How COVID-19 is transmitted completely upended; here’s what we need to reopen

If you’re working in an office or eating in a restaurant, and someone 30 feet away exhales tiny particles of the coronavirus, those particles can drift and infect you. Picture cigarette smoke wafting across a room. Same thing. The precautions global and federal agencies are advising aren’t good enough. ­Social distancing — keeping six feet away — and washing your hands won’t protect you from this airborne virus. That isn’t fear-mongering. It’s science.

To defeat COVID-19 and reopen our economy, we all need to become radical indoor environmentalists, shifting our attention from outdoor air quality to the air we breathe indoors.

New research from the ­National Academy of Sciences contends that airborne transmission of the virus is “highly virulent,” the “dominant” way it spreads.

On Monday, 239 scientists jointly announced research showing “beyond any reasonable doubt” that “viruses are released during exhalation, talking and coughing in micro-droplets small enough to remain aloft in the air” and that can spread across a room.

They didn’t say what proportion of infections are caused that way, but the evidence may explain how one “super-spreader” in a room can ­infect dozens of other people.

The scientists, including engineering experts, urged countries battling the virus to make buildings healthier, by improving ventilation and installing air-cleaning technologies.

Here’s the takeaway: Indoor air quality is the key to reopening safely.

The scientists cited research showing how three families at three different tables in a restaurant in China all became infected with the ­virus. One person at table A came in with it, and when he talked, he emitted viral droplets that were carried across the room in a stream of air-conditioned air, infecting diners at two other tables.

In a restaurant, you’re maskless and more vulnerable. The mounting evidence on airborne transmission underscores the importance of masks and eye glasses or goggles. Viral particles can invade eye membranes too. The journal Lancet reports that “eye protection is typically under-considered.”

As for improving indoor safety, kudos to Gov. Cuomo for becoming an indoor environmentalist. At his June 29 briefing, he expressed concern about the airborne virus particles circulating in malls.

Unfortunately, he went too far, mandating that they install specific equipment — HEPA filters — in their air conditioning, before they’re allowed to reopen.

Mall owners are pushing back against the HEPA mandate, saying the filters won’t work with their existing systems or will cost too much.

Airlines use HEPA. Most recycle about 30 percent of cabin air through HEPA filters, and exhaust the other 70 percent out of the plane. The cabin air is replaced about every three minutes. So a plane is an unlikely place to become infected by airborne COVID-19: A passenger must still worry about people seated close by and about contaminated surfaces, but not dirty air.

Unfortunately, few indoor spaces can be fitted like airplanes to turn over air in three minutes. But there are other, newer technologies that can be installed to combat airborne viruses.

“Healthy buildings should be the first line of defense” against the coronavirus, says Joseph Gardner Allen from Harvard’s School of Public Health. And against indefinite lockdowns.

Reopening plans proposed by most states and the Centers for Disease Control and Prevention overlook the problem of airborne spread and don’t consider high-tech remedies.

What the United States needs is a Green Indoor Deal, an infrastructure-spending plan to equip workplaces. It would be a bargain compared to prolonged unemployment benefits.

It could also help schools ­reopen. School-aged kids pose the lowest infection risk. Yet Mayor Bill de Blasio is insisting kids learn from home half the time. Why? The CDC recommends that students’ desks be spaced six feet apart, making it impossible to fit the whole class in one room. It’s going to be a nightmare for parents.

The CDC’s antiquated six-foot rule ignores that the virus can spread through the air and the technologies to battle that.

You may wonder why you haven’t heard this information from the CDC or the World Health Organization. They’re behind on the science. On Tuesday, WHO grudgingly acknowledged “the emerging evidence.”

It’s airborne, and it’s time to deal with that.

Betsy McCaughey is the chairwoman of the Committee to Reduce Infection Deaths and author of the forthcoming book “The Next Pandemic.”

https://nypost.com/2020/07/08/how-covid-19-is-transmitted-completely-upended-heres-what-we-need-to-reopen/

AnaptysBio’s imsidolimab an Orphan Drug in U.S. for rare type of psoriasis

The FDA designates AnaptysBio’s (ANAB +0.5%) imsidolimab, an interleukin-36 receptor (IL-36R) inhibitor, an Orphan Drug for the treatment of patients with generalized pustular psoriasis (GPP), a very rare form of psoriasis characterized by pus-filled blisters on the skin.

Among the benefits of Orphan Drug status in the U.S. is a seven-year period of market exclusivity for the indication, if approved.

https://seekingalpha.com/news/3589661-anaptysbios-imsidolimab-orphan-drug-in-u-s-for-rare-type-of-psoriasis

Merck inks new deal with Zymeworks for up to three antibodies

Merck (NYSE:MRK) inks an agreement with longtime partner Zymeworks (NYSE:ZYME) for a global license to develop and commercialize up to three multispecific antibodies to Merck targets in the animal health field using ZYME’s Azymetric and EFECT platforms.

Under the terms of the deal, ZYME will receive an undisclosed upfront payment and, if each program yields an approved product, up to $411M in option exercise fees, up to $480M in milestones and tiered royalties on net sales.

The companies have been working together since 2011 to develop bispecific antibodies. They expanded their partnership in 2014. The new agreement does not affect the original.

https://seekingalpha.com/news/3589660-merck-inks-new-deal-zymeworks-for-up-to-three-antibodies

Optinose surges on XHANCE promotion deal with Kaléo

OptiNose (NASDAQ:OPTN) +22.3% after-hours on news of an agreement with pharmaceutical firm Kaléo to co-promote its XHANCE exhalation nasal spray for the treatment of nasal polyps in adult patients.

Under the deal terms, Kaléo will promote XHANCE to an agreed-upon audience of office-based healthcare professionals to include nearly 6K prescribers, about half of whom are outside of the current Optinose called-on universe of ~10K healthcare professionals.

Last week, OptiNose said it started development of a new product candidate to combine its nasal Exhalation Delivery System technology with an antiseptic that has been recently shown to kill the virus that causes COVID-19.

https://seekingalpha.com/news/3589710-optinose-surges-on-xhance-promotion-deal-kaleo

Where did the Asian longhorned ticks in the US come from?

Asian longhorned ticks outside the U.S. can carry debilitating diseases. In the United States and elsewhere they can threaten livestock and pets. The new study, published in the journal Zoonoses and Public Health, sheds new light on the origin of these exotic ticks and how they are spreading across the United States.

“While additional samples from the tick’s native range are needed to pinpoint more exactly the source of the U.S. introduction, our data suggest that they came from one or more locations in northeastern Asia – either through a single introduction of at least three ticks or as multiple introductions from different populations,” said lead author Andrea M. Egizi, a visiting professor in the Department of Entomology at Rutgers University-New Brunswick and a research scientist with the Monmouth County Tick-borne Diseases Laboratory hosted by the Rutgers Center for Vector Biology.

In 2017, Rutgers Center for Vector Biology and other researchers detected an infestation of the Asian longhorned tick (Haemaphysalis longicornis), which is native to East Asia, in New Jersey. It was the first time established populations of this species had been detected in the United States. Subsequent investigations found the tick to be widespread in the eastern U.S. Rutgers researchers discovered it has been present in New Jersey since at least 2013.

Although this species transmits serious illnesses to people and animals in other countries, experts don’t know whether the tick populations in the United States will make people sick, according to the U.S. Centers for Disease Control and Prevention.

The species has two forms: one with males and females, and one with self-cloning females that lay eggs without needing to mate, a process called “parthenogenesis.” The self-cloning form, free from the need to look for mates, are especially likely to thrive and spread. A single female can establish a fast-growing population. This type entered Australia and New Zealand in the early 1900s, and now causes significant losses in the cattle industry.

Rutgers Center for Vector Biology researchers enlisted about 25 collaborators at 20 institutions to get samples of Asian longhorned ticks across the United States and internationally, and used gene sequencing to detect genetic similarities and differences between various populations.

Their findings indicate that at least three individual ticks, from self-cloning populations, were brought to the United States, which explains why all adult Asian longhorned ticks found in the U.S. so far have been female. Overall, U.S. ticks are more likely to have come from an East Asian country (or countries) than from Australia and New Zealand.

As part of the study, the U.S. Department of Agriculture Animal and Plant Health Inspection Service, Veterinary Services found evidence that these ticks traveled within the United States on wildlife as well as through the transport of pets or livestock.

“One thing we uncovered is the ease with which pets, especially dogs, can accidentally help ticks cross international borders and state lines,” said senior author Dina M. Fonseca, a professor and director of the Center for Vector Biology in the Department of Entomology in the School of Environmental and Biological Sciences. “Many countries require dogs to be treated for ticks and other parasites before entering the country, but the United States does not. We urge greater awareness of this issue to prevent future exotic tick introductions.”

Rutgers-affiliated coauthors include Matthew Bickerton and James L. Occi, both entomology doctoral students.

https://www.eurekalert.org/pub_releases/2020-07/ru-wdt070820.php

Limiting organ damage for patients with severe COVID-19

July 8, 2020

Patients with severe COVID-19 frequently experience a life-threatening immune reaction, sometimes called a cytokine storm, which can lead to respiratory failure, organ damage and potentially death. With no FDA-approved treatment currently available for SARS-CoV-2, the virus that causes COVID-19, researchers are racing to find ways to stop the virus or the inflammatory overreaction it provokes in its tracks.

In a paper published in Cancer and Metastasis Reviews and selected by the journal as the featured publication, a team of researchers from Beth Israel Deaconess Medical Center and Brigham and Women’s Hospital propose that controlling the local and systemic inflammatory response in COVID-19 may be as important as anti-viral and other therapies.

Led by Dipak Panigrahy, MD, of the Cancer Center at BIDMC, and Charles N. Serhan, PhD, DSc, director of the Center of Experimental Therapeutics and a member of the Department of Anesthesiology, Perioperative and Pain Medicine at Brigham and Women’s Hospital, the researchers suggest that a family of molecules naturally produced by the human body may be harnessed to resolve inflammation in patients with severe COVID-19, thereby reducing the acute respiratory distress and other life-threatening complications associated with the viral infection.

“Controlling the body’s inflammatory response is key to the management of COVID-19 and may be as important to managing the pandemic as anti-viral therapies or a vaccine,” Panigrahy said. “Our team proposes using molecules made by the body called pro-resolution lipid mediators — which are currently in clinical trials for other inflammatory diseases — as a novel approach to turning off the inflammation and preventing the cytokine storm caused by COVID-19.”

Cytokines are released by the body as part of its normal immune response to injured or infected tissues. Typically, the body also releases chemicals to put an end to — or resolve — the inflammatory response. But in a significant percentage of patients with severe COVID-19, the cytokines unleashed to kill the virus also do damage to infected lung cells. In turn, this injury to the lung tissues triggers additional inflammation, and the so-called “cytokine storm” begins to spiral out of control.

Naturally occurring molecules called resolvins — discovered by Serhan and colleagues at BWH in 2002 — actively turn off inflammation. Panigrahy, Serhan and colleagues have previously demonstrated that resolvins and related pro-resolution molecules could play a role in preventing cancer metastasis and progression. This class of molecules are also currently in clinical trials investigating their use against other inflammatory diseases, such as ocular, periodontal, and inflammatory bowel disease. Now, the scientists suggest, they could be re-deployed for the management of COVID-19.

“A paradigm shift is emerging in our understanding of the resolution of inflammation as an active biochemical process,” said Serhan. “Activating the body’s own resolution pathways with the use of resolvins and related pro-resolution molecules –which, importantly, promote blog clot removal– may complement current treatment strategies while limiting severe organ damage and improving outcomes in COVID-19 patients.”

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The Panigrahy laboratory is supported by the Credit Unions Kids at Heart Team; the C.J. Buckley Pediatric Brain Tumor Fund; and the Joe Andruzzi Foundation. This work also was funded in part by grants from the National Institutes of Health grants, including (R01GM038765).

https://www.eurekalert.org/pub_releases/2020-07/bidm-rpn070820.php

Lung, immune function in kids could protect from severe COVID-19

Differences in lung physiology and immune function in children could be why they are more often spared from severe illness associated with COVID-19 than adults, according to pediatric and adult physicians at The University of Texas Health Science Center at Houston (UTHealth) and Baylor College of Medicine, who teamed up to investigate the disparity.

The perspectives paper was recently published in American Journal of Physiology-Lung Cellular and Molecular Physiology.

According to the paper, only about 1.7% of the first 149,082 cases in the U.S. were infants, children, and adolescents younger than 18 years old. Authors noted that children under 18 make up 22% of the U.S. population. Only three pediatric deaths were identified by the Centers for Disease Control and Prevention (CDC) as of April 2020.

“These profoundly decreased rates of symptomatic infection, hospitalization, and death are well beyond statistical significance, require further examination, and may hold the key to identifying therapeutic agents,” the authors wrote.

Angiotensin-converting enzyme 2s, called ACE2, are the doors that allow SARS-CoV-2, the novel coronavirus that causes COVID-19, to enter the body’s cells. Children naturally have less ACE2 in the lungs than adults.

“ACE2 are important for viral entry and there seems to be less of them in children, because they increase with age,” said Matthew Harting, MD, MS, assistant professor in the Department of Pediatric Surgery at McGovern Medical School at UTHealth, pediatric surgeon with UT Physicians, and senior author of the paper. Harting is also director of the pediatric ECMO program providing advanced cardiac and respiratory support at Children’s Memorial Hermann Hospital.

In addition to fewer ACE2 receptors, the authors note the immune system in children responds to viruses differently than that of adults, leaving less opportunity for severe illness in pediatric patients. There are several different mechanisms behind the differences, including the retention of T-cells in children, which are able to fight off or limit inflammation.

“T-cells have a viral response and also an immune modulator response. In severe cases of adult COVID-19 patients, we’ve seen that those T-cells are reduced, so the ability to fight the virus is also reduced. In kids, those T-cells seem to be maintained, so they are still able to prevent the virus,” said Harry Karmouty-Quintana, PhD, an assistant professor in the Department of Biochemistry and Molecular Biology at McGovern Medical School, and a co-author of the paper.

Lung tissue in children naturally has a higher concentration of regulator T-cells. Patients with higher levels of T-cells also have higher levels of Interleukin 10 (IL-10), also known as human cytokine synthesis inhibitory factor, an anti-inflammatory cytokine.

“IL-10 inhibits the inflammation of other components like IL-6 that are detrimental. Adults tend to experience hyperinflammatory state, where kids do not,” Karmouty-Quintana said. “In preclinical studies in mice, IL-10 has also shown to decrease with age.”

The paper’s findings were made possible through collaboration in a multidisciplinary group made up of pediatric and adult physicians and scientists in pediatric surgery, adult critical care, neonatology, and molecular biology.

“We, as physicians, have been challenged with the question of how to treat COVID-19 and we’re learning in real time,” said Bindu Akkanti, MD, associate professor of critical care medicine with McGovern Medical School, attending physician in critical care with Memorial Hermann-Texas Medical Center, and a study co-author. “I knew that to figure out the best way to treat adults, we needed to get a team together to get to the bottom of why children were being spared from severe illness related to the virus. So, I reached out to Dr. Karmouty-Quintana and we teamed up with Dr. Harting and two other physicians in the Texas Medical Center to start investigating.” Akkanti also sees pulmonary patients at UT Physicians.

“Collaborations like this between adult and pediatric providers are really important and this disease highlights where we can learn a lot when we compare the way it behaves in younger kids with older people,” Harting said. “Even now as we’re learning about effective treatments, we’re seeing younger people handle this disease better than older people. Moving forward, physicians and scientists need multidisciplinary collaboration to continue learning – this is just another step in the right direction to attack this virus.”

Krithika Lingappan, MBBS, was the first author of the paper and Jonathan Davies, MD, was a co-author. Both Lingappan and Davies are assistant professors of pediatrics at Baylor College of Medicine and neonatologists with Texas Children’s Hospital.

As a result of the collaboration, the team has begun a new study using blood samples from patients in different stages of COVID-19 to continue to understand how to treat the virus and the disparities in disease progression between children and adults.

https://www.eurekalert.org/pub_releases/2020-07/uoth-lif070820.php