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WASHINGTON — A pattern is emerging among COVID-19 patients arriving at hospitals in New York: Beyond fever, cough and shortness of breath, some are deeply disoriented to the point of not knowing where they are or what year it is.

At times this is linked to low oxygen levels in their blood, but in certain patients the confusion appears disproportionate to how their lungs are faring.

Jennifer Frontera, a neurologist at NYU Langone Brooklyn hospital seeing these patients, told AFP the findings were raising concerns about the impact of the coronavirus on the brain and nervous system.

By now, most people are familiar with the respiratory hallmarks of the COVID-19 disease that has infected more than 2.2 million people around the world.

But more unusual signs are surfacing in new reports from the frontlines.

A study published in the Journal of the American Medical Association last week found 36.4 per cent of 214 Chinese patients had neurological symptoms ranging from loss of smell and nerve pain, to seizures and strokes.

A paper in the New England Journal of Medicine this week examining 58 patients in Strasbourg, France found that more than half were confused or agitated, with brain imaging suggesting inflammation.

"You've been hearing that this is a breathing problem, but it also affects what we most care about, the brain," S Andrew Josephson, chair of the neurology department at the University of California, San Francisco told AFP.

"If you become confused, if you're having problems thinking, those are reasons to seek medical attention," he added.

"The old mantra of 'Don't come in unless you're short of breath' probably doesn't apply anymore."

Viruses and the brain

It isn't completely surprising to scientists that SARS-CoV-2 might impact the brain and nervous system, since this has been documented in other viruses, including HIV, which can cause cognitive decline if untreated.

Viruses affect the brain in one of two main ways, explained Michel Toledano, a neurologist at Mayo Clinic in Minnesota.

One is by triggering an abnormal immune response known as a cytokine storm that causes inflammation of the brain — called autoimmune encephalitis.

The second is direct infection of the brain, called viral encephalitis.

How might this happen?

The brain is protected by something called the blood-brain-barrier, which blocks foreign substances but could be breached if compromised.

However, since loss of smell is a common symptom of the coronavirus, some have hypothesised the nose might be the pathway to the brain.

This remains unproven — and the theory is somewhat undermined by the fact that many patients experiencing anosmia don't go on to have severe neurological symptoms.

In the case of the novel coronavirus, doctors believe based on the current evidence the neurological impacts are more likely the result of overactive immune response rather than brain invasion.

To prove the latter even happens, the virus must be detected in cerebrospinal fluid.

This has been documented once, in a 24-year-old Japanese man whose case was published in the International Journal of Infectious Disease.

The man developed confusion and seizures, and imaging showed his brain was inflamed. But since this is the only known case so far, and the virus test hasn't yet been validated for spinal fluid, scientists remain cautious.

More research needed

All of this emphasises the need for more research.

Frontera, who is also a professor at NYU School of Medicine, is part of an international collaborative research project to standardise data collection.

Her team is documenting striking cases including seizures in COVID-19 patients with no prior history of the episodes, and "unique" new patterns of tiny brain haemorrhages.

One startling finding concerns the case of a man in his fifties whose white matter — the parts of the brain that connect brain cells to each other — was so severely damaged it "would basically render him in a state of profound brain damage," she said.

The doctors are stumped and want to tap his spinal fluid for a sample.

Brain imaging and spinal taps are difficult to perform on patients on ventilators, and since most die, the full extent of neurologic injury isn't yet known.

But neurologists are being called out for the minority of patients who survive being on a ventilator.

"We're seeing a lot of consults of patients presenting in confusional states," Rohan Arora, a neurologist at the Long Island Jewish Forest Hills hospital told AFP, saying that describes more than 40 per cent of recovered virus patients.

It's not yet known whether the impairment is long term, and being in the ICU itself can be a disorienting experience as a result of factors including strong medications.

But returning to normal appears to be taking longer than for people who suffer heart failure or stroke, added Arora.

By Issam Ahmed

NEW YORK — A virtual concert packed with A-listers — from The Rolling Stones to Taylor Swift to Billie Eilish — entertained fans around the world with a show celebrating health workers, as billions shelter at home due to coronavirus.

Lizzo, Jennifer Lopez, Stevie Wonder, Paul McCartney and LL Cool J also joined in the Lady Gaga-curated online party, which was backed by the international advocacy organisation Global Citizen in partnership with the World Health Organisation.

Before opening the show Lady Gaga — who began working with Global Citizen and the WHO weeks ago to fundraise for the battle against COVID-19 — said she was praying for medical workers and also "thinking of all of you that are at home, who are wondering when this is all going to be different."

"What I'd like to do tonight, if I can, is just give you the permission to, for a moment — smile," she said as she broke into a rendition of Nat King Cole's "Smile."

Stevie Wonder then wowed with a tribute to the late soul legend Bill Withers.

Sitting at his home piano Wonder, who turns 70 next month, played "Lean On Me" before launching into his own "Love's In Need Of Love Today" in his singular crystal-clear voice.

Mick Jagger also appeared ageless despite his 76 years as he delivered the classic "You Can't Always Get What You Want," as his fellow Stones played from their respective homes, including a grinning Charlie Watts on the air drums.

Also at her piano Swift played the vulnerable "Soon You'll Get Better," which the pop phenom wrote about her mother's struggles with cancer.

Global Citizen intended the primetime event broadcast on major television networks worldwide — and hosted by American late-night television personalities Jimmy Fallon, Jimmy Kimmel and Stephen Colbert — not as a fundraiser but as a moment of unity through song.

They also planned it as a "rallying cry" to support health workers, while coronavirus has at least 4.5 billion people forced or urged to stay home.

Prior to the event Global Citizen began urging philanthropists, companies and governments to support the WHO in its coronavirus response efforts, saying it has raised $35 million for local organisations and the international health body's COVID-19 Solidarity Response Fund.

'True heroes' 

In addition to performances — McCartney played "Lady Madonna," as Lizzo belted out a powerful version of "A Change Is Gonna Come" — the event highlighted the efforts of essential workers worldwide, including medical personnel and those delivering food and sanitary products to vulnerable populations.

None other than Queen Bey herself joined in to thank "true heroes" who are "away from their families, taking care of ours."

Beyonce, a Houston native, also emphasised that the coronavirus pandemic in the United States is disproportionately affecting black Americans, who make up a large part of "essential parts of the workforce that do not have the luxury of working from home," she said.

Indian actor Shah Rukh Khan and Nigerian singer Burna Boy were among the participants in the event that included former US first ladies Michelle Obama and Laura Bush as well as media personality and philanthropist Oprah.

British actor Idris Elba — who was diagnosed with and recovered from coronavirus — also took part.

"Tonight, through the universal language of music, we salute the bravery and sacrifice of health heroes and others," said UN Secretary General Antonio Guterres in a clip played during the broadcast.

"And please join our call for a global ceasefire to focus on our common enemy — the virus."

The show closed with a moving harmony of Celine Dion, Lady Gaga, Andrea Bocelli and John Legend performing Dion and Bocelli's 1999 hit duet "The Prayer," as renowned concert pianist Lang Lang accompanied.

'Serve humanity'

Saturday's online festivities kicked off with a six-hour pre-show streamed online, with stars across the globe including Christine and the Queens, Jennifer Hudson, Matthew McConaughey, Luis Fonsi and Kesha making appearances.

Football phenom David Beckham held a video chat with young athletes, encouraging them to keep honing their skills at home with sporting events cancelled indefinitely.

Adam Lambert performed a rendition of Tears for Fears' hit "Mad World," while The Killers delivered a stripped-back version of "Mr Brightside" and Hong Kong icon Eason Chan played John Lennon's "Love."

And New Yorker Sarah Jessica Parker of "Sex and the City" fame gave a shout out from her couch to medical workers toiling at the city's particularly hard-hit hospital Elmhurst.

Hospital workers also gave testimony on their vital work battling the virus.

Dressed in scrubs, Aisha al Muntheri spoke from Paris to say she was proud to serve "on the front lines with my colleagues."

"It's part of our value in medicine to serve humanity," she said.

"The humanity is our common language."

By Maggy Donaldson

Home Fire

Kamila Shamsie

London: Bloomsbury Publishing

Pp. 264

In her powerful, indeed explosive, seventh novel, Kamila Shamsie imbues the ancient story of Antigone with new, contemporary meaning. The plot of “Home Fire” spreads over three continents and has international implications, but it is first and foremost about the situation of British Muslims. Just as Antigone challenged King Creon to allow her brother a proper burial after he had led a rebellion against the tyrant, 21^st-century teenager, Aneeka, fights for justice for her twin, who had travelled to Syria to join Daesh. While refuting terrorism, this novel also questions the refusal of the UK, inter alia, to repatriate their citizens from the war zone.

Beyond such considerations, “Home Fire” is essentially about love, family, the lengths to which people will go for their loved ones, and the strategies they employ for surviving in a hostile world. The novel’s epigraph highlights the dilemma as stated in Sophocles’s tragedy: “The ones we love… are enemies of the state”.

Shamsie divides her book into five parts, with each of the main characters relating their perspective, thus telling several sides of the story and opening up for multiple interpretations. Three of the main characters, Isma, Aneeka and Parvais Pasha, are orphans, abandoned by their father who went to fight in Bosnia, Chechnya, Kashmir, Kosovo and finally Afghanistan, his name erased from the family memory. When the twins, Aneeka and Parvais, are still young, their grandmother and mother die in quick succession, leaving big sister Isma to raise them. Isma is the responsible one, delaying her academic career and working at a dry cleaner, in order to provide for her small family. She is acutely aware of how easily the Pakistani background of her parents, especially her now-deceased father’s “jihadi” history, can be turned against them, rendering them outsiders, foreigners, despite having been born in London and never visited Pakistan. Her response is to toe the line, making the compromises and calculations needed to avoid being harassed by the secret service and having one’s loyalty questioned.

Aneeka is more daring, more volatile, railing against large and small acts of othering, from lengthy interrogations at the airport to false expectations attached to her wearing the hijab. Her choice to study law is emblematic of her determination to face racism and injustice head on. To Isma, “Her sister, not quite nineteen, with her law-student brain… knew everything about her rights and nothing about the fragility of her place in the world”. (p. 6)

Parvais, meanwhile, seems somewhat oblivious, caring mostly about his sound system, until a Daesh recruiter appeals to his need to reclaim his father’s history and replace the alienation of his life in Britain with a sense of belonging. As the novel opens, his sense of being alone and betrayed is magnified by Isma’s departure to the US, to resume her graduate studies, and Aneeka’s increasingly independent life. Arriving in Raqqa, at the height of Daesh’s self-proclaimed Caliphate, he soon discovers his mistake after a few months in the media unit, but it is not easy to retrace his steps. “He didn’t know how to break out of these currents of history, how to shake free of the demons he had attached to his own heels”. (p. 171)

The counterpoint to the Pashas is the Lone family headed by Karamat, son of Pakistani immigrants, who has combined opportunism, belief in British democracy and a propitious marriage, to rise on the political scene. Having renounced his Muslim background and recently become Home Secretary, he immediately revokes the passports of anyone judged to be acting against state interests, making citizenship a privilege not a right. Though he can prevent Parvais’s repatriation, he is powerless to stop his charming, intelligent, somewhat spoiled son, Eemonn (an Anglicisation of Ayman), once the latter falls in love with Aneeka. Raised to feel entirely British, Eemonn has no reason to fear Googling While Muslim as do the Pasha siblings, but his love for Aneeka shows him another side of reality. From having previously put his father on a pedestal, Eemonn becomes “a son who was moving in the opposite direction of home, burning bridges in his wake, a trail of fire in the sky”. (p. 239)

These seminal changes cleave both families apart.

Shamsie amazes with her ability to portray the impact of the big currents of history on individual lives, employing rich visceral and sensory impressions and local details that lend authenticity to her narrative. For Isma, it is the sense of touch that denotes her love for the twins, harking back to her physical care of them as young. Similarly, for the twins, their sense of being one is reaffirmed by touching each other’s pulse. For Parvais, sound is all pervasive, from the trilling of birds to the screams of the tortured in Bagram prison, where his father was held by US forces, and the jarring echoes of violence in the Caliphate. Interspersing starkly revealing prose with beautiful lyricism and sometimes humorous wordplay, Shamsie’s nuanced descriptions of the meaning of love, betrayal, memory, loss and grief tugs at one’s heart.

Though most of the novel is heightened realism, its ending slips over into the surrealistic, leaving one with haunting images, conflicted emotions, and a sense that justice does not always prevail.

SAN FRANCISCO — Facebook is reaching out to give the world a hug — in the form of an emoji people can share while staying safely apart.

The line-up of characters available to express feelings in the social network will be expanded next week to include a well-known round yellow cartoon face with arms that gently embrace a red heart.

The move to express "care" adds to the existing emojis including the well-known "like" button and more recent icons to express love, laughter, sadness, anger and awe.

"We're launching new care reactions on Facebook app and Messenger as a way for people to share their support with one another during this unprecedented time," spokesman Alexandru Voica said in a series of tweets Friday.

"We hope these reactions give people additional ways to show their support during the #COVID19 crisis."

It has been about five years since Facebook expanded its emoji options for expressing feelings by tapping on a character and sharing it with a friend.

The new symbol "will start rolling out next week globally and you can use it to react to posts, comments, images, videos, or other content on the app and Facebook.com," Voica said.

Facebook's mobile Messenger service is getting a new emoji as well, this one a multi-hued bluish red heart drawn as though it is beating.

The use of Facebook and its services including messaging and video chat — used by more than two billion people — has surged as users around the world turn to the social networks to remain connected during the virus lockdowns.

LOS ANGELES — With Hollywood A-listers self-quarantined in their sprawling mansions due to the novel coronavirus, Los Angeles' notorious paparazzi have almost nobody to shoot — despite soaring demand for celebrity pictures.

The trendy nightclubs, restaurants and movie sets which are typically surrounded by photographers at all hours have been closed since California went into pandemic lockdown a month ago.

This has meant images of gossip magazine staples such as Ben Affleck walking his dogs, or Cameron Diaz popping out for groceries, are a hot commodity, with dozens of paparazzi vying for the same photos.

"Every photo is with sunglasses and a mask on at this point... those are the only pictures you're going to get," said Randy Bauer, founder of celebrity photo agency Bauer-Griffin.

"It's really not a pretty situation," he added.

Bauer estimates that his agency's photo output dropped almost overnight by 95 per cent after stay-at-home orders were issued and most businesses shuttered.

His agency, which employs around 20 photographers mainly on a freelance basis, went from issuing up to 7,000 celebrity photographs a month to around 500.

"That's if we're lucky," he told AFP. "The whole thing has been turned upside down."

'Bittersweet'

Paparazzi are just one of countless strands of the Hollywood entertainment industry decimated by the lockdown.

With movie premieres cancelled, traditional red-carpet photographers are also out of work.

Ironically, the absence of these glitzy images — used by newspaper, magazines and television networks around the world — has heightened demand for the street snaps delivered by paparazzi.

Even images of D-listers who previously wouldn't have drawn global interest are being greedily snapped up by showbiz publishers.

"It's very bittersweet, because we've got the demand, but no supply!" said Bauer. "But you can't have it all."

And there is another silver lining for those still in the paparazzi game.

The long-lens nature of street shots — often taken from cars — at least allows for social distancing, in contrast to the massed photographers previously breathing down each other's necks at premieres or outside clubs.

'Waiting, waiting'

Of course, the industry's controversial reputation means sympathy for paparazzi is likely to be limited.

"Some outside my house right now. Waiting, waiting for a walk that will never happen," wrote model Chrissy Teigen this week in a tweet that drew 350,000 "likes."

Photographer Mark Karloff, speaking on a recent episode of his "Paparazzi Podcast," admitted that "obviously the general public's gonna give us a big boohoo about, you know, paparazzi struggling."

"But we are family guys — we have kids, we have family — and we're human as well," he said.

Bauer, who had photographers permanently stationed outside top celebrity hangouts like Craig's Restaurant in West Hollywood, now advises freelancers on applying for unemployment.

For the first time, gig workers are eligible for benefits due to the coronavirus, providing paparazzi with some relief.

'Wild West'

Still, with celebrity sightings in such short supply, the prospect of a big payday continues to draw many out to the same handful of Hollywood stars' homes.

"It was like the Wild West man," said Karloff's podcast co-host, who goes by the alias "Jedi."

"I'd drive past Kate Hudson's house and see four or five different guys there. I'd drive past Reese [Witherspoon] and see a bunch there as well. There were just guys everywhere."

And there is always Affleck — who, according to Bauer, is now spotted out walking with new girlfriend Ana de Armas "more than he was before corona."

"A lot of times I was wondering why we were seeing so many celebrities out walking their dogs... what's happening?" he said.

"And then I just realised... the dog walkers aren't going to come to the house to do it. So they have to walk their own dogs." 

By Andrew Marszal

PARIS — Regular aspirin use reduces the risk of digestive tract cancer 20 to 40 per cent, according to findings published Thursday that bolster growing evidence the common analgesic can help prevent the disease.

A review of 113 recent studies covering more than 210,000 patients showed that bowel cancer risk dropped 27 per cent, oesophageal cancer by 33 per cent, stomach cancer by 36 per cent, and gastric cardia — where the stomach connects to the windpipe — cancer by 39 per cent.

For pancreatic cancer, which is almost always fatal, there was a nearly 25 per cent reduced risk after five years among people who used aspirin compared to those who did not, researchers reported in Annals of Oncology.

"These findings suggest there's a beneficial effect of aspirin in the prevention of bowel and other cancers of the digestive tract," said senior author Carlos La Vecchia, a professor of epidemiology at the School of Medicine in Milan.

About 175,000 people die from bowel cancer in the European Union every year, about 100,000 of them between the age of 50 and 74.

"If we assume regular use of aspirin increases from 25 to 50 per cent in this age group, this would mean 5,000 to 7,000 deaths from bowel cancer, and between 12,000 and 18,000 new cases, could be avoided," La Vecchia said in a statement.

Aspirin, which can cause stomach bleeding, is less often recommended or prescribed in patients older than 75.

A significant body of research over the last decade has established a strong statistical link between long-term aspirin use and a reduced incidence of different kinds of cancer, but the new study is the largest to date focused on the digestive tract, the authors said.

Most of the studies examined by La Vecchia and colleagues were designed to test or examine aspirin's capacity to reduce heart disease.

The longer people take aspirin and the higher the dose, the lower the risk of getting cancer, the new research found.

Overall, a daily "micro-dose" of 75 to 100 mg was linked to a 10 per cent drop in cancer incidence, while a daily 325 mg dose cut the risk 35 per cent.

For bowel cancer, the risk went down by four per cent after one year of daily use, by 11 per cent after three years, 19 per cent after five years, and 29 per cent after a decade.

"Taking aspirin for the prevention of bowel cancer, or any other cancers, should be done in consultation with a doctor," La Vecchia said.

"People who are at high risk of the disease are most likely to gain the greatest benefits."

The findings applied equally to men and women, and across all regions from which data was drawn.

By Marlowe Hood

Social distancing is one of the good habits we have come to adopt because of the Covid-19 threat. Along with frequent handwashing and wearing a mask in public, it is a direct, obvious precaution that is to help contain the pandemic.

What about also being careful with the countless software applications that have emerged since the beginning of the confinement? Not to mention the updates and the functionality that have been added to already existing software.

Last March 23, the New York Times wrote: “Big Tech could emerge from coronavirus crisis stronger than ever. Amazon is hiring aggressively to meet customer demand. Traffic has soared on Facebook and YouTube. And cloud computing has become essential to home workers.”

New software has always been a concern; for many reasons. First are the bugs. Rarely has a first version of an application come without bugs – these unintentional but nevertheless annoying, frustrating programming errors. Developers often label their first ready-to-release version as “beta”, as a kind warning to users, telling them that there may be errors in the software, pending more global testing.

In these times of understandable psychological stress, even updates to existing programmes can be scary. Just a few days ago a number of users has their Microsoft Office Suite (Word, Excel, etc.) blocked because of an update in their Windows system. They were asked to re-activate Office (i.e. to re-enter the purchase key) so as to make Office work again.

Normally once you have entered the key after purchasing the product you never need to re-enter it again. Those who had lost the key, simply because they had been using the otherwise legally purchased product for many years, had to contact Microsoft support to solve the unexpected, rather unusual problem.

We have all heard about the upcoming “social contact tracing apps for smartphones”. They are supposed to help track those who are certainly or even potentially virus bearers, through their portable handset. Last week, in a news thread relayed by the French newspaper Le Figaro, one could read that Apple and Google had announced a joint effort to develop such apps, with the aim of making them more performing, easier on battery consumption and better at exchanging information between iPhones and Android models.

This mere announcement has immediately raised concerns, more particularly in Europe, about the risk of the “Big Brother” syndrome, of possible technical failures (breach of security, hacking,…) and of communication errors.

Videoconferencing app Zoom usually requests you to enter two numbers to join an online meeting: the meeting number and a password. There is an option in the application that lets you, if you prefer, disable the password requirement. However, with the few cases of hacking of meetings that have taken place end March, Zoom has strongly recommended users to maintain the password option and not to disable it. All this, of course, is caused by the dramatic increase in using Zoom, as well as other videoconferencing software, during this stressful time of confinement.

So how to you trust apps, especially the very new, those that propose to help you cope with the confinement, to entertain you while at home or to make your grocery or drugstore orders easier? Do you simply go to Google Play or App Store and read the users’ reviews? There is no simple answer to this question.

In normal times, you would wait till the new application is well tested, till you have heard only good reports about it and till you know for sure that tens of thousands of people are happy with it and have found it safe. This usually takes months! By then the whole confinement situation may be over – which of course would be good news anyway… Who then would need “confinement assistance apps”?

My attitude towards new apps has changed very little in these trying times. I am still extra careful, whether Covid-19 or not. And though I happen to be a tech-head, if only by trade, when not for the love of technology, I don’t easily trust new apps. I’d take my time.

WASHINGTON — A one-time lockdown won't halt the novel coronavirus and repeated periods of social distancing may be required into 2022 to prevent hospitals from being overwhelmed, Harvard scientists who modelled the pandemic's trajectory said Tuesday.

Their study comes as the US enters the peak of its COVID-19 caseload and states eye an eventual easing of tough lockdown measures.

The Harvard team's computer simulation, which was published in a paper in the journal Science, assumed that COVID-19 will become seasonal, like closely related coronaviruses that cause the common cold, with higher transmission rates in colder months.

But much remains unknown, including the level of immunity acquired by previous infection and how long it lasts, the authors said.

"We found that one-time social distancing measures are likely to be insufficient to maintain the incidence of SARS-CoV-2 within the limits of critical care capacity in the United States," lead author Stephen Kissler said in a call with reporters.

"What seems to be necessary in the absence of other sorts of treatments are intermittent social distancing periods," he added.

Widespread viral testing would be required in order to determine when the thresholds to re-trigger distancing are crossed, said the authors.

The duration and intensity of lockdowns can be relaxed as treatments and vaccines become available. But in their absence, on and then off distancing would give hospitals time to increase critical care capacity to cater for the surge in cases that would occur when the measures are eased.

"By permitting periods of transmission that reach higher prevalence than otherwise would be possible, they allow an accelerated acquisition of herd immunity," said co-author Marc Lipsitch.

Conversely, too much social distancing without respite can be a bad thing. Under one modelled scenario "the social distancing was so effective that virtually no population immunity is built," the paper said, hence the need for an intermittent approach.

The authors acknowledged a major drawback in their model is how little we currently know about how strong a previously infected person's immunity is and how long it lasts.

Virus likely here to stay

At present the best guesses based on closely-related coronaviruses are that it will confer some immunity, for up to about a year. There might also be some cross-protective immunity against COVID-19 if a person is infected by a common cold-causing betacoronavirus.

One thing however is almost certain: the virus is here to stay. The team said it was highly unlikely that immunity will be strong enough and last long enough that COVID-19 will die out after an initial wave, as was the case with the SARS outbreak of 2002-2003.

Antibody tests that have just entered the market and look for whether a person has been previously infected will be crucial in answering these vital questions about immunity, they argued, and a vaccine remains the ultimate weapon.

Outside experts praised the paper even as they emphasised how much remained unknown.

"This is an excellent study that uses mathematical models to explore the dynamics of COVID-19 over a period of several years, in contrast to previously published studies that have focused on the coming weeks or months," Mark Woolhouse, an infectious disease epidemiologist at the University of Edinburgh said.

"It is important to recognise that it is a model; it is consistent with current data but is nonetheless based on a series of assumptions — for example about acquired immunity — that are yet to be confirmed." 

By Issam Ahmed

CHICAGO — To determine when Americans can safely venture out of their home bunkers, scientists must first understand who has already contracted the new coronavirus that causes COVID-19.

Nasal swab tests can detect the active virus, but the lack of widespread testing in the United States to date has left scientists with only a fraction of the information they need to understand the scope of the pandemic. Getting the full picture, they say, will require a reliable test that can detect antibodies to the virus in people’s blood.

The blood tests — which doctors call serology tests — may ultimately answer the questions needed to contain the pandemic and set the nation on a path toward normalcy: How many people have recovered from the disease without ever being tested? How common is it to have the disease without suffering symptoms? Can a person with antibodies safely return to work without fear of infecting others — or being reinfected?

With these urgent questions looming, the Food and Drug Administration has allowed scores of serology tests onto the market without the usual approval process, provided they met certain criteria. But doctors and public health officials say the result is a dizzying array of test options and uncertainty about their accuracy.

The FDA has given emergency approval to one company’s serology test, strictly for laboratory use in helping to diagnose COVID-19 cases. “The results obtained with this test should only be interpreted in conjunction with clinical findings, and the results from other laboratory tests and evaluations,” the FDA stated in its notice on the Cellex test.

Dr Stephen Hahn, commissioner of the FDA, spoke over the weekend about the importance of serology tests, which he called “one of the keys” to managing the pandemic, while also expressing concerns about the accuracy of tests not yet approved by his agency.

“I am concerned that some of the antibody tests that are in the market that haven’t gone through the FDA scientific review may not be as accurate as we’d like them to be,” Hahn said on ABC’s “This Week” news show. “No test is 100 per cent perfect. But what we don’t want are wildly inaccurate tests. Because, as I said before, that’s going to be much worse.”

In Chicago, Public Health Commissioner Allison Arwady said last weekend that a serology test her department was using had a higher rate of false negatives and positives than the nasal swab tests it also uses. The health department did not respond to questions about which blood test that was.

But, as she has before, Arwady stressed the essential nature of serology tests to taming the pandemic, saying they are “such an important thing.” She added that she was anxious to see which tests the FDA would eventually clear for use.

Dr Anthony Fauci, the federal government’s point person on the pandemic, told The Associated Press that most of the serology tests on the market have not been proved to work well. The infectious disease chief at the National Institutes of Health, Fauci said his staff is working with the FDA to validate the tests.

Some local institutions are already using the tests for diagnostic purposes. At a drive-up testing facility set up at Roseland Community Hospital on Chicago’s South Side, hundreds of people a day are getting the nasal swab, a blood test or both, said Dr Terrill Applewhite, chairman of the hospital’s COVID-19 task force.

Applewhite said he’s confident in the accuracy of the test the hospital is using.

With the goal of understanding the true scope of the pandemic, the National Institutes of Health has developed an in-house test that scientists plan to use as part of a new study announced last week. The study’s main objective is to determine how widespread the disease is and which communities have been hit hardest.

Part of the inquiry will involve trying to ascertain what percentage of the population that contracted the virus never got sick, a phenomenon that was discovered through previous testing.

People infected but free of symptoms were found on cruise ships, living in Italy and playing for the NBA. But just how many of those fortunate people exist is not known, and scientists are trying to pinpoint the real number. It’s a key question, given that asymptomatic patients may be silent spreaders of the virus.

The study involves collecting up to 10,000 blood samples from adult volunteers who don’t have COVID-19 symptoms and were not previously diagnosed with the disease. The blood will be collected either at designated labs or through mail-in kits.

Similar smaller studies exist but are not sufficient to give scientists a complete picture of the pandemic here in the United States, said Kaitlyn Sadtler, chief of immuno-engineering at NIH’s National Institute of Biomedical Imaging and Bioengineering.

The data from the NIH study will be combined over time with that from other research projects, Sadtler said. “This will be a giant team effort, with all scientists across the country,” she said.

Gigi Gronvall, a senior scholar at Johns Hopkins Centre for Health Security, said her institution is advocating for widespread use of antibody tests as part of a broader strategy to fully understand, manage and eventually end the pandemic.

“There’s a lot we need to know about this disease, so finding the prevalence in the population will be a big deal to [help people] know where you are more or less at risk, more or less likely to bump into someone who is infected,” she said. The testing, she added, also will be “part of a larger strategy for how people will go back to work and so forth.”

Gronvall said serology testing also could eventually answer trickier questions, such as what level of antibodies a person needs to be protected and how long those antibodies last.

“This is a new virus,” Gronvall noted. “We don’t know exactly what level of immunity you would need to protect against this infection. … Probably people who have had it are going to be immune for some time, but we don’t know what the expiration date is on immunity. And it’ll probably be different for different people, but we don’t know the range.”

In addition, Gronvall said, identifying antibodies that ably neutralise the virus could help lead to treatments or, ideally, a vaccine.

But, for now, the testing is being done mostly in an effort to understand the scope of the pandemic and help determine when it’s safe for people to venture out — at least until there’s a more sweeping solution.

 “The best solution here is going to be a vaccine… and so whatever we can do to test as many people until that time comes is a bridge,” Gronvall said.

Doctors on the ground say they are eager for the day when the FDA certifies the accuracy of tests that can be widely used. Part of the attraction is that serology tests are less expensive and simpler to process than the nasal swab tests.

“It’s a fairly cheap test, which is good, and it will tell you if you have you antibodies to the coronavirus, and that’s a very helpful piece of information,” said Dr Rahul Khare, founder and CEO of Innovative Express Care, an immediate care facility on the North Side. “I think there’s going to be, in late May or June, two types of people: those who have been exposed and are immune and those who have not who may get it.

“What we really want to know is of the people who have chronic conditions, who are elderly — have they gotten it and do they have to be extremely careful until there’s a way they can get antibodies to this somehow — be it by vaccine, be it by plasma transfusion — we don’t know yet,” he added. “But there will hopefully be a mechanism to develop those antibodies so the reaction of the body won’t be so great, causing all these illnesses that we’re seeing.”

By Hal Dardick

SAN FRANCISCO — Google and Apple unveiled a joint initiative Friday to develop a coronavirus smartphone "contact tracing" tool that could potentially alert people when they have crossed paths with an infected person.

The move brings together the largest mobile operating systems in an effort to use smartphone location technology to track and potentially contain the global COVID-19 outbreak.

The move would allow apps to be created enabling smartphones powered by Apple software and Google-backed Android operating system to exchange information with a joint "opt in system" using Bluetooth wireless technology.

The companies next month plan to release software interface technology to allow for interoperability — so that an alert would work regardless of the operating system.

"All of us at Apple and Google believe there has never been a more important moment to work together to solve one of the world's most pressing problems," the companies said in a joint statement.

The move comes with governments around the world studying or implementing measures to use smartphone location technology to identify people with the virus and keep them from infecting others, even as the efforts raise privacy and civil liberties concerns.

US President Donald Trump said during a briefing that the government would take "a very strong look" at the contact-tracing collaboration.

Privacy price?

Apple and Google contended that "privacy, transparency, and consent" were top priorities in the joint initiative, addressing concerns about systems which could disclose personal data on individuals.

"Contact tracing can help slow the spread of COVID-19 and can be done without compromising user privacy," Apple chief executive Tim Cook said in a tweet.

Tracking people's movements using their smartphones, while a temptingly powerful tool for containing the coronavirus comes with privacy concerns and fears regarding how the data might be misused.

"No contact tracing app can be fully effective until there is widespread, free, and quick testing and equitable access to healthcare. These systems also can't be effective if people don't trust them," said Jennifer Granick of the American Civil Liberties Union in a statement.

"People will only trust these systems if they protect privacy, remain voluntary, and store data on an individual's device, not a centralized repository,"

Apple and Android combined essentially power the world's smartphones, so working together would be required to effectively trace coronavirus contacts based on mobility data, according to analysts.

Apple has long made user privacy a selling point for iPhones, and is bringing those credentials to the coronavirus collaboration, noted Creative Strategies analyst Carolina Milanesi.

"Apple is providing their privacy seal, of sorts, to what is being done," Milanesi said. "That is good."

However, neither Apple nor Google can guarantee what ultimately becomes of mobility data gathered for the coronavirus fighting effort, warned analyst Patrick Moorhead of Moor Insights and Strategy.

"You put these two companies' ecosystems together and you have literally 100 per cent of mobile data," Moorhead said.

Technology-enabled or digital contact tracing has played a "conspicuously visible" part of the pandemic responses of South Korea, Singapore, Israel, and other nations, law professor and privacy researcher Ryan Calo said in Senate testimony this week.

"I understand the intuition behind digital contact tracing," Calo said in prepared remarks.

"But I see the gains in the fight against the virus as unproven and the potential for unintended consequences, misuse, and encroachment on privacy and civil liberties to be significant."

By Glenn Chapman