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October COVID-19 Report
2nd Big COVID-19 Vaccine trial paused due to possible serious side-effect – October
13,2020https://www.cbc.ca/news/health/oxford-vaccine-covid-19-pause-1.5717719- The University of Oxford and pharmaceutical company AstraZeneca announced theirpause on September 8o The company is running Phase 3 trails involving thousands of people in the
UK and smaller number of people in Brazil and South Africao They were also recruiting 30,000 people in the US for its largest study
o Trials have since resumed in the UK, Brazil, and South Africa but they havenot been approved to resume in the US- Johnson Pharmaceutical Companies announced their pause on Oct. 12
o The company is running both early and late-stage clinical trials and di not say
which the volunteer participated ino They announced they are pausing all its COVID-19 vaccine trials – including a
Phase 3 trial that started in late September and aimed to enroll 60,000
volunteers in Argentina, Brazil, Chile, Colombia, Mexico, Peru, South Africa,
and the U.S- Both of these vaccines were non-replicating viral vector vaccines- Both companies paused the trials due to an “unexplained illness” in one of thevolunteerso This triggered a “standard review process”
o Johnson Pharmaceutical Company refused to disclose details
o AstraZeneca acknowledged that the patient had neurological symptoms
associated with a spinal inflammatory disorder called transverse myelitis▪ This involves localized inflammation of the spinal cord which cancause symptoms such as weakness, loss of sensation, or even paralysisof the arms and legs
▪ This diagnosis was later confirmed by an internal report on theincident
Johnson & Johnson COVID-19 Vaccine Study Paused due to unexplained illness inparticipant – October 12, 2020
https://www.statnews.com/2020/10/12/johnson-johnson-covid-19-vaccine-studypaused-due-to-unexplained-illness-in-participant/- Johnson & Johnson’s COVID-19 vaccine study has been paused due to an
unexplained illness in a study participant- A document sent to outside researchers running the 60,000 patient clinical trial
stated that a “pausing rule” had been met
o The online system used to enroll patients in the study was closed and thedata and safety monitoring board convened

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The company has declined to provide further details about the study participant
who developed an unexpected illness
They did however emphasize the difference between a study pause and a clinicalhold which could last much longer
o The vaccine study is not currently under a clinical holdo Clinical trial pauses are not uncommon – especially given the size of this trial
Johnson & Johnson also stated that in cases like this, it is not always immediately
apparent whether the participant who experienced an adverse event received astudy treatment of a placebo
Johnson & Johnson began enrolling volunteers in its Phase 3 study on September 23
and researchers planned to enroll 60,000 participants in the U.S. and other countries

England Joins Other Countries in State of National Lockdown – October 31, 2020
https://www.theguardian.com/world/2020/oct/31/covid-running-riot-in-england-aslockdown-looms-scientist-says- Scientists on the Scientific Advisory Group for Emergencies in England have statedthat COVID-19 is spreading faster than their worst-case scenarios and could kill
85,000 people this winter- There are now many more cases, particularly in younger females between ages 2040
o 3 to4 times as many women in this age group are going to hospitals as men
o It is believed to be because they are being exposed to the virus in hospitality,
retails and some educational settings- Professor John Edmunds at the London School of Hygiene and Tropical Medicine
said that the spread of the coronavirus in England has been worse than theforecasted worst-case scenario- The Office for National Statistics infection survey found cases “continued to rise
steeply” in the week ending 23 October, with an estimated 568,100 people inhouseholds becoming infected- Scientific advisors at the top of government believe it is now too late for a 2 week
lockdown to have enough of an effect, and a longer one is needed to drive thereproduction number of the virus below 1- The advisers believe all parts of England are on course to eventually end up in tier 3
restrictions and death could potentially hit 500 a day within weeks- They are also confident that more than 50,000 new cases of coronavirus are now
occurring every day in England- Official documents released by the government showed that a Sage meeting on
October 8 said the number of infections and hospital admissions was “exceeding thereasonable worst case scenario planning levels at this time:- France and Germany announced national lockdowns earlier this week
- In Irelands, pubs and restaurants are closed, except for takeaways and deliveries
since October 16

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M4V 1N5-o Schools were also closed for 2 weeks
Wales is currently under a “firebreak” lockdown with leisure, hospitality, andtourism businesses closed

AstraZeneca shares turn negative after Brazilian health authority states that
Volunteer in COVID Vaccine Study Died – October 21, 2020
https://www.cnbc.com/2020/10/21/astrazeneca-shares-slide-after-brazilian-healthauthority-says-volunteer-in-covid-vaccine-study-dies.html- Brazilian authorities stated that a volunteer in AstraZeneca’s coronavirus vaccine
study diedo This led to the company’s shares to go down by 1% in early afternoon trading- The Federal University of Sao Paulo that is helping coordinate late-stage trials in
Brazil shared that the volunteer was Brazilian- A spokesperson from AstraZeneca declined to comment on the volunteer, citing“medical confidentiality and clinical trial regulations”- They also stated that all significant medical event are carefully assessed by trial
investigators and that these assessments have not led to any concerns about
continuation of the ongoing study- A spokesperson from the University of Oxfords, which is developing the vaccine with
AstraZeneca said that there have been no concerns about safety of the clinical trial
after the case in Brazil was assessed- It is unclear if the volunteer received the vaccine
o However, a source familiar with the situation has stated that the trial would
have been suspended if the volunteer had been a part of the group getting theshot- Brazil currently has the second deadliest outbreak in the world, behind the U.S. withat least 115,914 deaths according to data compiled by the Johns Hopkins University- AstraZeneca is one of 4 drug makers backed by the U.S. in late-stage testing for apotential vaccineo Their vaccine, AZD1222 uses genetic material from the coronavirus with amodified adenovirus
Big Contact tracing Study Shows Roel of Kids and Superspreaders in COVID-19
Pandemic – October 1, 2020
https://www.ctvnews.ca/health/coronavirus/big-contact-tracing-study-shows-role-ofkids-and-superspreaders-in-covid-19-pandemic-1.5127950- A new study published reports that young adults are the primary source ofcoronavirus spread- The study was based on a giant contact tracing effort involving more than 3 million
people in Indiao The study involved the universal contact tracing efforts undertaken in 2 large
states in the south of India

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M4V 1N5---o Authorities tracked down and tested more than 575,000 people exposed tonearly 85,000 confirmed cases from March until AugustThis is the largest contact tracing study in the world by far
The study showed that most COVID-19 patients never infected anyone elseo Researchers found that 70% of infected people did not infect any of theircontact,o Only 8% of the infect primary cases were responsible for 60% of the contacts
that were infected▪ This is a hugely disproportionate effecto The first patient in the chain of transmission were adults aged 20 to 45
The young and middle adult age group is the one that is coming in contact withpeople as they are most likely to be outside the household, therefore taking thedisease from one place to anotherThe study also contradicts the widely held belief that children are unlikely to catchthe coronaviruso The study showed that they are actually getting infected in significant
numberso This was true even though schools have been closed in India since March
The study also showed that lockdowns worked and that restriction lowered the rateof transmission
Case fatality ratios fell over timeo Those who tested positive in May and June were 13% less likely to die thanthose tested in March and April

32 Clinical Trails Happening in Canada – October 28, 2020-

20-5449: Nitric oxide – not to be confused with nitrous oxide, also known aslaughing gas – is being tested in intubated COVID-19 patients to see if it inhibits thedisease.
2149: Some critically ill COVID-19 patients at Sunnybrook Health Sciences Centre in
Toronto are subjects in this trial, which uses anesthetic drug isoflurane.
ARBS CORONA II: Normally used to treat high blood pressure, losartan is being
tested on COVID-19 patients in this trial.
CATCO: Toronto’s Sunnybrook Research Institute is handling the Canadian side of
the World Health Organization-backed trial of remdesivir in hospitalized COVID-19
patients.
CINC424J12301 RUXCOVID: Ruxolitinib, a drug used to treat high-risk
myelofibrosis, is being tested to see if it can stop the cytokine storm created when abody’s response to COVID-19 kicks its immune system into overdrive.
CIRCA-19: Tests of a cellular immunotherapy treatment are being conducted by ateam from the Ottawa Health Research Institute.

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COLCORONA-MHIPS-2020-01: The Montreal Heart Institute is behind one of two
Canadian trials involving colchicine, a medication normally used to treat gout. This
trial is partially sponsored by the Bill and Melinda Gates Foundation and is expected
to be completed by December.
CONCOR-KIDS: Some pediatric COVID-19 patients in Alberta hospitals are being
given this treatment, which uses frozen plasma from recovered patients.
CONTROL-COVID-FAVIPIRAVIR-1: Nova Scotia-based Appili Therapeutics isbehind this trial of favipiravir, an antiviral drug most commonly used in Japan.
CORIPREV-1: Lopinavir/ritonavir was approved for treatment of HIV/AIDS
infections in 2000, and is now being tested by Unity Health Toronto to see how it
affects COVID-19.
COVACTA: Drugmaker Hoffmann-La Roche is testing Actemra, a relatively newarthritis medication, to see how patients with severe pneumonia related to COVID19respond to it.
COVID-CTP-01: This is another trial involving nitric oxide, this one being carriedout in Quebec by Vancouver-based R&D firm SaNOtize.
GRAAL-2020-01: A team from Hamilton Health Sciences is behind a trial thatuses
plasma from recovered patients to treat hospitalized adults who have acute cases of
COVID-19.
GS-US-540-5821: Another trial investigating antiviral drug remdesivir, this one isbeing conducted by pharmaceutical company Gilead.
HEROS-1: Hydroxychloroquine is being given to front-line health-care workers forthis trial run by the University Health Network in Toronto.
IC.8: The only ongoing Canadian trial to involve a potential vaccine, this tests
involves recruiting patients at higher risk of severe complications and giving themIMM-101, a bacteria designed to boost their immune system and keep COVID-19 atbay.
F-4-2020: The Toronto-based University Health Network is taking part in this trial
involving peginterferon-lambda, a part of the human antiviral immune responsethat proponents believe may have a lower risk of serious side effects than otherpotential COVID-19 treatments.
LAU-20-01: Fenretinide, which has been found to be effective in fighting somecancer cells, is being tested against COVID-19 in this trial run by Laurent
Pharmaceuticals.
LOVIT-COVID: Researchers at the Sherbrooke University Hospital are examining
whether high doses of vitamin C can lessen organ dysfunction in hospitalized
patients.
MK-4482: Some hospitalized adults with COVID-19 are taking part in this trial,
which involves an experimental influenza drug known as MK-4482.
MP-31-2019-2945: COVID-19 patients in intensive care are eligible for thisSherbrooke University Hospital trial examining how high doses of vitamin C affectorgan dysfunction.

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NCT04405102: A multiple sclerosis-fighting drug known as ozanimod is being
given to COVID-19 patients who require oxygen in this Quebec-based trial.
OZM-113: The University of Manitoba is behind this trial, which gives therapeutic
doses of blood thinners to participating hospitalized COVID-19 patients.
PHRI.ACT.COVID19: The other Canadian trial to use gout-fighting drug colchicine,
this one is being carried out by Hamilton Health Sciences.
PREP2020: Another trial run by researchers from the University of Manitoba, thisone involves hydroxychloroquine.
PROTOCOL 214094: COVID-19 patients with severe pulmonary symptoms may be
eligible for this trial from pharmaceutical company GlaxoSmithKline, which uses anantibody known as Otilimab.
RAPID COVID COAG: This Toronto-based trial involves the use of blood thinners as
a COVID-19 therapy.
REMAP-CAP: This trial involving intensive care patients tracks the effectiveness ofseveral therapies being studied in other entries on this list, including
lopinavir/ritonavir, blood thinners and frozen plasma.
SAIL-004: Baricitinib, an arthritis drug, is being tested in hospitalized COVID-19
patients in a trial run by Dr. Lisa Barrett of Dalhousie University.
SAR153191: Another drug normally used to treat arthritis, sarilumab is being
tested on some hospitalized COVID-19 patients by pharmaceutical company Sanofi.
U-DEPLOY: This is the second of two Canadian trials involving anti-myelofibrosis
treatment ruxolitinib. Researchers in Toronto are monitoring how many COVID-19
patients’ symptoms worsen after they are given the drug.
VASCEPA-COVID-19-CARDIOLINK-9: Icosapent, a drug primarily used to help
prevent heart issues and strokes, is the focus of this trial.

Safety and Immunogenicity of Two RNA-Based COVID-19 Vaccine Candidates –October 14, 2020
https://www.nejm.org/doi/full/10.1056/NEJMoa2027906- In an ongoing, placebo-controlled, observer-blinded, dose-escalation, phase 1 trial
conducted in the U.S. a study randomly assigned health adults 18-55 years of age
and those 65-85 years of age to receive either placebo or 1 of 2 lipid nanoparticleformulated, nucleoside-modified RNA vaccine candidateso BNT162b1 – which encodes a secreted trimerized SARS-CoV-2 receptorbinding domain
o BNT162b2 – which encodes a membrane-anchored SARS-CoV-2 full-length
spike, stabilized in the prefusion conformation- In all group but 1, participants received 2 doses with a 21-day interval between
doses- In 1 group, participants received just 1 dose
- In each of the 13 groups of 15 participants, 12 participants received vaccine and 3
received placebo

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BNT162b2 was associated with a lower incidence and severity of systematic
reaction than BNT162b1, particularly in older adults
In both younger and older adults, the 2 vaccine candidates elicited similar dosedependent SARS-CoV-2- neutralizing geometric mean titers, which were similar toor higher than he geometric mean tier of a panel of SARS-CoV-2 convalescent serum
samples
The safety and immunogenicity data from this U.S. phase 1 trail of 2 vaccine
candidates in younger and older adults added to earlier interim safety andimmunogenicity data regarding BNT162b1 in younger adults from trails in Germany
The U.S. support the selection of BNT162b2 for advancement to a pivotal phase 2- 3
safety and efficacy evaluation

The Side-Effects of Dexamethasone – October 7, 2020
https://www.forbes.com/sites/brucelee/2020/10/07/dexamethasone-here-are-the-sideeffects-of-the-covid-19-coronavirus-treatment-that-trump-received/- To help treat the effects of COVID-19, President Donald Trump reportedly received
dexamethasoneo This is a corticosteroid- Dexamethasone has shown promise in decreasing the risk of death for patients withmore severe COVID-19 infections- However, it can have side effects such as stomach irritation, nausea, vomiting,headaches, dizziness, and irregular or absent menstrual periods, easy bruising of theskin, acne, hair loss, increase hair growth on different parts of the body, andsuppress your immune systemo It can also have potential impact on one’s mood, behavior, and thinking
o An article published in the Mayo Clinic Proceedings – studies have found thatbetween 1.8% to 57% of patients who have received corticosteroids had
adverse psychiatric reactions- The rationale for dexamethasone as a possible treatment is to reduce inflammationand suppress ones immune system by inhibiting cells and the production ofchemical involved
o This is good because the virus can trigger inflammation and an uncontrolled
immune response from your body
- The strongest evidence for dexamethasone’s use for COVID-19 comes from
RECOVERY – an ongoing clinical trial sponsored by the National Health Service inthe United Kingdom- A preliminary analysis of 6,425 RECOVERY trial participants (where 2,104 received
dexamethasone and 4,321, did not) showed that among those participant’s who
were already on mechanical ventilators when enrolled in the trials, 29.3% of thosereceiving dexamethasone ended up dying within 28 days of being enrolled in the
study compared to 41.4% of those who didn’t get the medication

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The 28-day mortality for those patients who were on supplemental oxygen but notmechanical ventilation on enrollment was 23.3% of those receiving dexamethasone
vs. 26.2% of those who did not
There was no significant difference in 28-day mortality between those who received
dexamethasone and those who didn’t for those who didn’t require oxygen therapy
This has led to the following recommendation in the NIH COVID-19 treatment
guidelines:o Using dexamethasone 6mg per day for up to 10 days or until hospitaldischarge, whichever comes first, for the treatment of COVID-19 in
hospitalized patients who are mechanically ventilated who require
supplemental oxygen but who are not mechanically ventilated
o They also recommend against using dexamethasone for the treatment of
COVID-19 in patients who do not require supplemental oxygen

COVID Study to Assess Pandemic’s Effects on Wellbeing of NHS Staff – October 10,
2020
https://www.bmj.com/content/371/bmj.m3942- A research project looking at the effects of the COVID_19 pandemic on thepsychological health and wellbeing of NHS staff in England has received 530,000
Euros in government funding- This is 1 of 6 research projects that share 2 million euros from UK Research andInnovation and the National Institute for Health Researcho 3 of the projects will look at the effects of the pandemic on children andyounger adultso 2 studies will focus on people with serious mental health problemso This one will focus on NHS Staff- The study started in April in King’s College Hospital NHS Foundation Trusto Now that there is new funding, it will be expanded to 18 other trusts
o Everyone on the payroll at each of the trusts including doctors, nurses,
cleaners, and security guards will be contacted- The study will use a combination of online questionnaires carried out at regularintervals and more detailed interviews with a smaller group of participants- A sister study will focus particularly on the pandemic’s effects on NHS workers fromethnic minority backgrounds- One study which will receive 495,000 euros will evaluate an online cognitive
behavioural therapy programme for children aged 5-12 years who have anxiety
o The study will assess whether an online programme is an effective
alternative to face-to-face provision by child and adolescent mental healthserviceso These services were already struggling to cope with increased demand
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2 other studies will use existing cohorts to assess COVID-19’s effects on people aged
14-17
The other study will work with a cohort of 5000 Londoners aged 15-17 to examine
whether changes in use of digital technology during the pandemic have had an
impact on adolescents’ mental health

The Hidden long-term cognitive effects of COVID-19 – October 8, 2020
https://www.health.harvard.edu/blog/the-hidden-long-term-cognitive-effects-of-covid2020100821133- It has become increasingly recognized that the virus also attached the nervous
system- Doctors in a large Chicago medical center found that more than 40% of patients with
COVID showed neurologic manifestations at the outset, and more than 30% of those
had impaired cognition- Sometimes the neurological manifestations can lead to death- COVID-19 can cause damage to the brain directly by encephalitis, which may havedevastating or subtle consequences- In a British study of 12 patients with encephalitis, 1 made a full recovery, 10 made apartial recovery, and 1 diedo They also found that a number of patients with COVID-19 suffered strokes▪ COVID infection is a risk factor for strokes- A group of Canadian doctors found that individuals over 70 years of age were atparticularly high risk for stroke related to COVD-19 infection but that even young
individuals are 7 times more likely to have a stroke from this coronavirus compared
to a typical flu- Autopsy data from COVID patients in Finland suggests that another major cause ofbrain damage is lack of oxygeno What is worrisome is that several of the patients who were autopsied did notshow any signs of brain injury during the course of their COVID infection –yet all had brain damage- In survivors of ICU stays due to acute respiratory failure or shock from any cause,
1/3 of people show such a profound degree of cognitive impairment that
performance on neuropsychological testing is comparable to those with moderate
traumatic brain injuryo This can have cognitive effects on memory, attention, and executive function
leading to difficulties managing medications, managing finances,comprehending written materials, and even carrying on conversations withfriends and family- A Chinese group of doctors and researchers examined several aspects of cognitive
function in 29 individuals who were thought to have fully recovered from COVID
infection and they found persistent impairment in sustained attentiono Doctors thought it might be linked to underlying inflammatory processes

Eugene Consulting Inc.
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M4V 1N5o It is however, equally likely that patients with COVID suffered silent strokes
or lack of oxygen that damaged their brains
Immediate and Long-term Consequences of COVID-19 Infections for theDevelopment of Neurological Disease – June 2020
https://alzres.biomedcentral.com/articles/10.1186/s13195-020-00640-3- Severely affected COVID-19 cases experience high levels of proinflammatory
cytokines and acute respiratory dysfunction and often require assisted ventilationo All of these things can cause cognitive decline- Patients who show neurological systems due to the COVID-19 infection included
cases with or without pre-existing neurological disorders- While in intensive care units, patients showed agitation, confusion, andcorticospinal tract signs such as enhanced tendon reflexes and clonus- In mild to moderate disease cases, patients reported olfactory and gustatory
dysfunctions- In about 11% of patients, anosmia occurred prior to any other clinical symptoms- COVID-19 can also lead to changes of coagulation and in particular, to inflammationinfused disseminated intravascular coagulation- Clinically striking are cases of Kawaski-like multisystem inflammatory syndromes
now being recognized in children and teenagers- There are at least 4 possible pathogenic mechanisms that may account for the
detrimental effects of COVID-19 on the CNS
o Direct viral encephalitis
o Systematic inflammationo Peripheral organ dysfunction (liver, kidney, lung)o Cerebrovascular changes- In most cases however, neurological manifestations of COVID-19 may arise from a
combination of the above- The fact that systematic inflammation has been shown to promote cognitive decline
and neurodegenerative disease makes it likely that COVID-19 survivors will
experience neurodegeneration in the following years- Evidence strongly suggests that patients surviving COVID-19 are at high risk forsubsequent development of neurological disease and in particular, Alzheimer’s
disease
Economic Consequences of COVID-19- October 19, 2020
https://voxeu.org/article/economic-consequences-covid-19-multi-country-analysis- On the supply side, infections reduce labour supply and productivity while
lockdowns, business closures, and social distancing also cause supply disruptions- On the demand side, layoffs and the loss of income and worsened economic
prospects reduce household consumption and firms’ investment

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M4V 1N5---This counterfactual analysis suggest that the pandemic will likely knock 3
percentage points off real world GDP relative to the level of global economic activity
that would have materialised in the absence of the shock
The U.S. and UK are likely to experience deeper and longer-lasting effects
China’s outcome has more than a 50% chance of being much better
The euro area is showing a negative skew, however there is some probability that it
recovers faster than the US by the end of 2021
Pulled by China, the rest of “Emerging Asia” has a higher chance of performing
better than the global average
Non-Asian emerging markets stand out for their vulnerabilityo They will likely suffer from a significant output collapse in the first andsecond quarter of 2020
o They have a less than 20-30% chance of not experiencing an output loss by
the end of 2021
Turkey, South Africa, and Saudi Arabia will almost certainly see at least 8 quarters ofseverely depressed economic activity
The study also estimates that the pandemic will likely lower long-term interest rates
in the advanced economies by about 100 basis points below their pre-COVID-19
lowso This is because the crisis raises precautionary savings and dampens
investment demand
However, in emerging market economies, borrowing rates could increase rapidly
The analysis points to large and persistent negative effects of the pandemic on theworld economy

WHO Study finds Remdesivir has little Effect on Hospital Stay or Mortality in COVID19 Patients 0 October 16, 2020
https://www.cbc.ca/news/health/remdesivir-covid-19-who-solidarity-trial-1.5764858- A clinical trial by the World Health Organization (WHO) has found that Gilead
Sciences Inc.’s remdesivir has little or no effect on COVID-19 patients’ length of
hospital stay or chances of survival- The study evaluated the effects of remdesivir, hydroxychloroquine, anti-HOV drug
combination lopinavir/ritonavir and interferon, in 11,266 adult patients acrossmore than 30 countries- They found that the 4 regimens appeared to have little or no effect on 28-day
mortality or the length of the in-hospital course among patients hospitalized with
COVID-19- Gilead, the company that developed the drug, is concerned that the data from thisopen-label global trial has not undergone the rigorous review as their data
contradicts data from a U.S. study or remdesivir that they conductedo Gilead’s study showed that the treatment cut COVID-19 recovery time by 5days compared with patients who got a placebo

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M4V 1N5--o The trial involved 1,062 patients
Dr. Grace Parraga at Western University is studying the long-term effects of the
COVID-19 virus on the lungso They are using ground-breaking lung imaging technology, which uses apolarized and magnetized gas that patients inhale▪ The harmless gas travels throughout the lungs once inhaled, whichallows researchers to track lunch function in real time to see if there
are any issues
They are finding that 6 months after, people are still not well, even if they only had
mild infections
The research shows that even young, healthy people with only mild cases of COVID19 can have permanent lunch damage after recovering from the infection

Effects of COVID-19 Outbreaks in Care Homes in the UK – October 1, 2020
https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(20)30012-X/fulltext- Detailed information on outbreaks on care home residents internationally, is scarce- This study looked at care home in one large health region in Scotland- The study conducted a population analysis of testing, cases, and deaths in carehomes in the National Health Service Lothian health region of the UK- They obtained data for COVID-19 Testing and deaths and analysed data by several
variables including type of care home, number of beds, and locality- Outcome measures included timing of outbreaks, number of confirmed cases in carehome residents, care home characteristics associated with the presence of an
outbreak, and deaths of residents in both care homes and hospitals- Conclusions:o The size of care homes for older people was strongly associated with a
COVID_19 outbreako Shielding care home residents from potential sources of SARS-COV-2
infection and ensuring rapid action to minimise outbreak size if infection is
introduced is important for any second wave