A person who owns a car or who has a college education may be less vulnerable to COVID-19, according to an analysis of cases in Tehran, Iran, one of the early epicenters of the pandemic. While such variables do not inherently lower a person’s risk, they do indicate an infrastructure of protection that persists despite how densely populated a person’s district might be.
The international collaboration published their results on April 3 in Sustainable Cities and Society.
“In the past few decades, there have been various efforts aimed at increasing urban density to enhance efficiency and contribute to climate change mitigation — but the COVID-19 pandemic has brought questions about the desirability of compact urban development to the forefront,” said paper author Ayyoob Sharifi, associate professor in the Graduate School of Humanities and Social Sciences and in the Graduate School of Advanced Science and Engineering at Hiroshima University. Sharifi is also affiliated with the Network for Education and Research on Peace and Sustainability.
Through a comprehensive data analysis from the early months of the pandemic (to April 4 and June 27, 2020), the researchers found that a population’s demographic structure — age, social and economic class, access to resources — is far more influential than simply how dense a population is. However, density is distinctly different than overcrowding for the resources available, the researchers said.
“We found that what drives the spread of infectious disease during a pandemic is overcrowding, which can occur in districts even with low density,” said paper author Amir Reza Khavarian-Garmsir, assistant professor in the Department of Geography and Urban Planning in the Faculty of Geographical Sciences and Planning at the University of Isfahan.
While a person less likely to be aware of or follow public health guidelines or more likely to use public transportation may be more at risk for the disease, the researchers didn’t find a statistically significant difference in urban districts with lower income and lower age compositions — indicating that age was one of the most significant risk factors for COVID-19 infection, despite density of living.
The data was obtained from Iran’s AC-19 app, which tracks positive cases and deaths by geographic location, the researchers assessed whether certain variables affected infection rates across the 22 districts and roughly 8.6 million residents of Tehran. They used structural equation modeling, which can use multiple factors to indicate the influence of unobservable variables, such as likelihood to follow public health recommendations, in combination with measurable factors, such as ease of access to medical facilities.
There are some drawbacks to the study, the researchers said, the main one of which is data availability and accuracy. The pandemic evolved so rapidly in the early months that tracking may not capture the full picture; and testing shortages and cost, as well as a relative lack of severe symptoms in children and young adults, may skew the number of true positive cases.
“It is perhaps too early to draw definitive conclusions, so future research should continue to investigate the relationship between urban density and transmission patterns of infectious disease,” Moradpour said.
The researchers said they hope their work will help policy makers develop guidelines to benefit all during urban and pandemic-preparedness planning.
“The next step is to further examine the impacts of urban density in other contexts,” Shafiri said. “In addition, we are trying to examine the long-term impacts of the pandemic on compact urban development policies.”
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A new study has shown that underweight and overweight women are at a significantly higher risk of experiencing recurrent miscarriages compared to those of average weight.
A research team led by the University of Southampton assessed the link between women’s lifestyle and risk of recurrent pregnancy loss, defined as women having two or more consecutive early miscarriages. The systematic review and meta-analysis study has been published in the journal Scientific Reports.
Miscarriage is the most common complication of early pregnancy, affecting 15 — 20% of all pregnancies. Recurrent pregnancy loss is a complex disease and although often attributed to numerous medical factors and lifestyle influences, the cause is deemed “unexplained” in around 50% of cases.
The results of this latest study found that there are higher occurrences of successive miscarriages in mothers who are underweight (having a Body Mass Index score of less than 18.5), overweight (having BMI between 25 and 30) and obese (having BMI above 30).
The study’s first author, Dr Bonnie Ng, MRC Fellow in Clinical and Experimental Sciences at the University of Southampton said, “Our study included sixteen studies and showed that being underweight or overweight significantly increases the risk of two consecutive pregnancy losses. For those with BMI greater than 25 and 30, their risk of suffering a further miscarriage increases by 20% and 70% respectively.’
The research team also set out to assess the impact of factors such as smoking and consumption of alcohol and caffeine. However they were unable to establish conclusively whether these have any impact or not due to inconsistencies of the results from a small number of studies and heterogeneity in women taking part in them.
Co-author Dr George Cherian, Specialist trainee in Obstetrics and Gynaecology, at Princess Anne Hospital, Southampton said, ‘while our study did not find any associations between recurrent pregnancy loss and lifestyle parameters such as smoking, alcohol and caffeine intake, further large-scale studies are required to clarify this.’
Whilst recognising that more observational and clinical research is needed to establish the full extent of lifestyle choices, the authors conclude that weight is a risk factor that can be modified to reduce the risk.
‘Our findings suggest that having an abnormal BMI exacerbates a woman’s risk of suffering from repeated miscarriages, and so clinicians really need to focus on helping women manage this risk factor’ concluded Ying Cheong, Professor of Reproductive Medicine at the University of Southampton and senior author of the paper.
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A candidate vaccine that could provide protection against the COVID-19 virus and other coronaviruses has shown promising results in early animal testing.
The candidate coronavirus vaccines, created by Virginia Tech’s University Distinguished Professor X.J. Meng and UVA Health’s Professor Steven L. Zeichner, prevented pigs from being becoming ill with a pig coronavirus, porcine epidemic diarrhea virus (PEDV).
The researchers have recently published their findings in the Proceedings of the National Academy of Sciences.
“The candidate vaccine was developed using an innovative vaccine platform targeting a highly conserved genomic region of coronaviruses,” said Meng, a University Distinguished Professor in the Department of Biomedical Sciences and Pathobiology in the Virginia-Maryland College of Veterinary Medicine. “The new vaccine platform utilizes a genome-reduced bacteria to express the coronavirus vaccine antigen on its surface. Such a vaccine platform can be manufactured with low cost in existing facilities around the world, which could meet the pandemic demand.”
Their coronavirus vaccine offers several advantages that could overcome major obstacles to global vaccination efforts. It would be easy to store and transport, even in remote areas of the world, and could be produced in mass quantities using existing vaccine-manufacturing factories.
“Our new platform offers a new route to rapidly produce vaccines at very low cost that can be manufactured in existing facilities around the world, which should be particularly helpful for pandemic response,” said Zeichner.

Working hours that deviate from an individual’s natural body clock are associated with greater cardiovascular risk, according to research presented at ESC Preventive Cardiology 2021, an online scientific congress of the European Society of Cardiology (ESC).
“Our study found that for each hour the work schedule was out of sync with an employee’s body clock, the risk of heart disease got worse,” said study author Dr. Sara Gamboa Madeira of the University of Lisbon, Portugal.
At least 20% of European employees work atypical hours or shifts,2 and growing scientific evidence associates these with deleterious cardiovascular outcomes.3 A number of explanations have been proposed, including sleep disruption and unhealthy behaviours. This study focused on the role of circadian misalignment, which is the difference between the “social clock” (e.g. work schedules) and the individual “biological clock.”
Dr. Gamboa Madeira explained: “We all have an internal biological clock which ranges from morning types (larks), who feel alert and productive in the early morning and sleepy in the evening, to late types (owls), for whom the opposite is true — with most of the population falling in between. Circadian misalignment occurs when there is a mismatch between what your body wants (e.g. to fall asleep at 10pm) and what your social obligations impose on you (e.g. work until midnight).”
The study included 301 blue collar workers, all performing manual picking activity in the distribution warehouses of a retail company in Portugal. Staff always worked either early morning (6am-3pm), late evening (3pm-midnight), or night (9pm-6am) shifts. Participants completed a questionnaire on sociodemographic factors (age, sex, education), occupational factors (work schedule, seniority), and lifestyle factors and had their blood pressure and cholesterol measured.
The Munich ChronoType Questionnaire was used to assess sleep duration, and to estimate each individual’s internal biological clock (also called chronotype). It was also used to quantify the amount of circadian misalignment (i.e. the mismatch between an individual’s biological clock and working hours) — referred to as social jetlag. Participants were divided into three groups according to hours of social jetlag: 2 hours or less, 2-4 hours, 4 hours or more.
The researchers used the European relative risk SCORE chart which incorporates smoking, blood pressure and cholesterol to calculate relative cardiovascular risk. Relative risk ranges from 1 (non-smoker with healthy blood pressure and cholesterol) to 12 (smoker with very high blood pressure and cholesterol). In this study, a relative risk of 3 or more was considered “high cardiovascular risk.” The researchers then investigated the association between social jetlag and high cardiovascular risk.
The average age of participants was 33 years and 56% were men. Just over half (51%) were smokers, 49% had high cholesterol, and 10% had hypertension. One in five (20%) were classified as high cardiovascular risk. Some 40% had a short sleep duration on workdays (6 hours or less). The average social jetlag was nearly 2 hours. In most workers (59%), social jetlag was 2 hours or less, while for 33% of staff it was 2-4 hours, and in 8% it was 4 hours or more.
A higher level of social jetlag was significantly associated with greater odds of being in the high cardiovascular risk group. The odds of being classified high cardiovascular risk increased by 31% for each additional hour of social jetlag, even after adjusting for sociodemographic, occupational, lifestyle, and sleep characteristics and body mass index.
Dr. Gamboa Madeira said: “These results add to the growing evidence that circadian misalignment may explain, at least in part, the association found between shift work and detrimental health outcomes. The findings suggest that staff with atypical work schedules may need closer monitoring for heart health. Longitudinal studies are needed to investigate whether late chronotypes cope better with late/night shifts and earlier chronotypes to early morning schedules, both psychologically and physiologically.”
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COVID-19 needs no introduction. Last year, the disease, which is caused by the virus SARS-CoV-2, reached every continent across the globe. By the end of March 2021, there had been an estimated 128 million cases recorded with almost three million of these being fatal. As scientists’ race to develop vaccines and politicians coordinate their distribution, fundamental research on what makes this virus so successful is also being carried out.
Within the Mathematics, Mechanics, and Materials Unit at the Okinawa Institute of Science and Technology Graduate University (OIST), postdoctoral researcher, Dr. Vikash Chaurasia, and Professor Eliot Fried have been using energy minimization techniques to look at charged proteins on biological particles. Previously they researched cholesterol molecules but when the pandemic hit, they realized that with the methods they had developed could be applied to the new virus. They collaborated with researchers Mona Kanso and Professor Jeffrey Giacomin, from Queen’s University in Canada, to take a close look at SARS-CoV-2 and see how the shape of the virus’ ‘spikes’ (which are officially called peplomers) aid its success at spreading so prolifically. Their study was recently published in Physics of Fluids.
“When one envisions a single coronavirus particle, it is common to think of a sphere with many spikes or smaller spheres distributed across its surface,” said Dr. Chaurasia. “This is the way the virus was originally modeled. But this model is a rough sketch and over the last year, we’ve come to learn much more about what the virus looks like.”
Instead, Dr. Chaurasia pointed out, the ‘spikes’ of the coronavirus particle are actually shaped like three small spheres stacked together to form a triangular shape. This is an important consideration because the shape of a viral particle can influence its ability to disperse.
To understand this, imagine a ball moving through space. The ball will follow a curve but, as it does this, it will also rotate. The speed at which the ball rotates is called its rotational diffusivity. A particle of SARS-CoV-2 moves in a similar way to this ball although its suspended in fluid (specifically, tiny droplets of saliva). The rotational diffusivity of the particle impacts how well it can align with and attach itself to objects (such as a person’s tissues or cells) and this has been key in its ability to successfully spread from person to person so quickly. A higher rotational diffusivity will mean that the particle shakes and jitters as it follows a trajectory — and thus may have difficulty attaching to objects or efficiently bouncing off an object to continue to move through the air. Whereas a lower rotational diffusivity has the opposite effect.
Another consideration was the charge of each spike. The researchers assumed that each is equally charged. The same charges always repel each other so if there are only two spikes on a particle and they have equal charges, they’ll be situated at either pole (as far away from each other as possible). As more equally charged spikes are added, they become evenly distributed across the surface of the sphere. This provided the researchers with a geometrical arrangement from which they could calculate the rotational diffusivity.
Previously, the researchers looked at a viral particle with 74 spikes. For this new study, they used the same particle but switched out the single-bead spikes for the three-bead triangles. When they did this, the rotational diffusivity of the particle was found to decrease by 39%. Moreover, this trend was found to continue with the addition of more spikes.
This was an important finding — having a lower rotational diffusivity means that the virus particles can better align and attach themselves to objects and people. Thus, this study suggests that the triangular shaped spikes have contributed to the success of SARS-CoV-2.
“We know it’s more complicated than this,” explained Dr. Chaurasia. “The spikes might not be equally charged. Or they might be flexible and able to twist themselves. Also, the ‘body’ of the particle might not be a sphere. So, we plan to do more research in this area.”
An additional interesting feature of this research is its connection to a question asked more than a century ago by physicist J. J. Thomson, who explored how a set number of charges will be distributed across a sphere.
“I find it fascinating that a problem considered more than 100 years ago has such relevance for the situation we’re in today,” said Professor Eliot Fried. “Although this question was first posed primarily from a standpoint of curiosity and intellectual interest, it has turned out to be applicable in unexpected ways. This shows why we mustn’t lose site of the importance of fundamental research.”
The scientists at OIST and at Queen’s University intend to continue to collaborate on this kind of research to shed light on the success of SARS-CoV-2. The researchers at Queen’s University have just been awarded a Mitacs Globalink Research Award to allow for lead author Mona Kanso to travel between Canada and Japan and work more closely with OIST.

When the first letter from Women & Infants Hospital arrived in the mail in July 2017, Elaine Meyer thought perhaps it was a fund-raising solicitation or clerical error. The letter, which included a billing invoice, addressed her as “Dear Patient,” but she had not been a patient at the hospital for nearly two decades. That’s when she and her husband, Barry Prizant, had completed their infertility treatment there.After three miscarriages, they had gone through several rounds of IVF at Women & Infants in Providence, R.I., near their home in Cranston, resulting in the creation of at least 18 test-tube embryos. One of those had become their son, Noah, born in December of 1996, and along with joy there had been a lot of mourning and reckoning with the reality that this would be the sole realization of their efforts.Dr. Meyer mentioned the letter to her husband and stashed it in a filing cabinet of her home office.But then another came the next month. “If you would like WIH to continue to store your embryos/oocytes,” the letter said, “please return a copy of this letter, signed and notarized, along with a check in the amount of $500.”Dr. Meyer, a longtime psychologist at Boston Children’s Hospital and associate professor of psychology at Harvard Medical School, read it with confusion and a growing sense of alarm. Without the payment, the hospital would consider embryos “legally abandoned” and may discard them.“I thought, ‘This can’t be right,’” she said. “We know we went back for all of our embryos.”Those frozen embryos, still in the hospital’s possession, are now at the center of a lawsuit that Dr. Meyer and Dr. Prizant have filed in Rhode Island’s Superior Court, alleging breach of contract, negligence, bailment and intentional infliction of emotional distress — all of which Women & Infants denies in its response. In a statement, a spokeswoman there declined to comment on the case, citing patient confidentiality and federal privacy laws. “We were always coming back for our embryos”: Dr. Meyer and Dr. Prizant.Maddie Malhotra for The New York TimesWhen the letters arrived, Dr. Meyer and Dr. Prizant, a speech and language pathologist and visiting scholar at Brown University, were then fulfilled empty nesters. Noah was in college, a successful student and happy young man that Dr. Meyer, now 63, calls “the light of our lives.”She was ensconced in her work educating students and health care professionals how to have difficult conversations with patients, upholding what she calls an “emotional standard of care.”Dr. Prizant, 69, who specializes in children and adults on the autism spectrum, was training other practitioners and churning out papers and podcasts. He is the author of “Uniquely Human,” a book written with Tom Fields-Meyer. He plays drums in a band and is proud of his roots in the stickball streets of Brooklyn. “Basically, I don’t like to take crap,” he said.He and his wife, a former 4H club member raised in a large working-class family in small-town Connecticut, met in 1985 while attending a conference at a psychiatric hospital. Married two years later, they wanted children but felt it was important for her to finish graduate school first. Dr. Meyer got pregnant at 34, then had a miscarriage. Two more miscarriages followed.The couple first sought treatment from Dr. Gary Frishman at Women & Infants, which is affiliated with Brown’s medical school, in 1995. Dr. Prizant gave his wife daily shots before her eggs were harvested at the clinic and mixed in a petri dish with his sperm to create embryos, some of which were then implanted in Dr. Meyer’s uterus. The first two cycles didn’t work.“It takes something that is supposed to be so private and so intimate and so tender and makes it a whole different affair,” Dr. Meyer said, recalling the experience. “You’re vulnerable and you’re completely dependent on other people. There are so many injections and appointments and disappointments, you put your trust in what the doctors tell you because you are desperate for the process to work.”During a third cycle, Dr. Meyer became pregnant with Noah. After his birth, she and her husband were optimistic they could have another child. There were nine embryos left over from the three cycles, and they signed agreements with the hospital to “cryopreserve” them for implantation in the future.A card made by the couple’s son, Noah.Maddie Malhotra for The New York TimesDr. Meyer felt an acute attachment to the embryos, calling each “a spark of life.” She would drive out of her way to pass by the hospital, stopping in the parking lot to sing lullabies to them while in her car. “We were always coming back for our embryos,” she said. “That was always the plan.”After Noah started preschool, the couple began anew at Women & Infants in August of 2000 with shots and doctor appointments. The hospital would thaw the nine embryos, and those that survived this process would be implanted in Dr. Meyer’s uterus, in the hopes that at least one would develop into a pregnancy.The couple said they were told all the embryos were thawed; they believe three survived the thaw and were implanted. But weeks later, they were called in for “the failure conversation” — what Dr. Meyer called the meetings with doctors to discuss an unsuccessful procedure and possible next steps.This one was with Dr. David Keefe, then the director of the hospital’s division of reproductive medicine. He advised Dr. Meyer that at 43, her and her husband’s most reasonable path to additional children was donor eggs or adoption.Dr. Prizant was done, emotionally exhausted. “It sets you in a constant state of grief,” he said of infertility treatment.Dr. Meyer, a devoted Quaker, needed a little more time and spiritual consultation, but also made peace, grateful for Noah. “We both decided,” Dr. Prizant said, “to look at having just one child as an opportunity to have more resources to serve many more children through our work.”A Crack in the GlassReading the second letter, which like the first one asked for $500, filled Dr. Meyer with dread. She left a voice mail message at the hospital. Days later, she spoke to a person who turned out to be a clerk in the billing department.“I am telling you, there are no embryos,” Dr. Meyer said, asking her to contact the lab itself.For weeks, she waited for a call back. Nothing. She called the clerk again. “I’ve confirmed with the lab, there are two frozen embryos,” the clerk said.Ms. Meyer was stunned, silent. Then she spoke. “Do you understand how serious this is?” she said.A few days later, she was driving back from the family cottage in South Kingstown, when Dr. Ruben Alvero, then the director of the fertility center at Women & Infants, called to confirm. “We have two of your embryos,” he said.She pulled her car to the side of the road.The embryos, Dr. Alvero said, had been found in a glass vial at the bottom of the tank. The vial has a crack in it, he told her, which meant that the embryos had been exposed, possibly for a decade, to the nitrogen cooling agent. They most likely are not viable, he told her, and apologized.Dr. Meyer told Dr. Alvero this was too much to take in from the side of the road. A meeting was arranged for December of that year, between Dr. Meyer, her husband, Dr. Alvero and Richard Hackett, who helped to create and manages the I.V.F. lab at Women & Infants. Dr. Frishman, who had been Dr. Meyer’s main doctor and is still on the staff at Women & Infants, did not attend.The four gathered in a conference room, with Dr. Prizant and his wife on one side, Dr. Alvero and Mr. Hackett on the other.According to the legal complaint, the men representing the hospital apologized for the circumstances that had brought them together and explained to the couple again what had happened. Two of Dr. Meyer and Dr. Prizant’s embryos had disappeared sometime before Dr. Meyer’s procedure in 2000, Dr. Meyer said they told her and her husband. The embryos were located in 2010 when the tank was emptied for cleaning or maintenance and re-entered into the inventory. The vial, as Dr. Alvero had told Dr. Meyer earlier in the fall, had been damaged. When the clinic implemented a new storage fee policy in 2017, the couple received the bills.She asked if the cells of the embryo still physically existed. They did, the men told her. Though likely compromised, the embryos are still intact, in their glass vial with her name on it.Dr. Meyer holds the lid of a petri dish containing embryos that were implanted in her in 2000.Maddie Malhotra for The New York Times“Those are ours!” Dr. Meyer blurted out, and said that she didn’t want the embryos discarded. Dr. Alvero told her that the hospital would continue to store them and that he would waive the $500 fee. He and Mr. Hackett apologized and flipped through pages in her huge medical file, which the men had brought to the meeting. Mr. Hackett stopped on one page, she said, and began tapping his fingers on it: a handwritten note that said “2 missing.”“You knew they were missing” and didn’t tell us, Dr. Meyer asked?No one ever tried to find the embryos, or thought to alert us when they were found years later, Dr. Prizant asked?Perhaps the couple forgot that they had been told that the embryos were missing, they said Dr. Alvero suggested.Dr. Prizant and Dr. Meyer were sure no one had ever told them anything was missing. Why would they have discussed adoption and egg donation if they had known two embryos were lost in the hospital? “That would have set us on a different course of action,” he said.Dr. Keefe, a professor of obstetrics and gynecology and a fertility specialist at New York University Langone Fertility Center, remembered his patients, and expressed surprise to learn of the two long-lost embryos. “Yikes,” he said. “I feel so terribly for this couple.”Dr. Keefe said that he would have only known if embryos were missing if someone from the lab had notified him, and in this case they had not. In the rare instances when embryos are lost or misplaced, he added, the protocol is to notify the patient immediately, apologize and explain in detail what might have happened. “Transparency is the foundation of trust and the essential element of the doctor-patient relationship,” he said.“These are not two cans of peaches on the shelf at a Stop & Shop,” he went on, speaking of the embryos. “They are much more like two kids on a playground. When you’re responsible for them and they’re lost, you notify the people who care about them the most and tell them all you can.”Dr. Meyer, who has devoted a career to speaking up for patients and more recently to studying and writing about bioethics, scoffs at the idea that she would have quietly accepted the news in 2000 that her embryos had been lost. “There is no way on God’s green earth,” she said.Dr. Alvero, now the director of reproductive endocrinology and infertility at the Lucile Packard Children’s Hospital at Stanford University and the president of the Society for Reproductive Endocrinology and Infertility, referred questions to the public relations department of Women & Infants. The hospital’s spokeswoman said Dr. Frishman and Mr. Hackett were not available for comment.‘My Line in the Sand’At the meeting in December 2017, Dr. Prizant and Dr. Meyer said, Dr. Alvero asked what might help them feel resolved about the situation.The couple said they wanted to find something meaningful to come from the careless treatment of their embryos. Perhaps it could provide a learning opportunity, they suggested — proposing, among other ideas, that Dr. Meyer could help train fertility staff at the hospital to interact more compassionately with and informatively to patients in the thicket of family planning.Dr. Meyer and Dr. Prizant on their wedding day.Maddie Malhotra for The New York TimesDr. Alvero and Mr. Hackett said they would consult with the hospital administration and get back in touch after the holidays. But by May 2018, after five months of silence, Dr. Meyer and Dr. Prizant wrote a letter to Dr. Alvero, copying the hospital’s interim president and chief executive, the Rhode Island attorney general and the head of the state’s department of health.“As parents who cherished children, we would NOT have forgotten that our embryos were missing,” they wrote. “We would not have rested until they were found and cared for.”Soon after mailing the letter, they got a phone call from Katherine Wills, the hospital’s director of risk management. “‘This happened a long time ago,’” Dr. Meyer recalled Ms. Wills telling her. Ms. Meyer felt the message was, “Get over it.”Dr. Meyer explained to Ms. Wills that embryos discovered in the bottom of the tank represented to her and her husband potential human beings: children, her and her husband’s children. “I was horrified,” Dr. Meyer said.That conversation, she said, “was my line in the sand.” Hesitant at first, Dr. Meyer and her husband decided to take legal action. “As a woman who had suffered miscarriages and infertility, all the powerful feelings of sadness, shame and grief came crashing back and the knot in my stomach was real.”They are seeking a jury trial and punitive, compensatory, consequential damages. But Dr. Meyer and Dr. Prizant said the real point of the lawsuit is to compel the hospital, and perhaps other infertility treatment providers, to commit to reliable and accountable storage management and patient care practices. (They want to urge vigilance on the increasing number of people freezing eggs and embryos.)In a legal filing, the hospital alleged that Dr. Meyer and Dr. Prizant “were guilty of comparative negligence” but provided no further detail. Angela L. Carr, the hospital’s lawyer, declined to comment.The couple at their cottage in South Kingstown.Maddie Malhotra for The New York Times“I would not be true to myself if I let this be swept under the rug,” Dr. Meyer said. “It is our job as parents to give our children, and in this case embryos, every opportunity for life and for dignity. We were denied our right to fulfill our role as parents.”‘You Assume There is Oversight’Dr. Prizant and Dr. Meyer’s saga is “an interesting story not because it’s unique but because it’s probably not unique,” said Jeffrey Kahn, the director of the Berman Institute of Bioethics at Johns Hopkins University. (He does not know the couple and is not involved in their case.) “There is so little regulation and no accounting of how many embryos there are in storage,” he said.The fertility industry is a lucrative business but operates largely unchecked by regulators, Dr. Kahn said, for several reasons, including federal policies in place since the mid-1980s. The policies bars federal dollars from being used for research that involves the harm or destruction of human embryos.Federal regulation tends to follow federal funding, often leaving privately funded I.V.F. facilities without oversight. Also, most of what takes place in an I.V.F. laboratory falls outside the purview of the Food and Drug Administration. “You assume there is oversight, as there is with most doctors and procedures, but when it comes to infertility, that turns out not to be true,” he said.A study published in 2020 in the journal Fertility & Sterility found that 133 lawsuits were filed in the previous decade over lost, discarded or damaged frozen embryos. That number reflects lawsuits filed, which is likely a fraction of actual occurrences, said Dov Fox, the director of the Center for Health Law Policy and Bioethics at University of San Diego and one of the study’s authors. Dr. Fox also noted that most of these types of suits settled out of court, with undisclosed terms and nondisclosure agreements, making it difficult to know the outcomes.Three lawsuits have been filed against Women & Infants Hospital related to lost embryos, including two in the mid-1990s, when Ms. Meyer was a patient. In 2019, a woman named Marisa Cloutier-Bristol described receiving in 2017 a bill from Women & Infants similar to the ones that Dr. Meyer and Dr. Prizant received, which notified Ms. Cloutier-Bristol that the hospital had a frozen embryo belonging to her and her late husband, despite having been told in 2003 that her I.V.F. cycle had not produced any viable embryos.“I felt like I was now grieving a child I didn’t even know existed, a child I could have had,” she told “Good Morning America” in 2019. She sued the hospital. (The case has since been dismissed. Through her lawyer, Ms. Cloutier-Bristol declined to comment.)As Dr. Meyer and Dr. Prizant’s case winds its way through the pandemic-delayed civil courts system, the couple is also thinking about what to do with their embryos.After seeking spiritual support and guidance at their temple and their Quaker meeting, the couple is leaning toward repossessing their embryos, and burying them in the backyard in Cranston, where her mother’s ashes, and the remains of the family dog, are buried. They also have talked to a rabbi about a cemetery burial.“We need to allow our embryos to finally have some peace and rest,” Dr. Meyer said. “And we need to find some peace and rest ourselves.”

SharecloseShare pageCopy linkAbout sharingimage copyrightOrklaThree people have died in what Danish health authorities say is a large outbreak of salmonella that has left 33 people ill.Nineteen people have been treated in hospital, according to Denmark’s SSI health agency. Those involved in the outbreak are aged between two and 92.All those affected ate Husk brand psyllium husk capsules from batches recalled by manufacturer Orkla Care.Authorities found traces of salmonella in the products at patients’ homes. The herbal products are generally used as a laxative. Luise Müller of Denmark’s Statens Serum Institut said it was the first time the agency had found a herbal medicine to be the cause of a salmonella outbreak.It is not clear which ingredient could have caused the poisoning. Salmonella bacteria can be found in raw or undercooked meat, eggs or other food products. Infection can cause fever, diarrhoea, stomach pain, vomiting and in some cases death. Ms Müller said that while it was not certain that the three deaths were caused by the herbal remedy, this high rate of hospital cases and deaths was unusual. “It’s because this product is taken by people who are already vulnerable and may have stomach problems,” she told the BBC. “And when they are hospitalised or die it’s with the underlying disease as well.”‘Recall of all Husk products’Orkla Care spokesman Hakon Mageli told the BBC that no clear connection had been confirmed between the three deaths and the products. However, as a precaution he said “we have decided right now to recall all Husk products because of the outbreak in Denmark, and also for the Swedish and Norwegian and Finnish market”.Although the main focus of the Danish health investigation had been Husk capsules, Mr Mageli said the recall also applied to Husk powder. The company issued its last recall of a batch of Husk supplements on Monday.Many of those affected by the outbreak became ill in March and the health agency first alerted the public to the outbreak on 9 April. By that time there was no indication of serious illness.Ms Müller said it was possible that some people were unaware they had contracted salmonella as they were already suffering from stomach problems. The three who died are thought to have been ill already but the health agency is unable to give details of their ages.She told the BBC that delays in the surveillance system meant that more cases were likely to arise, especially if people did not see there was a recall.Mr Mageli said Orkla products had been on the Danish market for 35 years and had never had any cases of salmonella. “We don’t know the reason [for the outbreak] but we have now started a full review of the process from the supply of raw materials to the finished product,” he said.

SharecloseShare pageCopy linkAbout sharingimage copyrightReutersAkhilesh Mishra started getting a fever and a cough last Thursday but he initially thought it was just the flu.Akhilesh began to worry the next day, when his father Yogendra developed similar symptoms. The two men decided to get Covid RT-PCR tests done and tried to book a slot online but the next available appointment was three days later.They finally managed to get a slot on Sunday. In the meantime, Yogendra was running a very high fever and his doctor advised him to look for a hospital bed, which turned out to be another daunting task. They were turned away by many private hospitals in the city of Noida and also in the capital, Delhi.The family finally managed to get a bed for him in a private hospital in Delhi and he is now recovering. ‘Covid lockdown will make us beg for food again”Think about ICU workers before you party’Is the world’s vaccine powerhouse running out of doses? Akhilesh had thought he would lose his father.”I felt depressed,” he said. “I feared that he was going to die without getting treatment. No son should have to go through what I went through. Everybody should have equal access to care.”The family’s story is not unique. Accounts of family members struggling to find a bed, or life-saving drugs or oxygen cylinders, are being reported all over India. In some cities, there is a long waiting list at the crematoriums.My otherwise healthy cousin in Ranchi passed away of covid symptoms last night. In his final hours neither could he get a Covid test (for days), nor could he get a hospital bed. Hospital won’t release the body without testing now. He’s not a stat. This is real.— अंशुल (@Ghair_Kanooni) April 15, 2021
The BBC is not responsible for the content of external sites.View original tweet on TwitterMy best friend from school is suffering from #COVID-19, her lungs r failing, the hospital she is currently admitted in not equipped with #ventilator. She needs a ventilator. Please let me know if you have any leads of a hospital+ventilator in #Ahmedabad where she can be treated.— Anjali Jain (@helloanjali) April 15, 2021
The BBC is not responsible for the content of external sites.View original tweet on TwitterBlack-marketing of drugsIn recent days in India, social media has been awash with desperate requests for help finding the drugs remdesivir and tocilizumab. The effectiveness of the two drugs is being debated across the world but some countries, including India, have given emergency use authorisation to both.The antiviral drug remdesivir is being prescribed by doctors across the country, and it is in high demand. India has banned exports, but manufacturers are still struggling to meet the demand. India has reported more than 150,000 Covid cases a day for the past three weeks.This is a call for help. Urgently need #Remdesivir for my mother who’s covid +ive and a chronic patient with Kartagener’s syndrome (a rare, severe lung disease). I am in Jamshedpur with her. She has high fever & her O2 is dropping despite continuous O2 support. Kindly amplify.— Sana Shakil (@sanashakil_TNIE) April 14, 2021
The BBC is not responsible for the content of external sites.View original tweet on TwitterHetero Pharma, one of seven firms manufacturing remdesivir in India, said the company was trying to ramp up production. The BBC has found that the shortage in supply is leading to black marketing of the drug in Delhi and several other cities. At least three agents contacted by the BBC in Delhi agreed to supply each 100mg vial of remdesivir for 24,000 rupees ($320; £232) – five times the official price. India’s health ministry recommends six doses of 100mg vials for a patient for one course of the drug, but doctors say up to eight doses are needed in some cases.That is a lot of money for a middle-class family. “I had to spend so much money to get the drug, said Atul Garg, whose mother was admitted to a private hospital in Delhi. Finding the drug required “hundreds of calls and many anxious hours”, Atul said.Emergency. A friend in Bhopal is looking to hospitalise her Covid+ mother. All hospitals in the city she has reached out to refused bed’s availability. Any lead for bed/oxygen cylinder would be extremely helpful. Please spread the word. DM if you have leads.— Kumar Sambhav (@Kum_Sambhav) April 12, 2021
The BBC is not responsible for the content of external sites.View original tweet on TwitterTocilizumab, a drug normally used to treat arthritis, has been proven to save lives in some clinical trials. But it has almost disappeared from the market in India. Rajiv Singhal, general secretary of the All India Chemists and Druggists Association, said his phone was ringing through the day as people asked him to help find the drugs. “The situation is so bad that I can’t even get the drugs for my own family members,” he said. “We are trying to take action against those who are black marketing, but I admit that there are leakages in the system.”Oxygen, X-rays and Covid testsThe demand for medical oxygen has also soared in several Indian sates. Several hospitals are turning patients away because they lack supplies. Maharashtra state Chief Minister Uddhav Thackeray asked the federal government to send oxygen by army aircraft, as road transportation was taking too long to replenish the supply in hospitals.The situation is much worse in small cities and towns. When patients are not able to find a hospital bed, doctors advise them to arrange oxygen cylinders at home.Nabeel Ahmed’s father was diagnosed with Covid on Friday in a small town in northern India. Five days later, he started having difficulty in breathing. The doctor advised Nabeel to get an oxygen cylinder at home. He had to drive for four hours to another city to pick one up. “It took me eight hours to get a cylinder for my dad while he was struggling to breathe,” he said.Another major problem patients are facing in smaller towns is that private labs are refusing to conduct chest X-rays and CT scans. Doctors often ask for these tests to assess the progress of the disease. Yogesh Kumar, who lives in the northern town of Allahabad, said the only way for him to get an X-ray done was to either get admitted to a hospital or to get the test done at a government-run hospital, where the waiting list was too long.A doctor in Allahabad told the BBC: “It’s unbelievable that I am unable to get X-rays done for my patients. We have to just rely on blood reports to assess the disease in some cases, which is not ideal.”image copyrightReutersBusy crematoriums Crematoriums in many badly affected cities are running day and night. In some cases, families have to wait for several hours to cremate the deceased. A recent report said that the metal structure of the furnaces inside a crematorium in the western Indian city of Surat had started melting because it had been running day and night without any break. A short video clip went viral recently showing dozens of funeral pyres burning in the northern city of Lucknow in the middle of the night.Many staff members at crematoriums are working without a break. They are getting exhausted. Many around India are asking if these situations were avoidable.”We did not learn lessons from the first wave. We were aware that the second wave was coming but we didn’t plan to avoid unfortunate incidences like shortages of drugs, beds and oxygen,” said epidemiologist Dr Lalit Kant.”We didn’t even learn from other countries which faced similar circumstances,” he said.Some names have been changed on request.Read more stories by Vikas Pandey’Think about ICU workers before you party”I have cancer in my 30s, but can’t get a Covid jab’India in ‘delicate phase’ as Covid cases surgeThe vaccine pioneer the world forgot

Dr. Anthony S. Fauci said he hoped for a decision “quite soon” on the Johnson & Johnson vaccine, as local governments shifted to more complicated two-dose vaccines for marginal populations.Dr. Anthony S. Fauci said on Thursday that he hoped the nation would soon be able to resume use of the Johnson & Johnson vaccine, as a “pause” that now looks indefinite threatened to upend vaccination efforts overseas and in some of the most marginalized communities in the United States.Dr. Fauci, President Biden’s chief medical adviser for the pandemic, made the comment during a hearing of the House Select Subcommittee on the Coronavirus Crisis, where he and other top federal health officials implored Americans to continue to get vaccinated and sought to reassure the nation that all three federally authorized vaccines are safe.“Hopefully we’ll get a decision quite soon, as to whether or not we can get back on track with this very effective vaccine,” Dr. Fauci told the panel. With cases rising in the Midwest, he added, the nation is in a “precarious situation” and it is imperative to vaccinate “as many people as quickly and as expeditiously as we possible can.”But it was increasingly clear that a suspension that initially was to last two to three days would be considerably longer, as officials wrestled with reports of at least six rare cases of blood clotting among women immunized with the Johnson & Johnson shot. Federal health agencies are trying to decide whether to recommend that doctors resume use of the vaccine, possibly with new restrictions.The vaccine has not been a major component of the Biden administration’s vaccination campaign. About 7.7 million Americans have received the Johnson & Johnson shot, accounting for fewer than 4 percent of the more than 198 million doses administered across the country.But while those numbers are small, many of the people the vaccine has been targeted at are vulnerable: homeless people in Baltimore, homebound residents in the District of Columbia, the poor and uninsured in Massachusetts, rural residents in a number of states. All are populations easier to reach with a single dose than the two-dose regimen of the Pfizer and Moderna vaccines.About 10 million doses shipped to the states are now on shelves awaiting a decision. And many people who might not seek out a shot but could have been reached with mobile clinics and concerted outreach may be left behind, at least for now.“There is a great deal of work going on with all of our vaccinators, providers around the state and with our team at the Minnesota Department of Health trying to help plan and shifting things around. It is a series of dominoes, obviously,” said Jan Malcolm, Minnesota’s health commissioner. “We very much regret the clinics that had to be canceled on short notice because of the pause in J&J, and that will continue to be an issue in the coming couple of weeks.”The White House press secretary, Jen Psaki, again calibrated President Biden’s promise that he would secure enough vaccine for all American adults by the end of May. Now, the White House is emphasizing that all adults who want a vaccine will get one.“That means that by the end of May, for about 80 percent of the population, by the end of July about 90 percent of the population,” Ms. Psaki told reporters.In Lexington, Ky., a Johnson & Johnson clinic for Friday was canceled, leaving around 400 people without appointments. All were offered a last-minute option to get a Moderna vaccine, but only about 65 accepted the offer, said Kevin Hall, a spokesman for the Lexington-Fayette County Health Department.“This was a major hit to our planning,” said Mr. Hall, whose agency had already used the Johnson & Johnson vaccine for inmates and homeless people, and had planned to offer neighborhood clinics in the coming weeks. “The logistics of pulling off a first-dose and second-dose clinic become much, much more difficult.”About 7.7 million Americans have received the Johnson & Johnson vaccine, accounting for fewer than 4 percent of the more than 198 million doses administered across the country.Matthew Hatcher/Getty ImagesDr. Letitia Dzirasa, the health commissioner in Baltimore, said the city had received only about 1,400 doses of the Johnson & Johnson vaccine to date, but many were targeted at homeless residents. The city may have to rethink plans it had been making for outdoor pop-up clinics and efforts to reach homebound residents with the one-dose vaccine this summer, she said.“We were thinking the J&J would be the ideal candidate to support that work,” she said.In Washington, D.C., officials are delaying a program to reach homebound residents with Johnson & Johnson shots. The city canceled appointments for about 1,200 people this week, but by now all should have received an invitation for a new appointment for one of the other two federally authorized vaccines, developed by Pfizer-BioNTech and Moderna.Other state and local health officials said they were getting by with those two vaccines. In the Flint, Mich., area, which has some of the country’s highest recent case rates, officials said they had been able to cover all planned clinics even without the Johnson & Johnson vaccine.“It has been smooth so far,” Dr. Pamela Hackert, the medical health officer for the Genesee County Health Department, said in an email.At Des Moines Area Community College in Iowa, administrators have been able to set up three on-campus clinics this month where students will be able to receive a two-dose vaccine. Rob Denson, the college president, said he had been pleased and surprised at his ability to arrange those future clinics so quickly.“I think we’re going to be awash in vaccine within a relatively short amount of time,” he said.But an extended break in Johnson & Johnson availability will begin to pinch, especially in poorer states with harder-to-reach populations. A spokeswoman for Dr. José Romero, the secretary of health in Arkansas, said that “the pause should be a sufficient length to answer safety questions, but not extended any longer than necessary.“His concern is that an overlong pause will increase hesitancy and decrease confidence,” said the spokeswoman, Danyelle McNeill. Dr. Romero leads the advisory committee to the Centers for Disease Control and Prevention that will ultimately recommend how to proceed with the Johnson & Johnson vaccine.The suspension in the United States may have more profound consequences overseas, where only a fraction of the rest of the world has so far been vaccinated. Dr. Luciana Borio, a former acting chief scientist at the Food and Drug Administration who also served on the National Security Council in the Trump White House, said the Johnson & Johnson vaccine was a crucial tool for stopping the spread of the virus around the world.“It’s a vaccine that can be manufactured quickly in very large scale and has much easier distribution procedures,” she said. “The world needs more companies like J&J supplying their vaccine.”Officials were counting on both Johnson & Johnson and another easy-to-distribute vaccine made by AstraZeneca to get inoculations to hard-to-reach parts of the globe. But recent reports of rare blood clots in recipients of the AstraZeneca vaccine have led a number of nations to reconsider its use.Some regions decided to shift to Johnson & Johnson; two weeks ago, the African Union acquired 400 million doses even as wealthier nations have shied away. The European Union said it would not buy more from Johnson & Johnson, and Australia announced it would not purchase any doses.In the United States, members of the C.D.C. advisory panel suggested on Wednesday that it would be a week to 10 days before they had enough information to assess the vaccine’s risks and could make a decision about its future in the United States. Dr. Fauci and two other officials — Dr. Rochelle Walensky, the C.D.C. director, and Dr. David Kessler, who runs the Biden administration’s vaccine effort — urged Americans to continue to get vaccinated.A medical worker giving the Johnson & Johnson vaccine in San Juan, P.R., last month.Ricardo Arduengo/Agence France-Presse — Getty Images“I hope we can all come together and send that message,” especially amid the spread of worrisome variants, Dr. Kessler said, adding that the three federally authorized vaccines have “an excellent safety profile.”.css-1xzcza9{list-style-type:disc;padding-inline-start:1em;}.css-rqynmc{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.9375rem;line-height:1.25rem;color:#333;margin-bottom:0.78125rem;}@media (min-width:740px){.css-rqynmc{font-size:1.0625rem;line-height:1.5rem;margin-bottom:0.9375rem;}}.css-rqynmc strong{font-weight:600;}.css-rqynmc em{font-style:italic;}.css-yoay6m{margin:0 auto 5px;font-family:nyt-franklin,helvetica,arial,sans-serif;font-weight:700;font-size:1.125rem;line-height:1.3125rem;color:#121212;}@media (min-width:740px){.css-yoay6m{font-size:1.25rem;line-height:1.4375rem;}}.css-1dg6kl4{margin-top:5px;margin-bottom:15px;}.css-16ed7iq{width:100%;display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;-webkit-box-pack:center;-webkit-justify-content:center;-ms-flex-pack:center;justify-content:center;padding:10px 0;background-color:white;}.css-pmm6ed{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}.css-pmm6ed > :not(:first-child){margin-left:5px;}.css-5gimkt{font-family:nyt-franklin,helvetica,arial,sans-serif;font-size:0.8125rem;font-weight:700;-webkit-letter-spacing:0.03em;-moz-letter-spacing:0.03em;-ms-letter-spacing:0.03em;letter-spacing:0.03em;text-transform:uppercase;color:#333;}.css-5gimkt:after{content:’Collapse’;}.css-rdoyk0{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;-webkit-transform:rotate(180deg);-ms-transform:rotate(180deg);transform:rotate(180deg);}.css-eb027h{max-height:5000px;-webkit-transition:max-height 0.5s ease;transition:max-height 0.5s ease;}.css-6mllg9{-webkit-transition:all 0.5s ease;transition:all 0.5s ease;position:relative;opacity:0;}.css-6mllg9:before{content:”;background-image:linear-gradient(180deg,transparent,#ffffff);background-image:-webkit-linear-gradient(270deg,rgba(255,255,255,0),#ffffff);height:80px;width:100%;position:absolute;bottom:0px;pointer-events:none;}#masthead-bar-one{display:none;}#masthead-bar-one{display:none;}.css-1pd7fgo{background-color:white;border:1px solid #e2e2e2;width:calc(100% – 40px);max-width:600px;margin:1.5rem auto 1.9rem;padding:15px;box-sizing:border-box;}@media (min-width:740px){.css-1pd7fgo{padding:20px;width:100%;}}.css-1pd7fgo:focus{outline:1px solid #e2e2e2;}#NYT_BELOW_MAIN_CONTENT_REGION .css-1pd7fgo{border:none;padding:20px 0 0;border-top:1px solid #121212;}.css-1pd7fgo[data-truncated] .css-rdoyk0{-webkit-transform:rotate(0deg);-ms-transform:rotate(0deg);transform:rotate(0deg);}.css-1pd7fgo[data-truncated] .css-eb027h{max-height:300px;overflow:hidden;-webkit-transition:none;transition:none;}.css-1pd7fgo[data-truncated] .css-5gimkt:after{content:’See more’;}.css-1pd7fgo[data-truncated] .css-6mllg9{opacity:1;}.css-1rh1sk1{margin:0 auto;overflow:hidden;}.css-1rh1sk1 strong{font-weight:700;}.css-1rh1sk1 em{font-style:italic;}.css-1rh1sk1 a{color:#326891;-webkit-text-decoration:underline;text-decoration:underline;text-underline-offset:1px;-webkit-text-decoration-thickness:1px;text-decoration-thickness:1px;-webkit-text-decoration-color:#ccd9e3;text-decoration-color:#ccd9e3;}.css-1rh1sk1 a:visited{color:#333;-webkit-text-decoration-color:#ccc;text-decoration-color:#ccc;}.css-1rh1sk1 a:hover{-webkit-text-decoration:none;text-decoration:none;}The reports of blood clots were the second recent blow to the Johnson & Johnson vaccine. Earlier this month, an ingredient mix-up at a Baltimore manufacturing plant owned by Emergent BioSolutions ruined up to 15 million doses of the vaccine. The F.D.A. is now inspecting the plant to see whether any doses manufactured there can be released to the public.Yet during a hearing that lasted more than two hours, just one lawmaker — Representative Mark E. Green, Republican of Tennessee, who is a doctor — asked about the Johnson & Johnson vaccine. He urged the doctors to be careful when they talked about the investigation, saying he worried that they would stoke fears that would discourage people from getting vaccinated.And there is early evidence that the concern is well taken. A Survey Monkey poll released on Thursday by Boston Children’s Hospital found that a willingness to get the Johnson & Johnson shot dropped 26 percentage points in two days among Americans who wanted to get vaccinated. The drop among women who wanted to get vaccinated was 31 percentage points, according to the survey, a project from the hospital’s Outbreaks Near Me initiative, a crowdsourced infectious disease surveillance system.“Anytime there is a concern or red flag raised at the federal level, that’s going to spark concern for the general public,” Dr. Dzirasa said.Thursday’s session was subtitled “A Science-Driven Approach to Swiftly and Safely Ending the Pandemic.” But whatever science was discussed was overshadowed by partisan posturing and bickering.Democrats worried about the Fox News host Tucker Carlson, who has used his show to wrongly assert that the vaccines do not work.Republicans, fresh off a trip to the nation’s southern border, used the session to attack the Biden administration’s handling of the immigration crisis. They waved photographs of migrants living in crowded conditions, while complaining about testing rules for those entering the country.Representative Jim Jordan, Republican of Ohio, and Dr. Fauci reprised their heated clash from the last time Dr. Fauci testified before the panel in July.“You’re ranting again,” Dr. Fauci said at one point.“I’m not ranting,” Mr. Jordan replied.“Yes, you are,” Dr. Fauci insisted.Representative Maxine Waters, Democrat of California, whose sister died of Covid-19, told Dr. Fauci, “I love you,” and told Mr. Jordan, “Shut your mouth.”Noah Weiland

A new study by Texas A&M University researchers published in PLOS ONE details a new model for making short-term projections of daily COVID-19 cases that is accurate, reliable and easily used by public health officials and other organizations.
Led by Hongwei Zhao, professor of biostatistics at the Texas A&M School of Public Health, researchers used a method based on the SEIR (susceptible, exposed, infected and recovered states) framework to project COVID-19 incidence in the upcoming two to three weeks based on observed incidence cases only. This model assumes a constant or small change in the transmission rate of the virus that causes COVID-19 over a short period.
The model uses publicly available data on new reported cases of COVID-19 in Texas from the COVID-19 Data Repository by the Center for Systems Science and Engineering at Johns Hopkins University. Texas A&M researchers used this data on disease incidence for Texas and a selection of counties that included the Texas A&M campus to estimate the COVID-19 transmission rate.
“The results indicate that this model can be used to reasonably predict COVID-19 cases two to three weeks in advance using only current incidence numbers,” Zhao said. “The simplicity of this model is one of its greatest strengths as it can be easily implemented by organizations with few resources. Forecasts from this model can help health care organizations prepare for surges and help public health officials determine whether mask mandates or other policies will be needed.”
They forecasted future infections under three possible scenarios: a sustained, constant rate of transmission; one where the transmission rate is five percent higher than current levels, reflecting a decrease in practices to prevent transmission or an increase in conditions that promote transmission; and one where transmission is five percent lower.
Estimating the current effective transmission rate can be tricky, since day-to-day variations in both infections and reporting can dramatically influence this estimate. Thus, the researchers smoothed daily reporting variations using a three-day weighted average and performed additional smoothing to account for data anomalies such as counties reporting several months of cases all at once.
The researchers compared their projections with reported incidence in Texas through four periods in 2020: April 15, June 15, August 15 and October 15. The number of new daily COVID-19 cases reported were relatively low in mid-April, when many businesses were shut down, and then started to increase in early May after phased re-openings began in Texas. The numbers increased sharply after Memorial Day, and then trended downward after a statewide mask mandate was enacted during the summer. Infections increased again after Labor Day, but then seemed to plateau until the middle of October, when the transmission rate was observed again to increase dramatically.
The statewide application of the model showed that it performed reasonably well, with only the second period forecast deviating from the actual recorded incidence, perhaps due to the dramatically changing numbers at the time when a great wave of COVID-19 occurred around the Memorial Day holiday. The model performed similarly well at the county level, though the smaller population and changes in population, such as students moving in and out of the area during the school year, influenced reporting of new cases.
However, the model is limited by the data it uses. Local testing and reporting policies and resources can affect data accuracy, and assumptions about transmission rate based on current incidence are less likely to be accurate further into the future. And as more people contract COVID-19 and recover, or are vaccinated, the susceptible population will change, possibly affecting transmission.
Despite these limitations, the researchers said the model can be a valuable tool for health care facilities and public health officials, especially when combined with other sources of information. The COVID-19 pandemic is not yet over, so having a tool that can determine when and where another surge might occur is important. Similarly, researchers hope to use these new tools at their disposal for future infectious disease needs.
Additionally, the model has been used to create a dashboard that provides real-time data on the spread of COVID-19 state-wide. It has been used locally by university administrators and public health officials.
Other School of Public health researchers involved in this study included Marcia Ory, Tiffany Radcliff, Murray Côté, Rebecca Fischer and Alyssa McNulty, along with Department of Statistics researchers Huiyan Sangand and Naveed Merchant.
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Materials provided by Texas A&M University. Original written by Rae Lynn Mitchell. Note: Content may be edited for style and length.