United States did not,” Emily writes. “ … Much of Taiwan’s coronavirus strategy — masks, contact tracing, testing, quarantine — has been well documented. But Chuang’s testimony about the earliest days of the outbreak offers additional lessons about how Taiwan was able to stop the coronavirus in its tracks — while the United States was overrun.”
A few more stories to catch up on this morning:


Three months into the pandemic, here’s how likely the coronavirus is to infect people

Three months into this pandemic, scientists are coming to understand the novel coronavirus. They know, for example, that as horrible as this virus is, it is not the worst, most apocalyptic virus imaginable. Covid-19, the disease caused by the virus, is not as contagious as measles, and although it is very dangerous, it is not as likely to kill an infected person as, say, Ebola.
But there is one critically important, calamitous feature of SARS-CoV-2: the novelty. When it jumped from an animal host into the human population sometime late last year, no one had immunity to it. That is one reason the new coronavirus is not comparable to a harsh strain of the flu going around.
The first cluster of mysterious, pneumonia-like respiratory illnesses was reported in Wuhan, China, at the end of December, and in the days that followed, it spread explosively. With astonishing speed, this submicroscopic pathogen has contaminated the planet, infecting more than 600,000 as of Saturday and killing at least 28,000, grinding global commerce to a near standstill and rattling the nerves of everyone brave enough to be following the news.
“This is a new virus that has landed in the human community. We are a brand-new, naive population. We’re kind of sitting ducks, right?” said Ilhem Messaoudi, a virologist at the University of California at Irvine.
Most viral contagions in circulation face obstacles in the form of people with at least partial immunity. But this coronavirus is a bulldozer. It can flatten everyone in its path.
When the virus infects people, they don’t get sick right away. Researchers believe the  incubation period before symptoms is roughly five days on average. In studying the pattern of illness, epidemiologists have made the dismaying discovery that people start shedding the virus — potentially making others sick — in advance of symptoms. Thus, the virus has a gift for stealth transmission. It seeds itself in communities far and wide, where vulnerable human beings represent endless fertile terrain.
At the genetic level, the new virus is not terribly different from the SARS virus that emerged in China in 2002 — which is why the new one has the derivative name SARS-CoV-2. SARS killed nearly 1 in 10 patients. But people with SARS infections did not shed the virus until they were already quite sick, and victims were typically hospitalized. SARS was snuffed out after causing about 8,000 infections and 774 deaths worldwide.
That successful fight may have led to some complacency; researchers say funding for SARS research dried up in recent years.
“We thought we cured it. We thought the virus disappeared. Well, the virus didn’t disappear, did it?” said Michael Buchmeier, a UC Irvine virologist who has studied coronaviruses for three decades.
Because this is such a contagious virus, a large percentage of the world’s population, potentially billions of people, could become infected within the next couple of years. Frantic efforts to develop a safe and effective vaccine are likely to take a year or more.
President Trump and others have repeatedly downplayed the threat of covid-19 by comparing its lethality to seasonal influenza, which claims tens of thousands of lives in the United States every year. But covid-19 may be many times as lethal for an infected person as seasonal flu.
Messaoudi noted that the health system is set up to deal with the seasonal flu, but not with a new, pandemic disease.
“We have a vaccine for the flu. And antivirals. It’s seasonal, we prepare for it, we try to get vaccination coverage; this is already what our system is dealing with,” she said. “This is the wrong time to deal with another surge of a respiratory disease that causes a lot of morbidity and potentially mortality.”
The bulldozer nature of coronavirus means widespread severe illnesses and deaths from covid-19 can happen with terrifying speed. This happened in northern Italy, where hospitals become overwhelmed and many patients couldn’t get standard lifesaving treatment.
The pandemic appears to be largely driven by direct, human-to-human transmission. That is why public health officials have told people to engage in social distancing, a simple but effective way to drive down virus’s reproductive number — known as R0, pronounced “R naught.” That is the average number of new infections generated by each infected person.
The R0 is not an intrinsic feature of the virus. It can be lowered through containment, mitigation and ultimately “herd immunity,” as people who have recovered become less susceptible to infections or serious illnesses. For the epidemic to begin to end, the reproduction rate has to drop below 1.
In the early days in China, before the government imposed extreme travel restrictions in Wuhan and nearby areas, and before everyone realized exactly how bad the epidemic might be, the R0 was 2.38, according to a study published in the journal Science. That is a highly contagious disease.
But on Jan. 23, China imposed extreme travel restrictions and soon put hundreds of millions of people into some form of lockdown as authorities aggressively limited social contact. The R0 plummeted below 1, and the epidemic has been throttled in China, at least for now.
The virus does have an innate infectivity, based on how it binds to receptors in cells in the respiratory tract and then takes over the machinery of those cells to make copies of itself. But its ability to spread depends also on the vulnerability of the human population, including the density of the community.
“If you have a seriously infectious virus and you’re sitting by yourself in a room, the R naught is zero. You can’t give it to anybody,” says Jeffery Taubenberger, a virologist with the National Institute of Allergy and Infectious Diseases.
Without a vaccine or a drug to stop infections, the best hope is to break the chain of transmission one infection at a time. There is no way to combat the virus through aerial spraying, dousing the public drinking water with a potion or simply hoping that it will magically go away.
“Social distancing is building speed bumps so that we can slow the spread of the virus. We have to respect the speed bumps,” Messaoudi said.
Melissa Nolan, an epidemiologist at the University of South Carolina, said the efficacy of social distancing “is the million-dollar question right now.”
She compared the current public measures to what happened during the 1918 influenza pandemic that killed an estimated 675,000 people in the United States, and in which some cities were more careful than others about enforcing social distancing.
“The USA is currently in a natural experiment of sorts, which each state implementing their own version of social distancing,” she said. “We will be able to compare the efficacy of these various public health policies, but not until more time has passed.”
The social distancing effort requires individual participation on behalf of a collective need. But it is self-interested first and foremost: No one wants to catch this virus. It can be deadly, and even if not, many victims are miserable for days or even weeks on end.
Not only must people limit their direct contact, they need to limit the amount that their paths overlap, because the virus can linger on surfaces.
The virus degrades outside a host because of exposure to moisture and sunlight, or from drying out. But a study published in the New England Journal of Medicine showed that in pristine laboratory conditions, some SARS-CoV-2 particles can remain potentially viable on metal or plastic for up to three days.
It is unclear to what degree contact with contaminated surfaces is playing a role in the contagion. This is obviously something everyone would like to know when they handle the pump at a gas station or go to a grocery store. Absent hard data, limiting contact with shared surfaces, such as door handles or checkout machines, and frequent hand-washing is highly advisable.
Even though we do not have a vaccine, and no one had immunity to this novel pathogen, people have some innate, mechanical defenses against viruses just like they do against pollen and dust, Taubenberger noted. Cells in the respiratory tract have tiny hairlike projections, called cilia, that move mucus toward the throat in a manner that helps clear invasive particles. This is not our body’s first viral rodeo.
joel.achenbach@washpost.com


Key terms of the coronavirus outbreak, explained: From asymptomatic to zoonotic

With health officials trying to prevent and prepare for the spread of the coronavirus in the United States, there is much panic and confusion and many questions. Here are some key terms and facts to know: Coronavirus: Covid-19: Zoonotic: Community transmission: Outbreak: Epidemic: Pandemic: Fatality rate: Asymptomatic transmission: Isolation: Quarantine: Containment: Mitigation: Vaccine: Anti-viral medicines:


U.S. stocks sink as U.K. coronavirus mutation sparks alarm

Global markets swooned Monday as a new coronavirus strain in the United Kingdom sparked renewed travel restrictions in Europe and uncertainty among investors.
Recent days had offered a parade of good news for traders, with the rapid-fire approval and rollout of Pfizer and BioNTech and Moderna’s coronavirus vaccines and the long-awaited deal on Congress’ $900 billion economic relief package. But a fast-spreading variant of the coronavirus in England has thrown another wrench into hopes that normalcy is just around the corner. Fears of the mutation prompted travel bans to the region by European countries and Canada over the weekend, as well as severe lockdown restrictions on millions in London and across southern England.
"The precautions required to assess the potential harm of the new Covid-19 strain will undoubtedly introduce additional risk to markets, which expected a smooth return to normal life following the vaccine’s rollout,” James McDonald, chief executive and chief investment officer of Hercules Investments, said Monday in comments emailed to The Post.
European markets plummeted on the news. The benchmark Stoxx 600 index declined 2.7 percent in midday trading, while France’s CAC 40 and Germany’s DAX both slumped nearly 3 percent. The U.K.’s FTSE 100 index declined 2.5 percent.
Major U.S. indices declined 1 percent or more at the opening bell Monday before recovering some losses. The Dow Jones industrial average ended the day barely positive at 30,215. The S&P 500 index had declined .4 percent to 3,694, while the tech-heavy Nasdaq ticked .1 percent lower to 12,742.
U.K. health officials have said the variant first identified there was spreading 70 percent faster than other strains. The variant has now been found in Australia, Denmark, the Netherlands, Italy and South Africa. But U.S. public health experts and federal officials say that while this strain is fast-spreading, it might not be any more dangerous than others already detected.
There is no evidence yet that the mutation could require changes to coronavirus vaccines, experts say, but investors still are thrown by the prospect of another major setback on the road to recovery. Despite the catastrophic impacts of the pandemic’s first wave, stock markets have hovered near or at record highs for weeks even as U.S. coronavirus deaths have soared past 317,000 and the economy shows signs of slowing.
“We should keep in mind how far we’ve come,” Chris Larkin, managing director of trading at E-Trade, said in comments emailed to The Post. “If the year had ended Friday, [the S&P’s] annual return would have been 14.8% — placing it comfortably in the top half of yearly gains since 1960. Not bad, considering the SPX was down 32% on the year in March.”
The prevailing unease was reflect in oil markets Monday, where the revival of European travel restrictions sparked fears of another broader lockdown. Brent crude, the global oil benchmark sank, 4.1 percent to trade at $50.10 per barrel. West Texas Intermediate crude, the U.S. benchmark, fell 4.2 percent to trade at $47.04 per barrel.
“Crude prices plummeted as a fast-spreading variant of the coronavirus emerging from the UK would cripple all travel across Europe and the US,” Ed Moya, senior market analyst at OANDA, said Monday in comments emailed to The Post. “The short-term crude demand outlook just got dealt a massive blow that will provide added uncertainty over the next couple of months. ”


U.S. officials debate travel bans as coronavirus variant spreads in Britain

The new, mutation-laden variant of the coronavirus that has been spreading rapidly in the United Kingdom may already be circulating in the United States and other countries, leading infectious-disease experts said Monday.
There is no evidence that this variant causes more severe illness from covid-19, the disease caused by the novel coronavirus. And scientists do not know with certainty whether this variant, officially known as B.1.1.7, is truly more transmissible. But it has the appearance of being so.
“We don’t know that for absolutely certain, but it is reasonable to assume that is going on,” Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday.
“Nor is there any indication that the mutation would interfere with the response to the vaccine,” Fauci added. “Having said all of that, when you’re dealing with mutations, you have to follow them very closely and don’t take them lightly.”
The appearance of a coronavirus variant — which experts are so far not describing as a functionally distinct “strain” — has generated a host of travel bans among nations hoping to limit import of the virus from the United Kingdom. This variant and another one identified in South Africa that contains a similar mutation have generated ominous headlines at a moment when positive news about vaccines had offered hope that the end of the pandemic could arrive in the not-too-distant future.
Several top infectious-disease experts said Monday the variant may not have originated in the United Kingdom. Instead, it may have been identified there first because the United Kingdom has a robust monitoring system that has examined tens of thousands of genomic sequences of virus samples.
The United States has lagged in sequencing and does not have nearly the same level of virus surveillance.
“It may very well be here. It may have even started here. The sequencing in the U.S. is so sporadic,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School.
“It makes sense that it was detected first in the U.K. because they have probably the world’s best surveillance program. It would not shock me at all to find out that it also is circulating in the U.S.,” said Angela Rasmussen, a virologist at the Georgetown Center for Global Health Science and Security.
She added that the coronavirus already in the United States is spreading easily, and a new variant will not change the need for people to follow public health guidance. A travel ban affecting flights from the United Kingdom might make little difference, she said.
“I don’t think a travel ban is going to be particularly helpful. We already have out-of-control transmission of all the variants that are circulating in the U.S. here,” she said.
Fauci said: “It very well might be here for all we know. That’s why we have a system to do surveillance.”
Throughout the country, public health and elected officials grappled with how to respond to the new variant while seeking to calm public nerves just as a mass vaccination campaign gets underway.
New York Gov. Andrew M. Cuomo (D) called on the federal government to halt flights from the United Kingdom, citing decisions by several European countries to do so and the unknowns about the new variant. In the absence of federal action, he said he had taken a step within his power: Asking the three airlines that fly from the U.K. into New York — British Airways, Delta and Virgin Atlantic — to require all travelers to test negative before boarding. All three airlines agreed to do so.
“I believe intuitively [the new variant] is already here . . . because if it’s been flying around the world, it will be here,” Cuomo said. “We learned this lesson the hard way, and we’re not going to go through it again. We have been victimized by federal incompetence and federal negligence, that is fact. And we are not going to be victimized again. . . . I believe my intuition is correct that this is another disaster waiting to happen.”
Across the Hudson River in New Jersey, officials seemed far less alarmed. Asked why he had not attempted to restrict travel from Britain, Gov. Phil Murphy (D) said: “I think the science around that is still to be determined.” But he added that the state was discussing the matter with the Port Authority of New York and New Jersey, which oversees airports in the region, including Newark Liberty International Airport.
Christina Tan, New Jersey’s state epidemiologist, noted that viruses frequently mutate and there is no evidence to suggest the variant would affect vaccination efforts. The main takeaway, she said, was that people should avoid travel that is not essential. “Whether you have concerns about a new variant from the U.K. versus a hot spot from another part of the country, does it really matter?” Tan said.
Canada issued a 72-hour ban on flights from the United Kingdom on Sunday, and it took effect within hours, at midnight. Canada’s minister of transport, Marc Garneau, said the move “will reduce the public health risks to Canadians.”
President Trump had issued a proclamation partially banning travel from the United Kingdom in March, though there were numerous exceptions, including for U.S. citizens and permanent residents, as well as some relatives. Travel fell sharply, but thousands of people have continued to fly to the United States from the United Kingdom each month.
According to the latest figures from the U.S. Bureau of Transportation Statistics and aviation data firm Cirium, more than 13,600 passengers flew directly from the United Kingdom to the United States in June. That figure has continued to climb. Airlines for America, an industry advocacy group, said total passengers arriving from London’s Heathrow Airport topped 30,000 in November.
U.S. officials said health authorities have been considering the best course, and discussions are underway among senior officials.
“CDC is following the situation closely and actively assessing the implications of the new variant and response options with respect to international travel,” the agency said in a statement.
In Chicago, Allison Arwady, commissioner of the city’s Department of Public Health, said the new variant did not give her “major pause” and should not undermine the vaccine campaign.
“It still has the same crown, it still has the same spikes, there’s no major changes in any way that we would anticipate the vaccine would not be effective,” Arwady said. “It does not in any way affect us here in Chicago in terms of our planning or how the virus is behaving here. And, importantly, nothing about this at this point is concerning from a vaccine protection standpoint.”
In California, Gov. Gavin Newsom (D) said his administration had been in discussion for the past 48 hours with airlines and “stakeholders” in the state about possible new quarantine and testing protocols for travelers arriving from the United Kingdom. He said he hoped “the federal government takes action in this space.”
He noted that researchers in California sequence 5,000 to 10,000 coronavirus samples a day and had seen no evidence of a new variant in the state.
Mark Ghaly, California’s health and human services secretary, described the variant as “a little bit more sticky than the covid virus that we’ve been seeing to date.” He said officials there are concerned “because of the unknowns” and will make recommendations about monitoring visitors from the United Kingdom and other affected areas.
“The last thing we want to do is let a new strain of covid come and spread more rapidly or easily across the state,” Ghaly said.
One place well positioned to identify the new variant if it is in the United States is Houston, where  scientists at Houston Methodist Hospital have produced 15,000 coronavirus sequences, according to hospital researcher James M. Musser. They haven’t seen it.
“That’s not to say that it won’t show up. But we do not have it now,” Musser said.
Musser noted that more than 8,000 people have been vaccinated at Houston Methodist,  with an additional 2,000 receiving the vaccine every day. Musser said he is concerned that vaccinations will put “massive selection pressure” on the virus to mutate and to evade the immune response.
“We are at war with an enemy that we have so little intel on, that it’s just shocking to me,” Musser said.
Data from the GISAID Initiative, which provides a global database of coronavirus genomes, shows the United States lags behind many countries in sequencing the virus, having sequenced just 0.3 percent of the approximately 18 million coronavirus cases that have emerged since the start of the year. Forty-four countries surpass that proportion. The United Kingdom has sequenced roughly 8 percent of its outbreak, ranking ninth in the world. Australia, Denmark, Gambia, Iceland, New Zealand, Taiwan and Vietnam have sequenced even higher percentages of their outbreaks.
The emergence of the new coronavirus variant could serve as a wake-up call about the need for better surveillance of the virus, said Jeremy Kamil, a virologist at the Louisiana State University Health Sciences Center-Shreveport.
“The same kind of infrastructure that you’d want to monitor for all kinds of infectious-disease threats is what you’d want to have in place now, but we just don’t really have it in place,” Kamil said.
There have been many false alarms about dangerous mutations of the coronavirus, starting early in the pandemic. But a number of scientists who have been skeptical about reports of mutations are saying this new variant — the existence of which was announced Dec. 14 in the House of Commons — looks like a truly more transmissible version of SARS-CoV-2.
They note that it is defined by not just one, but 17 mutations that popped up together and was first seen in a sample in September. There is no definitive scientific proof that this variant’s rapid spread in recent months is directly driven by the mutations. But they said the mutations are suspicious.
Eight affect the spike protein on the virus’s exterior. The mutations may be helping the virus bind more easily to human receptor cells, scientists said.
“My hunch is that it probably does have some kind of transmission advantage just because it did become so prevalent so quickly,” Rasmussen said.
“The preliminary data is strongly suggesting that it is spreading more easily,” Kristian G. Andersen, an immunologist at Scripps Research, said in an email Monday. “We need to act as if the lineage is indeed spreading more easily as we cannot afford to hope that it’s not and then be wrong about it.”
Even though the appearance of this variant is concerning and will require close surveillance, it is unlikely to undermine the vaccination program, said William Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health.
“The vaccine is a pretty thorough thing,” Hanage said. “Whether or not the existing vaccines are less effective against B.1.1.7 is at the moment not known. I think there is good reason to think they will not be severely impacted.”


Experts dispute reports that coronavirus is becoming less lethal

Has the novel coronavirus in Italy changed in some significant way? That was the suggestion of a top doctor in northern Italy who reports that patients to his hospital have been showing up with lower levels of the virus in their upper respiratory tracts compared with those two months ago.
Alberto Zangrillo, head of San Raffaele Hospital in Milan, roiled the global public health community on Sunday when he told RAI, the national TV station, that “the virus clinically no longer exists in Italy,” with patients showing minute amounts of virus in nasal swabs. Zangrillo theorized in a follow-up interview with The Washington Post that something different may be occurring “in the interaction between the virus and the human airway receptors.”
He added, “We cannot demonstrate that the virus has mutated, but we cannot ignore that our clinical findings have dramatically improved.”
The comments, which received widespread attention following a Reuters report, prompted vigorous pushback from Michael Ryan, a top official with the World Health Organization, who said Monday during an online news conference that “we need to be exceptionally careful not to create a sense that all of a sudden the virus by its own volition has now decided to be less pathogenic. That is not the case at all.”
The consensus among other experts interviewed Monday is that the clinical findings in Italy likely do not reflect any change in the virus itself.
Zangrillo’s clinical observations are more likely a reflection of the fact that with the peak of the outbreak long past, there is less virus in circulation, and people may be less likely to be exposed to high doses of it. In addition, only severely sick people were likely to be tested early on, compared with the situation now when even those with mild symptoms are more likely to get swabbed, experts said.
The pandemic is evolving rapidly, with the rate of new cases declining in some hard-hit areas of the world, including northern Italy and New York City, while rising dramatically in Brazil, Peru and India. The virus, however, is mutating at a slow rate, experts say.
Some strains
Vaughn Cooper, an infectious-disease expert at the University of Pittsburgh School of Medicine, said the new coronavirus mutates slowly compared with influenza and other microbes, and its genetic changes appear to be “mostly inconsequential.”
“I believe it’s safe to say that the differences that doctors are reporting in Italy are entirely due to changes to medical treatment and in human behavior, which limit transmission and numbers of new infections initiated by large inocula — a larger dose of virus appears to be worse — rather than changes in the virus itself,” he said.
All viruses evolve over time, and many infectious-disease experts think the novel coronavirus will eventually become less lethal to human beings, joining four other coronaviruses in causing common colds. But there is no solid evidence so far that it has changed significantly in the five months since it was first recognized among patients in Wuhan, China.
“The virus hasn’t lost function on the time scale of two months,” said Andrew Noymer, an epidemiologist at the University of California at Irvine. “Loss of function is something I expect over a time scale of years.”
In the United States, the pandemic has taken on a patchwork pattern, with much of the Northeast seeing marked improvement. But some places in the South — Alabama, Texas and Virginia, for example — as well as Wisconsin, California and Washington state are showing increases in confirmed cases, according to the coronavirus tracker of Johns Hopkins University.
“Every place has a different epidemic, and it’s not because of the virus,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security.
Slight tweaks in the microbe’s genetic makeup appear in different places on the planet. Epidemiologists use those mutations to track the virus’s spread. Those changes are akin to stickers slapped on a well-traveled suitcase — markers of where the luggage has gone that don’t impart any functional change.
Researchers Harm van Bakel, Emilia Sordillo and Viviana Simon at the Icahn School of Medicine at Mount Sinai, who have been focusing on the genetics of the novel coronavirus, said in an interview that they had not seen a dip in viral load among patients in that hospital system since March, nor have they detected any major genetic changes in the virus in New York City.
People in the United States are collectively holding their breath, meanwhile, to see if there is an uptick in cases in response to the reopening of the economy, public gatherings over the Memorial Day holiday weekend and the eruption of protests against police violence in cities in recent days.
Nuzzo pointed out that it usually takes around five days, and up to 14 days, for an infection to result in symptoms, and then there is a further time lag before someone seeks a test and gets a result. There is also a lag between when symptoms begin and a person with a serious illness requires hospitalization. Thus it may be several weeks before the lessening of social distancing could result in a detectable change in the trajectory of a local epidemic, she said.
Compounding the uncertainty
“We never knew where the transmission was occurring in the United States. And still don’t know,” she said. “Is it risky to go to the grocery store?”
Caitlin Rivers, an epidemiologist and senior scholar at Johns Hopkins, noted that it is hard to tell to what degree people are practicing recommended safety measures, such as social distancing, in communities that have eased stay-at-home orders. She is most concerned about crowded institutions in which social distancing is difficult or impossible.
“I think we will continue to see explosive outbreaks connected to institutions,” Rivers said.
Of the 10 counties in the United States experiencing the greatest increase in their seven-day new case average from Friday, May 22, to Friday, May 29, at least nine have experienced outbreaks at a correctional facility, detention center, food processing center, or long-term-care facility.
“An outbreak starts at an institution, then it starts to move into the community,” Rivers said. “We can’t just say, ‘It’s there at that place, it’s irrelevant to the rest of us.’ That’s not true.”


The coronavirus disarms the foot soldiers of the immune system. Scientists theorize that boosting them could fight covid-19.

Researchers across the planet are racing to harness one of the immune system’s front-line defenders as an early treatment for covid-19, the disease caused by the coronavirus that has killed more than 800,000 people globally.
Until now, early-stage treatments have remained elusive. But an improved understanding how the virus disarms some of the body’s immune fighters, called interferons, is creating excitement among scientists who theorize they might be able to counter that process and prevent infections from developing into severe disease.
Interferons are immune proteins that normally interfere with a virus’s life cycle — hence the name, interferon. In addition to their antiviral properties, they summon natural killer cells, “the best soldiers, as it were, of the innate immune system,” Anthony S. Fauci, director of National Institute of Allergy and Infectious Diseases, said in an interview.
That system is both the body’s whooping air-raid siren and its emergency responders rushing to the scene. The virus’s ability to hamstring this system may be one of the keys to its success.
Now, several trials are underway in the United States and elsewhere to see whether giving interferon drugs to coronavirus patients early on might prevent severe disease or hasten recovery if administered later.
Driving the trials are a spate of recent studies showing that interferons are weakest in the worst coronavirus cases. Scientists in France came to this conclusion after examining cells in the blood of 50 covid-19 patients who had spent 10 days in the hospital, as they wrote in a study published Aug. 7 in the journal Science.
“We found that the more severe the patients were, the less interferon type-1 they were producing,” said Benjamin Terrier, a professor of internal medicine at the National Reference Center for Rare Systemic Autoimmune Diseases in Paris’s Cochin Hospital, referring to a subset of the proteins normally deployed against viruses.
This spring, Benjamin tenOever, a microbiology professor at the Icahn School of Medicine at New York’s Mount Sinai Hospital, and his colleagues came to similar conclusions after studying the virus in samples taken from humans, ferrets and infected cells grown in a lab. Interferons, as they reported in the journal Cell, were lacking in all of those.
“The virus is very actively repressing both the production of and the sequencing of interferons,” meaning the process by which the body makes these proteins, tenOever said.
This weakening happens not only in patients’ lungs but in their blood, according to new research by Bali Pulendran, an immune system expert at Stanford University School of Medicine, and his colleagues.
The team isolated immune cells from the blood of patients with severe covid-19, placed them in petri dishes and tried to provoke them with bacteria and viruses. Normally, such provocations would cause the immune cells to erupt in a shower of interferons and other defensive molecules.
But, as the scientists reported in a paper published Aug. 11 in Science, those cells in covid-19 patients were inert. It was as though the coronavirus, or a consequence of its infection, had snipped their fuses.
“After eight days or so, the type-1 interferon system is completely absent, and silenced, by the infection,” Pulendran said.
Interferons’ therapeutic possibility
Researchers caution that many questions about interferon treatments for coronavirus patients remain unanswered. Past clinical studies that tested them to treat SARS and MERS showed little or no benefit.
But there are promising early signals. Preliminary results from a small randomized clinical trial, publicized in a news release in late July by the British company Synairgen, suggests that an inhaled interferon treatment reduced the odds of developing severe covid-19, compared with a placebo. Experts cautioned that the trial was small, just 101 patients, and the results were not yet published in a peer-reviewed study.
In France, investigators plan to test interferon treatments if cases continue to rise. But they are currently too low to enroll enough patients in a clinical trial, Terrier said.
A large, U.S. National Institutes of Health-sponsored clinical trial launched this month will test an interferon drug injected in patients hospitalized with covid-19. Those patients will receive interferon beta-1a, a synthetic molecule identical to the protein our bodies make, every other day for the first week of their hospital stay.
The trial is recruiting about 1,000 patients from 100 hospitals around the world. The patients will be sick but not so ill as to require ventilators to breathe. That speaks to the goal of treating the disease before it worsens.
“What you’re likely going to see, as more antivirals come along and then the monoclonal antibodies come along, will be a propensity to treating as early as you possibly can to prevent people from getting into the hospital,” Fauci said.
The patients in the study will also get remdesivir, an antiviral agent the FDA authorized in the spring. Researchers will compare their recovery against that of covid-19 patients who received remdesivir alone. “The purpose of it is to determine whether you get added value,” Fauci said. The trial is slated to run through November 2023.
Should interferon beta-1a prove useful, Fauci said he doubted there would be shortages, because it is already widely used, for instance, to treat multiple sclerosis. Interferon drugs were also previously used as a standard treatment for hepatitis C, though newer, more-effective therapies have largely replaced them.
Despite their potential, interferons may not be a panacea, scientists cautioned.
“In principle, you could think, why don’t we just give it to everybody who has a viral infection ever,” said Tufts University microbiologist Marta Gaglia. “But in reality, it has proven less effective than we would like.”
A critical factor may be getting the timing right. The new studies suggest interferon treatments would be most helpful in the earliest stages of the disease, but that window may close before most people are hospitalized and doctors can treat them.
“Interferon also has a lot of side effects,” Gaglia pointed out. These include muscle aches, fever and other ailments associated with flu infections. “So we wouldn’t want to use it unless we think it’s going to be beneficial.”
She said she would like the NIH-sponsored trial to answer whether giving interferon drugs to hospitalized patients is helpful, and what dosages yield the best results.
What’s more, pitting these virus fighters against the coronavirus too late in the process could actually worsen symptoms, according to animal models cited in a recent review of interferon studies.
Missing interferons, severe symptoms
Scientists theorize that the virus’s ability to disarm interferons early on may explain other aspects of the disease, such as the out-of-control inflammation reaction that develops in some patients.
As the immune system mounts an inflammatory defense — but there are too few interferons to quickly contain the virus — the body’s response can spiral out of control, several scientists said. In some cases, this uncontrolled inflammation becomes deadly.
Some experts also suggest that a person’s ability to mobilize interferons to wage a strong immune response at the start of the infection process may predict less severe disease.
“We know that individuals differ in their ability to mount an interferon response,” said pediatrician Petter Brodin, who studies the immune system at the Karolinska Institute in Sweden.
When otherwise healthy people fall ill, Brodin said, “it makes me wonder at least — do they have a genetic susceptibility, an underlying immunodeficiency that we haven’t picked up yet, which gives them this response, potentially because they failed to induce interferons?”
There is preliminary evidence for this, such as a case study of four men under age 35 who had rare genetic variants associated with impaired interferon response and who were hospitalized in the Netherlands with severe covid-19.
Cause and effect is very difficult to determine in the human immune system. The Science papers used a variety of techniques to examine the virus, but they described only single points in time.
“You are getting more of a snapshot,” said Gaglia, who was not involved with these reports. What happens on the third day of an infection may not be what happens on the 10th. “And so you are trying then to make an inference of the sequence of events.”
Additional studies of the immune system can help unravel the stages of infection. Pulendran said his team is collecting blood samples at regular, frequent intervals “to map out the trajectory of this disease.” The race to understand and shore up our inner defenses continues.
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Away from U.S. election fever, coronavirus rages on

You’re reading an excerpt from the Today’s WorldView newsletter.
It’s been a distracting week, but don’t ignore
At least 12 people in Denmark have been infected with the new strain, which was probably introduced to the mink population by humans before mutating and spreading back to the human population. Experts fear that current vaccines in production may prove ineffective against this version of the virus. Danish police and military personnel are expected to be deployed to carry out the mass cull, while authorities implemented new restrictions on movement between certain regions in northern Denmark.
Elsewhere in Europe, the surge of the coronavirus rages on. England reentered a national lockdown Thursday, with British Prime Minister Boris Johnson warning that such measures were necessary to prevent the collapse of the country’s health system. Italy reported 445 coronavirus-related deaths Thursday, the country’s highest daily fatality count since April.
Also on Thursday, France reported a daily record for coronavirus infections, with the country’s health minister saying that coronavirus patients already accounted for some 85 percent of French hospitals’ intensive-care capacity. This week, Germany, Hungary and Poland also all posted daily records in new coronavirus cases. The Czech Republic, which has the highest coronavirus infection rate in Europe after Belgium, asked the World Health Organization to send an emergency medical team to the country because thousands of Czech medical professionals have been infected with the virus.
Though death rates are not as high as they were in the first wave of the virus, they are slowly climbing around the world. According to a tally by researchers at Johns Hopkins University, Latin America now accounts for 1 out of 3 coronavirus-related deaths.
The picture is all the more alarming in the United States.
“With nearly 9.5 million coronavirus cases reported, the United States is adding new infections at an unprecedented rate,” my colleagues reported. “The seven-day average for new cases hit record highs in 20 states spanning every region of the country Wednesday, with the largest increases in Colorado, Maine, Minnesota and Iowa.”
Trump’s record in managing the crisis has not helped. In public and private, he has feuded with many of the administration’s senior public health officials, blaming their warnings and assessments for stoking panic and hurting the American economy. An internal report put forward at the beginning of the week by Deborah Birx, coordinator of the White House coronavirus task force, seemed to fault the administration for not adequately preparing for what could be a dark winter.
“We are entering the most concerning and most deadly phase of this pandemic … leading to increasing mortality,” said Birx’s report, which my colleagues reported on first. “This is not about lockdowns — it hasn’t been about lockdowns since March or April. It’s about an aggressive balanced approach that is not being implemented.”
Birx contradicted Trump on many fronts
“Even if Biden wins, we still have several months of the Trump administration in which the epidemic is at its worst,” Carlos del Rio, an infectious-disease expert at Emory University, told the New York Times. “Trump is not in charge. He’s given up, he has basically implied, ‘I don’t care about this’ and he has turned it over to the governors.”
The Biden camp has already assembled a coronavirus task force of leading public health experts, who will attempt to map out strategies for, among other things, an efficient, widespread delivery of vaccines and better coordination between federal agencies and the states, should there be a change in power. But their efforts may get stymied in the current smoldering political environment.
“The transition team has also discussed contingency plans for the possibility that the Trump administration would refuse to cooperate and share information during a transition, according to another source close to Biden,” Politico reported. “The prospect of dueling task forces in both outgoing and incoming administrations could create tension as the country races to develop a Covid-19 vaccine, as one or more of the candidates currently in clinical trials could be approved during the transition.”
Observers elsewhere can only shake their heads at America’s turmoil. “At a time when the nation should be pulling together with what the British would call Blitz spirit, the streets of many cities have been the setting for what appear to be the beginnings of civil strife,” noted an editorial in the National, an English-language daily in the United Arab Emirates.
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