The Count

Region	Cases	Deaths
World	22,028,137	776,592
US	5,609,068	173,618

Are You Safe on a Plane: New Study Offers Clues A surveillance state might not be an ideal place to live, but it sure makes for great epidemiology. In a Big Brother tour-de-force, Chinese epidemiologists have estimated the risk of traveling on their high-speed train system. The US still doesn't have anything that could be called high speed rail by global standards, but this analysis offers an excellent proxy for air travel risk in the COVID era.

How to Survive the Pandemic: Lessons from a Mountain For three days, the invisible virus disappeared. High in the Beartooth Wilderness, masks and hand sanitizer became irrelevant. No one needed stickers on the ground to maintain social distance. Instead, we worried about unambiguous, profoundly visible threats, from mosquitoes to grizzlies. Then everything changed.

(Note to readers: My recent escape from COVID took me farther off the grid than I'd planned with no regular internet for almost two weeks. I returned to a list of over 2,000 articles to sort through. I'm slowly catching up. Here's some of the most interesting of the 2,000+.)

Research News

Circulating mitochondrial DNA concentration predicts adverse outcomes in COVID-19 patients A team of American and Italian researchers demonstrated that serum concentrations of mitochondrial DNA on admission were associated with ICU admission, need for ventilation, and mortality, even after adjustment for other established risk factors.

New, dominant strain of SARS-CoV-2 has emerged* A strain that evolved in Europe and North America has become the dominant form of the virus globally, replacing the original strain, even in Southeast Asia.

Frequent contact with small children associated with less severe cases of COVID-19 A German study found that in a cohort of infected subjects, those without young children were more likely to experience severe symptoms. The authors suggest this might reflect exposure to other coronaviruses, with protection through cross-reactivity. This possible explanation was not verified.

Another choir practice outbreak demonstrates super spreader event. A French study of a choir practice showed a secondary attack rate of 70%. This, along with previous evidence, clearly demonstrates the extreme risk of indoor activities associated with forceful exhalation such as singing or yelling (e.g. rally or sporting event).

Hand Sanitizer as good or better than handwashing A Meta-analysis of disinfection techniques suggests that hand sanitizer may perform better than hand washing for reducing the risk of acquiring acute respiratory infections.

COVID-19 rule breakers tend to be rural, lower income, male, and less educated Data from the COVID Impact Survey found that living in an urban area, having post secondary education, being female, and having higher income were associated with a greater likelihood of following guidelines for preventing the spread of SARS-CoV-2.

Trends in COVID-19 incidence could not be explained by increased testing In an analysis of US states, COVID-19 testing positivity ratios have been increasing monotonically since mid-June nationally, suggesting testing rates do not explain increased incidence. States with Republican leadership were more likely to exhibit rising trends in incidence.

SalivaDirect Test for SARS-COV-2 reported to have high level of agreement with existing tests The saliva based test, developed by Yale University researchers, provides an extremely low cost test with a 90%+ level of agreement with onerous, expensive, currently available tests based on nasopharyngeal samples. The test relies on an alternative to nucleic acid extraction that reduces cost and processing time.

Secondary Attack Rate for persons traveling on trains within three rows of COVID-19 cases ranged from 0-10.3% * Chinese researchers evaluating the risk of transmission on Chinese High-Speed Trains found that those adjacent to cases had a base secondary attack rate of 3.5% that increased by 1.3% per hour of travel. The risk dropped to 1.65% and 0.38% at two and three seats apart respectively. This risk dropped by a factor of almost ten for other rows. (see blog post for details)

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*peer reviewed.