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A U.N. Security Council meeting on the 75th anniversary of the end of World War II in Europe on Friday saw a clash between Russia and some Europeans, calls for unity to fight COVID-19, and warnings that the seeds of a new global conflict must be prevented from growing. Nearly 70 speakers, including more than 45 foreign ministers and the European Union’s top diplomat, took part in the informal video meeting organized by Estonia, which holds the council presidency this month, on lessons learned from the war for preventing future atrocities and the Security Council’s responsibility. EU foreign policy chief Josep Borrell said the world is facing “its biggest crisis since the end of World War II” triggered by the outbreak of the coronavirus, which “is shaking the foundations of our societies and exposing the vulnerabilities of the most fragile countries.”

President Vladimir Putin told Russians they are "invincible" when they stand together as the country on Saturday marked the 75th anniversary of the end of World War II in lockdown from the coronavirus. With cases surging and authorities urging Russians to stay in their homes, celebrations of this year's Victory Day were muted after the Kremlin grudgingly postponed plans for a grand parade with world leaders. Instead of columns of military hardware and thousands of troops marching through Red Square as planned, Putin walked alone to lay flowers at the Eternal Flame outside the red brick walls of the Kremlin.

Myan Mode, a garment factory on the outskirts of Yangon, Myanmar, produces men's jackets, women's blazers and coats for Western fashion companies like Mango and Zara. Since the start of the coronavirus pandemic, it has seen a decrease in orders from international retailers.That was why it let go almost half of its 1,274 workers in late March, the factory's managing director said in response to protesters who arrived at the factory's doors to denounce the dismissals.Three fired sewing operators, however, said the factory was taking an opportunity to punish workers engaged in union activity. In an interview, the operators -- Maung Moe, Ye Yint and Ohnmar Myint -- said that of the 571 who had been dismissed, 520 had belonged to the factory's union, one of 20 that make up the Federation of Garment Workers Myanmar. About 700 workers who did not belong to the union kept their jobs, they said.Myan Mode's South Korean-based owner did not respond to requests for comment, and did not provide details about the firings.Moe, 27, was the factory union's president and had organized several strikes. Yint, 30, was the union's secretary, while Myint, 34, had been a union member since its founding in June 2018."The bosses used COVID as an opportunity to get rid of us because they hated our union," Moe said. He said he and other union members had been in discussions with the factory managers before the firings, demanding personal protective equipment and that workers be farther apart on the factory floor. "They thought we caused them constant headaches by fighting for our rights and those of our fellow workers."Union-busting -- practices undertaken to prevent or disrupt the formation of trade unions or attempts to expand membership -- has been a serious problem across the fashion supply chain for decades. But with the global spread of COVID-19 placing fresh pressures on the industry, it is a particular issue in South Asia, where about 40 million garment workers have long grappled with poor working conditions and wages."Union-busting is not a COVID-specific issue for the garment industry -- it happens all the time," said Luke Smitham of the sustainability consultancy Kumi Consulting.Zara's parent company, Inditex, which is supplied by Myan Mode, said its code of conduct for manufacturers expressly prohibited any discrimination against worker representatives. The company said in an email that it was "actively following the situation" at Myan Mode, and would "try to achieve the best possible solution for workers."Mango, which has started to reopen its stores in Europe, said in an emailed statement that it "understood the need to ensure that the human rights of factory workers are respected." The company added that it was maintaining "a continuous" dialogue with suppliers.Roughly 2% of garment workers in Myanmar, where the minimum wage is roughly $3.50 a day, and 0.5% of garment workers in Bangladesh belong to a union, according to affiliate data estimates collected by the global trade union IndustriALL. While Cambodia's workforce is more unionized than others in the region -- around 80% -- the unions there are fragmented, meaning successful collective bargaining negotiations can be difficult.Tear gas, water cannons, police brutality and imprisonment were some of the tools used by the governments of Bangladesh, Cambodia, India and Myanmar to punish striking garment workers and union members last year, according to the International Trade Union Confederation, an umbrella group for unions around the world. It noted that many workers in those countries who tried to form a union were dismissed from jobs or blacklisted by factories. And the number of countries that exclude workers from the right to establish or join a trade union increased to 107 in 2019 from 92 in 2018.Andrew Tillett-Saks, a labor organizer in Yangon, said he had seen a surge in unionizing by garment workers in Myanmar over the last 18 months -- and a reaction from factory owners. Before the pandemic, he said, some garment factories with fledgling unions were abruptly closing and firing union members, then reopening weeks later to supply the same brands under a slightly different name with a new group of nonunionized workers.Tillett-Saks said that much of the focus had been on whether brands would pay wages for workers during the pandemic, or for orders that had already been produced. But factory owners "taking this as an opportunity to break down labor movements in the supply chain could be an even bigger issue."Some brands, like H&M, have tried to facilitate union activity in supplier factories by signing ACT, an agreement brokered by IndustriALL and designed to secure fair wages for workers through collective bargaining and building guarantees of labor rights into purchasing agreements. But there are still hurdles. Before the International Labor Organization, a U.N. agency, can take action, allegations of mistreatment must be sent in writing from a national or international trade union organization and then reviewed internally by the agency -- a complicated process even before the pandemic."We have heard allegations of anti-union discrimination in recent weeks," said John Ritchotte, a specialist in social dialogue and labor administration in Asia for the International Labor Organization. "However, it is currently more difficult than usual for us to verify those allegations through our usual procedures because of travel restrictions and local lockdowns."In the weeks since the Myan Mode layoffs, around 15,000 jobs in the textile industry have been lost and about 40 factories closed across Asia, said Khaing Zar Aung, president of Industrial Workers Federation of Myanmar.Moe said the fired Myan Mode workers had protested outside the factory for weeks, watching as daily wage workers entered and scores of exhausted former colleagues left at midnight after overtime shifts. Eventually, management offered severance but not re-employment to the 571 fired workers, plus 49 employees who had walked out in solidarity. All but 79 eventually took the severance pay.The Garment Manufacturers Association in Cambodia said about 60% of its factories -- where union members have also been targeted -- had been severely affected by canceled orders of ready-made garment exports because of the pandemic.On March 31, several dozen union workers at the Superl leatherwear factory on the outskirts of Phnom Penh -- which produces handbags for brands like Michael Kors, Tory Burch and Kate Spade -- were told they were being let go. One was a woman who was six months pregnant.Soy Sros, a factory shop steward and the local president of the Collective Union of Movement of Workers, wrote about the company's actions on Facebook, stating it violated a March 6 appeal from the Cambodian government saying COVID should not be used as a chance to discriminate against union members.Twenty-four hours later, Sros was forced by factory management to take down her post and make a thumbprint on a warning letter accusing her of defamation. On April 2, she was removed from the factory floor by the police and charged with posting fake information on social media. She is now in jail.Superl, which is headquartered in Hong Kong, did not respond to requests for comment, nor did Michael Kors and Tory Burch, who regularly place orders at the factory. Another customer, Tapestry, the owner of Kate Spade, declined to comment.In Myanmar, Moe, Yint and Myint all said they did not regret joining the union despite the difficulties they had faced. They said the loss of jobs was proof that worker representation was needed."I worry for the future of garment workers here without representatives," Myint said, referring to both the firings at Myan Mode and other factories across Asia. "But for now, I worry about providing for my family and getting food on the table."This article originally appeared in The New York Times.(C) 2020 The New York Times Company

Cybertip.ca, an online sexual exploitation of children tipline, says it saw a 66 per cent spike in reports in April.

LA LOCHE, Sask. - Amanda Black feels lucky that her symptoms have remained mild since she tested positive last week for COVID-19. She and her six-year-old son, Malachi, have runny noses and can't taste their food. "We seem to be OK so far," Black said in an online video from her home in La

My brother's death last month caused great pain. COVID-19 and its restrictions, which have delayed his funeral, made grieving so much harder.

It seems like people who get infected with SARS-CoV-2 retain immunity, but we can’t be sure how long that immunity will last. We still lack the testing capabilities to be certain.eamesBot / Shutterstock

This story was updated post-publication to include information from a study published on the preprint server medRxiv on April 17, 2020.

With more than half a million cases of COVID-19 in the United States1 and the number of deaths increasing daily, it remains unclear when and how we might return to some semblance of pre-pandemic life. This leaves many grappling with an important question: Do you become immune after SARS-CoV-2 infection? And, if so, how long might that immunity last?

In 2019, the virus SARS-CoV-2 jumped to a human host for the first time, causing the disease COVID-19. When you become infected with a new virus, your body does not possess the antibodies necessary to mount a targeted immune response. Antibodies, proteins belonging to the immunoglobulin family, consist of four chains of amino acids that form a characteristic Y-shaped structure. Antibodies are manufactured by the immune system to bind to antigens (viral proteins) to neutralize viral infectivity.

When you inhale an aerosolized droplet containing SARS-CoV-2, the virus encounters the cells of the mucous membrane lining the respiratory tract. If effective contact is made, the virus binds to a particular receptor on these cells called ACE-2. After binding ACE-2, a host enzyme is co-opted to cleave the virus’ surface protein, called the spike protein, allowing the virus to enter the cell.

It appears that individuals with COVID-19 do create neutralizing antibodies—the basis of immunity.

Within the first few hours of infection, the body’s first line of defense—the innate immune response—is activated. The innate immune response is non-specific. When a “foreign” molecule is detected, innate immune cells signal to other cells to alter their response or prepare to combat infection.

In the following days, the adaptive immune response is activated, which is more specific. The adaptive immune response will peak one to two weeks post-infection and consists of antibodies and specialized immune cells. It is called the “adaptive” immune response because of its ability to tailor the response to a specific pathogen. Antibodies can neutralize viral infectivity by preventing virus from binding to receptors, blocking cell entry, or causing virus particles to aggregate.2 Once an infection has resolved, some of these antibodies remain in the body as immunological memory to be recruited for protection in the case of reinfection. To be immune to a virus is to possess this immunological memory.

Many vaccines work by activating the adaptive immune response. Inactivated virus, viral protein, or some other construct specific to a particular virus are introduced into the body as vaccines to initiate an immune response. Ideally, the body creates antibodies against the viral construct so that it can mount a succinct response when infected by the virus. However, in order to work effectively, a vaccine must provoke an immune response that is sufficiently robust. If the body only produces low concentrations of neutralizing antibodies, adequate immunological memory may not be sustained.

While there is still much that we have to learn about SARS-CoV-2, it appears that individuals with COVID-19 do create neutralizing antibodies—the basis of immunity. However, we don’t know for certain how long that immunity might offer protection. On the question of COVID-19 re-infection, Matt Frieman, a coronavirus researcher at the University of Maryland School of Medicine, commented in a recent interview with NPR: “We don’t know very much … I think there’s a very likely scenario where the virus comes through this year, and everyone gets some level of immunity to it, and if it comes back again, we will be protected from it—either completely or if you do get reinfected later, a year from now, then you have much less disease. That’s the hope, but there is no way to know that.”3

Immunity to a virus is measured by serological testing—patient blood is collected and analyzed for the presence of antibodies against a particular virus. Serological data is most informative when collected long-term, so the data we have been able to obtain on SARS-CoV-2 is limited. However, data on other coronaviruses that we’ve had the opportunity to study in more depth can inform our estimations on how this outbreak may evolve.

First, we can look to the coronaviruses that are known to cause the common cold. Following infection with one of these coronaviruses, disease is often mild; therefore, the concentration of antibodies detected in the blood is low. This is because mild disease often indicates a less robust immune response. Interestingly, it is not the virus itself that causes us to feel sick, but, rather, our body’s response to it. Typically, the sicker we feel, the stronger the immune response; therefore, after a cold, we are often only protected for a year or two against the same virus.4 While SARS-CoV-2 wouldn’t necessarily act like these common coronaviruses, the body’s response to these coronaviruses serves as a point of reference upon which to make predictions in the absence of virus-specific data.

We can also look to coronaviruses that are known to cause severe disease, such as SARS-CoV, which caused the 2002-2003 outbreak of SARS in China. One study discovered that antibodies against SARS-CoV remained in the blood of healthcare workers for 12 years after infection.5 While it is not certain that SARS-CoV-2 will provoke a response similar to that of SARS-CoV, this study provides us with information that can inform our estimates on immunity following COVID-19 and provide hope that immunity will provide long-term protection.

If immunity to SARS-CoV-2 diminishes as it does for common cold coronaviruses, it is likely that wintertime outbreaks will recur.

Scientists have also been working to analyze antibodies in samples from individuals infected with SARS-CoV-2. A research group in Finland recently published a study detailing the serological data collected from a COVID-19 patient over the course of their illness.6 Antibodies specific to SARS-CoV-2 were present within two weeks from the onset of symptoms. Similarly, another recent report analyzing patients with confirmed COVID-19 indicated that it took approximately 11-14 days for neutralizing antibodies to be detected in blood.7 Both of these studies, while preliminary, suggest that the basis for immunity is present in patients infected with SARS-CoV-2.

Another report looked at the possibility for recurrence of COVID-19 following re-infection with SARS-CoV-2.8 In this study, rhesus macaques were infected with SARS-CoV and allowed to recover after developing mild illness. Once blood samples were collected and confirmed to test positive for neutralizing antibodies, half of the infected macaques were re-challenged with the same dose of SARS-CoV-2. The re-infected macaques showed no significant viral replication or recurrence of COVID-19. While macaques “model” human immunity, not predict it, these data further support the possibility that antibodies manufactured in response to SARS-CoV-2 are protective against short-term re-infection.

We can also analyze a virus’ structure, and the information gained from sequencing the viral genome, when trying to predict its behavior. All viruses continually undergo mutation in the process of rapid replication. They lack the necessary machinery to repair changes incurred to the genetic sequence (we as humans also incur mutations to our genetic sequence daily, but we have more sophisticated genetic repair mechanisms in place). The occurrence of significant genetic changes to the viral genome that result in viable genetic changes to a virus is termed antigenic variation. We see a lot of antigenic variation in influenza viruses (thus the need to create new vaccines each year); but the coronaviruses seem to be relatively stable antigenically.4 This is because most coronaviruses have an enzyme that allows them to correct genetic errors sustained during replication. The more stable a virus remains over time, the more likely that antibodies manufactured in response to infection or vaccination will remain effective at neutralizing viral infectivity.

All this considered, it appears that immunity is retained following SARS-CoV-2 infection. So too, that immunity might persist long enough to warrant the implementation of vaccination. However, we still have much to learn about this virus, and whether there may be some cross-immunity between SARS-CoV-2 and other coronaviruses. The widespread variation in patient immune responses adds an additional layer of complexity. We still don’t have a good understanding of why people have different responses to viral infection—some of this variation is owed to genetic variation, but how and why some people have more robust immune responses and more severe disease is still unknown.4 In some cases, individuals show a high immune response because the concentration of virus is high. In other cases, individuals show a high immune response because they differ in some aspect of immune regulation or efficiency. However, as levels of immunity increase generally across a population, the population approaches what is called “herd immunity”—when the percentage of a population immune to a particular virus is sufficiently high that viral load drops below the threshold required to sustain the infection in that population.9

How the pandemic will evolve in the coming months is uncertain. Outcomes depend on a myriad of factors—the duration of immunity, the dynamics of transmission and how we mitigate those dynamics through social distancing, the development of therapeutics and or vaccines, and the ability of healthcare systems to handle COVID-19 caseloads. If immunity to SARS-CoV-2 diminishes as it does for common cold coronaviruses, it is likely that wintertime outbreaks will recur in coming years.10 Whether immunity to other coronaviruses might offer some cross protective immunity to SARS-CoV-2 will also play a role, albeit to a lesser extent. Widespread serological testing to assess the duration of immunity to SARS-CoV-2 is imperative, but many countries still lack this capability.

A recent study looking at serological data from 3,300 symptomatic and asymptomatic individuals in California estimates that there may be as many as 48,000-81,000 people who have been infected with SARS-Cov-2 in Santa Clara County, which is 50- to 85-fold more cases than we previously thought.11 This small-scale survey emphasizes the importance of serological testing in determining the true extent of infection.

The continuation of rigid social distance also hangs in a balance—one-time social distancing measures may drive the SARS-CoV-2 epidemic peak into the fall and winter months, especially if there is increased wintertime transmissibility.10 New therapeutics, vaccines, or measures such as contact tracing and quarantine—once caseloads have been reduced and testing capacity increased—might reduce the need for rigid social distancing. However, if such measures are not put in place, mathematical models predict that surveillance and recurrent social distancing may be required through 2022.10 Only time will tell.

Helen Stillwell is a research associate in immunobiology at Yale University.

References

1. The COVID Tracking Project https://covidtracking.com/data/us-daily (2020).

2. Virology Blog: About Viruses and Viral Disease. Virus neutralization by antibodies. virology.ws (2009).

3. GreenfieldBoyce, N. Do you get immunity after recovering from a case of coronavirus? NPR (2020).

4. Racaniello, V., Langel, S., Leifer, C., & Barker, B. Immune 29: Immunology of COVID-19. Immune Podcast. microbe.tv (2020).

5. Guo, X., et al. Long-Term persistence of IgG antibodies in SARS-CoV infected healthcare workers. bioRxiv (2020). Retrieved from doi: 10.1101/20202/02/12/20021386

6. Haveri, A., et al. Serological and molecular findings during SARS-CoV-2 infection: the first case study in Finland, January to February 2020. Euro Surveillance 25, (2020).

7. Zhao, J., et al. Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019. Clinical Infectious Diseases (2020). Retrieved from doi: 10.1093/cid/ciaa344

8. Bao, L., et al. Reinfection could not occur in SARS-CoV-2 infected rhesus macaques. bioRxiv (2020). Retrieved from doi: 10.1101/20202.03.13.990226

9. Virology Blog: About Viruses and Viral Disease. Herd immunity. virology.ws (2008).

10. Kissler, S.M. Tedijanto, C., Goldstein, E., Grad, Y.H., & Lipsitch, M. Projecting the transmission dynamics of SARS-CoV-2 through the post-pandemic period. Science eabb5793 (2020).

11. Bendavid, E., et al. COVID-19 antibody seroprevalence in Santa Clara County, California. medRxiv (2020). Retrieved from doi: 10.1101/2020.04.14.20062463

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Rumor has it that Spring has finally reached our worldwide headquarters here in beautiful downtown Philadelphia. (See photo at right.) While we wait to go outside, please enjoy this month’s selection of noteworthy news:

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Plus, I share my favorite chart of 2020 (so far).

P.S. Join the more than 9,200 followers of my curated links to neat stuff at @DrugChannels on Twitter. My recent tweets have highlighted: Prime Therapeutics new gene therapy offering, AmerisourceBergen’s laudable deal with the Justice Department, the Costco/Instacart deal, Rite Aid’s new CEO, clinical trial trends, vaccine pricing, and much more! I have also been tweeting under-the-radar stories about how the coronavirus is affecting drug channels.

Tomorrow (May 1), Drug Channels Institute will host the first of two live video webinars: Industry Update and COVID-19 Impact: Retail & Specialty Pharmacies. We'll host the second video webinar—Industry Update and COVID-19 Impact: PBMs & Payers—on May 8. CLICK HERE TO LEARN MORE AND SIGN UP. Contact Paula Fein (paula@drugchannelsinstitute.com) for our special promo codes for multiple viewing sites. DCI will donate 20% of all profits from these events to The Center for Disaster Philanthropy’s COVID-19 Response Fund.

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This photo is free of all copyright restrictions and available for use and redistribution without permission. Credit to FDA's Office of Regulatory Affairs, Health Fraud Branch is appreciated but not required.

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