えはら医院Ehara Clinic

Is
To spread energy throughout the world.

We will help you to cure your illness.
When you are not feeling well, a little encounters and interactions here will be the beginning for your recovery.
And to have positive feelings and fulfilling your time regained.

We hope that our being could be a source of peaceful mind for everyone.

【Notice】
※COVID-19 saliva PCR test 25,000 yen (tax excluded). English negative certificate 5,000 yen (tax excluded).
※ COVID-19 antibody test (Roche®) 2500 yen (tax included).
Above tests are only carried out on people without any COVID-19 symptoms (e.g. fever, cough) or who have not had contact with a person potentially infected with the COVID-19 virus. Those who already show COVID-19 symptoms or have had contact with a potentially infected person should stay at home and get in touch with the health hotline by calling 042(362)2334.

※ We announced the epidemic forecast at Japan for next year on May 24 of【COVID-19 Updates】, as follows,
“There will be little or no epidemic or small outbreaks from summer to fall during 2020, although small clusters may occur. After the end of this year or during the spring and summer of 2021, there will be a relatively large second wave or no outbreak.”　See text for commentary

※ << Recommended Virus Spread Map >>You can see when and where the virus expand by playing the genome epidemiology site map. Genomic epidemiology of novel coronavirus - Global subsampling

【COVID-19 Updates 】
[July 9] 　Although the blood group genome is located on chromosome 9, it has been pointed out that the genome that is clearly associated with aggravation is located at a specific site on chromosome 3. Its genome type was inherited almost as it was from Neanderthals in Croatia or Denisovans 40,000 to 60,000 years ago. And the severity risk was 70% higher. Thirty % of South Asians, especially 63% of Bangladeshi, 8% of Europeans, and 4% of Americans had that type. Africans and East Asians did not (153).
(153)The major genetic risk factor for severe COVID-19 is inherited from Neandertals/bioRxiv
Asymptomatic infection accounts for 17 to 30% of all infections. Out of the total number of infected people, pre-symptomatic infections are 47%, asymptomatic infections are 6.6%, so that silent infections account for more than 50% of the total infections. According to simulations, it was difficult to control infections without isolating 30-40% of silent infections (154). It is still needed either to thoroughly increase the number of tests to detect and isolate silent infections at an early stage, or do not walk indoors that may cause silent infections due to obstruction of traffic to the outside air (152).
(154)The implications of silent transmission for the control of COVID-19 outbreaks/PNAS
[July 8] The spread of infected circle starting from the proband of infection is uneven, slow and small in one place, fast and large in another. Although 9 out of 10 people do not get a secondary infection, only the 10th person infects 20 people, so the reproduction number becomes 2. This is different from the fact that the reproduction number becomes 2 when all 10 people of flu infects 2 persons each. The reason why a super spread event occurs in a short time that cannot be explained only by contact or splash is the proband who is exhaling viruses each time he breathes, rather than the special proband as a super spreader. He is in a closed space with no air flow, so that secondary infection occurs by inhaling that air. This is the most relevant explanation. The answer to why it took as long as two months from December when the virus was brought to Italy to the outbreak was that it was a chain of super spread events due to airborne infection (151). Keep in mind that the virus excreted in exhaled breath of asymptomatic infected may stay alive in the air for up to 3 hours (152).
(151)Most People With Coronavirus Won’t Spread It. Why Do a Few Infect Many?/NYT
(152)It is Time to Address Airborne Transmission of COVID-19/Clinical Infectious Diseases
[July 7] According to a survey of 92,000 people in Brazil, if a person is vaccinated with flu vaccine within 1-2 months, even if they get COVID, severity rate is 8% lower, ventilator usage was 18% lower and mortality was 17% lower. More surprisingly, even if vaccinated after the onset of COVID, it was less severe and the mortality rate was 27% lower. Flu vaccine trains and activates various innate immune cells other than those that are only against influenza. This is called an off-target effect in which immune effects can be obtained against viruses other than influenza. BCG, measles, smallpox, and live polio vaccines are said to have similar immunostimulatory effects (150).
(150)Inactivated trivalent influenza vaccine is associated with lower mortality among Covid-19 patients in Brazil/medRxiv
[July 6] 　RT (Reverse Transcription)-LAMP method is expected to replace the current PCR test by expanding the test capacity more than 4 times. It can avoid recognizing accidentally other species of coronaviruses or common cold viruses. The concordance rate with PCR test was 94%, but efforts are currently being made to improve accuracy. It eliminates the need to extract RNA, so it costs only one-tenth and results in about 30 minutes (149). Domestic products have also been released.
(149)Standard operating procedures for SARS-CoV-2 detection by a clinical diagnostic RT-LAMP assay/medRxiv
[July 5] SARS-CoV-2 attaches to and invades an area of the gut called ACE2. ACE2 on cells of the intestine controls the absorption of amino acids and regulates the intestinal environment. The high quality gut bacterial environment created by a fiber-rich diet produces short-chain fatty acids. This promotes antiviral immunity, such as interferon and T-cells, which may increase protection in the lungs. However, when SARS-CoV-2 infects the gut, it conversely reduces ACE2 and increases the amount of bad gut bacteria. For mice, the bad environment with reduced ACE2 was improved by administration of tryptophan and nicotinamide. Even for humans infected with SARS-CoV-2, transplantation of good gut bacteria or infusion of ingredients that produce the equivalent effect may be effective (147)(148).
(147)ACE2 links amino acid malnutrition to microbial ecology and intestinal inflammation/nature
(148)Potential causes and consequences of gastrointestinal disorders during a SARS-CoV-2 infection/Cell Reports
[July 4] The pandemic was caused by the G-type virus, a point mutation of the D-type virus from China. The G-type virus, which is more infectious than the D-type virus, excreted a larger amount of virus and replaced the D-type virus all over the world. Viruses usually change shape in a direction where the neutralizing antibodies made by the immune system are not effective. Fortunately, however, the neutralizing antibody we have now was effective against the G-type virus. They were also not lethal (146).
(146)Tracking changes in SARS-CoV-2 Spike: evidence that D614G increases infectivity of the COVID-19 virus/Cell
Once inside a cell, SARS-CoV-2 hijacks the circuitry made up of enzymes called kineses, which are necessary for cell survival and mitotic growth. It then stops the cells from dividing and monopolizes the circuitry and materials needed for its own growth. In addition, many octopus-like protrusions are generated from the surface of the cells. The proliferating virus is then released from these protrusions to infect neighboring cells. There are more than eight drugs currently being tested to suppress kaines. Silmitasertib in particular is showing promise. It is intended to be used as a combination cocktail with other drugs, such as Remdesivir (145).
(145)The Global Phosphorylation Landscape of SARS-CoV-2 Infection/Cell
[July 3] Since the 1976 flu was similar to the 1918 pandemic strain, a vaccine was created in a hurry. However, it resulted in 500 paralysis and 25 deaths. Fifty% of people wanted to get vaccination, but ended up with a vaccination rate of 22% (143). Right now, a series of early clinical trials are ongoing (144). However, without sufficient efficacy and safety, it is not possible to gain the confidence to obtain herd immunity. In fact, while Moderna's messenger RNA vaccine was shown to be effective, one of the subjects had high fever and fainting in the first clinical trial. Unlike clinical trials, vaccination to all people is vaccination to all subjects, and ultimately, if all people do not get vaccinated, the true effect and safety are unknown (143).
(143)Here’s how we’ll know when a COVID-19 vaccine is ready/NATIONAL GEOGRAPHIC
(144)BioNTech and Pfizer’s Covid-19 vaccine trial yields positive results/FT
Even if the vaccine came to market successfully, on the other hand, a virus mutation has been confirmed in the European strain that hit the east coast. And its infectivity seems to be increasing. The vaccine currently in clinical trials is based on the premutation type. We have to recreate it from scratch (145).
(145)The D614G mutation in SARS-CoV-2 Spike increases transduction of multiple human cell types/bioRxiv
The virus is made up of 30,000 linked gene blocks. Every time it infects cells, one block in it is usually replaced by a different one, or missing by mistake. And as a result, it is said that it will evolve in a direction that will be advantageous to its own survival. It is suspected that the Indian strains are becoming more attenuated in that direction because of mutations and deletions at 10 locations in these blocks (146).
(146)Unique mutations could weaken Indian SARS-CoV-2 strain/NMLS
[July 2] 　Natural phenomena that occur on earth such as pandemics, climate change and extinction of species are interconnected. What they have in common is a phenomenon in which a positive feedback action acts on the dynamics, and they gradually build up while escalating. When the momentum exceeds some line, there must be a transition or disappearance that can never be recovered. There is a long time lag before a phenomenon becomes apparent. Even though the habitat of an organism including humans may seem to have diminished slightly, it is a common phenomenon that extinction has already been determined (142).
(142)COVID-19: Analogues and lessons for tackling the extinction and climate crises/Current Biology
[July 1] The earth is like a living organism, and all living organisms and other environments that compose it form a single integrated body. It has a total self-regulatory ability to maintain the liquidity of a living creature's stream, which flows through every corner of it for life. Observations support that the organisms in it do not evolve completely at random, but evolve with irreversible changes due to contingency, depending on changes in the environment. The evolution of organisms occurs in the direction of fusion due to the collision of separate genomes. The human genome and various viral genomes will collide with each other due to artificial changes in the environment (141).
(141)Evolutions’ next major transition
[June 30] 　Elderly people and obesity are the main targets of SARS-CoV-2, which infects 10 million people worldwide, whereas the fragmentation of supply chain mainly targets children and malnourished, and 820 million people are short on food. In fact, the main cause of food insecurity is severe damage to edible plants by RNA virus infection as same as SARS-CoV-2, although being quietly ongoing. To protect the plant, bioengineered vaccines for plants are used. Similar to a new type of vaccine for humans, this causes somatic cells to make fragments of the virus and learn to immunize against it. Applying this, human vaccine proteins are now mass-produced by plants. A plant of the genus Tobacco called Nicotiana benthamiana has the ability to make proteins at high speed, and can make flu vaccine at 4 times faster than conventional. Similarly, SARS-CoV-2 protein is being produced, and it is in progress to supply it in large quantities as a test reagent or vaccine (139)(140).
(139)Pandemics of People and Plants: Which Is the Greater Threat to Food Security?/Molecular Plant
(140)medicago
[June 29] 　Obesity easily causes severe COVID-19 and increases mortality. This is still a hypothesis, but it is expected that evidence will be gradually obtained in the future. The reason is that if you put a fire where there is plenty of fuel, the fire will naturally grow. Obesity not only makes blood clots more likely, but fat cells secrete many components that enhance inflammation. At the same time, the proliferation of adipocytes reduces the secretion of hormones that suppress inflammation. And when excess fat is deposited, inflammation in the lungs is exacerbated (138).
(138)When two pandemics meet: Why is obesity associated with increased COVID-19 mortality?/Med
[June 28] 　The future of the Southern Hemisphere entering winter will give us a hint for our future. For the concerned Southern Hemisphere parents, what to do if a child develops a cold is the task at hand (135). Child COVID-19 is visually indistinguishable from a common cold. However, in reality, it is unlikely to be possible if epidemic is considerably suppressed in the country or region, and unless it is a close contact. In Australia, PCR test positivity is 6 to 28 out of 45,000 cases per day, or 1 out of 1600 to 7500. (Japan has 40-100 cases out of 5,000 or 1 out of 50-125 cases.) If you reach such a point, most of the result is negative, and at the same time the result is a fairly accurate answer. Unless you're a heavy contact person, you're unlikely to be infected. Furthermore, SARS-CoV 2 infects by sticking to the portion of human cells called ACE2, but younger humans have less ACE2, and younger children have extremely less, so the virus may not infect and pass by children (136). Therefore, the probability of a child being infected is extremely close to zero if there is no infected person nearby (137). It is extremely important that caregivers of nursery, school teachers and parents do not get infected.
(135)Coronavirus or just a common cold? What to do when your child gets sick this winter/The Conversation
(136)Nasal ACE2 Levels and COVID-19 in Children/JAMA
(137)Yes, we’ve seen schools close. But the evidence still shows kids are unlikely to catch or spread coronavirus/The Conversation
[June 27] 　Those who showed a large decrease in physical activity due to stay home had worse mental health conditions such as anxiety, depressed mood, positive feelings, self-control, and vitality. Furthermore, it was confirmed that the effect was stronger in women (134). It is consistent with the observation in our clinical field.
(134)The impact of physical activity on psychological health during Covid-19 pandemic in Italy/Heliyon
[June 26] 　Vaccines are no longer a crystal of high technology. UK are starting a clinical trial of the latest self-amplifying messenger RNA vaccine, which is still under development, based on public funds and donations. It is made by wrapping only the necessary genome in nanoparticles without treating the bacteria or viruses as a whole. It is expected to be highly effective with a small amount of components, has few adverse reactions, and can be mass-produced in a short time with a simple process. This technology is used for vaccines for many viruses such as HIV. It will be the first large-scale clinical trial to see how the new type of vaccine that has just been prepared can actually be useful (131)(132).
(131)Government-funded Imperial College COVID-19 vaccine moves into first human trials/GOV.UK
(132)Self-amplifying RNA SARS-CoV-2 lipid nanoparticle vaccine induces equivalent preclinical antibody titers and viral neutralization to recovered COVID-19 patients/bioRxiv
Cholesterol medications has been shown to reduce mortality over the risk of becoming infected. In addition, a blood pressure drug called ARB, or ACE inhibitor that was taken at the same time, did not affect this results (133).
(133)In-hospital Use of Statins is Associated with a Reduced Risk of Mortality among Individuals with COVID-19/Cell Metabolism
[June 25]　 It is an extremely rational phenomenon that the idea that wearing a mask is an act contrary to the basic needs of humans is connected to a strong resistance to wearing a mask in the US. Even from the history of AIDS prevention, it is difficult to achieve the daily use of masks with no resistance, unless you have empathy and consider the belief that forcing a mask is an infringement of civil liberties, and the fact that wearing a mask can increase your physical risk (130). In this way, the shout of "Please put on a mask" will disappear in no time, even if it is a scientific fact, if the reason remains unknown to the whole society.
(130)The Dudes Who Won’t Wear Masks/The Atlantic
[June 24th] The first concept of Gilead's plan is to make remdecivir widely available outside the ward as an early treatment drug. A clinical trial of inhaled remdecivir is the beginning. Secondly, because remdecivir alone is not effective enough, it is necessary to establish a combination treatment with other drugs such as dexamethasone or tocilizumab that suppress hyperimmune reactions. Originally, many viruses have the property of being easily hidden in human cells, and it can be said that complete elimination with only one drug is rather rare. Even in the history of HIV treatment, there has been a visible improvement in treatment only after the emergence of combination therapy. The third is to expand the subjects that can be administered. In addition to children, they are planning clinical trials for pregnant women and end-stage renal disease (129).
(129)An Open Letter from Daniel O’Day, Chairman & CEO, Gilead Sciences/STORIES@Gilead
[June 23] In the US, where public-private partnerships are common, they plan to popularize, for example, a method of testing saliva for 4 people at once in order to expand screening for asymptomatic people. Only when the specimens of 4 persons have a positive reaction, it is enough to examine for 1 person in order. The lower the infection rate of the whole society, the more efficient it will be, for example in Japan. If you can ensure that you can examine more saliva than four at a time, you can be even more efficient (127). The more societies that maintain good social distances and facemasks, the more likely the negative results from this method will be true negative (128).
(127)Coronavirus (COVID-19) Update: Facilitating Diagnostic Test Availability for Asymptomatic Testing and Sample Pooling/FDA
(128)What a Negative COVID-19 Test Really Means/The Atlantic
SARS-CoV 2 has been found to infect many pet, husbandry and wild animals from humans. It goes to monkeys, ferrets, cats, and hamsters. Experiments have shown that it can also infect rabbits, sheep, goats, cows, horses and squirrels. Cats, dogs, which is the closest to humans, pigs, and mink which had actual infection to human, can be an asymptomatic reservoir. Surveillance of these animals will then be as important as one of pigs for the prevention of Japanese encephalitis.
(126)Host range of SARS-CoV-2 and implications for public health/Microbe
[June 22] Agriculture started 12000 years ago, and humans gradually expanded their living groups. At the same time, the opportunities to come in contact with mammals and birds other than dogs increased. As a result, zoonosis became an infectious disease, and with the expansion of trade, the pandemic was repeated in human history (124). This time, the effectiveness of the virus growth inhibitor GC376, which is used for coronavirus treatment in cats, was confirmed, and movement toward clinical trials has started (125).
(124)What the archaeological record reveals about epidemics throughout history – and the human response to them/the Conversation
(125)Anivive Repurposes Veterinary Drug GC376 for COVID-19 And Submits Pre-IND to FDA/P&T community
[June 21] Clinical trials of remdecivir on 50 non-mild children with COVID-19, including newborns, will begin in the US and Europe. They use their wisdom to efficiently carry out what is necessary and what they can do when they can, so as not to repeat the same mistakes in the future.
(123)Gilead to enroll pediatric patients for late-stage remdesivir study/REUTERS
[June 20] We do not yet know exactly how easily infected children will transmit or how clusters are likely to occur in a group of children, but two reports have provided clues, so we performed a very rough calculation. Susceptibility under age of 20 is 0.22 to 0.5 times that of adults (121) (122), 0.3 times more likely to develop symptoms under age of 19 than adults(121), and transmission from asymptomatic persons to others is 0.2 times higher than those with symptoms (101). Based on these, the ease of transmission from children to others is 0.10 to 0.18 times that of adults, R = 0.6 (122) for adults is R = 0.06 to 0.10 for children, and the tertiary infection rate is 0.022 to 0.09 times that of adults. Especially in infants, the tertiary infection rate is 0.02 to 0.04 times that of adults, and even under the conditions of childcare or school life, it seems to be less than 0.09. Even adults may not have a tertiary infection (122), so the infectivity from children and the cluster incidence rate in children are so low that they can be ignored.
(121)Age-dependent effects in the transmission and control of COVID-19 epidemics/nature medicine
(122)Household secondary attack rate of COVID-19 and associated determinants in Guangzhou, China: a retrospective cohort
study/Infectious Disease
[June 19] 　　Development of neutralizing antibody therapeutics is underway overseas. However, the problem is how to isolate from the original antibody to mass-produce. There is a limit to the amount that can be obtained from engineered mice or recovered humans. There is also a method of artificial synthesis, but a method has been devised to have engineered cows make large amounts of human antibodies (119)(120).
(119)The Promise of Antibody Treatments for Covid-19/WIRED
(120)SAB Biotherapeutics Confirms Neutralizing Antibodies to SARS-CoV-2 and Begins Clinical Manufacturing of Novel COVID-19 Therapeutic Candidate/businesswire
[June 18th] If the fire to kill the virus becomes too large, your body will not hold up, so you just have to weaken the momentum of the fire to some extent, and a drug that weaken the firepower have the effect of suppressing the severity of disease (116). However, it will take more time to burn out the virus. If you turn off the heat with steroids, it will take longer for the virus to disappear (117)(118). It seems that it is necessary to adjust the heat appropriately.
(116)GM-CSF blockade with mavrilimumab in severe COVID-19 pneumonia and systemic hyperinflammation: a single-centre, prospective cohort study/Rheumatology
(117)Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis/Leukemia
(118)Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients/JCV
[June 17] Dexamethasone 6 mg daily for 10 days or less for critically ill patients reduced the fatality rate by 20% when oxygen was needed and by 30% when ventilator was needed. Neither serious adverse events nor secondary infections (115). In treating the illness that can be called a fire of the immune system, not only an aggressive attitude to remove the cause of the fire but also a protective treatment to prevent the fire from spreading will still be effective.
(115)Commonly used steroid reduces risk of death in sickest coronavirus patients, preliminary study results suggest/cnn
[June 17] 　Rally for vaccine clinical trials and therapeutic drug development has begun overseas. Final clinical trials of Sinovac Biotech vaccine begin in South America (112). Production system that can supply 100 million bottles per year is being prepared. Two antibody cocktail therapy is expected to be effective in both treatment and prevention. It has advantage that virus resistance will be unlikely to occur. Regeneron begins clinical trials (113). Furthermore, it is reported that a component called Nsp9, which is essential for the proliferation of SARS-CoV 2, were able to be extracted and created. It has the same structure as other coronaviruses. A drug that interferes with the action of Nsp9 can be expected to suppress the onset and severity (114).
(112)Sinovac says early data show its Covid-19 vaccine generated immune responses/STAT
(113)Studies in humanized mice and convalescent humans yield a SARS-CoV-2 antibody cocktail/Science
(114)Crystal structure of the SARS-CoV-2 non-structural protein 9, Nsp9/iScience
[June 16] In the US, where both the number of infection and fatalities are 120 times that of Japan (110), it is estimated that the number of infection will double to the present number in the next two months. However, air of resignation is beginning to drift, "We can't go back to lockdown now" (111). On the other hand, development of genome editing technology test and treatment method, implementation of more than 440,000 PCR tests daily including saliva PCR, approval of remdecivir and practice of antiandrogen treatment, clinical trial of antibody therapeutic drug, the start of more than 160,000 clinical trials of moderna, AstraZeneca and J&J vaccines. These substantial treatment and prevention are being put into practice in order to compete with the momentum of re-expansion of virus. So Japan seems safe and quiet.
(110)CDC
(111)The Virus Will Win/The Atlantic
[June 15] SARS-CoV 2 changes genes only around 1/2 to 1/6 as fast as influenza. It is assumed that SARS-CoV 2 will be mutated to reduce the number of asymptomatic individuals, prolong the presymptomatic period, and decrease the severity of the disease because it will adaptively evolve in a direction in which viruses can reproduce as if many creatures do so. However, with sufficient infectivity, sufficient population to be transmitted, and no pressure to prevent the virus from reproducing, no obvious changes in the virus are visible (109).
(109)On the evolutionary epidemiology of SARS-CoV-2/Current Biology
[June 14] First reason why the number of infection and severe cases in Africa is lower than expected is due to the overwhelmingly large population of young people. The second is the impact of climate (107). Another way to think of this is that there is one-way selective pressure that creates a game-like symbiotic relationship where one infection is dominant and another is inferior under some environment. Africa may be already close to being full of several infectious diseases, so that it may be difficult for new infectious diseases that are difficult to adapt to the pressure to enter. Additionally, human body, once one germ inhabits, is equipped with an immune mechanism that prevents strong reactions when the next germ enters, so the symptoms might not stand out even when a new virus comes in (108).
(107)Socio-demographic and epidemiological consideration of Africa’s COVID-19 response: what is the possible pandemic course?/nature medicine
(108)Regulation of the host immune system by helminth parasites/JACI
[June 13] 　　In fact, experimental models are indispensable for efficiently finding new candidates and confirming the efficacy of drugs and vaccines. With creation of a mouse model in which SARS-CoV 2 can be infected like humans, new drugs and vaccines are much easier to find. (106). The road of development has expanded greatly.
(106)Generation of a Broadly Useful Model for COVID-19 Pathogenesis Vaccination, and Treatment/Cell
[June 12]　　 Immune cells that set fire to invasion of viruses try to get rid of them by igniting fire. However, in the event of a big fire, body will be lean, so immune cells that extinguish fire will also be ejected. BCG is expected to educate the igniters, while actually it also has the effect of educating the fire fighters. As a result, even if the virus comes in, it does not have to be a big fire or serious illness. The importance of extinguishing fire is also known for COVID-19 and Kawasaki disease (30)(104). Mixture of bacterias is known to educate fire fighters. The clinical trial begins (105). There exist countries around the world that can explore various possibilities and carry out clinical trials immediately.
(104)Transforming Growth Factor-β Signaling Pathway in Patients With Kawasaki Disease/Circulation
(105)OM85: could bacteria in a capsule protect us from coronavirus and other respiratory infections?/The Conversation
[June 11]　　It has been reported that two inoculations of rhesus monkeys with inactivated vaccine have good results in efficacy and safety with no complaints (103). If no doubt, possibly, you'll see footage of January's deja vu, ending a flash of clinical trials in Africa or South America, and getting vaccinated in mainland China by beginning of autumn breeze.
(103)Development of an inactivated vaccine candidate, BBIBP-CorV, with potent protection against SARS-CoV-2/Cell
[June 10] 　Positive rate of antibody test in domestic is around 0.5%. This is roughly the same as number of people infected during an epidemic of viral gastroenteritis. This number can be interpreted as high enough in just one epidemic. It corresponds to the fact that designated hospitals became dysfunctional due to overflow of infected patients even in Japan. It may be actually due to just the luck attributed to facemask wearing habit for Japanese people, in contrast to 19% in New York City or 7% in Sweden.
It has been recognized that the more frequent the chances of getting intimate contact with an index person, the extremely higher the susceptibility to infection becomes, and the farther away it becomes extremely lower (57). 16% of persons who contacted the pre-onset index person more than 5 times in 2 days, that is, concentrated contacts such as family members, got secondarily infected. They are more likely to be infected 29 times higher than those who only contacted once in 2 days. Risk of infections were about 1/5 lower from asymptomatic patients than that from those who developed symptoms (101).
Facemask has now proven to be effective against this phenomenon of susceptibility (86). If everyone always wears a mask in public, even asymptomatic, it will reduce the effective reproduction number twice as compared to if masking only after symptoms appear. It is estimated that if more than 50% of people wear facemasks in public at all times, spread of infection can be suppressed even under loose restrictions (102).
(101)Secondary Transmission of Coronavirus Disease from Presymptomatic Persons, China/EID
(102)A modelling framework to assess the likely effectiveness of facemasks in combination with ‘lock-down’ in managing the COVID-19 pandemic/The Royal Society A
[June 10] 　　Kawasaki disease (KD) is a post-infectious systemic inflammatory syndrome triggered by viral infection. CoV-2-related paediatric inflammatory multisystem syndrome (CoV-PIMS), namely the severe form of KD, occured in 4~5 weeks period after COVID-19 infection(99). The crucial difference of CoV-PIMS from KD is that 76% of children have myocarditis and easily fall into shock. This is the typical severe state of COVID-19. The high risk of aggravation on having African ancestry was also common with the risk of severity for COVID-19 in adults (100).
(99)SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020/Eurosurveillance
(100)Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study/BMJ
[June 9] 　　Now, if you look at the trends in the number of infections, you can imagine any possible future that may happen. The difference from before the outbreak was not because the numbers became readable, but because it was possible to add meaning to the numbers just by the experiential learning effect (97). The announcement such as "Now is a situation around what month and day" is more convincing.
(97)Of Viruses, Vaccines, and Variability: Qualitative Meaning Matters/Trends in Cognitive Sciences
There are two reasons why we should prepare saliva antigen test or PCR on hand at a general clinic or hospital. First, humans are creatures that seek social and physical contact with their peers and loved ones in an effort to defend their minds against threats and seek to work together. The rational recognition of the threat that oneself or loved ones may die, rather evokes the instinct of wanting to meet directly. It is impossible to eliminate social contact under threat. This is incorporated into the logic of what to prepare as cognitive and behavioral sciences in countries with advanced science (98). Second, now is the time nursery or school is reopened, a summer cold in which fever was the main symptom, has already begun. The differential diagnosis without any specific diagnostic method for COVID-19 was completely the same as in February, we had to rely on the dangerous intuition that it was probably a cold or maybe a cold. Medical examination itself must be frozen again.
(98)Pandemics and the great evolutionary mismatch/Current Biology
[June 6] 　　Saliva PCR is likely to become popular in Japan this month. Next, it seems that therapeutic drugs will be popular earlier than vaccines. This is because development of neutralizing antibody drugs is gaining momentum. For example, small neutralizing antibody called VHH made by animal llama neutralized SARS-CoV 2 more efficiently than conventional antibodies in the lab. It is highly stable, and it seems that it will be possible for delivery to use inhalation therapy as used for treatment of asthma or influenza (93).
(93)Coronavirus: why we’re using llamas to help fight the pandemic/The Conversation
[June 5] 　　　There are few reports of clusters from childcare facilities in the world (91). It is assumed that the risk of spreading infection from child population is low. However, when we actually come to where children may play with each other, a question arises as to how far we can forgive. Though the way of thinking varies depending on your environment in which parents are placed, it is necessary to allow each other's values, at the same time so as not to forcibly change rules set by each other. Each family should decide how far their families can tolerate and how realistic they can be without requiring 100% to children (92).
(91)16 infected north of Montreal in Quebec's first COVID-19 outbreak in a daycare/CTVnews
(92)How Do You Decide if Children Can Play Together Again?/NYT
[June 4] 　　We know that men are twice as likely to become more severe than women. However, a survey result showed that there are obviously many men who don't wear masks in areas where it is not compulsory, and men are more likely to think that they are okay and reluctant to wear masks (90).
(90)The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission/PsyArXiv
[June 3] SARS-CoV 2 appears to be the result of frequent recombination between bats, pangolins and human coronaviruses. The part necessary to infect humans was completely replaced by pangolins (88). In addition, the part required for SARS-CoV 2 growth was adapted to humans whose body temperature is lower than that of bats (89).
(88)Emergence of SARS-CoV-2 through recombination and strong purifying selection/ScienceAdvances
(89)Structural and biochemical characterization of nsp12-nsp7-nsp8 core polymerase complex from SARS-CoV-2/Cell Reports
[June 2] 　　Results of phase 1 trial for patients of the neutralizing monoclonal antibody treatment, which was reported here on April 25 and was expected to be rapidly put into practical use and to be definitely effective, will be released by Eli Lilly in this month. At the same time, they are strengthening production system so that they can supply large quantities in this fall (87).
(87)Lilly Begins World's First Study of a Potential COVID-19 Antibody Treatment in Humans/Eli Lilly
[June 1] Celltrion announced to start clinical trials of neutralizing antibody therapeutics in July (85). Once the expected safety of the treatment is confirmed, peace of mind spreads at once. No doubt, we have entered the stage where the progress of therapeutics is expanding and accelerating.
(85)Celltrion Announces Positive Pre-clinical Results for COVID- 19 Antiviral Antibody Treatment, Showing Improvement in Recovery Time/businesswire
[June 1]　　 It is common for major scientific advances to happen as if rising suddenly from the first floor to the second floor one day. Now is the time humankind is in danger of survival, unlike the normal times, the chance must be increased obviously that treatment with genome editing technology will be commercialized in a surprisingly short period of time (84).
(84)Development of CRISPR as an Antiviral Strategy to
Combat SARS-CoV-2 and Influenza/Cell
[May 30] 　　All the tests are already completed with just saliva. RNA detection kit using genome editing technology can bring results within one hour at home without sending saliva to lab. It will cost around ＄1~2 and replace PCR test (77). Antigen testing has also become possible with saliva (78). Antibody testing for herd immunity has become possible with saliva as well (79). These kits become available soon before we move to the next stage.
(77)Rapid home-based coronavirus tests are coming together in research labs — we’re working on analyzing spit using advanced CRISPR gene editing techniques/The Conversation
(78)Japan to approve quick antigen, saliva-based coronavirus tests/Xinhua
(79)COVID-19 serology at population scale: SARS-CoV-2-specific antibody responses in saliva/medRxiv
[May 24]　 This is an epidemic forecast in Japan for the next year based on the epidemic model published in Science Journal, although there are pros and cons regarding suggesting a prospect (60).
The epidemic curve is supposed to be most affected by population immunity, or in other words, susceptibility to infection (61). Successful clinical trials of more than 100,000 vaccines in the US starting in July or later are likely to lead to rapid changes in population immunity associated directly with effective number of reproductions (62).
We takes into account many variables that have persistent recursive effect on the effective reproduction numbers or susceptibility to infection. Impact of climate on virus spread is minimal (61). Changes in human cognition and behavior, changes in timing of government intervention, and real economic dynamics that affects human migration and population density. It also assumes that social distancing measures are maintained unless there is effective vaccines or treatments.

“There will be little or no epidemic or small outbreaks from summer to fall during 2020, although small clusters may occur.
After the end of this year or during the spring and summer of 2021, there will be a relatively large second wave or no outbreak.”

Above is a prediction at this moment.
(60)Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period/Science
(61)Susceptible supply limits the role of climate in the early SARS-CoV-2 pandemic/Science
(62)Exclusive: U.S. plans massive coronavirus vaccine testing effort to meet year-end deadline/Reuters
[May 6] RNA viruses containing SARS-CoV2 have been incorporated into the chains of human genes and have helped to expand human diversity (33). There is also a theory that AIDS is cured when the body's immune reaction to eliminate the virus does not occur, and at the same time, the virus is completely incorporated into the chain of human genes (34).
(33)Endogenous non-retroviral RNA virus elements in mammalian genomes/Nature
(34)HIV infection en route to endogenization: two cases/Clinical Microbiology and Infection

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