COVID-19 situation: 27 May 2020

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Pandemic Threats and Health Emergencies

COVID-19 situation: 27 May 2020

Welcome to this special issue of the newsletter where we highlight latest research and policy news and literature on COVID-19 situation

Please send your feedback, articles and reports, or questions you would like to share to Dr. Chadia Wannous via email  cwannous@yahoo.com  

Wishing you useful reading!
Chadia

COVID-19 Outbreak Situation 

 
Situation updates:

WHO situation report 127 by 27 May 2020

  • WHO Director-General Dr Tedros, in his regular media briefing, mentioned that “over 400 hospitals in 35 countries are actively recruiting patients and nearly 3500 patients have been enrolled from 17 countries” as part of the Solidarity Trial which was established to evaluate the safety and efficacy of four drugs and drug combinations against COVID-19.
  • The WHO Regional Office for Europe along with the European Centre for Disease Prevention and Control (ECDC),said that they will continue to repurpose their influenza surveillance systems to also detect the COVID-19 virus.
  • Facing an unprecedented global demand for essential COVID-19 medical supplies, WHO is working with partners to help secure supplies to assist the most vulnerable countries.
  • Data as received by WHO from national authorities by 10:00 CEST, 26May2020

More info here https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200526-covid-19-sitrep-127.pdf
 
Links to the COVID-19 dashboards for most up-to-date figures:
Global dashboard https://covid19.who.int/
WHO COVID-19 alerts in African Region
WHO COVID-19 readiness dashboard in African Region
WHO COVID-19 situation dashboard in European Region
WHO COVID-19 weekly surveillance dashboard in European Region
WHO COVID-19 situation dashboard in the Eastern Mediterranean Region
PAHO COVID-19 alerts in the Region of the Americas
 
All information about COVID- 19 can be found here:https://www.who.int/emergencies/diseases/novel-coronavirus-2019
 
Latest updates - Live press conference (Geneva)
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
 
===================
Situation update for the EU/EEA and the UK as of 27 May 2020
As of 27 May 2020, 1 368 974 cases have been reported in the EU/EEA and the UK: United Kingdom (265 227), Spain (236 259), Italy (230 555), Germany (179 364), France (145 555), Belgium (57 455), Netherlands (45 578), Sweden (34 440), Portugal (31 007), Ireland (24 735), Poland (22 074), Romania (18 429), Austria (16 497), Denmark (11 428), Czechia (9 050), Norway (8 364), Finland (6 628), Luxembourg (3 995), Hungary (3 793), Greece (2 892), Bulgaria (2 460), Croatia (2 244), Estonia (1 834), Iceland (1 804), Lithuania (1 639), Slovakia (1 513), Slovenia (1 469), Latvia (1 053), Cyprus (939), Malta (611) and Liechtenstein (83).
As of 27 May 2020, 161 917 deaths have been reported in the EU/EEA and the UK: United Kingdom (37 048), Italy (32 955), France (28 530), Spain (27 117), Belgium (9 334), Germany (8 349), Netherlands (5 856), Sweden (4 125), Ireland (1 615), Portugal (1 342), Romania (1 210), Poland (1 024), Austria (643), Denmark (563), Hungary (505), Czechia (317), Finland (312), Norway (235), Greece (173), Bulgaria (133), Luxembourg (110), Slovenia (106), Croatia (101), Estonia (65), Lithuania (65), Slovakia (28), Latvia (22), Cyprus (17), Iceland (10), Malta (6) and Liechtenstein (1).
https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea
 
Situation dashboard: latest available data
https://qap.ecdc.europa.eu/public/extensions/COVID-19/COVID-19.html
 
=====================

Tough summer ahead for South America's COVID-19 hot spots
Worries are also rising about the pandemic's impact on the healthcare of Latin Americans who have noncommunicable diseases, who make up 25% of the population.
More »
 
The US CDC reported 1.63 million total cases (15,342 new) and 97,669 deaths (620 new). Daily COVID-19 deaths in the United States are generally on the decline, but the total could potentially reach 100,000 deaths in the coming days. In total, 12 states (increase of 2) reported more than 40,000 cases, including New York with more than 350,000; New Jersey with more than 150,000; and Illinois with more than 100,000.
 
=========================
Control Measures

Stay-home orders likely slowed COVID-19 spread, study finds
The community infection rate dropped 58% after the orders were issued.
More »
 
Reopening too soon could trigger an “immediate second peak” in countries where coronavirus cases are on the decline, according to WHO emergencies chief Mike Ryan, noting that swathes of the globe are still in the midst of their first wave of infections.
Reuters
 
COVID-19 patients who tested positive weeks after recovering showed no evidence of passing the virus on to others after their symptoms resolved, according to research from South Korea's CDC.
NPR Goats and Soda
 
We’ll Be Wearing These Things on Our Faces for a Long Time
The Atlantic

Beyond Summer 2020: Safety Abroad in a Recovering World
https://www.insidehighered.com/views/2020/05/12/issues-concerning-overseas-travel-international-educators-must-consider-coming
====================
Countries Measures
 
The lockdown lift
National and local authorities around the world are beginning to wind down restrictions imposed to slow the spread of the new coronavirus, gradually lifting the lockdowns that have stunted economies, decimated jobs and thrown millions into poverty.
The following chart shows the status of social distancing measures in five important areas: schools, shops, bars and restaurants, public transport and international travel. Exceptions to the general rule are noted where significant.
The chart focuses on the countries and U.S. states with the highest number of infections, as well other territories whose economies are regionally important.
The chart will be updated as more governments announce measures to reopen their economies, or if they go too far and have to pull back.
https://graphics.reuters.com/HEALTH-CORONAVIRUS/REOPENING/jbyprjmdepe/index.html
 
The largest lockdown in the world is ending. India is bracing for what comes next. 
Washington Post

US COVID-19 hospitalizations up as officials respond to Memorial Day festivities
Health officials in St. Louis are calling for Lake of the Ozarks partygoers to quarantine for 14 days.
More »

Did the U.S. miss its chance to block Covid-19?
New research undermines the prevailing theory that the Covid-19 outbreak in Washington state — the country’s first — was triggered by the very first confirmed case of the infection in the U.S. The study, posted to a preprint site so not yet peer-reviewed or published in a scientific journal, also raises the disturbing possibility that because the outbreak started in mid-February, there was more time to stop it,
STAT's Helen Branswell reports.
 
The Trump administration says it will purchase 100 million COVID-19 testing swabs by the end of the year and distribute them to states, who will decide how to distribute them, according to the new COVID-19 Strategic Testing Plan delivered to Congress on Sunday.
The Washington Post
 
77 Nobel Laureates Denounce Trump Officials For Pulling Coronavirus Research Grant
NPR Goats and Soda

Ahead of the covid curve-Egypt chose a looser lockdown. Its economy is still in crisis
Other Arab states will face similar problems
https://www.economist.com/middle-east-and-africa/2020/05/23/egypt-chose-a-looser-lockdown-its-economy-is-still-in-crisis
 
New Zealand, which has mounted one of the world’s most successful COVID-19 containment efforts, announced that it will relax restrictions on the size of gatherings later this week.
 
On May 25, Japan lifted the state of emergency on its remaining 5 prefectures, including the Tokyo area, which means that the emergency has been lifted for the entire country. Japan will reportedly implement contact tracing and individual exposure notification via a smartphone app in the coming weeks.
 
Scientific networks are helping African countries to access coronavirus lab supplies
Nature

Scaling Up African Pharmaceutical Manufacturing in a Time of COVID-19
Council on Foreign Relations

===========================
 
Scientific Publications, Reports and News

Healthy lives depend on a healthy planet
After the COVID-19 pandemic, people deserve a green recovery that improves their life chances
https://news.trust.org/item/20200526074433-7t0dm
 
The Special Challenge of Fighting COVID-19 in Africa
Scientific American (commentary)

Curbing zoonotic diseases
Will wet markets be hung out to dry after the pandemic?
They can breed new diseases, but banning them entirely might not be the best response
https://www.economist.com/international/2020/05/26/will-wet-markets-be-hung-out-to-dry-after-the-pandemic

To hell with experts
How the world’s premier public-health agency was handcuffed
The CDC has been absent with leave during the spread of covid-19
https://www.economist.com/united-states/2020/05/23/how-the-worlds-premier-public-health-agency-was-handcuffed

Swiss study indicates children infrequently transmit COVID-19 to adults
A study today in Pediatrics looked at COVID-19 transmission dynamics in 39 Swiss family household clusters of illnesses and identified only 3 (8%) in which a child was the suspected index patient. The study suggests children most commonly contract the virus from adults, and not vice versa and could favor school reopening.
May 26 Pediatrics study
May 26 Pediatrics commentary
 
South Korean Study Shows No Evidence Recovered COVID-19 Patients Can Infect Others
South Korea's Center for Disease Control has reassuring news about people with COVID-19 who test positive for the coronavirus weeks after their symptoms have resolved. Health officials there studied 285 patients who tested negative for the virus after recovering, but weeks later tested positive again. the scientists followed up with nearly 800 of those people's personal contacts, such as family members. They found no evidence that they had contracted the virus from the people who had a fresh positive result. The scientists also tried to grow the virus in secretions from these patients. They could not.
https://www.npr.org/sections/goatsandsoda/2020/05/22/861061727/south-korean-study-shows-no-evidence-recovered-covid-patients-can-infect-others
 
WHO Warns of a ‘Second Peak’ in Areas where COVID-19 Declining
Countries where coronavirus infections are declining could still face an “immediate second peak” if they let up too soon on measures to halt the outbreak, the World Health Organization said on Monday. The world is still in the middle of the first wave of the coronavirus outbreak, WHO emergencies head Dr Mike Ryan told an online briefing, noting that while cases are declining in many countries they are still increasing in Central and South America, South Asia and Africa.
https://www.reuters.com/article/us-health-coronavirus-who-peak/who-warns-of-second-peak-in-areas-where-covid-19-declining-idUSKBN2311VJ

Study tells ‘remarkable story’ about COVID-19’s deadly rampage through a South African hospital
On 9 March, a patient who had recently traveled to Europe and had symptoms of COVID-19 visited the emergency department of St. Augustine’s, a private hospital in Durban, South Africa. Eight weeks later, 39 patients and 80 staff linked to the hospital had been infected, and 15 patients had died—fully half the death toll in KwaZulu-Natal province at that time.
Now, scientists at the University of KwaZulu-Natal have published a detailed reconstruction of how the virus spread from ward to ward and between patients, doctors, and nurses, based on floor maps of the hospital, analyses of staff and patient movements, and viral genomes. Their 37-page analysis, posted on the university’s website on 22 May, is the most extensive study of any hospital outbreak of COVID-19 so far
https://www.sciencemag.org/news/2020/05/study-tells-remarkable-story-about-covid-19-s-deadly-rampage-through-south-african
 
===================
Testing

Coronavirus antigen tests: quick and cheap, but too often wrong?
https://www.sciencemag.org/news/2020/05/coronavirus-antigen-tests-quick-and-cheap-too-often-wrong
 
COVID-19 antibody tests are wrong up to half the time—and are not accurate enough to be the basis of policy decisions, the CDC warned in new guidance. CNN
 
================
Tracking

Researchers are tapping electronic health records in the Covid-19 response. For the data wranglers, that's a daunting and time-consuming task,
STAT’s Rebecca Robbins  

Germany’s Faith in Contact Tracing
Germany’s early, strong push on contact tracing may be helping the country keep COVID-19 deaths—10 per 100,000 people—comparatively low. Germany’s approach—emphasizing tracking infection chains above “all else,” could offer lessons as the US ramps up tracing. German tracers rely on old-fashioned phone calls and quarantines, eschewing the high-tech approaches of countries like China, Singapore, and South Korea that are a harder sell in Europe, given privacy concerns. They concede the process becomes more challenging as restrictions ease and contacts increase—but believe ongoing caution and respect for distancing efforts are helping.
The Washington Post

6 Pieces Of Advice From A Veteran Contact Tracer And A Newbie
NPR

Here’s How Wuhan Tested 6.5 Million for Coronavirus in Days
The New York Times
 
Digital Contact Tracing Poses Ethical Challenges
 The Hub

============
Treatment

Remdesivir Study Holds Up—But It's Not a Wonder Drug
Scientists released the data from a study that prompted support of remdesivir as another potential treatment, The New York Times reported Saturday.
Published in the New England Journal of Medicine Friday evening, the numbers reinforce the findings that the drug shortens recovery time in hospitalized patients from 15 days to 11 days. But the researchers emphasize that while the results were generally positive, it’s not a wonder drug. “Given high mortality despite the use of remdesivir, it is clear that treatment with an antiviral drug alone is not likely to be sufficient,” they concluded.
See also: Remdesivir for the Treatment of COVID-19 – Preliminary Report (The New England Journal of Medicine)

‘Medications should be prescribed by doctors’
With the world’s third-highest number of confirmed COVID-19 cases, Brazil is in turmoil: the country has seen two health ministers depart within the past two months, and its leadership is promoting unproven treatments. Physicist Luiz Davidovich, president of the Brazilian Academy of Sciences, spoke to Nature about how organizations such as his are working hard to counter anti-science rhetoric. “Medications should be prescribed by medical doctors, not by the president of Brazil,” says Davidovich.
Nature | 5 min read
 
Q&A : Hydroxychloroquine and COVID-19
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-hydroxychloroquine-and-covid-19

Study: Low oxygen, inflammation predict critical COVID-19 illness, death
Low oxygen levels at hospital admission and signs of inflammation were the strongest predictors of serious COVID-19 illness and death in a prospective cohort study published late last week in BMJ.
May 22 BMJ study

COVID-19 cuts large swath of critical illness, death on West Coast, study finds
The likelihood of COVID-19 patients needing intensive care in Kaiser Permanente healthcare systems in California and Washington state was 40.7%, and the risk of death was 18.9%, according to a prospective cohort study also published in BMJ.
May 22 BMJ study
 
CONVALESCENT SERUM
A recent study (preprint) evaluates the use of convalescent plasma as a treatment for severe COVID-19 cases. The matched control study, conducted by the Icahn School of Medicine at Mount Sinai (New York, US), included 39 severe COVID-19 patients who were treated using convalescent plasma from recovered COVID-19 patients. The study group was retrospectively matched to controls based, in part, on their supplemental oxygen requirement at the start of the study. The researchers found a statistically significant improvement in supplemental oxygen requirements following the treatment as well as reduced mortality among non-intubated patients. While the positive results are encouraging, further analysis, including via randomized, placebo-controlled trials, are necessary to better characterize the effects of convalescent plasma as a COVID-19 treatment and associated risks.
 
=============
Vaccines
 
Exclusive: big pharma rejected EU plan to fast-track vaccines in 2017
The Guardian
 
Safety, Tolerability, and Immunogenicity of a Recombinant Adenovirus Type-5 Vectored COVID-19 Vaccine: a Dose-escalation, Open-label, Non-randomised, First-in-human Trial
A vaccine to protect against COVID-19 is urgently needed. We aimed to assess the safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31208-3/fulltext

Coronapod: Vaccine-trial results
Get the expert view from Nature’s news team in our weekly audio overview of the state of coronavirus science. This week, we dig into the hope and caution inspired by the latest vaccine trials and consider the United States’ ruction with the WHO.
Nature Coronapod | 34 min listen
 
As data starts to trickle out from Covid-19 vaccine trials, how are researchers conducting this research?
Watch short explainer from STAT.
 
Even if the autumn brings the first signs of a potentially effective coronavirus vaccine candidate, that will still only be the beginning of a long road to a widely available vaccine, warns Seth Berkley of the GAVI vaccine alliance,
Reuters reports.
  
Missteps in the pandemic response have given vaccine skeptics fresh ammo, says vaccine scientist Peter Hotez,
The Atlantic reports.
 
American taxpayers funded R&D for remdesivir
A once-rejected drug now pegged as a potential blockbuster COVID-19 therapy—but drugmakers will have few constraints in pricing the drug because the government has not fought for patent rights.
The Washington Post   
 
========================
 
Consequences of the Outbreak on Society and Economy

Coronavirus cutbacks could reverse hard-fought equity gains in STEM workforce
Women’s jobs are “the first to go" in pandemic-related cuts.
https://www.natureindex.com/news-blog/coronavirus-pandemic-job-cutbacks-reverse-equity-gains-women-in-stem-science-research-workforce

FIFA, European Commission and World Health Organization launch #SafeHome campaign to support those at risk from domestic violence
The campaign is being published on various FIFA digital channels, with #SafeHome also being supported with multimedia toolkits for the 211 FIFA member associations and for various media agencies to help facilitate additional localisation and to further amplify the message worldwide.
Video 1: Survivor advice 1
Video 2: Survivor advice 2 
Video 3: Survivor support
Video 4: Perpetrator advice 
Video 5: Government advice 
 
WHO, the United Nations’ specialised health agency, and FIFA, football’s world governing body, collaborate closely to promote healthy lifestyles, which includes being free of violence, through football globally. The two organisations jointly launched the “Pass the message to kick out coronavirus” campaign in March 2020 to share advice on effective measures to protect people from COVID-19. This was followed by the #BeActive campaign in April 2020 to encourage people to stay healthy at home during the pandemic. 
https://www.who.int/news-room/detail/26-05-2020-fifa-european-commission-and-world-health-organization-launch-safehome-campaign-to-support-those-at-risk-from-domestic-violence
 
COVID-19 and violence against women: What can the health sector/system do?
https://apps.who.int/iris/bitstream/handle/10665/331699/WHO-SRH-20.04-eng.pdf
 
An open letter from organizations representing health professionals worldwide calls for stimulus plans that contribute to improving public health.
(The Guardian | 5 min read)
 
COVID-19: 15,000 Rohingya refugees under quarantine as cases hit 29
 CNA

Rohingya targeted in Malaysia as coronavirus stokes xenophobia
https://news.trust.org/item/20200522233401-o2ha6
 
Doctors face pay cuts, furloughs and supply shortages as coronavirus pushes primary care to the brink
 CNBC
 
As Covid-19 tears through Navajo Nation, young people step up to protect their elders
STAT

Urban slums are uniquely vulnerable to COVID-19. Here’s how to help
https://news.berkeley.edu/2020/04/27/urban-slums-are-uniquely-vulnerable-to-covid-19-heres-how-to-help/

'No time': Latin America's slum dwellers lead coronavirus battlehttps://news.trust.org/item/20200525101755-n1rl2

'Feels like I'm flying to Mars': What air travel is like during coronavirus
https://news.trust.org/item/20200522154405-rkn83

From Brazil to Kenya, coronavirus widows lose their husbands and then their land
With COVID-19, women around the world are being evicted and forced to marry male relatives hungry for land
https://news.trust.org/item/20200526181233-nxk1q

A maid dodging coronavirus in a virtual world spotlights inequality in India
Players must try to avoid starving or catching COVID-19 under lockdown
https://news.trust.org/item/20200526151103-k342t
-----------------------------
 
Risk Communication
 
Coronavirus misinformation needs researchers to respond
Nature (commentary)

Biopharma companies are spreading misinformation — and taking advantage of it
https://www.statnews.com/2020/05/26/biopharma-companies-spreading-misinformation-taking-advantage-of-it
 
China Accuses US of Spreading ‘Conspiracies’ (BBC)
China's foreign minister has accused the US of spreading "conspiracies and lies" about the coronavirus, ratcheting up tensions between the two nations. The US has been infected by a "political virus" that compels some politicians to repeatedly attack China, Wang Yi told reporters on Sunday. He urged the US to "stop wasting time and stop wasting precious lives" in its response to the Covid-19 outbreak. Tensions between Washington and Beijing have escalated as the virus has spread.
https://www.bbc.com/news/world-asia-china-52790634
 
Updated WHO Myth buster
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters
 
UNESCO mythbusting
https://en.unesco.org/sites/default/files/disinfodemic_deciphering_covid19_disinformation.pdf
 
---------------------------------
WHO Technical Guidance
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
 
New
 
Smithsonian Science Education Center With Support of the World Health Organization Launches New COVID-19 Guide for Youth
The Smithsonian Science Education Center will disseminate the information to youth worldwide in collaboration with WHO, IAP, educators, and museum and research center networks. The guide is free, will be available to youth in more than 15 languages, particularly African and Asian languages, and can be found at https://ssec.si.edu/covid-19.
 
=====================
The CDC published new guidance on COVID-19
https://www.cdc.gov/coronavirus/2019-ncov/whats-new-all.html
 
========================
 
Resources

Lancet Coronavirus Resource Centre
This resource brings together new 2019 novel coronavirus (2019-nCoV) content from across The Lancet journals as it is published. All content listed on this page is free to access.

https://www.thelancet.com/coronavirus

Elsevier’s free health and medical research on novel coronavirus (2019-nCoV)
https://www.elsevier.com/connect/coronavirus-information-center

CIDRAP COVID-19 Resource Center
CIDRAP has created a one-stop comprehensive compilation of the most current, authorititive information available on the novel coronavirus. Visit the Resource Center often, as the outbreak is constantly evolving

COVID-19 SARS-CoV-2 preprints from medRxiv and bioRxiv
https://connect.medrxiv.org/relate/content/181
==============

Training:
WHO training
https://openwho.org/courses

The following resources for COVID-19 have been launched :

  • How to put on and remove PPE for COVID-19 in Albanian and Macedonian
  • SARI treatment facility design in French
  • Clinical care SARI in Macedonian
  • Country preparedness and response in Spanish
  • Health and safety briefing for respiratory diseases – ePROTECT in Vietnamese

 
New certificates available
Participants can now gain a Record of Achievement if they score 80% or higher on the assessments in the following courses:

 

ECDC COVID-19 Micro learning 
https://eva.ecdc.europa.eu/mod/forum/discuss.php
============================

Research and Development

·      Global research on coronavirus disease (COVID-19)

·      Database of publications on coronavirus disease (COVID-19)
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov
 
A strategic approach to COVID-19 vaccine R&D
https://science.sciencemag.org/content/early/2020/05/12/science.abc5312/tab-pdf
 
GLOBAL EFFORT ON COVID-19 HEALTH RESEARCH
Global Effort on COVID-19 Health Research is a new cross UK government funding call aiming to support applied health research that will address COVID-19 knowledge gaps. The focus is on understanding the pandemic and mitigating its health impacts in LMIC contexts. The call prioritises epidemiology, clinical management, infection control and health system responses.
https://www.ukri.org/funding/funding-opportunities/global-effort-on-covid-19-geco-health-research
 
GLOVES-19
All emergency/frontline health workers to participate in a research study "GLobal Observations and Views of Emergency Frontline Health Workers Survey in COVID-19" (GLOVES-19) led by Drs. Adnan Hyder and Katherine Douglass of the Department of Global Health at the Milken Institute School of Public Health, George Washington University.
Taking part in this research is completely voluntary. If you choose to take part in this study, you will be asked to complete an online survey. The survey will take approximately 15 minutes of your time.
https://publichealthgwu.qualtrics.com/jfe/form/SV_2aaO4vRVuguBn3n
 
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COVID-19 Call to Action: Short – Term Assignments with the WHO Global Outbreak Alert and Response Network (GOARN)
Your expertise is needed to address COVID-19
The One Health Commission (OHC), the One Health European Joint Programme (OHEJP), and other groups are partnering with the World Health Organization’s Global Outbreak Alert and Response Network (GOARN) to share this call. The GOARN, a collaboration of over 200 institutions and networks that identifies experts willing and able to assist during an outbreak or pandemic, is seeking experts with a minimum of 5-yrs experience in relevant disciplines to help build capacity for the global COVID-19 pandemic response. https://conta.cc/2VPQ0xk
================================
 
Help Fight Coronavirus- Donate Now
Everyone can now support directly the response coordinated by WHO. People and organizations who want to help fight the pandemic and support WHO and partners can now donate through the COVID-Solidarity Response Fund for WHO at www.COVID19ResponseFund.org.
 

 

 

Knowledge Sharing

Thank you for reading. If you have thoughts, feedback, story ideas, or questions you would like to share or interested in partnering with us on a special event coverage, please send a note to Chadia Wannous via emailcwannous@yahoo.com  

 

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