Daily Archives: June 1, 2020

A medical professional administers a coronavirus test at a drive-thru testing site run by George Washington University Hospital, on May 26, 2020 in Washington, D.C. Drew Angerer/Getty Images hide caption

A medical professional administers a coronavirus test at a drive-thru testing site run by George Washington University Hospital, on May 26, 2020 in Washington, D.C.

In April, New Orleans health officials realized their drive-through testing strategy for the coronavirus wasn't working. The reason? Census tract data revealed hot spots for the virus were located in predominantly low-income African-American neighborhoods where many residents lacked cars.

In response, officials have changed their strategy, sending mobile testing vans to some of those areas, says Thomas LaVeist, dean of Tulane University's School of Public Health and Tropical Medicine and co-chair of Louisiana's COVID-19 Health Equity Task Force.

"Data is the only way that we can see the virus," LaVeist says. "We only have indicators. We can't actually look at a person and tell who's been infected. So what we have is data right now."

Until a few weeks ago, racial data for COVID-19 was sparse. It's still incomplete, but now 48 states plus Washington D.C., report at least some data; in total, race or ethnicity is known for around half of all cases and 90% of deaths. And though gaps remain, the pattern is clear: Communities of color are being hit disproportionately hard by COVID-19.

Public health experts say focusing on these disparities is crucial for helping communities respond to the virus effectively so everyone is safer.

"I think it's incumbent on all of us to realize that the health of all of us depends on the health of each of us," says Dr. Alicia Fernandez, a professor of medicine at the University of California San Francisco, whose research focuses on health care disparities.

NPR analyzed COVID-19 demographic data collected by the COVID Racial Tracker, a joint project of the Antiracist Research & Policy Center and the COVID Tracking Project. This analysis compares each racial or ethnic group's share of infections or deaths where race and ethnicity is known with their share of population. Here's what it shows:

Major holes in the data remain: 48% of cases and 9% of deaths still have no race tied to them. And that can hamper response to the crisis across the U.S., now and in the future, says Dr. Utibe Essien, a health equity researcher at the University of Pittsburgh who has studied COVID-19 racial and ethnic disparities.

"If we don't know who is sick, we're not going to know in six months, 12 months, 18, however long it takes, who should be getting the vaccination. We're not going to know where we should be directing our personal protective equipment to make sure that health care workers are protected," he says.

A heavy toll of African-American deaths

NPR's analysis finds that in 32 states plus Washington D.C., blacks are dying at rates higher than their proportion of the population. In 21 states, it's substantially higher, more than 50% above what would be expected. For example, in Wisconsin, at least 141 African Americans have died, representing 27% of all deaths in a state where just 6% of the state's population is black.

"I've been at health equity research for a couple of decades now. Those of us in the field, sadly, expected this," says Dr. Marcella Nunez-Smith, director of the Equity Research and Innovation Center at Yale School of Medicine.

"We know that these racial ethnic disparities in COVID-19 are the result of pre-pandemic realities. It's a legacy of structural discrimination that has limited access to health and wealth for people of color," she says.

African-Americans have higher rates of underlying conditions, including diabetes, heart disease, and lung disease, that are linked to more severe cases of COVID-19, Nunez-Smith notes. They also often have less access to quality health care, and are disproportionately represented in essential frontline jobs that can't be done from home, increasing their exposure to the virus.

Data from a recently published paper in the Annals of Epidemiology reinforces the finding that African-Americans are harder hit in this pandemic. The study from researchers at amfAR, the Foundation for AIDS Research, looks at county-level health outcomes, comparing counties with disproportionately black populations to all other counties.

Their analysis shows that while disproportionately black counties account for only 30% of the U.S. population, they were the location of 56% of COVID-19 deaths. And even disproportionately black counties with above-average wealth and health care coverage bore an unequal share of deaths.

"There's a structural issue that's taking place here, it's not a genetic issue for all non-white individuals in the U.S.," says Greg Millett, director of public policy at amfAR and lead researcher on the paper.

Hispanics bear a disproportionate share of infections

Latinos and Hispanics test positive for the coronavirus at rates higher than would be expected for their share of the population in all but one of the 44 jurisdictions that report Hispanic ethnicity data (42 states plus Washington D.C.). The rates are two times higher in 30 states, and over four times higher in eight states. For example, in Virginia more than 12,000 cases 49% of all cases with known ethnicity come from the Hispanic and Latino community, which makes up only 10% of the population.

Fernandez has seen these disparities first-hand as an internist at Zuckerberg San Francisco General Hospital. While Latinos made up about 35% of patients there before the pandemic, she says they now make up over 80% of COVID-19 cases at the hospital.

"In the early stages, when we were noticing increased Latino hospitalization at our own hospital and we felt that no one was paying attention and that people were just happy that San Francisco was crushing the curve, it felt horrendous," she says. "It felt as if people were dismissing those lives. ... It took people longer to realize what was going on."

People get free COVID-19 tests without needing to show ID, doctor's note or symptoms at a drive-through and walk up Coronavirus testing center located in Arlington, Va., on May 26th. Olivier Douliery/AFP via Getty Images hide caption

People get free COVID-19 tests without needing to show ID, doctor's note or symptoms at a drive-through and walk up Coronavirus testing center located in Arlington, Va., on May 26th.

Like African-Americans, Latinos are over-represented in essential jobs that increase their exposure to the virus, says Fernandez. Regardless of their occupation, high rates of poverty and low wages mean that many Latinos feel compelled to leave home to seek work. Dense, multi-generational housing conditions make it easier for the virus to spread, she says.

The disproportionate share of deaths isn't as stark for Latinos as it is for African-Americans. Fernandez says that's likely because the U.S. Latino population overall is younger nearly three-quarters are millennials or younger, according to data from the Pew Research Center. But in California, "when you look at it by age groups, [older] Latinos are just as likely to die as African-Americans," she says.

Other racial groups

While data for smaller minority populations is harder to come by, where it exists, it also shows glaring disparities. In New Mexico, Native American communities have accounted for 60% of cases but only 9% of the population. Similarly, in Arizona, at least 136 Native American have died from COVID-19, a striking 21% of deaths in a state where just 4% of the population are Native American.

In several states Asian Americans have seen a disproportionate share of cases. In South Dakota, for example, they account for only 2% of the population but 12% of cases. But beyond these places, data can be spotty. In Iowa, Maine, Michigan, Oklahoma and Wisconsin, Asian Americans and Hawaiian and Pacific Islanders are counted together, making comparison to census data difficult.

Fernandez points out that if COVID-19 demographic reporting included language, public health officials might see differences among different Asian groups, such as Vietnamese or Filipino Americans. "That's what's going to allow public health officials to really target different communities," she says. "We need that kind of information."

Understanding the unknowns

Months into the pandemic, painting a national picture of how minorities are being affected remains a fraught proposition, because in many states, large gaps remain in the data.

For instance, in New York state until recently the epicenter of the the U.S outbreak race and ethnicity data are available for deaths but not for cases. In Texas, which has a large minority population and a sizable outbreak, less than 25% of cases and deaths have race or ethnicity data associated with them.

There are also still concerns about how some states are collecting data, says Christopher Petrella, director of engagement for the Antiracist Research and Policy Center at American University. For example, he says West Virginia which claims to have race data for 100% of positive cases and 82% of deaths only reports three categories: white, black and "other."

Also, some states appear to be listing Hispanics under the white category, says Samantha Artiga, director of the Disparities Policy Project at Kaiser Family Foundation.

"There's a lot of variation across states in terms of how they report the data that makes comparing the data across states hard, as well as getting a full national picture," Artiga says.

But experts fear that the available data actually undercounts the disparity observed in communities of color.

"I think we have the undercount anyway, because we know that minority communities are less likely to be tested for COVID-19," says Millett. NPR's own analysis found that in four out of six cities in Texas, testing sites were disproportionately located in whiter communities. Millet points to a recent study, released pre-peer review, that found that when testing levels went up in disadvantaged neighborhoods in Philadelphia, Chicago and New York City, so too did the evidence of the disproportionate impact of COVID-19 on these communities.

A registered nurse draws blood to test for COVID-19 antibodies at Abyssinian Baptist Church in the Harlem neighborhood of New York City on May 14. Churches in low income communities across New York are offering COVID-19 testing to residents. Angela Weiss/AFP via Getty Images hide caption

A registered nurse draws blood to test for COVID-19 antibodies at Abyssinian Baptist Church in the Harlem neighborhood of New York City on May 14. Churches in low income communities across New York are offering COVID-19 testing to residents.

Lawmakers have raised concern about the way the Centers for Disease Control and Prevention reports racial and ethnic data; the agency didn't report on demographics early on in the crisis, and even now it updates it weekly but with a one- to two-week lag. Democratic senators Patty Murray of Washington and Democratic Rep. Frank Pallone, Jr., of New Jersey called a recent report on demographics the CDC submitted to Congress "woefully inadequate."

"The U.S. response to COVID-19 has been plagued by insufficient data on the impact of the virus, as well as the federal government's response to it," Murray and Pallone wrote in a letter sent May 22 to Health and Human Services Secretary Alex Azar. They called on the Trump administration to provide more comprehensive demographic data.

A tailored public health response

Essien says he's heard concerns from colleagues that by focusing on race and ethnicity in the disease, "some of the empathy for managing and treating is going to go away."

"If people feel like, 'Well, this is a them problem and not a me problem ... then that may potentially affect the way that people think about the opening up of the country," he says.

But unless testing and other resources are directed now to communities that need them most, the pandemic will go on for everyone, says Nunez-Smith.

"This is important for everyone's health and safety," she says.

Nunez-Smith says race and ethnicity data is necessary for officials to craft tailored public health responses.

"For many people, physical distancing is a privilege," she says. "If you live in a crowded neighborhood or you share a household with many other people, we need to give messaging specific to those conditions. If you need to leave home for work every day, if you need to take public transportation to get to an essential frontline job, how can you keep safe?"

A tailored public health response is already happening in Louisiana, where LaVeist says his task force has recently recruited celebrities like Big Freedia, a pioneer of the New Orleans hip-hop subgenre called bounce, to counter misinformation and spread public health messages about COVID-19 to the African-American community.

Given the pandemic's disparate toll on communities of color, in particular low-income ones, Fernandez and Nunez-Smith say the public health response should include helping to meet basic needs like providing food, wage supports and even temporary housing for people who get sick or exposed to the virus.

"We have to guarantee that if we recommend to someone that they should be in quarantine or they should be in isolation, that they can do so safely and effectively," Nunez-Smith says.

Nunez-Smith says if you don't direct resources now to minority communities that need them most, there's a danger they might be less likely to trust and buy into public health messaging needed to stem the pandemic. Already, polls show widespread distrust of President Trump among African-Americans, and that a majority of them believe the Trump administration's push to reopen states came only after it became clear that people of color were bearing the brunt of the pandemic.

Fernandez notes that among Latinos, distrust could also hamper efforts to conduct effective contact tracing, because people who are undocumented or in mixed-status families may be reluctant to disclose who they've been in contact with.

"This is a terrible time for all of us who do health equity work," says Fernandez, "partly because this is so predictable and partly because we're standing here waving our arms saying, 'Wait, wait. We need help.' "

Connie Hanzhang Jin, Alice Goldfarb and Selena Simmons-Duffin contributed to this report.

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Growing Data Show Blacks And Latinos Bear The Brunt Of COVID-19 : Shots - Health News - NPR

Experts warn that coronavirus infections could begin to increase as businesses begin to reopen and stay-at-home orders slowly lift.

Experts are bracing for a second wave of the coronavirusExactly when it will happen, how it will happen and if we're already starting to see the effects are still unknown. But scientists, health officials and government leaders around the world have warned that new COVID1-19 cases could surge aslockdown restrictions liftand people come into closer contact with one another than they have in weeks. Because the coronavirus is a highly contagious pathogen that spreads through breath and saliva, experts are urging lawmakers to be on the lookout for a second "peak,"a sharp increase in cases that falls short of a full-blown second "wave."

There's still much that doctors and scientists don't know about the coronavirus that'sinfected nearly 6 million peopleand taken almost 400,000 lives, but most experts agree that until we have an effective coronavirus vaccine, the only way to slow the spread of the virus is by taking precautions likesocial distancing,wearing face masksin public and washing hands correctly and frequently.

Even so, some public health experts sayit's too soon to reopen businesses and resume social activities, such as going to the lake or beachand visiting amusement parks, even with limited capacity. Others argue that cities must reopen to keep the economy afloat, and that protective health measures will curb coronavirus transmissionin restaurants, schools, malls and on planes. The Centers for Disease Control and Prevention have also released guidelines to help local governments identify phases for reopening, and interim suggestions for restaurants, schools and industry.

Keep track of the coronavirus pandemic.

The full extent of short- and long-term effects of the coronavirus and the COVID-19 disease it causes are still unknown, including how long you may be immune after you recover and if it's possible to become reinfected. It also isn't clear how governments would respond to a surge in coronavirus infections, though some countries, such asLebanon and South Korea, have already reinstated lockdown orders in areas where the virus seems to be reemerging.

This story provides an overview to help keep you informed of the current discussion. It will update frequently in light of new and changing information provided by health officials, global leaders and the scientific community, and is not intended as a medical reference.

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As countries and states begin to ease lockdown restrictions, health officials around the globe are already on the lookout forrising infection ratesthat could signal a second wave of coronavirus-related illness. Most public health experts -- including the Director of the CDC,Dr. Robert Redfield, andDr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease --anticipate the next big uptickto happenthis fall or winter.

Why then? Flu casestend to drop off during the summer, which has led some health experts tohope COVID-19 cases go downwhen the weather gets warmer as well.Dr. Amesh Adalja, a pandemic preparedness expert at Johns Hopkins University,told the Los Angeles Timesthat other coronaviruses don't fare well during summer months because, once outside the body, both the hotter temperatures dry them out and the ultraviolet light from sunnier weather affects them.

Astudy published in the Canadian Medical Association Journal, however, offers data to suggest that this particular coronavirus,SARS-CoV-2, seems impervious to temperature differences and only slightly affected by humidity. Anoutbreak in MumbaiandIndonesia's ongoing struggleto contain the virus highlight how the pandemic isaffecting countries across climate zones, including many regions at or near the equator.

It may be that fall and winter upswings could occur as a result of economies reopening and people coming into closer contact, transmitting the infection anew, but that reasoning is pure speculation and not the result of scientific study. We'll need to wait to see what actually transpires.

Different parts of the country are lifting lockdown orders at their own pace, including deciding when to open nonessential businesses.

Generally speaking, a "wave" in a pandemic is a period of increasing disease transmission following an overall decline. Currently, although cases of the coronavirus continue to increase in some parts of the US, rates of new infections appear to be decliningin the country overall. That same mix of upward and downward trends can be seen globally, prompting executive director of the World Health Organization Mike Ryan to estimate that we are "right in the middle of the first wave." If and when infection rates have declined across the board, then begin to climb again, that will indicate the next or "second wave." The longer the pandemic goes on, the more waves are likely to occur.

Read more: 7 things to not do when coronavirus lockdown and quarantine end

The coronavirus pandemichasn't affected all parts of the country in the same way or at the same time. Cities and states went into lockdown and quarantine at different times, and that's also how the country is starting to get out of it, with different areaseasing restrictions in phases and at their own pace.

Some health experts have warned the lack of a unified reopening planmight help spread the coronavirus andcould actually fuel a second wave as people travel from the hardest hit areas to places with far fewer infections. Ali Khan, a former CDC official, said a second wave might comprisemany simultaneous, smaller outbreaks that, taken together, seem more like a singular wave.

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Spikes in new coronavirus cases have already been documented in areas emerging from lockdown. Wisconsin, for example, experienced its biggest single-day increase in new infections and deaths exactly two weeks after the state Supreme Court overturned the governor's stay-at-home order. Georgia, which was one of the first states to start lifting lockdown orders, is beginning to see an uptick in new cases after several weeks of plateau.

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Although some experts hope the coronavirus, like many other viruses, dissipates during hotter, sunnier weather, new research suggests temperature does not affect the virus.

If there is a second coronavirus wave, the severity of the outbreak would depend on multiple factors, like how well people maintain social distancing and howmany people wear face masks. The widespread availability of tests might also play a role, in addition to contract tracing for anyone who tests positive.

For example, a recent study and computer model developed under De Kai, a computer scientist with appointments at both the University of California at Berkeley and Hong Kong University, proposes that if 80% of the population wore face masks in public,coronavirus transmission rates would plummet(PDF) to about 8% compared to wearing no masks.

Basically, the more measures there are in place to help reduce disease transmission -- and the more effectively those measures are followed -- the lower the infection rate may be the second time around, according to the computer model.

Other factors that could come into play are any potentialgenetic mutations in the coronavirus that could make it more or less transmissible, thedevelopment of an effective vaccine, the development ofsafe, effective treatments for the COVID-19 disease and the ability to test a large number of the population, even people who don't appear to be sick.

Most experts agree that widespread testing will be necessary to help curb outbreaks while we wait for a coronavirus vaccine.

It's possible. Decisions about future quarantines are up to government leaders working with health officials, but there is an indication that the need could occur.

In some parts of the world that have experienced a second wave of coronavirus infections after lifting lockdown restrictions, such measures have been reinstated. About a month ago,Singapore, Hong Kong, theJapanese island of Hokkaido andsome areas of Chinaall brought back lockdown measures to combat a second instance of rising infection rates. More recently, Lebanon and South Korea have brought back such orders as well.

Until there's aneffective vaccine, it's possible that different parts of the world will see fluctuating degrees of lockdown as governments adjust their response in the ongoing battle against the coronavirus.

Perhaps the most pressing questions of all are what a second wave of coronavirus might mean for you. Here's how we think life will look after quarantine ends as the public braces for a second wave. If you do have to leave the house, here are some practical ways to stay safe when you go out. Finally, don't unlearn all the good habits you've developed during the pandemic -- like frequently washing your hands.

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A second wave of coronavirus: When it could come, how long it could last and more - CNET

When experts recommend wearing masks, staying at least six feet away from others, washing your hands frequently and avoiding crowded spaces, what theyre really saying is: Try to minimize the amount of virus you encounter.

A few viral particles cannot make you sick the immune system would vanquish the intruders before they could. But how much virus is needed for an infection to take root? What is the minimum effective dose?

A precise answer is impossible, because its difficult to capture the moment of infection. Scientists are studying ferrets, hamsters and mice for clues but, of course, it wouldnt be ethical for scientists to expose people to different doses of the coronavirus, as they do with milder cold viruses.

The truth is, we really just dont know, said Angela Rasmussen, a virologist at Columbia University in New York. I dont think we can make anything better than an educated guess.

Common respiratory viruses, like influenza and other coronaviruses, should offer some insight. But researchers have found little consistency.

For SARS, also a coronavirus, the estimated infective dose is just a few hundred particles. For MERS, the infective dose is much higher, on the order of thousands of particles.

The new coronavirus, SARS-CoV-2, is more similar to the SARS virus and, therefore, the infectious dose may be hundreds of particles, Dr. Rasmussen said.

But the virus has a habit of defying predictions.

Generally, people who harbor high levels of pathogens whether from influenza, H.I.V. or SARS tend to have more severe symptoms and are more likely to pass on the pathogens to others.

But in the case of the new coronavirus, people who have no symptoms seem to have viral loads that is, the amount of virus in their bodies just as high as those who are seriously ill, according to some studies.

And coronavirus patients are most infectious two to three days before symptoms begin, less so after the illness really hits.

Some people are generous transmitters of the coronavirus; others are stingy. So-called super-spreaders seem to be particularly gifted in transmitting it, although its unclear whether thats because of their biology or their behavior.

On the receiving end, the shape of a persons nostrils and the amount of nose hair and mucus present as well as the distribution of certain cellular receptors in the airway that the virus needs to latch on to can all influence how much virus it takes to become infected.

A higher dose is clearly worse, though, and that may explain why some young health care workers have fallen victim even though the virus usually targets older people.

The crucial dose may also vary depending on whether its ingested or inhaled.

People may take in virus by touching a contaminated surface and then putting their hands on their nose or mouth. But this isnt thought to be the main way the virus spreads, according to the Centers for Disease Control and Prevention.

That form of transmission may require millions more copies of the virus to cause an infection, compared to inhalation.

Coughing, sneezing, singing, talking and even heavy breathing can result in the expulsion of thousands of large and small respiratory droplets carrying the virus.

Its clear that one doesnt have to be sick and coughing and sneezing for transmission to occur, said Dr. Dan Barouch, a viral immunologist at Beth Israel Deaconess Medical Center in Boston.

Larger droplets are heavy and float down quickly unless theres a breeze or an air-conditioning blast and cant penetrate surgical masks. But droplets less than 5 microns in diameter, called aerosols, can linger in the air for hours.

They travel further, last longer and have the potential of more spread than the large droplets, Dr. Barouch said.

Updated May 28, 2020

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you arent being told to stay at home, its still a good idea to limit trips outside and your interaction with other people.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

More than 40 million people the equivalent of 1 in 4 U.S. workers have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people dont need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks dont replace hand washing and social distancing.

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

Three factors seem to be particularly important for aerosol transmission: proximity to the infected person, air flow and timing.

A windowless public bathroom with high foot traffic is riskier than a bathroom with a window, or a bathroom thats rarely used. A short outdoor conversation with a masked neighbor is much safer than either of those scenarios.

Recently, Dutch researchers used a special spray nozzle to simulate the expulsion of saliva droplets and then tracked their movement. The scientists found that just cracking open a door or a window can banish aerosols.

Even the smallest breeze will do something, said Daniel Bonn, a physicist at the University of Amsterdam who led the study.

Observations from two hospitals in Wuhan, China, published in April in the journal Nature, determined much the same thing: more aerosolized particles were found in unventilated toilet areas than in airier patient rooms or crowded public areas.

This makes intuitive sense, experts said. But they noted that aerosols, because they are smaller than 5 microns, would also contain much less, perhaps millions-fold less, virus than droplets of 500 microns.

It really takes a lot of these single-digit size droplets to change the risk for you, said Dr. Joshua Rabinowitz, a quantitative biologist at Princeton University.

Apart from avoiding crowded indoor spaces, the most effective thing people can do is wear masks, all of the experts said. Even if masks dont fully shield you from droplets loaded with virus, they can cut down the amount you receive, and perhaps bring it below the infectious dose.

This is not a virus for which hand washing seems like it will be enough, Dr. Rabinowitz said. We have to limit crowds, we have to wear masks.

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Its Not Whether You Were Exposed to the Coronavirus. Its How Much. - The New York Times

Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

For the third consecutive day, Utah recorded more than 200 new COVID-19 cases. Saturdays total of 269 is the second highest reported since the pandemic began and came after the state reported 343, the highest, on Friday.

In comparison, on Wednesday, shortly after the Memorial Day holiday, the number of new cases had been only 86.

The Utah Department of Health also reported four more deaths Saturday, bringing the states total to 112.

The big spikes in new cases come two weeks after most of the state moved on May 16 to the low-risk yellow category for COVID-19 restrictions, encouraging more people to leave their homes. But officials have cautioned against jumping to conclusions about blaming that for the spike.

Dr. Angela Dunn, the states epidemiologist, said Friday that it could be explained by catching up after a lull in testing attributed to the Memorial Day weekend and said the number of new cases this week is only a slight increase over the previous week.

Or, she said, there could be an actual uptick in cases, including outbreaks like the one happening at the Salt Lake Veterans Home. She has said the state was anticipating a rise in cases as restrictions loosened.

Jenny Johnson, spokeswoman for the state health department, said Saturday, What were seeing in our numbers is usually a lag from when an infection actually occurred . It could take up to 14 days for you to show symptoms of COVID-19 after youre infected.

With that, she said it is possible that moving to yellow status could be part of the reason for the jump in new cases. But she said a temporary drop in testing over the holiday weekend followed by an increase may be part of the reason, too. Were not totally sure.

New data also show that the Bear River Health Department which includes Box Elder, Cache and Rich counties saw a big increase cases in the past two days, from 117 on Thursday to 190 on Saturday.

As Dr. Dunn said yesterday, we expect as the economy opens to have potential localized outbreaks, which is what we might be seeing up in the Bear River area, Johnson said.

She said that underscores the need for residents to continue caution as the economy opens more.

We really need people to still be vigilant about good hand hygiene, social distancing, wearing a mask when you can't social distance appropriately when you're out in public. Those things are all really important, Johnson said.

If you have even mild symptoms of COVID-19 get tested so that we can identify cases quickly and help people understand how important it is to isolate or quarantine as appropriate.

The total number of confirmed cases in Utah since the pandemic began is now 9,533.

The four deaths reported Saturday include three Salt Lake County residents and one from Weber County all with underlying health conditions, and two were residents of long-term care facilities. Two were men and two were women. Two were older than 85, one was between ages 60-84, and one was younger than age 60.

Also added back into the state totals was a death that was earlier reported, but had been removed temporarily from totals for more investigation to ensure it had been caused by COVID-19.

The health department also reported on Saturday 10 more hospitalizations, for a total of 763 since the pandemic began. And 99 people are currently in hospital.

The state reported 4.250 more people received tests for COVID-19. That brings the total to 210,105, with a positive rate of 4.5%.

The state considers 5,995 cases recovered which is defined as still being alive three weeks since being diagnosed.

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Utah sees another spike in coronavirus cases, third big day in a row - Salt Lake Tribune

As the crisis has unfolded, scientists have discovered more evidence about a strange and worrying feature of the coronavirus. While many people who become infected develop a cough, fever and loss of taste and smell, others have no symptoms at all and never realise they're carrying Covid-19.

Researchers say it's vital to understand how many are affected this way and whether "silent spreaders" are fuelling the pandemic.

When people gathered at a church in Singapore on 19 January, no-one could have realised that the event would have global implications for the spread of coronavirus. It was a Sunday and, as usual, one of the services was being conducted in Mandarin. Among the congregation at The Life Church and Missions, on the ground floor of an office building, was a couple, both aged 56, who'd arrived that morning from China.

As they took their seats, they seemed perfectly healthy so there was no reason to think they might be carrying the virus. At that time, a persistent cough was understood to be the most distinctive feature of Covid-19 and it was seen as the most likely way to transmit it. Having no symptoms of the disease should have meant having no chance of spreading it.

The couple left as soon as the service was over. But shortly afterwards, things took a turn for the worse, and in a wholly confusing way. The wife started to become ill on January 22, followed by her husband two days later. Because they had flown in from Wuhan, the epicentre of the outbreak, that was no big surprise.

But over the following week, three local people also came down with the disease for no obvious reason, leading to one of Singapore's first and most baffling coronavirus cases. Working out what had happened would lead to a new and disturbing insight into how the virus was so successfully finding new victims.

"We were extremely perplexed," says Dr Vernon Lee, head of communicable diseases at Singapore's Ministry of Health. "People who didn't know one another somehow infected each other," while showing no sign of illness. This new batch of cases simply did not make sense, according to what was known about Covid-19 back then.

So Dr Lee and his fellow scientists, along with police officers and specialist disease trackers, launched an investigation, generating detailed maps showing who was where and when. This involved the very best of the process known as contact tracing - a version of which is getting under way now in the UK. It's seen as a vital system for tracking down everyone involved in an outbreak and helping to stamp it out, and Singapore is renowned for the skill and speed with which this is carried out.

Amazingly, within a few days, investigators had spoken to no fewer than 191 members of the church and had found out that 142 of them had been there that Sunday. They quickly established that two of the Singaporeans who became infected had been at the same service as the Chinese couple.

"They could have spoken to each other, greeted each other, during the usual activities of a church service," says Dr Lee.

That was a useful start and would explain in theory how the infection could have been passed on, apart from one key factor. It did not answer the crucial question of how the virus could have been transmitted by the two Chinese people when at that stage they had shown no indication of having the disease.

And on top of that was an even greater puzzle. It was confirmed that the third Singaporean to become infected, a 52-year-old woman, had not been at the same service as the others. Instead she had attended another event in the same church later that day, so how could she have picked up the virus?

Investigators resorted to going through the CCTV recordings made at the church that Sunday to search for clues. And they stumbled across something completely unexpected - the woman who'd attended the later service, after the Chinese couple had left, had sat in the seats they had used several hours earlier.

Somehow, despite having no symptoms and not feeling ill, the Chinese husband and wife had managed to spread the virus. Maybe they'd had it on their hands and touched the seats, maybe their breath carried the infection and it landed on a surface, it's not clear, but the implications were huge.

For Dr Lee, piecing everything together, there was only one possible explanation - that the virus was being passed by people who had it without even realising. This was a revelation that would be relevant the world over because the central message of all public health advice on coronavirus has always been to look out for symptoms in yourself and others.

But if the virus was also being spread by people without symptoms, silently and invisibly, how could the disease be stopped? He remembers the moment, while working in his office, when the reality dawned on him. "Every time you make a scientific discovery, it is like a 'eureka' moment when you realise that this is something important that you've uncovered, through the hard work of many individuals and teams."

What was revealed was what's known as "pre-symptomatic transmission" where someone is unaware of being infected because the cough, fever and other classic symptoms have yet to begin.

Along with many others, this study highlighted a critical period of 24-to-48 hours before the visible onset of the disease in which people can be highly infectious, perhaps even their most infectious.

Being aware of that is potentially invaluable, because as soon as you realise you're ill then everyone you've been in close contact with can be warned to stay at home.

That would mean that they would be isolating during the key phase of infection before their own symptoms start. But exactly how the disease can be transmitted without a cough to project droplets containing the virus is still open to debate.

One option is that simply breathing or talking to someone can do the job. If the virus is reproducing in the upper respiratory tract at that time then it's possible that some of it will emerge with each exhalation. Anyone close enough, especially indoors, could easily pick it up.

And another potential form of transmission is by touch - the virus gets onto someone's hands and they touch another person or a door handle - or a seat in a church. Whatever the route, the virus is clearly exploiting the fact that people are bound to be less vigilant if they're not aware that they might be infected.

This is an even more mysterious scenario, and one that scientists simply have no definitive answer to. It's one thing to know that people can be infectious before their symptoms show, quite another when they become infected but never have any sign of it.

This is what's known as being "asymptomatic" because you are a carrier of the disease but do not suffer in any way yourself. The most famous case is that of an Irish woman who was working as a cook in New York at the beginning of the last century.

Wherever Mary Mallon was employed, in house after house, people became ill with typhoid and at least three, maybe many more, died of it, but she was completely unaffected. Eventually a connection was established and it was confirmed that she was the unwitting spreader of the disease.

Reporters dubbed her "Typhoid Mary", a label she always resented, but the authorities took no chances and kept her in confinement for 23 years until her death in 1938.

Staff nurse Amelia Powell was shocked when she found out that she is asymptomatic. She was at work on her hospital ward at Addenbrooke's Hospital in Cambridge in April when a doctor rang to give her the result of a swab test.

She had been feeling normal and safe behind the personal protective equipment she had to wear while caring for patients with Covid-19. But suddenly all those assumptions were undermined because, to her horror, she had tested positive.

"It was a bit like hearing that someone in the family had passed, it was surreal. "I thought, 'This can't be right, not me, I'm absolutely fine,'" says 23-year-old Amelia.

She had to leave her post straightaway to go into isolation at home.

"I was worried because I've seen the other side, with patients deteriorating very quickly with it, so I did wonder if this would happen to me." But, to her surprise, at no point did she feel unwell. "I had nothing, literally - I was exercising indoors, eating normally, sleeping normally."

At the moment it's impossible to know how many cases of infection exist but remain hidden from view.

The discovery that Amelia was infected was only revealed because she was part of a study of all the staff at her hospital. It produced the surprising result that as many as 3% of more than 1,000 people were positive while showing no symptoms at the time of the test.

An even greater proportion of asymptomatic cases was found on the Diamond Princess cruise ship which had been sailing off the coast of Japan earlier this year. Later branded "a petri dish for infection", it had around 700 cases.

Researchers found that three quarters of the people who had tested positive had no symptoms.

And at a care home in Washington state more than half the residents were positive but had no sign of the illness.

Different studies suggest a huge range of possibilities for how many cases are asymptomatic stretching from 5% to 80% of cases. That was the conclusion of an analysis by Prof Carl Heneghan of the University of Oxford and colleagues who looked at 21 research projects.

The upshot, they said, was that "there is not a single reliable study to determine the number of asymptomatics". And they said that if the screening for Covid-19 is only carried out on people with symptoms - which has been the main focus of UK testing policy - then cases will be missed, "perhaps a lot of cases".

The biggest concern of Amelia, the nurse, was that she might have unwittingly transmitted the virus either to those she works with or to the patients who depend on her help.

"I don't think I passed it on because all the colleagues I work with tested negative but it was worrying to think how long I'd been positive for," she says. "But we still don't know if people who are asymptomatic are contagious or not - it's very bizarre and the information about it at the moment is minimal."

One study in China which found that the number of asymptomatic cases was actually greater than those with symptoms had a warning for the authorities. "As 'silent spreaders'," the scientists wrote, "asymptomatic carriers warrant attention as part of disease prevention and control."

The team that studied that Diamond Princess reckoned that asymptomatic cases were likely to be less infectious than people with symptoms but even so they're estimated to have caused a significant number of cases.

To try to get an answer, scientists in Norwich are pushing for the population of the entire city to be tested.

"Asymptomatic cases may be the 'dark matter' of the epidemic," according to Prof Neil Hall, head of the Earlham Institute, a life science research centre, who's leading the initiative. Dark matter is the invisible substance believed to make up most of the matter in the universe, and it's yet to be identified.

Prof Hall worries that asymptomatic cases may actually be driving the pandemic, keeping it going despite public health measures. "If you have people who don't know they're ill while using public transport and health care facilities, inevitably that's going to increase transmission," he says.

"Any intervention that's only based on people coming to primary health care when they have symptoms will only deal with half the problem."

A team of scientists in California believes that not knowing who's carrying the virus without symptoms is the "Achilles Heel" of the fight against the pandemic.

In their view, the only way to stop the disease from spreading is to find out who's infected regardless of whether they think they are or not. That was also the recommendation of MPs on the Commons Science and Technology Committee in a letter to the Prime Minister Boris Johnson.

They wrote that the risk of asymptomatic transmission has "a profound consequence for the management of the pandemic". And they said that anyone looking after vulnerable people - such as health workers or care workers - should be given regular testing.

A similar approach is being adopted on a far larger scale in the Chinese city of Wuhan, where the pandemic is thought to have begun.

As many as 6.5 million people there were tested in as little as nine days in a mass screening programme designed to detect the disease - including in those showing no symptoms.

As lockdown measures are eased and more people start to use public transport, return to work or go shopping, getting to grips with the invisible risk matters more than ever. At the moment, there is no way of telling who among the growing crowds may be carrying the virus without knowing.

That's why governments the world over say it's essential that everyone cooperates with efforts to trace the contacts of anyone infected and then quickly self-isolates. They also advise that the best defence remains social distancing - to keep apart wherever you can. But where that isn't possible, the recommendation is to cover your face, even with a mask that's homemade.

When the US government announced this policy, it highlighted the discoveries made in the church in Singapore back in January. The logic is that this is not about protecting yourself, it's about protecting others from you, in case you're infected but don't know it.

Many health professionals worry that masks might distract people from hand washing or social distancing, or increase the risk of contamination if they're clumsily handled. But more and more governments, most recently that of the UK, have become convinced of the benefits.

Not that face coverings will halt the pandemic on their own. But because there's still so little we know about asymptomatic transmission, almost anything is worth a try.

When you talk to intensive care doctors across the UK, exhausted after weeks of dealing with the ravages of Covid-19, one phrase emerges time after time: "We've never seen anything like this before."

They knew a new disease was coming, and they were expecting resources to be stretched by an unknown respiratory infection which had first appeared in China at the end of last year.

"It felt in some ways like we were trying to prepare for the D-Day landings," says Barbara Miles, clinical director of intensive care at Glasgow Royal Infirmary, "with three weeks to get ready and not a great deal of knowledge about what we would be facing".

Read a summary, often in their own words, of what doctors have learnt about how Covid-19 attacks the human body.

Read the original here:

Coronavirus: The mystery of 'silent spreaders' - BBC News

I need to take a trip that would be either a few hours flying or multiple days driving. Which is safer?

As lockdown orders are relaxed to some capacity in countries around the world, travel is starting to see an uptick for the first time since mid-March. But when it comes to taking a longer trip, is it better to travel by car or by plane?

Dr. Henry Wu, a professor of infectious disease medicine at Emory University and director of its TravelWell Center, says there is no definite answer but it all comes down to planning ahead.

Regardless of whether you fly or drive, Wu says that the first thing to keep in mind is that until a vaccine is developed and proven effective, it's impossible to fully mitigate all the coronavirus risks, including those associated with traveling.

That means that in accordance with the Centers for Disease Control and Prevention's guidance, travel should still be limited to circumstances in which it's absolutely necessary. And for people who are immunocompromised or at high risk of developing severe illnesses, it should be avoided as much as possible.

If you feel you need to take a trip, one main benefit of driving is that it gives you a greater sense of control over your surroundings although that doesn't mean it's necessarily safer than flying.

Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University, says the key to staying safe is taking measures like wearing a mask and carrying hand sanitizer when in public spaces. He worries, from a behavioral point of view, that people are less likely to follow hygiene protocols over the course of several stops on a long drive.

Here are some essential steps Wu and Gostin suggest to prepare for a road trip:

However, both Wu and Gostin point out that there are certain unavoidable risks that come with driving like the chances of getting in an accident or having car trouble. And you should always consider your own comfort level with long road trips and unknown highways.

If I decide to take an overnight road trip, how should I choose my lodging?

Gostin says the safest option would be camping sleeping in your car or on camping grounds with your own tent and supplies. That eliminates the risks of staying in an indoor space where you could come into contact with others. If camping isn't an option, there are other steps to lower the risks of an overnight stay.

Wu and Gostin recommend choosing a hotel or motel option without elevators or other confined spaces like a crowded breakfast buffet that could force you to come in close contact with employees and other guests.

"The more people, the smaller the space, the less [air] circulation and the longer you're there, your risk goes up," says Gostin.

Ask ahead of time that the hotel or Airbnb is using EPA-approved disinfectants to clean all surfaces in the room between guests, and, if possible, try to request rooms that have been unoccupied for several days although there's no way to know for sure that you're getting an honest answer.

"We know that COVID-19 virus viability on environmental surfaces is limited, and it really depends on the type of surface, the temperature and the humidity. But in most situations, [the virus] is not viable after several days," says Wu. "So if you have a room that's been empty for four or five days or even more, [that's] better."

It's also a good idea to bring your own alcohol wipes for the road and, once inside the room, to wipe down areas that could have been touched by prior occupants: door knobs, tabletops and the TV remote. Or just avoid touching these whenever you can.

Gostin also suggests staying in your room as much as possible. If you have a room with windows that can open, wipe them down before opening them to let in fresh air.

What if I'd rather travel by plane?

If driving for several days seems daunting, taking a flight might be preferable.

"Air circulation systems on planes are quite good. They have high-efficiency particulate air (HEPA) filters and high rates of air exchange," says Wu. "But that still doesn't protect you from what is happening immediately around you."

One of the biggest risks of flying is that it's hard to predict how full a flight might be or how much you'll be able to socially distance from other passengers and employees, even as airlines make efforts to minimize close contact.

Read more about the risks of flying and safety precautions you can take here.

Could I take a bus or train instead?

Like airplanes, buses and trains both mean traveling in an enclosed environment. One of Wu's main concerns is the type of air filters used, which may vary from vehicle to vehicle. It might not be possible to find out what type of filter is used in the particular bus or train you are riding or whether it's effectively circulating the air.

Additionally, not all bus and train companies might be able to exert as much environmental controls as airlines in terms of requiring empty seats between passengers and notifying you if your vehicle is expected to be at full capacity.

Greyhound currently requires all passengers and employees except children under two and people with breathing difficulties to wear masks on buses. In addition to requiring face covering, Amtrak is limiting seat capacity to 50% on each train. All caf seating is closed.

The same prevention tactics apply to train or bus travel as flying wash hands often, wipe down surfaces before you touch them and avoid removing your mask.

And when deciding between a train or plane ride, keep in mind the matter of time spent in potentially crowded travel situations matters.

"I would pick whatever's shortest," says Wu.

I live in an apartment building. Could I get the coronavirus through the air conditioning system?

We know that the coronavirus is primarily transmitted through respiratory droplets if an infected person coughs, sneezes or talks near other people, they expel droplets that could get someone else sick.

Could the droplets travel through the air-handling system in an apartment or condo building and into another unit, potentially infecting the neighbors?

There is still no definite answer. The Center for Disease Control and Prevention says that "the contribution of small respirable particles, sometimes called aerosols or droplet nuclei, to close proximity transmission is currently uncertain. However, airborne transmission from person-to-person over long distances is unlikely."

That's not to dismiss the risks of aerosol transmission. One study focused on a case in Guangzhou, China, in which three families contracted COVID-19 from eating in the same restaurant. This infection has been primarily attributed to poor ventilation within that particular restaurant.

But Dr. Abraar Karan, physician at Harvard Medical School, says the chances of getting sick from particles being spread from one room to another through the air conditioning system seems unlikely.

William Bahnfleth, engineering professor at Penn State University and chair of the Epidemic Task Force for American Society of Heating, Refrigerating and Air Conditioning Engineers, says it does not seem likely that you could get sick from the AC in your building.

"If they're small enough, [viral particles] can move through the air. They can move from place to place in a building, either through the air conditioning system or just on air currents under the influence of pressure differences in the building," he says. "But the real important question is, is there enough of that happening that anyone gets an infection from that? And so far, there doesn't seem to be evidence that that has happened."

Dr. Emily Landon, hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine, agrees. She points to places like Hong Kong, Singapore and South Korea, where many people live in high-rises, and there have been no documented reports of infection due to air conditioning between apartments.

What's more, if you live in a building with what's called "once-through ventilation air supply," then the air comes in from the outside, is cooled or heated and does not "intentionally circulate air between units," Bahnfleth says.

If you're still concerned about airflow in your apartment, Bahnfleth suggests opening your windows if possible to bring in fresh air, although this might not be the best option in a high-rise. And although an air purifier or cleaner cannot fully protect you from COVID-19, the Environmental Protection Agency says having one in your home can be a part of your prevention strategy.

"When used along with other best practices recommended by the Centers for Disease Control and Prevention, operating an air cleaner can be part of a plan to protect yourself and your family," the agency said in a statement.

As we learn more about the virus, it's possible that the guidance related to air conditioning systems will change. But for now, Landon says it's not a primary concern for the spread of COVID-19.

"The preponderance of the evidence suggests that [getting infected through air conditioning systems] should not be a problem, but it's a new virus," says Landon. "We don't know everything that there is to know."

Read the original post:

Coronavirus FAQs: Is It Safer To Fly Or Drive? Is Air Conditioning A Threat? - NPR

In 2019, the disease, transmitted by the Aedes aegypti mosquito, had ravaged Latin America, which suffered its worst dengue epidemic on record with more than 3 million cases and more than 1,500 deaths.

The outbreak hit Honduras particularly hard, overwhelming a public health system that had already been weakened by budget cuts and pervasive corruption and was barely equipped to meet usual demands, much less an epidemic of record size. By the end of 2019, Honduras had suffered about 61 percent of the dengue deaths in Central America.

The highest number of dengue cases occurred in the department of Corts, where efforts to control its transmission were further hampered by a lack of trained personnel and by the regions ubiquitous criminal gangs, which for months blocked government health care workers from gaining access to some of the hardest-hit neighborhoods.

Dengue remains a major concern in Latin America and the Caribbean this year. According to the latest statistics from the Pan American Health Organization, about 1,426,000 cases have been recorded in the region so far, fewer than during the same period last year. But regional health officials fear this may be an undercount caused by the focus on the coronavirus and the disease it causes, Covid-19.

Covid has been able to sometimes deviate attention from other pressing problems, said Dr. Marcos Espinal, director of the department of communicable diseases at the Pan American Health Organization, based in Washington, D.C.

On Tuesday, Dr. Carissa F. Etienne, the director of the Pan American Health Organization, said the Americas, with more than 2.4 million Covid-19 cases and more than 143,000 deaths, had become the epicenter of the pandemic.

Original post:

In Some Nations, Coronavirus Is Only One of Many Outbreaks - The New York Times

The coronavirus that caused SARS was hosted by bats and palm civets. It jumped to humans because we had been pushing and pushing high-density urban population centers more deeply into wilderness areas, destroying that natural buffer and replacing it with monoculture crops and concrete.

When you simultaneously accelerate development in ways that destroy more and more natural habitats and then hunt for more wildlife there, the natural balance of species collapses due to loss of top predators and other iconic species, leading to an abundance of more generalized species adapted to live in human-dominated habitats, Johan Rockstrom, the chief scientist at Conservation International, explained to me.

These include rats, bats, palm civets and some primates, which together host a majority of all known viruses that can be passed on to humans. And when these animals are then hunted, trapped and taken to markets in particular in China, Central Africa and Vietnam, where they are sold for food, traditional medicine, potions and pets they endanger humans, who did not evolve with these viruses.

SARS jumped from mainland China to Hong Kong in February 2003, when a visiting professor, Dr. Liu Jianlun, who unknowingly had SARS, checked into Room 911 at Hong Kongs Metropole Hotel.

Yup, Room 9-1-1. I am not making that up.

By the time he checked out, The Washington Post reported, Liu had spread a deadly virus directly to at least eight guests. They would unknowingly take it with them to Singapore, Toronto, Hong Kong and Hanoi, where the virus would continue to spread. Of more than 7,700 cases of severe acute respiratory syndrome tallied so far worldwide, the World Health Organization estimates that more than 4,000 can be traced to Lius stay on the ninth floor of the Metropole Hotel.

It is important to note, though, that SARS was contained by July 2003 before becoming a full-fledged pandemic thanks in large part to rapid quarantines and tight global cooperation among public health authorities in many countries. Collaborative multinational governance proved to be a good buffer.

Alas, that was then. The latest coronavirus is aptly named SARS-CoV-2 with emphasis on the number 2. We dont yet know for sure where this coronavirus that causes the disease Covid-19 came from, but it is widely suspected to have jumped to a human from a wild animal, maybe a bat, in Wuhan, China. Similar jumps are bound to happen more and more as we keep stripping away natures natural biodiversity and buffers.

Read more here:

Coronavirus Showed How Globalization Broke the World - The New York Times

New York City, long the epicenter of the global coronavirus crisis, is poised to start reopening in slightly more than a week, setting the stage for a slow and tentative recovery after two months of suffering, social isolation and economic hardship.

Gov. Andrew M. Cuomo said on Friday that he expected the city to meet several benchmarks that would permit millions of virus-weary residents to enjoy the first signs of a normal life as early as June 8. Retail stores could open for curbside or in-store pickup, and nonessential construction and manufacturing could resume, part of an initial phase that could send as many as 400,000 people back to work.

As other parts of the nation, including less populated sections of New York State, have reopened, New York City, which lost more than 20,000 lives to the virus, has taken longer to recover. It required a gargantuan effort to even reach the point where officials were comfortable with loosening the restrictions on movement and commerce that were put in place in March.

Deaths in New York have dropped to only dozens a day, rather than the 700 or 800 a day that were taking place in April, and the number of virus patients on intensive care in the citys public hospitals has fallen by more than half.

That progress largely came because many New Yorkers followed the rules, and have been wearing face coverings and maintaining social distance as requested. The rewards of vigilance have been manifest not only in decreasing fatalities, but also in the declining number of people testing positive for the virus and of those requiring hospital stays because of it.

I am proud of the way New York is figuring it out, Mr. Cuomo said.

But even with the strides the city has made, the road to normalcy will no doubt be steep and rocky. Since February, nearly 900,000 local jobs have vanished and thousands of businesses have closed their doors some forever. Revenues from sales taxes are expected to drop by $1 billion, part of an estimated $9 billion budget shortfall that could push officials into risky borrowing and force drastic cuts to essential city services.

Even as summer nears, once bustling swaths of Midtown Manhattan remain all but abandoned, marred by vacant streets and shuttered storefronts. The subway system is limping along at record low ridership. Tourism has evaporated. Broadway theaters plan to remain dark at least until Labor Day, and many industry leaders say they may stay closed until January.

Under the first phase of reopening, much of the city would still be shut down, with restaurants and bars limited to takeout and delivery service, and offices, gyms, movie houses and grooming salons all closed.

Mayor Bill de Blasio, appearing virtually with Mr. Cuomo on Friday, seemed optimistic as he called the plan to begin reopening in June the gateway to the next big step. But neither he nor the governor has figured out certain crucial details yet, perhaps most notably how to get millions of commuters safely back onto public transit.

On Thursday, Mr. de Blasio said that between 200,000 and 400,000 people in New York could return to work under the first phase of recovery. But when questioned on Friday if the city was prepared for the coming spike in commuters, he appeared to dodge the issue, saying that many city dwellers would simply walk or bike to their jobs while others would drive or take taxis.

For the next few months, people are going to make their own choices, the mayor said. Some people are going to be comfortable with mass transit, some are not. We just have to be honest and real about that.

While Mr. Cuomo insisted that the subways were safe, he also said that it would be up to riders themselves not to create a public health risk by violating social distancing protocols.

We will need a cooperative public where if youre on a subway platform and you see it is crowded, OK, wait for the next one, he said.

Both leaders cautioned that while the dangers of the virus had receded, New Yorkers needed to continue taking measures to keep its spread in check. More than 5,000 people in the city tested positive for infection last week alone a steep drop from early April, when 40,000 people a week were testing positive, but still a significant number.

Officials have required each of the states 10 regions to meet seven health-related metrics before beginning the reopening process. New York City, the only region that has yet to do so, has not reached the benchmark of having 30 percent of its hospital beds available it was close, at 28 percent nor has it deployed enough contact tracers to adequately track the spread of the disease.

The city currently has 1,700 contact tracers in place who will act as disease detectives, getting in touch with those who came in contact with a person with the virus in order to map potential vectors of infection. Having a robust contact tracing program is crucial to quelling the outbreak and paving the way to reopening. But in a sharp departure from tradition, the city took the project away from public health officials and gave it to the public hospital system.

Despite such lingering problems, New York has come a long way since the first dark days of the pandemic, when ambulance sirens wailed around the clock and hospitals were so swamped with incoming patients that some were dying untreated in emergency rooms.

Updated May 28, 2020

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you arent being told to stay at home, its still a good idea to limit trips outside and your interaction with other people.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

More than 40 million people the equivalent of 1 in 4 U.S. workers have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people dont need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks dont replace hand washing and social distancing.

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

After an initial shock, New Yorkers accustomed themselves with unexpected speed to the new realities of wearing nitrile gloves to walk their dogs and standing on strips of masking tape spaced six feet apart while waiting to pay for their groceries.

Reopening the city could prove tricky, however, especially if residents inured to social distancing rules are suddenly thrust back into contact with their neighbors in coffee shops or on packed subway platforms. Tensions have already emerged from time to time as prickly city dwellers have gotten used to policing one another about their sense of personal space and mask-wearing habits.

Under Mr. Cuomos plan, New York City will have to remain at Phase 1, the lowest level of openness, for at least two weeks as health officials make sure that new infections do not creep up and that hospitals maintain their state of readiness. State officials are planning to distribute free face coverings to businesses in the city that are preparing to reopen and to set up a hotline that employers can call for what the governor described as practical questions.

Much of upstate New York was given permission on Friday to enter Phase 2, which allows most stores, offices and hair salons to open, with restrictions on capacity and social distance.

New York City, however, was nowhere near such freedoms, and it remained unclear how and when it could get there.

Nobody has been here before, Mr. Cuomo said, acknowledging that even he was unsure how the city would move forward.

Nobody can give you the answers, he confessed. They dont even know the questions.

Azi Paybarah and Katie Van Syckle contributed reporting.

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Battered by Coronavirus Outbreak, NYC Finally Moves Toward Reopening - The New York Times

Back at home after his harrowing month in the hospital, ODonnell has set his sights on competing in an Ironman race in Arizona this fall. He acknowledged it was a lofty goal.

Updated May 28, 2020

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you arent being told to stay at home, its still a good idea to limit trips outside and your interaction with other people.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

More than 40 million people the equivalent of 1 in 4 U.S. workers have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people dont need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks dont replace hand washing and social distancing.

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

Theyre not sure if Ill ever get full lung capacity back, he said. I may or may not.

Had he not contracted the virus, ODonnell, an executive at a chemical company, would be doing three runs, three swims and three bicycle workouts per week at this point in his training cycle. But the virus derailed his life plans.

After returning home, he needed a walker just to go out to the mailbox at the end of the driveway. In his first attempt to exercise, two days after he left the hospital, he walked for seven minutes at a speed of 1.2 miles per hour using supplemental oxygen. He has been trying to add a minute of time, and a bit of speed, each day.

ODonnell said he was struggling with a fair amount of doubt about his ability to get back in shape for the race. But he has motivated himself with the secondary goal of raising money for coronavirus relief, and he has been repeating the same mantra ever since he was struggling in his hospital bed: Dont stop. Dont quit. Keep moving forward.

This mentality has helped other athletes who have been hit with serious symptoms.

The 29 days Tsang Yee-ting spent in the hospital were the most she had been away from a karate mat since being introduced to the sport at age 6. A member of the Hong Kong national team, Tsang, 27, contracted the coronavirus in March while preparing to qualify for the Summer Olympics.

For the next month, she battled a range of symptoms, the worst a searing pain that engulfed the lower half of her body. Walking was a struggle. Lying down offered no relief. As she fought a virus that doctors were still learning about, all sorts of thoughts about her body and about her future spiraled through her mind, she said.

Of course I was worried, Tsang said. Karate is my life.

But even as the virus and isolation from her family levied an emotional toll on her, Tsang resolved to stay as active as possible to keep herself sane. She acquired elastic bands and, on days when her body felt strong enough, completed mini-workouts in the tight confines of her hospital room.

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These Athletes Had the Coronavirus. Will They Ever Be the Same? - The New York Times