COVID-19 Update: Fauci's Stark Warning, WHO Backtracks

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Here are the coronavirus stories Medscape's editors around the globe think you need to know about today.

"It Isn't Over Yet"

Stores are reopening, restaurants are serving customers, and people are talking about sending kids back to school in September. Does this signal the end of the COVID-19 pandemic? Not so fast, says Anthony Fauci, MD, whose latest declaration could curb that kind of wishful thinking: "It isn't over yet."

Acknowledging his own surprise at how rapidly SARS-CoV-2 has spanned the globe, Fauci also admitted that we are "still at the beginning of really understanding" this virus and the disease it causes.

Speaking at a biotechnology innovation conference, Fauci shared his views on why COVID-19 has been so devastating for the African American community, and why we will likely end up with more than one vaccine when we reach the finish line of the vaccine race that's currently underway.

WHO Backtracks on Asymptomatic Comments

Fear of transmitting, or acquiring, the virus that causes COVID-19 even if you or the other person is asymptomatic has been a strong driver of widespread compliance with facemasks and physical distancing. So when a WHO epidemiologist, Maria Van Kerkhove, PhD, suggested this week that asymptomatic transmission of the virus was "very rare," the level of confusion among the public health community jumped precipitously.

Van Kerkhove clarified her statement the next day saying that we really don't know how often an asymptomatic person infects a secondary individual. But the number of asymptomatic people isn't trivial. Recent data published in Annals of Internal Medicine indicate that 40%-50% of people with COVID-19 may be asymptomatic, but have viral loads similar to those of presymptomatic individuals. Until we know how much transmission occurs from asymptomatic people, that risk hasn't been eliminated, and these people must be considered infectious.

COVID-19 Surges Among States

The COVID-19 pandemic remains a fluid situation in the United States. This week, 19 states are experiencing increases in case numbers, while 24 states are seeing reductions, and seven are holding steady.

Public health experts expected, and warned, that efforts to reopen the country could have consequences, and since Memorial Day nine states have seen spikes in COVID-19 hospitalizations. These increases followed the lifting or easing of lockdown restrictions, and it's feared that similar peaks might occur as a result of protests taking place around the country.

Hospitals in many states are gearing up for a potential surge of infected patients. Arizona hospitals, for example, have been warned to activate emergency plans to deal with a rapid increase in COVID-19 positive cases in the weeks since stay-at-home orders were lifted.

HHS Slates $15 Billion for Clinicians With Medicaid Patients

Federal officials are preparing to distribute $15 billion in financial aid to clinicians who see patients enrolled in Medicaid and State Children's Health Insurance Program. The Department of Health & Human Services (HHS) also on Tuesday announced plans to distribute $10 billion in Provider Relief Funds to safety-net hospitals.

The new tranche of aid for providers is likely to serve pediatricians, obstetrician/gynecologists, dentists, and healthcare professionals who deliver opioid treatment and behavioral services, HHS said. The payments are intended to amount to at least 2% of reported gross revenue from patient care.

Altruism Is Alive and Well

In a recent study of human behavior, Perry Wilson, MD, sees a glimmer of hope that in spite of our differences, humans are hardwired to take care of each other. It's a study of human prosocial behavior — an action that benefits someone else, even if it harms ourselves.

Wilson argues that prosocial behavior goes a long way toward explaining why we were willing to endure the inconvenience of staying home, wearing masks, and maintaining physical distancing to protect others who are more vulnerable to infection than ourselves.

This Internet-based reciprocity study showed that altruism still exists in the human race. People are willing to give to others with no expectation of return, even to random strangers; as highly social creatures, humans are capable of integrating vast amounts of social information effortlessly before engaging in a behavior.

You can read about the study in Science Advances.

Low COVID-19 Risk From Bystander CPR

Because out-of-hospital cardiac arrests are a risk for COVID-19 patients, questions have been raised about the risk of infection to bystanders who try to help by performing CPR.

A new analysis published in Circulation may assuage some of that concern. The study authors, using previous research to come up with a model that roughly assumes a 10% risk for transmission to bystanders performing hands-only CPR without personal protective equipment, show that treating 100 patients could result in one bystander infection (10% with COVID-19 × 10% transmission).

A critical care physician not involved in the research said although the calculations made might be "too narrow and simple," this study "serves as sort of a reassurance that bystander CPR is still way more likely to create benefit rather than excess risk to the bystander, and with some very simple safety measures it might be possible to still safely perform bystander CPR."

In Memoriam

As frontline healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk of infection. More than 1000 throughout the world have died.

Medscape has published a memorial list to commemorate them. We will continue updating this list as, sadly, needed. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

If you would like to share any other experiences, stories, or concerns related to the pandemic, please join the conversation here.

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