Category Archives: Genetic Medicine

This is part of our Coronavirus Update series in which Harvard specialists in epidemiology, infectious disease, economics, politics, and other disciplines offer insights into what the latest developments in the COVID-19 outbreak may bring.

Past work by a range of scholars has shown that 200 black people die every single day in these United States who would not have died if the health experience of African Americans was equivalent to that of whites, said Harvard social scientist David Williams during an online discussion about race and health care last week.

And the coronavirus pandemic provides new figures to support that grim statistic.

A recent CDC report found that among 580 hospitalized COVID-19 patients with race/ethnicity data, approximately 45 percent were white, 33 percent were black, and 8 percent were Hispanic, suggesting that black populations might be disproportionately affected by COVID-19. And a Washington Post analysis revealed that in places such as Chicago and Louisiana, African Americans account for 67 and 70 percent of COVID-19-related deaths respectively, while representing only 32 percent of the population. Experts expect to see more numbers like these as more states and cities report.

As someone who has studied the devastating and fragmented HIV epidemic in African American communities, I had become increasingly concerned that something similar might be happening with the spread of the coronavirus, in other words, that communities of African American people are at risk, said Evelynn Hammonds, Barbara Gutmann Rosenkrantz Professor of the History of Science, last Thursday during the debut of the webinar series Epidemics and the Effects on the African American Community from 1792 to the Present by the Project on Race & Gender in Science & Medicine at the Hutchins Center for African & African American Research.

The recent headlines, added Hammonds, who is also a professor of African and African American Studies, began to highlight my worst fears.

While Thursdays talk helped shine a light on the health disparities related to coronavirus, across the University health care disparities more broadly have long been a focus of academic investigation and research. Those who have spent years studying the issue say the higher rates of conditions such as obesity, diabetes, asthma, and heart disease in African American communities conditions that put people at higher risk of death from infections with the novel coronavirus is a societal failure.

Its been hard for Americans to understand that there are racial structural disparities in this country, that racism exists, said Camara Phyllis Jones, an epidemiologist, family physician, and senior fellow at the Morehouse School of Medicine. If you asked most white people in this country today, they would be in denial that racism exists and continues to have profound impacts on opportunities and exposures, resources and risks. But COVID-19 and the statistics about black excess deaths are pulling away that deniability.

Jones, whose work examines the impacts of racism on the health and well-being of the nation, and who is the 20192020 Evelyn Green Davis Fellow at the Radcliffe Institute for Advanced Study, points to residential segregation as a driver of broad health disparities.

Its segregation in terms of access to healthy foods, and to green space, and excess exposure to environmental hazards, which is why we have things like more obesity leading to more diabetes and more heart disease and more kidney failure, said Jones.

Similarly, those and other social and economic inequities also have led to the higher rates of African Americans contracting the coronavirus, a range of experts say, as opposed to any genetic or biological predisposition.

The coronavirus is really exposing class- and race-based vulnerabilities, particularly in the form of what I think of as toxic inequality, especially the clustering of COVID-19 cases by community, said Robert Sampson, Henry Ford II Professor of the Social Sciences.

African Americans, even if theyre at the same level of income or poverty as white Americans or Latino Americans, are much more likely to live in neighborhoods that have concentrated poverty, polluted environments, lead exposure, higher rates of incarceration, higher rates of violence so that goes beyond individual poverty and we know that many of these things lead to long-term health consequences, he said.

Sampson, who studies links between poverty and social mobility,is one of many scholars at Harvardtargeting inequality. In 2016, he published a paperdemonstrating that Chicagosblack and, to a lesser extent, Hispanic neighborhoods disproportionately bear the burden of lead toxicity that is often found in the citys soil, old paint, and plumbing. He describes the findings as the ecology of toxic inequality.

Adding to the risk amid the current pandemic, said Williams, the Florence Sprague Norman and Laura Smart Norman Professor of Public Health, is the fact that many African Americans work in service jobs that cant be done from home, placing them directly in harms way. He also cited the implicit bias in the nations health care system studies have shown African American patients receive poorer-quality health care than whites as another dimension at which racism could also be affecting the death rates for African Americans.

Both Jones and Sampson advocated for a more widespread national testing strategy for the coronavirus to slow the infection rate. Jones urges a turn away from a clinical health care approach that narrowly focuses on confirming a COVID-19 diagnosis for those who are sick to a broader public health, population-based strategy that tests not only those with symptoms, but also a sample of those who are asymptomatic. Such a step, she argues, could alter the course of the epidemic.

Having that good sense of the extent of the disease will help you know where you have to deploy the health care resources in the weeks and months ahead, as well as isolate asymptomatic spreaders and their contacts, Jones said. And decreasing the spread of COVID-19 will be good for everybody, but especially those who are more exposed, less protected, with higher chronic disease burdens and fewer health care resources.

To help drive change forward, Williams urges scholars to engage with policymakers. I hope those of us in academia can work with those in policy circles to try to gain momentum, to say, We have a problem as a nation; we can do better; we must do better, said Williams.

Hammonds also sees the need for academic engagement.

Theres a lot of information available to people who are well-educated, who can understand the sort of analytical framework in which we come to these questions, said Hammonds. But its not well understood at the level of the high school curriculum, or the undergraduate curriculum, or even graduate school curriculum outside of professional schools of public health. So it seems to me that theres a lot of information that is siloed that needs to be much more expanded.

In a sign of possible movement in that direction, Vice President Mike Pence and Surgeon General Jerome Adams held a conference call last Friday with hundreds of leaders of the African America community to discuss the alarming statistics. The government is working on increased testing and outreach efforts to communities of color, Adams said after the call, and on increased social and financial supports.

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Health care disparities in the age of coronavirus - Harvard Gazette

How is Ireland doing in the fight to slow the spread of Covid-19?

After more than two weeks of lockdown with wide ranging restrictions limiting commercial and social life, the battle rages on and there are no definitive signs that a peak has been reached. The country is at a delicate and critical point in its response to the coronavirus outbreak, according to Liz Canavan the assistant general secretary at the Department of the Taoiseach. Many people have fallen ill and too many have died and while there is some optimism that the Republic may not be hit as hard by Covid-19 as Italy, Spain and the UK, it is still too early to say what may happen in the weeks ahead.

What are the numbers?

On Tuesday, April 14th, 41 more people were reported to have died from coronavirus in the Republic taking the total number of fatalities to 406 while the number of known cases reached 11,479. Modelling data used by the National Public Health Emergency Team shows the daily growth rate has fallen from 33 per cent in the early stages of the outbreak to 9 per cent this week.

What is happening in Northern Ireland?

Ten more coronavirus-related deaths were announced in Northern Ireland on Tuesday, bringing the total number of fatalities to 134. On the same day a total of 1,967 cases had been identified in the North.

How is the Republic doing when it comes to testing?

Testing and contact tracing in real time between 24 and 48 hours is needed to fully contain the disease, experts have said. Minister for Health Simon Harris has said the mantra is to test, test, test. There have been widely reported shortages of testing kits and lab supplies and the waiting times for results, according to the Department of Health, was about seven to 10 days. But things have improved.

HSE chief executive Paul Reid said a backlog in testing had been reduced from a high point of about 35,000 people waiting for results to some 11,000. He told a briefing in Dublin on Tuesday that 25 laboratories were now being used to examine Covid-19 tests, including 20 in hospitals, the national lab in UCD, a Department of Agriculture facility and in Germany. Mr Reid said nearly 8,000 tests were completed on Saturday. That backlog will continue to be reduced and will be reduced completely by the end of this week, he said.

How does that compare with elsewhere in the world?

Mr Reid, has said that Ireland is a top-tier country although that claim has been disputed by some. Dr Sean LEstrange, a social scientist in UCD, has conducted a comparative analysis of reported testing figures. It is difficult to support the claim that Irelands testing practice for Covid-19 is in the top tier in the world, he wrote this week. Ireland is not doing badly and it is certainly not amongst the worst in the world by any stretch of the imagination. Yet compared with other similar-sized and resourced states in the European context, its performance is decidedly middling, he wrote.

How important is the testing?

If you have symptoms, it may not matter all that much. If you become sick enough to be hospitalised, you will get a fast-track result but if not, you stay at home and self-isolate until the symptoms lift. The reason testing really matters is that it is a key part of relaxing restrictions. Building a system that can turn around results, and fast, is key, according to chief medical officer Dr Tony Holohan. We need to have a contact-tracing capacity and testing capacity to give us real-time in other words same-day or following-day results, he said.

Speaking of testing, will the Leaving and Junior Certificate exams go ahead?

Last week, Taoiseach Leo Varadkar said the State exams would go ahead by hook or by crook and so they will or at least one set will. It was confirmed on Friday that the Leaving Cert would take place in late July or August. The Junior Cert, meanwhile, is set to be replaced by school-based exams which will run early in the new school year.

The changes mean tens of thousands of students who are due to progress to third level and further education are likely to commence their courses much later than originally planned. Deadlines for students to complete practicals and project work in a number of subjects such as history, geography and home economics will also be extended until late July. Students had been given a deadline of May 15th to complete this work. While the move will bring much-needed clarity to students over contingency plans for the Leaving Cert, it is likely to be a major disappointment for many students who now face an extended summer preparing for the exams.

Movement is still seriously restricted, what powers do garda have to enforce this?

At the beginning of last week, Mr Harris signed regulations granting powers of enforcement to garda. The powers were passed by the Oireachtas in late March but became active only with the Ministers signature. The regulations are based on the guidelines issued by the Government two weeks ago and anyone exercising more than 2km from their home or with people from outside their household will be in breach of the law. Anyone travelling beyond 2km for non-essential reasons will also be in breach. An offence will be committed only if a person refuses a direction from a garda to comply with the regulations. It is not the breaching of regulations that is illegal, but disobeying the gardas instructions once caught.

Will there be many arrests?

Front-line garda have been instructed to use a four-step graduated policing response in the days ahead and should give members of the public every opportunity to comply with the regulations.

Enforcement will be a last resort and only when all other avenues have been exhausted in most cases, an internal Garda document says. Before resorting to arrest, garda must go through the four-step escalation process termed Engage, Explain, Encourage, Enforce. Engage involves asking people their name and address, reason for travel and if they are aware of the restrictions. Garda may arrest anyone who refuses to give their name and address. If required they then move on to the explain stage, which involves highlighting the risks of breaking the rules. They must then encourage those in breach to stay at home to save lives. The final step, enforce, involves using Garda powers to discourage further non-compliance. This should be done only when necessary and proportionate.

How was the bank holiday weekend?

There was a very high level of compliance with restrictions on non-essential travel over the bank holiday weekend, according to Ms Canavan. A major policing operation was put in place over the Easter bank holiday with checkpoints across the country to ensure people complied with public health guidelines, over fears people would travel to holiday homes due to the fine weather.

And were there many arrests?

Garda made seven arrests over the long weekend under the new legislation. An Garda Sochna said these arrests were made when people repeatedly refused to comply with directions to abide by the movement restrictions which prohibit unnecessary travel and exercise further than 2km from the home. In addition there were 144 incidents where garda enforcing the coronavirus restrictions instead made arrests under other, long-standing legislation. These incidents included arrests for public order breaches, assault, road traffic offences and drug offences. The arrests were made at house parties and street gatherings and where garda found people engaged in non-essential travel.

If I got Covid-19 can I get it again?

No one knows for certain what level of immunity those who have had and then recovered from the illness will have. We simply dont know yet what it takes to be effectively protected from this infection, Dawn Bowdish, a professor of pathology and molecular medicine in Ontario told Scientific American this week.

What we do know is that immunity to other coronaviruses, including the common cold, can start declining within weeks of infection.

Within weeks? That doesnt sound good?

No, but studies of Sars-CoV the virus that causes Sars, which shares a lot of the same elements as Covid-19 suggest that immunity peaks at around four months and offers protection for roughly two to three years. That would give time for a vaccine to be developed without those with the Covid-19 antibodies becoming reinfected.

Are more young people dying from the illness than expected?

The early narrative was that Covid-19 was an illness that largely spared young and healthy people but as it has spread across the world, it has shown itself to be more indiscriminate than many health experts initially thought. As it stands in Ireland more than 90 per cent of the victims have been over 65. While older people and those with pre-existing conditions are most at risk, it has occasionally hit young and apparently fit people including healthcare workers exposed to those with the virus. The youngest person to die so far was aged 30, the oldest was 105 years.

Why is that?

Sometimes previously undiagnosed conditions are later revealed and sometimes there are no such explanations.

What are the scientists saying?

There have been many theories circulating in medical and scientific circles. There is a school of thought which suggests that a huge dose may hit people much harder than smaller doses while another school of thought points to genetic susceptibility with some people more vulnerable to the virus than others, irrespective of their age. It is very possible that some of us could have a particular genetic make-up that makes it more likely that we will respond badly to an infection with this coronavirus, virologist Michael Skinner at Imperial College London told the Guardian newspaper this week.

A person with a high viral load has more virus particles than one with a low load, said virologist Alison Sinclair at Sussex university. We do not yet know what impact viral load has on the symptoms of a person infected with Covid-19. Whether there is a link between a high viral load and worse outcomes is going to be important to find out.

What has been happening in nursing homes in Ireland?

The number of coronavirus infection clusters in nursing homes around the country has reached 149, according to the latest detailed figures on coronavirus cases released by State officials. Nursing homes now account for one-third of the clusters of infection across the country. This is incredibly serious not only because of the vulnerability of those in such care settings. It has become clear that Covid-19 has virus loads which are three times what might be found with other respiratory viruses such as flu, including in older patients, who are more contagious than expected.

How significant is that?

It is very significant. These are the highest viral loads for any virus I know, Prof Marc Van Ranst at the Rega Institute for Medical Research in Leuven, Belgium, said this week. He said he was astonished at the number of the germs he saw from patient throat samples in his lab. Especially surprising, he said, was that elderly people harbour prodigious quantities of virus.

Not many elderly [people] are going to transmit the influenza virus to someone else. They get infected, but are not infecting others, said Prof Van Ranst not so for Covid-19. When I look at the viral loads that we find in elderly people, it is mind boggling, he said. That has been for me the big surprise with this virus. This will influence how contagious elderly people can be and perhaps is reflected in the high number of Covid-19 clusters in nursing homes, he added.

What else have we learned in recent days?

The virus is also abundant in the throats of younger patients according to viral counts reported in the science journal Nature. Nine young to middle-aged office workers near Munich, Germany, who showed mild flu-like symptoms, had their nose and throat swabbed daily and spit samples collected for viral counts. We detected Sars-CoV-2 in enormous amounts in the upper respiratory tract, said Prof Clemens Wendtner, who led the research in Germany 1,000 times more than for Sars. This was shocking news.

All nine patients showed a high rate of viral replication and shedding in their throat during their first week of infection. The virus does not need to travel to the lungs to replicate, and is abundant in the throat, making it easy to pass on. It can be spread easily by sneezing or coughing, said Prof Wendtner.

The viral loads that people encounter when someone coughs in their general direction, are so high, said Prof Van Ranst, that it makes transmission likely to happen. Compared to other respiratory viruses, this is remarkable, he added. It also meant it was easier for those with even mild symptoms to contaminate surfaces.

The Nature paper confirms that for the milder form of the disease, it doesnt go as far as the lungs, but stays in the throat, said immunologist Prof Luke ONeill of Trinity College Dublin. It means it is very transmissible just by talking. You dont need to cough, he said. Also, people without symptoms, are very infectious, he added. Sars never infected the throat. Went straight to the lungs. So thats a big difference, he explained.

Are men more likely to die than women?

The short answer is yes. With the worldwide death toll closing in on 130,000 it has become clear that men are much more likely to die from coronavirus than women. Charity Global Health 50/50, which campaigns for gender equality in health, has been tracking the breakdown internationally for deaths from the virus. In every country that publishes the data, significantly more men than women have died.

In Italy, which has the highest number of deaths from the disease, men account for 58 per cent of all hospitalised cases and 72 per cent of all deaths. In Spain, men account for 59 per cent of all hospital admissions, 72 per cent of intensive care unit admissions and 65 per cent of all deaths. In China, where the virus first started, 64 per cent of fatalities have been men.

In the Republic men account for less than half (45 per cent) of all confirmed cases, but 71 per cent of deaths.

Why is that?

Irelands deputy chief medical officer Dr Ronan Glynn said there were a number of hypotheses as to why this phenomenon was happening. It is either biology or behaviour or a mixture of both, he said. In some countries significantly greater proportions of men smoke. The activity of smoking is often associated with touching your face. Royal College of Surgeons in Ireland professor of medicine Sam McConkey believes the reasons may be more general.

Its just speculation, but Im happy to speculate that men in general do not look after themselves, he said. We drink too much and we smoke too much and we do not go to the doctor. Women are much better at getting proper diagnosis and taking the proper tablets.

How long will the restrictions be in place?

As it stands the restrictions on movement and social and commercial life in the country will remain in place until May 5th but even then we are only likely to see a partial lifting of the strict regime and that is contingent on the rate of infections continuing to fall.

What does partial mean?

Senior Government officials have begun to work on plans for a phased exit from the lockdown with the priorities expected to include the reopening of more retail businesses, construction and maybe schools although that might only be for some classes and for a portion of the week only.

When the time comes for restrictions to be eased they will be lifted in reverse order with movement and retail looked at first.

Dr Cillian De Gascun, chairperson of the coronavirus expert advisory group, has warned against complacency about the dangers of Covid-19 because given the opportunity this virus will run rampant and he warned that we are not going to return to a normal state of affairs soon.

What else in being considered to bring the pandemic under control here?

Prof McConkey has said the Government was at a crossroads and was faced with two decisions on treating Covid-19. The first option would to continue efforts to flatten the curve over a period of six to nine months while the second choice is more severe and would see a short, sharp response to try to prevent the spread of the virus entirely in Ireland. This move would require a 32-county approach.

It would be challenging. It would mean restricting travel and quarantining people coming into the country, Prof McConkey said. I feel it has to be a national decision, we would have to get Northern Ireland to go with us on this journey. It would have to be an all-island approach. It needs national discussion and involve all the parties in Northern Ireland. This is the approach being adopted in countries such as South Korea and New Zealand.

Will the virus diminish as the summer approaches and temperatures climb?

That was a hope in the very early days of the crisis. While it is getting warmer, experts are no longer holding out much hope that better weather will kill off coronavirus. The flu virus goes into decline in warmer months, and is spread the same way as Covid-19, by way of small mucus droplets suspended in the air. When conditions are warmer, droplets are more likely to fall to the ground and not cause infection which is one reason flu is seasonal and dominant in winter. The other is because exposure to the cold during winter coincides with immune systems being stressed. There is no indication that any of this applies to Covid-19, Prof Kingston Mills from Trinity College told this publications Science Editor Kevin OSullivan. He said it may prove to be the case but caution had to be applied. He pointed out that Spain is a damn sight warmer, and look at what its going through.

Why are some people so infectious and what are superspreaders?

One of the questions scientists have been asking as the virus continues to spread is if some people are more infectious than others and the answer appears to be yes. There do seem to be superspreaders, a loosely defined term for people who infect a disproportionate number of others, whether as a consequence of genetics, social habits or simply being in the wrong place at the wrong time. There are also people who are infected but unlikely to spread the infection.

Two factors are at play, Martina Morris, emeritus professor of statistics and sociology at the University of Washington told the New York Times this week. There has to be a link between people in order to transmit an infection, she says. But, she adds, a link is necessary but not sufficient. The second factor is how infectious a person is. We almost never have independent data on those two things.

If you are the first person in a crowded room to get infected, and if this is an easily spread disease, you will look like a superspreader, she says. Anyone in that room could have had the same impact. You were just the first in line.

Dr Thomas Frieden, former director of the United States Centers for Disease Control and Prevention said superspreading events may involve people with symptoms that linger but who are not sick enough to stay at home. Or they could involve infected people who shed an unusual amount of virus.

People have been attacking 5G masts?

There was a suspected arson attack on two large telecommunications masts in Co Donegal over the bank holiday weekend. Conspiracy theorists have linked new 5G technology to the cause of the global pandemic. The Government here and governments across the EU have all stressed there is absolutely no link between 5G and Covid-19.

What is happening on the economic front?

The coronavirus pandemic has brought the global economy to its knees and is likely to result in the worst economic downturn since the Great Depression, the International Monetary Fund (IMF) has said. In its latest world economic outlook report, it said it expects the global economy to contract sharply by 3 per cent in 2020 with the euro zone, the epicentre of the pandemic for the past month, experiencing a much sharper 7.5 per cent contraction.

Its outlook for Ireland is slightly better though still grim. It expects the economy to contract by 6.8 per cent this year, less severe than the Central Bank projection for an 8 per cent contraction. The IMF expects the Irish economy to bounce back strongly next year, expanding by 6.3 per cent, against a euro-zone average of 4.7 per cent. However, unemployment could prove trickier to ease. The IMF says the jobless rate in Ireland will rise to an average of 12 per cent in 2020, up from a low of 4.8 per cent in February, and will stay elevated at almost 8 per cent in 2021.

What are the unemployment figures in Ireland?

There are 533,000 people registered for the 350 weekly Covid-19 unemployment benefit payment which was introduced in the wake of huge job losses. The take up of a temporary wage subsidy scheme for businesses was continuing to grow, and in total 199 million has been paid out under the scheme to date.

What is being done to aid European economies?

A 500 billion deal was reached between EU finance ministers last week. It has several elements. There is the employment guarantee scheme recently invented by the European Commission. If member states put up 25 per cent collateral, they can get a slice of loans raised by the commission on the market. This would be used to subsidise companies to keep employees on the books. The scheme would be worth a maximum of 100 billion.

There are also loans from the European Investment Bank to support companies: 25 billion of extra guarantees, so it can step up lending by 200 billion.

But the biggest chunk is from the EUs bailout fund, the European Stability Mechanism, which was created to dig out states during the euro zone debt crisis. States can borrow up to 2 per cent of their GDP, with a total of 240 billion available. Usually, taking loans from the ESM comes with the requirement to balance the books known as reforms by supporters, austerity by critics.

This time, borrowing will come without these strict conditions as long as the money is solely for responding to the pandemic and relates directly or indirectly to health spending.

What else is happening?

The European Commission says the new deal should be seen in the context of various other measures, particularly the decision by the European Central Bank to throw off prior restraints to print money, by buying government bonds to keep EU countries liquid. Finance ministers and the commission have also agreed to relax the usual budget rules to give states free rein to spend and support companies, and freed up existing unused funds from the EU budget to be used to respond to the crisis.

What is the Irish Government saying about the deal?

Minister for Finance Paschal Donohoe has said the Government may need limited access to the new European Union Covid-19 rescue package to help fund the wage subsidy scheme and support companies in difficulty.

Mr Donohoe has expressed confidence that the country can create a new economy and create new services to recover and move forward, but he cautioned, we have a journey ahead of us.

The new welfare supports will be monitored and may need to be strengthened to aid the recovery as at least 200,000 workers access the wage subsidy scheme. The Minister said it was possible that Ireland would need to access funds from the European Investment Bank to help fund companies and will consider whether to access the programme to help fund wage subsidy schemes. It is hoped that Ireland will not need to use the fund from the European Stability Mechanism, he added.

What are other people saying?

Alan Ahearne, the professor of economics at NUI Galway said the rescue package was a positive outcome, but warned that the figure needed was likely to increase. Prof Aherne said that as it stands Ireland will not need to borrow from the European Stability Mechanisms new low-cost loan fund, as the European Central Bank keeps borrowing costs close to zero. He said he was cautiously optimistic the recovery would be much, much quicker than a usual recession given the welfare supports that have been put in place.

Is China over the crisis now?

No one thinks the crisis is over in any country in the world. However, the country where the first cases of the virus were recorded more than 100 days ago has made substantial progress in recent days. It reported zero new coronavirus deaths on one day last week for the first time since it started publishing daily figures in January. That is a milestone that offers grounds for some relief as the country works to stave off a second wave and struggles with ongoing outbreaks in Wuhan. The National Health Commission reported 32 new cases across China on Tuesday, all of them imported infections, bringing the number of cases involving overseas travellers to 983.

Are EU countries about to ease restrictions?

Some EU countries are easing some restrictions or at least they will in the days ahead. In Denmark, there is what has been described as a cautious reopening, starting with daycare and primary schools opening. The Danish prime minister Mette Frederiksen has described the process as a bit like walking the tightrope. In Austria, small shops, hardware and gardening stores have been allowed to reopen under certain conditions with all retailers likely to follow from May 1st. Spain and Italy have also started to partially lift restrictions.

The European Commission has urged all EU states to co-ordinate as they begin to ease lockdown measures, warning that failure to do so could result in new spikes of the epidemic.

In a set of recommendations to be adopted this week, the commission said: It is time to develop a well co-ordinated EU exit strategy. The exit strategy should be co-ordinated between the member states, to avoid negative spillover effects.

And when will it all end allowing normality to be restored?

No one can answer that question with any confidence but it is unlikely that all restrictions will be lifted for several months and the aftershocks, in terms of public health, economic life and social activities will be felt for a lot longer than that.

While Mr Harris has raised the prospect of easing some restrictions, he warned: There isnt going to be a magic point at the start of May where life as we knew it before the coronavirus can resume. I think, being truthful, social distancing is going to remain a very big part of life not just in Ireland but the world over until we get to a vaccine or effective treatment for the coronavirus.

He said the key indicators to watch in the coming weeks would be the rate of growth of the virus, the average number of people in intensive care units and the reproductive rate of the virus, which measures how many people each infected person is likely to pass the virus on to.

Original post:
Coronavirus in Ireland: What we know so far - The Irish Times

Lets hear it for the female of the species and (more guardedly) for her second X-chromosome! Female superiority in colour vision, immune response, longevity, even basic survival from birth to death are illustrated in Sharon Moalems The Better Half. After decades, if not centuries, of bad press for women and their vulnerable biology, this book argues that in fact almost everything that is biologically difficult to do in life is done better by females.

Moalem, a Canadian-born physician, is a research geneticist who has identified two new rare genetic conditions. He has worked across the world in paediatric medicine, including clinics for HIV-infected infants and is also a biotechnology entrepreneur and bestselling author. The Better Half is his latest foray into the field of popular science, and presents a general argument for the superiority of womens biology to mens.

In most circumstances, a human female has two X-chromosomes, one from her father and one from her mother; a male has just one, inherited from his mother, which is paired with a Y-chromosome, inherited from his father. Moalem believes that the X-chromosome has always received a poor press, and that it is time this negative view is counteracted. He draws on swathes of medical and historical data to show that, in many instances, the superiority of womens biology is explicitly linked to their possession of the second X-chromosome. The greater complexity of womens biology, he claims, is the secret of their success it is more difficult to make a female but, once made, she trumps the male in her lifelong survival skills, for instance in her hyperefficient immune system shrugging off infection and maximising the benefits of vaccination which means that females can avoid the consequences of a wide range of life threatening events ranging from starvation and cancer to, Moalem has cautiously concluded, Covid-19.

In mainstream genetics it was long held that, despite having two X-chromosomes, female cells only made use of one: the second randomly switched off or deactivated early on in embryonic development, a process rather summarily described as an instance of genetic redundancy. There was some evidence that the deactivation reduced female chances of succumbing to X-linked problems, due to the availability of an undamaged back-up. It was acknowledged, for example (though rather grudgingly), that women generally escaped being colour blind. Moalem notes that when he was studying genetics there was much emphasis on the tiny Y-chromosome as what makes a man. He observes wryly that maybe this positivity was related to the fact that most of the people who were speaking breathlessly about the Y had one as well.

Now a new spin on the X-inactivation story is emerging in genetics. Via a process called escape from X-inactivation, it turns out that the silenced X-chromosome is not so silent after all there are escapees which may continue to offer back-up services, for instance providing extra cellular recovery options in the face of traumatic injury. It is to the benefits offered by this flexible availability within different cells that Moalem attributes the secrets of womens biological superiority.

Statistics going back as far as 1662 show women living longer than men, and todays figures show that 95% of people who have reached the age of 110 and over are female. In sport, womens success in races such as ultra-marathons offer a different perspective on what it means to be physically superior. In the spirit of Angela Sainis book Inferior, Moalem notes that this superiority has largely been ignored by medical science. And he discusses the medical trial data whose absence is observed by Caroline Criado-Perez in Invisible Women, her exploration of how the world is designed for men. Medicine needs to stop ignoring the secrets of womens biological successes, Moalem argues, and find ways of harnessing them to improve the survival chances of the whole of the human race.

Imagine you live in a world where most individuals can see 1m colours. But in one group of these people (lets call them males), about 8% cannot tell the difference between colours such as red and green, and a smaller number are totally colour blind. In a second group in this population (lets call them females), almost all can see the standard 1m colours, but some (perhaps as many as 15%) can see 100m colours. Would you excitedly rave about the amazing talent of this latter group? Or would you just describe them as not usually colour blind? This same group has an immune system that has a profound talent to fight off many forms of infection and reap major benefits from vaccinations with the down side that sometimes such hyperefficiency can lead to autoimmune disorders such as multiple sclerosis. Would you celebrate the former or emphasise the latter? For years, it is the drawbacks that have been underlined.

Research geneticists rarely get out in the field to notice the much greater survival rates of girls in paediatric ICUs

The Better Half is an eye-opening book. In explaining why the advantages that accompany females greater genetic options have to date been largely ignored, Moalem points to paradigm blindness, and to the fact that research geneticists rarely get out in the field to notice, for example, the much greater survival rates of girls in paediatric ICUs (rates which, he discovers, have been clearly obvious to the nurses doing the frontline caring).

I take issue with one part of his chapter on The Male Brain, for the moment setting aside the unproven assumption that the brains of men are different from the brains of women. Moalem chooses to consider autism, and it appears as a given in his book that autism is more common in boys than girls (itself an assumption that is increasingly being challenged). Yet at the more impaired end of the autism spectrum, it is possible that there are as many girls as boys, and his suggestion that females have a different kind of autism doesnt quite prove his wider argument. The X-linked disorders such as fragile-X or Rett syndrome receive only a passing mention not surprisingly perhaps as they run counter to his argument about the superiority of the X-chromosome.

What about hormones? Moalem has perhaps missed a good opportunity to counter oestrogens frequently negative press, and to laud its potentially neuroprotective effects. The greater susceptibility of women to Alzheimers disease is put down by Moalem to a form of anti-inflammatory process linked to an overefficient immune system; their lesser susceptibility to Parkinsons disease (surely a possible inclusion in the list of female genetic successes) is unexplained.

One section of the book focuses on why womens health is not mens health, and considers the failures of drug companies to test their products on females as well as males. For sure this has had detrimental consequences on, for example, the accuracy of dosage rates. But in at least one of the examples he gives, that of Ambien, body mass and blood volume are key factors in calculating dosage rates: because people vary enormously in size and shape, simply dividing test participants into males and females still risks inaccuracy. He is talking about averages, its true, but even so Moalem seems firmly wedded to the notion that genetic females and genetic males can be neatly categorised into two distinct types, and that the understanding of genetic sex will provide all the answers we need.

The impression given in The Better Half is that there is a lifelongfree-ranging choice between X-chromosomes available to the female, her cells dancing back and forth between the best options that will help her to heal quicker after a car crash or to overcome the bacterial infection that might lead to an ulcer. There are brief and tantalising hints about the escapees from X-inactivation in several chapters of Moalems book, but it is a shame that we are never given a full, head-on account.

Yet this book is full of wonderful titbits of information from the existence of a female prostate gland to the number of honey bee flying miles it takes to make 1lb of honey. The celebration of the genetic diversity offered by the females second X-chromosome is wholehearted and the examples Moalem gives are highly effective. He has written a powerful antidote to the myth of the weaker sex.

The Better Half: On the Genetic Superiority of Women by Sharon Moalem is published by Allen Lane (RRP 20).

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The Better Half by Sharon Moalem review on the genetic superiority of women - The Guardian

At the heart of the COVID-19 pandemic is a coated ball of genetic code with protein spikes that look like a crown. There is no forethought of action, no malice. In fact, depending on your point of view, it might not qualify as life.

It's called SARS-CoV-2, Severe Acute Respiratory Syndrome-CoronavVirus-2, a sister strain of the virus that caused the original SARS outbreak in the early 2000s.

And, yes, washing your hands is a very good way to deactivate it, said Michael Conway, an molecular virologist and associate professor of microbiology with CMU's School of Medicine. Not kill it, because whether it's alive is an open question.

Viruses don't grow or consume things for energy, he said, both of which are two components of living things. A bacteria consumes things -- sugar, proteins, fats -- which is a primary difference between the two different kinds of microorganisms.

Soap, bleach or really any detergent helps dissolve a layer of fat that surrounds the genetic code, which plays a critical role in using a host cell to reproduce more virus particles. That fat protects the virus' body itself, he said. Without it, the virus just kind of shuts down.

The genetic material inside the virus comes as both DNA and RNA. The primary difference between the two is in the structure. DNA looks like a twisting ladder called a double helix. RNA is a single strand. SARS-CoV-2 is an RNA virus, sharing a family with viruses that cause diseases like Ebola and polio.

It's comes from a large group of RNA viruses called coronaviruses, because the first time someone looked at one through a powerful microscope, the now-famous protein spikes on the surface looked like a crown, Conway said. Corona is Latin for crown.

When the virus gets into your body, the spikes of that crown help the virus stick to a host cell. Once attached, the cell covers the virus, trapping it. If this is left unchanged, the virus would be deactivated.

But, the virus can poke a hole in the cell wall, inserting the genetic material into the space between the cell's machinery. The RNA hijacks the cell and converts the genetic material into proteins, which become new particles of virus.

It's currently unknown how the new virus particles escape the host cell, Conway said. Either they poke a hole and squirt out, or the new viruses rupture the host cell, killing it.

The body itself has a complex way to fight off this infection.

Where the infection lands, it's possible that local cells recognize that something is wrong and communicate with each other to just shut the infection down.

If that doesn't work, he said, the body's adaptive immune system is activated. That create proteins specifically tailored to deactivate a specific virus.

This is available to all readers in the interest of public safety. Please consider supporting local news; subscribe for only 99 for the first month.

RNA viruses normally have a high mutation rate, Conway said, which is one reason why the common cold is so hard to stamp out. Viruses that mutate look different to the body.

So far, however, SARS-CoV-2 appears to have a low mutation rate, which provides hope in developing an effective long-term solution.

Coronaviruses aren't new things to humanity, he said. SARS-CoV-2 is new, which is why it's called a novel coronavirus.

Like its relatives, the viruses that cause SARS and Middle East Respiratory Syndrome, it originated in bats. SARS jumped to people using civets -- a raccoonlike cat found in Southeast Asia -- and MERS jumped to people from bats by way of camels.

That's also not a new phenomenon.

"In my opinion, we should have been prepared for this," Conway said.

READ MORE:

The one thing you can count on in life is things are gonna change.

Michiganders getting tested and treated for COVID-19 will not have to worry about paying for those services.

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When COVID-19 broke out in Michigan last month, most spring events promptly closed. That meant the cancellation of most of Pete Lieber's cater

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The virus behind the pandemic: How does it work ... and is it life? - The Morning Sun

The State of Maryland is taking new steps to increase capacity for COVID-19 testing and personal protective equipment for medical workers, Gov. Larry Hogan said Friday.

Heres a look at updates from Hogans latest news conference on how Maryland is using tech in the response to the pandemic:

As it seeks more testing capability, the state is entering a partnership with the Baltimore-based University of Maryland School of Medicine (UMSOM)to ramp up tests for COVID-19.

We have invested $2.5 million in a joint partnership with the University of Maryland School of Medicine to provide the technology to launch a large-scale COVID-19 testing initiative which will be enable their lab to run 20,000 tests per day, Hogan said.

The lab will ramp up to that capacity over the next few months and will enable people to get results within 24 to 48 hours, as opposed to waiting for weeks, UMSOM said.

The ability to test patients for COVID-19 is considered a major weapon in the effort to stop the spread, since knowing who has the new coronavirus can allow them to be isolated from others and treated. But there has been a shortage nationwide. Hogan said the state has been seeking to acquire more testing kits from federal partners and private sector companies.

The initiative will be led by Dr. Clare Fraser, who directs the downtown Baltimore-based Institute for Genome Sciences (IGS) and Dr. Sanford Stass who chairs the UMSOM Department of Pathology and Department of Medical and Research Technology.

We already have the capability to perform testing in patients who are admitted to University of Maryland Medical Center to test for COVID-19, Stass said in a statement. This new funding initiative, however, will greatly improve our capabilities to reach deeper into the community and help provide expanded testing which is desperately needed to help bring the epidemic under control in the State of Maryland.

The lab at IGS is being reconfigured and will process samples from patients using robotics and automation of parts of the following process, per the schools press release:

Analyzing test samples from patients suspected of having COVID-19 is a complex multi-step process that involves first transferring a portion of the sample to an inactivation solution and extracting its RNA, which contains the virus genetic code. The RNA is then converted to DNA and amplified using the CDC recommended assay. The laboratory at the UMSOM faculty practice site ultimately determines whether the patients sample contains the novel coronavirus.

The lab plans to call up additional personnel to staff up to 60 people over the next several months.

We will call in extra technicians who are currently working from home, so ramping up to a full staff could be done initially without an immediate need to hire additional employees, Fraser said in a statement. I am sure many of our laboratory staff would be eager to return onsite to work for such a worthwhile endeavor.

Analysis will take place at University of Maryland Pathology Associates in downtown Baltimore, which received regulatory approval.

Along with expanding capacity to stop the spread, the larger-scale initiative could also help to ensure surveillance after social distancing measures are relaxed.

Another frequently talked-about nationwide shortage is the low supply of personal protective equipment that can protect medical workers from being exposed to the virus.

The number one problem we have today is the lack of PPE, Hogan said. Its definitely not anywhere near what it needs to be.

In one approach to getting more available, Marylands Department of Transportation and FEMAare opening a newdecontaminationfacility at BWI Airport to clean and sterilize the highly sought N95 masks. The unit, which is made by Columbus, Ohio-based Battelle, will allow 80,000 of the respirator masks to cleaned per day.

As everyone knows, these masks are in very short supply worldwide, Hogan said. This newly developed technology will allow them to be reused, which will help protect our healthcare workers and those on the front lines.

The state is also setting up a new platform, called COVID Connect, which will serve as a registry for patients who have recovered from COVID-19.

The registry will also serve as a communication platform to share experiences and lend support to others who are coping with the recovery process, Hogan said. It will also provide opportunities for these recovered patients to learn about potential resources and clinical study opportunities which may contribute to scientific progress in the fight against COVID-19.

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University of Maryland School of Medicine is launching a large-scale COVID-19 testing initiative in Baltimore - Technical.ly

BETHESDA, Md., April 10, 2020 /PRNewswire/ -- The American College of Medical Genetics and Genomics (ACMG) and the American Board of Medical Genetics and Genomics (ABMGG) recognize that medical genetics and genomics trainees and genetic counseling students are experiencing unprecedented challenges due to the COVID-19 pandemic. Many are unable to engage in planned educational activities necessary to meet training program requirements.

In an effort to help lighten this burden and to provide top-quality online educational opportunities to those who may be either quarantined or must work from home,the ACMG and the ABMGG are collaborating to provide complimentary access to educational programming for clinical genetics residents, laboratory genetics fellows and genetic counseling students.

ACMG President Anthony R. Gregg, MD, MBA, FACOG, FACMG said, "As the COVID-19 pandemic challenges each of us to adapt, ACMG looks forward to providing high-quality educational materials at no charge to trainees and genetic counseling students. At ACMG we value education. It is a core member service. If you are a trainee whose education is threatened by COVID-19, we will help you beat that threat. This makes perfect sense - if you are a trainee or student - you are us!"

"Optimal patient care begins with optimal education of trainees in medical genetics and genomics in training programs across the country," said Max Muenke, MD, FACMG, chief executive officer of the ACMG. "We at the College have a passion for education. At a time of COVID-19 where most trainees are working from home, we are happy to offerfree of chargea number of online courses and lectures to genetic counseling graduate students, residents in clinical genetics and genomics, and fellows in all laboratory specialties of genetics and genomics."

Medical genetics and genomics residents and lab fellows, as well as genetic counseling students, will be able to access an extensive, curated collection of educational content online at the ACMG Genetics Academy at http://www.acmgeducation.netIndividuals must attest that they are current trainees in an ACGC-, ACGME- or ABMGG-accredited training program.

Miriam Blitzer, PhD, FACMG, CEO of the ABMGG, commented, "The ABMGG recognizes that current circumstances surrounding COVID-19 are impacting trainees and have disrupted required training. We are excited that ACMG is offering access to excellent educational activities to allow for continued learning during this time."

ACMG's "Curated Collection of Educational Resources for Genetics and Genomics Residents, Trainees and Genetic Counseling Students" will include:

Individuals who complete coursework through the ACMG Genetics Academy will obtain a certificate of completion. ACMG and ABMGG both commit to providing these free educational resources until September 1, 2020.

Staying current on advances in medical genetics and genomics is more important than ever. ACMG and ABMGG wish the next generation of the medical genetics healthcare team strength, resilience and good health as we work together to fight the pandemic and to care for patients and families. We appreciate your commitment to caring for patients whether you are in the lab, the clinic, providing telegenetics services, or serving your patients and communities in other ways. Our primary concern, now and always, is for the health, safety and well-being of healthcare providers, patients, students and the communities we serve.

About the American College of Medical Genetics and Genomics (ACMG) and ACMG Foundation

Founded in 1991, the American College of Medical Genetics and Genomics (ACMG) is the only nationally recognized medical society dedicated to improving health through the clinical practice of medical genetics and genomics and the only medical specialty society in the US that represents the full spectrum of medical genetics disciplines in a single organization. The ACMG is the largest membership organization specifically for medical geneticists, providing education, resources and a voice for more than 2,400 clinical and laboratory geneticists, genetic counselors and other healthcare professionals, nearly 80% of whom are board certified in the medical genetics specialties. ACMG's mission is to improve health through the clinical andlaboratory practice of medical genetics as well as through advocacy, education and clinical research, and to guide the safe and effective integration of genetics and genomics into all of medicine and healthcare, resulting in improved personal and public health. Four overarching strategies guide ACMG's work: 1) to reinforce and expand ACMG's position as the leader and prominent authority in the field of medical genetics and genomics, including clinical research, while educating the medical community on the significant role that genetics and genomics will continue to play in understanding, preventing, treating and curing disease; 2) to secure and expand the professional workforce for medical genetics and genomics; 3) to advocate for the specialty; and 4) to provide best-in-class education to members and nonmembers. Genetics in Medicine, published monthly, is the official ACMG journal. ACMG's website (www.acmg.net) offers resources including policy statements, practice guidelines, educational programs and a 'Find a Genetic Service' tool. The educational and public health programs of the ACMG are dependent upon charitable gifts from corporations, foundations and individuals through the ACMG Foundation for Genetic and Genomic Medicine.

About the American Board of Medical Genetics and Genomics

The American Board of Medical Genetics and Genomics (ABMGG) is an independent nonprofit organization whose mission is to serve the public and medical profession by establishing professional certification standards and promoting lifelong learning, as well as excellence in medical genetics and genomics. Established in 1980, the ABMGG is one of the 24 certifying boards of the American Board of Medical Specialties (ABMS). For more information, visit http://www.abmgg.org.

Kathy Moran, MBAkmoran@acmg.net

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SOURCE American College of Medical Genetics and Genomics

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ACMG and ABMGG Collaborate to Provide Trainees and Genetic Counseling Students Complimentary Access to Online Medical Genetics Education Courses...