Discussion thread V - COVID-19 (new coronavirus)

[Pathfinder]

How Coronavirus Spreads through the Air: What We Know So Far

The virus that causes COVID-19 can persist in aerosol form, some studies suggest. But the potential for transmission depends on many factors, including infectiousness, dose and ventilation

By Tanya Lewis on May 12, 2020
...
Cowling hypothesizes that many respiratory viruses can be spread through the airborne route—but that the degree of contagiousness is low. For seasonal flu, the basic reproduction number, or R0—a technical designation for the average number of a people a sick person infects—is about 1.3. For COVID-19, it is estimated to be somewhere between two and three (though possibly as high as 5.7). Compared with measles, which has an R0 in the range of 12 to 18, these values suggest most people with the disease caused by SARS-CoV-2 are not extremely contagious.

But there are seeming exceptions, such as the choir practice in Washington State, Cowling says. For unknown reasons, some individuals seem to infect many more people than others do. These so-called superspreaders were documented in the SARS outbreak of 2003, too. In what has become known as the 20/80 rule, about 80 percent of infectious-disease-transmission events may be associated with just 20 percent of cases, Cowling notes. “We don’t know how to identify those 20 percent,” he says. “But if we were able to, in some way, then that would be a major advance.”

Ventilation likely also plays an important role in how easily the virus can be transmitted through the air. Indoor spaces probably pose a higher risk than outdoor ones, especially if they are poorly ventilated, Cowling and others say. Crowded areas such as bars, restaurants and subway trains could all be risky—especially if people are asymptomatic and spend long periods of time in such areas. Precautions could include better ventilation, regular cleaning and mask wearing.

...

https://www.scientificamerican.com/article/how-coronavirus-spreads-through-the-air-what-we-know-so-far1/

[Mary Wilson]

Johns Hopkins launches online course to train army of contact tracers to slow spread of COVID-19

The free course, developed with Bloomberg Philanthropies, is available via Coursera to anyone in the world beginning May 11
Katie Pearce

...The free six-hour course is open to anyone, but taking and passing it will be a requirement for thousands of contact tracers being hired by the state of New York to fight the pandemic. Within hours of its release Monday, more than 400 people had already registered for the class, according to Joshua Sharfstein, a vice dean at the Bloomberg School...

https://hub.jhu.edu/2020/05/11/free-contact-tracing-course-johns-hopkins/

[Mary Wilson]

Considerations for school-related public health measures in the context of COVID-19

Annex to Considerations in adjusting public health and social measures in the context of COVID-19

10 May 2020
| COVID-19: Critical preparedness, readiness and response

WHO TEAM
WHO Global
REFERENCE NUMBERS
WHO REFERENCE NUMBER: WHO/2019-nCoV/Adjusting_PH_measures/Schools/2020.1
COPYRIGHT
CC BY-NC-SA 3.0 IGO

https://www.who.int/publications-detail/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19

[Pathfinder]

Sorry, but I’m in a flame war with a choir director that alleges little or no risk to younger age groups because the fatal stats are skewed toward >60 (a result of the MMWR report on the choir outbreak in mid-March (report was in May). However, I read elsewhere that younger age groups are being hit with permanent lung impairments and other complications after COVID recovery. Is there a report, article or chart on that somewhere?

Many thanks,

J.

Translation Google

Coronavirus in children: danger at school? A team of French doctors reassures


Benoit Deshayes ,Updated on 13/05/20 15:23Linternaute.com

LAST MINUTE - A study carried out in Ile-de-France with children confirms that they are both not very carriers of the coronavirus and not very contagious. It is the pediatrician and infectiologist at the Cr?teil hospital (Val-de-Marne) Robert Cohen who brought the first conclusions of this study, on BFMTV Tuesday May 12, going so far as to describe Covid-19 as "disease adults ". The specialist, whose study we mentioned in our article below, confirmed that the risk of contracting the coronavirus is "extremely low" in children, "we can say a thousand times lower than in adults". "Children are not very carriers, little transmitters, and when they are contaminated it is almost always adults in the family who have contaminated them", adds the latter, while the reopening of schools raises fears both for the health of children, but also for that of the adults they interact with (parents, teachers, grandparents ...). "It is not in this sense that transmission occurs most often. This does not mean that it can never be transmitted in this direction, but it is not the mode of contagion", specifies Robert Cohen, who also minimizes the potential for contamination of children with each other. Robert Cohen finally indicates that these results "completely confirm all of the scientific literature" on the subject. And he even dares: "If the epidemic starts again it is not by schools but by adults", confirming recent remarks by the Minister of Education Jean-Michel Blanquer, according to which "

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The bell rang. After a pre-return to school yesterday, between 1 million and 1.5 million children return to school starting this Tuesday and all this week in France, against the backdrop of the strong concern of parents, teachers and even mayors, who question the advisability and the risks of reopening the establishments of their municipalities. The impact of SARS-CoV-2 on the young, who seem to be much less affected than the rest of the population, is still difficult to grasp, but many fragmented scientific elements can already be gathered as well as many opinions of experts.


Among the latter, Christ?le Gras-Le Guen, Professor of the University of Pediatrics, head of the general pediatrics and pediatric emergencies department at CHU Nantes, very recently assured in an interview with The Conversation that "families must be reassured". "This disease, of which we certainly do not know everything, has absolutely not shown any disturbing character in young people. In the vast majority of cases, there are no contraindications for these children, considered usually as fragile and kept safe from viral infections, do not go back to school, "said the one who is also Vice-President of the French Pediatric Society.



Severe Covid-19 damage remains exceptional in very young people, as shown by statistics and clinical observations at this stage (children represent between 1 and 2% of confirmed cases and severe attacks are counted in the tens in France ). But uncertainty remains and many questions remain unanswered about the coronavirus in children: are children under 15 really protected by their immune system or are they simply less exposed than adults to the disease for some unknown reason? Can a resurgence of cases still occur? What are the specific symptoms of coronavirus in child? Can Coronavirus Put Children at Risk? What is the potential for contagiousness and transmission of the disease from children to adults? Will the coronavirus come back in force this summer using schoolyards as a springboard? Point by point, here is what we can answer at this stage on these questions.


What do scientific studies say about children and the coronavirus?

At this stage, we first know that children seem less affected and suffer from visibly (clinically) less severe forms of the disease. Very often, children are asymptomatic or "not very symptomatic" in essence, conclude the various studies published on the subject. As of February 24, the online scientific journal JAMA (of the Journal of the American Medical Association) informed that of the 72,314 first cases of coronavirus then recorded in China, only 2% were children and adolescents under 19 years of age and who 'There were no deaths in children under 9 years of age. Other studies published in the same review ( here or here ), in the Lancet digital health , the recognized Pediatric infectious didease , the Pediatrics site , or an Israeli study indicate that children rarely seem to be affected by Covid-19 and that, when they are, they are affected by mild forms (from "asymptomatic" to "moderate"). ).
This observation is shared by several other publications mentioned on the website of the French Pediatric Society or even by studies relating more specifically to the contagiousness of children that we mention below . Worldwide, "critical forms of the disease in children seem very rare (around 1% of the total)" and "only a handful of deaths have been reported", summarized in early May the site Don't Forget The Bubbles (DTFB), specialized in pediatrics, and which has analyzed all the studies on the subject.

Also reassuring statistics

Chinese and Spanish statistics, like data from the Italian Higher Health Institute ( Istituto Superiore di Sanit? ), seem to confirm this. Just like French statistics. In its weekly bulletin of April 16, Sant? publique France counted that around a hundred young people aged 14 and under were hospitalized, including thirty in intensive care. The number of serious cases recorded among children under 15 years old then represented only 0.6% of the total in France between March 16 and April 12, at the time when the epidemic was strongest, according to the agency. .

Among these children, a third were babies three months or less, says Le Monde , which specifies that these children generally suffered from "an isolated fever, without respiratory signs". "A significant part has an underlying pathology, according to data from French pediatricians", still ensures the evening paper.

A series of studies conducted in France

To have a global view of the impact of the coronavirus in children in France, the national pediatric clinical research network Pedstart (one of the thematic networks of F-CRIN , supported by Inserm), set up in mid-April "a Task Force which aims to gather all the information concerning the infected pediatric population". This will identify "in real time the clinical studies carried out in France on Covid-19 in children" (some of which are mentioned below) and study "the impact of Covid-19 on French pediatric clinical research and European ". "As far as Covid-19 is concerned, we have listed 18 studies to date, some of which are still being designed. The majority of them are observational studies, that is to say that we do not test of medication, "says R?gis Hankard, coordinator of the Pedstart pediatric clinical research network, in The Conversation. "A single study, linked to a larger adult project, that of Didier Raoult in Marseille, is testing a drug, but it only concerns 5 children, and there is no control group," he said. "Other studies concern the reaction of children who are victims of cancer or other infectious diseases, congenital cardiomyopathies, those who carry dermatological signs, etc."

We can also cite the study carried out by Arnaud Fontanet, epidemiology of infectious and tropical diseases and member of the Scientific Council on Covid-19 with children from six primary schools in Cr?py-en-Valois, a French commune very affected at the beginning of the epidemic, to "find out if they were infected during the epidemic period of February". The latter, who spoke on April 30 during a parliamentary hearing, believes that "we have a bunch of arguments that suggests to us that in children under 10 the situation is probably less severe than in adults, that they are probably less susceptible to infection and less contagious. But we want to be able to verify this. "

Do children have better immune defenses against coronavirus?

"Why do children have mild symptoms with little hospitalization? I admit that today I have no answer," epidemiologist Antoine Flahault, director of the Institute of Health, told AFP. global at the University of Geneva. On Sunday April 19, during a government press conference, Florence Ader, infectiologist and pulmonologist at the Croix-Rousse hospital of the Hospices Civils de Lyon (HCL), also recognized that we do not know stage the exact causes of this relative safety of the virus on the youngest. Immunity is a first explanation which seems to be followed by Sant? publique France. The official French agency published on May 5 on its site a summary of international studies on the subject. According to her, children seem to be as prone to infection with SARS-CoV-2 as adults, but most of them develop "mild" forms of the disease, even without symptoms at all, which makes them more difficult to detect.

According to Robert Cohen, pediatrician and infectious disease specialist working in Saint-Maur-des-Foss?s, children are generally less sensitive to viruses and their consequences on the body, as can be observed for diseases such as measles, chickenpox or mumps, which adults can suffer in a much more significant way. Etienne Javouhey, head of the pediatric emergency and resuscitation service at the CHU de Lyon, suggests that the immune response of children would be different because they are generally more exposed to viral infections, which would make them "more quick to defend themselves against to a new virus. " Children are also regularly affected by viruses of the coronavirus family, which could allow them to already have suitable immune defenses. They would develop interferons (proteins of the immune system) which would allow them to defend themselves. Etienne Javouhey also cites in Le Monde very regular vaccinations which would protect them more than adults, by stimulating their immune system.

But this explanation of a more suitable immune response can be disputed. According to Christ?le Gras-Le Guen, University Professor in pediatrics, head of the general pediatrics and pediatric emergency department at CHU Nantes, the immune system of very young children "is not yet able to defend them effectively against bacteria that will not make them hot or cold later. " "Having an illness that turns out to be serious for the elderly and which is not serious for the very young is unheard of," she said, taking the example of the flu which also affects young people so badly. children than the elderly.

Can children not be infected at all?

Other experts believe that children, especially those under the age of 10, are less likely to get Covid-19 than adults, that they simply would not be infected, and that immune defenses do not are not really for much. On the Don't Forget The Bubbles site, already mentioned above, two pediatric specialists, Alasdair Munro and Damian Roland, judge "more and more likely that there are fewer children affected by Covid-19" than adults. They are based on tests carried out massively in South Korea, Iceland or in the Italian city of Vo, where the number of positive children was much lower than that of adults.

Other more hypothetical explanations come from studies carried out in particular in the United States. An American researcher showed at the beginning of the year that the reason for the protection of children against Covid-19 is linked to a different hemoglobin in children, fetal hemoglobin, whose protective properties are well known, and which is gradually disappearing with age. The track of the ACE2 cellular receptor, or "angiotensin 2 converting enzyme", is also explored. This enzyme, present in our lungs, arteries, kidneys, digestive system and even the heart, is one of the entry points for the virus. It also constitutes a serious avenue for progress on potential treatment. ACE2 is especially less present in children, but scientists remain divided on this hypothesis. Other scientists, such as the immunologist Jean-Laurent Casanova in Le Monde believes that genetic factors are predominant.

These leads suggest that the virus could simply find closed doors in children, which also suggests Pr Christ?le Gras-Le Guen. She testified to her astonishment about "cases of mothers who are positive for the virus, but whose newborns have not been infected, despite their close proximity". "For the moment we do not know how it is possible [...]. The information available seems to indicate that SARS-CoV-2 does not" cling "very much in children", assures the latter in an interview at The Conversation site.

Do children really get coronavirus less often?

Effective immune response or outright absence of SARS-CoV-2 infection: these are the two hypotheses that need to be decided for the moment to determine why children seem less affected. And the results of the screenings seem to lean more towards the second option. A large study conducted in Iceland, and mentioned in the New England Journal of Medicine , indicated in mid-April that the positive tests in children were twice less numerous than in adults. What seems to confirm the pediatric infectiologist Robert Cohen who heads the Pediatric Infectious Pathologies Group ( GPIP). According to him, children tested by PCR tests are "3 to 5 times less positive" than adults. "According to data collected in the pediatrician network, approximately 12,000 children have been tested on a suspicion of Covid-19, and 6.3% of these tests have been positive. This makes just over 700 cases ", says for her part Christ?le Gras-Le Guen who" notes that the distribution is very different according to the regions ".

Children are therefore less likely to contract the coronavirus. However, studies seem to support the opposite hypothesis. The specialized site MedRxvid published in March a study that had not yet been validated by a scientific reading committee on the subject. Based on a sample of 1,286 people in contact with patients from Shenzhen in China, between January and February, she estimates that young people are not particularly protected against infection, the contamination rates being similar among those under 19 to that of the rest of the population. The study has since been challenged by several scientists.

Number of tests further increases uncertainty

And this is where the question of the number of tests performed on children arises crudely. It is indeed possible that children have not yet been massively linked to the virus simply because the tests carried out on this population are much less frequent. The president of the Federation of Doctors of France, Jean-Paul Hamon, warns in Le Point: "We have no certainty". The overall vision of the epidemic in children may indeed be biased by the fact that they are very little tested unlike other age groups. "The kids are fine and don't go to the hospital, so they're not tested," said Sharon Nachman, professor at the Renaissance medical school at Stony Brooks Children's Hospital,
"We only have two objective data: there are fewer serious forms, and fewer positive tests in children arriving at the hospital compared to adults", summarizes Isabelle Sermet-Gaudelus, pneumopediatrician at the Parisian hospital Necker- Sick children in Figaro. But the question of why remains unanswered: "Do children develop a healthy carrier that will immunize them, or very symptomatic forms - mini-pharyngitis type - which will go unnoticed? Or do they not are not infected at all? There is, at this stage, no clear conclusion, "she said.

Are there specific symptoms of coronavirus in children?

Despite reassuring statistics and analyzes, the coronavirus nevertheless succeeds in rare cases in falling through the cracks. A few deaths of very young patients since the start of the epidemic have already aroused emotion in France and abroad. On April 9, J?r?me Salomon, the Director General of Health, reported the death of a child of ten years in Ile-de-France, affected by the coronavirus, but who presented "significant comorbidities". A few days earlier, on March 24, a 16-year-old girl from Essonne died at the Necker hospital after a brutal worsening of her health. She hadn't suffered from any "particular illness before," according to her family. There is also the death of a 12 year old girl in Belgium,

A mysterious infection, which is on the rise in Europe, has also started to doubt doctors and scientists since April 27. Between Kawasaki disease and toxic shock, it ranges from digestive disorders to myocarditis and therefore to serious heart failure. Even if the link between these new suspected cases and the coronavirus is not yet established, this new infection, which concerns a still very limited group of children, could demonstrate that the coronavirus is indeed dangerous also for the little ones.
...

Less serious than these particular cases or the toxic shocks mentioned above, weirdness has also been observed recently in children with specific symptoms. Spanish dermatologists and podiatrists have reported since the beginning of April that young patients, sometimes showing symptoms of Covid-19, also have lesions on the tips of the toes, or had them just before. Lesions that are described as "purplish" or "brightly colored", sometimes accompanied by "bumpy skin and a burning sensation" and followed by persistent "crusts" and "slight discoloration", according to the document posted April 9 on the website of the General Council of Spanish podiatrists .

This phenomenon, which is also on the increase, and concomitant with the coronavirus pandemic, has been confirmed by the International Federation of Pediatricians and by the Northwestern University Feinberg School of Medicine in the United States, which a doctor says "does not seem to be a coincidence. ", even if the link is not formally established. These rashes in any case already have a nickname, the "Covid-19 toes". They usually subside after a week and would be of no consequence. Several specialists nevertheless consider that it might be wise to carry out tests on these young patients.

Are children really contagious?

Regarding the spread of the virus via children, we can only evoke for the moment a hypothesis supported by a few conclusions more than by well-established scientific documentation. Studies on respiratory viruses and influenza in particular, for which there is sufficient medical experience, show that the spread through children is increased. The school was even presented as an "area of amplification" of the disease in a report from the High Council for Public Health in 2012. Even further back in time, a model published in 2008 by a team of French researchers estimated that closing schools could reduce the total number of influenza cases by pandemic by about 15% and the height of the peak by 40%.

Several specialists nevertheless qualify this postulate. "Contrary to what we know with the flu where children are the main transmitters, it seems that with the coronavirus they excrete less virus", according to Pr Odile Launay, specialist in infectious diseases at Cochin hospital in Paris . Pascal Cr?pey, epidemiologist at the School of Advanced Studies in Public Health (EHESP), also assured France News that this "initial argument" according to which "this coronavirus behaves a little like a flu" in children, presented as "strong transmitters" was probably being questioned. "We can now see that this coronavirus does not behave in exactly the same way," he says.

A smaller virus?

"The virus exists in children but probably in smaller quantities than in adults", assured for its part on BFMTV on April 19 Jean-Fran?ois Delfraissy, president of the Scientific Council, on the front line to advise the government in this health crisis . "There have been no large outbreaks from schools, except in the Oise where the virus came from outside," he added. The risk of transmission by children is considered "possible, but not certain" by the specialist who admitted on April 15 during a parliamentary hearing that "there is a lack of data" on the capacity of transmission of the virus between children and children to their families.

The logic of low transmission capacity was however taken up by the Minister of Health Olivier V?ran on France 2 on April 21. "The studies are being stabilized," said the latter. "We tend to think that the smaller the children, especially those under the age of ten, the lower the risk of transmission would be," he added, claiming to give this information "in the conditional because the evolution of scientific knowledge on this virus is constant. "

What studies have been done on contamination by children?

No large-scale study has yet been produced in France on Covid-19 in young children and their potential for contamination. This will soon be the case. The infectious pathology group (GPIP) led by Robert Cohen, began a study on April 14 which will last a month. It concerns 600 children examined in city pediatrics in the Paris region, divided into two groups: half showing symptoms of the coronavirus, the other showing none of the symptoms. In addition to the medical impact on the child, the "repercussions this may have on adults" will be examined. The study, called "Pandor", is supported in particular by the Val-de-Marne Children's Clinical and Therapeutic Association ( Activ ) and the French Pediatric Society ,
Another longer-term study is underway through cooperation between the Necker hospital in Paris and the French Atomic Energy Commission (CEA). 1000 children who came to consult for all types of reasons will be tested, as well as one of their parents. "By analyzing the antibodies, we will know who has contaminated whom. We could have fairly rapid returns," we tell Necker, adding that the positive cases will be followed for a year. In total, around fifteen studies focusing on younger populations are already underway in France, says Le Figaro.

The case of Contamines-Montjoie, in the Alps

In the meantime, some studies, often partial, have already given some answers to the question of contamination by children. The most important screening carried out to date at the scale of a country, in Iceland (and already cited above), tends to confirm that children play a weak role in transmission. The French Pediatric Society also cites a dozen studies on its website, generally based on very small samples. One of these studies, based on the Contamines-Montjoie cluster in the Alps, one of the first of the epidemic in France, was published on the Clinical Infection Diseases website April 11. She concludes that a 9-year-old child, presenting symptoms of the coronavirus and tested positive, did not transmit the disease despite "close interactions within schools", the latter having attended "three schools and a ski class" before being placed in isolation with the other infected from this chalet where a Briton had spread the virus. In the same group, an "asymptomatic adult" had a "viral load similar to that of a symptomatic patient". In conclusion, the study suggests a potentially different transmission dynamic in children. "

A publication, published in March in the journal The Pediatric Infectious Disease Journal, is based on the work of the universities of Friborg in Switzerland and Melbourne in Australia, which themselves are based on three studies conducted in China. They tend to show that children who contracted the coronavirus first came into contact with infected adults in their families. The conclusion: "the importance of children in the transmission of the virus remains uncertain". Another study by the Institute of Public Health in the Netherlands from the statistics of the disease in the country seems to show that "the under 20s play a much less important role in the spread of the virus than adults and the elderly". However, the Dutch institution recommends applying a safety distance of 1.5 meters between students and their teacher as much as possible.

Less optimistic studies on the contagiousness of children

Because other studies are less optimistic about the potential for contamination of children. A study by several doctors at Geneva university hospitals, and pre-published on the MedRxiv site on April 27, showed that although they are underrepresented in the number of cases, "SARS-CoV- 2 infected children of all age groups. " Above all, she argues that "despite the high proportion of mild or asymptomatic infections, it would be naive not to consider them as transmitters". In 23 newborns, children and adolescents symptomatic and positive for the coronavirus, the viral load was once again comparable to that of adults.

"Symptomatic children of all ages shed the infectious virus at the onset of the acute illness," said the study. "Therefore, transmission of SARS CoV-2 in children is plausible. Given the relatively low frequency of children currently infected, biological or other unknown factors could reduce transmission in this population "nevertheless reassured the researchers. advocating "extensive serological surveys and systematic surveillance of acute respiratory diseases to understand the role of children in this new pandemic".

An alarming study from Berlin

The Berlin Charity University Hospital also published at the end of April a large study on the viral load of the coronavirus in 3712 of its Covid-19 patients, dividing them into different age groups . The results, pre-published on the establishment's website, show that there would be "no significant difference between the age categories, including children", which suggests that the coronavirus could be just as powerful in children as in adults. "The data indicate that viral loads in very young children do not differ significantly from those in children under the age of five," said the study, which warns black and white against unlimited reopening of schools. and kindergartens in Germany in the current situation.

"Children can be as contagious as adults," say the signatory German doctors, who worked under the leadership of Dr. Christian Drosten, a virologist recognized in Germany, Angela Merkel's advisor on the virus and the initiator of very broad policy. testing conducted in the country. Something to throw trouble again on the gradual reopening of schools in Germany as in several other European countries, even if several scientists, including Alasdair Munro, researcher in pediatric infectious diseases at the University Hospital of Southampton, in the United Kingdom, and the Swiss epidemiologist Leonhard Held, disputed the methodology and the conclusion of the study. By re-analyzing its results, they even lean more towards the opposite interpretation and a lower viral load than adults.

In detail, the Berlin Charity Hospital, with the help of several virology laboratories in the German capital, tested 59,831 patients for suspected Covid-19 between January 26 and the end of April 2020. 3712 ( or 6.2%) of the tests received a positive result. Two categories have been created. The first categorization was based on age groups: 1 to 10 years old, 11 to 20 years old, 21 to 30 years old, 31 to 40 years old, 41 to 50 years old, 51 to 60 years old, 61 at 70, from 71 to 80, from 81 to 90 and from 91 to 100 years. The second categorization was made on broader "social" ranges: kindergarten (0-6 years), primary school (7-11 years), high school (12-19 years), university (20-25 years), young adult (26-45 years old) and adult (over 45 years old). If the detection rate is lower in children,

What are the opinions of doctors on the transmission of coronavirus by children?

Among physicians and scientists, the precise question of the diffusion of Covid-19 by children is extensively discussed, often on the basis of clinical observations. And certainties seem to be evolving on this issue. "Regarding contagiousness, we are sorely lacking in data," admits Etienne Javouhey in Le Monde. "But contrary to what was said at the beginning of the epidemic, children are not more contagious than adults. I personally even think the opposite." Robert Cohen, for his part, seems to be inclined to contaminations more common from adult to child than vice versa: "Almost all the cases reported are cases of family contamination from parents to children [...]. 10, there is a contaminator in the sick family before them [...].
"Everyone started with the idea that children are often carriers of the virus, that they do not get sick, but that they transmit it. The first data do not go in this direction", explains Pr Robert Cohen at the microphone of Europe 1 . Professor Didier Raoult is one of those who call for calm. The Marseille infectious disease specialist, already at the forefront of his disputed tests on chloroquine , has published a study with his team which would demonstrate that children and adolescents do not have a particularly high concentration of virus and are not very contagious.

Others wonder like Isabelle Sermet-Gaudelus, from Necker, in the Figaro: "We do not know if being asymptomatic is linked to a lower viral load and what are the type and duration of immunity triggered by the meeting of the virus, "said the pediatrician. Professor Pierre-Yves Bo?lle, a researcher at the Pierre Louis Institute of Epidemiology and Public Health, also confirms in Le Figaro: "Can this translate into a lesser ability to transmit it, in the absence cough? We can hope so, but we don't have the answer. " He has since clarified his thought, still in the Figaro: "It is possible that the fact of not coughing or running from the nose reduces the probability of transmitting the virus".

Up to Geneva, the subject is debated. The professor of public health at Antoine Flahault University assures that there are few reports showing that the circulation of the virus is intense in children. "The data even seem to suggest that students play a small role in the spread of the virus," he says in Le Figaro. He nevertheless considers the reopening of schools to be "premature". "In the case of influenza, the closure of schools is the measure that has best shown its effectiveness on the mortality of seniors, a group to be protected in the first place".

Scientific advice not followed on the school and lively debates

The reopening of schools, even gradual, from May 11 causes in any case heated debates. The Scientific Council threw a pavement in the pond on Saturday April 25, by confirming in an opinion devoted to the deconfinement of the schools that it had recommended a reopening of the classes in September, "by precaution", and not on May 11, like l 'decided the government. The Scientific Council says nevertheless to have taken "note of the political decision" to reopen them gradually as of spring, by "taking into account the health stakes but also societal and economic". He therefore therefore recommends a battery of measures, including the compulsory wearing of an anti-spray mask in middle and high schools, the taking of temperature at home by parents,

An opinion by Inserm researchers published in mid-April also recommended a resumption of class in September, it was not taken into account either. Result: the fear is palpable. "From the health point of view, this is not a very good idea. There is a general principle which is to deconfine in the reverse order of confinement. The schools should therefore have been the last to reopen their doors", advances in Le Point Professor Eric Caumes, head of the infectious diseases department of the Piti?-Salp?tri?re hospital in Paris. The president of the Federation of Doctors of France, Jean-Paul Hamon, considers that the resumption of the courses is a "useless risk" which one will make run "with the whole of the population".

The Order of Physicians also opposed the date of May 11, through the voice of its president, Patrick Bouet, in Le Figaro. "There is no medical explanation to be defined in the school environment first," says Dr. Bouet, who advances: "We know that children are potential vectors without developing the infection themselves, unless rare exceptions ". On the other hand, he also considers it "very difficult in a school environment to enforce barrier gestures". He fears that the measure "will lead us to a rebound in the virus". For Karine Lacombe, head of the infectious diseases department at the Parisian Saint-Antoine hospital, teachers should pass serological tests to determine if they are immune or they should wear masks. Children should also stay away from the elderly.

Consternation among teachers

With parents and among elected officials too, the reopening of classes is worrying, as recently reported by Ouest-France . But it is especially in the educational community that consternation is most visible. "It is anything but serious (...). We know that it is a place of high transmission, of high contamination. It seems to be in total contradiction with the rest", reacted Francette Popineau, secretary general of Snuipp- FSU, first primary union from April 14. We must "give us the health conditions for this recovery," she added since on RTL. "We have not yet understood if we would have masks, if children would have them, how we will set up distance, 15 in a class it can be a lot" ...
"The minister gives the pledge of a gradual recovery," said St?phane Crochet of SE-Unsa, interviewed by AFP on April 22. But "many questions remain in terms of health". "We were rather talking about the month of June, simply to see the students and to reweave links", was astonished as for him Philippe Vincent, head of the syndicate of principals (Snpden-Unsa) in Le Parisien . "No recovery without health guarantees," also warns Snes-FSU, the first secondary union when another side union, Snalc, considers "unacceptable" the assumption of 15 students per class.

A "playable" reopening according to some doctors

Some doctors nevertheless believe that a reopening of classes on May 11 is "playable" or even desirable. "Children aren't super-transmitters of Covid-19, it's time to go back to school," said Alasdair Munro and another British infectious disease specialist Saul Faust in a column published May 6 by the medical journal Archives of Disease in Childhood .
"We will see after fifteen days of reopening if the impact is negative," said, in France this time, Pascal Cr?pey in Le Monde Tuesday, April 14. He believes that given the month and a half of class that is looming before the summer vacation, "the two options - reopen or maintain the closure until the start of the school year - held up." "I understand very well the fears aroused by the reopening of schools. We learn it every day and the things that we believe we know at the moment T can still change at the moment T + 1. We have to be careful and continue the search ", he adds on France Info. "Keeping schools closed could also have pushed parents to turn their children over to grandparents, a much more at risk group." "It is fairly consistent. It is the least at risk population, they will have to immunize themselves to protect the most vulnerable," confirms Pierre Parneix, head of the Support Center for the prevention of infections associated with care of New Aquitaine.

"Depending on the evolution, everything can be revised at any time if there were any surprises, especially in the wrong way", abounds Professor Bouchaud of CHU Avicenne. His colleague Professor Fr?d?ric Adnet, head of the emergency department of this establishment located in Bobigny, even believes that "it is a very good thing that children go back to school". "The children do not risk anything, they are affected by the coronavirus, but not in serious forms. The deaths are tiny," assures the one who is also director of Samu 93. He believes that the contamination of adults is even a risk which can to assume responsibility, since "the parents of children at the cr?che or primary school are rather young as well as the teachers" who "


Professor Robert Cohen, already cited several times in this article, says for his part that the risk of reopening classes is "modest" for children who present "6 to 15% of positive diagnoses" against "30 to 35 % for adults ". He would also be mastered for teachers and parents, he said: "Even if we think that children are not major contaminators, school arrivals and departures are moments of encounter between adults. It may be that which plays a role in the epidemic, much more than the children themselves ", he analyzes on Radio France. And to conclude that a gradual recovery before the summer will prepare for the start of the school year by limiting the risks, with the implementation of barrier actions in small groups. " It would have been no less dangerous in September with a massive comeback. We will have to change our habits by then. "

https://www.linternaute.com/actualit...cours-d-ecole/

[Pathfinder]

Note:
This article was posted on May 1st. The schools reopened on Monday in Switzerland.

Translation Google



Swiss
Modified May 01, 2020 at 23:04


Daniel Koch: "I am sure of our analysis concerning children"


While Swiss schools are due to reopen in ten days, the position of the FOPH on the risk of coronavirus transmission by children is raising criticism, even among scientists. Daniel Koch explained to RTS what his analysis and certainty are based on.

Between his remark on grandparents who can once again take their grandchildren in their arms and the decision of the Federal Council to open schools without special measures, Daniel Koch, "Monsieur coronavirus" of the Federal Office of Health public (OFSP), faces many justification requirements.

His situation was further complicated with the publication on Friday of a document from the scientific task force established by the Confederation, which concluded that the question of the role of children in transmission "remains open and that the evidence is currently insufficiently solid". Then a few hours later, it was the turn of a Geneva study to estimate "that it would be naive not to consider the children as transmitters".

>> Read: Risky or not, the deconfinement of children supported by the FOPH divides the experts

These new publications did not shake Daniel Koch, who did not reverse his position at the press conference of the day. An asserted position, the foundations of which he explained in an interview with RTS Friday morning.

RTSinfo: What scientific studies have been decisive in explaining the position of the FOPH on children and the risks linked to the coronavirus?

Daniel Koch: In science, it is never a single element that takes over. The infectious disease pediatricians, who are in the best position to talk about children, and with whom we spoke, support our decision. This is also the case for the Swiss Pediatric Society (SSP).

All serious and observational studies, like those in Iceland and Australia , make it clear that children are rarely affected by the disease and are not the engine of the epidemic.

RTSinfo: However, we hear scientific voices calling for caution following recent publications on the viral load of children. Shouldn't we listen to them?

Daniel Koch: The German and Geneva studies that you mention do not concern the spread of the virus. What they are saying is that sick children have a viral load similar to that of adults. This does not prove that they transmit the disease and that they maintain the disease, although there may always be exceptions. For me, it is obvious that children without symptoms do not transmit the disease.

RTSinfo: What about sick children?

Daniel Koch: For sick children with symptoms, we don't know, that remains a possibility. But so far, studies have shown virtually no cases of contamination of adults by children. The opposite is listed.

RTSinfo: Wouldn't this "possibility" that you are talking about call for caution?

Daniel Koch: The search for evidence should not be reversed. For the moment, everything indicates that children are not transmitting the disease. Unlike the flu or other respiratory illnesses where children play a major role in the epidemic, with coronavirus it is different. And it is fortunate that this disease is so serious in so many other ways.

RTSinfo: Should measures be taken in schools, such as taking temperatures?

Daniel Koch: No, sick children will not go to school anyway.

RTSinfo: Are you sure of your position on the role of children in this pandemic, or do you sometimes doubt it?

Daniel Koch: I'm sure. My job is to look after the health of the population. I assure you that I take this role very seriously. There are currently elderly people who suffer a lot from isolation. If we can alleviate this suffering by allowing meetings between grandparents and grandchildren, this is also part of my job. It is not a risk taking or a gamble.

Interview by Marc Renfer


Posted on May 01, 2020 at 6:48 pm - modified on may 01, 2020 at 23:04

https://www.rts.ch/info/suisse/11291...-enfants-.html

[Mary Wilson]

15 states now investigating child illness possibly linked to coronavirus, Cuomo says

BY AUDREY MCNAMARA

MAY 13, 2020 / 3:20 PM / CBS NEWS

"New York is in many ways the tip of the arrow here," Cuomo said. "(We are) looking at 102 cases where children who may have been infected with the COVID virus show symptoms of an inflammatory disease like Kawasaki Disease, or toxic shock-like syndrome."

According to the governor (Cuomo), 14 other states, as well as Washington D.C. and five European countries, have reported cases. The states are: California, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Massachusetts, Mississippi, New Jersey, Ohio, Pennsylvania, Utah and Washington...

https://www.cbsnews.com/news/kawasaki-disease-15-states-child-illness-coronavirus-cuomo/

[bertrand789]

Un texte impressionnant, qui redore un peu l'image de ce corps m?dical qui a perdu la confiance de bien des fran?ais. Le mensonge en bande organis?e c'est tr?s destructeur. Tous ceux qui suivent la gestion de crise depuis un moment le savent ...
Il est le reflet de la m?decine d'un pays, ou l'approche ethnique et ou "raciale", donc g?n?tique est inconcevable, officiellement, sauf pour la recherche. Ceci est une faiblesse, pas un d?faut.
Je voulais dire que, sur ce forum, il a ?t? indiqu? que suivant des particularit?s g?n?tiques, exemple groupe sanguin, et autres, ou l'?tat de sant? av?r?, les faits pouvaient ?tre diff?rent. Pour un parent, on ne veut pas entendre parler des enfants, mais de leur enfant. Je ne pr?tend nullement que l'exercice est simple ou a d?j? ?t? fait , mais nous sommes au temps d'internet et internet impose une communication d'un tout autre niveau. Ce que beaucoup ont du mal ? entrevoir...

An impressive text, which slightly restores the image of this medical profession which has lost the confidence of many French people. Lying in organized gangs is very destructive. All those who have been following crisis management for a while know this ...
It is the reflection of the medicine of a country, or the ethnic and or "racial" approach, therefore genetic is inconceivable, officially, except for research. This is a weakness, not a defect.
I wanted to say that, on this forum, it was indicated that according to genetic particularities, example blood group, and others, or the state of proven health, the facts could be different. For a parent, we do not want to hear about children, but about their child. I am not claiming that the exercise is simple or has already been done, but we are in the age of the internet and the internet requires communication on a whole new level. What many have trouble seeing ...

[gsgs]

there were also some Drosten-podcasts about the role of children.
When you look at the cases-statistics, then Children are very rare, but apparently this
is because they rarely get tested.
I saw one estimate that children are ~1/3 as likely as adults to get it.
But in some locations children got it sometimes early in the wave
and then it went down in children (maybe due to early schoolclosures)
I also saw some studies recently concluding that school-closures were effective
(but lockdowns were not)

[Pathfinder]

Translation Google

Coronavirus: "There is nowhere a second wave", according to Didier Raoult

Professor Didier Raoult, infectiologist and professor of microbiology, believes that "the epidemic is ending", without a second wave.

Paul Turban
Journalist

PUBLISHED ON 5/13/2020 AT 2:00 P.M. UPDATED ON 14/05/2020 AT 10:51

"The epidemic is ending." The verdict is final, and argued. This Tuesday, May 12, in a video intervention on YouTube, Professor Didier Raoult, infectiologist and professor of microbiology, delivered his last analysis of the epidemic of new coronavirus. "Nowhere is there a second wave, or a camel's back , it's the common curve," said Didier Raoult .

"There will be a few sporadic cases that will appear here or there , possibly if there is someone super contagious, there will be a few cases around him, according to the infectious disease specialist . But that no longer reflects an epidemic dynamic . epidemic is ending. "

"Everywhere, things are stopping, explains the infectious disease specialist, whether it is detected cases, hospitalized cases, hospitalized cases in intensive care ..., estimated Professor Raoult. The dead, it will be longer because unfortunately there will be a few dead who are currently in intensive care who will appear. But we can see that this episode is being resolved . "

https://www.rtl.fr/actu/bien-etre/coronavirus-il-n-y-a-nulle-part-de-deuxieme-vague-selon-didier-raoult-7800510497

[bertrand789]

Quand dans une r?gion, on subventionne des paysans pour se reconvertir dans une certaine forme d'?levage, avec de l'argent public, puis que l'on d?cide de fermer ce type d'?levage avec compensation en ?voquant un danger nomm?, il faut que certains faits soient produits, il me semble ?

N'ayant vu aucun signalement au niveau de l'O.I.E et ou F.A.O, je suis, un peu, ?tonn? ...


When in a region, we subsidize peasants to reconvert in a certain form of breeding, with public money, then that we decide to close this type of breeding with compensation by evoking a named danger, it is necessary that certain facts are produced, it seems to me?

Having seen no reports at the level of the O.I.E, I am, a little surprised ...

https://www.youtube.com/watch?v=xKXAvz8n7Io

[sharon sanders]

China has 1.4 billion people to feed. This is the prevailing situation. They have tried to encourage people to eat grocery market packaged poultry with limited success. Also, there has been an official ban on eating cats and dogs for about 10 years.

[bertrand789]

20 avril 2020 0164

https://www.fr24news.com/fr/a/2020/04/les-chinois-ont-eleve-denormes-rats-pour-leur-viande-et-ont-celebre-100-raisons-de-les-manger-avant-le-coronavirus.html

https://www.amazon.com/Rhizomys-domestic-technology-Chinese-QING/dp/7122256235

[sharon sanders]

Translation Google

Coronavirus: "There is nowhere a second wave", according to Didier Raoult

Professor Didier Raoult, infectiologist and professor of microbiology, believes that "the epidemic is ending", without a second wave.

Paul Turban
Journalist

PUBLISHED ON 5/13/2020 AT 2:00 P.M. UPDATED ON 14/05/2020 AT 10:51

"The epidemic is ending." The verdict is final, and argued. This Tuesday, May 12, in a video intervention on YouTube, Professor Didier Raoult, infectiologist and professor of microbiology, delivered his last analysis of the epidemic of new coronavirus. "Nowhere is there a second wave, or a camel's back , it's the common curve," said Didier Raoult .

"There will be a few sporadic cases that will appear here or there , possibly if there is someone super contagious, there will be a few cases around him, according to the infectious disease specialist . But that no longer reflects an epidemic dynamic . epidemic is ending. "

"Everywhere, things are stopping, explains the infectious disease specialist, whether it is detected cases, hospitalized cases, hospitalized cases in intensive care ..., estimated Professor Raoult. The dead, it will be longer because unfortunately there will be a few dead who are currently in intensive care who will appear. But we can see that this episode is being resolved . "

https://www.rtl.fr/actu/bien-etre/co...ult-7800510497

I do not know this fellow but I think he is a proponent of the azithromycin/chloroquine combination? We have some papers on this in the treatments subforum of the scientific library. link

I think he is saying in the french translation that the epidemic curve is over and now we will not see a second wave but only sporadic cases that pop-up?

We can look at China and other countries in Asia for some type of clue on this. It appears in China, at least what they are disclosing, that there is some pop-up activity. link

Singapore developed a large problem in a housing complex. Japan has gone to a broader emergency declaration. South Korea seems to be doing fairly well. It seems like a mixed bag of situations right now.

For the northern hemisphere the challenge will be when all schools are back in session and the weather cools. I have no idea what is going to happen but it appears humans are a host for COVID-19 and we will live with this illness until we have 70%ish herd immunity or a safe and effective vaccine.

I do not get involved in the politics of COVID-19, which sadly, is now a political football, at least in the U.S.

For coronavirus there are two well known examples - although entirely different diseases: 2003 SARS and MERS. 2003 SARS burned out partially because it was less infectious than COVID-19. It was also more deadly. MERS has been doing a "slow burn" since 2012. Camels are one host animal and humans in the Middle East have constant contact with them, especially in Saudi Arabia. MERS cases happen year round but occur more frequently in the fall and winter.

So based on MERS I would guess that COVID-19 is here to stay, especially given its highly infectious nature, circulating among humans with a general characteristic to occur more frequently in the fall and winter. Will COVID-19 infections in the future occur in large curved outbreaks or lower levels of sustained transmission? I don't think anyone knows.

Meanwhile, I am taking responsibility for myself. I am in several risk categories so I am avoiding all crowds. I wear a mask when I go out (rarely) - and I still stay 6 feet away from other people. I wipe down deliveries. I eat a lot of "hurricane" food, do house projects, and play with my dogs. My little dog has a new trick. She can get on my bed by climbing her way up off lower furniture and then jumps across the divide to land on the bed. Saves me a lot of getting up and down.

[Sally Furniss]

Weta Digital ( Peter Jackson ) made the visual effects for Lord of the Rings

Executive producer David Conley said the company was trying to buy some equipment from Wuhan.

"We were just hearing whispers from concerned crew about family members in China, there was this mysterious illness, that's all we knew.

"And then when we started trying to purchase some substantial hardware, there started to be these delays."

Weta Digital started getting more reports from colleagues around the world and began its own pandemic planning, initially as more of a theoretical exercise.

more....

https://www.rnz.co.nz/news/national/...nomic-recovery

[sharon sanders]

?????

I do not know the bias (if any) of this media.

A list with 640k cases - one on each line?


Leaked Chinese Virus Database Covers 230 Cities, 640,000 Updates

New information may offer insight into the honesty of China’s coronavirus numbers.

BY ISAAC STONE FISH, MARIA KROL SINCLAIR | MAY 12, 2020, 8:32 PM

snip

While not fully comprehensive, the data is incredibly rich: There are more than 640,000 updates of information, covering at least 230 cities—in other words, 640,000 rows purporting to show the number of cases in a specific location at the time the data was gathered. Each update includes the latitude, longitude, and “confirmed” number of cases at the location, for dates ranging from early February to late April.

https://foreignpolicy.com/2020/05/12...-number-cases/

[Gert van der Hoek]

There seem to be 2 paradigms regarding government policy in relation to Covid-19:

1. Try to stop the outbreak. Lockdown if necessary to buy time to eradicate the virus. Test, isolate & treat, trace contacts.

2. Let it go, we can't stop it. If necessary implement measures - temporary (mild) lockdown - to slow down the outbreak if health facilities get overwhelmed, protect - if possible - the vulnerable people (f.i. elderly).


What can we say about this? Based on our feelings, based on the incomplete science we have?

Many questions. For instance: some countries are doing "good" , others are doing "bad". For now.
If - if - a 2nd wave starts, what will happen? Bad 2nd wave in "good" countries? Benign 2nd wave in "bad" countries? We don't know.

My feeling right now: we don't know much about the current virus outbreak. So better be safe than sorry. We know how to deal with infectious diseases, like Ebola: find patients, isolate and treat, do contact tracing. Lockdowns should be early, fast and strong and temporary. To buy time for testing and tracing. Also to prevent to much economic damage, especially for the poor.

If lockdowns are too late and too little, they can do much harm?

Not easy to decide what to do.

[bertrand789]

I do not agree with your description. For me, China has been a pressure cooker for a long time with regard to these pathogens. This suggests that the vector and or carrier animals are in x places and x species (see the bamboo rat file) There is therefore coexistence in humans of x immunities, before this event ...

There is certainly the event evoked, but this event had prodomes on the one hand, on the other hand the measures taken, which do not concern only humans, suggest that Chinese knowledges are more important at this stage than the shared, even if I recognize that they have and do a real feat in terms of communication.
I am more and more certain that we must help the Chinese and that by helping the Chinese we will all help each other.

I like the name Chernobyl Chinese, because it is also an American or European Chernobyl. So if the prerequisite is that we are all with our Chernobyl, we are probably going much better ...

Je ne suis pas d'accord avec votre description. Pour moi, la Chine est, au regard de ces pathog?nes, une cocote minute, depuis un bon moment. Ceci sugg?re que les animaux vecteurs et ou porteurs sont en x endroits et de x esp?ces ( voir le dossier rat des bambous ). Il y a donc coexistence chez les humains de x immunit?s , avant cet ?v?nement...

Il y a certes l'?v?nement ?voqu?, mais cet ?v?nement a eu des prodomes d'une part, d'autre part les mesures prises, qui ne concernent pas que les humains, laissent entrevoir que le su chinois est plus important ? ce stade que le partag?, m?me si je reconnais qu'ils ont et font un v?ritable exploit en terme de communication.
Je suis de plus en plus certain qu'il faut aider les chinois et qu'en aidant les chinois on s'aidera tous.

J'aime la d?nomination Tchernobyl chinois, car cela est aussi un Tchernobyl am?ricain ou europ?en . Donc si le pr?alable admis est que nous sommes tous avec notre Tchernobyl, on va surement beaucoup mieux avanc? ...