CORONA Main Coronavirus thread

Trivium Pursuit

Veteran Member
Prayers added. I wish there was a way you could avoid this assignment. Not just because of the hospital you'll be going to, but where you will be staying, where you will be eating, etc. Stay safe, wear masks and gloves everywhere, and if you are staying in a motel, do your own sanitizing when you check in and then refuse entry to everyone, including housekeeping, until you leave.

Thank you, I was able to switch to an apartment in November, due to the extreme long duration of the project. These projects are usually 4-6 months duration, but this is easily the biggest hospital system in Texas, so I've been here 14 months. I got a boot tray and the shoes go into that and I spray the bottoms of them with lysol. And let mail sit for days and so forth and so on.


passin' thru

Trivium Pursuit

Veteran Member
Today was my 1st 12 hour shift rounding in one of my hospitals here around Dallas since February. My data will not be representative, however because it turns out that I was assigned to a heart hospital. And some nurses told me last week that they try to keep that hospital "clean". Meaning always just people going in for heart stuff and not sending corona virus patients there.

That said, today was an interesting day. They had a celebration. Somebody who had been hospitalized there for 2 months with Corona virus (probably dx'ed with it after arriving), including some time on a ventilator, was wheeled out today and declared cured. All the nurses on the floor and a number of other personnel all lined up, it's kind of like one of those send offs for someone who has beaten cancer. We all applauded and they wheeled him out. I was tempted to take a picture but respected the patient's privacy.

It felt pretty good. But I learned something pretty sobering. Nurses there told me at 1 point this guy was on 16 IV lines just to keep him alive. They have a little isolated area off one of the ICU's where they have 2 patients right now who are in isolation. I didn't ask but I'm fairly certain that they have it. I saw the whole procedure of someone coming out of one of those Rooms. Getting off the booties and so forth on the spiked tray that is filled with decontaminats. And outside the next Room, a doctor came and they gave the doctor a phone or a walkie talkie to call in and talk to a nurse who is very heavily gowned up in the Room working with the patient.

In the area outside the rooms, a nurse with disinfecting every chair, keyboard, desk, railing, etc , around. I asked how frequently she is doing and she said every 2 hours.


TB Fanatic
Three Gorges Dam secretly discharged, leaked govt doc shows; China warns US not to 'cross the line'
•Premiered 3 hours ago

China in Focus - NTD

Amid the Three Gorges Dam's fast-rising water level, speculation was rising among locals that the dam was leaking water downstream. Based on an internal document we obtained, the authorities ordered workers at the dam to release water downstream on Sunday evening.

400k people face quarantine as another county in China goes under lockdown. Despite few reported virus cases, the county is adopting the same measures as epicenter Wuhan used when the virus first hit.

A Chinese farmer suddenly loses the legitimacy of his land. The farmer and his family have been farming there for four generations in the past 60 years.

Contradictory virus numbers are coming out of China’s capital. That’s as one hospital reports more virus cases than all of Beijing combined.

Shares for one Chinese company listed in Nasdaq plunged over 20%, after some of the gold it used to obtain loans turned out to be fake.

The situation between the U-S and the Chinese regime is still tense. Now, the Wall Street Journal reports that Beijing quietly warned the Trump administration not to cross a line on issues it considers “off limits.” Beijing warned there would be retaliation, particularly in regards to the Phase One trade deal.

Heliobas Disciple

Has No Life - Lives on TB
(fair use applies)

World's dominant strain of coronavirus 'is 10 TIMES more infectious than the one that jumped to humans in China' because it mutated so its vital spike protein doesn't snap as often in the body, scientists say
By Sam Blanchard
Published: 13:41 EDT, 29 June 2020 | Updated: 22:07 EDT, 29 June 2020

  • Experts in Florida have added deeper understanding about the changed virus
  • They say spike protein in original version of Covid-19 was weaker and snapped
  • But the dominant strain in Europe and North America has evolved to be stronger
  • This does not, however, appear to make patients any sicker or less sick

A mutated version of the coronavirus that has gripped Europe and the West is more infectious because it doesn't break as often while inside the body, a study has found.

Researchers at The Scripps Research Institute in Florida say the 'spike protein' that the virus uses to attach to cells in the airways has adapted since January.

It used to break off regularly while trying to bind to receptors in people's airways, which it would use to gain entry to the body, but is now more resilient, they say.

A genetic mutation which scientists around the world have been picking up on for months appears to have caused this spike to be less likely to snap, and also to force the coronaviruses to produce more of them to make itself more infectious.

As a result the virus appears to be approximately 10 times more infectious than it was when it first jumped to humans in China at the end of the year, scientists say.

The mutated version of the virus, dubbed G614 - a change from D614 - is a tiny change in its genetic make-up that scientists weren't sure what to make of when they found it.

But by May research had found it had become the dominant strain being found in Covid-19 patients across the UK, US, Canada and Italy.

Lead researcher on the Scripps institute's study, Dr Hyeryun Choe, told the Washington Post the mutation seemed to have happened to 'compensate' for the weakness of the spike protein in the past.

The Post reported it appeared to have become approximately 10 times more infectious as a result of this change.

The way the virus enters the body is by using its spike to latch onto a receptor - called an ACE-2 receptor - inside someone's airways.

ACE-2 receptors are essentially tiny gateways that the virus uses to get into the blood and then multiply rapidly, destroying cells around them in the process and triggering illness.

Dr Choe and her colleagues examined the differences between the spike proteins, dubbed S, on the outside of both versions of the coronavirus.

They found: 'These results show SG614 is more stable than SD614, consistent with epidemiological data suggesting that viruses with SG614 transmit more efficiently.'

The spike was stronger, they said, and as a result the virus was better able to bash through the gateway of the ACE-2 receptors.

Dr Choe told the Washington Post: 'The epidemiological study and our data together really explain why the [G variant's] spread in Europe and the US was really fast... This is not just accidental.'

However, this improved spike strength did not seem to be making people any sicker - or any less sick.

This, they suggested, could be because the spike had nothing to do with the virus's ability to reproduce - to replicate - once it was inside the body.

The process of reproduction, and using the body's resources to achieve this, is how the coronavirus causes illness.

Dr Choe's study added: 'An interesting question is why viruses carrying the more stable SG614 appear to be more transmissible without resulting in a major observable difference in disease severity.

'It is possible that higher levels of functional S protein observed with SG614 increase the chance of host-to-host transmission, but that other factors limit the rate and efficiency of intra-host replication.'

The paper was published online on bioRxiv without being reviewed by independent scientists.

Researchers in the UK and US had in May noted that the G614 version of the virus had become 'the dominant pandemic form in many countries'.

They said it was first found in Germany in February and had since become the most common form of the virus in patients worldwide - it appears to force out the older version whenever they clash.

Viruses mutate naturally all the time and it is not usually cause for alarm but should be studied in case they change so much they become unrecognisable to the body and immunity from a first infection cannot protect against them, as is the case with flu.

A study done by scientists at the University of Sheffield and Los Alamos National Laboratory, New Mexico, found that D614 appeared to have been the virus's original state in humans, and the one found in Wuhan.

It made up the vast majority of all Covid-19 infections in China, and Asia as a whole, and also seemed to be the first version of the virus to appear in the countries they studied.

However, the mutated version - G614 - started to appear soon after in Europe and North America in particular, before going on to take over as the dominant virus.

'A clear and consistent pattern was observed in almost every place where adequate sampling was available,' the researchers said.

'In most countries and states where the COVID-19 epidemic was initiated and where sequences were sampled prior to March 1, the D614 form was the dominant local form early in the epidemic.

'Wherever G614 entered a population, a rapid rise in its frequency followed, and in many cases G614 became the dominant local form in a matter of only a few weeks.'

They said the G614 mutation may give the virus a 'selective advantage' which makes it better able to bind to cells in the airways, or to shed viruses which it uses to reproduce and spread.

It could do this because the D614G mutation appeared to affect the shape of the 'spike' protein that the virus uses to attach to a person's cells and infect them.

A sample of 447 hospital patients in Sheffield showed that people had a higher viral load when infected with G614, meaning they had a higher quantity of viruses circulating in their body.

This could make them more likely to spread COVID-19 because they could be more likely to show symptoms and have more viruses on their breath, for example.

The researchers wrote: 'An early April sampling... showed that G614's frequency was increasing at an alarming pace throughout March, and it was clearly showing an ever-broadening geographic spread.'

And they added: 'Through March, G614 became increasingly common throughout Europe, and by April it dominated contemporary sampling.

'In North America, infections were initiated and established across the continent by the original D614 form, but in early March, the G614 was introduced into both Canada and the USA, and by the end of March it had become the dominant form in both nations.'


Viruses are known to change over time because they are subject to random genetic mutations in the same way that all living things are.

These mutations can have various effects and many will only happen briefly and not become a permanent change as newer generations of viruses replace the mutated ones.

However, some of the mutations might turn out to be advantageous to the virus, and get carried forward into future generations.

A virus may change its structure by accident but turn out to be more infectious that way, meaning it can infect more hosts, reproduce more, and become more dominant than its less fertile predecessor.

Or if a virus becomes less dangerous to its host - that is, it causes fewer symptoms or less death - it may find that it is able to live longer and reproduce more.

As a result, more of these less dangerous viruses are produced and they may go on to spread more effectively than the more dangerous versions, which could be stamped out by medication because more people realise they are ill, for example.

The mutation may then be taken forward in the stronger generations and become the dominant version of the virus.

In an explanation of an scientific study about HIV, the NHS said in 2014: 'The optimal evolutionary strategy for a virus is to be infectious (so it creates more copies of itself) but non-lethal (so its host population doesn’t die out).

'The "poster boy" for successful long-living viruses is, arguably, the family of viruses that cause the, which has existed for thousands of years.'


Heliobas Disciple

Has No Life - Lives on TB
(fair use applies)

This coronavirus mutation has taken over the world. Scientists are trying to understand why.
By Sarah Kaplan and Joel Achenbach
June 29 at 9:00 AM

When the first coronavirus cases in Chicago appeared in January, they bore the same genetic signatures as a germ that emerged in China weeks before.

But as Egon Ozer, an infectious-disease specialist at the Northwestern University Feinberg School of Medicine, examined the genetic structure of virus samples from local patients, he noticed something different.

A change in the virus was appearing again and again. This mutation, associated with outbreaks in Europe and New York, eventually took over the city. By May, it was found in 95 percent of all the genomes Ozer sequenced.

At a glance, the mutation seemed trivial. About 1,300 amino acids serve as building blocks for a protein on the surface of the virus. In the mutant virus, the genetic instructions for just one of those amino acids — number 614 — switched in the new variant from a “D” (shorthand for aspartic acid) to a “G” (short for glycine).

But the location was significant, because the switch occurred in the part of the genome that codes for the all-important “spike protein” — the protruding structure that gives the coronavirus its crownlike profile and allows it to enter human cells the way a burglar picks a lock.

And its ubiquity is undeniable. Of the approximately 50,000 genomes of the new virus that researchers worldwide have uploaded to a shared database, about 70 percent carry the mutation, officially designated D614G but known more familiarly to scientists as “G.”

“G” hasn’t just dominated the outbreak in Chicago — it has taken over the world. Now scientists are racing to figure out what it means.

At least four laboratory experiments suggest that the mutation makes the virus more infectious, although none of that work has been peer-reviewed. Another unpublished study led by scientists at Los Alamos National Laboratory asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others.

The mutation doesn’t appear to make people sicker, but a growing number of scientists worry that it has made the virus more contagious.

“The epidemiological study and our data together really explain why the [G variant’s] spread in Europe and the U.S. was really fast,” said Hyeryun Choe, a virologist at Scripps Research and lead author of an unpublished study on the G variant’s enhanced infectiousness in laboratory cell cultures. “This is not just accidental.”

But there may be other explanations for the G variant’s dominance: biases in where genetic data are being collected, quirks of timing that gave the mutated virus an early foothold in susceptible populations.

“The bottom line is, we haven’t seen anything definitive yet,” said Jeremy Luban, a virologist at the University of Massachusetts Medical School.

The scramble to unravel this mutation mystery embodies the challenges of science during the coronavirus pandemic. With millions of people infected and thousands dying every day around the world, researchers must strike a high-stakes balance between getting information out quickly and making sure that it’s right.

A better lock pick

SARS-CoV-2, the novel coronavirus that causes the disease covid-19, can be thought of as an extremely destructive burglar. Unable to live or reproduce on its own, it breaks into human cells and co-opts their biological machinery to make thousands of copies of itself. That leaves a trail of damaged tissue and triggers an immune system response that for some people can be disastrous.

This replication process is messy. Even though it has a “proofreading” mechanism for copying its genome, the coronavirus frequently makes mistakes, or mutations. The vast majority of mutations have no effect on the behavior of the virus.

But since the virus’s genome was first sequenced in January, scientists have been on the lookout for changes that are meaningful. And few genetic mutations could be more significant than ones that affect the spike protein — the virus’s most powerful tool.

This protein attaches to a receptor on respiratory cells called ACE2, which opens the cell and lets the virus slip inside. The more effective the spike protein, the more easily the virus can break into the bodies of its hosts. Even when the original variant of the virus emerged in Wuhan, China, it was obvious that the spike protein on SARS-CoV-2 was already quite effective.

But it could have been even better, said Choe, who has studied spike proteins and the way they bind to the ACE2 receptor since the severe acute respiratory syndrome outbreak in 2003.

The spike protein for SARS-CoV-2 has two parts that don’t always hold together well. In the version of the virus that arose in China, Choe said, the outer part — which the virus needs to attach to a human receptor — frequently broke off. Equipped with this faulty lock pick, the virus had a harder time invading host cells.

“I think this mutation happened to compensate,” Choe said.

Studying both versions of the gene using a proxy virus in a petri dish of human cells, Choe and her colleagues found that viruses with the G variant had more spike proteins, and the outer parts of those proteins were less likely to break off. This made the virus approximately 10 times more infectious in the lab experiment.

The mutation does not seem to lead to worse outcomes in patients. Nor did it alter the virus’s response to antibodies from patients who had the D variant, Choe said, suggesting that vaccines being developed based on the original version of the virus will be effective against the new strain.

Choe has uploaded a manuscript describing this study to the website bioRxiv, where scientists can post “preprint” research that has not yet been peer reviewed. She has also submitted the paper to an academic journal, which has not yet published it.

The distinctive infectiousness of the G strain is so strong that scientists have been drawn to the mutation even when they weren’t looking for it.

Neville Sanjana, a geneticist at the New York Genome Center and New York University, was trying to figure out which genes enable SARS-CoV-2 to infiltrate human cells. But in experiments based on a gene sequence taken from an early case of the virus in Wuhan, he struggled to get that form of the virus to infect cells. Then the team switched to a model virus based on the G variant.

“We were shocked,” Sanjana said. “Voilà! It was just this huge increase in viral transduction.” They repeated the experiment in many types of cells, and every time the variant was many times more infectious.

Their findings, published as a preprint on bioRxiv, generally matched what Choe and other laboratory scientists were seeing.

But the New York team offers a different explanation as to why the variant is so infectious. Whereas Choe’s study proposes that the mutation made the spike protein more stable, Sanjana said experiments in the past two weeks, not yet made public, suggest that the improvement is actually in the infection process. He hypothesized that the G variant is more efficient at beginning the process of invading the human cell and taking over its reproductive machinery.

Luban, who has also been experimenting with the D614G mutation, has been drawn to a third possibility: His experiments suggest that the mutation allows the spike protein to change shape as it attaches to the ACE2 receptor, improving its ability to fuse to the host cell.

Different approaches to making their model virus might explain these discrepancies, Luban said. “But it’s quite clear that something is going on.”

Unanswered questions

Although these experiments are compelling, they’re not conclusive, said Kristian Andersen, a Scripps virologist not involved in any of the studies. The scientists need to figure out why they’ve identified different mechanisms for the same effect. All the studies still have to pass peer review, and they have to be reproduced using the real version of the virus.

Even then, Andersen said, it will be too soon to say that the G variant transmits faster among people.

Cell culture experiments have been wrong before, noted Anderson Brito, a computational biologist at Yale University. Early experiments with hydroxychloroquine, a malaria drug, hinted that it was effective at fighting the coronavirus in a petri dish. The drug was touted by President Trump, and the Food and Drug Administration authorized it for emergency use in hospitalized covid-19 patients. But that authorization was withdrawn this month after evidence showed that the drug was “unlikely to be effective” against the virus and posed potential safety risks.

So far, the biggest study of transmission has come from Bette Korber, a computational biologist at Los Alamos National Laboratory who helped build one of the world’s biggest viral genome databases for tracking HIV. In late April, she and colleagues at Duke University and the University of Sheffield in Britain released a draft of their work arguing that the mutation boosts transmission of the virus.

Analyzing sequences from more than two dozen regions across the world, they found that most places where the original virus was dominant before March were eventually taken over by the mutated version. This switch was especially apparent in the United States: Ninety-six percent of early sequences here belonged to the D variant, but by the end of March, almost 70 percent of sequences carried the G amino acid instead.

The British researchers also found evidence that people with the G variant had more viral particles in their bodies. Although this higher viral load didn’t seem to make people sicker, it might explain the G variant’s rapid spread, the scientists wrote. People with more virus to shed are more likely to infect others.

The Los Alamos draft drew intense scrutiny when it was released in the spring, and many researchers remain skeptical of its conclusions.

“There are so many biases in the data set here that you can’t control for and you might not know exist,” Andersen said. In a time when as many as 90 percent of U.S. infections are still undetected and countries with limited public health infrastructure are struggling to keep up with surging cases, a shortage of data means “we can’t answer all the questions we want to answer.”

Pardis Sabeti, a computational biologist at Harvard University and the Broad Institute, noted that the vast majority of sequenced genomes come from Europe, where the G variant first emerged, and the United States, where infections thought to have been introduced by travelers from Europe spread undetected for weeks before the country shut down. This could at least partly explain why it appears so dominant.

The mutation’s success might also be a “founder effect,” she said. Arriving in a place like Northern Italy — where the vast majority of sequenced infections are caused by the G variant — it found easy purchase in an older and largely unprepared population, which then unwittingly spread it far and wide.

Scientists may be able to rule out these alternative explanations with more rigorous statistical analyses or a controlled experiment in an animal population. And as studies on the D614G mutation accumulate, researchers are starting to be convinced of its significance.

“I think that slowly we’re beginning to come to a consensus,” said Judd Hultquist, a virologist at Northwestern University.

Solving the mystery of the D614G mutation won’t make much of a difference in the short term, Andersen said. “We were unable to deal with D,” he said. “If G transmits even better, we’re going to be unable to deal with that one.”

But it’s still essential to understand how the genome influences the behavior of the virus, scientists say. Identifying emerging mutations allows researchers to track their spread. Knowing what genes affect how the virus transmits enables public health officials to tailor their efforts to contain it. Once therapeutics and vaccines are distributed on a large scale, having a baseline understanding of the genome will help pinpoint when drug resistance starts to evolve.

“Understanding how transmissions are happening won’t be a magic bullet, but it will help us respond better,” Sabeti said. “This is a race against time.”


Heliobas Disciple

Has No Life - Lives on TB
(fair use applies)

"This Is Not Just Accidental": How One Coronavirus Mutation Helped The Virus Conquer The Globe
by Tyler Durden
Mon, 06/29/2020 - 19:55

Scientists have been hard at work unraveling the mysteries of SARS-CoV-2 since January, when Beijing finally shared a mapped genome with the global scientific community (though early research also filtered out via the British journal "The Lancet"). At this point, scientists around the world have examined hundreds of thousands of viral samples from around the world. They've compared and contrasted their genetic code, and they've identified what appears to be an important pattern. That is: the earliest version of the virus that spread in Wuhan is not genetically identical to the iteration that went on to conquer Europe and the US.

According to a Bloomberg report comparing the findings from four non-peer-reviewed studies, it appears that a notable mutation of the virus that emerged broadly and early during its global campaign helped render COVID-19 more infectious in later iterations than it was during the early weeks of the outbreak, raising fears that the virus could continue to evolve in a way that eludes scientists working on a vaccine, or simply makes the virus more deadly.

At least four laboratory experiments suggest that the mutation makes the virus more infectious, although none of that work has been peer-reviewed. Another unpublished study led by scientists at Los Alamos National Laboratory asserts that patients with the G variant actually have more virus in their bodies, making them more likely to spread it to others.
The mutation doesn't appear to make people sicker, but a growing number of scientists worry that it has made the virus more contagious.
"The epidemiological study and our data together really explain why the [G variant's] spread in Europe and the U.S. was really fast," said Hyeryun Choe, a virologist at Scripps Research and a lead author of an unpublished study on the G variant's enhanced infectiousness in laboratory cell cultures. "This is not just accidental."

Another team of researchers described the feeling of shock when they realized just how much more effective this mutation made the virus in terms of its ability to break into human cells.

Neville Sanjana, a geneticist at the New York Genome Center and New York University, was trying to figure out which genes enable SARS-CoV-2 to infiltrate human cells. But in experiments based on a gene sequence taken from an early case of the virus in Wuhan, he struggled to get that form of the virus to infect cells. Then the team switched to a model virus based on the G variant.
"We were shocked," Sanjana said. "Voilà! It was just this huge increase in viral transduction." They repeated the experiment in many types of cells, and every time the variant was many times more infectious.

The mutation in question is known as D614G, or just "G" for short. So far, the "G" mutation has been found in roughly 70% of the half a million or so samples that have uploaded to a shared database for scientists around the world. This has convinced many scientists of its significance, especially because the mutation occurs in a part of the genome that governs the infamous "spike" protein that gives the virus its name ("corona" = crown in Latin) and is believed to enable it to infiltrate human cells.

"I think that slowly we're beginning to come to a consensus," said Judd Hultquist, a virologist at Northwestern University.
And although it won't help the quest for a cure, understanding the role of these mutations is critical for understanding how the virus works. This, in turn, would allow scientists to track mutations and help them discern which might enhance the virus's capability to destroy human life.

"Understanding how transmissions are happening won't be a magic bullet, but it will help us respond better," Sabeti said. "This is a race against time."

Though, to be sure, even with all the research that's been done so far, scientists can't say much, if anything, for certain about the mutation. There may be other explanations for the G variant's dominance in the global pandemic: perhaps biases in where genetic data are being collected has led it to be overrepresented in samples, or quirks that led the "G" variant to dominate in particularly susceptible populations.

"The bottom line is, we haven't seen anything definitive yet," said Jeremy Luban, a virologist at the University of Massachusetts at Amherst.

Remember that the next time you hear Trump, Dr. Fauci or the White House "vaccine czar" discuss the possibility of having a vaccine available by year end, or next time you see a country contract to buy millions of doses of Gilead's remdesivir, just keep this in mind.


Heliobas Disciple

Has No Life - Lives on TB
(fair use applies)

Is coronavirus getting WEAKER? Italian study shows lower viral load and milder symptoms in COVID-19 patients in May than April peak - but fails to explain if the virus or human behavior have changed

By Reuters and Natalie Rahhal
Published: 06:34 EDT, 29 June 2020 | Updated: 20:22 EDT, 29 June 2020

  • Italian researchers at San Raffaele Hospital found that the viral loads detected in covid-positive patients were lower in May than in April
  • Patients swabbed in April were more likely to have worse symptoms and need to be hospitalized
  • Another Italian researcher, and doctors in Pennsylvania, have reported declining viral loads, leading to speculation that the virus is getting weaker
  • But the new study did not look at the genomes of viral samples

A small study by researchers in Italy has found that COVID-19 patients who were tested for the novel coronavirus at a hospital there in May had fewer virus particles than those who were tested a month earlier.

The researchers offered some theories for the lower 'viral load', including that lockdown measures may have reduced patients' exposure to the virus, but their study did not provide evidence to explain their finding.

Another Italian doctor said last month that 'the virus clinically no longer exists in Italy', suggesting the interaction between the virus and its human host had changed and that the virus is no longer replicating at such a rapid rate inside the body.

Alberto Zangrillo, head of intensive care at Italy's San Raffaele Hospital in Milan, said at the time that his comments would be reinforced by soon-to-be published research co-led by fellow scientist Massimo Clementi.

But Clementi's study, published on Monday in the journal Clinical Chemistry and Laboratory Medicine, did not look for mutations in the virus or changes in patients that might explain why the illness seemed less severe overall in the May patients.

Without that information, it is not possible to say whether the virus is changing in ways that give humans a fighting chance against the virus, or if - through testing, social distancing and mask-wearing - we are simply better at fighting it.

Instead, the new study looked for links between illness severity and the amount of virus - the viral load - in the patients.

The researchers analysed 200 nasopharyngeal swabs taken at the San Raffaele hospital.

Half were from patients treated in April - at the pandemic's peak - and half were from patients treated in May.

Based on the results, the researchers calculated that patients' viral loads were higher in April.

Patients swabbed in April also had more severe symptoms and were more likely to need hospitalisation and intensive care, they found.

Viral loads were similar in men and women, but were higher in patients aged 60 and over, and in those with severe COVID-19.

Clementi's team said that while it was theoretically possible that the new coronavirus had mutated, they did not have molecular data to prove it.

Theirs is not the only hospital to see falling viral loads.

Doctors at the University of Pittsburgh Medical Center in Pennsylvania have noted anecdotally that their patients don't seem as sick, and that COVID-19 tests show lower viral loads.

The most optimistic - and unproven - scenario is that, perhaps, the virus has mutated in such a way that it is less contagious than in the past several months.

All viruses mutate, and usually the surviving viruses have mutated in ways that help them to make copies of themselves and spread more rapidly.

That was not the case for SARS-CoV-1, which struck the world in 2002 and 2003.

The strain that became dominant actually mutated to become less infectious, a shift partly credited for its sudden disappearance and the abrupt, unceremonious end of the epidemics.

Scientists can hope SARS-CoC-2 might do the same - but so far, the evidence to suggest it will is thin. In fact a growing body of evidence suggests a stronger variation of the virus has become the dominant one in much of the world, including the US and Italy - though Italy's epidemic has certainly quieted.

In the US, however, cases are surging in new hotspots, like Texas, Arizona and Florida.

There are varying explanations for these rises proposed, and they mirror explanations for the lower viral loads seen by scientists like those in Italy and Pittsburgh.

President Trump and the CDC have credited the rising case rates to better (or in Trump's case, 'GREAT') testing.

More tests are certainly being run in the US than were last month, or in the preceding months. More Americans are turning up to get tested, too.

As of Monday, the US has run 31,557,407 coronavirus tests.

With wider availability of tests and greater general awareness about coronavirus, more Americans may be getting tested earlier in the course of their infections, too, driving up the number of positives in asymptomatic people.

That may also drive down the viral loads detected in those tests, if indeed people are getting tested before the virus has had the opportunity to replicate extensively inside their cells.

Other possible explanations include wider use of social distancing in May versus April, warmer temperatures, increased use of face masks and hand-washing, and less pollution, they said.

In particular, may scientists theorize that people who are exposed to coronavirus repeatedly may be more bombarded by the infection - which could help explain the more severe illness seen in frontline and essential workers (especially black and Latinx people in the US) who are faced with a day-in and day-out onslaught of virus.

More people leaving their homes amid states' reopenings may help explain rising infection rates in states like Texas and Arizona.

And lower viral loads seen in Italy and Pittsburgh may be a natural follow-on to decreasing exposures after lockdowns.

But it will take continued, consistent testing, genome sequencing studies of the coronavirus's mutations.


Heliobas Disciple

Has No Life - Lives on TB
(fair use applies)

U.S. Coronavirus Cases Surge Amid Strains on Hospitals
Several states and locales pause or roll back their reopening plans

By Lukas I. Alpert And Ian Lovett
Updated June 29, 2020 8:35 pm ET

A surge in coronavirus cases in parts of the U.S. has prompted several states and locales to pause or roll back reopening as some hospital systems began groaning under the strain.

Nearly 39,000 coronavirus cases were recorded nationwide Sunday, according to data from Johns Hopkins University. It was the second straight decrease after Friday’s record of 45,255 new infections, but still above April highs. World-wide, confirmed Covid-19 infections neared 10.2 million, with nearly 503,000 deaths. The U.S. accounts for about a quarter of each figure.

In Los Angeles, officials on Monday painted a dire portrait of the spread of Covid-19 within the most populous county in the nation. They banned all July 4 fireworks displays and ordered beaches closed over the coming holiday weekend.

Arizona Gov. Doug Ducey followed in the footsteps of several other governors in hard-hit areas by closing bars throughout the state. The governor also closed gyms, movie theaters and water parks and limited gatherings to 50 people or less.

Officials in New York, which has seen cases steadily declining, said they were considering slowing down some efforts to reopen in light of rising cases elsewhere, while Broadway extended the cancellation of all performances until the end of the year.

In Florida, beaches in some of the state’s largest counties were ordered closed for July Fourth weekend. And doctors in Texas warned that some hospitals were on the verge of being overwhelmed.

Los Angeles County reported a daily record of 2,903 new coronavirus cases Monday, bringing the total number of cases there to 100,772, with 3,326 deaths. A week ago, officials estimated that one in 400 Los Angeles County residents was infected with Covid-19. Now, they estimate, the figure has increased to one in 140 people.

Christina Ghaly, director for the Los Angeles County Department of Health Services, said that while the county currently had enough hospital capacity, it could begin running out of beds in the next few weeks. “We are now, very sadly, likely to see an increase in mortality in the weeks ahead,” she said.

As in other parts of the country, the rise in Los Angeles County cases has been fueled by young people, with a 40% increase among residents aged 18 to 40 over the last two weeks. Half a million people visited nightlife spots on June 20, the first Saturday that bars were allowed to open in the county.

Bars in seven California counties, including Los Angeles County, were ordered to close again over the weekend to counter the troubling surge in cases. One county, Imperial, returned last week to a full stay-at-home lockdown after positive test rates there rose to 23%. Authorities moved some 500 patients from Imperial County hospitals to other parts of the state to reduce pressure on the health care system, Gov. Gavin Newsom said.

Over the past two weeks, coronavirus-related hospitalizations in California increased by 43% and intensive-care unit admissions jumped 37%, Mr. Newsom said. Coronavirus patients are occupying 7% of the state’s hospital beds. Overall, 58% of all available hospital beds in the state are in use.

In Texas, coronavirus patients have filled about 10% of the state’s beds, and 80% of all available hospital beds are occupied, according to data from the state health department.

Texas, which has seen cases multiply this month, reported more than 5,000 new cases on Sunday for the sixth straight day, with 5,357, according to the state’s Health Services Department. Bexar County, where San Antonio is located, on Saturday warned residents that local hospitals were approaching capacity.

“It’s going to become unsustainable to have this number of admissions if this trend continues,” Dr. Federico Vallejo, a pulmonary critical-care doctor from South Texas, told The Wall Street Journal.

As coronavirus has begun to spread in GOP-led states, Republicans have started making the case that wearing masks and taking other precautions are needed to avoid any future shutdown of the economy. President Trump has so far resisted calls to wear a mask.

Senate Majority Leader Mitch McConnell (R., Ky.), who has worn a mask around the Capitol for weeks, on Monday pressed others to do the same.

“We must have no stigma, none, about wearing masks when we leave our homes and come near other people,” Mr. McConnell said on the Senate floor. “In fact, the more we hate the pain and suffering that accompanied the strict stay-home guidelines a few months ago, the happier we should be to take reasonable small steps every day to ensure our country can stay on offense against the virus.”

In New York, Gov. Andrew Cuomo and New York City Mayor Bill de Blasio said Monday that—given the surge of cases in other parts of the U.S.—they were considering postponing efforts to restart indoor dining at restaurants in the city that was to resume as early as next week. The state last week delayed the opening of malls, gyms and movie theaters, which had been slated to resume business Friday in some upstate regions.

The Broadway League, a trade association, said that all Broadway performances would be suspended through the rest of 2020. But, Mr. Cuomo said the MTV Video Music Awards would proceed Aug. 30 at the Barclays Center, in front of a small or limited audience.

New York reported 853 coronavirus related hospitalizations, down from more than 18,000 during the peak. The state recorded 391 new cases and seven deaths on Sunday. Mr. Cuomo said the state had equipment, testing capacity and advice to share with others that are facing an increase of infections.

“I will never forget how good this country was to New York,” he said, adding that nearly 30,000 health-care professionals came to New York during the peak of the state’s crisis. “We don’t forget; we’ll be there for other people.”

New Jersey Gov. Phil Murphy said the state was indefinitely postponing reopening restaurants for indoor dining, citing rising cases in other states. The state had planned to allow indoor dining to resume Thursday.

Florida on Sunday recorded 5,266 new cases after a jump over the weekend with close to 9,000 new cases a day, but the percentage of positive results among total people tested rose slightly to just under 14%, the state health department said.

Several large counties, including Miami-Dade and Broward, have moved to close beaches for the July Fourth weekend. The city of Jacksonville, where President Trump plans to accept the Republican presidential nomination at the end of August, issued a mandatory mask requirement for all public spaces.

U.S. stocks climbed Monday, as investors weighed the surge in coronavirus infections with the possibility of renewed lockdowns.

The World Health Organization on Monday said the pandemic was speeding up and suggested countries do a better job of contact tracing—tracking who a sick person had been in contact with and isolating those who may have been exposed.

Outside the U.S., India’s steep increase in infections continued, with 19,459 new cases reported Monday, according to the Ministry of Health and Family Welfare. That brings the total to 548,318, behind only the U.S., Brazil and Russia.

Iran reported the highest-ever daily death toll from Covid-19 on Monday, with 162 fatalities logged overnight, as it continues to struggle with a surge in infections amid an easing of lockdown restrictions.

Researchers in the U.K. have found that risk of coronavirus is higher for minority populations, mirroring a trend documented in the U.S. Studies show black and ethnic-minority people are more likely than whites to die from Covid-19, the illness caused by the virus.


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‘Our Luck May Have Run Out’: California’s Case Count Explodes
Los Angeles County, which has been averaging more than 2,000 new cases each day, surpassed 100,000 total cases on Monday.

By Shawn Hubler and Thomas Fuller
June 29, 2020

SACRAMENTO — Only a few weeks ago, thousands of Southern Californians were flocking to beaches, Disneyland was announcing it would soon reopen and Whoopi Goldberg was lauding Gov. Gavin Newsom on “The View” for the state’s progress in combating the coronavirus. The worst, many in California thought, was behind them.

In fact, an alarming surge in cases up and down the state was only just beginning.

Over the past week California’s case count has exploded, surpassing 200,000 known infections, and forcing Mr. Newsom to roll back the state’s reopening in some counties. On Monday, he said the number of people hospitalized in California had risen 43 percent over the past two weeks.

Los Angeles County, which has been averaging more than 2,000 new cases each day, surpassed 100,000 total cases on Monday, with the virus actively infecting one in every 140 people, according to local health officials. More than 2,800 cases were announced in the county on Monday, the most of any day during the pandemic.

More than 7,000 new cases were announced across California on Monday, its highest single-day total of the pandemic.

On Sunday, Mr. Newsom shut down the bars in a half-dozen counties, including Los Angeles County and in the Central Valley, and recommended that another eight counties voluntarily close their nightspots and gathering places. On Friday, Imperial County, along the Mexican border, was told to return to a stay-at-home order. And Disneyland has since rescinded its decision to open its gates.

California was the first state to shut down and one of the most aggressive in fighting the virus. But the state that was so proactive in combating the spread of the coronavirus is now being forced to ask itself what went wrong.

“To some extent I think our luck may have run out,” said Dr. Bob Wachter, a professor and chair of the department of medicine at the University of California, San Francisco. “This is faster and worse than I expected. You have to have a ton of respect for this thing. It is nasty and it just lurks and waits to stomp on you if you let your guard down for a second.”

On Monday, the governors of New York and New Jersey said they were reconsidering plans to allow indoor dining in the coming days because they were so alarmed by the rise in coronavirus cases in the South and the West.

The head start that California appeared to enjoy — the companies that allowed employees to work from home as early as February, the governor who warned residents in daily briefings to stay home and appeared to be listened to — was not protective enough in the long run.

Younger people appear to account for the large surge in new cases, as they have in many other states. Latinos, who make up a large swath of the state’s essential work force, have also recently seen consistently high case counts.

And just as in Texas and Florida, the state’s reopening appears to have triggered a large resurgence. Pressured in part by businesses, church groups and conservatives, Mr. Newsom ceded control of much of the timing of reopening to local officials who were eager to regain a sense of normalcy and stem economic losses. The result was a decentralized, haphazard process that sowed confusion and gave residents a false sense that they were in the clear.

Unlike people in the Northeast, many Californians did not have a sense of urgency or immediacy toward the virus because infection rates had been so low for months. There were no overflowing morgues or ambulance sirens at all hours.

In a state with 40 million people, outbreaks have been heterogeneous: San Quentin State Prison on the San Francisco Bay, food-processing plants in the Central Valley, nursing homes, dense urban neighborhoods filled with essential workers and family gatherings in remote rural communities have all accounted for clusters of cases.

But health experts and state officials say the ultimate reasons for the surge lie in the millions of individual decisions made across the vast state.

Mayor Eric Garcetti of Los Angeles blamed “irrational exuberance.”

“A lot of people didn’t stick with the plan,” the mayor said in an interview on Friday. “The idea was, we would do a move, wait three weeks, check the impact, take the next move.”

Instead, Mr. Garcetti said, the reopening “was like a tidal wave — one move led to the next, led to the next, led to the next. And then we had the protest on top of that, and other things. And we have yet to be able to identify where spread is happening and what we can do to crank it down.”

State Senator Richard Pan, a Sacramento physician who led the state’s push to tighten immunization requirements, said that the state might have flattened its curve at first, but that it never bent it down toward zero.

“How this disease spreads is all about the margins,” Dr. Pan said. “All it takes is, like, 5 percent more people doing more high-risk behavior to change its direction.”

Dr. Pan blames partisanship and misinformation spread by President Trump. On the weekend after June 20, when bars reopened in Los Angeles County, an estimated 500,000 people visited nightspots. Additionally, half of the restaurants visited by county inspectors are not complying with new public health rules, according to health officials.

“I’m frustrated because it’s not that we don’t know what to do,” Dr. Pan said. “We know what to do. We’re just not doing it.”

California was one of the earliest states to get hit by the virus. Soon after it first appeared on American shores, Silicon Valley, south of San Francisco, was considered a major hot spot, seeded by travelers arriving from China.

Counties across the Bay Area banded together to announce the nation’s first stay-at-home order on March 16, followed by a statewide order three days later. Cellphone data showed that Californians moved around less than people in other states, and infection rates stabilized at a plateau well below the levels experts had projected, making military field hospitals and sports arenas and auditoriums — all mobilized in case of a shortage of beds — unnecessary.

By May, with low case counts remaining steady, Mr. Newsom was coming under increasing pressure to reopen. Harmeet K. Dhillon, a civil rights attorney and member of the Republican National Committee, filed more than a dozen lawsuits related to the reopening. If residents could congregate at Costco, they should be able to go to church, she argued. Elon Musk, the head of Tesla, railed that his Bay Area car factory was forced to shut and threatened to move the company’s headquarters out of California.

Mr. Newsom localized the reopening process, allowing counties to move at different speeds, repeatedly declaring that “localism is determinative,” and vowing to collaborate with county governments, not issue orders. Church congregations were allowed to meet with restrictions.

Advocates for reopening like Ms. Dhillon felt vindicated.

“I feel that our lawsuits were responsible for large sectors of California’s economy opening up much sooner than the governor originally intended,” she said, adding that she fielded countless calls from business owners. “People are absolutely devastated.”

But Mr. Newsom was also criticized by those who worried the state was reopening too quickly.

Dr. Sara Cody, the chief health officer of Santa Clara County and the architect of the Bay Area’s stay-at-home orders, said the system was bewildering to residents who cross county lines regularly.

“For the public it’s incredibly confusing,” Dr. Cody said in an interview. “What’s the message? How can it be that something is OK here and in the adjoining county it’s not?”

The measures have become even more disparate in the past few weeks. In Napa and Sonoma Counties, wine tastings and restaurant meals are permitted both indoors and outside. In San Francisco, restaurant dining is only available outdoors. Mayor London Breed of San Francisco announced last week that the city would postpone the reopening, scheduled for Monday, of hair and nail salons, massage shops, museums, tattoo parlors and outdoor bars.

Diana Dooley, a former state secretary of Health and Human Services who dealt with the Ebola and Zika pandemics during her tenure, said she had watched “with great empathy” as the crisis gripped California. Initially, she said, “it looked like the Bay Area was driving the decisions.” And as the virus spread, Californians were generally compliant.

“But after several months, the impatient people have made top-down orders very hard to enforce,” she said.

The result, she said, is a sense in some parts of the state of “a kind of liberty gone rampant.”

“People want to go to bars, they want to go to picnics,” she said. “These protest rallies have heightened that sense of ‘I want to be in a crowd.’ We’re coming up on the Fourth of July and people want to be in connection with each other.”

“You can only lead if people follow,” Ms. Dooley said. “Newsom has done a pretty good job of creating awareness, and people in California are more inclined to believe this is serious. But what they can do about it, we’re still getting to.”

David Townsend, a veteran Democratic political consultant in the state, said California’s size and political complexity pose a considerable challenge. Although the Legislature is overwhelmingly Democratic, more than a fifth of the electorate is Republican.

“You have the Inland Empire doing one thing, Los Angeles doing another, Orange County — it’s pretty hard to corral everybody in California and get them to do the right thing. It’s just so big.”

Mr. Townsend said the pressure would be tough for any governor.

“How do you put the genie back into the bottle?” Mr. Townsend added. “I’m not sure there’s much more he can do.”


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L.A. County issues dire warning amid ‘alarming increases’ in coronavirus cases
By Rong-Gong Lin II
June 29, 2020 1:08 PM UPDATED7 PM

Los Angeles County health officials issued a dire warning Monday that conditions amid the COVID-19 pandemic are deteriorating rapidly and the highly contagious virus is spreading swiftly in the nation’s most populous county.

They said they are now faced with one of their biggest fears: that the reopening of L.A. County would coincide with sudden jumps in disease transmission that have the potential to overwhelm public and private hospitals.

L.A. County has long been the epicenter of the coronavirus in California — with nearly 98,000 confirmed cases and more than 3,300 deaths — but officials said Monday that the outbreak is worsening.

Barbara Ferrer, the director of public health for L.A. County, said that new data show “alarming increases in cases, positivity rates and hospitalization.”

“This does indicate — definitively — that we have increased community transmission,” Ferrer said. “There’s so much at stake, since these continued increases will result in many more people becoming seriously ill, and many more deaths of COVID-19.”

“This is the time to hunker down back in your home whenever you can,” Ferrer said, urging people to wear their masks and practice social distancing. “Please, let’s not let go of everything we worked hard and sacrificed for.”

She urged people to avoid crowds. “It’s just not safe right now,” she said.

“We’re seeing more people get sick and go into the hospital. This is very much a change in the trajectory of the epidemic over the past several days. It’s a change for the worse and a cause for concern,” said Dr. Christina Ghaly, L.A. County’s director of health services.

The daily number of new coronavirus cases that require hospitalization could be four to five times the peak of what L.A. County saw in late March and early April, “placing tremendous burden on our healthcare system and hospitals and resulting in much otherwise unnecessary suffering and mortality,” Ghaly said.

With a predicted increase in hospitalizations, for the first time since the coronavirus crisis seemed to ease locally, L.A. County is now projecting the possibility of running out of hospital beds in two to three weeks. Likewise, the number of intensive care unit beds could be exhausted sometime in July.

If the increased disease transmission rate continues as it has done so over the last few weeks, it “suggests that we are at risk of running out of hospital beds if we don’t take steps to increase that capacity within the next two to three weeks,” said Dr. Roger Lewis, a biostatistician, director of the COVID-19 demand modeling unit for L.A. County and chair of the emergency department at Harbor-UCLA Medical Center.

“We did anticipate that we would see increases in cases of hospitalization. The problem was that we didn’t expect to see increases that were this steep so quickly,” Ghaly said.

The county is able to meet hospital demand currently, but many of the patients who have already been exposed to the virus will now be filling the beds in the coming weeks. It can take three to four weeks after exposure to the virus for infected people to become sick enough to be hospitalized, and four to five weeks after exposure for some of the most vulnerable patients to die from the disease

“So even if steps are taken immediately to reduce the spread in the community, we do expect to see a continued uptick in the next two to four weeks,” Lewis said.

All public and private hospitals in L.A. County need to be prepared to treat more patients based on these projections, Ghaly said. Hospitals can create new capacity by reducing elective procedures and surgeries and take steps to expeditiously discharge patients who no longer need hospital care.

Hospitals can also add more beds beyond their normal licensed capacity, typically 20% to 40% over, by creating space they normally wouldn’t utilize for in-patient care, such as emergency departments, recovery rooms, and pre- and post-operative care units, Ghaly said. Some hospitals can also reopen previously licensed or staffed wards.

The best place to treat a patient who needs hospital care is in a hospital. Alternate care sites present a host of challenges, Ghaly said.

The effective transmission rate of the coronavirus has now increased. Previously, through the beginning of May, for every one person infected, fewer than one other person on average was infected — a testament to the success of the stay-at-home order. But by early June, as the reopening accelerated, the coronavirus transmission rate had crept above 1, meaning for every one person infected, an additional 1.26 people are infected on average.

“We expect the number of cases to rise quickly,” Ghaly said.

Although this rate is lower than what L.A. County saw earlier in the pandemic, when every one infected person on average infected three other people, the current rate can still cause a much larger number of new cases “because of the much broader base of infected individuals that we have today,” Ghaly said.

Last week, there was an estimated 1 in 400 people in L.A. County who was infectious with the virus and infecting others — people who weren’t hospitalized or in isolation at home. Now, there’s an estimated 1 in 140 people people actively infecting others, Ghaly said.

That means a typical large, busy store is likely to have multiple infectious persons enter and shop every day, officials said.

The increase in transmission likely occurred sometime around the week of Memorial Day week or shortly thereafter. At the time, L.A. County officials decided to gradually reopen the economy because the data were stable, with no increases in hospitalizations and a decline in new deaths, Ferrer said.

But unfortunately, people and businesses haven’t been adhering to health orders to wear masks in public and stay away from crowded situations. Just this past weekend, masks or face shields were not being worn by workers at about half of inspected restaurants and bars. Officials have also seen examples of overcrowding at public spaces.

“I’ve had an explosion of new outbreaks in workplaces. One that got shut down this past weekend, it had over 115 infections. Again, very little compliance with the directives on how to operate a factory with as much safety as possible,” Ferrer said.

“And we’ve had numerous examples of outbreaks happen because families are getting together with extended family members and friends to celebrate weddings, things they had postponed, and again, created higher risk, and there was transmission,” Ferrer said.

Ferrer also said that, according to data by Foursquare, that the weekend after June 20, the day when bars reopened in L.A. County, 500,000 people visited nightlife spots. And the county has observed a 40% increase in coronavirus cases among younger people, between the ages of 18 and 40, in the last two weeks.

People are often most infectious with the coronavirus before they develop symptoms, Lewis said. There are people who also become infected and can transmit to others who never develop any symptoms at all.

Health officials urged people to avoid gathering with friends and family for the Fourth of July weekend. “We’d love to spend it with close family and friends [but] I strongly advise against it,” Ferrer said. “This is a time to still stay within your household, as much as possible.”

She said outside activities with household members are good. “Take solace in the fact that we’re all going to do it this way ... in hopes that by next July Fourth, which I see is totally possible, we’re celebrating in ways we’re much more accustomed to,” Ferrer said. “We need to get this back under control.”

Now is a tenuous moment in L.A. County, and Ferrer urged the elderly and those with underlying conditions to stay at home. “There is far too much risk at the moment ... Everyone else should stay home as much as they can,” Ferrer said.

“Businesses and individuals need to figure out how we personally are going to help to turn things around,” Ferrer said. “Otherwise, we’re quickly moving towards overwhelming our healthcare system and seeing even more devastating illness and death.”


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L.A. County Sheriff Refuses to Enforce Beach Closure Order for July 4th Weekend
Joshua Caplan
29 Jun 2020

Los Angeles County Sheriff Alex Villanueva said Monday that he refuses to enforce a directive to close beaches for July 4th weekend.

In a statement to Fox Los Angeles reporter Bill Melugin, Villanueva revealed that his office was not consulted regarding the decision. His officers will only enforce the closing parking lots, the sheriff said.

Villanueva told Melugin: “We were not consulted on the beach closure, and will only assist our beach cities in closing parking lots and traffic enforcement on PCH. In regards to enforcing the beach closure, we will not be enforcing it because we are “Care First, Jail Last.”

Earlier Monday, Los Angeles County’s public health department announced the beach closure order, citing the surge in Chinese coronavirus cases. Additionally, public health officials said fireworks will be banned.

The announcement coincided with L.A. County confirming an additional 2,900 virus cases. California has a total of nearly 217,000 cases and around 6,000 deaths. Officials said:

Data show increases in people testing positive for the virus and increases in hospitalizations as a result. Projections by the Department of Health Services show a marked increase in hospitalizations in the coming weeks, which could cause a surge in our healthcare system.

Barbara Ferrer, the county’s director of public health, said in a separate statement:

Closing the beaches and prohibiting fireworks displays during this important summer holiday weekend was an incredibly difficult decision to make, but it’s the responsible decision to protect public health and protect our residents from a deadly virus. The Fourth of July holiday weekend typically means large crowds and gatherings to celebrate, a recipe for increased transmission of COVID-19.

On Sunday, California Gov. Gavin Newsom (D) ordered bars in Los Angeles County and six other counties to close, citing the spread of the virus.

Newsom tweeted: “Due to the rising spread of #COVID19, CA is ordering bars to close in Fresno, Imperial, Kern, Kings, Los Angeles, San Joaquin, and Tulare, while recommending they close in Contra Costa, Riverside, Sacramento, San Bernardino, Santa Barbara, Santa Clara, Stanislaus, & Ventura.”


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California, Texas see record COVID-19 surges, Arizona clamps down

Dan Whitcomb, Maria Caspani
June 29, 2020 10:52 AM

LOS ANGELES (Reuters) - California and Texas both marked record spikes in new COVID-19 infections on Monday, a Reuters tally showed, as Los Angeles reported an “alarming” one-day surge in America’s second-largest city that put it over 100,000 cases.

Los Angeles has become a new epicenter in the pandemic as coronavirus cases and hospitalizations surge there despite California Governor Gavin Newsom’s strict orders requiring bars to close and residents to wear masks in nearly all public spaces.

“The alarming increases in cases, positivity rates and hospitalizations signals that we, as a community, need to take immediate action to slow the spread of COVID-19,” Barbara Ferrer, director of public health for Los Angeles County, said in a statement announcing the sharp rise.

“Otherwise, we are quickly moving toward overwhelming our healthcare system and seeing even more devastating illness and death,” Ferrer said.

Los Angeles Mayor Eric Garcetti announced a “hard pause” on when movie theaters, theme parks and other entertainment venues can reopen. Los Angeles County is the biggest movie theater market in the United States.

Los Angeles County said its beaches will be closed for the Independence Day weekend and fireworks displays will be banned.

Statewide positive tests for COVID-19, the respiratory illness caused by the virus, rose by at least 7,418 in California Monday to nearly 223,000, the biggest one-day increase since tracking began. Los Angeles County, with a population of 10 million, has recorded 100,000 cases.

California is among a number of U.S. states including Florida, Texas and Arizona battling a new wave of infections as the nation emerges from weeks of clamp-downs on residents and businesses. COVID-19 infections in Texas rose by 6,545 on Monday to nearly 160,000, also setting a record for a one-day increase.

Nationally, cases rose by more than 40,000, for the fourth time in the past five days.


Arizona Governor Doug Ducey on Monday ordered the closure of bars, nightclubs, gyms, movie theaters and water parks for at least 30 days. Ducey also delayed the start of public schools until at least Aug. 17.

“Our expectation is that next week our numbers will be worse,” Ducey said at an afternoon news conference. Vice President Mike Pence will travel to Phoenix on Wednesday to discuss efforts to fight the pandemic’s resurgence.

Texas and Florida ordered the closure of all their recently reopened bars on Friday.

New Jersey Governor Phil Murphy said on Monday indoor dining will not resume on Thursday as planned and would be postponed indefinitely.

In Kansas, Governor Laura Kelly imposed a statewide mandate requiring the wearing of masks in public spaces, which she said was necessary to avoid another shutdown.

Beaches in Florida’s Broward County and Palm Beach County will not open for the July 3-5 holiday weekend, officials said on Sunday, a blow to residents hoping to celebrate Independence Day there. Miami-Dade County has also announced beach closures for the holiday weekend.

AMC (AMC.N), the largest U.S. movie theater chain, on Monday said it was pushing back the reopening of its theaters to July 30 from July 15.

In June, 22 U.S. states reported record increases in new cases, often multiple times, including Alaska, Arkansas, Montana, New Mexico, North Carolina, Oregon and Utah.
Slideshow (8 Images)

The city of Jacksonville, Florida, venue for part of the Republican nominating convention in August, said on Twitter it would be requiring masks in public starting later on Monday.

White House press secretary Kayleigh McEnany said on Monday that Trump “has no problem with masks and to do whatever your local jurisdiction requests.”

The New York Times reported on Monday that 43% of U.S. deaths from COVID-19 were linked to nursing homes and long-term care facilities. The paper cited its own tracking database.


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Nearly one-third of ICU coronavirus patients in a Houston hospital system are reportedly under 50
Tim O'Donnell
10:20 a.m.

Texas has emerged as one of the United States' coronavirus hot spots in recent weeks, and data shows the recent spike doesn't completely match up with the early days of the pandemic in terms of demographics.

Back in April, when the virus first peaked, most of the patients testing positive in the Houston Methodist Hospital system were over 50, The New York Times reports. Now, the majority are reportedly relatively young. And while it's widely believed younger, healthier people are at a lower risk of developing severe infections or dying, there are no guarantees. In the Methodist system, nearly one-third of intensive care patients are under 50, which the Times notes is higher than the previous surge.

Meanwhile, The Texas Tribune and Fox4 in Dallas previously reported that people under 50 made up 50 percent of those hospitalized with the virus in June, as well as 30 percent of those in intensive care.

Of note: hospitals are seeing younger patients now in June compared to March around when coronavirus started appearing in North Texas. Seeing a sharp jump in hospital patients ages 21-40. 50% of hospitalizations are under 50, 30% critical care under 50. @FOX4
— Lynnanne Nguyen (@LynnanneFOX4) June 22, 2020

The trend doesn't appear to be confined to Texas, at least anecdotally. Last week, The Wall Street Journal reported that states like Arizona, Florida, and California were also seeing more patients in their 20s, 30s, and 40s testing positive and winding up in the hospital. Read more about Houston Methodist Hospital's experience with the coronavirus at The New York Times.


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States reverse openings, require masks amid virus resurgence
2 hours ago

Arizona’s Republican governor shut down bars, movie theaters, gyms and water parks Monday and leaders in several states ordered residents to wear masks in public in a dramatic course reversal amid an alarming resurgence of coronavirus cases nationwide.

Among those implementing the face-covering orders is the city of Jacksonville, Florida, where mask-averse President Donald Trump plans to accept the Republican nomination in August. Trump has refused to wear a mask during visits to states and businesses that require them.

Arizona Gov. Doug Ducey’s order went into effect immediately and for at least 30 days. Ducey also ordered public schools to delay the start of classes until at least Aug. 17. Most Arizona bars and nightclubs opened after the governor’s stay-at-home and business closure orders were allowed to expire in mid-May.

Arizona health officials reported 3,858 more confirmed coronavirus cases Sunday, the most reported in a single day in the state so far and the seventh time in the past 10 days that daily cases surpassed the 3,000 mark. Since the pandemic began, 74,500 cases and 1,588 deaths stemming from the virus have been reported in Arizona.

“Our expectation is that our numbers next week will be worse,” Ducey said Monday.

The state is not alone in its reversal. Places such as Texas, Florida and California are backtracking, closing beaches and bars in some cases amid a resurgence of the virus.

In New Jersey, Gov. Phil Murphy announced Monday that he’s postponing the restarting of indoor dining because people have not been wearing face masks or complying with recommendations for social distancing. New Jersey has been slowly reopening, and on Monday indoor shopping malls were cleared to start business again.

Democratic governors in Oregon and Kansas said Monday that they would require people to wear masks. Oregon Gov. Kate Brown’s order will require people to wear face coverings in indoor public spaces starting Wednesday. Kansas Gov. Laura Kelly said she will issue an executive order mandating the use of masks in stores and shops, restaurants, and in any situation where social distancing of 6 feet (2 meters) cannot be maintained, including outside. The order goes into effect Friday.

“The evidence could not be clearer: Wearing a mask is not only safe, but it is necessary to avoid another shutdown,” Kelly said.

Idaho is moving in a different direction, at least when it comes to the elections. Despite the continuing spread of the virus, state elections officials said Monday that they would allow in-person voting — as well as mail-in ballots — for August primaries and the November general election, the Idaho Statesman reported. Idaho’s May 19 primary was the first statewide election held by mail only. The primary had record voter turnout.

In Texas, a group of bar owners sued on Monday to try to overturn Republican Gov. Greg Abbott’s order closing their businesses. They contend Abbott doesn’t have the authority, and they complained that other businesses, such as nail salons and tattoo studios, remain open.

“Gov. Abbott continues to act like a king,” said Jared Woodfill, attorney for the bar owners. “Abbott is unilaterally destroying our economy and trampling on our constitutional rights.”

But Democratic New York Gov. Andrew Cuomo said that Abbott is on the right path, and he added that Trump should order the wearing of masks.

“States that were recalcitrant ... are doing a 180, and you have the same states now wearing masks,” Cuomo said. “Let the president have the same sense to do that as an executive order, and then let the president lead by example and let the president put a mask on it, because we know it works.”

One of Cuomo’s Republican counterparts, Utah Gov. Gary Herbert, on a conference call with Vice President Mike Pence and members of the White House coronavirus task force, also asked Pence and Trump to issue a national call to wear masks.

Republican Florida Gov. Ron DeSantis has opposed a statewide mask requirement but said in response to Jacksonville’s action that he will support local authorities who are doing what they think is appropriate.

In recent weeks, the Republicans moved some of the convention pageantry to Jacksonville after Democratic Gov. Roy Cooper of North Carolina objected to the holding of a large gathering in Charlotte without social-distancing measures.

Less than a week after Jacksonville Mayor Lenny Curry said there would be no mask requirement, city officials announced on Monday that coverings must be worn in “situations where individuals cannot socially distance.”

White House spokeswoman Kayleigh McEnany responded by saying the president’s advice is to “do whatever your local jurisdiction requests of you.”

Elsewhere around the world, Britain reimposed lockdown restrictions on the city of Leicester after a spike in cases, ordering the closing of schools along with stores that do not sell essential goods.

The European Union is preparing a list of 15 countries whose citizens will be allowed to visit the bloc beginning Wednesday, Spain’s foreign minister, Arancha Gonzalez Laya, told the Cadena SER radio network. Because of the resurgence in the U.S., America may not be on that list.

“This is not an exercise to be nice or unfriendly to other countries. This is an exercise of self-responsibility,” she said.


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Oregon governor says hospitals could be overwhelmed if coronavirus cases not reduced, mandates face coverings
“Over the last month, we have seen the disease spread at an alarming rate"

By Morgan Phillips
Published 6 hours ago

Gov. Kate Brown announced Monday that Oregon residents will be required to wear face coverings inside public indoor spaces, warning that hospitals in her state could be overwhelmed if the spread of coronavirus doesn’t slow.

“From the beginning of the reopening process, I have said that reopening comes with the risk of seeing an increase in COVID-19 cases beyond our health systems’ capacity to test, trace, and isolate them,” Brown said in a statement. “Over the last month, we have seen the disease spread at an alarming rate in both urban and rural counties.”

“Modeling from the Oregon Health Authority shows that if we don’t take further action to reduce the spread of the disease, our hospitals could be overwhelmed by new COVID-19 cases and hospitalizations within weeks,” the Democratic governor continued. “I do not want to have to close down businesses again like other states are now doing. If you want your local shops and restaurants to stay open, then wear a face covering when out in public.”

Face masks are already required in eight counties, but will now be required in indoor public spaces statewide beginning July 1.

She urged residents to keep Fourth of July celebrations “small and local,” citing a spike in coronavirus which followed Memorial Day celebrations.

Oregon saw 247 new coronavirus cases on Sunday, bringing the state’s total to 8,341 cases. No new deaths were reported Sunday, leaving the state’s death count at 202.


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Massachusetts is among only 4 states on track to containing coronavirus, one model shows
The commonwealth's COVID-19 preparedness "meets or exceeds international standards," according to Covid Act Now.

Christopher Gavin
June 29, 2020 | 3:09 PM

Massachusetts is among only a handful of states that is on its way to containing COVID-19, according to one model.

The tool, created by Covid Act Now, a collection of epidemiologists, health and public policy experts, and technologists, shows the commonwealth is one of four states “on track” to stopping the spread of the coronavirus.

The other states are nearby, too: Connecticut, New York, and New Jersey, which encompassed some of the hardest hit areas when the pandemic emerged in the United States in March.

As of Sunday, Massachusetts had logged 108,667 total probable and confirmed cases, data from the state Department of Public Health shows. The state has seen 8,060 related deaths over the course of the pandemic.

According to data collected by Covid Act Now that was last updated Friday, Massachusetts is seeing the number of active cases dropping; can likely handle a new wave of COVID-19; has sufficient testing capacity; and has conducted enough contact tracing to help contain the virus.

“Massachusetts is on track to contain COVID,” Covid Act Now says on its website. “Cases are steadily decreasing and Massachusetts’s COVID preparedness meets or exceeds international standards.”

The data shows the state’s infection rate has dropped to .75 from a peak of 2.76 in March.

“On average, each person in Massachusetts with COVID is infecting 0.75 other people,” the group says. “Because each person is infecting less than one other person, the total number of current cases in Massachusetts is shrinking.”

Meanwhile, the positive test rate is at 2.3 percent, down from an apex of 28.9 percent on April 15 in the Bay State.

“A low percentage (2.3%) of COVID tests were positive, which suggests enough widespread, aggressive testing in Massachusetts to detect most new cases,” Covid Act Now said. “Identifying and isolating new cases can help contain COVID without resorting to lockdowns.”

Massachusetts is currently in the second part of Phase 2 in its four-stage reopening plan. As of last week, restaurants are now able to offer indoor dining to customers once again, thanks to declining metrics, officials said.

“Per best available data, Massachusetts has 2,500 contact tracers,” Covid Act Now said. “With an average of 202 new daily cases, we estimate Massachusetts needs 1,010 contact tracing staff to trace all new cases in 48 hours, before too many other people are infected. This means that Massachusetts is likely able to trace 100 percent of new COVID infections in 48 hours. When this level of tracing is coupled with widely available testing, COVID can be contained without resorting to lockdowns.”

Probably not coincidentally, Massachusetts is also among the top four states in the country for regular mask usage, according to data collected by the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

Elsewhere in New England, Maine, New Hampshire, Vermont, and Rhode Island have all “controlled disease growth,” the Covid Act Now map shows.

Meanwhile, cases in Arizona, Florida, and Texas have surged recently, boosting the number of cases recorded in the country past 2.5 million on Sunday, The Washington Post reports.

The latest model from Covid Act Now says Arizona is experiencing an “active or imminent outbreak” along with Missouri and Alabama. Texas and Florida are “at risk.”


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NY malls can’t open without air conditioning systems that filter the coronavirus, Gov. Cuomo says
Published Mon, Jun 29 202011:56 AM EDT |Updated Mon, Jun 29 20202:42 PM EDT
Noah Higgins-Dunn

Key Points
  • New York malls will need high quality air systems that can filter out the coronavirus before they will be allowed to reopen, Gov. Andrew Cuomo said on Monday.
  • High efficiency particle air filters, or HEPA filters, have been shown to help reduce the presence of Covid-19 in the air, according to a presentation from Cuomo.
  • He said the state recommends all businesses and offices “explore the potential for their air conditioning air filtration system.”

New York malls will need high quality air systems that can filter out the coronavirus before they will be allowed to reopen, Gov. Andrew Cuomo said on Monday.

“Any malls that will open in New York, large malls, we will make it mandatory that they have air filtration systems that can filter out the Covid virus,” Cuomo said at a press briefing.

High efficiency particle air filters, or HEPA filters, have been shown to help reduce the presence of Covid-19 in the air, according to a presentation from Cuomo.

The U.S. Centers for Disease Control and Prevention says the coronavirus is thought to spread primarily through person-to-person contact, when an infected person produces respiratory droplets by coughing, sneezing or talking in close contact with other people. It’s possible someone can become infected by touching a surface and then touching their mouth, nose or eyes, but that’s not considered to be the main way the virus is transmitted, the CDC says.

Some epidemiologists say the virus also appears to spread through exhaled air when people talk or breathe, known as aerosols, according to Nature.

The coronavirus’ particle has a diameter of about .125 micron, he said, pointing to recent studies. HEPA filters are designed to filter particles that are .01 micron and above.

New York has not allowed malls to reopen in the state yet, Cuomo said. He said the state recommends all businesses and offices “explore the potential for their air conditioning air filtration system.”

New Jersey allowed malls to reopen on Monday while following the same health precautions required of other stores but without advanced filtration systems, according to the state’s guidelines.

Cuomo has allowed other businesses to reopen without installing high-end filtration systems. So far, indoor retail, except for malls, indoor and outdoor dining and some office spaces have reopened in different regions of the state with reduced capacity.

New York City is expected to begin on July 6 its next phase of reopening, which will allow for indoor dining and personal care services such as nail salons, spas, massage parlors, and tattoo and piercing facilities with limited occupancy.

Cuomo said on Monday, however, that he’s concerned about the city’s enforcement of previous reopenings and that it has experienced a lack of compliance when it comes to social distancing and mask wearing, he said.

“You can see it in pictures, you can see it if you walk down the street, you can see the crowds in front of bars, you can see the crowds on street corners. It is undeniable,” Cuomo said.

Indoor dining has proven problematic in other states where cases are rising, Cuomo said. Meanwhile, outdoor dining has so far worked well across the state, including in New York City, he added.

Cuomo said the state is reviewing the data and talking with local business owners but could decide to postpone indoor dining at restaurants. The state will provide a final decision by Wednesday, he said.

“This is a real issue. Our reopenings have worked very well. We’re not going backwards; we’re going forwards,” Cuomo said. “A lot of other states have actually had to go backwards.”

To illustrate the state’s progress suppressing the coronavirus outbreak, Cuomo appeared in front of a sculpture of a mountain that represented the curve of the outbreak, saying it was “the mountain that New Yorkers climbed,” reaching the peak in the first 42 days. On Sunday, the state reported 853 people currently hospitalized with Covid-19, down from a peak of more than 18,800.

“Do you know what this is? This is the mountain,” Cuomo said while standing in front of the green sculpture.

He has previously called the state’s outbreak a mountain, referring to the shape of newly reported Covid-19 cases on a chart. Earlier in June, Cuomo said he was going to declare the “Covid mountain” the highest mountain in the state of New York.


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In Hot-Spot States, Virus Testing Means Long Lines, Delays
Emma Court (Bloomberg)
4 hrs ago

The U.S. is again grappling with a shortfall of testing that has hobbled the nation since the pandemic’s early weeks, and now threatens to further undermine containment efforts at a crucial moment.

In new hot spots like Arizona, Texas and Florida, where Covid-19 is rapidly spreading, lines for testing extend outside of urgent-care offices and other sites. Two high-school football stadiums in Houston regularly hit capacity by mid-morning and have to turn people away.

The country’s largest labs are forecasting a surge in demand that could lead to longer waits for test results, and have warned that limited amounts of critical testing supplies could become a constraint. Though capacity has expanded, widespread testing remains elusive, in part due to persistent supply shortages.

“We are still grossly inadequate. We’re so far behind,” said Howard Forman, director of the Yale School of Public Health’s health-care management program. “We still have a supply issue, and then we had a demand issue. You have both issues playing out. At the federal, state and local level, you need both those things addressed.”

The testing dearth comes months into a public-health crisis in which, absent a vaccine, Covid-19 screenings have become the first line of defense. Reopening states only turned up the pressure, boosting demand for testing as Americans increasingly went back to work, ate out, got haircuts and gathered socially.

The surge in cases has forced states to reconsider their reopening efforts. New Jersey Governor Phil Murphy on Monday paused plans to restart indoor dining on July 2. New York Mayor Bill de Blasio and New York Governor Andrew Cuomo also said skyrocketing cases in the South and West have prompted them to consider postponing dining’s return. U.S. virus deaths have exceeded 125,000 out of more than 2.5 million reported cases.

The pause in reopening was endorsed by Larry Kudlow, the top White House economic adviser. And Senate Majority Leader Mitch McConnell on Monday joined Vice President Mike Pence in encouraging the public to wear masks. On Tuesday, top federal health officials including infectious-disease expert Anthony Fauci are expected to appear at a Senate committee hearing to discuss efforts to get back to work and school.

Worldwide, deaths have surpassed 500,000. The World Health Organization said “the worst is yet to come” as some countries see a resurgence of cases. Half the deaths are coming from the Americas.

Arizona Governor Doug Ducey announced on Monday that the state would pause operation of bars, gyms and movie theaters as well as tubing and water parks. Ducey said he is targeting reopening in 30 days. Crisis standards of care were put in place and hospitals were told to prepare for a surge, Arizona Department of Health Services Director Cara Christ said.

The shortfalls in U.S. testing availability highlight the Trump administration’s failure to execute a cohesive national strategy. The burden shifted to states, which were provided some testing supplies in May and but have been told only limited amounts are available thereafter.

The U.S. processed about 557,000 tests each day, on average, over the last week, according to the Covid Tracking Project. Given the size of the current U.S. outbreak, 2 million to 4 million tests a day would be needed “to do something to really wipe it out,” Forman estimated. “We’re not really close to that.”

In Texas, which is quickly becoming the new U.S. epicenter, the strain from increasing testing demand was felt by hospitals, public-health departments and patients alike. Houston Mayor Sylvester Turner said capacity at the Delmar and Butler stadium sites will be expanded by 30% starting Tuesday.

A line that started before 5 a.m. Sunday at an urgent-care center in South Austin was compared to the wait for a wristband to Austin City Limits, the city’s annual music festival, or the queue for barbecue at Franklin’s, which would draw dozens customers to its doors before sunrise.

Kaitlin Heikes, a 26-year-old San Antonio resident, had to drive 45 minutes to Spring Branch for a rapid test. She made an appointment on Sunday for the following day after she didn’t have any luck on Friday or Saturday.

At the Houston Methodist hospital system, demand for testing doubled over the last week or so, David Bernard, medical director of clinical pathology, said in a Friday interview. The lab has faced an uphill battle securing supplies, and equipment is needed after diagnostics companies initially prioritized early hot spots like New York.

“We’ve been stretched,” Bernard said. Test manufacturers “don’t give you as much as you want, and it’s been a struggle. We’ve had to work as hard as we can to get things done.”

Covid cases are on the rise in Harris County, home to sprawling Houston, which for a time had been able to meet demand, said Umair Shah, executive director of Harris County Public Health.

‘Not Enough’

“We’re doing everything we can to meet or increase capacity,” Shah said in an interview. “But it is not enough right now.”

A local Texas health department was still receiving test results by fax as recently as last week, slowing them down further, said David Lakey, UT System’s vice chancellor for health affairs and chief medical officer and the former commissioner of the Texas Department of State Health Services.

“If we had today 6,400 new cases and you have that kind of volume each day, there isn’t possibly a way for the staff of the local health departments” to do contact tracing, he said. “They are getting overwhelmed right now.”

California has experienced delays, too. Barbara Ferrer, who directs Los Angeles County’s health department, said in an interview that some testing centers can take a week to report results, also creating problems for contact tracing. At that point, those who test positive will have had days to go around infecting more people before the county can talk to them and the people around them, Ferrer said.

Los Angeles County counted its highest daily totals of new cases and people who are hospitalized due to the virus, Ferrer said at a daily briefing Monday. The seven-day average rate of positive tests has jumped to 8.4% from 4.6% in late May, the county said in a release.

In Florida, hundreds of cars have been lining up at test centers. Health officials said wait times could be up to four hours on Monday at the Hard Rock Stadium site serving the Miami metropolitan area, and the Orange County Convention Center site in Central Florida had waits of about five hours. In St. Petersburg, local police said a site at Tropicana Field ran out of tests only about an hour due to “overwhelming turnout.”

“The testing capacity is disappointing,” St. Petersburg Mayor Rick Kriseman wrote in a tweet. “We are working with the state to bring additional, expanded testing.”


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Asymptomatic COVID-19 carriers easily contaminate their surroundings, study shows
by John Anderer

WASHINGTON — It doesn’t matter if you feel sick or you feel like a million bucks. Even asymptomatic COVID-19 patients can not only infect others directly, but also contaminate the surrounding environment. That’s the conclusion drawn from a new study using Chinese data.

The study’s authors say their findings emphasize the importance of hospitals properly cleaning all areas touched or inhabited by all COVID-19 patients.

“Placement of COVID-19 patients in rooms with negative pressure may bring a false feeling of safety and rigorous environment cleaning should be emphasized,” writes lead study author Zhiyong Zong, from the Department of Infection Control at West China Hospital.

Testing hospital rooms

It isn’t exactly breaking news that coronavirus patients can spread the virus to frequently touched items like clothes or furniture. However, this study focused more broadly on patients’ overall surroundings, a topic that’s understood far less extensively.

Researchers took samples from the surroundings and air within six negative pressure non-intensive care unit rooms that had been inhabited by 13 confirmed COVID-19 patients (two of those patients were asymptomatic). Areas and objects that were swabbed included bedrails, bedside tables, door handles, toilet handles, toilet bowls, and sinks. Additionally the research team checked bedsheets, pillows, floors, foot flush buttons, equipment belts on the walls, and air exhaust vents.

While all of the air samples ultimately came back negative, 44 out of 112 (39.3%) tested surface samples were indeed positive for the coronavirus.

“The SARS-CoV-2-positive rate also ranged from 16.7% to 53.9% for the individual sites,” the authors write. “Bedrails (53.9%), pillows (50.0%), bedsheets (50.0%), air exhaust outlets (50.0%), and light switches (40.0%) were the top five contaminated sites.”

Serious risks for asymptomatic COVID-19 patients

The authors say their study proves just how easily the virus can spread, even from asymptomatic people. For that reason, it may be wise to avoid even being in the same room or sharing items with others if you’ve been exposed.

“The findings suggest that patient surroundings in this non-ICU negative pressure isolation ward for COVID-19 patients with mild disease or no symptoms were extensively contaminated by SARS-CoV-2,” the study reads. “In particular, in a single room with an asymptomatic patient, four sites including bedrail, pillow, bedsheet and the air exhaust outlet were SARS-CoV-2 positive. This highlights that asymptomatic COVID-19 patients can contaminate their surroundings and therefore make persons who have direct contact with them such as their family members and healthcare workers be exposed to SARS-CoV-2”

Most asymptomatic carriers will hopefully just want to stay home and avoid going out. But researchers say that even this approach puts people’s families and relatives in harm’s way. A safer option may be shelter hospitals.

“The findings also highlight that environmental cleaning should be emphasized,” the researchers note.

The study is published in mSphere.


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An enduring coronavirus mystery: Why do only some get sick?
Months into a pandemic that has killed nearly 500,000 people worldwide, scientists are still trying to answer crucial questions about the coronavirus.

By Denise Chow
June 29, 2020, 3:32 PM EDT / Updated June 29, 2020, 5:07 PM EDT

Months into a pandemic that has caused more than 500,000 deaths worldwide, scientists are still trying to answer crucial questions about the coronavirus.

Chief among them: everything about asymptomatic patients.

People who contracted COVID-19 but didn't get sick and had no symptoms have been one of the most confounding factors of the public health emergency. The United States has more than 2.5 million confirmed coronavirus cases, but it's likely that many asymptomatic people have fallen through the cracks of official counts.

Now, scientists say that without a better understanding of how many people have been asymptomatically infected, it's difficult to know precisely how they contribute to the spread of the virus and whether they have developed antibodies or other protections that would confer some type of immunity against reinfection.

Dr. Jorge Mercado, a pulmonologist and critical care doctor at New York University's Langone Hospital-Brooklyn, said scientists still aren't sure why some people who have been exposed to the virus get very sick, while others develop no symptoms.

"We really don't know much about this disease," he said. "We know a little more than we did three months ago, but there are still a lot of things we don't have answers to."

Public health officials are struggling to get a handle on the true number of people who have been infected. The Centers for Disease Control and Prevention said Thursday that the number of COVID-19 cases in the U.S. — including those that are asymptomatic — may be 10 times higher than what has been reported, meaning the true case count could be closer to 23 million.

"Our best estimate right now is that for every case that's reported, there actually are 10 other infections," Dr. Robert Redfield, director of the CDC, said Thursday.

Early on, many asymptomatic cases went unnoticed because states were dealing with dire shortages of test kits and supplies, which limited testing capacity to only the sickest patients. Many asymptomatic people likely had no idea they were ever positive, said Dr. Marybeth Sexton, an assistant professor of medicine at Emory University in Atlanta.

"We tend to pick up asymptomatic or mildly symptomatic people when we do contact tracing, so when we get someone who is positive and we start testing people they've been in contact with," she said. "I think it'll be a long time before we know for sure what the true percentage is."

Sexton added that the virus' long incubation period has also led to some confusion over how "asymptomatic" is defined. According to the CDC, it could take up to 14 days after exposure for someone to show any symptoms.

"There are people who are positive but truly have no symptoms, and there are people who go on to develop very mild or atypical symptoms, and then there are people who think they are asymptomatic until you query them about some of the more unusual manifestations of COVID-19," she said. "But sometimes, these all get lumped together as 'asymptomatic.'"

It's thought that people in all three categories — including those who are presymptomatic — can transmit the virus, although there was again some confusion about the nature of asymptomatic spread. In early June, the World Health Organization was forced to clarify that the coronavirus can be spread by people with no symptoms after one of the agency's top infectious disease epidemiologists, Maria Van Kerkhove, said she thought asymptomatic spread of COVID-19 was "very rare."

Van Kerkhove's assessment was roundly criticized by scientists around the world. A day later, she said her response had been based on several studies that hadn't undergone peer review, and she made it clear that the WHO's guidance still stands.

Yet even if scientists are sure that asymptomatic people can be so-called silent spreaders — transmitting COVID-19 even if they show no symptoms — it's not known to what degree they are contributing to the outbreaks.

"It's been very hard thus far to nail down how much of transmission is due to asymptomatic people and how much is due to people who get quite sick," Sexton said.

Another big unknown is how asymptomatic people's immune systems respond and whether they will develop antibodies or other protections against the virus.

A study published June 18 in the journal Nature Medicine was the first to examine the immune responses in asymptomatic coronavirus patients. The researchers followed 37 asymptomatic people in China's Wanzhou district and compared them to 37 people who had symptoms.

Although it was a small study, the scientists found that the asymptomatic patients did develop antibodies, which are protective proteins the immune system produces in response to infections. But the researchers discovered that antibody levels among those people diminished within two to three months.

It's not yet known whether COVID-19 antibodies confer any kind of immunity, but if they do, the recent results suggest that the protections may not last long — particularly among those who are asymptomatic.

Mercado said it's possible that even low antibody levels could afford some protection, although more studies are needed to know for sure.

"There's a glimmer of hope that an antibody response can at least decrease the chances that you'll progress to a severe disease," he said.

Dr. Daniel Kuritzkes, chief of the infectious diseases division at Brigham and Women's Hospital in Boston, said it's not altogether surprising that asymptomatic patients would have more modest immune responses. But he noted an intriguing finding from the Nature Medicine study that further muddies the definition of "asymptomatic" coronavirus patients.

In CT scans of the study participants, the researchers found signs of lung inflammation, known as pulmonary infiltrates, even in people who showed no symptoms. Signatures of inflammation were observed in 57 percent of the asymptomatic group, a "surprising" find because it's not common to conduct CT scans on people who aren't exhibiting symptoms of a respiratory infection, Kuritzkes said.

"It makes you wonder if they really were asymptomatic, because clearly they had some pneumonia," he said. "It just goes to show that the absence of symptoms is not the absence of infection."

Sexton said that the recent study, while small, reveals some insights into the immune responses of asymptomatic patients but that the results also show how much remains unknown about this population.

"Until we know how much transmission asymptomatic people are responsible for, it makes an incredible amount of sense to keep stressing that everyone should wear a mask," she said. "If you happen to be in that category and you're wearing a mask, that's going to keep you from infecting people and putting those viral particles out in the environment. And everyone else wearing a mask is doing the same for you."


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‘It’s frightening’: Doctors say half of ‘cured’ COVID patients still suffer
Bnei Brak woman tells The Times of Israel that a month after testing negative she has severe fatigue and anxiety – and her husband is worse than he was when hospitalized

By Nathan Jeffay
28 June 2020, 11:09 pm

Recovered COVID patients are baffling doctors with complaints of freak pains, lungs that just won’t get back to normal, and a range of incapacitating psychological issues.

“What we are seeing is very frightening,” Prof. Gabriel Izbicki of Jerusalem’s Shaare Zedek Medical Center told The Times of Israel. “More than half the patients, weeks after testing negative, are still symptomatic.”

Izbicki is working on a study that involves follow-up with patients who were in hospitals or coronavirus hotels, looking at the aftereffects of the virus and trying to understand why patients continue to suffer long after being confirmed negative. “There is very little research about the mid-term affect of coronavirus,” he said, adding that it is much needed to guide doctors.

In Bnei Brak, at Israel’s first community clinic, doctors have been seeing a spike in recent days in the patients with pains that appear to come from nowhere.

“It can appear in the arms, legs, or other places where the virus doesn’t have a direct impact, and if you ask about the pain level on a 1 to 10 scale, can be 10, with people saying they can’t get to sleep,” said Eran Schenker, director of the month-old clinic in Bnei Brak run by Maccabi Healthcare Services. “It’s something which we’re starting to see much more in the last week.”

‘Broken’ by the virus

A patient from the clinic spoke to The Times of Israel on condition that her name is not published. She was diagnosed in March and tested negative a month ago. But the woman, a Bnei Brak resident in her 40s, still has severe fatigue and anxiety, and can only walk for a few minutes at a time.

Her husband, who also caught coronavirus in March and tested negative last month, now “feels like he’s broken,” she said. “He’s actually worse than he was when he was hospitalized.”

Her husband, 55, had some health problems before contracting coronavirus in March, but was active “from morning until night,” with plenty of energy. He is now extremely lethargic, can hardly walk, and has heart problems, she said.

This came as a particular shock to the family, as during his initial hospitalization in March and early April he did not require oxygen and X-rays showed no damage to his lungs. He was hospitalized again during April with pneumonia-like symptoms, and declared negative in May. But the man then developed pains and significant breathing problems, and has seen cardiologists, neurology experts, rehabilitation teams, and other professionals at the clinic.

This man was “one of the hard cases, but he’s not the worst and we have patients who suffer more,” according to Schenker.

He said that with all illnesses patients can be left reeling from long hospitalizations, and ventilators use can slow full recuperation — but COVID-19 is causing patterns that are not usually seen.

“We’re amazed that people aren’t just suffering from the things we expected, but things we just weren’t aware would have relevance,” he told The Times of Israel. “It’s not textbook.”

He stressed that his patients are not all newly recovered. “Some of them had coronavirus in March, so they may have been recovered for months,” he said.

Izbicki, director of Shaare Zedek’s Pulmonary Institute, also emphasized that many of his patients have long been declared coronavirus-free. One of the biggest surprises, he said, is that there is no predicting which patients will find the disease hard to shake, and which will not.

“There is no correlation between seriousness of disease during hospitalization and extent of symptoms afterwards,” he said, discussing preliminary results from his study on recovered patients who were treated in hospitals and coronavirus hotels.

“Within the symptoms that we checked for, we revealed general weakness among the majority of patients alongside shortness of breath, sustained cough, and other complex breathing and pulmonary issues,” he said, adding that he is also familiar with the freak pains that Schenker discussed.

These pains — seen in young patients and old alike — have doctors scratching their heads. Schenker said: “Painkillers block the pain but don’t relieve the source, but we don’t know how to address the source and you can’t be on painkillers the rest of your life.”

While the pains are excruciating for some, others describe the pains more as a major discomfort: burning sensations, tingling, or just a hard-to-place sense that a limb does not feel normal.

The patients with these pains do not normally raise red flags during the main medical examinations. Schenker said: “We check their lung and hearts and they have no disease, and they have no neurological issues. We do scans and can’t see anything, but they have this pain — we’re told about it again and again.”

Dan Oyero, Maccabi’s deputy director of medicine in central Israel, said that the overarching issue doctors are dealing with is the far-reaching change in people’s lives, for which doctors cannot predict an end point.

“The most distressing thing is that people compare how they feel now compared to how they were a few weeks ago before they were infected,” he said. “And they say they just can’t do the things they used to do.”

The sense of taste and smell, lost during the illness, sometimes does not return. When patients ask if it will come back, given that doctors have such limited experience of the disease, they cannot give a clear answer. “We just don’t know,” said Oyero.

When doctors can invoke a precedent from other illnesses, it can be bad news.

Elderly patients who were badly stricken by the coronavirus, even if they had no previous respiratory issues, can find their lungs working at half capacity, long after testing negative, said Schenker.

“They have two lungs, but they are the equivalent of one, because each lung is working at 50% — and it could be like this for the rest of their lives,” he said. He draws this conclusion from the pattern of lung damage that is seen from some other diseases — but normally only affecting patients who had previous lung complications.

“The damage was not done by the virus, but by an inflammation process which, we know from other diseases, will not leave lungs with the capacity to exchange oxygen as before,” Schenker commented.

Izbicki said that in his experience, COVID-related lung damage can affect patients of all ages, and said he shares the concern that people will not regain full lung performance. “We don’t know if the lung function tests will become normal,” he said.

Some patients require physical therapy. Schenker said: “We’ve seen cases of weight loss that have been so extreme that people find it hard to walk.” Meanwhile, some who are physically able to move around just don’t have the energy or motivation to do so.

Some of these patients are young and normally energetic, Schenker said.

“It’s amazing how many people went back to work — they can be educators, lawyers and in other professions — but when they sit for an hour they feel anxiety, feel insecure, and sometimes the people suffer from depression beyond what we expected.”

Oyero said:“The main complaints are actually fatigue, compacts [intense periods] of low energy — nothing we can give a name to. Many people say that they don’t have the energy they had before. They are more tired. Some say they don’t have the drive to do things. We can’t give the complaints a name or tell them they have a particular syndrome, but we’re trying to help them.”


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What they don’t tell you about surviving COVID-19
'Recovered' doesn't mean healthy again

Mike Moffitt, SFGATE
Updated 11:18 am CDT, Sunday, June 21, 2020

Most people who catch the new coronavirus don’t experience severe symptoms, and some have no symptoms at all. COVID-19 saves its worst for relatively few.

ICU nurse Sherie Antoinette has seen the serious cases first hand.

The lucky ones — if you can call them that — recover, but not in the sense that their lives are back to normal. For some, the damage is permanent. Their organs will never fully heal.

“When they say ’recovered,’ they don’t tell you that that means you may need a lung transplant,” Antoinette wrote in a Twitter post. “Or that you may come back after discharge with a massive heart attack or stroke, because COVID makes your blood thick as hell. Or that you may have to be on oxygen for the rest of your life.”

COVID 19 is the worst disease process I’ve ever worked with in my 8 years as an ICU nurse.
When they say “recovered” they don’t tell you that that means you may need a lung transplant.
Or that you may come back after d/c with a massive heart attack or stroke bc COVID makes
— Cherie Antoinette (@sheriantoinette) June 14, 2020

Antoinette’s tweet prompted a flurry of responses from former COVID-19 patients, family of patients and nurses working on the frontline of the disease.

We have selected some of their tweets and are running them with minor editing for clarity. SFGATE makes no claims to their authenticity.

I'm currently in the hospital after having a heart attack caused by clotting that resulted from COVID 19. I have a stent in my heart and need to wear a heart monitoring vest at all times. Now I face months of recovery including physical and occupational therapy. I'm only 29.


I went into acute kidney failure and needed dialysis. I now have asthma, chronic cough and an irregular heartbeat. I have conditions I never had before, plus I’m wiped all the time. I hope this gets better, but you [Sherie] are on the money. And, mine was considered a low-moderate case.

— Stephanie McCarroll

These are my observations (of hospitalized patients):

1) Everybody is so swollen their skin has blisters and is so tight it looks like it’s about to burst, from head to heel. And skin so dry peeling and flaky that to slather Vaseline on every shift is almost necessary — all over.

2) Everybody’s skin is weeping clear fluid and has sores and the skin just slides off with slightest turn or rub, all over the body.

3) Everybody’s blood is thick as slush. Can’t figure out what’s making it clot like that, but it’s dark and thick.

4) Everybody’s kidneys are failing. Urine dark or red, which could contribute to the swelling, but we don’t know yet.

5) Everybody has an abnormal heart rhythm. Not sure of the cause. But even without underlying heart problems, it’s not beating normally.

6) Seems counterproductive, but the ones that are not breathing on the ventilator have to lay flat on their stomachs to breathe better. And even some on the ventilator are on their stomachs. And the slightest turn for some is what leads to their almost immediate death. Bathing, cleaning and turning to prevent skin breakdown causes most to code blue, so a decision has to be made on which is most important.

7) Everyone has a Foley catheter and a rectal tube — incontinent of bowel and bladder.

8) Everybody on tube feeding. Everybody.

Never before in my entire career have I seen a disease process attack in this way.

— 20-year veteran nurse in NYC via Dr. Dee Knight

I spent 10 days on a ventilator last March with ARDS [Acute Respiratory Distress Syndrome] and I'm still on oxygen. Going home is just the beginning of the next steps in recovering. Every aspect of my life has changed for the worse. Please support and help anyone you know who survived. And wear a mask!

— Nurse @liveV4Vendetta

I'm just getting over a "mild" case after over two months. There's scarring in my lower right lung and my stomach and digestion are a mess like never before. But I'm coughing way less and can take walks again.

And, btw, this is the third time in two months that I've "gotten better." I'm just hoping it's the last and it doesn't all come back AGAIN.

— Eli

I’m a nurse on a COVID floor, I caught it. I am a relatively healthy 24-year-old and could barely walk up a half flight of stairs. My blood pressure skyrocketed, chest pain was debilitating. I’m 8 weeks out and still feeling the chest pain and shortness of breath. This is no joke.

— Alicia

I had COVID for over 60 days. I’m 33 years old, was super healthy, pescatarian, 125 pounds, and ran and did yoga every day. I couldn’t walk for two weeks besides a couple steps. It was the worst illness of my life.

I didn’t realize I had COVID symptoms for weeks. Here were the early signs:

- Waking up sweaty (I normally don’t sweat at night).

- Slight sporadic chills but no fever (or I thought I had no fever bc I only took my temp during the day).

- I could smell fine but would have weird smells like metallic or gas. Also, tasted metallic in the past 2-3 weeks. Apparently, a metallic taste or smell is related to lung problems.

- Loose stool but not terrible.

— Covid teacher (To read more about her symptoms and treatment, see her blog.)

I "recovered" March 29. I was born 65 years ago with chronic bronchitis that usually popped up maybe twice a year. Now, after COVID-19, I have acute bronchitis attacks 3-4 times a month and get winded walking to the mailbox.

— Hollis Charles

On right, lung of worlds first lung transplant for COVID— on left normal lungs
She is 20
— jeanne fisher (@jeannefisher17) June 15, 2020

I got COVID in March, and in May, developed symptoms of encephalomyelitis/chronic fatigue syndrome that leave me bedridden for days at a time. I’m so glad someone mentioned this so I know that I’m not the only one experiencing this.

— @PinkkYaYa

My mom worked on a COVID ward and contracted it, spent a month in ICU. She’s lucky enough to be home now, but she struggles to get up stairs and it’s going to be a long road to recovery. Thank you for everything that you do.

— Leanne

My coworker — an otherwise totally healthy 30-year-old — is still having issues breathing, two full months later. We’ve got patients coming back to the ER after they’re “recovered” because they can’t breathe or they get a blood clot. It’s so insane.

— Andi

I had it back in March and did 6 days on a ventilator. To date, I’m still short of breath with little exertion. I have pains all over that I have never had before. I’ve noticed I don’t urinate as much as I use to. And my legs & feet keep swelling so large no shoes fit. Even flops.

— Melly B.

I’m a healthy, active 23 year-old and I still have significant lung damage two months after I’ve “recovered.”

— Laney Whitney

Yeah, my mom "recovered" mid-May, except she had *nothing* left. Couldn't even eat or drink, they wanted to surgically insert feeding tube into her stomach. I had to invoke her DNR instructions, that SUCKED. She passed May 25. Thanks for all you do, be safe, good luck.

— @DevinCojones

Worst sickness ever. Left me and my husband sick and weak for almost two months. Almost killed my perfectly healthy 41-year-old nephew. Took down a 36-year-old friend with two bouts of pneumonia. Wear a freaking mask, people. How hard is that?

—Padma’s mom

My husband and I caught COVID two and a half months ago. While my symptoms were mild, he nearly had to be admitted because he couldn't breathe, and now, a month after he's recovered, we've discovered he has PERMANENT LUNG DAMAGE.

This is not “just the flu.” It isn't.

— Sue Mii

I had a "mild" case in February. I wasn’t hospitalized. Still extremely ill with a myriad of symptoms, including inflammation and lots of pain for 3 weeks. I have no doubt this virus causes permanent damage. Talk with someone who's had it before you decide to go without a mask.

— Leicia Faye


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‘They want to kill me’: Many COVID patients have terrifying delirium
Doctors say the condition is bedeviling coronavirus patients of all ages with no previous cognitive impairment.

Pam Belluck
June 29, 2020 | 10:35 AM

Kim Victory was paralyzed on a bed and being burned alive.

Just in time, someone rescued her, but suddenly, she was turned into an ice sculpture on a fancy cruise ship buffet. Next, she was a subject of an experiment in a lab in Japan. Then she was being attacked by cats.

Nightmarish visions like these plagued Victory during her hospitalization this spring for severe respiratory failure caused by the coronavirus. They made her so agitated that one night she pulled out her ventilator breathing tube; another time, she fell off a chair and landed on the floor of the intensive care unit.

“It was so real, and I was so scared,” said Victory, 31, now back home in Franklin, Tennessee.

To a startling degree, many coronavirus patients are reporting similar experiences. Called hospital delirium, the phenomenon has previously been seen mostly in a subset of older patients, some of whom already had dementia, and in recent years, hospitals adopted measures to reduce it.

“All of that has been erased by COVID,” said Dr. E. Wesley Ely, a director of the Critical Illness, Brain Dysfunction and Survivorship Center at Vanderbilt University and the Nashville Veteran’s Administration Hospital, whose team developed guidelines for hospitals to minimize delirium.

Now, the condition is bedeviling coronavirus patients of all ages with no previous cognitive impairment. Reports from hospitals and researchers suggest that about two-thirds to three-fourths of coronavirus patients in ICUs have experienced it in various ways. Some have “hyperactive delirium,” paranoid hallucinations and agitation; some have “hypoactive delirium,” internalized visions and confusion that cause patients to become withdrawn and incommunicative; and some have both.

The experiences are not just terrifying and disorienting. Delirium can have detrimental consequences long after it lifts, extending hospital stays, slowing recovery and increasing people’s risk of developing depression or post-traumatic stress disorder. Previously healthy older patients with delirium can develop dementia sooner than they otherwise would have and can die earlier, researchers have found.

“There’s increased risk for temporary or even permanent cognitive deficits,” said Dr. Lawrence Kaplan, director of consultation liaison psychiatry at the University of California, San Francisco Medical Center. “It is actually more devastating than people realize.”

The ingredients for delirium are pervasive during the pandemic. They include long stints on ventilators, heavy sedatives and poor sleep. Other factors: Patients are mostly immobile, occasionally restrained to keep them from accidentally disconnecting tubes, and receive minimal social interaction because families cannot visit and medical providers wear face-obscuring protective gear and spend limited time in patients’ rooms.

“It’s like the perfect storm to generate delirium; it really, really is,” said Dr. Sharon Inouye, a leading delirium expert who founded the Hospital Elder Life Program, guidelines that have helped to significantly decrease delirium among older patients. Both her program and Ely’s have devised recommendations for reducing delirium during the pandemic.

The virus itself or the body’s response to it may also generate neurological effects, “flipping people into more of a delirium state,” said Dr. Sajan Patel, an assistant professor at the University of California, San Francisco.

The oxygen depletion and inflammation that many seriously ill coronavirus patients experience can affect the brain and other organs besides the lungs. Kidney or liver failure can lead to buildup of delirium-promoting medications. Some patients develop small blood clots that do not cause strokes but spur subtle circulation disruption that might trigger cognitive problems and delirium, Inouye said.

Nails in a rotating head

“AK-47,” Ron Temko wrote in shaky handwriting from his hospital bed.

Then he pointed at his neck to show where the assault rifle should aim.

Temko, a 69-year-old mortgage company executive, could not speak because of the breathing tube in his mouth — he had been on a ventilator at UCSF Medical Center for about three weeks by then. So, on a Zoom call nurses arranged with his family, he wrote on paper attached to a clipboard.

“He wants us to kill him,” his son gasped, according to Temko and his wife Linda.

“No, honey,” Linda implored, “you’re going to be OK.”

At home now in San Francisco after a 60-day hospitalization, Temko said his suggestion that his family shoot him stemmed from a delirium-fueled delusion that he had been abducted.

“I was in a paranoiac phase where I thought there was some sort of conspiracy against me,” he said.

When he was first placed on the ventilator, doctors used a lighter sedative, propofol, and dialed it down for hours so he could be awake and know where he was — a “regimen to try to avoid delirium,” said Dr. Daniel Burkhardt, an anesthesiologist and intensivist who treated him.

But then Temko’s respiratory failure worsened. His blood pressure plummeted, a condition propofol intensifies. To allow the ventilator to completely breathe for him, doctors had him chemically paralyzed, which required heavier sedatives to prevent the trauma of being conscious while unable to move.

So Temko’s sedation was switched to midazolam, a benzodiazepine, and fentanyl, an opioid — drugs that exacerbate delirium.

“We had no choice,” Burkhardt said. “If you’re very sick and very unstable, basically what happens is we conclude you have bigger problems. You know, I have to get you to live through it first.”

After about two weeks, the sedative-weaning process began, but other delirium-related quandaries emerged. Temko began experiencing pain and anxiety, compelling doctors to balance treating those conditions with using medications that can worsen delirium, they said.

The repeated nursing visits Temko needed interrupted his sleep-wake cycle, so he would often take daytime naps and become sleepless and agitated at night, said Jason Bloomer, an ICU nurse.

At home, his wife kept her phone by her pillow so she could hear him via a nurse’s tablet. “He would wake up and was confused and anxious and he’d start getting all worked up to where the ventilator couldn’t work,” said Linda Temko, who would reassure him, “It’s OK, breathe.”

His hallucinations included a rotating human head. “Every time it came around, someone put a nail in it, and I could see that the person was still alive,” he said.

He imagined that his wristwatch (which was actually at home) was stolen by a man who turned it into a catheter. The man played a recording of Ben Bernanke, the former Federal Reserve chairman, and told Temko that because he recognized the name, “‘You know too much, you’re not leaving the hospital.’”

When Bloomer asked, “Do you feel safe?,” Temko shook his head no and mouthed around his breathing tube: “‘Help me.’”

Later, he became despairing. “I did not know if I wanted to live or die,” he said.

He met with Kaplan, the psychiatrist, who recognized his symptoms as delirium, partly because Temko bungled tests like naming the months backward and counting down from 100 by sevens. “He could only get from 100 to 93,” Kaplan said, adding, “The cardinal sin of delirium is always impaired attention.”

Kaplan prescribed Seroquel, which he said helps with perceptual disturbances and anxiety.

Temko said another turning point came when Bloomer said that with months of hard work, recovery was likely.

An optimistic cognitive sign, said Kaplan, is that Temko can now describe his delirium in much more detail than he could several weeks ago.

‘I saw the devil’

Some coronavirus patients develop delirium even after relatively short ICU stints.

Anatolio José Rios, 57, was intubated for just four days at Massachusetts General Hospital and did not receive highly delirium-inducing sedatives. Still, as sedation was lifted, he heard booms, and saw flashes of light and people praying for him.

“Oh my God, that was scary,” he said. “And when I opened my eyes, I saw the same doctors, the same nurses who were praying for me in my dream.”

After the ventilator was disconnected, Rios, a normally gregarious man who hosts a radio show, only responded with one- or two-word answers, said Dr. Peggy Lai, who treated him.

“I saw people lying on the floor like they were dead in the ICU,” he said. He imagined a vampirelike woman in his room. He was convinced people in the hall outside were armed with guns, threatening him.

“’Doctor, do you see that?’” he recalled saying. “’They want to kill me.’”

He asked if the door was bulletproof and, to calm him, the doctor said yes.

Like many delirious patients, Rios warped typical hospital activities into paranoid imaginings. Watching a hospital employee hanging a piece of paper, he said, he thought he saw a noose and feared he would be hanged. His delusions were not helped by one of many seemingly small delirium-fueling factors: His eyeglasses had not yet been returned to him.

After 10 days of hospitalization, he spent two months in a rehabilitation center because of foot inflammation, recently returning to his East Boston apartment. In May, his father in Mexico died of COVID-19, Rios said. He reflected on another hallucination in the hospital.

“I saw the devil, and I asked him, ‘Can you give me another chance?’ and he said, ‘Yes, but you know the price,’” Rios recalled. “Now I think I know the price was my father.”

‘Down a rabbit hole’

Two months after returning home from her three-week hospitalization, Victory said she has been experiencing troubling emotional and psychological symptoms, including depression and insomnia. She has been noticing the smell of cigarettes or wood burning, a figment of her imagination.

“I feel like I’m going down a rabbit hole, and I don’t know when I will be back to myself,” she said.

Dr. Kevin Hageman, one of her physicians at Vanderbilt University Medical Center, said she “was pretty profoundly delirious.”

Victory, a Vietnamese immigrant and previously healthy community college student majoring in biochemistry, said she did not remember yanking out her breathing tube, which was reinserted. But she recalled visions blending horror with absurdity.

One moment, scientists in Japan were testing chemicals on her; the next, she was telling them, “‘I am an American, and I have a right to eat a cheeseburger and drink Coca-Cola,’” she recalled, adding: “I don’t even like cheeseburgers.”

Along with this agitated hyperactive delirium, she experienced internalized hypoactive delirium. In a recovery room after leaving the ICU, she would stare for 10 to 20 seconds when asked basic questions, said Hageman, adding, “Nothing was quite processing.”

Victory managed to take a picture of herself with nasal oxygen tubes and a forehead scar, post it on Facebook and write “I’m alive” in Vietnamese so her parents in Vietnam would know she had survived. But another day, she called her husband, Wess Victory, 15 or 20 times, repeatedly saying, “I give you two hours to come pick me up.”

“It was heartbreaking,” said Wess Victory, who patiently told her she could not be released yet. “For four or five days, she still couldn’t remember what year it was, who the president was.”

Finally, he said, “something clicked.”

Now, to help overcome the fallout from the experience, she has started taking an antidepressant her doctor prescribed and recently saw a psychologist.

“People think when the patient got well and out of the hospital, it will be OK, it’s over,” Kim Victory said. “I worry if the virus didn’t kill me back then, would that have affected my body enough to kill me now?”


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Las Vegas Workers Sue Casinos Over Covid-19 Safety
Owners of Harrah’s, MGM Grand didn’t adequately protect employees from getting sick, lawsuit says

By Katherine Sayre
Updated June 29, 2020 8:06 pm ET

Las Vegas Strip hospitality workers filed a lawsuit against casino operators on Monday, accusing the companies of failing to protect employees from Covid-19, one of the first efforts to hold employers legally responsible for infections as cases in the U.S. surge.

The lawsuit, filed in U.S. District Court in Las Vegas against the owners of Harrah’s, MGM Grand and Bellagio casinos, says the companies didn’t immediately shut down food-and-beverage outlets and other areas after learning of positive cases, didn’t immediately inform employees when co-workers tested positive and didn’t adequately contact-trace before allowing colleagues of infected employees to return to the job.

Culinary Union Local 226 and Bartenders Union Local 165, through their joint bargaining agency, filed the lawsuit against Harrah’s Las Vegas LLC, a subsidiary of Caesars Entertainment Corp., and the Signature Condominiums LLC at the MGM Grand and Bellagio LLC, subsidiaries of MGM Resorts International.

The lawsuit said unsafe working conditions violate the unions’ contract. The unions represent 60,000 hospitality workers.

In response to the lawsuit, MGM Resorts said the company has offered free testing to workers before returning to the job and requires testing for anyone with symptoms or who might have been exposed. Managers have been trained in response protocols and work closely with public-health officials on contract tracing following positive test results, according to the company.

A Caesars Entertainment spokesperson said the company had no comment on the lawsuit. In a statement, the company said when a restaurant worker tested positive recently, Caesars launched an investigation at the direction of the Southern Nevada Health District, which identified co-workers who came in close proximity with the worker, the company said. The workers were placed on paid self-isolation and the restaurant has been temporarily closed for cleaning, the company said.

Senate Republicans and the Trump administration have pushed to shield companies from liability during the coronavirus pandemic as a condition of the next round of relief for households and businesses. U.S. companies have expressed concern about litigation as workers get sick or die from Covid-19, the illness caused by the new coronavirus.

The U.S. Chamber of Commerce has said the risk of class-action claims and other lawsuits could deter businesses from reopening.

Las Vegas casinos were allowed to reopen on June 4 with masks voluntary for guests.

Three weeks later, after calls from unionized workers, Nevada Gov. Steve Sisolakordered anyone inside casinos to wear face coverings beginning June 26.

Nevada reported 734 new cases Monday, bringing the total to 17,894 cases and 504 deaths.

Sixto Zermeno, a bellman at the Signature at MGM Grand for 10 years who is part of the lawsuit, said that when he was called back to work, the hotel was short-staffed, and guests weren’t social-distancing or wearing masks. On June 10, he was tested for Covid-19 after getting a fever and headache, and the next day learned that he was positive.

He said management was difficult to reach to report his case, and after alerting the MGM Resorts corporate office, the company didn’t immediately close down the bell desk and valet booth where he worked.

Bellmen and valets who worked shifts with him continued to interact with guests, according to the lawsuit.

“We’re not just numbers,” Mr. Zermeno said at a news conference Monday. “We’re families also. We’re human. I just want them to care, honestly.”

At least three valets and bellmen at the Signature have tested positive, according to the lawsuit.

It also says that Harrah’s failed to properly respond when a food runner at Guy Fieri Vegas Kitchen and Bar, co-managed by Harrah’s, tested positive.

Nineteen union workers or their dependents have died from Covid-19, according to the union.


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Behind the Trump team’s U-turn, mounting fears about a mission-accomplished message
After weeks of celebrating states that reopened, the vice president and others on Monday changed course — commending governors who slowed their plans.

06/29/2020 07:39 PM EDT

Mike Pence couldn’t bear to stay quiet much longer.

The vice president worried that a weeks-long public hiatus by his coronavirus task force had created an information void that contributed to a sharp rise in confirmed cases across the southern and western United States.

With a televised briefing on Friday, organized at Pence’s direction on a day’s notice, the group revealed an undercurrent of fear behind the scenes of the federal government as the virus mounted its resurgence.

Over the weekend, Pence stepped up his urgency. Other Trump officials and allies issued stark new warnings as case counts soared in some of the nation’s largest states. And the machinery that had lined up behind President Donald Trump’s mission-accomplished message suddenly started to fade away.

The striking shift in the vice president’s tone — from zealously defending Trump’s push to reopen the U.S. economy to complimenting governors on Monday for halting their states’ reopenings — underscores Pence’s thorny position as he works to balance his and Trump’s political futures, which largely rely on convincing voters an economic rebound is on the horizon, with ensuring an appropriate response to an unwieldy new phase in the coronavirus pandemic.

Inside the Department of Health and Human Services, officials have agonized over Pence’s recent messages on coronavirus, saying that his ever-sunny tone could confuse Americans about the actual risks of the outbreak.

“We are winning the fight against the invisible enemy,” Pence contended in a June 16 op-ed that blamed the media for creating an “overblown” sense of panic about increased coronavirus infections during America’s phased economic reopening.

Pence spent Friday’s press conference touting the nation’s progress in fighting the coronavirus and defending the “constitutional rights” of people to participate in large gatherings, such as the Tulsa, Okla., Trump rally that Pence attended earlier this month, where a very small percentage of the crowd could be seen wearing protective coverings.

But the briefing foreshadowed a change in Pence’s own relaxed response to the novel coronavirus — a shift that intensified during his visit to a Texas mega-church, where he affirmed the importance of protective face coverings as a way to prevent transmission. It’s “just a good idea,” he said Sunday.

Pence praised Texas Gov. Greg Abbott, a Republican who had proudly pushed to reopen his state quickly, for taking steps “to limit the kind of gatherings and meetings in certain places in communities that may well be contributing to the community spread that we’re seeing…”

Pence’s pro-mask endorsement drew praise from corners of the administration on Monday. One senior administration official said it was “a step in the right direction that President Trump should also take.”

Anne Schuchat, principal deputy director at the Centers for Disease Control and Prevention, commented that “we need to get everybody on board at this point,” during a Monday webinar hosted by the Journal of the American Medical Association. (Schuchat did not cite Pence specifically, but spoke after the journal’s editor-in-chief praised the vice president for coming out in favor of masks over the weekend.)

But other recent comments by Pence — including his victory lap during Friday’s news conference about the amount of medical supplies and equipment procured by the administration — marked a jarring contrast against the alarm bells top health officials sounded last week.

“There are more cases. There are more hospitalizations in some of those places and soon you’ll be seeing more deaths,” Dr. Anthony Fauci, one of the health experts on the White House coronavirus task force, said during the task force briefing as Pence quietly looked on.

“The window is closing,” added HHS Secretary Alex Azar during a Sunday morning appearance on NBC. “We have to act, and people as individuals have to act responsibly.”

Azar’s comments previewed the sharper tone that both he and Pence have adopted in the past 48 hours, as more than a dozen states confront alarming surges in confirmed Covid-19 cases that could overwhelm hospitals and plunge some communities back into lockdowns that residents and business owners anxiously hope to avoid.

Six states — Texas, Florida, Idaho, Tennessee, Utah and Georgia — all reported their highest single-day totals of new coronavirus cases on Saturday, a development Abbott described as “a very dangerous turn” in his state.

Top White House officials remain divided over the best course of action as the rate of new infections spikes in states across the U.S. Some officials, including health aides, believe the government needs to offer Americans more information on a regular basis about the best practices to keep Americans safe in the age of Covid-19 as well as continuing updates on new infections. Other aides firmly believe the White House should charge ahead with its economic message, regardless of the virus. That faction inside the White House does not want regular briefings on the state of Covid-19 or too many public appearances from officials like Fauci that could sour the nation’s mood in the coming months.

The steep rise in infections led a number of Republicans in the last 48 hours to start promoting the idea of wearing masks in public, or donning face coverings themselves.

Pence wore a mask on Sunday as he stepped off the government plane in Texas to greet the governor, as did Sen. John Cornyn, White House coronavirus response coordinator Dr. Deborah Birx and Housing and Urban Development Secretary Ben Carson, all of whom joined the vice president on his Sunday trip to Texas.

Meanwhile, Senate Majority Leader Mitch McConnell took to the Senate floor on Monday to say there should be “no stigma — none — about wearing masks when we leave our homes and come near other people.”

“Wearing simple face coverings is not about protecting ourselves. It is about protecting everyone we encounter,” McConnell said, weeks after Trump mocked his 2020 Democratic challenger, Joe Biden, for wearing a mask outdoors on Memorial Day.

During Pence’s call with governors on Monday, Abbott cited festivities over Memorial Day weekend, as well as his decision to permit bars to reopen, as two reasons Texas has witnessed skyrocketing cases and hospitalizations in the past three weeks. Arizona Gov. Doug Ducey similarly said coronavirus cases in his state had slowed to a crawl before the latest surge, which began after restaurants, gyms and non-essential industries were given the greenlight to resume business in May and early June.

The surges in the south are leading other states, such as New Jersey, to halt their plans to open indoor dining at restaurants — a sign of mounting worries hitting state leaders across the nation just as they hoped to be putting the crisis behind them.

At a coronavirus task force meeting on Friday, counselor to the president Kellyanne Conway — who managed the president’s 2016 campaign — told aides the administration needed to make its priorities clear to the American public — including ideas about whether it was more important for bars in Texas and Florida to re-open this summer, or for schools to start on time in the fall, said a person familiar with the meeting.

White House coronavirus task force members spent much of Monday’s call with governors focusing on the drivers behind the precipitous rise in cases, according to two people familiar with the discussion. Notably absent from the conversation were previous dismissals by Pence and others that the increase in cases was largely the result of expanded testing.

Though Trump has continued to cling to increased testing as the primary explanation for new Covid-19 outbreaks, Pence has come to terms with the reality that testing alone cannot account for the surge of cases in the last week, according to a person familiar with his thinking.

In another striking departure from Trump, who sidelined the federal government’s task force last month to ensure his reopening message was front and center, Pence specifically commended governors on Monday for issuing new guidance or halting their plans to reopen. It was a significant break from his previous approval of states that had raced to start their economies back up.

Fauci, an expert in infectious diseases who established a ubiquitous on-screen presence during the early days of the pandemic, pointed to the resurgence of Covid-19 as a harsh reminder that it can often take two to three weeks for new coronavirus clusters to appear in data.

One senior administration official said the Trump campaign has been nervously monitoring data out of Oklahoma to determine whether the president’s June 22 rally, which the local fire department estimated 6,200 people attended, leads to apparent surge in surrounding counties over the next two weeks.

“There is definitely an acknowledgement that a surge is happening,” said one of the people familiar with Monday’s call with governors, which this person said was “the first time” administration officials admitted that a slow-speed reopening is likely safer than the rapid approach Trump has embraced.

Still, Pence and other top officials offered a mostly optimistic perspective of the coronavirus crisis, emphasizing that the nation is better-prepared to manage new outbreaks and encouraging governors to focus specifically on reminding younger Americans of the risk they could pose to older relatives if they become infected. Azar on the call avoided faulting the reopenings themselves for the upswing in cases, placing the blame instead on people failing to behave responsibly as states loosened their social distancing restrictions.

Task force members were also noncommittal about taking a stronger stand on mask-wearing, in response to Utah Gov. Gary Herbert’s request on the call for Trump to join his vice president in publicly urging Americans to wear face masks.

The Trump administration is, however, reviewing a new round of public health guidance for how states can mitigate the risks of coronavirus, with a focus on warnings about gatherings and the need for face coverings, said three officials. That guidance could be released by the July 4th holiday weekend, when Trump is expected to be in South Dakota to participate in a fireworks show at Mount Rushmore.

Meanwhile, Pence has canceled campaign-related events in Florida and Arizona this week — two states where coronavirus cases are rising rapidly — but is still expected to meet with both governors.

Before traveling to Texas on Sunday, where he spoke at First Baptist Church of Dallas alongside pro-Trump pastor Robert Jeffress and later met with Abbott, Pence organized the press conference last week where he and task force officials updated Americans on the resurgent virus. A person familiar with the matter said Pence arrived at the decision to hold a public briefing — following weeks of behind-the-scenes task force meetings — after he and several health officials expressed concern that an information void may have contributed to the sharp rise in coronavirus cases. The task force had stopped its near-daily briefings in early May when Trump and other senior administration officials began pushing states to reopen their economies.

But unlike those briefings, where top economic officials often made appearances to promote lifting bans on non-essential business operations and to laud the president’s leadership, Friday’s update was almost singularly focused on addressing recent Covid-19 outbreaks and encouraging Americans to exercise restraint and social distancing. While Pence spun a rosy picture about progress in testing and dismissed concerns about the president’s campaign schedule, he never once interjected when the health officials standing beside him gave sober assessments about the status of the pandemic.


Heliobas Disciple

Has No Life - Lives on TB
(fair use applies)

Masks are dividing Florida’s Republican leaders as coronavirus outbreak spreads
Some have supported mask ordinances, some are suing to stop them and some are trashing them on TV.

By Steve Contorno
Published 6 hours ago | Updated 5 hours ago

The record-setting pace of new coronavirus cases in Florida has been met with mixed signals from Republican leaders over how far to push Floridians to wear masks. Monday was an exposition in how a piece of cloth has vexed the party of freedom and personal responsibility.

In Jacksonville, Republican Mayor Lenny Curry made it mandatory to wear a mask in indoor public spaces as the city looks to contain the outbreak ahead of the August Republican National Convention. Meanwhile, U.S. Sen. Rick Scott, a Republican, ripped mask mandates during a Fox News interview and suggested leaders should “inform us (but) stop telling us what to do.” Gov. Ron DeSantis has said he won’t stand in the way of local rules regarding masks while simultaneously suggesting that policing facial-wear would “backfire.”

“We left it to the locals to make decisions about coercive measures or impose any kind of criminal penalties,” DeSantis said Monday. “We’re not going to do that statewide.”

Experts agree that masks can help stop transmission of the disease, and many Republican leaders are encouraging people to wear them, including DeSantis, Scott and U.S. Sen. Marco Rubio. After eschewing face wear early on, DeSantis and his aides are more frequently spotted wearing masks at public events. Rubio has donned a mask in his Twitter picture.

However, for many Republicans a mandate is a step too far. Leon County Republican Party Chairman Evan Power sued his county over a mask order earlier this month. State Rep. Anthony Sabatini, R-Howey in the Hills, joined Hillsborough County GOP chairman Jim Waurishuk outside the local courthouse Monday to announce a lawsuit against the county’s mask order.

“We have real concerns of governments overreaching during these periods of time that can hurt us in the future,” Power said. “It should be handled by local businesses. The government’s job is to educate people on the right thing to do, not force mandates down.”

The division among Florida Republicans can be traced to the confusing cues coming from President Donald Trump. His administration has officially recommended mask wearing for months, but the president himself is rarely spotted in public with a mask on and they were not required at his recent campaign rally in Tulsa. Trump recently ridiculed his November election foe, Democrat Joe Biden, for covering his face.

Trump also moved the Republican National Convention out of Charlotte after clashes with state and local leaders over safety measures related to the coronavirus, including whether attendees needed to wear masks. Now, the new host city, Jacksonville, is requiring people to wear face masks two months out from the convention. Curry, a former state party chairman, resisted the action for weeks but changed course on Monday amid rising fears and the convention fast approaching.

Whether that mandate lasts until the convention commences on Aug. 24 remains to be seen. It is also possible that city leaders carve out an exemption for attendees, though discussions on health precautions are fluid, RNC organizers said.

“The event is still two months away, and we are planning to offer health precautions including but not limited to temperature checks, available (personal protective equipment), aggressive sanitizing protocols, and available COVID-19 testing,” convention spokesman Mike Reed said. We have a great working relationship with local leadership in Jacksonville and the state of Florida, and we will continue to coordinate with them in the months ahead.”

Florida on Monday reported 28 deaths from COVD-19 and 5,266 new cases, bringing the number of people infected in Florida to 146,341. However, half of those cases have come in the past two weeks and many Florida counties, including Hillsborough, Pinellas and Miami-Dade, have turned to mask mandates to help slow the spread, using emergency powers granted during this public health crisis. Even Martin County, nestled in the red part of Florida, required employers and workers to wear masks.

There’s overwhelming bipartisan support for face masks and most people have worn them without incident. In a recent statewide survey, 85 percent of respondents, including 78 percent of Republicans, told the pollster St. Pete Polls that they would wear masks when they go out in public.

But an active and vocal minority of residents who oppose face masks have garnered considerable attention. Angry citizens flooded a recent Palm Beach County Commission meeting to protest a new mask ordinance, sharing unfounded claims about adverse effects that went viral. A 11,000-member Facebook group once dedicated to reopening the state for business has turned into a forum for strategies to eschew face mask rules at businesses.

Florida Republicans face an uphill battle containing the outbreak as long as these sentiments are out there, leaders have acknowledged.

“We’re not done with this. We all have to take this seriously,” Scott told Fox News. “We’ve got to continue to talk about the importance of wearing masks and continue to talk about the importance of social distancing.”


Heliobas Disciple

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CDC says U.S. has ‘way too much virus’ to control pandemic as cases surge across country
William Feuer
Published Mon, Jun 29 20204:45 PM EDT | Updated Mon, Jun 29 20205:30 PM EDT

Key Points
  • The coronavirus is spreading too rapidly and too broadly for the U.S. to get it under control as some other countries have, Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, said Monday.
  • The U.S. stands in stark contrast to countries like South Korea, New Zealand and Singapore as it continues to report over 30,000 new infections per day.
  • “This is really the beginning,” Schuchat said of the U.S.’s recent surge in new cases.
The coronavirus is spreading too rapidly and too broadly for the U.S. to bring it under control, Dr. Anne Schuchat, principal deputy director of the Centers for Disease Control and Prevention, said Monday.

The U.S. has set records for daily new infections in recent days as outbreaks surge mostly across the South and West. The recent spike in new cases has outpaced daily infections in April when the virus rocked Washington state and the northeast, and when public officials thought the outbreak was hitting its peak in the U.S.

“We’re not in the situation of New Zealand or Singapore or Korea where a new case is rapidly identified and all the contacts are traced and people are isolated who are sick and people who are exposed are quarantined and they can keep things under control,” she said in an interview with The Journal of the American Medical Association’s Dr. Howard Bauchner. “We have way too much virus across the country for that right now, so it’s very discouraging.”

New Zealand’s outbreak peaked in early April, when the country reported 89 new cases in a single day, according to data compiled by Johns Hopkins University. On June 8, officials declared that there no more active infections in the island country of almost 5 million. Since then, a handful of cases have entered the country from international travelers, but health officials have managed to contain infections so far to fewer than 10 new daily cases per day through June.

South Korea was among the first countries outside of China to battle a coronavirus outbreak, but health officials managed to contain the epidemic through aggressive testing, contact tracing and isolating of infected people. The outbreak peaked at 851 new infections reported on March 3, according to Hopkins’ data, but the country has reported fewer than 100 new cases per day since April 1.

Like South Korea, Singapore found early success in preventing the spread of the virus through aggressive testing and tracing. However, in April the virus began to circulate among the island country’s migrant worker community, ballooning into an outbreak that peaked on April 20, when the country reported about 1,400 new cases, according to Hopkins’ data. Daily new cases have steadily dropped since then and on Sunday, the country reported 213 new cases, according to Hopkins’ data.

While the outbreaks in New Zealand, South Korea and Singapore have been of different magnitudes and followed different trajectories, officials in all three countries now quickly respond to every new infection in order to stamp out what remains of the outbreak, Schuchat said. The U.S. stands in stark contrast as it continues to report over 30,000 new infections per day.

“This is really the beginning,” Schuchat said of the U.S.’s recent surge in new cases. “I think there was a lot of wishful thinking around the country that, hey it’s summer. Everything’s going to be fine. We’re over this and we are not even beginning to be over this. There are a lot of worrisome factors about the last week or so.”

The sheer size of the U.S. and the fact that the virus is hitting different parts of the country at different times complicates the public response here compared with other countries, Schuchat said. South Korea, for example, was able to concentrate their response on the southern city of Daegu, for a time, and contact tracers were quickly deployed when new cases were later found in the capital Seoul.

“What we have in the United States, it’s hard to describe because it’s so many different outbreaks,” Schuchat said. “There was a wave of incredible acceleration, intense interventions and control measures that have brought things down to a much lower level of circulation in the New York City, Connecticut, New Jersey area. But in much of the rest of the country, there’s still a lot of virus. And in lots of places, there’s more virus circulating than there was.”

The coronavirus has proven to be the kind of virus that Schuchat and her colleagues always feared would emerge, she said. She added that it spreads easily, no one appears to have immunity to it and it’s in fact “stealthier than we were expecting.”

“While you plan for it, you think about it, you have that human denial that it’s really going to happen on your watch, but it’s happening,” she said. “As much as we’ve studied [the 1918 flu pandemic], I think what we’re experiencing as a global community is really bad and it’s similar to that 1918 transformational experience.”

With the current level of spread, Schuchat said the U.S. public should “expect this virus to continue to circulate.” She added that people can help to curb the spread of infection by practicing social distancing, wearing a mask and washing their hands, but no one should count on any kind of relief to stop the virus until there’s a vaccine.

“We can affect it, but in terms of the weather or the season helping us, I don’t think we can count on that,” she said.


Heliobas Disciple

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People with coronavirus are crossing the US-Mexico border for medical care
By Catherine E. Shoichet
Updated 7:24 AM ET, Mon June 29, 2020

Chris Van Gorder says he's seeing a telling trend in the hospitals he runs.

Coronavirus patients are showing up in emergency rooms after calling 911 from the US-Mexico border.

"They'll literally come to the border and call an ambulance," says Van Gorder, president and CEO of Scripps Health, a hospital system in southern California.

The rise in ambulance traffic from the border, which several officials described to CNN, is a symptom of the pandemic's spread in the region -- and a sign of the many connections between communities in both countries.

"There just is not a wall for viruses at the border," says Josiah Heyman, director of the Center for Inter-American and Border Studies at the University of Texas at El Paso. "The wall is an illusion, because the two sides are really woven together."

An increase in cross-border coronavirus cases, which began getting public attention in May, overwhelmed some California hospitals and spurred the state to create a new patient transfer system to help.

"It's an unprecedented surge across the border," says Carmela Coyle, president and CEO of the California Hospital Association.

In the past five weeks, more than 500 patients have been transferred to hospitals across the state from California's Imperial County, which has the state's highest per capita rate of coronavirus cases -- and, according to officials, has seen a large number of patients crossing from Mexico.

But Van Gorder, Coyle and other officials in California say this isn't an immigration issue.

Most of the coronavirus patients crossing the border, they say, are Americans.

In a call with state hospital leaders earlier this month, the head of California's emergency medical services authority, Dr. David Duncan, described the steady stream of patients coming to Imperial County as "gas on the fire."

"We've got this continual flow of Covid coming across the border in the form of US citizens that carry and continue to escalate and fuel the Covid pressures that we see," Duncan said.

The view from the border

Officials estimate about a quarter of a million US citizens live across the border in the Mexican state of Baja California. Many work in the US and have family members there. Some regularly go to US hospitals when they need medical attention. Others decided to cross this time because Mexican hospitals were overwhelmed by a crush of coronavirus cases.

"What has happened as the situation has worsened on the Mexican side of the line is that a number of the US citizens are returning to the United States to seek care for Covid-19," says Coyle of the California Hospital Association.

Officials in Mexico's Baja California state say the number of active coronavirus cases there are now declining. But the state -- which is home to large cities like Tijuana and Mexicali -- has been hit hard by the pandemic. With more than 1,700 dead, it's among the Mexican states with the highest Covid-19 death tolls and death rates per capita.

Sergio A. Beltrán, US Customs and Border Protection's officer in charge for the Calexico ports of entry, said in a statement to CNN that he started to see an increasing flow of people coming across the border for medical care a few months ago.

"While it varies from day to day, and shift to shift, we have experienced a significant increase in medical-related calls at the Calexico ports of entry that can be directly linked to the COVID-19 pandemic over the last couple of months," he said. "We're definitely seeing people on a daily basis. And we still have our regular medical-related calls that aren't COVID-related from people in accidents or having other medical issues and are coming for medical treatment in the US."

Sometimes people walk to the port of entry or drive themselves to the border crossing, then call for an ambulance to get them to a US medical facility when they arrive. And sometimes, he said, travelers arrive at the border in Mexican ambulances and have already arranged for US ambulances to meet them there.

What happened in California hospitals as more coronavirus patients crossed

At El Centro Regional Medical Center in Imperial County, coronavirus cases started to climb in early May as the situation across the border in Mexicali worsened, says Adolphe Edward, the hospital's CEO.

"That uptick just took a fast, escalating move," Edward says.

At one point that month, the 161-bed hospital saw so many coronavirus cases that it had to stop accepting any new patients in its emergency room.

Edward says he heard first-hand from his own staff one reason the numbers were going up.

"I've got over 60 staff members that travel back and forth every day. They live in Mexicali, but they come to work here," he says. "They told me it took Mexicali a while to get to the point where they put (social distancing) restrictions. I think that's one reason why the number is as high as it is now."

About 90 miles to the west, Scripps Mercy Hospital Chula Vista, which is across the border from Tijuana, was also seeing cases starting to climb.

Officials began tracking the travel histories of patients there, and quickly spotted a trend: Many had recently been in Mexico.

"About half the patients that are testing positive are indicating they've crossed the border within the previous week," Van Gorder says.

"The patients that cross the border appear to be sicker than the patients that we've normally been seeing," he says. "It may be that they waited in Mexico too long, or they went to a Mexican hospital and decided to get their care here."

'It's almost like a waterfall cascading'

The flow of patients across the border has been steady for weeks, says Coyle of the California Hospital Association. And now hospitals across the state -- including as far north as Sacramento -- are taking in coronavirus patients from Imperial County as part of a new patient transfer system set up to ease the pressure, Coyle said.

A challenge across the region, she says, is that so many patients are sick with the same condition, requiring the same equipment for treatment, at the same time.

"That is what driving the shortages of service and supply in Mexicali, driving these expats back to the United States and then driving a very unique movement of patients into and more broadly across the state of California," she says. "It's almost like a waterfall cascading."

Even though the US-Mexico border has been closed to all but essential travel since March, thousands of people still cross daily.

Van Gorder says he's concerned that officials are moving too quickly towards reopening.

"We still don't have our arms completely around Covid and the Covid spread," he says. "And as a border community, I think we have a double risk."

On Friday Gov. Gavin Newsom said the percentage of positive coronavirus tests in Imperial County was so high that he was recommending that officials reinstate a stay-at-home order there. State officials have said US citizens crossing into California for medical care are among the factors driving the uptick. The governor said Friday that "it's too early to tell" if the high number of cases in neighboring Arizona are also a contributing factor , adding that a "deep dive" study by the CDC is underway.

What's happening in other parts of the border

Heyman, of the University of Texas at El Paso, says there's one thing that's important to remember about coronavirus -- and other issues -- along the vast US-Mexico border.

"The two sides can't be kept separate," he says. "If there's a problem on one side of the border, it flows to the other side."

In earlier days of the pandemic, Mexican officials expressed concern about travelers from the US bringing coronavirus into the country.

In the Mexican border city of Nogales in May, officials installed "sanitizing tunnels" that sprayed a disinfectant solution on people who'd just come from the US.

"I don't know what they thought they were doing," says Arturo Garino, the mayor of the sister city on the US side of the border, Nogales, Arizona. But Garino says he's concerned about the flow of people traveling across the border, too.

While coronavirus cases are surging, particularly in two Arizona counties along the border -- Santa Cruz and Yuma -- Garino says officials haven't pinpointed the cause.

"It has to do a lot with social distancing. It has to do a lot with gatherings," he says. "And I know a lot of residents here go into Mexico and vice versa."

Garino, who recently signed an order requiring people in his city to wear masks in public places, says he's worried about the frequent cross-border travel that's a part of daily life there intensifying the spread of the virus.
"I'm concerned because of the spike in cases that we have," he says. "We're trying to do our best to curb this virus, and we continuously keep on going up and up and up."


Heliobas Disciple

Has No Life - Lives on TB
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Terror groups aiming to deploy 'coronavirus spreaders' for new Jihad attacks
According to anti-terror cops in Russia, sick Jihad groups are encouraging new members to spread coronavirus in public places. The disease sparked a pandemic earlier this year

ByDavid Rivers
12:54, 29 JUN 2020 | Updated12:55, 29 JUN 2020

Sick terror groups are instructing new recruits to spread coronavirus for Jihad attacks, according to authorities in Russia.

Head of the Commonwealth of Independent States (CIS) Anti-Terrorism Centre, Andrei Novikov, said units were recruiting "Jihad soldiers".

He added that they are being told to spread Covid-19 in public places.

The disease has sparked a global pandemic and has killed more than 500,000 since it emerged in Wuhan, China, at the end of last year.

But according to Russian intelligence, it could be exploited by terror units.

Novikov said: "While governments are trying to ensure health security, focusing on protecting the lives and health of their people, recruiters of international terrorist groups are not just taking advantage of the difficult situation in order to recruit more ‘Jihad soldiers,’ they are calling on infected members to spread COVID-19 as wide as possible in public places, state agencies and so on."

He added: "Accordingly, countries that have effective systems to control the epidemiological situation, identify the infected and treat the sick are in the best position."

He added that such a move marks a new psychological threat, reports Tass.

Earlier today, it emerged that schools, offices and hospitals in the UK have been urged to rehearse for terror attacks following a stabbing in Reading that left three people dead.

The advice booklet published by says: "Defending your organisation against a marauding terrorist attack is undoubtedly a challenging task.

"However, with well developed procedures, security systems, training and rehearsal, lives can be saved."

It continues: "Rehearsing the response to a marauding terrorist attack is the only way to ensure that the procedures and technical systems function as expected and to highlight areas for improvement," the advice says.

"Rehearsals are also key in preparing security and front-line personnel since the actions required of them during an attack do not form part of their usual duties.

"Testing components and later full integration of your procedures using practical rehearsals will highlight real-world issues and areas for further improvement."


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Researchers report nearly 300 cases of inflammatory syndrome tied to Covid-19 in kids
By Helen Branswell
June 29, 2020

Two U.S. research groups have reported finding nearly 300 cases of an alarming apparent side effect of Covid-19 in children, a condition called multisystem inflammation syndrome, or MIS-C. While researchers have previously reported on the condition, the papers mark the first attempt to measure how frequently the side effect occurs and how it affects children who develop it.

The studies, published in the New England Journal of Medicine, describe children who develop severe inflammation affecting multiple organ systems after having had Covid-19, sometimes between two and four weeks after the infection. The majority of the children were previously healthy.

In one of the studies, led by researchers at Boston Children’s Hospital, 80% of the children who developed the condition required intensive care, 20% required mechanical ventilation, and four children, or 2%, died. In the second study, from researchers from New York state, a similar percentage of 99 children who developed the syndrome required ICU care and two children died. In both studies, many of the children developed cardiovascular and clotting problems and many had gastrointestinal symptoms. A high proportion also had skin rashes.

“Ours were really sick kids,” said Adrienne Randolph, an ICU physician at Boston Children’s Hospital and senior author on one of the papers, which was based on reports from 26 states.

Manish Patel, from the Centers for Disease Control and Prevention’s Covid-19 response team, said the message to parents is they should be on the lookout for fever and rash in children who have recently had Covid-19.

“I think being a little vigilant is important,” said Patel, who is an author on Randolph’s paper. “Fever, rash and I think especially in the setting of areas where you have a lot of coronavirus infections, SARS-CoV-2 infections — have a lower threshold for seeking care, I would say.”

On the whole, children appear to contract SARS-CoV-2 less often than adults and have a milder course of disease when they do.

But in late April, doctors in London alerted the world to the possibility that some children who had Covid-19 appeared to go on to develop something that looked like Kawasaki’s disease, an inflammatory condition that can attack the heart. KD, as it is called, is generally seen in children under the age of 5. Shortly thereafter, doctors in New York began to report cases as well.

In mid-May, the CDC asked doctors across the country to be on the lookout for cases of multisystem inflammatory syndrome in children.

The nearly 300 cases identified in these two studies share some similarities with KD, but there are also differences. Few of the children are under the age of 5. The average age of children in the larger study was 8; 42% of the children in the New York cohort were aged 6 to 12.

Another difference: While KD disproportionately affects children of Asian descent, MIS-C cases in the New York cohort were of all racial and ethnic backgrounds, the researchers reported.

“Among our patients, predominantly from the New York Metropolitan Region, 40% were Black and 36% were Hispanic. This may be a reflection of the well-documented elevated incidence of SARS CoV-2 infection among black and Hispanic communities,” they wrote.

The New York group estimated that the majority of MIS-C cases occurred about one month after the peak of Covid-19 cases in the state. They estimated that between March 1 and May 10, two of every 100,000 people under the 21 years of age who had laboratory-confirmed SARS-CoV-2 virus developed MIS-C in the state. The infection rate in people under the age of 21 years was 322 in 100,000 over that period.

An editorial written by Michael Levin, from the department of infectious diseases at Imperial College London, said there have been roughly 1,000 pediatric cases of the condition reported worldwide to date. He suggested more are likely going unrecorded, because case definitions require evidence of prior Covid-19 infection.

“There is concern that children meeting current diagnostic criteria for MIS-C are the ‘tip of the iceberg,’ and a bigger problem may be lurking below the waterline,” Levin wrote.


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China’s military approves coronavirus vaccine for use on soldiers
By Yaron Steinbuch
June 29, 2020 | 10:28am

The Chinese military has received the green light to use a coronavirus vaccine developed by its research unit and a biotech company, according to a report.

The Central Military Commission approved the use of the Ad5-nCoV vaccine candidate on Thursday for a period of one year, CanSino Biologics said in a filing, Reuters reported.

It was developed jointly by CanSino and the Beijing Institute of Biotechnology at the Academy of Military Medical Sciences. The company said clinical trials proved the vaccine was safe and showed some efficacy, according to the news outlet.

The Ad5-nCoV is one of China’s eight COVID-19 vaccine candidates approved for human trials at home and abroad. It also won approval for human testing in Canada.

“The Ad5-nCoV is currently limited to military use only and its use cannot be expanded to a broader vaccination range without the approval of the Logistics Support Department,” CanSino said, referring to the Central Military Commission.

CanSino declined to disclose to Reuters whether the innoculation is mandatory or optional, citing commercial secrets.

The Phase 1 and 2 clinical trials of the CanSino vaccine candidate showed it has the potential to be effective, but its commercial success cannot be guaranteed, the company said.

China earlier this month offered two other vaccine candidates to employees at state-owned firms traveling abroad.

Separately, AMS received an approval earlier this month to test its second experimental COVID-19 vaccine in humans.

No vaccine has yet been approved for commercial use, but more than a dozen vaccines from more than 100 candidates worldwide are being tested in humans.


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WHO Chief On COVID-19 Pandemic: 'The Worst Is Yet To Come'
Scott Neuman
June 29, 20207:47 PM ET

The head of the World Health Organization is warning that the COVID-19 pandemic is actually speeding up and he criticized governments that have failed to establish reliable contact tracing to stop the spread of the coronavirus.

Speaking at a briefing in Geneva, Tedros Adhanom Ghebreyesus said: "We all want this to be over. We all want to get on with our lives. But the hard reality is this is not even close to being over."

"Although many countries have made some progress, globally the pandemic is actually speeding up," he said.

He said the solution is the same as it has been since the early days of the pandemic: "Test, trace, isolate and quarantine."

"If any country is saying contact tracing is difficult, it is a lame excuse," he said.

According to the latest tally from Johns Hopkins University, there have been more than 10 million confirmed coronavirus infections worldwide since the virus was first identified in China late last year, with more than a half-million deaths. The U.S. alone accounts for more than one-quarter of all confirmed cases, with nearly 126,000 deaths.

"If any country is saying contact tracing is difficult, it is a lame excuse," says @WHO Chief @DrTedros, pointing
out that many public health professionals have risked their lives to do contact tracing in active conflict zones,
including @DrMikeRyan when fighting #Ebola in DRC.
— Global Health Strategies (@GHS) June 29, 2020

"[The] lack of national unity and lack of global solidarity and the divided world ... is actually helping the virus to spread," Tedros said. "[The] worst is yet to come."

"I'm sorry to say that, but with this kind of environment and conditions we fear the worst," he said.

The head of WHO's emergencies program, Mike Ryan, said there had been "tremendous work" toward a coronavirus vaccine but said there's no guarantee of success.

In the U.S., a spike in coronavirus infections has been driven in part by people unwilling to heed public health guidelines to wear masks and continue social distancing.

Currently, the U.S. leads the world in both coronavirus infections and COVID-19 deaths. Brazil ranks second in the number of infections, followed by Russia, India and the United Kingdom.

President Trump has been highly critical of the WHO, accusing it of helping China cover up the extent of the pandemic within its borders. Earlier this month, the president announced that the U.S. was "terminating" its decades-long relationship with the WHO and would withdraw vital U.S. funding.


Heliobas Disciple

Has No Life - Lives on TB
And just for the heck of it, I'll end the posts for tonight with this bit of cheery news/not. :eek:

(fair use applies)

New swine flu found in China has pandemic potential, researchers say
Agence France-Presse
Published: 7:42am, 30 Jun, 2020 | Updated: 10:08am, 30 Jun, 2020

  • Named G4, virus is genetically descended from H1N1 strain behind 2009 outbreak
  • Tests show 10.4 per cent of swine workers and up to 4.4 per cent of general population may have been exposed

Researchers in China have discovered a new type of swine flu that is capable of triggering a pandemic, according to a study published Monday in the US science journal Proceedings of the National Academy of Sciences.

Named G4, it is genetically descended from the H1N1 strain that caused a pandemic in 2009.

It possesses “all the essential hallmarks of being highly adapted to infect humans”, say the authors, scientists at Chinese universities and China’s Centre for Disease Control and Prevention.

From 2011 to 2018, researchers took 30,000 nasal swabs from pigs in slaughterhouses in 10 Chinese provinces and in a veterinary hospital, allowing them to isolate 179 swine flu viruses.

The majority were of a new kind which has been dominant among pigs since 2016.

The researchers then carried out various experiments including on ferrets, which are widely used in flu studies because they experience similar symptoms to humans – principally fever, coughing and sneezing.

G4 was observed to be highly infectious, replicating in human cells and causing more serious symptoms in ferrets than other viruses.

Tests also showed that any immunity humans gain from exposure to seasonal flu does not provide protection from G4.

According to blood tests which showed up antibodies created by exposure to the virus, 10.4 per cent of swine workers had already been infected.

The tests showed that as many as 4.4 per cent of the general population also appeared to have been exposed.

The virus has therefore already passed from animals to humans, but there is no evidence yet that it can be passed from human to human – the scientists’ main worry.

“It is of concern that human infection of G4 virus will further human adaptation and increase the risk of a human pandemic,” the researchers wrote.

The authors called for urgent measures to monitor people working with pigs.

“The work comes as a salutary reminder that we are constantly at risk of new emergence of zoonotic pathogens and that farmed animals, with which humans have greater contact than with wildlife, may act as the source for important pandemic viruses,” said James Wood, head of the department of veterinary medicine at Cambridge University.

A zoonotic infection is caused by a pathogen that has jumped from a non-human animal into a human.



Veteran Member
And just for the heck of it, I'll end the posts for tonight with this bit of cheery news/not. :eek:

(fair use applies)

New swine flu found in China has pandemic potential, researchers say
Agence France-Presse
Published: 7:42am, 30 Jun, 2020 | Updated: 10:08am, 30 Jun, 2020

  • Named G4, virus is genetically descended from H1N1 strain behind 2009 outbreak
  • Tests show 10.4 per cent of swine workers and up to 4.4 per cent of general population may have been exposed

Researchers in China have discovered a new type of swine flu that is capable of triggering a pandemic, according to a study published Monday in the US science journal Proceedings of the National Academy of Sciences.

Named G4, it is genetically descended from the H1N1 strain that caused a pandemic in 2009.

It possesses “all the essential hallmarks of being highly adapted to infect humans”, say the authors, scientists at Chinese universities and China’s Centre for Disease Control and Prevention.

From 2011 to 2018, researchers took 30,000 nasal swabs from pigs in slaughterhouses in 10 Chinese provinces and in a veterinary hospital, allowing them to isolate 179 swine flu viruses.

The majority were of a new kind which has been dominant among pigs since 2016.

The researchers then carried out various experiments including on ferrets, which are widely used in flu studies because they experience similar symptoms to humans – principally fever, coughing and sneezing.

G4 was observed to be highly infectious, replicating in human cells and causing more serious symptoms in ferrets than other viruses.

Tests also showed that any immunity humans gain from exposure to seasonal flu does not provide protection from G4.

According to blood tests which showed up antibodies created by exposure to the virus, 10.4 per cent of swine workers had already been infected.

The tests showed that as many as 4.4 per cent of the general population also appeared to have been exposed.

The virus has therefore already passed from animals to humans, but there is no evidence yet that it can be passed from human to human – the scientists’ main worry.

“It is of concern that human infection of G4 virus will further human adaptation and increase the risk of a human pandemic,” the researchers wrote.

The authors called for urgent measures to monitor people working with pigs.

“The work comes as a salutary reminder that we are constantly at risk of new emergence of zoonotic pathogens and that farmed animals, with which humans have greater contact than with wildlife, may act as the source for important pandemic viruses,” said James Wood, head of the department of veterinary medicine at Cambridge University.

A zoonotic infection is caused by a pathogen that has jumped from a non-human animal into a human.

The bad news just keeps coming.
I don't know how you can sleep after posting all those articles but thanks to you and others for keeping us informed.


Contributing Member
U.S. Coronavirus Cases Surge

Gainesville Publix workers test positive for COVID-19

( 19 LARGE FOOD STORES…...ALL workers are tested weekly….if you can test positive, YOU GET 2 WEEKS PAID TIME OFF)

June 29, 2020

About 13.5% of all statewide tests from the past 24 hours indicated a new Florida COVID-19 case.



“Paul Myers, administrator for the Department of Health in Alachua County, said last week that most of the new cases are occurring among those between the ages of 18 and 25.

He said this is partly due to an
increase in testing for this age group
as they start internships
or return to jobs.

Many of those who tested positive were asymptomatic.”

(86.5 %…….were showing no symptoms and did not “test positive”……..and ARE NOT SICK

13.5%……..MOST showing no symptoms did “test positive”……..and ARE SICK

98-99% of the people tested…………….HAD NO SYMPTOMS…………………………



Learn to pronounce
adjective: asymptomatic

  1. (of a condition or a person) producing or showing no symptoms.

    "infection is usually asymptomatic"

COVID-19 has a 98.54% survival rate ………...SOME SAY 99.4%





Veteran Member
Why isn’t Indiana seeing COVID-19 spikes like other states?
Posted: Jun 30, 2020 / 05:27 AM EDT / Updated: Jun 30, 2020 / 05:27 AM EDT

INDIANAPOLIS — Friday saw the highest single-day spike of coronavirus cases in the country, and while 31 states are seeing a rise in cases, Indiana remains steady. The question is why?

“I think Indiana following the staged approach reopening really helped,” explains Shandy Dearth, director of Undergraduate Epidemiology at Indiana University’s School of Public Health. “I think the fact the stages were more spread out helped Indiana’s numbers.”

Dearth looks to states like Florida or Texas that have seen big spikes and believes they may have opened too soon or too quickly. Certain cities in Florida are closing their beaches for Fourth of July weekend because of the mass amounts of people utilizing the coastline.

“I think we saw the large crowds in some of the Florida bars, and some of those things. If you are indoors, the transmission rate really increases,” says Dearth.

Indiana has not seen the type of case numbers northeast states like New York have seen, but those states are now doing well. Dearth credits that to New York’s mandatory mask rules

“I think we really need to focus more on the need for masks, and wearing masks, and possibly mandating mask use,” details Dearth. “I see a couple northern [Indiana] counties have mandated mask use, and I would say that other counties should look at that if it’s not going to happen from the state level.”

While Indiana has a host of large events coming up soon, Dearth believes it’s less about people showing up from out of state as much as it is their health habits, or if they head to large crowds. Vice President Mike Pence recently said that younger Americans are part of a key demographic impacted by these spikes.

“Teenagers and young adults have that built in sense of invincibility,” explains Kimble Richardson, a mental health counselor with Community Health Network. “Part of that is good. You are starting out in life, you can conquer the world, do anything. On the other end, sometimes it keeps us from being safe.”

Richardson believes more people should be wearing masks, but says seeing other people without masks in public can lead to a false sense of safety. Even he has contemplated taking his off when he sees others do the same, but knows he should not. He has advice for how to approach a situation with friends or family who are not practicing safe habits in public.

“It’s probably not the right thing to say, ‘You should be wearing a mask,’ because people get defensive when they hear things like that. You could say, ‘I would appreciate if you put a mask on.’ It’s a consistent message, and we probably need to be reminding our kids daily.”

Richardson advises parents to practice habits at home before children head back to school.

“I think you want to set a good example. If you want your child to wear a mask in public places, you better be wearing a mask too,” says Richardson.

Several states have begun slowing re-open plans, or in some cases back tracking. If that were to happen to Indiana, Dearth would expect a partial reduction in bar limits, not a full shut down.

“The fact that so many states are seeing such increasing numbers, if I had to make a bet on something, I would say that we are going to have an increase in cases,” glooms Dearth.