Culture

As the COVID-19 pandemic enters its third month, businesses in the United States are marketing unlicensed and unproven stem-cell-based "therapies" and exosome products that claim to prevent or treat the disease. In Cell Stem Cell on May 5, bioethicist Leigh Turner describes how these companies are "seizing the pandemic as an opportunity to profit from hope and desperation."

"I'm concerned that individuals purchasing these supposed 'therapies' for COVID-19 will be scammed," says Turner (@LeighGTurner), an associate professor at the University of Minnesota Center for Bioethics. "I'm also worried that they'll be injured as a result of being given products that haven't been adequately tested, or that they'll forgo measures like social distancing because they've paid for a product that they think will protect them from being infected or getting sick."

Many stem cell clinics have a history of selling unproven and unlicensed interventions for injuries and illnesses ranging from Alzheimer's disease to pulmonary disorders to spinal cord injuries. Since the COVID-19 pandemic began, some have added claims about "immune-boosting" therapies for treating COVID-19 and acute respiratory distress syndrome (ARDS) caused by infection with SARS CoV-2. These companies advertise stem cell interventions and exosome products derived from such sources as umbilical cords and amniotic fluid. Turner says uncritical news media accounts have compounded some of these claims by reporting on preliminary evidence and case studies.

Yet rigorous clinical trials on these stem cell products have not yet been done. "Randomized controlled trials are needed to establish whether particular stem cell products are safe and efficacious in the treatment of COVID-19-related ARDS," he explains.

Turner has studied the US direct-to-consumer marketplace for stem cell clinics for nearly a decade. "These businesses have a long history of claiming to treat diseases and injuries for which evidence-based therapies do not yet exist," he says. To find out what these businesses were promoting, he did Google searches on a variety of terms related to stem cell treatments, COVID-19, and ARDS. He also searched YouTube for promotional videos made by these clinics.

"I found more examples of businesses peddling stem cell products for COVID-19 than I had space to describe in detail," he notes. "I wasn't surprised at how quickly some of these companies began making these claims. For them, the COVID-19 pandemic is an opportunity to generate a new revenue stream."

In the paper, Turner also discusses the role of medical organizations, noting that while most are doing a good job of criticizing deceptive advertising, some have been promoting these interventions despite the lack of scientific evidence supporting their use.

"I want members of the public to know that some companies are trying to take advantage of them by selling supposed treatments that aren't backed by credible evidence," Turner concludes. "I'm also hoping that this paper will catch the attention of regulatory bodies like the Food and Drug Administration (FDA) and the Federal Trade Commission (FTC), as well as state medical boards and state attorney general offices. The FDA and FTC have issued letters to some businesses, but additional regulatory action is needed."

A new study has found an association between low average levels of vitamin D and high numbers of COVID-19 cases and mortality rates across 20 European countries.

The research, led by Dr Lee Smith of Anglia Ruskin University (ARU) and Mr Petre Cristian Ilie, lead urologist of Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, is published in the journal Aging Clinical and Experimental Research.

Previous observational studies have reported an association between low levels of vitamin D and susceptibility to acute respiratory tract infections. Vitamin D modulates the response of white blood cells, preventing them from releasing too many inflammatory cytokines. The COVID-19 virus is known to cause an excess of pro-inflammatory cytokines.

Italy and Spain have both experienced high COVID-19 mortality rates, and the new study shows that both countries have lower average vitamin D levels than most northern European countries. This is partly because people in southern Europe, particularly the elderly, avoid strong sun, while skin pigmentation also reduces natural vitamin D synthesis.

The highest average levels of vitamin D are found in northern Europe, due to the consumption of cod liver oil and vitamin D supplements, and possibly less sun avoidance. Scandinavian nations are among the countries with the lowest number of COVID-19 cases and mortality rates per head of population in Europe.

Dr Lee Smith, Reader in Physical Activity and Public Health at Anglia Ruskin University, said: "We found a significant crude relationship between average vitamin D levels and the number COVID-19 cases, and particularly COVID-19 mortality rates, per head of population across the 20 European countries.

"Vitamin D has been shown to protect against acute respiratory infections, and older adults, the group most deficient in vitamin D, are also the ones most seriously affected by COVID-19.

"A previous study found that 75% of people in institutions, such as hospitals and care homes, were severely deficient in vitamin D. We suggest it would be advisable to perform dedicated studies looking at vitamin D levels in COVID-19 patients with different degrees of disease severity."

Mr Petre Cristian Ilie, lead urologist of Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, said: "Our study does have limitations however, not least because the number of cases in each country is affected by the number of tests performed, as well as the different measures taken by each country to prevent the spread of infection. Finally, and importantly, one must remember correlation does not necessarily mean causation."

Plastic may be an indispensable part of our daily lives, but its robustness and abundance have led to its overuse, putting a huge burden on the environment. Large emissions of plastic waste result in its accumulation in water bodies: in fact, recent studies have estimated about 0.27 million tons of plastic floating in the world's oceans. Because plastic does not decompose in water, it is a serious hazard for the marine life. Thus, to prevent plastic pollution, it is crucial to understand exactly how plastic is emitted into the oceans. Previous studies have tried to analyze plastic emissions, but they had some limitations: they focused on mostly mismanaged plastic waste and not how these plastic emissions actually originate.

To this end, a group of scientists at the Tokyo University of Science, led by Prof Yasuo Nihei, developed a new method to combat plastic emissions. In a study published in Water, they generated a "high-resolution map of 1 km grids of plastic emissions across Japan. Prof Nihei explains, "If plastic waste continues to flow into the sea, the amount of plastic waste will increase. To prevent this, it is necessary to clearly indicate where and how plastic debris is currently being generated."

To begin with, the scientists focused on the different types of plastics: microplastic (MicP), which is less than 5 mm in size, and macroplastic (MacP), which is greater than 5 mm. They understood that controlling MicP was crucial because--owing to its small size--it is particularly hard to recover once it enters the ocean. Moreover, it can easily be ingested by marine organisms, which can negatively affect ecosystems worldwide. To avoid the emission of MicP in water bodies, it was important to find out exactly where these emissions were coming from.

The scientists followed a three-step process to map plastic emissions (Figure 1). First, they measured MicP concentration across 70 rivers and 90 sites in Japan and examined the relation between MicP concentration and land characteristics. They collected the ratio of MacP/MicP concentrations to evaluate the MacP concentration from the MicP concentration. Next, to obtain outflow discharge at 1 km grids, they performed a "water balance analysis" in which they measured precipitation of water, distributed into three categories: evaporation, surface runoff, and underground infiltration. Finally, they calculate total plastic emission, which is the product of MicP and MacP concentrations and outflow discharge. Their findings revealed that MicP concentrations and basin characteristics were significantly correlated, meaning that the physical features of water bodies dictate the amount of plastic waste accumulated. Not just this, their analysis helped the scientists to estimate the annual plastic emission in Japan, which ranged from 210 to 4,776 tons/year of total plastic.

The scientists then evaluated a high-resolution map of plastic emission over 1 km grids across Japan (Figure 2). They identified the critical areas where plastic emissions were the highest. Their analysis showed that these emissions were high in rivers near urbanized areas, with a high population density. Among these, cities like Tokyo, Nagoya, and Osaka were found to be hotspots for plastic emissions. Thus, this method was useful in understanding exactly where strict countermeasures should be enforced.

Unlike previous studies, this study does not assume that the plastic waste is only proportional to mismanaged plastic waste but, in fact, takes into account the origin of plastic emissions. This makes it easier to implement measures and curb plastic emissions in specific areas. Prof Nihei concludes, "Our findings provide new insights that may be used to draft countermeasures against plastic emissions, thereby reducing outflow of marine pollutants from Japan. We also introduce a new method that can be used to evaluate plastic inputs in other regions of the world."

As the world economy is falling into one of the biggest contractions of the last decades, a new study of economic recession patterns finds that the likelihood of a downturn was high even before the onset of the Coronavirus crisis.

Recessions are business cycle contractions that happen when there is a general decline in economic activity. They may entail varying duration and intensity and could lead to substantial losses in terms of GDP, employment, household income, and investment spending. When a country falls into a recession, governments can employ multiple tools to recover, such as increasing spending, reducing taxes, or selling bonds.

Several economists warned that ominous signs were present in terms of the state of the global economy long before the COVID-19 outbreak at the end of 2019, pointing to specific vulnerabilities of current economic structures. The authors of the study, which was published in the journal PLOS ONE, found evidence that a recession stipulates adjustments to the economy at the aggregate level, which in turn influence the length of the following recovery period. In fact, according to the authors there was an 85% probability that after the great economic crisis of 2008, the next recession would happen before the start of 2020.

To capture the combined effect of adjustments in the economy and policy interventions on the remaining time before the next recession, the researchers built a diagnostic model to estimate the duration of expansion periods and the onset of the next recession in the business cycle. The recession data indicated that the length and depth of recessions have an impact on the time between these events.

"Recessions do not feature any regular periodicity and this statistical study tried to understand how corrective actions like market adjustments, stimulus packages, regulations of the financial sector, and trade reforms, affect the arrival times of new recessions. Our model accounts for the combined effect of these adjustment processes, as well as for the length and depth of previous recessions," explains study coauthor Matthias Wildemeersch, a researcher in the IIASA Advanced Systems Analysis Program.

The researchers applied their model to historical recessions in the US and European markets and the results show that adjustments of economic systems can indeed be detected in this type of data. Moreover, the newly developed statistical tool enables comparison between adjustment processes in different economies. Both in the US and Europe, the results indicate that the economy achieves a more stable state through corrective measures and adjustment processes taking place after each recession. However, the results further reflect that adjustments in the American economy were more profound than in Europe, which can imply that historically, the American economy has been more effective in their adjustments than the European economy.

"This suggests that closer integration of countries in the European Union, of which many share the same currency but no common fiscal policy, could allow for a more effective European response to future crises," says IIASA researcher Piotr Zebrowski, another coauthor of this study.

The authors hope that their statistical model can be of use to policymakers by providing broader insights into the long-term effects of adjustment processes.

Current knowledge about the role of aerosols in the transmission of SARS-CoV-2 warrants urgent attention. Current guidance and public health information has slowly shifted focus towards aerosols as a transmission pathway - predominantly associated with breathing and talking by asymptomatic individuals. Providing guidelines for sufficient inhalation protection will be important in curbing the spread of COVID-19.

The study, "Consideration of the Aerosol Transmission for COVID-19 and Public Health," recently published in Risk Analysis, provides several lines of evidence for aerosol transmission, as well as recommendations for further research and public health communication.

To date, the primary transmission methods of concern have been near field transmission (coughing and sneezing) and hand-to-face transport from infected surfaces. More attention should be paid to the inhalation of aerosols, which are small particles that can remain airborne and are capable of short- and long-range transport.

On April 1, 2020, a letter produced by the National Academy of Sciences Committee on Emerging Infectious Diseases and 21st Century Health Threats concluded that even with limited research on SARS-CoV-2 specifically, "the results of available studies are consistent with aerosolization of virus from normal breathing."

Reports of asymptomatic individuals infecting others with COVID-19 reveals that activities such as normal breathing, talking, etc., produce small droplets that are capable of being transported, as healthy individuals are presumably not coughing or sneezing on a regular basis.

Since the aerosol particles produced by talking and breathing are so small, they linger in the air for relatively long periods of time before gravity pulls them to the ground. This allows them to be transported over greater distances. A 2006 study of SARS-CoV-1 found that particles with a diameter of 1-3 μm remained suspended in the air almost indefinitely, particles 10 μm in size took 17 minutes, and 20 μm took 4 minutes to fall to the floor. A recent laboratory study found that the virus can remain viable and infectious in aerosols for hours (it remained viable for the entire three-hour duration of the study) and on surfaces for up to days.

The authors, Elizabeth L. Anderson, Paul Turnham, John R. Griffin and Chester C. Clarke, Exponent, Inc., propose the following recommendations to address aerosol transport of COVID-19:

Collect data to explore the concentration, duration of survival and transport distances for SARS-CoV-2 in aerosol form under differing temperatures and humidity levels.

Further explore airborne concentrations and the role of dose to various parts of the respiratory tract in the progression and severity of the disease.

Investigate the potential for aerosol contamination of buildings, rooms and surfaces to provide a basis for decontamination protocols

Explore and record data to determine the role human activities play in potentially generating aerosols capable of transmitting SARS-CoV-2 in both enclosed and open spaces

Further explore appropriate measures to curb inhalation exposure to small aerosols (

Tel Aviv University (TAU) researchers have developed a safe and accurate 3D imaging method to identify sperm cells moving at a high speed.

The research, a study of which was published in Science Advances on April 10, was led by Prof. Natan Shaked of the Department of Biomedical Engineering at TAU's Faculty of Engineering together with TAU doctoral student Gili Dardikman-Yoffe.

The new technology could provide doctors with the ability to select the highest-quality sperm for injection into an egg during IVF treatment, potentially increasing a woman's chance of becoming pregnant and giving birth to a healthy baby.

"The IVF procedure was invented to help fertility problems," explains Prof. Shaked. "The most common type of IVF today is intra-cytoplasmic sperm injection (ICSI), which involves sperm selection by a clinical embryologist and injection into the woman's egg. To that end, an effort is made to select the sperm cell that is most likely to create a healthy embryo."

Under natural fertilization in the woman's body, the fastest sperm to reach an egg is supposed to bear high-quality genetic material. Progressive movement allows this "best" sperm to overcome the veritable obstacle course of a woman's reproductive system.

"But this 'natural selection' is not available to the embryologist, who selects a sperm and injects it into the egg," Prof. Shaked says. "Sperm cells not only move fast, they are also mostly transparent under regular light microscopy, and cell staining is not allowed in human IVF. Existing imaging technology that can examine the quality of the sperm's genetic material may cause embryonic damage, so that too is prohibited. In the absence of more precise criteria, sperm cells are selected primarily according to external characteristics and their motility while swimming in water in a dish, which is very different from the natural environment of a woman's body.

"In our study, we sought to develop an entirely new type of imaging technology that would provide as much information as possible about individual sperm cells, does not require cell staining to enhance contrast, and has the potential for enabling the selection of optimal sperm in fertilization treatments."

The researchers chose light computed tomography (CT) technology for the unique task of sperm cell imaging.

"In a standard medical CT scan, the device rotates around the subject and sends out X-rays that produce multiple projections, ultimately creating a 3D image of the body," says Prof. Shaked. "In the case of the sperm, instead of rotating the device around this tiny subject, we relied on a natural feature of the sperm itself: Its head is constantly rotating during the forward movement. We used weak light (and not X-rays), which does not damage the cell. We recorded a hologram of the sperm cell during ultrafast movement and identified various internal components according to their refractive index. This creates an accurate, highly dynamic 3D map of its contents without using cell staining."

Using this technique, the researchers obtained a clear and accurate CT image of the sperm at very high resolution in four dimensions: three dimensions in the space at resolution of less than half a micron (one micron equals one millionth of a meter) and the exact time (motion) dimension of the second sub-millisecond.

"Our new development provides a comprehensive solution to many known problems of sperm imaging," Prof. Shaked says. "We were able to create high-resolution imaging of the sperm head while it was moving fast, without the need for stains that could harm the embryo. The new technology can greatly improve the selection of sperm cells in vitro, potentially increasing the chance of pregnancy and the birth of a healthy baby.

"To help diagnose male fertility problems, we intend to use our new technique to shed light on the relationship between the 3D movement, structure and contents of sperm and its ability to fertilize an egg and produce a viable pregnancy," Prof. Shaked concludes. "We believe that such imaging capabilities will contribute to other medical applications, such as developing efficient biomimetic micro-robots to carry drugs within the body."

Washington - (May 4, 2020) - The first ever set of specific recommendations to support transgender autistic young people was co-created by these youth and their families working hand-in-hand with clinical experts. The resulting model offers clinicians a set of concrete ways to provide this unique population the support they need.

The recommendations, A Clinical Program for Transgender and Gender-Diverse Neurodiverse/Autistic Adolescents Developed through Community-Based Participatory Design, were published by the Journal of Clinical Child and Adolescent Psychology on May 4, 2020.

"The idea of patients helping to co-design their own care isn't new, but including the perspectives of autistic youth in their own care is quite new," says John Strang, Psy.D., who directs the Gender and Autism Program within the Center for Autism Spectrum Disorders at Children's National Hospital.

He continues, "And for the many youth who are both transgender and autistic, including their voices and perspectives in their clinical care is critical. Without their input, there is a great risk for misunderstanding their needs - and for marginalization."

"This was an important process in which to participate, and will hopefully help those -- autistic people, trans people, and autistic trans people alike -- who often only see themselves represented by cisgender, neurotypical researchers and providers. It is a relief to be a part of creating something like this," adds Marissa Alexa McCool, a co-researcher who is an autistic transgender woman.

The new publication builds on previously published broad clinical guidelines for providers, now integrating the perspectives of autistic transgender individuals themselves. The program includes specific approaches for supporting young people in their diverse needs, and identifies three key components central to this care:

1. Helping autistic, gender-diverse young people build community together, which they need and often want, in contrast to clichés about lack of desire for social contact in autism. Many autistic transgender young people prior to entering clinical care have never met another person who is transgender and autistic. The connections that they built with one another through this new clinical care model were critical in helping them develop a positive sense of identity and to know that they are not alone in this world.

2. Introducing the youth to a broad spectrum of gender diverse and/or neurodiverse role models helps make possibilities for their future more concrete, and builds a sense of hopefulness and pride. Abstract concepts such as gender or future gender can be particularly challenging for autistic youth. The new care model addresses this by providing these youth opportunities to meet and interact with a range of living role models who represent various gender identities as well as neurodiversity experiences.

"Being able to see and hear about the diverse journeys of adults who have already navigated gender and/or autism-related diversity has been helpful in making the various options more tangible for gender diverse autistic youth," says Dr. Strang. "The chance to meet role models with different gender-related experiences - transgender, cisgender, exploring - has helped autistic gender diverse youth to better figure out what is most true for them and what they need from us."

3. Supporting the gender expression needs of autistic transgender youth through gender style coaching. Because of autism-related sensory sensitivities and problems with planning and social understanding, autistic transgender young people often have difficulty achieving their desired gender transition. Gender-style coaching can help autistic youth reach their gender-related goals in ways that accommodate and support the young person's autism-related challenges.

The perspectives included in the new clinical program were from a range of ages and backgrounds, as well as across multiple points in time to make sure that as youths' own views evolved, their evolving needs were captured as well.

The authors created a specific clinical guide to complement the publication, which is available on the Children's National website.

"We're so happy to have been able to partner with self-advocates from the autistic transgender and gender diverse communities, youth who are living this experience, and their families, to co-create a community-driven model that can be used for kids seeking guidance and support," says Dr. Strang.

"We hear over and over again that what parents and care providers really need are concrete tools to support young people with co-occurring autism and gender diversity, so that's what we sought to do here," he concludes. "It's exciting because, for the first time, we have some simple tools to support these kids. And this is critical, because although the co-occurrence of autism and gender diversity has been of great interest to researchers, nearly all studies to date have focused on how many transgender youth are autistic, instead of how to help and support this poorly understood group."

CHAMPAIGN, Ill. -- When tested in brain cells and in a mouse model of Alzheimer's disease, a new compound significantly reduced the number of amyloid plaques in the brain, lessened brain inflammation and diminished other molecular markers of the disease.

The researchers who developed the compound report their findings in the journal ACS Chemical Neuroscience.

Amyloid plaques are a hallmark of Alzheimer's disease in the brain, as is the accumulation of a protein known as p-tau, said Liviu Mirica, a chemistry professor at the University of Illinois at Urbana-Champaign who led the research. Postdoctoral researcher Hong-Jun Cho is the first author of the study.

Recent studies show that aggregates of p-tau collect around amyloid plaques, increasing the neuroinflammation that is associated with Alzheimer's, Mirica said.

"It's possible that the amyloid plaques somehow trigger the aggregation of the p-tau proteins in the extracellular environment," he said. "And this process then spurs the spread and formation of p-tau inside the neurons, where it starts to clump together."

This clumping leads to the formation of "neurofibrillary tangles" in the neurons that disrupt cell function and ultimately lead to cell death, he said.

Scientists do not clearly understand the mechanisms that lead to Alzheimer's disease. Many studies have focused on dissolving or disrupting the formation of the amyloid plaques, which are composed of a protein fragment called the beta-amyloid peptide.

"Everybody was trying to attack the amyloid plaques to dissolve them, but we've learned that Alzheimer's is a bit more complicated than we thought," Mirica said.

Previous research has found that soluble beta-amyloid fragments are more dangerous to brain health even before they aggregate into plaques.

"Studies have found strong evidence that these soluble peptides are the most neurotoxic species and are causing memory loss and neuron cell death," Mirica said. Plaque formation might be an attempt by the brain to neutralize the threat, he said.

Metal ions such as copper and iron also play a role in Alzheimer's pathology. These metals form associations with the beta-amyloid peptide, stabilizing the more dangerous, soluble beta-amyloid species. Metal ions also contribute to the damaging oxidative stress and brain inflammation seen in Alzheimer's.

"To address these different pathological aspects of Alzheimer's disease, we developed a compound known as L1 that interacts with different regions of the beta-amyloid peptide, as well as with metal ions," Mirica said. "When tested in mice genetically predisposed to develop Alzheimer's-like pathologies, our compound could cross the blood-brain barrier, reduce neuroinflammation and decrease the levels of amyloid plaques and of p-tau aggregates associated with these plaques."

The findings suggest that drugs that interact with different regions of amyloid-beta protein fragments and other Alzheimer's-associated peptides and metal ions could improve outcomes for people with Alzheimer's disease.

A small study funded by the National Institutes of Health suggests that sleep problems among children who have a sibling with autism spectrum disorder (ASD) may further raise the likelihood of an ASD diagnosis, compared to at-risk children who do not have difficulty sleeping. Previous research has shown that young children who have a sibling with ASD are at a higher risk for also being diagnosed with the condition. The study appears in The American Journal of Psychiatry.

If confirmed by other studies, the findings may give clinicians a tool to identify sleep problems early and provide interventions to reduce their effects on the health and development of children with autism. The findings may also provide insights into the potential role of sleep problems in the development of ASD.

The study was conducted by Annette M. Estes, Ph.D., of the University of Washington Autism Center in Seattle, and colleagues in the NIH Autism Centers of Excellence Infant Brain Imaging Study Network. NIH funding was provided by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Mental Health.

"The results are a promising lead," said Alice Kau, Ph.D., of NICHD's Intellectual and Developmental Disabilities Branch. "If confirmed by more in-depth studies, patterns of sleep disturbance in early life might be used to pinpoint increased risk for ASD among young children already at risk because they have a sibling with ASD."

ASD is a neurological and developmental disorder that begins early in life and affects how a person interacts with others, communicates, and learns.

The researchers analyzed data from a long-term study of children who do and do not have siblings with ASD. When the children were 6 and 12 months of age, parents were asked to respond to an infant temperament questionnaire that asks how much difficulty their child has falling asleep at bedtime and falling back to sleep after waking up during the night. At these time intervals, the children also received MRI scans to track their brain development. At 24 months, the children were assessed for ASD.

Of the 432 children participating in the study, 305 had a sibling previously diagnosed with ASD. Of this group, 71 were also diagnosed with ASD at 24 months; while 234 children in this group did not meet the diagnostic criteria for ASD. Of the 127 children who did not have a sibling with ASD, none met the diagnostic criteria for ASD.

On average, high-risk children who met criteria for ASD scored higher for sleep problems at 6 and 12 months, compared to the other groups. These children also had more growth in the brain's hippocampus region from 6 to 24 months, compared to high-risk children without sleep problems. This finding is notable because the hippocampus is involved in storing and retrieving memories, and previous studies in adults have linked insomnia with a smaller hippocampus volume.

The study did not look for cause and effect relationships, so the authors could not say why sleep problems were linked with larger hippocampus volume in the children who went on to meet ASD criteria. Moreover, they noted that their study could not provide information about the overall quality of the children's sleep, such as the degree of sleep fragmentation and sleep duration. The study authors called for additional studies with more comprehensive measures of sleep to confirm their findings.

The UK government made key failings in their strategic preparations and emergency response to coronavirus and this, in turn, undermined the NHS's ability to cope with the crisis.

These are the findings recently published in a research paper for the Journal of Risk Research by academics from Cass Business School, Glasgow Caledonian University, Vlerick Business School, and Nottingham University Business School.

The researchers conducted an extensive review of the literature focusing on key organisational resilience research, allowing them to identify the 'good, the bad and the ugly' of preparedness in readiness and response to the current pandemic.

The academics found that the NHS's resilience to the pandemic was compromised by an over-reliance on 'lean production' and 'just in time' continuity planning. This left NHS stockpiles short of vital supplies and capacity for personal protective equipment (PPE), ventilators and testing.

They argue that 'strategic redundancy' and 'slack in the system' could have left the NHS much better prepared to avoid the late 'ramping up' of capacity by government health officials in the face of the immense stresses and demands placed on global supply chains by a pandemic.

However, the researchers suggest this flawed strategy was not simply due to a lack of foresight. Instead they suggest that the UK government failed adequately to take account of known threats and clear signals of systemic weaknesses in the event of a pandemic uncovered by emergency exercises such as Operation Cygnus, the three-day simulation in 2016 which focused on the response and planning to a flu pandemic involving government and public health bodies.

The researchers suggest that, as the UK undergoes a period of adjustment in response to Covid-19, a new independent body should be set up to take responsibility for future national emergency preparedness free from political interference.

Lead researcher Dr Cormac Bryce, Cass Business School, said the paper has implications for future inquiries into the UK government's handling of the pandemic. He said it also highlights the need for new institutional arrangements to strengthen independence and transparency at the science-policy interface between expert advice, government decision-making, and provision for future pandemic threats.

"Benjamin Franklin suggested that by failing to prepare we should prepare to fail. We are witnessing the tragic consequences of such governmental failures - an overreliance on 'just in time' delivery amongst other factors has led to inadequate stockpiling of PPE and ventilators. Even though the warnings to prepare were there for those willing to look and act for years," he said.

"This inability to develop resilience in the face of Covid-19 has hampered the adaptation to the pandemic due to the slow upscaling of testing for key workers and the vulnerable in care homes - those most at risk."

While attention remains focused on the number of COVID-19 deaths and new cases, a separate statistic - the number of recovered patients - may be equally important to the goal of minimizing the pandemic's infection rate as shelter-in-place orders are lifted.

The presumed immunity of those who have recovered from the infection could allow them to safely substitute for susceptible people in certain high-contact occupations such as healthcare. Dubbed "shield immunity," the anticipated protection against short-term reinfection could allow recovered patients to expand their interactions with infected and susceptible people, potentially reducing overall transmission rates when interactions are permitted to expand.

New modeling of the virus' behavior suggests that an intervention strategy based on shield immunity could reduce the risk of allowing the higher levels of human interaction needed to support expanded economic activity. The number of Americans infected by the novel coronavirus is likely much higher than what has been officially reported, and that could be good news for efforts to utilize their presumed immunity to protect the larger community.

However, there are two important caveats to the strategy. The first is that the duration of immunity to reinfection by SARS-CoV-2 remains unknown; however, individuals who survived infections by related viral infections, like SARS, had persistent antibodies for approximately two years - and those who survived infection to MERS had evidence of immunity for approximately three years. The second issue is that determining on a broad scale who has antibodies that may protect them from the coronavirus will require a level of reliable serological testing not yet available in the United States.

"Our model describes ways in which serological tests used to identify individuals who have been infected by and recovered from COVID-19 could help both reduce future transmission and foster increased economic engagement," said Joshua Weitz, professor in the School of Biological Sciences and founding director of the Interdisciplinary Ph.D. in Quantitative Biosciences at the Georgia Institute of Technology. "The idea is to think in advance about how identifying recovered individuals could help serve the collective good, using information collected on neutralizing antibodies in new ways."

A paper describing the modeling behind the concept of shield immunity was published May 7 in the journal Nature Medicine by a team of researchers from Georgia Tech, Princeton University and McMaster University. The researchers studied the potential impacts of presumed immunity among recovered persons using a computational model of COVID-19 epidemiological dynamics, building upon a SEIR (susceptible-exposed-infectious-recovered) framework.

In a population of 10 million citizens, for example, the model predicts that in a worst-case transmission scenario, implementation of an intermediate shielding strategy could help reduce deaths from 71,000 to 58,000, while an enhanced shielding plan could cut deaths from 71,000 to 20,000. The model also suggests that shielding could enhance the effects of social distancing strategies that may remain in place once higher levels of economic activity resume.

Identification of individuals who have protective antibodies against the novel coronavirus has begun only recently. Antibody tests are not 100% specific, implying that tests can lead to false positives. However, targeted use of antibody testing in groups with elevated exposure will lead to increases in positive predictive value, even with imperfect tests. The serological antibody test differs from widespread polymerase chain reaction (PCR) testing being done to determine whether people are actively infected with the virus.

Among healthcare professionals, serological testing could identify recovered individuals who might then be able to interact with patients with reduced concern for infection. Other recovered individuals could be used to help reduce transmission risk in nursing homes, the food service industry, emergency medical services, grocery stores, retailing and other essential operations. Across society, the relatively small number of individuals with immunity could substitute for people whose immunity status isn't known; reducing transmission risk both for recovered individuals and those who remain immunologically naive.

"We want to think about serology as an intervention," Weitz said. "Finding out who is immune to the coronavirus could make a big difference in trying to reduce the risk to people who would be vulnerable by interacting with someone who could pass on the disease."

Serological testing to identify those with immunity might begin with healthcare workers, who may be more likely to have been infected by the coronavirus because of their exposure to infected persons, Weitz said. Because so many infections do not produce the distinctive COVID-19 symptoms, it's likely that many people have recovered from the illness without knowing they've had had it, potentially expanding the pool of recovered persons.

"There may be a deeper pool of individuals who can help within their own fields and other fields of specialization to reduce transmission," Weitz said. "The reality is that people within high-contact jobs probably are likely to have a higher incidence of infection than other groups."

But using antibody information about individuals would create potential privacy issues, and require that those individuals make informed decisions about accepting additional risks for the greater good of the community.

"What this model says is that if we could identify individuals who are immune, there is a chance that some individuals would not have to reduce their level of interaction with others because that interaction would be less risky," he added. "Rather than trying to keep reducing interactions, which is helpful for reducing transmission but bad for what it does for the economy, we might be able to maintain interactions while reducing the risk, combined with other mitigation approaches."

Ultimately, addressing the pandemic will require development and mass production of a vaccine that could boost immunity levels beyond 60 percent in the general population. Until that is available, Weitz believes that shield immunity could become part of the approach to the challenge.

"We don't have a silver bullet," he said. "Until we have a vaccine, we will have to use a combination of strategies to control COVID-19, and shield immunity is potentially one of them."

To keep patients and health-care providers safe from COVID-19, while providing urgent treatment to stroke patients, extra precautions must be taken, according to new guidelines published in the journal Stroke.

The guidelines were established by the Society of Vascular & Interventional Neurology (SVIN).

UCLA professor of neurology Dr. David Liebeskind, who is president of SVIN and director of the UCLA Stroke Center, expressed concern that fear of COVID-19 may make patients hesitate to seek treatment in the event of a possible stroke.

"People are passing away or having severe strokes out of the hospital," he said. "There are a lot of people who are not coming in."

Delaying treatment by just 15 minutes can make a world of difference in terms of the patient's recovery. Yet stroke centers around the country report that they are treating fewer patients than usual. To minimize the possibility of transmitting infections among patients in the hospital, the SVIN team developed guidelines based on review of the published research, consensus among practicing neurologists and shared best practices.

"Some of these things are intuitive or straightforward in terms of minimizing exposure and maximizing the use of personal protective equipment," said Dr. Liebeskind. Because stroke patients may be unable to communicate and describe their history or symptoms, he said, every patient should be initially considered to be positive for COVID-19.

According to the guidelines, a definitive diagnosis of COVID-19 should be made as soon as possible, as patients who test negative can decrease the use of protective equipment. Patients who test positive should be placed in isolation in a negative pressure room, when available.

Any tests that do not change the treatment strategy should be delayed or deferred until COVID-19 status is established, the guidelines recommend.

The doctors say that telemedicine can play a monumental role in minimizing the number of people who come in direct exposure to the patient. For an acute stroke or thrombectomy code, one person in protective equipment can be with the patient, while another coordinates care via computer or phone.

Remote tele-stroke technology can also be used to obtain history, perform neurological exams and monitor the patient after the stroke has been treated.

"Telemedicine in neurology has evolved over the last 10 years to meet the needs of a consultation," said Dr. Liebeskind. "In stroke, imaging becomes incredibly important, and that becomes integrated as well. We can do the examination very easily via telemedicine, using a video link at the patient bedside. And, through that same link we can access the imaging information as well. At UCLA, we also have dedicated robots that can travel through the hospital that can do all of this."

A head CT or computerized tomography scan is typically the first test performed in the event of a stroke. A chest CT can be performed at the same time, to check the lungs for COVID-19, if this does not unduly delay stroke treatment. Angiography is another imaging technique that allows doctors to look at the blood vessels.

"The use of specific imaging approaches in planning endovascular therapy, and the decision-making regarding the use of intubation and general anesthesia, is always a case specific medical decision in any clinical environment," Dr. Liebeskind said.

Where possible, conscious sedation can be an alternative to general anesthesia and intubation. This could protect patients from unnecessary intubation and conserves mechanical ventilators, he said.

Finally, after thrombectomy or surgery to remove the blood clot, doctors should consider relocating patients back to primary stroke centers to recover, especially for hospitals overwhelmed with critical care or intensive care unit bed shortages. This can help maintain thrombectomy access, Dr. Liebeskind said.

"Our ability to deliver comprehensive stroke care, including endovascular therapy for acute ischemic stroke, remains an intact valuable resource for patients everywhere," he added.

MAYWOOD, IL-Broad modifications to current standards for treating acute stroke patients during the COVID-19 pandemic may be needed to preserve health care resources, limit disease spread and ensure optimal care, according to a Loyola Medicine neurologist.

"Doctors are seeing a rise in COVID-19 patients of all ages suffering from stroke and other vascular complications, as the COVID-19 virus overwhelms the health care system," said Jose Biller, MD, chairperson of neurology at Loyola University Medical Center, and professor, Loyola University Chicago Stritch School of Medicine, and co-author of a new editorial, "Acute Stroke Care in the Coronavirus 2019 Pandemic."

"COVID-19 may increase the risk of stroke as a result of several mechanisms, including enhanced inflammatory response, increased blood clotting tendencies, and damage of the inner layers of the blood vessels (endothelial damage)," said Dr. Biller. In general, the majority of stroke patients are older and have underlying medical conditions associated not only with risk for acute ischemic stroke (AIS), but also poor outcomes associated with COVID-19.

Dr. Biller says new guidelines are needed to safely manage stroke patients, both with and without COVID-19, within the limitations of strained health systems during this "ferocious novel pandemic."

"We believe that it is crucial for the stroke community to relax guidelines and stroke pathways while continuously providing high quality of care, including treatment algorithms, post intravenous thrombolysis monitoring, diagnostic work up, disposition planning, prevention measures, in order to optimally care for stroke patients while minimizing the chances of contributing to the rapid spread of COVID-19," according to the editorial, co-authored by Rima M. Dafer, MD, MPH, and Nicholas D. Osteraas, MD, MS, both of Rush University Medical Center, and appearing in the Journal of Stroke and Cerebrovascular Diseases.

The recommendations pertain to all aspects and stages of care, and include the following highlights:

Prehospitalization. Patients or loved ones should continue to call 911 to report a stroke. In addition to standard triage, emergency medical system (EMS) personnel should screen patients over the phone for COVID-19 symptoms. Telemedicine should be considered for patients with low suspicion of stroke, or mild symptoms with no potential indication for intervention. All patients with acute stroke symptoms should be treated as suspected or possible COVID-19 patients.

Emergency Room Evaluation. In the emergency room, patients should be screened for COVID-19 prior to evaluation by the stroke team. All patients should wear a mask.

Hospitalization. Hospitals should designate isolated units for stroke care. Patients receiving intravenous chemical thrombolysis (a common stroke treatment involving an intravenous injection of drugs directly to the blood clot) may be monitored virtually with two-way video conferencing to minimize staff infection.

Rehabilitation Planning. Rehabilitation for stroke patients can include physical, occupational, and speech therapy, along with other rehabilitation. All therapists and health care workers caring for COVID-19 patients should wear appropriate protective gear. Whenever appropriate, therapy services should emphasize patient exercises that can used at home.

Family Members. As many hospitals have restricted visitors during COVID-19, extra effort will need to be made to reach families by phone to discuss a patient's condition, treatment options and discharge planning. Exceptions to the visitor policy, such as discussions regarding end-of-life care, should be made when appropriate.

Transfers. Stroke care often involves networks of hospitals; commonly a comprehensive "hub" with multiple smaller hospitals or "spoke" sites which transfer stroke patients to the "hub" for emergency treatment or Intensive Care Unit (ICU) care. Tele-stroke should be encouraged to evaluate patients and to prevent unnecessary transfers. For AIS patients, neuroimaging and COVID-19 screening should be obtained at the smaller, spoke site hospital before a patient is transferred to a larger medical center.

Discharge Planning. Discharges to acute rehabilitation institutions and long-term facilities have been delayed due to concerns about the spread of COVID-19 infections in long-term care facilities and nursing homes. Hospitals may need to designate rehabilitation beds for patients who do not qualify for transfer to acute inpatient facilities, as well as discussing possible discharge to home when medically stable and appropriate until the pandemic is under control.

Finally, the article recommends establishing stroke networks within cities, as well as collaboration between institutions "as the surge of COVID-19 worsens." This should include "collaborations among stroke networks to establish a rotating weekly coverage for acute stroke care in a specified geographic area; thus, both freeing hospital resources and releasing stroke call responsibilities, and allowing these physicians to help in caring for patients on the COVID-19 units."

The COVID-19 pandemic has revealed major deficiencies and inequities in the U.S. healthcare system, shining a spotlight on improvements that must be made to steel the country for future disasters, argues Maia Dorsett in an Editorial. "US healthcare is incentivized to react to sickness rather than proactively focus on health maintenance," Dorsett writes. "As an emergency physician, I witness the impact of this approach daily." Dorsett further argues that - much like a school shooting or a terrorist attack - the COVID-19 pandemic should be defined as a mass casualty incident (MCI), which occur when casualties overwhelm local resources such as personnel and equipment. Public health systems designed to improve the health of the general population are underfunded and understaffed, with emergency departments operating near or beyond capacity on a given day while underlying issues such as housing, food security, and safety from violence remain inadequately addressed. These systemic weaknesses make it more difficult for society to cope with slow-moving MCIs such as COVID-19. As with all MCIs, understanding four phases of the emergency management cycle can help to analyze and guide the response to this pandemic: mitigation, preparation, response, and recovery. Dorsett contends that inadequate preparation for COVID-19, including stockpiling personal protective equipment, ventilators, and testing equipment, led to a sense of betrayal among healthcare professionals forced to contend with the pandemic using inadequate resources. "Emergency management is a cycle and we must now use the recovery phase to analyze the strengths and deficiencies of our response to begin the mitigation and planning phases for the next, unplanned hazard," Dorsett writes. "We can hope that our collective memory is long, not short."

Researchers using a technique known as "lucky imaging" with the Gemini North telescope on Hawaii's Maunakea have collected some of the highest resolution images of Jupiter ever obtained from the ground. These images are part of a multi-year joint observing program with the Hubble Space Telescope in support of NASA's Juno mission. The Gemini images, when combined with the Hubble and Juno observations, reveal that lightning strikes, and some of the largest storm systems that create them, are formed in and around large convective cells over deep clouds of water ice and liquid. The new observations also confirm that dark spots in the famous Great Red Spot are actually gaps in the cloud cover and not due to cloud color variations.

Three years of imaging observations using the international Gemini Observatory, a program of NSF's NOIRLab, have probed deep into Jupiter's cloud tops. The ultra-sharp Gemini infrared images complement optical and ultraviolet observations by Hubble and radio observations by the Juno spacecraft to reveal new secrets about the giant planet.

"The Gemini data were critical because they allowed us to probe deeply into Jupiter's clouds on a regular schedule," said Michael Wong of UC Berkeley. "We used a very powerful technique called lucky imaging," adds Wong. With lucky imaging, a large number of very short exposure images are obtained and only the sharpest images, when the Earth's atmosphere is briefly stable, are used. The result in this case is some of the sharpest infrared images of Jupiter ever obtained from the ground. According to Wong, "These images rival the view from space."

Gemini North's Near Infrared Imager (NIRI) allows astronomers to peer deep into Jupiter's mighty storms, since the longer wavelength infrared light can pass through the thin haze but is obscured by thicker clouds high in Jupiter's atmosphere. This creates a "jack-o-lantern"-like effect in the images where the warm, deep layers of Jupiter's atmosphere glow through gaps in the planet's thick cloud cover.

The detailed, multiwavelength imaging of Jupiter by Geminiand Hubble has, over the past three years, proven crucial to contextualizing the observations by the Juno orbiter, and to understanding Jupiter's wind patterns, atmospheric waves, and cyclones. The two telescopes, together with Juno, can observe Jupiter's atmosphere as a system of winds, gases, heat, and weather phenomena, providing coverage and insight not unlike the network of weather satellites meteorologists use to observe Earth.

Mapping giant lightning storms

On each of its close passes over Jupiter's clouds, Juno detected radio signals created by powerful lightning flashes called sferics (short for atmospherics) and whistlers (so-called because of the whistle-like tone they cause on radio receivers). Whenever possible, Gemini and Hubble focused on Jupiter and obtained high-resolution, wide-area maps of the giant planet.

Juno's instruments could determine the latitude and longitude coordinates of clusters of sferic and whistler signals. With Gemini and Hubble images at multiple wavelengths, researchers now can probe the cloud structure at these locations. By combining these three pieces of information the research team found that the lightning strikes, and some of the largest storm systems that create them, are formed in and around large convective cells over deep clouds of water ice and liquid.

"Scientists track lightning because it is a marker of convection, the turbulent mixing process that transports Jupiter's internal heat up to the visible cloud tops," explained Wong. The largest concentration of lightning seen by Juno came from a swirling storm called a "filamentary cyclone." Imaging from Gemini and Hubble shows details in the cyclone, revealing it to be a twisted collection of tall convective clouds with deep gaps offering glimpses to the water clouds far below.

"Ongoing studies of lightning sources will help us understand how convection on Jupiter is different from or similar to convection in the Earth's atmosphere," Wong commented.

Glowing features in the Great Red Spot

While scanning the gas giant for gaps in cloud cover, Gemini spotted a telltale glow in the Great Red Spot, indicating a clear view down to deep, warmer atmospheric layers.

"Similar features have been seen in the Great Red Spot before," said team member Glenn Orton of JPL, "but visible-light observation couldn't distinguish between darker cloud material, and thinner cloud cover over Jupiter's warm interior, so their nature remained a mystery."

Now with the data from Gemini, this mystery is solved. Where visible light images from Hubble show a dark semicircle in the Great Red Spot, images taken by Gemini using infrared light reveal a bright arc lighting up the region. This infrared glow, from Jupiter's internal heat, would have been blocked by thicker clouds, but can pass through Jupiter's hazy atmosphere unobscured. By seeing these features as bright infrared hotspots, Gemini confirms that they are gaps in the clouds. Even though earlier observations have seen dark features in the Great Red Spot, the rapidly swirling winds within it hid the true nature of these spots until the simultaneous Hubble and Gemini observations were conducted.

"NIRI at Gemini North is the most effective way for the US and the international Gemini partnership investigators to get detailed maps of Jupiter at this wavelength," explained Wong. Gemini achieved a 500-kilometer (300-mile) resolution on Jupiter. "At this resolution, the telescope could resolve the two headlights of a car in Miami, seen from New York City," said Andrew Stephens, the Gemini astronomer who led the observations.[1]

"These coordinated observations prove once again that ground-breaking astronomy is made possible by combining the capabilities of the Gemini telescopes with complimentary ground- and space-based facilities," said Martin Still, an astronomy program director at the National Science Foundation, which is Gemini's US funding agency. "The international Gemini Partnership provides open access to a powerful combination of large telescopes' collecting area, flexible scheduling, and a broad selection of interchangeable instruments."