As Covid-19 cases surge to their highest levels in dozens of states, the nations testing effort is on the brink of paralysis because of widespread delays in getting back results. And that is very bad news, because even if testing is robust, the pandemic cannot be controlled without rapid results.

This is the latest failure in our national response to the worst pandemic in a century. Since the Trump administration has abdicated responsibility, governors must join forces to meet this threat before the cataclysm that Florida is experiencing becomes the reality across the country.

Testing should be the governors first order of business.

Despite President Trumps boast early this month that testing is so massive and so good, the United States two largest commercial testing companies, Quest Diagnostics and LabCorp, have found themselves overwhelmed and unable to return results promptly. Delays averaging a week or longer for all but top-priority hospital patients and symptomatic health care workers are disastrous for efforts to slow the spread of the virus.

Without rapid results, it is impossible to isolate new infections quickly enough to douse flare-ups before they grow. Slow diagnosis incapacitates contact tracing, which entails not only isolating those who test positive but also alerting the infected persons contacts quickly so they can quarantine, too, and avoid exposing others to the virus unwittingly.

Among those who waited an absurdly long time for her results was the mayor of Atlanta, Keisha Lance Bottoms. We FINALLY received our test results taken 8 days before, she tweeted last week. One person in my house was positive then. By the time we tested again, 1 week later, 3 of us had COVID. If we had known sooner, we would have immediately quarantined.

Another complaint came this week from Mr. Trumps former acting chief of staff, Mick Mulvaney, who wrote in an op-ed commentary for CNBC that my son was tested recently; we had to wait 5 to 7 days for results. Noting, too, that his daughter was told she didnt qualify for a test, he added, That is simply inexcusable at this point in the pandemic.

As summer turns to fall, slow and fragmented testing will fatally undermine the reopening of schools and universities, whose plans are predicated on quickly identifying outbreaks and suppressing spread. Testing for millions of students will feed into an already failing national system.

Vice President Mike Pences casual invocation of an extraordinary national success in testing in a recent call with governors was flatly wrong, as is the presidents similar trumpeting of testing success. These claims contribute to a false sense among the public that testing may have had early stumbles but is ramping up slowly but surely.

The reality is that the spread of the virus has vastly outpaced the expansion of testing capacity. That spread in turn results in more illness and therefore more tests to process, which further slows down turnaround time in a vicious cycle. The dedication and patience of thousands of people waiting in serpentine lines of cars for hours to be tested are wasted when the results arent returned quickly enough.

We are at this point because of the absence of a coordinated federal plan, and, indeed, because of a White House that seems actively hostile to producing one. The nations governors and state legislators must fill the void.

Unity among the states is not just about neighborliness but also about self-interest. So long as interstate travel continues, inadequate testing anywhere threatens public health everywhere, including in places that have found or developed localized testing capacities and are less sensitive to the bottlenecks that Quest and LabCorp are experiencing.

The signal difference between federal and state leadership is that the former can print money and the latter cannot. If states are to step up, they will need resources: money from Congress without executive branch holdup, coordination and mutual aid from one another, and cooperation and expertise from the public itself.

Heres what the governors need to do to bolster the overall testing capability before the end of the summer, best begun with a summit in the next two weeks.

Governors must work collectively to fill gaps in their own testing and contact-tracing programs. The National Governors Association helped in a similar effort to curb the spread of the Zika virus.

In March there was a mad scramble and competition for personal protective equipment. Now, the allocation of tests and test processing may end up in another free-for-all. A coordinated approach by all states would avoid that. Consistent metrics must be established for accountability and to identify trigger points that call for rapid policy responses. Acting in concert can make it easier to undertake tough or controversial decisions like ordering lockdowns when testing shows renewed spread.

Governors should also agree to assist in sharing local test processing capacity, including by university labs, so it is available wherever it is most needed. Relying largely on two large commercial testing companies, as we are now, has proved to be a major vulnerability.

For example, the Broad Institute of M.I.T. and Harvard has stepped up in Massachusetts with more testing capacity so much so that it is not being fully used. But no process is in place for a doctor in, say, Arizona to prescribe a test that the Broad will process. Thats a problem that governors can help solve. They can also find ways to subsidize investments by labs to expand capacity, to help untangle medical insurance complications so tests are covered and to prompt innovations in testing.

In particular, they should encourage the academic and commercial sectors to develop, test and produce new, rapid, point-of-care testing. More broadly, they should recruit data scientists and experts in science communication ready to lend their skills to a unified effort.

We cant allow the delays at Quest and LabCorp to mark the start of a downward spiral. Instead, we must marshal a nationwide strategy to place the United States in the ranks of other countries that are successfully beating back the pandemic.

Sorting out testing is foundational to slowing the spread of the virus. From there, governors can build a comprehensive national plan of attack. Doing so will require new forms of coordinated governance. In the absence of federal leadership, its up to governors to step to the fore.

Margaret Bourdeaux is research director of the Program of Global Public Policy at Harvard Medical School. Beth Cameron is the vice president for Global Biological Policy and Programs at the Nuclear Threat Initiative. Jonathan Zittrain is a professor of law and computer science at Harvard and co-chair with Dr. Bourdeaux of the Berkman Klein Centers Digital Pandemic Response Practice.

The Times is committed to publishing a diversity of letters to the editor. Wed like to hear what you think about this or any of our articles. Here are some tips. And heres our email: letters@nytimes.com.

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Testing Is on the Brink of Paralysis. Thats Very Bad News. - The New York Times

I'm hearing a lot of talk about the coronavirus spreading through aerosols is wearing a mask in a grocery store enough protection? What else should I do to stay safe?

Quick answer first: Going to the grocery store where you and everyone else is wearing a mask and keeping a distance from each other is still considered a low-risk activity. Go get your summer strawberries!

For background, aerosols are tiny microdroplets containing the virus that can be expelled when we talk or breathe and can stay aloft and travel on air currents. It's still unclear how much of a role they play in spreading the virus, but recently more than 200 scientists wrote an open letter asking the World Health Organization to pay more attention to them.

The agency still maintains that the greater risk of spread appears to be from droplets larger particles, also expelled when we talk or breathe, which settle more quickly and are less likely to accumulate in the air. However, WHO released a new scientific brief on July 9 saying that airborne transmission might be contributing to spread in crowded, poorly-ventilated indoor spaces such as gyms, choir practice rooms and nightclubs. But how much transmission aerosolized particles are responsible for, versus droplets and contaminated surfaces, they can't say for sure.

"What we are calling for is more systematic research to be done in these types of settings," said Maria Van Kerkhove, technical lead for WHO's health emergencies program, at a press conference on Friday. In other words, stay tuned.

Bottom line: It's impossible to rule out that some amount of transmission may be caused by aerosols. If you want to err on the side of caution, here's what some infectious disease researchers say can help minimize the risks:

Face away from people when you talk: When you're talking face to face with someone, you're in direct line of the plumes of breath that come out of their mouths when they speak. "If there's any scenario where I'm face to face, with someone, I move my head off-center so I'm no longer inhaling that direct plume," says Seema Lakdawala, a flu transmission researcher at the University of Pittsburgh. One tip that helps her is to not make direct eye contact with people. It can be awkward, she acknowledges, but "it's not just about protecting myself, but also about protecting other people," since it's possible to shed the virus without knowing you're infected.

Wear your mask properly: Wear a layered cloth mask in public spaces, especially if you're indoors or in a setting where you can't socially distance. Make sure it covers your nose and mouth. This will catch many of the droplets that come out when you breathe or speak and prevent them from getting into the air. Ideally, to take precautions against tiny, aerosolized microdroplets, "we should be masking everyone with better masks," says Abraar Karan, a physician at Harvard Medical School. But the N95 masks that effectively filter most aerosol particles are in short supply and uncomfortable to wear. Karan suggests well-fitting KN95 masks which have similar protection (but make sure your mask isn't counterfeit).

Make the indoors more like the outdoors: "You limit aerosol transmission by increasing ventilation and increasing air circulation by opening a window, putting on a fan and just moving the air," says Lakdawala, who keeps several fans running at all times in her lab and office space. Moving air disperses the particles in the air and makes it less likely that someone will breathe in a concentrated cloud of infectious virus. Donald Milton, an infectious disease aerobiologist at the University of Maryland and lead author on the open letter about aerosols, also recommends cleaning indoor air, through air filtration and ultraviolet sanitizing light. "You wouldn't drink water downstream from another town without treating it. But we breathe air from other people without treating it," he says.

Limit the amount of time you're in close contact with people: The public health rule of thumb for what counts as an exposure is close contact with an infected person for 15 minutes or more, so uncrowded grocery stores where everyone is masked and moving represents a relatively low-risk situation, both Lakdawala and Milton agree. Hopefully, you're not standing in one aisle for very long, but you're going to shop efficiently, says Lakdawala, "So even if there are fine aerosols that are getting released by somebody who is infected, they're getting diluted out as these people move in air currents." Indoor bars, restaurants and other situations where people are staying in one place for a period of time, and speaking or singing loudly, make Milton more wary. "I don't know how to drink a beer with a surgical mask on," he says. "And I wouldn't go sing at choir practice, OK?"

Keep a buffer of personal space: This isn't just important for the spray of droplets, it may also help when it comes to tiny airborne particles. If you are planning to sit and talk to a friend, keeping a distance of at least 6 feet creates more opportunities for airflow between you and others. "We have a happy hour in our neighborhood where everybody brings our chairs, and we sit on someone's lawn," says Lakdawala. "Everyone is spatially distanced, and we bring our own drinks and talk." Maintaining a distance from others means there's more ventilation and space for air to pass between you, says Lakdawala.

Each precaution adds another layer of safety from aerosolized particles, says Milton. "Wearing a mask means you're putting less virus droplets into the air, sucking less out [of the air]. Keeping distances means there's less of it near you. And having good ventilation or air sanitation means what's in the air is getting removed. All of those things add up to giving you good protection."

See the article here:

How To Protect Yourself From The Risk Of Airborne Coronavirus Transmission? : Goats and Soda - NPR

There were 71,135 new cases reported Thursday, topping the previous high of 67,791 new coronavirus cases reported across the country two days ago.

Florida reported 13,965 of Thursday's cases, the second most reported in a day in the state.

Right now, tests are being done in much larger numbers -- a positive development -- but this increase is also slowing down results.

Adm. Brett Giroir, assistant secretary for health at the US Department of Health and Human Services, said Thursday that health officials want to reduce wait times for results.

"Even in the large commercial labs, and we follow this every single day, there may be an outlier that's 10 days or 12 days, we can't deny that that happens," Giroir said. He wants test results back as fast as possible, but a three-day turnaround is "very reasonable."

Commercial labs have said they are backed up, with results often taking as long as seven days to turn around. "I'm never going to say that I'm happy with any turnaround time, Giroir added.

Giroir says 700,000 to 800,000 people are being tested each day.

That means it'll be a week before officials know how many of them are infected.

In the meantime, state and local leaders are making decisions on whether to stop reopenings or reimpose restrictions.

And with a lack of federal mandates, they're taking matters into their own hands, such as requiring people to wear masks in public.

Colorado Gov. Jared Polis announced that face masks are required in public places when social distancing is impossible. The order takes effect at midnight on Thursday.

Arkansas Gov. Asa Hutchinson announced a statewide order effective Monday. Masks will be required when people are in the presence of non-household members and aren't able to socially distance.

Alabama and Montana issued statewide facial covering orders on Wednesday.

Large retail chains have also mandated masks in stores. CVS, Publix and Target announced new rules for stores in states and cities where there are no government-mandated ordinances.

Fauci has warning for young people

Dr. Anthony Fauci cautioned against young people assuming they are immune to serious infection.

While the data shows that young people are less likely than older people to become seriously ill, Fauci said he has seen ample evidence of young people being "knocked out on their back and brought to their knees pretty quick" by Covid-19. "I've never seen an infection with this broad range of manifestations."

He told Facebook CEO Mark Zuckerberg that many young people are getting infected and some of them feel horrible for weeks.

The nation's leading infectious disease expert directly urged young people to consider their societal responsibility.

"You're going to get back to normal, and you'll be able to freely have fun, go to the bars, go with the crowds, but not now," he said. "Now's not the time to do that."

As morgues fill up, two counties bring in refrigerated trucks

Thirty-nine states reported an increase in the number of new cases from the week before. California, Florida, Arizona and Texas have become the states to watch as surging coronavirus cases lead to a shortage of hospital beds.

In Arizona's Maricopa County, which has the most Covid-19 cases in the state, the medical examiner's office has ordered four portable coolers with additional ones expected in the coming days, said Fields Moseley, the county spokesman. The medical examiner's office morgue had a total of 156 deceased people -- with a surge capacity of just over 200, Moseley said Wednesday.

In Texas, the city of San Antonio and Bexar County have secured several refrigerated trailers to store bodies until they can be released to funeral homes, Mario Martinez, Metro Health Assistant Director, said in a video interview released by the city.

He said that they currently have two in operation and another three will be operational by the end of the week.

Cameron and Hidalgo counties in Texas are sharing a large refrigerated trailer to store bodies of coronavirus patients because of a lack of space at the morgues.

"I'm pleading with everybody in our neck of the woods, help us do your part, people's lives are at stake -- not just the people getting sick, but doctors, nurses working to the bone, EMS personnel, transporting people," Cameron County Judge Eddie Trevio Jr. told CNN affiliate KVEO.

The Dallas County morgue had to use an external refrigerated truck this week due to the increased caseload, the Medical Examiner's Office told CNN.

"We have had to go to the external refrigerated truck once this week due to increased caseload, but today we are back with all cases inside," Dr. Jeffrey Barnard, the Dallas County Medical Examiner, said in a statement. "I anticipate that we will at some point have to use the truck again based on continuing increased volume."

Georgia governor, Atlanta mayor clash

Gov. Brian Kemp extended Georgia's emergency coronavirus restrictions and said while people are "strongly encouraged" to wear face coverings -- they're not required. The order, which expires July 31, limits public gatherings to 50 people and mandates social distancing.

His order prevents local governments from implementing stricter rules than the state's -- including requiring face masks.

But on Thursday, Michael Smith, press secretary for Atlanta Mayor Keisha Lance Bottoms, told CNN the "Mayor's Order remains in effect, as science and data will continue to drive the City's decisions. Masks save lives."

Epidemiologist says California needs more contact tracers

To combat the rise in coronavirus cases in California, there needs to be enough contact tracing staff in regions where Covid-19 infections are increasing, the principal investigator for the state's contact tracing program told CNN, but not all regions require an equal number of tracers.

"They're not, in their current level, they're not in all places," said University of California, San Francisco epidemiologist Dr. George Rutherford, who also leads the university's contact tracing training program. "If we spread it evenly there still probably wouldn't be enough in the highest incidence areas."

Health officials, he said, cannot forecast how much contact tracing is needed in a region until public health departments are alerted to positive results, but the teams are scalable. "We can call in extra people if there's a surge," Rutherford said.

CNN's Lauren Mascarenhas, Joe Sutton, Jon Passantino, Sarah Moon, Jennifer Henderson and Maggie Fox contributed to this report.

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More than 71,000 new cases of coronavirus were reported in the US on Thursday, the most ever - CNN

COLUMBUS, OhioCuyahoga County and two southwest Ohio counties have been taken off the states watch list for the highest coronavirus alert status, Gov. Mike DeWine said Thursday.

However, all three of those counties, as well as 19 counties in total, are now on red-alert for coronavirus, meaning that about 60% of Ohio residents are now required to wear masks in indoor public places and when riding public transportation.

Speaking during a televised briefing, DeWine said that even though Cuyahoga County is no longer on the cusp of reaching purple status, the county is still at a critical stage, averaging 179 new cases per day up 49 additional cases per day since June 23.

The reason Cuyahoga was downgraded was because hospital admissions have not been increasing at the rate they have in the past weeks, according to DeWine spokesman Dan Tierney. However, the governor said during his briefing that the county is very close to meeting the threshold for new hospital admissions -- one of the factors that determine each countys threat level.

Some new cases in Cuyahoga are being driven by out-of-town travel and recreational activities, the governor said. Its critical the residents of Cuyahoga County remain vigilant and do all they can to reduce their risk and exposure to the coronavirus, he said.

Butler and Hamilton counties were also removed from the purple watch list, though like Cuyahoga they remain on red alert. Only one red-level county was downgraded: Trumbull County, which fell to orange, the second-lowest of the four alert levels.

Eight other counties have been elevated to red-alert status for the first time: Allen, Athens, Delaware, Licking, Lucas, Richland, Scioto, and Union counties, DeWine said. Athens County is now the only Ohio county on the purple alert watch list, the governor said.

Outbreaks at bars in the college town of Athens have resulted in the Southeast Ohio county logging more coronavirus cases during the last two weeks than the rest of the pandemic combined, he said.

The governor has said there is community spread of COVID-19 in all of Ohios 88 counties. Each countys color designation is determined by monitoring seven different data indicators, including recent increases in community spread, doctors visits, hospitalizations, and ICU visits, among other factors.

Counties are designated red if they trigger 4-5 of those metrics; counties that have six or all seven of the factors are designated purple.

Besides the mask requirement for both red and purple counties, the DeWine administration largely leaves it up to individual Ohioans to determine for themselves what the difference is between red and purple levels. In red counties, residents are encouraged to consider necessary travel and limit attending gatherings of any number. In counties under the purple, or Level 4, counties, people are advised to limit themselves to necessary travel and only leave home for supplies and services.

During a statewide address on Wednesday, DeWine urged all Ohioans to take immediate action to slow the spread of the virus, including wearing masks while in public. But he also didnt announce any new health orders, saying that discussion is for another time.

Dr. Andrew Thomas, chief clinical officer at Ohio State University Medical Center, said during DeWines Thursday briefing that the color-coded system is meant to be an alert in the same way a weather forecast is.

This is not a grade. This is a warning system, he said.

DeWine

In this case, we can do something with this information.

"

Read more Ohio coronavirus stories:

Ohio Democrats turn on Gov. Mike DeWine for not imposing sterner coronavirus rules

Gov. Mike DeWine implores Ohioans to take immediate action to slow coronavirus, but gives no mandates

Ohio travelers must now quarantine when visiting New York, New Jersey, Connecticut due to coronavirus spike

Ohios new color-coded coronavirus alert system guidelines leave a lot of room for interpretation

Gov. Mike DeWine cancels Tuesday coronavirus briefing, the first scheduled since the state hit a record number of cases

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Cuyahoga County taken off coronavirus watch list,' but more Ohio counties put on red-alert for the virus - cleveland.com

The BDN is making the most crucial coverage of the coronavirus pandemic and its economic impact in Maine free for all readers. Click here for all coronavirus stories. You can join others committed to safeguarding this vital public service by purchasing a subscription or donating directly to the newsroom.

Another 20 cases of the coronavirus have been detected in Maine, health officials said Thursday.

There have now been 3,598 cases across all of Maines counties since the outbreak began here in March, according to the Maine Center for Disease Control and Prevention. Thats up from 3,578 on Wednesday.

Of those, 3,207 have been confirmed positive, while 391 are likely positive, according to the Maine CDC.

New cases were tallied in Androscoggin (1), Aroostook (1), Cumberland (10), Hancock (1), Lincoln (1), Penobscot (1) and York (4) counties. Daily changes in county-level data may vary from new case reports as the Maine CDC continues to investigate cases.

No new deaths were reported Thursday, leaving the statewide death toll at 114. Nearly all deaths have been in Mainers over age 60.

So far, 374 Mainers have been hospitalized at some point with COVID-19, the illness caused by the coronavirus. Of those, 13 people have been hospitalized, with 11 in critical care and four on ventilators.

Meanwhile, 15 more people have recovered from the coronavirus, bringing total recoveries to 3,094. That means there are 390 active and likely cases in the state, up from 385 on Wednesday.

Heres the latest on the coronavirus and its impact on Maine.

Maines top epidemiologist said Thursday he is concerned about the rollout of a controversial new federal requirement that hospitals send their data on the coronavirus response straight to a database in Washington rather than first directing it to the state. Charles Eichacker, BDN

Maintaining mental health during this uniquely stressful time is more important now than ever. There are many steps you can take to address mental health issues at this moment in the pandemic. Sometimes, though, the best help is going to come from a professional. If your daily stress and anxiety has started to interfere with your daily life and functioning, here is how to go about finding a therapist during the pandemic. Sam Schipani, BDN

Maine saw a spike in new jobless claims last week, but state labor officials said they are investigating whether that could be attributed to fraud. Christopher Burns, BDN

The Maine Center for Disease Control and Prevention said Thursday that new COVID-19 outbreaks have been detected at three Portland-area businesses. Bill Trotter, BDN

The number of new coronavirus cases in Maine dropped again last week alongside a small dip in testing, leaving the state among one of only two where daily cases are decreasing. Jessica Piper, BDN

As of Thursday evening, the coronavirus has sickened 3,556,403 people in all 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and the U.S. Virgin Islands, as well as caused 138,141 deaths, according to Johns Hopkins University of Medicine.

Read the rest here:

July 16 evening update: The latest on the coronavirus and Maine - Bangor Daily News

While good ventilation can dilute aerosols, it is far less effective against droplets, which are much wider and heavier in the same way that a passing breeze would perturb the trajectory of a Ping-Pong ball, but not a cannonball.

The study points to a more important role for aerosolized flu transmission than some might assume, Dr. Marr said.

Determining the exact size of that role, however, is another matter entirely. Its very hard to conduct these human challenge studies and separate the different modes of transmission, Dr. Marr said. That problem applies across respiratory viruses, including the coronavirus.

Part of the problem is the continuum on which aerosols and droplets exist. Though they go by different names, the two categories really belong to the same group: globs of fluid that come in varying sizes. Blobs less than five micrometers in diameter are termed aerosols, which can exit the airway at the slightest breath and waft away; anything larger is a droplet, hefty enough to fall to the ground within a few feet of its source. The boundary between them is somewhat arbitrary, though generally speaking, the smaller the particle, the farther it travels.

When people expel fluid from their airway, it tends to manifest in a mixture, some bigger, some smaller and everything in between, said Seema Lakdawala, who studies influenza transmission at the University of Pittsburgh.

Updated July 16, 2020

Even after they exit an individual, these fluidic blobs remain dynamic. Large droplets, for instance, can disperse or evaporate into little aerosols in midair. Others might scatter onto a surface or a hand, lingering for minutes or hours before encountering someone new. And the rates at which all these events occur can shift, depending on the force with which someone, maybe a loud talker, expels these droplets or the amount of air flow in an area, Dr. Lakdawala said.

Everyone thinks transmission is a very binary concept, she added. The reality is that there is a continuum of aerosols.

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The Flu May Linger in the Air, Just Like the Coronavirus - The New York Times

Well, I was writing just the other day about what we dont know about the T-cell response to coronavirus infection, and as of today we know quite a bit more. And from what I can see, we have encouraging news, mixed with some things that were going to need to keep an eye on.

Heres a post from May on a paper in Cell that looked at T cell responses in recovering SARS CoV-2 patients and compared them to reports of people who had been infected with original SARS back in 2003, and to people who had never encountered either. It also has some background on T cells in general, which might be useful if you dont have that info right at the top of your brains queue. Thats the paper that showed that the T-cell response to this virus is less Spike-o-centric than it was to SARS. It also showed that there are, in fact, people who have both CD4+ and CD8+ T cells that recognize protein antigens from the new coronavirus even though they have never been exposed to SARS, MERS, or the new virus. The paper speculated that this might be due to cross-reactivity with proteins from the common cold coronaviruses, and raised the possibility that there might be a part of the population that has at least some existing protection against the current pandemic.

Now comes a new paper in press atNature. It confirms that convalescent patients from the current epidemic show T-cell responses (mostly CD4+ but some CD8+ as well) to various epitopes of the N (nucleocapsid) protein, which the earlier paper had identified as one of the main antigens as well (along with the Spike and M proteins, among others, with differences between the CD4+ and CD8+ responses as well). Turning to patients who had caught SARS back in 2003 and recovered, it is already known (and worried about) that their antibody responses faded within two or three years. But this paper shows that these patients still have (17 years later!) a robust T-cell response to the original SARS coronaviruss N protein, which extends an earlier report of such responses going out to 11 years. This new work finds that these cross-react with the new SARS CoV-2 N protein as well. This makes one think, as many have been wondering, that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between (1) antibody responses that seem to be dropping week by week in convalescent patients but (2) few (if any) reliable reports of actual re-infection. That would be good news indeed.

And turning to patients who have never been exposed to either SARS or the latest SARS CoV-2, this new work confirms that there are people who nonetheless have T cells that are reactive to protein antigens from the new virus. As in the earlier paper, these cells have a different pattern of reactivity compared to people who have recovered from the current pandemic (which also serves to confirm that they truly have not been infected this time around). Recognition of the nsp7 and nsp13 proteins is prominent, as well as the N protein. And when they looked at that nsp7 response, it turns out that the T cells are recognizing particular protein regions that have low homology to those found in the common cold coronaviruses but do have very high homology to various animal coronaviruses.

Very interesting indeed! That would argue that there has been past zoonotic coronavirus transmission in humans, unknown viruses that apparently did not lead to serious disease, which have provided some people with a level of T-cell based protection to the current pandemic. This could potentially help to resolve another gap in our knowledge, as mentioned in that recent post: when antibody surveys come back saying that (say) 95% of a given population does not appear to have been exposed to the current virus, does that mean that all 95% of them are vulnerable or not? Ill reiterate the point of that post here: antibody profiling (while very important) is not the whole story, and we need to know what were missing.

There are still major gaps in our knowledge: how many people have such unknown-coronavirus-induced T-cells? How protective are they? How long-lasting is the T-cell response in people who have been infected with the current SARS CoV-2 virus, and how protective is it in the declining-antibody situation that seems to be common? What sorts of T cell responses will be induced by the various vaccine candidates? We just dont know yet. But were going to find out.

More:

New Data on T Cells and the Coronavirus - Science Magazine

Since the beginning of the pandemic, the World Health Organization has stressed that, primarily, Covid-19 spreads through very close personal contact. The virus-laden droplets exhaled from a sick persons mouth and nose, the thinking goes, are heavy, and fall to the ground before they can get much farther than 6 feet.

But as the pandemic has unfolded, contact tracing studies have shown this isnt always the case. In China, an air conditioner pushed virus-laden air across three tables in a restaurant, infecting people seated at each one. Researchers reviewed video from the restaurant and saw many of these patrons were more than 6 feet apart from one another, suggesting that the virus traveled through the air.

In Washington state, one person at a choir practice infected 52 of the other participants; its thought the singing could have led more virus to linger in the air. Carefully controlled laboratory studies are also suggesting that under the right indoor conditions, SARS-CoV-2, the virus that causes Covid-19, can float in the air and, to a certain degree, spread that way.

Last Thursday, the WHO changed its language to recognize that fact. Short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out, the WHO now states. Previously, the organization maintained that airborne transmission was unlikely to occur outside the hospital setting, where some procedures can generate super-small particles that linger in the air longer than large respiratory drops.

This change comes after a letter appeared in the journal Clinical Infectious Diseases, co-signed by 239 scientists and engineers, which implored WHO and other public health agencies that its time to address airborne transmission of Covid-19. With the WHOs recognition of this mode of transmission, the authors hope, communities can think more about the ventilation of indoor spaces and perhaps engineer solutions to make these spaces safer.

It turns out scientists have been debating whether respiratory diseases like the flu and coronavirus should be labeled airborne for a century. More commonly, the airborne designation is only applicable to extremely contagious diseases, like measles.

A lot of these terms are confusing (even to the scientists), and they dont answer the question laypeople care about: Which air is safe to breathe in during the Covid-19 pandemic, and which air is not safe?

To answer that question, its helpful to understand two different scientific perspectives on the matter. One is: What physically happens when a sick person breathes, sneezes, or coughs into a room? The other is: What patterns have epidemiologists observed in the way people are exposed to the virus and get sick?

Lets start with the first.

Theres a relatively simple, if outdated, way of thinking about how respiratory diseases can spread.

It starts like this: When you exhale, sneeze, or cough, you release a cloud of gas and liquid droplets.

If those droplets are relatively big, theyre heavy and fall to the ground before evaporating, like raindrops do. Others are smaller, and made smaller still by evaporation. These smaller droplets can linger in the air longer, drifting on air currents for perhaps hours. If a droplet is small enough, the moisture in it evaporates before it has the chance to reach the ground (provided the humidity in the room is average). If theres stuff like germs in that droplet, they become light enough to float on air currents, like the dust you can see suspended in the air. These particles are often called aerosols.

This framework is old, and it comes from William Wells, a scientist who studied tuberculosis transmission in the 1930s. In a 1934 paper, Wells concluded: It appears, therefore, that transmission of infection through air may take one of two forms depending upon the size of the infected droplet.

When it comes to Covid-19, one of the first questions epidemiologists tried to answer was: Is the virus spread in the dust that floats or the big drops that fall?

If its the small dust, alarm bells go off. These are the prototypical airborne diseases. They include measles, chickenpox, and tuberculosis, and they are extremely contagious. On average, one person infected with measles will infect 12 to 18 others.

If its the big drops, its still concerning. Diseases like the flu, whooping cough, the common cold, and coronaviruses are primarily large droplet-borne. With these diseases, only the closest contacts to an infected person get infected because large droplets quickly fall to the ground (within 6 feet or so). Its also possible for these big drops to fall on surfaces, and those surfaces can become contaminated too. Luckily, in the case of Covid-19, theres a growing consensus that getting sick from touching contaminated surfaces is rare. But keep washing your hands!

(Interestingly, theres no one reason a new virus, like SARS-CoV-2, would go one route or the other. Its possible, says University of Leicester virologist Julian Tang, that there may be a difference in the immune response with these airborne diseases that makes saliva and mucous less viscous, leading to more virus in small drops. Also, Tang writes in an email, it is possible (though no one has studied this yet) that exhaled breath from measles/chickenpox cases may just be shedding much more virus (maybe millions of virus per minute) compared to respiratory viruses, which only exhale 100s to 1000s of viruses per minute.)

A part of why the terminology here is so confusing, and theres so much debate about it, is that the words aerosol and droplet mean different things to different scientific disciplines.

An aerosol is a particle in the air, said Lidia Morawska, an engineer and the director of the International Laboratory for Air Quality and Health at Queensland University of Technology. A droplet is a liquid aerosol. To her, the distinction between droplets and aerosols doesnt make any sense. To her, they are all aerosols.

Wells outlined a clear distinction between droplets and aerosols according to their size. Big drops fall, and little aerosolized drops float. Its now appreciated that the actual picture is a lot more complicated.

Were always exhaling, in fact, a gas cloud that contains within it a continuum spectrum of droplet sizes, says Lydia Bourouiba, an MIT researcher who studies the fluid dynamics of infections. And, as she explained in a March paper in JAMA, the conditions of the cloud itself can affect the range of some of the droplets. If propelled by a cough or sneeze, Bourouiba finds, droplets can travel upward of 20 feet. The cloud mixture, not the drop sizes, determines the initial range of the drops and their fate in indoor environments.

The speed of the cloud, the temperature and humidity of the environment, and the individual droplet makeup of each cloud determines how long the droplets persist in the air, Bourouiba explained in JAMA.

Which is to say: There are conditions (coughing and sneezing) under which large drops dont immediately fall to the floor and can spread more than 6 feet away from a person, and they can linger in the air for longer.

Theres growing theoretical evidence for the airborne spread of the coronavirus. Lab studies, in idealized conditions, also show that the virus can live in an aerosolized form for up to 16 hours (the scientists in this case intentionally created aerosolized droplets with a machine).

Another study tracked with lasers the various droplets expelled from a human mouth during speech. It found normal speech generates airborne droplets that can remain suspended for tens of minutes or longer and are eminently capable of transmitting disease in confined spaces.

Some studies, the WHO reports, have found evidence of the viruss RNA in the air of hospital rooms, but notes no studies have found viable virus in air samples, meaning the virus was either incapable of infecting others or was in very small quantities unlikely to infect others.

What we are trying to say is, well, lets not worry about whether you call it aerosol or whether you call it a droplet, Morawska, the co-author of the recent commentary imploring the WHO and others to address airborne transmission of Covid-19, says. It is in the air, she says, and you inhale it. Its coming from our nose from our mouths. Its lingering in the air and others can inhale it.

That the WHO updated its language is a sign that its starting to appreciate this perspective.

But this perspective is limited. These lab studies cant perfectly generalize to the real-world conditions in which the virus spreads and infects others. Just because a virus travels far in a drop doesnt mean it can infect people across great distances. Viruses can degrade quickly outside the body. Also, dose matters. Small exposures to the virus may not be enough to get a person sick.

So to find out how people actually get sick with Covid-19, we need contact tracing studies.

Lab studies note the theoretical possibility of airborne transmission. But thats only one part of the answer to the question which air is safe to breathe? Epidemiologists come at this question from another angle, looking at patterns of virus spread observed in the real world and working backward to determine if airborne spread factors in.

Contact tracing studies show us that while droplets being inhaled by people within 6 feet of an infected person explains most of the transmission of Covid-19, there are limited times and environments in which SARS-CoV-2 can behave a bit like an airborne virus.

So we need to define which types of contact, which type of environments, lead to that type of transmission, Muge Cevik, a physician and virology expert at the University of St. Andrews, says. In households, she says, an infected person can be isolated in one room and not spread the virus to others in the home (if they remain isolated). A systematic review of studies in The Lancet of both SARS-CoV-2 and similar viruses found large reductions in risk if people just stay 1 meter (3 feet) away from one another. This suggests a lot of the risk of catching Covid-19 is from the large drops that fall quickly to the ground.

But then there are cases where people are packed together in an enclosed space like a church, with singing or shouting where the transmission looks a little more like airborne transmission.

The infamous choir practice in Washington state is an example of where airborne transmission might have happened. But what made this event so risky was the convergence of many risk factors: the singing activity (during which the infected person released viral particles into the air), the time spent together (the practice was 2.5 hours), and the interaction between the choir members in an enclosed space (not only did they all practice together, they also split up into smaller groups and shared cookies and tea).

Another study from China investigated an outbreak that started at a Buddhist temple event, tracing much of the spread to the confines of one of the buses transporting people to the function. The bus had one sick person aboard, and 24 out of 67 people on that bus got sick, possibly indicating airborne transmission. Those who sat by the windows fared better, indicating the importance of ventilation.

I think we just need to get away from this terminology and give much more clear definitions, Cevik says. For her, its about getting people to think critically about which situations are riskier than others. Risk is a spectrum. Its not only the distance, but its about timing, what type of activities youre involved in. I know its a bit complex, but thats the reality.

Perhaps part of the reason the WHO has been slow to address the airborne transmission of Covid-19 is because in a health care setting, airborne means a very specific thing.

Though infection prevention experts know theres a fuzzy boundary between drops that fall and specks that float, the dichotomy between airborne and droplet-borne is baked into how health care workers are trained to respond to outbreaks. Weve trained [health care workers] for decades to say, airborne is tuberculosis, measles, chickenpox, droplet is flu and pertussis and meningitis, Saskia Popescu, a hospital epidemiologist in Arizona, says. And thats, unfortunately, kind of antiquated. But thats how weve always done it.

They do it because there are very specific sets of guidelines in place to deal with extremely contagious airborne diseases in a hospital setting. For instance, a patient with a dangerous airborne disease often needs to be put in a room with an air pressure lower than the rest of the rooms in the building. That way, no virus in the air of that room can escape it (since air flows from high pressure to low pressure).

For droplet transmission, health care workers can be a little more lax; they can wear simple surgical masks during routine care and can save high-filtration (and sometimes scarce) respirators for the most dangerous procedures and cases.

In this light, it makes some sense that the WHO has been hesitant to label Covid-19 an airborne infection. Its not an airborne infection like measles is. It is not as contagious. Contact tracing studies consistently find that Covid-19 is spread most readily among people in the closest physical contact to one another. Airborne means something very specific, very resource-intensive, and very scary for hospitals and the people who work in them. And Covid-19 doesnt match that definition.

The debate often isnt very nuanced because of these rigid categories, Daniel Diekema, an infectious diseases physician and epidemiologist at the University of Iowa, says. As soon as you say airborne in the hospital infection prevention world, it brings to mind pathogens like tuberculosis, measles, chickenpox. Its clear the respiratory viruses, influenza, coronaviruses, are not airborne in the same way that the measles, varicella [chickenpox] become airborne.

But at the same time, with Covid-19 and other respiratory viruses, there definitely are small-particle aerosols produced, he says. And in the right setting, where theres poor ventilation, indoors, and a crowded environment, there is a risk for transmission among individuals, even if they may be more than 6 feet apart.

Neither contact tracing studies nor lab studies can perfectly answer the question of which air is safe? But thats science for you. Scientists use imperfect methods, attacking from many angles, to try to arrive at the truth, which can take a while to nail down precisely.

Overall, the recognition that Covid-19 can spread through the air shouldnt really change how we, individually, protect ourselves and others against it. Six feet of distance between people is still a good barrier to prevent spread via large drops. Mask-wearing could help prevent both large drops and small drops from being released in the first place. Time matters too: the longer we spend in an enclosed, poorly ventilated space with others, the greater the chances of being exposed to an infectious dose of the virus.

The bottom line, as a trio of engineers from Clarkson University writes in the Conversation, is that while staying six feet from other people reduces exposure, it might not be sufficient in all situations, such as in enclosed, poorly ventilated rooms.

We still need to think about the environments were in: Indoors is much riskier than outdoors (where greater airflow can disperse drops and aerosols more quickly, and where the environment is less conducive to SARS-CoV-2 survival). And indoors, ventilation can make a big difference. An indoor space where the air is constantly refreshed with air from the outdoors is better than one where the air is stagnant. (The American Society of Heating, Refrigerating and Air-Conditioning Engineers has published extensive guidelines on how to reopen buildings with increased ventilation during the pandemic.)

We also still need to think about the activity were engaging in. Shouting, singing, and other such activities produce more droplets (of any size) than just sitting quietly.

Morawska hopes that in bringing attention to airborne spread of Covid-19, there can be more attention paid to engineering solutions for indoor spaces to mitigate the spread of the pandemic.

Public health officials have continually stressed social distancing, mask-wearing, and hand-washing as ways to stop the spread of Covid-19. But have you ever heard a restaurant reopening announce theyve improved ventilation or increased ventilation? No. This is really the point, Morawska says. If Covid-19 is in indoor air, we should also be doing something about the air.

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Is the coronavirus airborne? The latest guidance from the WHO, explained. - Vox.com

The number of confirmed cases of the coronavirus illness COVID-19 world-wide rose to 13.6 million on Thursday, after a record of about 230,400 new infections were counted on Wednesday, according to data aggregated by Johns Hopkins University.

That was higher than the previous one-day record of roughly 229,000 counted last Friday, the data show. The U.S. recorded another 66,300 cases on Wednesday, just below the record of more than 67,000 cases reported on Tuesday.

A full 43 states and territories have seen case numbers rise in the past 14 days, according to a New York Times tracker, showing Florida is the new hot spot in the U.S. Hospitals in parts of the South and West are straining to handle the case load. The cities of Houston, Miami and Phoenix are reporting dire shortages of intensive-care unit beds and staff.

Public health experts and academics are astounded at the White House move to order hospitals to report COVID-19 data to the Department of Health and Human Services, instead of the Centers for Disease Control and Prevention, the nations premier public health agency. The decision is expected to make the data less transparent to the public and to researchers.

See also:Trumps pandemic response was hindered by missed opportunities, ignored warnings

... HHS and the White House broke a system that was working to put in a no-bid contract contractor, inexperienced to try to do something that is mission-critical to solve the pandemic, said Tom Frieden, a former head of the CDC and now a senior fellow for global health at the Council on Foreign Relations. Just when you think cant get less organized or less functional, it does, in this country.

There was further outrage about Georgias Gov. Brian Kemp ban on Georgias cities and counties from ordering people to wear masks in public places. Kemp voided orders on Wednesday that at least 15 local governments across the state had adopted, as the Associated Press reported.

Georgia has lost 3,091 people to the pandemic so far, the Johns Hopkins data show.

The ban comes as other states are moving in the opposite direction, ordering residents to cover their faces, including Alabama on Wednesday. Public health experts agree that wearing a face mask, washing hands frequently and socially distancing are vital measures to contain the spread. Retailers Walmart Inc. WMT, +0.15% and Kroger Co. KR, -0.11% have both said face masks are mandatory for shoppers in their stores. The National Retail Federation is recommending that all retailers follow their example.

Savannah Mayor Van Johnson was the first local official to defy Kemp and order masks, and had said police would start writing $500 citations to businesses that didnt enforce the law. Johnson called Kemp out by name on Twitter.

The Harvard Global Health Institute (HGHI) shot down a suggestion by CDC Director Robert Redfield earlier this week that COVID-19 cases in the South were being caused by people from the North vacationing there after Memorial Day weekend. Redfield said there was a pop in cases around June 12 to June 16 caused by vacationers driving down south.

This is not what the data say, the HGHI said in a report. Infections in states including Nevada and Florida actually stared rising on June 1.

Remember that there is always a lag between when infections occur and when they begin to be diagnosed, said the report. This means that the increase in confirmed cases around June 1 comes from infections occurring around May 24, right around the Memorial Day weekend (and well before mid-June, as Dr. Redfield suggests.) So the data show that these outbreaks started before Northern vacationers supposedly traveled South.

The more likely explanation is that infections are spiking because states reopened far too early.

Virginia, on the other hand, remaine

d in phase 1 of its reopening through the end of May and has fared significantly better than its neighbors, said the report.

The HGHIs tracking tool is currently showing 11 states flashing red, led by Florida, which now has a seven-day average rate of 51.8 cases per 100,000 people. Harvard researchers say those states the other 10 are Arizona, Louisiana, South Carolina, Alabama, Texas, Georgia, Nevada, Tennessee, Mississippi and Idaho need to reimpose stay-at-home orders.

The number of confirmed deaths from COVID-19 climbed to 584,990, while the number of people who have recovered climbed to 7.6 million.

The U.S. leads the world with 3.49 million cases and 137,420 deaths.

Brazil is second to the U.S. with 1.97 million cases and 75,366 deaths. India is third measured by cases at 968,876 followed by Russia with 751,612 and Peru with 337,751.

The U.K. has 45,138 fatalities, the highest in Europe and third highest in the world.

China, where the illness was first reported late last year, has 85,247 cases and 4,644 fatalities.

Read also: Russia accused by U.S., Britain, Canada of hacking coronavirus vaccine trials

Johnson & Johnson CFO Joseph Wolk told CNBC that the company expects the Phase 1 trial for its COVID-19 vaccine candidate to begin next week.

Wolk said the Phase 1 trial is expected to enroll more than 1,000 participants, primarily between the ages of 18 and 55 years old, although the company also plans to include a group of people who are 65 years old or older in the early-stage trial.

He also said that J&J is in talks with the National Institutes of Health to move up the timeline for the anticipated Phase 3 trial to late September.

The science still has to play out, Wolk said.

Dynavax Technologies Corp. DVAX, +1.38% announced that it will work with the Icahn School of Medicine at the Mount Sinai Hospital system in New York on a universal influenza vaccine. Mount Sinai has received funding from the National Institute of Allergy and Infectious Diseases to develop a vaccine and aims to use Dynavaxs adjuvant technology to support that process.

A universal flu vaccine would get rid of the need for annual flu vaccination, the organizations said in a news release.

See also: This new study shows how well a coronavirus vaccine must work before we can stop social distancing

The number of Americans applying for jobless benefits fell slightly in the second week of July to a post-pandemic low of 1.30 million, but the grudgingly small decline points to ongoing stress in the labor market as the economy struggles to cope with the latest coronavirus outbreak, MarketWatchs Jeffry Bartash and Greg Robb reported.

New applications for unemployment compensation, a rough gauge of layoffs, fell 10,000 in the seven days ended July 11 to 1.30 million from a revised 1.31 million in the prior week, the Labor Department said Thursday. The figures are seasonally adjusted.

Economists polled by MarketWatch had forecast 1.24 million new claims. These figures reflect applications filed the traditional way through state unemployment offices.

An unadjusted 928,488 people also applied for benefits through a temporary federal-relief program.

Initial jobless benefit claims have stalled since mid-June when they hit 1.57 million. An economic rebound in May and June has lost momentum in July amid a fresh wave of coronavirus cases that has forced many states to either reimpose partial lockdowns or pause reopening plans.

The latest setback is expected to put more people out of work again and delay the return of others to their jobs, making it harder for the economy to recover. Economists say Washington has to extend emergency unemployment benefits and increase other aid to prevent the situation from getting worse.

The trend in initial jobless claims has now just about stopped falling; next week could easily see an increase, for the first time since March, in the wake of the continued gradual reimposition of restrictions across the South and parts of the West, said Ian Shepherdson, chief economist at Pantheon Macroeconomics.

Separately, sales at U.S. retailers posted a big increase in June for the second month in a row, but that trend too may be sapped by the rise in new cases. Retail sales climbed 7.5% last month following a record 18.2% increase in May, the government said Thursday. Economists polled by MarketWatch had forecast a 5.4% increase.

Retail sales may have had a strong showing for June, but thats old news given how quickly the coronavirus resurgence is beating up the economy, said Robert Frick, corporate economist at Navy Federal Credit Union.

Morgan Stanley and Bank of America were the latest big banks to post earnings and they showed the same trend as other banks of strong trading and investment banking fees, offset by the need to set aside huge provisions for potential loan losses.

Banks are warnings that they may be facing a wave of defaults as companies struggle in the pandemic.

There was more upbeat news from Dominos Pizza, which has been thriving during lockdown periods and as consumer eat at home more. Johnson & Johnson beat profit and sales estimates for its latest quarter, amid strong demand for drugs.

Cowen downgraded Walt Disney Co.s DIS, -1.21% stock on concerns that its parks and film business will be disrupted for longer than investors anticipate, and Citi reiterated a sell rating on Tesla Inc. TSLA, -2.93%, after its massive year-to-date rally, which has come even as its main plant in Fremont, California was shut down for much of the last quarter.

What hasnt changed, in our view, is the lack of evidence to support the recent narrative in the stock-namely that Tesla is already experiencing seemingly unlimited demand thats decoupled from autos, that traditional & emerging competitors stand little chance, that FSD/AV [fully self-driving technology] is industry leading and that Tesla should be valued vs. large Tech names, analyst Itay Michaeli wrote in a note to clients.

It is tough to fight the momentum, but its even tougher to construct a fundamental risk/reward framework that makes sense here (particularly with COVID-19 risks), even if one is constructive on Tesla the company.

Elsewhere, companies offered updated guidance and outlined ways they are managing liquidity in the pandemic, among other issues. MMM, +0.73%

Heres the latest news about companies and COVID-19:

3M Co. MMM, +0.73% , the maker of Post-it Notes and industrial products, has filed 18 lawsuits and shut down thousands of deceptive websites and social media posts as it moves to prevent COVID-19 fraud and profiteering. The company is working with law enforcement agencies to help protect the public against those parties who are exploiting the strong demand for its products, which include N95 masks and other equipment. The schemes we shut down were not only unlawful, they also endangered lives and wasted precious time and resources by diverting buyers from legitimate sources of much-needed respirators, Denise Rutherford, senior vice president of corporate affairs said in a statement. 3M has created hotlines and websites for consumers to report suspected fraud and has published pricing information for N95 masks to help them avoid inflated prices. The company has won 6 temporary restraining orders and 4 preliminary injunction orders from courts that halted unlawful actions, said the statement.

Abbott Laboratories ABT, -0.34% reported second-quarter profit and revenue that beat expectations and provided an upbeat full-year outlook. For 2020, the company expects adjusted EPS of at least $3.25, above the FactSet consensus of $2.90. Were a leader in the global COVID-19 testing efforts, weve continued to advance our pipeline and, importantly, we saw significant improvements in growth trends throughout the quarter in the business areas that were initially most impacted by the pandemic, said Chief Executive Robert Ford.

Alcoa Corp. AA, +6.30% reported a narrower second-quarter loss and sales were slightly ahead of expectations. The company made progress on its continuing asset review in preparation for potential sales and cost-cutting goals related to the pandemic. It increased its liquidity after completing the sale of $750 million worth of bonds on Monday, at a 5.5% coupon rate that was lower than any of its previous debt issuance. Despite challenging market conditions, our team has lowered production costs, increased output, maintained stable shipments, and improved our balance sheet, Chief Executive Roy Harvey said in a statement. We continued to make progress in executing our strategic actions and 2020 programs, and we finished the quarter with a cash balance of nearly one billion dollars.

American Airlines Group Inc. AAL, -7.36% sent notices to 25,000 workers -- about one-fifth of its workforce -- about potential furloughs as the airline copes with what it calls slackening demand for air travel during the pandemic. American, which is prohibited from slashing jobs or pay rates through Sept. 30 under terms of $25 billion in federal payroll support, also urged employees to take buyout and early retirement packages before being forced to cut their jobs. The airline, which reported an 80% plunge in June revenue, says it will be overstaffed by 20,000 when federal aid expires Oct. 1.

Separately, American Airlines Group Inc. and JetBlue Airways Corp. JBLU, -4.58% announced a partnership aimed at creating more options for travelers in the Northeast U.S., to give the more choices across the airlines domestic and international routes. The partnership includes an agreement that proposes code-share and loyalty benefits for flight offerings in New York and Boston. The partnership will allow American to launch service from New Yorks JFK airport to Tel Aviv and to Athens, and the JFK to Rio de Janeiro flight will return as a daily route in winter 2021, and will allow JetBlue to add flights in New Yorks LaGuardia Airport and New Jerseys Newark airport and grow its presence at JFK.

Bank of America Corp. BAC, -2.72% posted net income of $3.5 billion, or 37 cents a share, in the second quarter, down from $7.3 billion, or 74 cents a share, in the year-earlier period. The number was weighed down by a $4 billion build in loan loss provisions during the coronavirus pandemic. Revenue fell to $22.3 billion from $23.1 billion. The FactSet consensus was for EPS of 28 cents and revenue of $21.8 billion. Strong capital markets results provided an important counterbalance to the COVID-19-related impacts on our consumer business, Chief Executive Brian Moynihan said in a statement. Net interest income fell 11% to $10.8 billion, driven by lower interest rates. Noninterest income rose 5% to $11.5 billion, buoyed by strong capital markets results. Sales and trading revenue rose 28% to $4.2 billion, as FICC (fixed income, currencies and commodities) revenue climbed 50% to $4.2 billion and equities revenue rose 7% to $1.2 billion. Investment banking fees rose 57% to a record $2.2 billion, amid record capital raising by companies seeking to bolster liquidity during the pandemic.

Charles Schwab Corp. SCHW, -2.07% reported a second-quarter profit that topped expectations but revenue that fell why, as the pandemic created a myriad challenges for its clients. Total client assets as of the end of June were $4.11 trillion, up 11% from a year ago. We grappled with the ongoing health crisis, a contracting U.S. economy, and sustained pressures on interest rates, yet there were some encouraging signs as the quarter progressed, including domestic equity markets recovering to pre-pandemic levels, said Chief Executive Walt Bettinger.

Dominos Pizza Inc. DPZ, -1.48% reported second-quarter earnings and revenue that far exceeded expectations during the pandemic. U.S. same-store sales grew 16.1%, and international same-store sales rose 1.3%. The FactSet consensus was for domestic growth of 11.9% and a global rise of 0.7%. As of June 14, Dominos had $248 million in cash and equivalents and $4.17 billion in total debt. The company borrowed $158 million under its variable funding notes during the quarter as a precautionary measure.

Bankrupt department store retailer J.C. Penney Co. Inc. JCPNQ, -0.36% announced a company restructuring that includes 152 store closures and a head count reduction of 1,000 workers across corporate roles, management and internationally. J.C. Penney filed for bankruptcy protection in May after which Cowen analysts forecast the company would have to shutter 25% of its locations. J.C. Penney has 90,000 employees, according to FactSet and, as of February 2020, had 850 locations in the U.S. and Puerto Rico.

J.Jill Inc. JILL, +38.07% reached an agreement with lenders to extend a forbearance period to July 23 to give the company more time to complete negotiations. We are making progress with the negotiations and expect a resolution soon, Interim Chief Executive Jim Scully said in a statement. The Quincy, Mass.-based womens clothing retailer entered the forbearance agreements in June after falling out of compliance with certain covenants on its asset-based lending facility and term loans during pandemic. The uncertainty created by recent events generate scenarios that raise substantial doubt about our ability to continue as a going concern within one year after the date the financial statements are issued, the company said in its 10k filing published in June.

Johnson & Johnson JNJ, +0.66% reported second-quarter profit and sales that beat expectations, and raised its full-year outlook. Consumer health sales fell 7.0% to miss expectations, while pharmaceutical sales grew 2.1% to slightly top expectations and medical device sales dropped 33.9% but was above expectations. Our second quarter results reflect the impact of COVID-19 and the enduring strength of our pharmaceutical business, where we saw continued growth even in this environment, said Chief Executive Alex Gorsky. The company raised its 2020 guidance ranges for adjusted EPS to $7.75 to $7.95 from $7.50 to $7.90 and for sales to $79.9 billion to $81.4 billion from $77.5 billion to $80.5 billion

Morgan Stanley MS, +2.51% reported a second-quarter profit that rose above expectations, amid strength in the trading and investment banking businesses. Net income increased to $3.20 billion, or $1.96 a share, from $2.20 billion, or $1.23 a share, in the year-ago period. The FactSet consensus for earnings per share was $1.12. Revenue 30.9% to $13.41 billion. Noninterest revenue grew 28% to $11.81 billion, to beat the FactSet consensus of $9.36 billion and net interest income rose 31% to $1.60 billion to top expectations of $985.2 million. Within noninterest revenue, trading revenue soared 71% to $4.68 billion and investment banking revenue jumped 35% to $2.14 billion. The second quarter tested the model and we performed exceedingly well, delivering record results, said Chief Executive James Gorman. This builds on the momentum of a very strong first quarter, while more than 90% of our employees continue to work from home, demonstrating the ongoing operational resilience of our platform.

Norwegian Cruise Line Holdings Ltd. NCLH, -15.62% is offering $250 million of stock in a syndicated deal. J.P. Morgan, Citigroup, Goldman Sachs, Barclays, Mizuho Securities and UBS are joint book-runners on the deal. Proceeds will be used for general corporate purposes. Cruise operators have been hit hard by the coronavirus pandemic, which has halted all sailings due to the high risk of passengers becoming infected in close quarters.

Penske Automotive Group Inc. PAG, +3.82% preannounced expectations of a surprise second-quarter profit, citing a significant improvement in operations during June. Based on the performance of its U.S. and U.K. retail automotive dealerships and its used vehicle supercenter, Penske expects to report EPS of 52 cents to 57 cents, which compares with the FactSet consensus for a loss of 16 cents a share. All of its U.S. retail automotive dealerships are open after closing during the pandemic. Strong sales of used units in June led to combined U.S. and U.K. operations generating a profit that was more than double that of the period last year. Our performance in June is the result of a strong operational focus to control costs, manage vehicle inventory, and maximize gross profit, said Chief Executive Rob Penske.

Sleep Number Corp. SNBR, -9.19% reported a steep drop in second-quarter revenue caused in large part by the pandemic. The mattress companys revenue tumbled 20% to $284.9 million from $356 million a year ago. Analysts surveyed by FactSet had expected sales of $251 million.

Additional reporting by Tim Rostan and Jaimy Lee

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Coronavirus update: Global COVID-19 cases climb to 13.6 million after record one-day tally of 230,400 new infections - MarketWatch

By: Stephen M. Hahn, M.D., Commissioner of Food and Drugs, Patrizia Cavazzoni, M.D., Acting Director, Center for Drug Evaluation and Research, and Peter Marks, M.D., Ph.D., Director, Center for Biologics Evaluation and Research

When the U.S. Food and Drug Administration learned of the novel coronavirus (COVID-19) and its potentially devastating effects, we acted swiftly to set the regulatory stage for drug and biologics manufacturers to develop products to treat this serious disease. To meet this urgent need, the FDA created the Coronavirus Treatment Acceleration Program (CTAP) to enable the FDAs Center for Drug Evaluation and Research (CDER) and Center for Biologics Evaluation and Research (CBER) to leverage cross-agency scientific resources and expertise to bear on COVID-19 therapeutic development and review. Were excited to say that there are now more than 510 drug development programs in planning stages, and as of today, the agency has reviewed more than 230 trials of potential therapies for COVID-19.

While the FDA is part of a whole of government approach to COVID-19, CTAP is a distinct component of this effort focusing specifically on therapeutics, not vaccines or devices. Another major initiative of the U.S. government, Operation Warp Speed (OWS), funds and rapidly develops or co-develops vaccines, therapeutics, and diagnostics, while the FDA, through CTAP, regulates therapeutic development. There is a clear delineation between OWS executive actions and FDA regulatory decision-making.

The FDA recognized that there would be a need for early and frequent discussions between the agency and potential therapeutic product developers. So early on, we set up an email inbox for COVID-19 therapeutic development inquiries, COVID19-productdevelopment@fda.hhs.gov. It helps researchers and developers get directed to the right person on the first try and enables us to track inquiries.

Each inquiry the FDA receives is reviewed by a triage team that is composed of experienced clinical reviewers, other scientific reviewers, policy experts and regulatory project management staff. The team strives to acknowledge receipt within 24 hours. These staff help those with proposals for potential COVID-19 therapeutics identify and add any information necessary to ensure that the proposal is complete enough for productive discussion. Then, the team sends the proposal with a brief synopsis to the right organizational unit within the FDA for review by disease area experts.

Teams of experienced clinical reviewers and regulatory affairs experts in CDER and CBER provide outreach and regulatory advice to less experienced inquirers. Preliminary, partially-formed inquiries go to them before they are assigned to product review teams to determine next steps for engaging with the FDA, including what regulatory submission is appropriate, what to include in that submission, and how to submit it.

Once individual inquiries develop into proposals, our discussions with sponsors can then meet several key milestones:

We will continue to report the number of active drug development programs, studies underway, EUAs and approvals at our CTAP program dashboard monthly.

Behind the scenes of CTAP, office leaders within CDER and CBER align our efforts across therapeutic areas, scientific disciplines, and organizational units. Clinical, operations and policy supervisors meet regularly to discuss staffing support, trial design, endpoint selection, and consistency of practice and expectations for COVID-19 submissions. Clinical and biostatistical experts meet regularly to share information, advance our scientific understanding and develop consistent approaches. Senior leadership stay actively engaged on key drug and biologic development and review issues.

When CTAP started, we achieved extraordinary turnaround times for certain significant inquiries and proposals, to get key studies going rapidly. For therapeutic development programs with strong rationales and evidence, we continue to dramatically exceed standard timelines. We have found that a complete pre-IND submission is the key to expediting comprehensive pre-IND advice, more rapid review of the subsequent IND and more rapid clinical trial initiation.

While we have shortened our timelines, our regulatory review and decision-making processes have not changed. Interactions with review teams follow our usual stable, predictable, and flexible process. We give all researchers and developers our best advice, apply our legal and regulatory standards, and make decisions on the basis of the science and the data.

Safe and effective COVID-19 therapeutics and other medical products are a very high priority at the FDA. We understand the impact of this public health emergency and approach our role in facilitating the development and availability of important medical products with the strongest sense of urgency.

Go here to see the original:

An Update and Behind the Scenes: FDA's Coronavirus Treatment Acceleration Program - FDA.gov

Good morning.

(This article is part of the California Today newsletter. Sign up here to receive it by email.)

Californians who dont have symptoms of Covid-19 will probably have a harder time getting tested for the coronavirus, according to new, stricter guidelines state officials unveiled on Tuesday.

It is critical we continue to be deliberate and creative about testing, Dr. Mark Ghaly, the states head of health and human services, said in a statement. We must do this so that testing is readily available and affordable to those who need it, especially those communities experiencing the worst impacts.

In a virtual news conference, Dr. Ghaly said California was also exploring opportunities for pooled testing, a strategy that could help identify infections in large groups more quickly.

The shift in testing strategy comes as more states around the country have scrambled to ramp up testing, which has resulted in tighter supply chains and longer turnaround times in California, the nations most populous state.

California has contended with an explosion in cases, prompting Gov. Gavin Newsom on Monday to announce the most sweeping rollback yet of reopening plans.

[Read about which businesses were ordered to close down.]

As of Tuesday, California was averaging 8,334 new cases per day over the past week, compared with 3,041 new cases per day on average just a month ago.

Heres what to know about the changes:

Why are they happening now?

Over the past two weeks, the state reported 107,600 tests per day on average a huge increase over the past couple of months. But the states percentage of tests that have come back positive for the virus has inched upward, as well, to 7.1 percent on average over the past two weeks.

Our testing capacity has increased exponentially, Dr. Ghaly said in the statement. At the same time, new national supply chain challenges and large volumes of specimens sent to commercial laboratories have resulted in growing delays in processing times.

What do the new guidelines say?

Previously, state and local officials had encouraged anyone who wanted to get tested to see if they were eligible, whether or not they had symptoms, as testing capacity ramped up across California and case numbers were less troubling.

Under the new guidelines, Dr. Ghaly said that testing would be much more strategically targeted at people in communities where risks of transmission are higher.

Of course, people who have severe symptoms will be prioritized for tests with quick results so they can get a diagnosis and be treated.

According to the new rules, people who have been hospitalized fall in the Tier 1 priority group, along with people who must be tested as part of investigations into specific outbreaks.

Tier 2 includes everyone else with Covid-19 symptoms, as well as people who live or work in the kinds of facilities where outbreaks have been most severe, such as nursing homes, prisons and homeless shelters. It also includes health care workers who have frequent interactions with the public or with people who may have Covid-19.

Tier 3 includes workers in remaining essential sectors, like grocery stores, logistics, manufacturing and education, if they dont have symptoms.

And then, theres Tier 4, which will be implemented only when the test turnaround time is less than 48 hours, as monitored by the state. Thats when anyone else who doesnt have symptoms, but is worried they may have been infected, can get tested.

How will these new rules help stop the spread of the virus?

While individual actions, like following distancing and mask-wearing rules, are critical for curbing the spread of the virus, increasingly, experts have recognized that many transmissions are taking place because Californians who work in low-wage, high-risk jobs havent been able to stop working.

In a first-of-its-kind analysis, researchers at the University of California, Merced, Community and Labor Center found a connection between high concentrations of low-wage work in certain counties like at farms and in warehouses and the prevalence of Covid-19.

Our findings emphasized the importance of not just regulating business openings, but mitigating Covid spread by innovating health and safety reforms for workers, Ana Padilla, the centers executive director, told me.

One way to do that is to ensure that workers in those communities have access to testing and that workplace outbreaks are transparent. That would mean requiring counties to report test results by industry, the report said.

Although we have guidance and support, we know that testing in those environments is key, Dr. Ghaly said on Tuesday, adding that thats why the new testing strategy involves homing in on workplace outbreaks.

Updated July 15, 2020

Still, he said the state hadnt specifically asked counties to report test results by industry or employer.

[Read more about how the pandemic has put warehouse workers in the Inland Empire in a tough spot.]

We often link to sites that limit access for nonsubscribers. We appreciate your reading Times coverage, but we also encourage you to support local news if you can.

The Trump administration abandoned its plan to strip international college students of their visas if they didnt attend at least one class in person. It was a rare and swift reversal in response to fierce opposition. [The New York Times]

Most of the nations big school districts including in Los Angeles and San Diego arent ready to reopen, because the test positivity rates in the communities where theyre located are much too high. And reassuring examples of schools reopening abroad dont apply here. [The New York Times]

Bankruptcy forced Stockton to defund its Police Department, making it an inadvertent laboratory for pushes to reduce the roles of law enforcement officers in keeping communities safe. [The Los Angeles Times]

If you missed it, heres what Stocktons mayor had to say about calls to defund the police now. [The New York Times]

Transit agencies around the country are struggling. In the Bay Area, there are too many disjointed systems and not enough riders. [Bloomberg CityLab]

Wineries were beginning to settle into a new normal. Then they were told they had to shut down indoor operations.[The San Francisco Chronicle]

He goes by Bruce or Paco or Peter or Pierre or Abraham. He is a peacock. And hes tearing a North Oakland neighborhood apart. [SFGate]

We joke about it: How many years has it been since 2020 started? How many lifetimes?

Theres a sense that were living through a momentous period in history a global pandemic, uprisings over racial justice that have poured into every corner of society and broad recognition that the world is changing rapidly.

So museums and curators are asking us all to help them help future generations understand this time by documenting it. Everything, like protest signs, shopping lists, or snippets of video.

Whatever were taking to be ordinary within this abnormal moment can, in fact, serve as an extraordinary artifact to our childrens children, Tyree Boyd-Pates, an associate curator at the Autry Museum of the American West, told Lesley M.M. Blume, in this article. The Autry is asking for submissions to its Collecting Community History Initiative.

California Today goes live at 6:30 a.m. Pacific time weekdays. Tell us what you want to see: CAtoday@nytimes.com. Were you forwarded this email? Sign up for California Today here and read every edition online here.

Jill Cowan grew up in Orange County, went to school at U.C. Berkeley and has reported all over the state, including the Bay Area, Bakersfield and Los Angeles but she always wants to see more. Follow along here or on Twitter.

California Today is edited by Julie Bloom, who grew up in Los Angeles and graduated from U.C. Berkeley.

Read more from the original source:

Why You May Not Be Able to Get a Coronavirus Test in California - The New York Times

These mucosal immune responses seem to underlie the success of the oral polio vaccine, which contains a weakened form of polio virus and has helped most of the world eradicate polio. When it debuted in the 1960s, the vaccine was considered, in many ways, an enormous improvement over its injected predecessor because it targeted the bodys immune response in the gut, where the virus thrives. Many people who took the oral vaccine seemed to quash infections even before they felt symptoms or passed the germ on to others.

It was a fabulous vaccine to stop the transmission of polio, said Dr. Anna Durbin, a vaccine expert at Johns Hopkins University. It helped induce herd immunity, she said, referring to the threshold of the population that needs to be immune to a pathogen to keep it from spreading.

Vaccines given through muscle are great for prompting the body to churn out antibodies in the bloodstream, like IgG. If a pathogen shows up, hordes of these on-call molecules will rush to meet it.

For many respiratory infections, thats good enough.

The majority of respiratory vaccines, like the measles vaccine, are given intramuscularly, and it works, Dr. Iwasaki said. If enough antibodies reach the right mucosal surface, it doesnt really matter how they were induced.

Still, relying on that strategy alone can be risky a bit like shoring up a banks security at every entrance except for the one a thief would most likely hit. Sentinels roving throughout the building could subdue the interloper after they trip the alarm. But by that point, some damage has probably already been done.

Updated July 15, 2020

Its mainly a timing issue, Dr. Bhattacharya said. If you have circulating cells and molecules, theyll eventually find the infection. But youd rather have a more immediate response.

Without a strong mucosal response, injected vaccines may be less likely to produce so-called sterilizing immunity, a phenomenon in which a pathogen is purged from the body before its able to infect cells, Dr. Durbin said. Vaccinated people might be protected from severe disease, but could still be infected, experience mild symptoms and occasionally pass small quantities of the germ onto others.

More here:

Nasal Coronavirus Vaccines May Work Better Than Injected Ones, Researchers Say - The New York Times

In echoes of the early days of the Covid-19 pandemic, some American states and localities are reversing economic reopenings after spread of the coronavirus accelerated in some regions.

Americas Sun Belt, the region extending from southern California to Florida, has been particularly hard-hit, and now further flung and less populous states are joining the ranks rolling back reopenings.

New Mexico again banned indoor dining. Nevada closed bars in counties with major outbreaks. And Oregon, in the Pacific north-west, banned private indoor gatherings of more than 10 people. Arizona and Texas reimposed restrictions on indoor dining and bars in early July.

California, the most populous state, dramatically expanded restrictions. Indoor operations of theaters, wineries, restaurants and bars were all stopped this week. In addition, some of the nations largest school districts have announced classes will be virtual this fall. Students in Los Angeles, San Diego and Atlanta will not have in-person classes.

The reopening plan was great if everything went well, the Miami mayor, Francis X Suarez, told the Republican Florida governor, Ron DeSantis, at a public roundtable Tuesday. But I think the fact is things have not gone according to plan.

If things do not improve quickly I think were going to be under a significant amount of pressure to shut down, Suarez said.

Florida closed indoor dining in late June but has persisted with other reopening plans. DeSantis called on schools to reopen in a few weeks, and Disney World reopened some of its parks to thousands of visitors on Saturday.

Republican officials moved the national convention, where Donald Trump will formally accept the nomination of his party, from North Carolina to Florida to avoid social distancing and mask requirements. But with cases rising, officials moved the biggest events outdoors, the New York Times reported.

Louisiana, an early center of outbreaks after Mardi Gras this spring, has again seen a spike in Covid-19 cases. Vice-president Mike Pence traveled to the state on Tuesday but was not greeted by one of its top officials, attorney general Jeff Landry, who tested positive for Covid-19 despite showing no symptoms.

The governor, John Bel Edwards, enacted a statewide mask mandate for people aged eight and older, which took effect Monday. He also returned bars to takeout and delivery only. Restaurants, casinos, gyms, salons and other businesses remain open, with occupancy restrictions.

But Americas vast landscape and varied politics means even as many states across the south and west roll back reopening, places whose overburdened health systems became emblematic of the perils of Covid-19 have continued to reopen.

The New York governor, Andrew Cuomo, will allow malls to reopen in some parts of the state. New York City hit a hopeful milestone on Saturday: for the first time since 11 March, no one died of coronavirus.

Its something that should make us hopeful, but its very hard to take a victory lap because we know we have so much more ahead, said the mayor, Bill de Blasio, on Monday, according to NPR. This disease is far from beaten. While New York state announced only 677 new cases of coronavirus on Sunday, Florida reported more than 15,000.

In contrast to states in the south and west, some parts of the north-eastern economy never reopened. In New York City, Broadway shows are likely to remain closed until at least this winter, and indoor dining is still banned.

Across the river in New Jersey, gyms remain closed. Indoor dining in New Jersey was slated to reopen at very limited capacity, but the proposal was rolled back after photos emerged of unmasked crowds at beach bars on the Jersey shore.

Unlike in states such as New York, which has metrics that would trigger closures if the virus began to spread, Miami mayors said Florida had no such plan.

Renewed restrictions in the south and west have also brought renewed frustration. In New Mexico, businesses forced to close their doors again protested against the governors order. At some point you have to protect your livelihood, Kathy Diaz, owner of Monroes Restaurant, told local news station KOB4.

Parents of schoolchildren in Jacksonville, Florida, called for school reopenings, and anti-mask protesters have organized demonstrations against local mask mandates.

Marlyn Hoilette, a nurse who spent four months working in the Covid-19 unit of her Florida hospital until testing positive recently, said she worries about returning to work.

Nurses are getting sick, nursing assistants are getting sick and my biggest fear is that it seems we want to return folks to work even without a negative test, said Hoilette, who works at Palms West hospital in Loxahatchee, Florida. Its just a matter of time before you wipe the other staff out if youre contagious, so that is a big problem.

Read more:

'Things have not gone according to plan': America's coronavirus reopening falls apart - The Guardian

Now the economy is traveling sideways, as business failures mount and the virus continues to maim and kill. New applications for unemployment insurance, for instance, are leveling off at more than 1 million a weekmore than double the highest rate reached during the Great Recession, a sign that more job losses are becoming permanent. After rising when the government sent stimulus checks and expanded unemployment-insurance payments, consumer spending is falling again, down 10 percent from where it was a year ago. Homebase, a provider of human-resources software, says that the rebound has hit a plateau, in terms of hours worked, share of employees working, and number of businesses open.

The next, terrifying phase of the coronavirus recession is here: a damaged economy, a virus spreading faster than it was in March. The disease itself continues to take a bloody, direct toll on workers, with more than 60,000 Americans testing positive a day and tens of thousands suffering from extended illness. The statistical value of American lives already lost to the disease is something like $675 billion. The current phase of the pandemic is also taking an enormous secondary toll. States with unmitigated outbreaks have been forced to go back into lockdown, or to pause their reopening, killing weakened businesses and roiling the labor market. Where the virus spreads, the economy stops.

That is not just due to government edicts, either. Some consumers have rushed back to bars and restaurants, and resumed shopping and traveling. Young people, who tend to get less sick from the coronavirus than the elderly, appear to be driving todays pandemic. But millions more are making it clear that they will not risk their life or the life of others in their community to go out. Avoidance of the virus, more so than shutdown orders, seems to be affecting consumer behavior. Places without official lockdowns have seen similar financial collapses to those with them, and a study by University of Chicago economists showed that decreases in economic activity are closely tied to fears of infection and are highly influenced by the number of COVID deaths reported in a given county.

Read: A devastating new stage of the pandemic

In other ways, the spread of COVID-19 is keeping Americans from going back to work. The perception of public transit as unsafe, for example, makes it expensive and tough for commuters to get to their jobs. Schools and day-care centers are struggling to figure out how to reopen safely, meaning millions of parents are facing a fall juggling work and child care. This is a disaster. The lingering uncertainty about whether in-person education will resume isnt the result of malfeasance, but utter nonfeasance, the former Department of Homeland Security official Juliette Kayyem has argued in The Atlantic. Four months of stay-at-home orders have proved that, if schools are unavailable, a city cannot work, a community cannot function, a nation cannot safeguard itself.

See the original post:

The Terrifying Next Phase of the Coronavirus Recession - The Atlantic

Other schools, like Boston University, are forging ahead building their own high-capacity labs to regularly test their campus communities.

But whether there is enough laboratory capacity in Massachusetts to regularly test tens of thousands of college students is an open question. So, too, is the prospect of persuading hordes of students to regularly submit to nasal swabbing and to dutifully adhere to social distancing.

The higher education plans are being firmed up as waiting times grow for test results in Massachusetts and nationwide. Some national commercial laboratories used by businesses and health centers in Massachusetts to process the tests recently acknowledged waiting times stretching longer than five days as the surging virus in Southern and Western states fuels a demand for more testing.

Plentiful and timely lab results are crucial to quickly contain future clusters of COVID-19 on college campuses and beyond, and to prevent clusters from mushrooming into larger outbreaks, health experts say.

If we are going to [use] testing to control outbreaks, you have to get results back in one to two days, even three days is too slow, said Samuel Scarpino, a Northeastern University disease tracker. If I were ... anyone setting policy, I would have that on my daily dashboard and would make a lot of decisions about reopening based on that number.

Testing is just one facet of the complex plans colleges are developing this summer that they believe will make it safe to welcome students back to campus this fall. Some schools, like BU, Northeastern, and Tufts, plan to allow all undergraduates to return to campus if they wish, while others, like UMass Boston, plan to continue almost entirely online. Harvard plans to allow freshmen on campus, but all courses will be virtual. MIT will allow only seniors on campus this fall. In normal years, Massachusetts draws 500,000 college students per year who contribute $25 billion to the state economy.

A report last month from a task force of higher education leaders who advised Governor Charlie Baker on reopening colleges suggested a multipronged approach. The ideas included social distancing, masks, improved building ventilation, and reconfigured classrooms, residence halls, and dining facilities, in addition to robust coronavirus testing programs.

The report suggested several strategies for how schools should tackle the labor and cost of testing, which is expected to run about $25 per test for schools that use the Broads program, the report said.

It recommended that schools organize students and staff into groups that will be tested more or less frequently depending on their risk of exposure. Essential campus workers and students who live in dormitories, for example, would be tested most often.

The report also recommended three types of testing an initial test for everyone at the start of the semester, quick testing of symptomatic people, and routine testing at least once a week for everyone else.

Testing broadly is the sine qua non for safety, said Dr. Sandro Galea, dean of the Boston University School of Public Health and a member of the task force. The more capacity we have, the better.

The Broad Institute, known for cutting-edge biomedical research, has become a pivotal player for college coronavirus testing, recently negotiating testing contracts with several schools. In addition to Harvard and Clark, the institute is working with Emerson College, Tufts University, the University of Massachusetts Medical School, and Wellesley College.

The Broad recently expanded its daily capacity to 35,000 tests and can turn them around in less than 24 hours, a spokesman said in a statement. The lab has the ability to ramp up to 100,000 daily if needed, the spokesman said, but declined to comment further on its new college testing program.

The Broad, which opened its testing lab in March, has so far not processed more than 7,000 tests in a day, according to the website where it posts its daily output.

Dr. Ashish Jha, a global health professor at the Harvard T. H. Chan School of Public Health, said it is imperative that schools have a substantial amount of testing because relying on students to consistently practice social distancing is not practical.

And although this might be an unruly demographic, he said, students will likely submit to tests.

I generally think there is a way that if you implement your policy well, you can probably ensure that everybody does it, Jha said.

Maybe Im being too cynical, but I just feel like 20-year-olds really adhering to strict social distancing guidelines is going to be a tall order, and therefore it is that much more important that we do aggressive testing, he added.

Jha said he is pretty confident the Broad will be able to handle the daily testing load it is taking on.

But if the Baker administration believes it is important for colleges and universities to reopen, officials should figure out how to increase testing capacity statewide, he said.

"The state's got to keep pushing on that, and keep trying to drive toward higher capacity," he said.

A plan the state recently submitted to federal regulators raises questions about the scope of campus testing. It indicates the administration anticipates that only about 10,000 individuals in total will be tested daily statewide in September and about twice that come October long after campuses reopen. It is silent on expected turnaround times for results.

A Baker administration spokeswoman declined to comment about testing on campus. She said in a statement the administration is seeking to expand testing capacity but did not touch on turnaround times.

Oversight of the testing varies among local campuses. In many instances, colleges and universities are outsourcing the screenings. Several plan to ask students to swab their own noses with shorter swabs than are used in many public testing sites, where medical workers typically collect samples deep within the nasal cavity. Some schools will have medical staff observing as the students swab their own noses.

Anthony Monaco, the president of Tufts University who was a member of the higher education task force, said the group believes the biggest risk for spread on campuses will be within dorms. But he said it will be important for schools to also test students who live off campus.

Monaco said Tufts is developing an app that will let students know when they are scheduled to be tested and send reminders. The details are not finalized, he said, but there would likely be repercussions for missing a test, such as not being able to participate in a campus activity.

The testing will be a significant investment for schools, he said, on top of other adjustments like extra housing they are building to quarantine students.

They all add up, but for one semester, perhaps two, its an investment we need to make, Monaco said.

Kay Lazar can be reached at kay.lazar@globe.com Follow her on Twitter @GlobeKayLazar. Laura Krantz can be reached at laura.krantz@globe.com. Follow her on Twitter @laurakrantz.

See the original post here:

Coronavirus testing is key to colleges reopening - The Boston Globe

Here are five things you need to know about the coronavirus outbreak this Wednesday evening. We'll have another update for you on Thursday morning.

Boris Johnson has for the first time promised to hold an "independent inquiry" into the coronavirus pandemic. He told MPs during Prime Minister's Questions that the government would seek to learn lessons "in the future" and "certainly we will have an independent inquiry into what happened". However, the prime minister said it was not right to devote "huge amounts of official time" to an inquiry while the UK was "in the middle" of a pandemic.

There are no plans to make face coverings mandatory for office workers in England, Health Secretary Matt Hancock has told the BBC. He said face coverings helped prevent virus spread during short interactions with strangers, but that social distancing and hand washing were more effective for contact with people over long periods of time. Face coverings in shops will become mandatory in England on 24 July - but what's the best one for you and how should you wear it? Here is our handy guide.

Seventeen-year-old employees are the group most likely to have been put on furlough during the coronavirus crisis, official data shows. HM Revenue and Customs said men aged in their 40s and women aged 41 to 58 were least likely to have been put on the scheme. More than nine million workers who are unable to do their job because of the coronavirus outbreak have had their wages paid by the government.

Driving lessons in Wales will be able to resume from 27 July, with theory and practical driving tests phased in from 3 August, First Minister Mark Drakeford has said. Driving lessons resumed in England on 4 July. Scotland and Northern Ireland have separate arrangements.

Captain Sir Tom Moore, the 100-year-old who raised more than 32m for NHS charities, is to receive his knighthood from the Queen in his own personal ceremony at Windsor Castle on Friday. In May, the prime minister made a special nomination for the war veteran to be knighted.

Get a longer coronavirus briefing from the BBC in your inbox, each weekday morning, by signing up here.

You can find more information, advice and guides on our coronavirus page and get all the latest from our live page.

Plus, what can police do about coronavirus rule breakers? Our home affairs correspondent explains.

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Coronavirus: Virus inquiry promised and office-worker face coverings rejected - BBC News

Almost 1 in 5 new cases of the coronavirus reported around the world came from just three U.S. states Florida, Texas and California a new NBC News tally revealed Tuesday.

The 27,574 cases recorded in those states Monday accounted for 18.9 percent of the global total and represented more than a third of the 61,751 new cases reported in the U.S.

Meanwhile, the two-week death total in Texas was up by 99 percent over the previous two weeks.

In Florida, the two-week death total rose by nearly 84 percent, and in California it jumped by nearly 27 percent.

As of Tuesday afternoon, there had been 3,407,556 confirmed coronavirus cases in the U.S., and the death toll was 136,832, NBC News figures showed.

Florida reported 9,194 more cases and 133 deaths from Monday. Texas added 7,489 cases and 59 deaths. California recorded 5,063 more cases and 40 deaths.

On Tuesday evening, Los Angeles County alone announced a new single day record with 4,244 cases and 73 deaths.

Arizona, which has also had big increases in new cases in recent weeks, reported 4,273 more infections and 92 more deaths.

Texas' Latino community has been hit especially hard of late, and Rep. Joaquin Castro, a Democrat whose district includes San Antonio, blamed President Donald Trump and Gov. Greg Abbott for being "slow to test people, slow to trace the infection and slow to treat people."

Let our news meet your inbox. The news and stories that matters, delivered weekday mornings.

They "tried to pretend like it wasn't a big problem because they didn't want to end up on the news every day the way New York did, and that's had an incredible effect on this community, and in the last three weeks, it's really exploded," Castro told MSNBC's Garrett Haake.

Full coverage of the coronavirus outbreak

Trump and Abbott have been accused of not having moved quickly enough to combat the coronavirus, and it wasn't until this month that Abbott mandated that people wear masks in public. Trump wore a mask for the first time in public just two days ago, and he predicted this month that the pandemic would "just disappear."

The staggering new sums were reported as Dr. Brett Giroir, the assistant secretary of health and human services for health, insisted on NBC's "TODAY" that "we're turning the corner on the current outbreak."

"We are all very concerned about the outbreak," Giroir said. "About half the cases are in four states: Texas, California, Florida and Arizona. But we are in a much different place now than we were several months ago, a much better place."

Maybe. But 41 states have had increases in cases over the last two weeks, and eight states have had spikes of more than 100 percent over the last 14 days, according to NBC News' Medical Unit.

And when Vice President Mike Pence arrived Tuesday in Louisiana to meet with officials about the pandemic, state Attorney General Mike Landry wasn't there to greet him on the tarmac because he has tested positive, The Advocate newspaper of Baton Rouge reported.

"Out of an overabundance of caution with the Vice President coming to our state, I was tested for Cornavirus," Landry wrote in an email to staffers. "Though experiencing no symptoms, I tested positive for COVID-19."

In other developments:

"The amount of time it is taking to receive testing results is hurting the ability of long term facilities to fight the virus," the letter states. "For nursing homes and assisted living communities to protect residents and staff, we need on-site testing with reliable and rapid results.

"We don't have a Dr. Fauci problem," Graham said. "I have all the respect in the world for Dr. Fauci. I think any effort to undermine him is not going to be productive, quite frankly." Trump has also denied trying to torpedo Fauci.

There was also a smidgen of troubling news out of New York, which in April was posting Texas-size case numbers and since then has succeeded in flattening the coronavirus curve.

Download the NBC News app for full coverage and alerts about the coronavirus outbreak

Gov. Andrew Cuomo reported that 1.5 percent of the 60,045 COVID-19 tests performed Monday came back positive. That is the highest positive rate in the state since June 5.

Cuomo also reported five more coronavirus deaths Monday.

On Sunday, the State Department of Health reported that there were zero COVID-19 deaths Saturday, the first time that has happened since March 13.

CORRECTION (July 14, 2020, 9:45 p.m.): An earlier version of this article misspelled the first name of a senator from South Carolina. He is Lindsey Graham, not Lindsay.

Nigel Chiwaya is a data reporter for NBC News.

Corky Siemaszko is a senior writer for NBC News Digital.

See the original post:

Florida, Texas and California account for about one-fifth of the world's new coronavirus cases - NBC News

A coronavirus patient in Anahuac was flown by helicopter to a hospital in El Campo 120 miles away because closer facilities could not take him.

Ambulances are waiting up to 10 hours to deliver patients to packed Hidalgo County emergency rooms.

And short-staffed hospitals in Midland and Odessa have had to turn away ailing COVID-19 patients from rural West Texas facilities that cant offer the care they need.

As the tally of coronavirus infections climbs higher each day, Texas hospitals are taking extraordinary steps to make space for a surge of patients. Some facilities in South Texas say they are dangerously close to filling up, while hospitals elsewhere are taking precautionary measures to keep their numbers manageable.

Doctors warn of shortages of an antiviral drug that shows promise for treating COVID-19 patients. And epidemiologists say the states hospitals may be in for a longer, harder ride than places like New York, where hospitals were stretched to capacity in the spring and some parked refrigerated trailers outside to store bodies of people who died from COVID-19.

It used to [be that] if one hospital got kind of overwhelmed you would start transferring out ICU patients to other facilities that had ICU beds available, said Dr. Robert Hancock, president of the Texas College of Emergency Physicians. And there really is none of that now, because everybodys in the same boat and theyre struggling to get their own patients admitted.

Cases of the new coronavirus have surged in Texas since Memorial Day weekend at the end of May, one month after Gov. Greg Abbott allowed a phased reopening of businesses. In June, Abbott scaled back parts of that plan, first pausing elective procedures in the states biggest cities in an attempt to conserve hospital capacity for COVID-19 patients, then ordering bars to close and capping restaurant occupancy at 50%.

Last week, he expanded the ban on elective procedures to more than 100 counties across broad swaths of the state, a sign of the increasing urgency of the virus toll on Texas hospitals. Then he warned that if the trend continues, he might order another economic lockdown.

Its going to be a rough few weeks, said John Henderson, president of the Texas Organization of Rural and Community Hospitals. Most everything were seeing is worrisome or scary.

State data shows the hardest-hit regions include most of Texas biggest cities, as well as large swaths of South and Central Texas and the Gulf Coast.

Dr. John Zerwas, the executive vice chancellor for health affairs at the University of Texas System and a former state representative who is advising Abbott on coronavirus response, forecasted that July will be a month for peak activity related to the epidemic.

Probably toward the end of the month, well be seeing ourselves get into a bit more comfortable place, he said.

Local officials in urban centers throughout Texas say more restrictions are needed now to slow the virus spread and keep hospitals from being overwhelmed in the future. On Sunday, Houston Mayor Sylvester Turner called on the governor to shut down businesses for two weeks.

Many Texas hospitals have stopped accepting transfer patients in order to maintain space for a surge thats expected to come. In the Rio Grande Valley, that moment has already arrived, with hospital beds in short supply.

The tsunami is here, Hidalgo County Judge Richard Cortez said last week.

DHR Health, based in Edinburg, the county seat, is creating a third special COVID-19 ward in a facility normally used for physical therapy after spending more than $9 million to convert a hospice center and rehabilitation facility into COVID-19 units.

Were full to the gills, said Dr. Carlos J. Cardenas, chairman of the board at DHR Health.

In neighboring Cameron County, all of the hospitals were at or above capacity and holding patients in their emergency departments Monday, said Dr. James Castillo, the county health authority. Some were converting or eyeing areas not typically used for patient care, like conference rooms or lobbies, he said.

At Valley Baptist Medical Centers in Brownsville and Harlingen which keep opening new units to care for critically ill patients there were people waiting in the emergency room hallways for treatment this week, said Dr. Jamil Madi, medical director of the ICU in Harlingen. The hospitals are nearly out of ventilators and are starting to consider older models and disaster ventilators that are less optimal for treating the virus, he said.

Theres nothing else other than COVID. You treat COVID, you look at COVID, you see COVID, you smell COVID, you hear COVID. Everythings COVID, Madi said. There are two parallel worlds: The world inside the hospital and the world outside. We need people to understand that it is a dire situation going on inside the hospital.

Ambulances are sometimes waiting hours to deliver patients to the emergency rooms, said Mack Gilbert, chief operating officer of Med-Care EMS, which services most of Hidalgo County. Normally, the wait is less than 30 minutes, he said.

You cant blame the hospitals for being full. The ICUs are full, Gilbert said. But the longer [the patients are] with us, the longer it takes to get them the care they need. Were not really set up for long-term care like that, for four to six to eight hours.

The extended delay also leaves medics in the confined space of an ambulance with a COVID-19 positive patient for longer, increasing their risk of exposure to the virus even though they wear full protective gear, Gilbert said.

The state sent hundreds of medical personnel to South Texas earlier this month to alleviate staffing shortages. It also deployed a fleet of 10 ambulances to Hidalgo, of which Med-Care can use two for 12 hours a day.

Gilbert is grateful these guys are doing a great job. But in a 12 hour shift, they're only able to do three calls, because each call is taking four hours, he said.

In Houston, major hospitals have had to treat hundreds of COVID-19 patients in their emergency rooms as they await space in intensive care units. Data shows the dozen busiest hospitals in the area are increasingly telling emergency responders that they cannot safely accept new patients.

Ripple effects can be felt throughout the region, including at El Campo Memorial Hospital, about 75 miles southwest of Houston.

Under normal circumstances, hospitals in Houstons world-renowned Texas Medical Center would accept transfers of medically complex patients from smaller regional hospitals that are less equipped to handle them. But with many Houston hospitals diverting patients away, smaller facilities like the 49-bed El Campo Memorial Hospital have taken them on.

On Monday, the hospital was caring for 18 coronavirus patients, including at least two who were admitted from Houston and the Anahuac patient who was transported by helicopter, said Nathan Tudor, chief executive of the Mid Coast Health System, which includes the hospital.

Traditionally, if the complex cases need to go out, they do go to Houston, Tudor said. Were just praying that this virus gets behind us sooner rather than later.

In Dallas, some hospitals are gearing up for crisis as the number of admitted patients climbs. After requests from Abbott and Dallas Mayor Eric Johnson, federal medical teams are heading to Parkland Memorial Hospital, one of the citys biggest facilities, to help treat an onslaught of patients.

Additional staff is our primary need, said Donna Richardson, chief nursing officer for Parkland Health and Hospital System.

Similar teams were already sent to Houston and San Antonio.

And for the next two weeks, Medical City Healthcare is suspending elective surgeries at 10 of its 16 North Texas facilities, even though the governors order allows such surgeries to take place outside Dallas County.

The pause will enable us to safely and quickly expand capacity and staff to care for hospitalized patients, spokeswoman Janet St. James said. While we currently have adequate capacity, staff, and [personal protective equipment] we are concerned that there is a misconception in the community that this rate of growth can continue.

Meanwhile, short-staffed West Texas hospitals have been forced to turn away patients from rural areas, where small regional hospitals lack the resources to treat the sickest patients.

Earlier this month, Medical Center Health System in Odessa went on diversion meaning it did not accept transfer patients from regional hospitals outside the county as it faced severe staffing shortages. Currently, more than 20 staff members are out because either they or their family members have been exposed to COVID-19, said Trevor Tankersley, a spokesperson for the Medical Center Health System in Odessa.

When MCHS resumed accepting transfer patients, 15 arrived in one day, from West Texas towns as far-flung as Kermit and Alpine. Soon after, the citys other major hospital, Odessa Regional Medical Center, stopped accepting transfers.

Nearby Midland Memorial Hospital stopped accepting transfers of critical patients Thursday, spokeswoman Tasa Richardson said. At that point, the 286-bed hospital was treating 34 coronavirus patients. By Monday, the number had grown to 44.

Its important that the numerous rural hospitals in the region have somewhere to send their patients, hospital representatives said.

We know what its like to be in a small hospital outside of this area and not have the resources, and its difficult to turn down a request for a transfer to a higher level of care, said Dr. Rohith Saravanan, Odessa Regional Medical Centers chief medical officer. There is really no option for that patient at that point theres no care they can provide that would give these patients a good fighting chance.

But even larger hospitals face severe staffing limitations. At ORMC, nurses in the intensive care unit are working with twice as many patients as they normally would. In remote West Texas, there is a severe shortage of nurses, respiratory therapists, and radiology and medical technicians, he said. So the hospital is turning to more expensive contract labor.

We have the bed capacity, we have [personal protective equipment]. ... The capacity is limited mostly by staffing, Saravanan said. There isnt any talent in the area that we can tap into.

Farther west, El Pasos University Medical Center is doing OK on capacity and ... able to handle all patients under a surge planning process that was set up early on, said Ryan Mielke, the hospitals director of public affairs.

Neighboring El Paso Childrens Hospital is prepared to offer up a number of its own units for adult COVID-19 patients if that becomes necessary, but we are not close to reaching that right now, said Audrey Garcia, director of marketing for El Paso Childrens.

You just gotta pray that it stays on that curve, Garcia said.

Health care workers urged Texans to wear masks, wash their hands frequently and avoid contact with others as much as possible to help prevent new coronavirus infections.

The community has an expectation of us as a hospital. The expectation is that well have beds to take care of them, staff to take care of them, medications, Saravanan said. They need to have an expectation of themselves to say, Were gonna do everything we can so we dont have to utilize those resources. The only way we can do that is by preventing the spread of this disease.

Disclosure: The Texas College of Emergency Physicians, the University of Texas System, the Texas Organization of Rural and Community Hospitals, and Parkland Health and Hospital System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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Texas hospitals are running out of drugs, beds, ventilators and even staff - The Texas Tribune

On the last Friday of June, after Gov. Greg Abbott of Texas said that bars across the state would have to shut down a second time because coronavirus cases were skyrocketing, Mick Larkin decided he had had enough.

No matter that Mr. Larkin, an owner of a karaoke club in Wichita Falls, Texas, had just paid $1,000 for perishable goods and protective equipment in anticipation of the weekend rush. No matter that the frozen margarita machine was full, that 175 plastic syringes with booze-infused Jell-O were in place, or that there were masks for staff members and hand sanitizer for guests.

That day, June 26, Mr. Larkin and his partner dumped what they had just bought into the trash and decided to close their club, Krank It Karaoke, for good.

We did everything we were supposed to do, Mr. Larkin said. When he shut us down again, and after I put out all that money to meet their rules, I just said, I cant keep doing this.

It was harrowing enough for small businesses the bars, dental care practices, small law firms, day care centers and other storefronts that dot the streets and corners of every American town and city to have to shut down after state officials imposed lockdowns in March to contain the pandemic.

But the resurgence of the virus, especially in states such as Texas, Florida and California that had begun to reopen, has introduced a far darker reality for many small businesses: Their temporary closures might become permanent.

Nearly 66,000 businesses have folded since March 1, according to data from Yelp, which provides a platform for local businesses to advertise their services and has been tracking announcements of closings posted on its site. From June 15 to June 29, the most recent period for which data is available, businesses were closing permanently at a higher rate than in the previous three months, Yelp found. During the same period, permanent closures increased by 3 percent overall, accounting for roughly 14 percent of total closures since March.

Researchers at Harvard believe the rates of business closures are likely to be even higher. They estimated that nearly 110,000 small businesses across the country had decided to shut down permanently between early March and early May, based on data collected in weekly surveys by Alignable, a social media network for small-business owners.

Christopher Stanton, an associate professor at Harvard Business School who was one of the researchers, said it was difficult to accurately gauge how many small businesses were closing because, once they shut their doors for good, the owners were hard to reach. He added that it could take up to a year before government officials knew the true toll the pandemic was taking on small businesses.

At the moment, 39 states continue to record growing numbers of new cases daily.

It is not clear how many of the businesses Yelp is tracking count as small defined by the Small Business Administration as those with 500 or fewer employees. But the company found that, among the tracked businesses which include restaurants, retailers and other independent, consumer-facing operations retail businesses, led by beauty supply stores, have been closing at the highest rate since the pandemic began. Restaurants are the next hardest-hit group.

Small businesses account for 44 percent of all U.S. economic activity, according to the S.B.A., and closures on such an immense scale could devastate the countrys economic growth. If they were grouped together, small businesses would be among the countrys biggest employers, said Satyam Khanna, a resident fellow at the Institute for Corporate Governance and Finance at New York University School of Law who has written about the effects of the pandemic on small businesses.

So when small businesses close en masse, an entire sector of the economy suffers, Mr. Khanna said. There is lower cash flow, higher debt and more unemployment. That leads to a big drag on the eventual recovery, he said. Because they are such an important source of jobs, losing them the way we are losing them now is going to make things far worse than they otherwise need to be.

Because small businesses depend heavily on foot traffic and operate on thin margins, they are especially vulnerable to the ripple effects of a widespread shutdown.

For nearly two decades, Rich Tokheim and his wife sold sports memorabilia hats, T-shirts, coffee mugs and other trinkets to fans in Omaha at their store, The Dugout. Since 2011, The Dugout has occupied prime real estate across the street from the citys 24,000-seat baseball stadium, which usually hosts the College World Series each spring.

The 2020 World Series was canceled in March. In the weeks that came after, other sporting events were scrapped starting with college sports and extending to professional leagues that have struggled to relaunch their activities.

Mr. Tokheim, 58, watched his business fall off with growing unease, but it was only after a friendly chat with a retired college athletic director in May that the gravity of his situation hit home. He was already worried about the state of the virus in Nebraska, and whether there was enough tracking. Then the athletic director predicted that if college football was canceled for the year, it would be the end of Division I sports as a whole.

That really put me in overdrive, Mr. Tokheim said. He negotiated an early exit on his store lease and announced a clearance sale at the store. The Dugout closed for good on June 30.

The governments Paycheck Protection Program, rolled out in April and administered by the S.B.A., earmarked $660 billion of aid for small businesses, but stipulated that a loan would be forgiven only if most of it was used to pay employee wages for eight weeks. The rules were later relaxed, but in a sign of how many small-business owners did not feel confident that they would be on steady ground by the time repayment was due, roughly $130 billion of aid money remained untapped when the program ended in June.

Even for those who took a P.P.P. loan, survival is no guarantee. Nick Muscari, a 38-year-old restaurateur in Lubbock, Texas, received one. His restaurant, Nicks Sports Grill and Lounge, had been the culmination of Mr. Muscaris lifes work his years of toil as a waiter, pizza cook and manager at restaurants and bars beginning in his teenage years. Three years ago, he bought out the two partners who helped him start the restaurant in 2010. He considered it a crowning achievement, but to do so, he had to borrow money. He still owes a bank $80,000.

Mr. Muscari tried to ride out the spring lockdown that temporarily shuttered his restaurant with the help of the P.P.P. money. But when the states second closure order took effect on June 26, he decided to close for good.

It had been in the back of our minds, just like, you know, if this happens again, can we make it? Mr. Muscari said. We were following all the rules and people were spread out. We never had anybody catch the virus in our establishment."

Mr. Muscari, with the business closed and its 30 employees jobless, has nothing left but his house and his car. He also expects his landlord to try to sue him for the eight years worth of rent he is contracted to pay on his defunct restaurants space.

Many small businesses are also finding it onerous keep up with constantly changing local guidelines, while others are deciding that no matter what their local officials say, it just is not safe to keep going. Gabriel Gordon, the owner of a tiny but popular barbecue restaurant in Seal Beach, Calif., decided to close permanently after studying the restaurants layout. He had determined that the kitchen would never be safe for multiple staff members to occupy at once while the virus was still active in the area.

Its essentially two hallways that are 11 feet wide, Mr. Gordon said, describing the shape of the restaurant, Beachwood BBQ. There are food trucks that are larger than my kitchen.

Whatever the specific reasons may be for each closure, Justin Norman, Yelps vice president of data science, said that the federal government should offer small businesses more help. Mr. Norman said Yelp was concerned about the effects of small-business closures, especially those owned by people of color, on society. Yelp, however, also has a financial interest in maintaining a robust small-business environment, because it relies heavily on advertising by businesses on its platform.

The time is right now to inject more capital or we may lose them forever, Mr. Norman said. Its going to make our economies worse, its going to make our communities worse.

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I Cant Keep Doing This: Small-Business Owners Are Giving Up - The New York Times

Most of the new cases are young people between the ages of 15 and 25, the Washtenaw County Health Department said in a press release Monday.

It is believed that the party took place between July 2 and 3, and health officials are now asking anyone who attended the party to self-quarantine and monitor themselves for symptoms of the virus for 14 days.

There were an additional 66 people who are believed to have had face-to-face contact with a confirmed case. That number does not include family members who are immediate household contacts of the newly identified cases, the release said.

Over the weekend, Louisiana Gov. John Bel Edwards said may new cases had been linked to casual gatherings in people's backyards. The governor issued a restriction mandating gatherings be under 50 people.

Local health officials said this cluster in Michigan highlights how easily and rapidly the virus can infect people.

Spread from the party has impacted people outside the county and even the state, according to the release.

The party and subsequent events have led to additional exposures at retail stores, restaurants, businesses, canoe rentals, clubs, camps, athletic teams and a retirement community, the release said.

"None of us wants to be the reason someone in our community or county becomes seriously ill or dies," says Brian Marl, mayor of the city of Saline. "We have the opportunity to work together and with our local health department to contain this as quickly as possible. We know what we need to do, and we can certainly do it."

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43 new coronavirus cases have been linked to one large house party in Michigan - CNN