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Public restrooms could be spreading #Coronavirus

Guest contributor

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A series of papers published in the New England Journal of Medicine raised concerns about the potential for asymptomatic patients to spread the COVID-19 virus, but when these findings are coupled with earlier studies, they suggest an entirely unappreciated way in which the virus can spread. A German study documented the spread of infection from an asymptomatic carrier, writes Dr. Robert D. Morris. 

A second paper showed that levels of the virus in asymptomatic patients can be high as levels in symptomatic patients. Given that more than half of the infected passengers on the Diamond Princess Cruise had no symptoms, it’s clear that there are many asymptomatic infections. The possibility that people without symptoms can spread the disease may explain why the disease has been so difficult to contain. But how is it spreading?

On that front, a third paper on this issue raises a possibility that has already drawn extensive media attention and misinterpretation. The paper looked at how long the virus stays viable on various surfaces and in aerosols. As well described in a Wired magazine article, the paper showed that the droplets deposited on a surface can survive for between 24 (on cardboard) and 72 (on steel or plastic) hours. It also found that it remained viable in an aerosol for up to three hours. This did not mean, as some outlets have claimed, that airborne transmission is likely. The aerosol from a hairspray, for example, does not remain in the air for three hours after you spray it. But there is another place aerosols are found and nobody’s talking about it.

A study of Chinese hospitals around Wuhan during the peak of the outbreak found that samples taken in the bathrooms of patients had concentrations of the virus that were higher than any other area of the hospital, including patient rooms, with the exception of the areas where they removed contaminated protective gear. Flushing toilets have long been known to produce aerosols when flushed. The presence of corona virus in feces is well established, including the faeces of asymptomatic children. In fact, fecal contamination may well have played a role in the 2002 SARS outbreak in Hong Kong.

In other words, public restrooms may well be an important mechanism for spreading the Covid-19 virus. In light of these facts, I believe the following steps are critical to protecting public health:

  1. All public health agencies and local governments should give serious consideration to closing or restricting the use of public restrooms during the course of the epidemic.
  2. The public should be advised to avoid the use of public restrooms whenever possible, and
  3. Hand dryers, particularly high velocity air dryers should be disconnected in all public restrooms immediately given their documented ability to distribute bacterial spores.

We need urgent federal action on this issue.

Dr. Robert D. Morris is a Seattle epidemiologist and senior advisor to EHTrust.org

COVID-19

US supports WTO waiver of Intellectual Property on COVID-19 vaccines

Catherine Feore

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In a surprise announcement by the US Trade Representative Katherine Tai has announced that the US supports the waiver of IP protections on COVID-19 vaccines to help end the pandemic and will “actively participate in WTO negotiations to make this happen”.

The USTR said that extraordinary times and circumstances called for extraordinary measures. 

In March, European Commission trade spokesperson Miriam Garcia Ferrer told journalists that the current view of the European Union was that the problem of access to vaccines would not be resolved by waiving patent rights. 

Garcia Ferrer said that the real problem lay in insufficient manufacturing capacity to produce the required quantities. The European Commission very much welcomed the statement of WTO Director-General Ngozi Okonjo-Iweala who has said there should be a third way to broaden access to vaccines through facilitating technology transfer within the multilateral rules, to encourage research and innovation while at the same time allowing licensing agreements that helped to scale up manufacturing capacities. 

South African/Indian proposal

WTO members recently debated the proposal submitted by South Africa and India calling for a waiver from certain provisions of the TRIPS (Trade-Related Aspects of Intellectual Property Rights) Agreement in relation to the “prevention, containment or treatment” of COVID-19. Since its submission, the proposal has received further support from Kenya, Eswatini, Mozambique, Pakistan, Bolivia, Venezuela, Mongolia, Zimbabwe, Egypt and the African Group within the WTO. 

The proponents argue that the waiving of certain obligations under the agreement would facilitate access to affordable medical products and the scaling-up of manufacturing and supply of essential medical products, until widespread vaccination is in place and the majority of the world’s population is immune. 

However, there is a lack of consensus and divergence on what role intellectual property plays in achieving the goal of providing timely and secure access to safe, efficacious and affordable vaccines to all. Proponents argue that existing vaccine manufacturing capacities in the developing world remained unutilized because of IP barriers. Other delegations asked for concrete examples of where IP would pose a barrier that could not be addressed by existing TRIPS flexibilities.

The outgoing chair of the TRIPS Council, Ambassador Xolelwa Mlumbi-Peter of South Africa, said swift action is urgently required to help scale up COVID-19 vaccine production and distribution. She called on members to shift gears and move towards a solution-oriented discussion.

The next regular TRIPS Council meeting is scheduled for 8-9 June, but members agreed to consider additional meetings in April in order to assess potential progress on the IP waiver discussion.

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EMA starts rolling review of COVID-19 Vaccine (Vero Cell) Inactivated

EU Reporter Correspondent

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EMA’s human medicines committee (CHMP) has started a rolling review of COVID-19 Vaccine (Vero Cell) Inactivated, developed by Sinovac Life Sciences Co., Ltd. The EU applicant for this medicine is Life'On S.r.l.

The CHMP’s decision to start the rolling review is based on preliminary results from laboratory studies (non-clinical data) and clinical studies. These studies suggest that the vaccine triggers the production of antibodies that target SARS-CoV-2, the virus that causes COVID-19, and may help protect against the disease.

EMA will evaluate data as they become available to decide if the benefits outweigh the risks. The rolling review will continue until enough evidence is available for a formal marketing authorisation application.

EMA will assess the compliance of COVID-19 Vaccine (Vero Cell) Inactivated with the usual EU standards for effectiveness, safety and quality. While EMA cannot predict the overall timelines, it should take less time than normal to evaluate an eventual application because of the work done during the rolling review.

EMA will communicate further when the marketing authorization application for the vaccine has been submitted.

How is the vaccine expected to work?

COVID-19 Vaccine (Vero Cell) Inactivated is expected to prepare the body to defend itself against infection with SARS-CoV-2. The vaccine contains SARS-CoV-2 that has been inactivated (killed) and cannot cause the disease. COVID-19 Vaccine (Vero Cell) Inactivated also contains an ‘adjuvant’, a substance that helps strengthen the immune response to the vaccine. 

When a person is given the vaccine, their immune system identifies the inactivated virus as foreign and makes antibodies against it. If, later, the vaccinated person comes into contact with SARS-CoV-2, the immune system will recognise the virus and be ready to defend the body against it.

What is a rolling review?A rolling review is a regulatory tool that EMA uses to speed up the assessment of a promising medicine during a public health emergency. Normally, all data on a medicine or vaccine’s effectiveness, safety and quality and all required documents must be ready at the start of the evaluation in a formal application for marketing authorization. In the case of a rolling review, EMA’s human medicines committee (CHMP) reviews data as they become available from ongoing studies. Once the CHMP decides that sufficient data are available, the company can submit a formal application. By reviewing the data as they become available, the CHMP can come to an opinion on the medicine’s authorisation sooner.During the rolling review, and throughout the pandemic, EMA and its scientific committees are supported by the COVID-19 EMA pandemic task force (COVID-ETF). This group brings together experts from across the European medicines regulatory network to advise on the development, authorization and safety monitoring of medicines and vaccines for COVID-19 and facilitate quick and coordinated regulatory action.

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Ukraine's capital Kyiv eases coronavirus restrictions

Reuters

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Ukraine's capital Kyiv on Saturday (1 May) eased tough restrictions imposed last month to prevent the rapid spread of the new coronavirus.

In early April, Kyiv limited its public transport services, closed schools and kindergartens, theatres and shopping centres, and banned spectators from sporting events.

Starting from Saturday, the capital will allow the operation of transport, cafes and restaurants, although passenger and customer numbers will be restricted. Wearing masks is still mandatory in transport and public places.

Shopping malls and sports clubs were able to reopen on Saturday, while schools and kindergartens will open from 5 May, local authorities said.

Last month, Kyiv recorded some of highest numbers of new infections among Ukrainian regions, but new cases dropped significantly last week.

Ukraine has registered more than 2 million infections and 44,436 deaths since the pandemic started last year.

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