Hot on the virus trail

Scientists are using advanced genome sequencing technology to unravel the crisscrossing paths the new coronavirus took around the globe. They hope to better understand the spread of the virus and how to contain it.

A virus can replicate itself billions of times within an infected person’s body. Tiny genetic mutations arise in some of those replications and can eventually result in new families of the virus. Scientists can track the spread of the coronavirus by analyzing mutation patterns.

“What we’re essentially doing is reading these small fragments of viral material and trying to jigsaw puzzle the genome together,” Pavitra Roychoudhury, a researcher for two Seattle institutions analyzing the virus’s mutations, told The New York Times.

Researchers from Germany and Cambridge, England, have reconstructed the early paths of the disease caused by the new coronavirus in humans using COVID-19 samples collected around the world between Dec. 24 and March 4. They discovered three distinct variations, which they labeled A, B, and C in the study, published April 8 in the journal Proceedings of the National Academy of Sciences.

Their analysis showed that type A, the first to show up in Wuhan, China, where the outbreak originated, was surprisingly not the predominant strain in the city. Two mutations of A led to type B, the major Wuhan variant. It appeared prevalent in cases throughout East Asia but didn’t travel much outside that area. Type A, on the other hand, tended to infect Americans living in Wuhan and people in the United States and Australia. That could mean other nationalities had more resistance to type B than East Asians, said Peter Forster, the lead researcher.

COVID-19 cases on the West Coast of the United States seemed to originate in China, while East Coast cases came mostly from Italy and other parts of Europe, former U.S. Food and Drug Administration Commissioner Scott Gottlieb said in an interview on CBS News’ Face the Nation on Sunday. Forster said his team’s data suggests the first infection and spread among humans may have occurred outside Wuhan as early as mid-September.

U.S. health officials confirmed the first case of COVID-19 in the country on Jan. 21, when doctors diagnosed a Washington state man who had just returned to the Seattle area from Wuhan. Cases also surfaced in Chicago, Phoenix, and Los Angeles in the middle of January, but containment measures appeared to extinguish them, The New York Times reported. But by March 15, the disease had appeared in all 50 states.

More recently, researchers found cases spreading from a larger cluster, with its own distinct genetic signature, originating in the New York area. But of all the viral branches, the strain from Washington state, which originated in China, remains the earliest and most potent and has surfaced in Arizona, California, Connecticut, the District of Columbia, Florida, Illinois, Michigan, Minnesota, New York, North Carolina, Oregon, Utah, Virginia, Wisconsin, Wyoming, and six other countries.

A COVID-19 patient on a ventilator in the emergency room at St. Joseph’s Hospital in Yonkers, N.Y. Associated Press/Photo by John Minchillo (file)

When to ventilate—and when not to

Ventilators can save lives in the most severe cases of the coronavirus, but new research indicates doctors may overuse the medical technique and harm their patients. Some 50 percent of people diagnosed with COVID-19 and placed on ventilators die, and damage caused by the machine may account for some of those deaths, according to a study published on April 21 in the American Journal of Tropical Medicine and Hygiene.

The National Institutes of Health released guidelines on April 21 that encourage doctors to start with less invasive breathing support, like nasal cannulas. If mechanical ventilation becomes necessary, the NIH recommends delivering only low volumes of oxygen.

Physicians have clung to tried-and-true treatment methods typically used for pneumonia patients, but COVID-19 affects people differently than other types of viral pneumonia. “There is mounting evidence that lots of patients are tolerating fairly extreme” low levels of oxygen in the blood, suggesting less need for a ventilator, Muriel Gillick of Harvard Medical School, told Stat.

Patients with other types of pneumonia typically gasp for breath and can barely speak when their oxygen saturation level—a measure of how well their blood is oxygenated—drops below 90 percent. But at even much lower oxygen levels, COVID-19 patients can often speak in full sentences without getting winded and show no signs of respiratory distress.

Unlike with other viral types of pneumonia, areas of healthy, elastic lung tissue can sit right next to damaged areas in those with COVID-19. Forcing high-pressure oxygen-enriched air into elastic tissue in large volumes can cause tissue leaks, swelling, and inflammation and can result in increased mortality, the researchers wrote. —J.B.

A COVID-19 patient on a ventilator in the emergency room at St. Joseph’s Hospital in Yonkers, N.Y. Associated Press/Photo by John Minchillo (file)

A plea for help

Seven medical professionals wrote a letter this month asking states that use the death penalty to share some of their stockpiled execution drugs. They said healthcare facilities need them to sedate and control pain for COVID-19 patients on ventilators.

“I'm not trying to comment on the rightness or wrongness of capital punishment,” said Joel Zivot, associate professor of anesthesiology and surgery at Emory University and one of the seven who signed the letter. “I’m asking now, as a bedside clinician caring for patients, please help me.”

But many of the 25 states that execute prisoners on death row closely guard information about their execution drugs and may hesitate to share which drugs they use because pharmaceutical companies could refuse to continue to supply them for executions, said Robert Dunham, executive director of the Death Penalty Information Center. Wyoming, the only state that responded to the letter, indicated it doesn’t have any of the drugs requested.

The medical experts asked for the sedative midazolam, the paralytic agent vecuronium bromide, and the opioid fentanyl. Demand for those drugs surged by 73 percent in March. Doctors need them because putting a patient on a ventilator “with no drugs … would be torture,” Zivot said. —J.B.

A COVID-19 patient on a ventilator in the emergency room at St. Joseph’s Hospital in Yonkers, N.Y. Associated Press/Photo by John Minchillo (file)

You’ve got a friend in me

A round little robot with a smiling face took off for the International Space Station aboard the SpaceX Dragon cargo capsule on Dec. 5. Now, the Crew Interactive Mobile Companion, or CIMON 2, performs tasks for the astronauts with emotional-sounding responses and a sense of humor.

CIMON 2, built at the German Aerospace Center, is the second artificial intelligence robot to come aboard the space station. Its predecessor, CIMON, debuted in 2018. The robot uses fans to move around the European research module and rotates to face astronauts when they speak to it. The IBM programmed unit can follow verbal commands and assists the astronauts by reading instructions out loud while they perform procedures. It also speaks, hears, sees, nods, and shakes its head. CIMON 2 can document experiments, search for items, monitor inventory, or take photos and videos to assist the astronauts in their daily work.

Engineers also designed CIMON 2 to detect and react to emotional cues. They hope it can be “an empathetic conversational partner” for lonely astronauts, IBM representatives told Space.com.

Psychologists helped develop CIMON 2 to respond using different tones that sound teasing or sad. The robot can feign a sense of humor, too. European Space Agency astronaut Luca Parmitano told CNN that when he asked it to share a fact about space, it answered, “The Apollo crew did not have any life insurance.” —J.B.