Daily Archives: August 15, 2020

August 15, 2020, 2:44 PM

5 min read

The novel coronavirus has now killed more than 762,000 people worldwide.

More than 21.1 million people across the globe have been diagnosed with COVID-19, the disease caused by the new respiratory virus, according to data compiled by the Center for Systems Science and Engineering at Johns Hopkins University. The actual numbers are believed to be much higher due to testing shortages, many unreported cases and suspicions that some national governments are hiding or downplaying the scope of their outbreaks.

The United States is the worst-affected country in the world, with more than 5.3 million diagnosed cases and at least 168,446 deaths.

Latest headlines:

Here's how the news is developing today. All times Eastern. Please refresh this page for updates.

On Saturday, New York Gov. Andrew Cuomo said New York had its lowest number of COVID-19 hospitalizations since March 17. The governor also announced a record-high in the number of tests.

Since March 17, hospitalizations have dropped to 523; the number of COVID-19 tests reported to New York State is at 88,668.

"In New York, we knew from the beginning that testing would be a key factor in controlling this new virus. We ramped up testing immediately and took a nation-leading role in developing capacity to test as many New Yorkers as possible, and I'm proud that we continue to raise the bar and we've broken our record high once again," Cuomo said. "Yesterday's numbers -- especially the new low in hospitalizations -- continue to reflect the progress we've made during this pandemic, but we will keep monitoring the data and the alarming increases in cases around the country. My message is the same: stay New York Smart, wash your hands, socially distance, and wear masks!"

Gov. Cuomo also confirmed 734 additional cases of novel coronavirus, bringing the statewide total to 424,901 confirmed cases in New York State, with the highest concentration in New York City.

As of Friday, there were five deaths due to COVID-19 in New York state, bringing the total to 25,244.

The University of Notre Dame reported 29 cases of COVID-19 in a one-week period, reports the South Bend Tribune.

The cases were from Aug. 6 to Aug. 14. On Friday, Aug. 14, the university reported 10 new cases.

Notre Dame's spokesperson, Paul Browne, told the South Bend Tribune that many of the COVID-19 cases were traced to an off-campus party where students didn't wear masks and didn't practice social distancing.

"What is reinforces is our concern that it only takes a weak link. You can have a strong chain, but if you have only one weak link, it can cause numbers to spike," Brown said. "Notre Dame officials believe they can still get the virus under control without canceling in-person classes and sending students home."

The virus not only struck students who attended the party, but some who came in contact with those who attended," Browne said.

Fall high school sports in Florida are a go after the Florida High School Athletics Association voted Friday to begin sports throughout in the Sunshine State on Aug. 24.

Practices can begin this month with games set to resume in September. Teams, according to FHSAA, can start later and not opt-in to state-wide play due to coronavirus hot spots.

The organization also said that "schools may opt out of the State Series by September 18th with the ability to form their own regional schedule upon approval from the FHSAA."

Florida Gov. Ron DeSantis has been a strong advocate for reopening schools and sports in the state, despite the summer surge in cases and deaths.

"To our parents you deserve the choice of in-person instruction or distance learning and I'm glad that so many school districts are making this vision a reality," DeSantis said a press conference this week. "To our teachers and school administrators thank you for refusing to let obstacles stand in the way of providing opportunities for our kids. This has been a difficult time, but I believe your hard work will do more than you know to get our society back on its feet."

In Florida, more than 563,000 people have been diagnosed with COVID-19 and at least 9,141 people have died of the virus.

The state reported more than 6,200 new COVID-19 cases and 200 deaths on Friday.

HERRIMAN, UT - AUGUST 13: Members of the Herriman Mustangs take the field before their game against the Davis Darts at Mustang Stadium on August 13, 2020 in Herriman, Utah. This is the first high school football game in the country this season since the spread of the coronavirus (COVID-19).

ABC News' Tom Shine and J. Gabriel Ware contributed to this report.

Originally posted here:

Coronavirus updates: University reports 29 cases of COVID in a single week - ABC News

Air conditioners on a building. Scientists say there has been too little research into the role of heating, ventilation and air conditioning systems in the spread of the coronavirus. Sami Sarkis/Getty Images hide caption

Air conditioners on a building. Scientists say there has been too little research into the role of heating, ventilation and air conditioning systems in the spread of the coronavirus.

In the dog days of August, air conditioning is everywhere.

Is that a problem when it comes to the spread of the coronavirus?

The answer to that question rests on the way the virus is transmitted a topic that is still being researched.

Droplet transmission is considered the most common method: A virus-filled particle of breath or spittle comes out of the nose or mouth of an infected individual when they breathe, speak, cough or sneeze. These droplets generally disperse within a few feet of the person who expels them. But if they come into contact with someone's eyes, nose or mouth, they can transmit the virus.

Then there's aerosol transmission when an infected person expels microscopic infectious particles so tiny that they linger in the air and spread from person to person in air currents. Since they are much smaller than droplets, aerosols can travel greater distances and get deep into the lungs of someone who inhales them.

Among scientists, there is ongoing debate about the extent to which aerosol transmission causes infection. However, it has been generally accepted that it does occur, especially in closed indoor settings. Consequently, there's a possibility that air conditioning may be a potential route of transmission sucking in virus particles breathed out by an infected person and then blowing those infectious particles back out in the same room or even another room several floors away.

In fact, other infectious diseases such as measles, tuberculosis, chickenpox, influenza, smallpox and SARS have all been shown to spread through heating, ventilation and air conditioning systems.

But drawing definitive conclusions about the role that HVAC systems might play in spreading COVID-19 is difficult. There are only a few published studies looking at that issue, and experts admit there has been too little research into the role of HVAC systems in the spread of the novel coronavirus.

"We didn't focus on ventilation as much early on as we probably should have," says Abraar Karan, a physician and global health researcher at Harvard Medical School.

What we do know is this: HVAC systems primarily recirculate air in a room or a building and don't bring in any fresh air from outside. So yes, theoretically virus-containing aerosols could be sucked into an air conditioning system and then circulated around a building.

In one study, which is available online as a pre-print and has not undergone scientific review, researchers in Oregon collected samples from various places inside a hospital's HVAC system and found genetic material from SARS-CoV-2, the virus that causes COVID-19. This demonstrates that it may be possible for the virus to be transmitted through HVAC systems.

However, researchers did not assess if the genetic material they found was able to cause infection, and they noted there were no confirmed COVID-19 cases associated with the samples found in the ventilation systems.

There is currently no other evidence documenting the possibility of COVID-19 transmission through an air conditioning unit.

The bigger risk, says Edward Nardell, a professor of environmental health and immunology and infectious diseases at Harvard Medical School, is that hot weather outside causes people to seek air-conditioned comfort indoors. And indoors, there is less ventilation and more opportunity to spread disease.

"It is not the air conditioner that is doing anything particularly," Nardell says. "It is the fact that you are indoors, you are not socially distancing and you are rebreathing the air that people have just exhaled."

When you shut the doors and windows to keep the hot air outside, you are essentially eliminating the flow of fresh air so everyone in the room is breathing and rebreathing the same air. If someone in the room is infected with COVID-19, then they are breathing out the virus, which can linger in airborne droplets and be inhaled by another person, potentially causing infection.

By comparison, if you were outside and near an infected person who breathed out some viral particles, there is a much larger volume of air flowing to disperse and dilute those particles quickly, reducing the risk of spread to another person nearby. That is why infectious disease experts consider outdoor gatherings and activities less risky than indoor ones (though not completely risk-free).

The other major risk is that air conditioning units, fans or even an open window can create strong enough air currents to move virus-containing droplets around a room. This happened in January at a restaurant in Guangzhou, China, where a person with COVID-19 infected five other people sitting at neighboring tables from 3 to 6 feet away, according to a study by scientists from the Chinese Center for Disease Control and Prevention. After examining video footage of the diners who were infected and simulating the transmission of the virus, scientists concluded that the small outbreak was caused by strong air currents from the air conditioning unit above the diners, which was blowing virus-containing aerosols from an infected person to those nearby. The restaurant also had no windows and thus no ventilation bringing in fresh air and diluting virus particles in the air.

The fact that aerosolized viral droplets can move in air currents in this way means that if you are in a room with an infected person and fresh air is not circulating, even if you are socially distancing to keep 6 feet apart at a minimum, you may not be safe, Nardell says. Although there are currently no published studies that have examined exactly how far airborne COVID-19 particles can travel, previous research on influenza found that viral particles may travel upward of 30 feet in the air.

To be clear, this is only a concern in shared public places. At home, the risk of contracting COVID-19 through air currents or air conditioning units is no more likely than spreading the virus through close contact or touching contaminated surfaces.

And it's not just warm weather and air conditioning that poses a threat. Cold weather in the winter that similarly forces people to go inside and crank the heat also creates an environment with little ventilation where viral particles can be spread through the air and cause infection. Ride-sharing services and taxis are another place where you may be in a closed space with someone who is infected. Virus particles could spread through air currents in the car, Karan points out.

Whether you're taking a taxi or escaping the heat or cold indoors, Karan's advice is the same.

"I would say keep the windows open and talk to your employers about [whether] they're looking into air filtration systems that are able to filter a wide range of particles," he says. He also adds that we need to design a better protective mask, one that can filter out the virus and is comfortable enough to wear all day.

To Karan, the looming question is: How do we live safely indoors with COVID-19? That is the next frontier.

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What We Know About How Air Conditioners Spread COVID-19 : Goats and Soda - NPR

"I'm not anti-vaccine. My kids were both vaccinated with everything, but I would not take a Covid vaccine today," Bailey told CNN.

"I have underlying health issues ... I would want to see enough studies in a long-term period of what the ramifications are for the vaccine."

Bailey said she doesn't trust US President Donald Trump, and that consensus around a vaccine among the world's top scientists and at least six months of testing would be just "a start" in persuading her to take it. "It's much too soon for me, I'd have to say, 18 months."

Neil Johnson, a physicist at George Washington University who is studying vaccine skepticism on social media, told CNN the four most common objections are: safety; whether a vaccine is needed; trust of the establishment and pharmaceutical companies; and perceived uncertainty in the science.

To see how widespread hesitancy is, he suggests asking your family and friends whether they would take a Covid-19 vaccine if one were available now.

"I would be surprised if you ask 10 people and you get all 10 jumping and saying yes without adding any caveats," he said.

Doubts over Covid-19 vaccine

Johnson said this was a "massive issue" -- and possibly an even bigger one than the polls indicate.

"What the question probably should have said is, will you have the Covid vaccine, will you be first to have it? And of course, I think that the answer for that will be no, I'll wait 'til everyone else has had it.

"There's always doubt among the anti-vax[xers], but there's now a sufficient doubt among this undecided population.

"I'm very, very concerned, I don't think public health has had this challenge [before] ... because there haven't been social media and these kinds of online influences."

Global spread of vaccine hesitancy

Johnson told CNN that in Africa, misinformation is spreading about the program being used as a cover to sterilize swathes of the population. "The fear about that is actually huge in developing countries now," he said.

Countering the objections

"There's clearly cause for concern; the emphasis on speed, on rushing a new vaccine," Jeremy Ward, who published a study on vaccine hesitancy with French research consortium Coconel in The Lancet in May, told CNN.

"I think the main factor is trust in institutions," said Ward. He said coronavirus debates in France had become highly politicized. Coconel's study found that those who had voted for a far-left or far-right candidate, or didn't vote at all, were much more likely to say that they would refuse a vaccine.

His research suggests that Russia could have more vaccine refusers than any other country.

Ratzan said the issue isn't just the inaccurate information, it's the growing lack of trust in institutions. "I think we're starting to see these two factors really wear down the public psyche and vaccine acceptance along with it, which is a huge concern," he said.

An earlier CUNY School of Public Health Covid-19 study found that just 42% of likely vaccine refusers in New York would be swayed by approval from the FDA or Centers for Disease Control and Prevention.

Several surveys and reports found hesitancy among Black and ethnic minority communities, which are disproportionately affected by the virus.

Time to prepare

Dr. Mike Ryan, executive director of WHO's Health Emergencies Program, said in a Thursday briefing: "People need to be allowed to have a conversation about vaccines, and have a proper conversation. It's not a one-way street. It's not about shoving things down people's throats. It's about having a proper discussion, good information, good discussion on this -- and people will make up their own minds."

"I think science and government have a job to do that is to make the case. I think communities and people have a job to do, which is to listen to that case, and hopefully the result of that will be a widely accepted successful vaccine that could bring this pandemic to an end," Ryan said.

Experts say we need a strategy for when a vaccine is produced, covering who will receive one first, how and where it will be distributed, possible different options, and how concerns will be addressed.

Ward emphasized that this is not just about convincing people a vaccine is safe but about doing everything possible to ensure it really is. "When you produce a new vaccine with such speed, it's not just communication, it's also transparency and making the right decisions," he said.

Community groups including the National Black Church Initiative have been working to ensure sufficient numbers of African Americans participate in vaccine trials. Ratzan said involvement from respected community members was vital to ensure people feel "they're being listened to, their concerns are met, and that the vaccine they are getting is held to the highest standards of safety and efficacy."

The timeline is vital. Ratzan added that with a new medicine, 18 months could be spent working with companies, medical groups and doctors and thinking about branding, social media or text campaigns. "We don't have any of that now," he said.

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Vaccines are safe. But huge numbers of people around the world say they wouldn't take a Covid jab - CNN

Should you get re-tested for the Covid-19 coronavirus after you have recovered from Covid-19? Well, ... [+] the CDC has some new guidance, sort of. (Photo by Robin Utrecht/SOPA Images/LightRocket via Getty Images)

Oh no they didnt.

The Centers for Disease Control and Prevention (CDC) didnt exactly say whether or how long you may remain immune to the Covid-19 coronavirus after recovering from an infection. But a new addition to the CDCs When to Quarantine web site did say something interesting:

People who have tested positive for COVID-19 do not need to quarantine or get tested again for up to 3 months as long as they do not develop symptoms again.

Hmm. Why wouldnt you need to quarantine or get tested again? Isnt re-infection with the virus a possibility? Or could you have that magical word that begins with the letter I and rhymes with the phrase hot dog eating community? In other words, is the CDC now suggesting that you may have immunity to the virus for up to three months after getting infected? Well, thats certainly one way of interpreting the statement. For example, here is a tweet response to this updated CDC guidance:

So looks like you dont have to go through that wonderful cotton-swab-way-up-your-nose experience for the three months after youve recovered from Covid-19, right? Maybe. Possibly. Perhaps. Read a little bit further on the CDC website, like one sentence further, and youll see the following:

People who develop symptoms again within 3 months of their first bout of COVID-19 may need to be tested again if there is no other cause identified for their symptoms.

So you may have immunity for up to three months, unless, of course, you dont have immunity for that long. Seems like that statement has the certainty of saying, I love you until, of course, someone else better comes along, right? Maybe, perhaps. Possibly. Well, not exactly.

Even though those on social media seemed to take the relatively new statements on the CDCs website (apparently these statement were added on August 3) as a statement about immunity, an August 14 CDC media release suggested otherwise. This release was entitled, Updated Isolation Guidance Does Not Imply Immunity to COVID-19. Here is what the release said: On August 3, 2020, CDC updated its isolation guidance based on the latest science about COVID-19 showing that people can continue to test positive for up to 3 months after diagnosis and not be infectious to others. The media release continued by saying, Contrary to media reporting today, this science does not imply a person is immune to reinfection with SARS-CoV-2, the virus that causes COVID-19, in the 3 months following infection. So what does the updated guidance really mean? The CDC release added that The latest data simply suggests that retesting someone in the 3 months following initial infection is not necessary unless that person is exhibiting the symptoms of COVID-19 and the symptoms cannot be associated with another illness.

Looks like then the CDC didnt really make a statement about immunity to the Covid-19 coronavirus. This makes sense given the current state of the science. The answer to the big question of whether and how long you may develop immunity against the virus has been like taking a selfie while riding a roller coaster on a vibrating pillow: its still a moving target and unclear. As I have covered before for Forbes, scientists still dont know for sure how immunity against Covid-19 coronavirus may work. Are you immune after you recover from an infection? If so, how long may not immunity last? Does everyone develop this kind of immunity?

Covid-19 virus antibody testing is different from testing for the presence of the virus. (Photo by ... [+] MARK RALSTON/AFP via Getty Images)

Several studies have suggested that immunity may last for at least a few months. In a research letter published in the New England Journal of Medicine in July, a team from the David Geffen School of Medicine at the University of California, Los Angeles (UCLA), led by Otto Yang, MD, a Professor of Medicine, described how they followed the antibody levels over time in a sample of 34 patients who had had mild Covid-19 coronavirus infections. Now 34 people isnt a lot of people unless you want to play charades on Zoom or are waiting in line for the bathroom. Nevertheless, the study did show that recorded blood levels of immunoglobulin G in this sample dropped fairly rapidly after recovery from a mild severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection. (You can say IgG instead of immunoglobulin G if you want to say it faster or are running from a tiger.) The average half-life for IgG in the blood was about 36 days, which meant that after about a month blood levels had dropped by roughly half. The research team followed each patient for an average of only 86 days so didnt report if patients still had IgG after three months.

As I have written before, IgG is the important antibody for longer term immunity. To remember this, think G for go as in the song Please Dont Go, by KC and the Sunshine Band. Thus, the UCLA study suggests that the antibody immune response may still be around after three months but may soon thereafter be gone baby gone.

Another piece of evidence is a pre-print article entitled SARS-CoV-2 infection induces robust, neutralizing antibody responses that are stable for at least three months posted on medRxiv. The title of this pre-print kind of gives away the conclusion of the study, sort of like renaming the movie Avengers: Infinity War with the title Large purple guy wears glove with bling and snaps fingers, making half of humanity disappear to set up a very lucrative sequel.

For this second study, a team from Mount Sinai Hospital in New York City led by Carlos Cordon-Cardo, MD, PhD, a Professor of Pathology, Molecular and Cell Based Medicine, analyzed data from a database consisting of 19,860 people screened at Mount Sinai Health System in New York City for IgG against the SARS-CoV2. Over 90% of those who had experienced mild-to-moderate Covid-19 had measured IgG in their blood about three months after the infection. Moreover, these antibodies were able to neutralize the SARS-CoV-2 in test tubes. So, like the title of the pre-print said, you may have antibody protection against the virus for at least three months.

Keep in mind though that such a pre-print is not the same as a publication in a reputable scientific journal that has gone through peer-review. In other words, other real scientists havent had a chance to formally review the study, offer feedback, and suggest changes. The study is still in the hey look, this may be interesting phase and not the heres established scientific evidence phase. So take the results from any study posted on medRxiv with a ham, cheese, and egg biscuit full of salt for now.

Another thing to consider is that IgG levels dont exactly fit immunity to a T. The response provided by your immune system to the SARS-Cov2 in part can be a bit like a friends with benefits relationship. It can be quite complex with much more than what initially meets the eye. Your immune system can produce various types of lymphocytes to help with the immune response to an infection. These include B lymphocytes, which can secrete the aforementioned antibodies that are readily measurable by blood tests. However, other components, such as T cells or T lymphocytes, can be at work under the covers, so to speak. T cells have nothing to do with T-shirts but instead are cells that can help neutralize or kill viruses in different ways.

A study published in the journal Nature found T cells in people recovering from Covid-19 and that these T cells seemed to recognize the N-proteins in the SARS-Cov2. So even if antibodies were to disappear from your blood a few months after an infection, T cells could potentially hang around for longer and provide some defense against getting infected again.

The Centers of Disease Control and Prevention (CDC) web page has some new guidance about Covid-19 ... [+] coronavirus testing and quarantine. (Photo Illustration by Pavlo Gonchar/SOPA Images/LightRocket via Getty Images)

Thus, its not completely surprising that the CDC has added the two lines with the three month timeline to their quarantine and Covid-19 testing recommendations. The dearth of more definitive guidance may not feel very satisfying, but in the words of Wilson Phillips, hold on, the science is still emerging. Scientists need more time, resources, and funding to figure things out and gather more evidence. Its been only about six or seven missed haircuts since this completely new virus emerged.

For now, the CDC is trying to give you some respite to actions that could get out of control. In theory, you could keep testing yourself up the wazoo after recovering from an infection. (Figuratively, of course, and not literally. You shouldnt be testing your bottom for the SARS-CoV2.) After all, arent people in the White House getting tested each and every day for the Covid-19 coronavirus? The new CDC recommendation may give your nose a break. It may also keep you from quarantining constantly.

So, the CDC guidance may be more about practicing moderation than having strict definitive directions to follow to a T. The immune response, the situation, and in turn what you should do may still vary significantly from person-to-person and depend on how severe your infection happened to be. As Buffy sang to Big Bird on Sesame Street, different people, different ways. After all, maybe you dont have to worry so much about getting re-infected in the three months after youve recovered from Covid-19. That is, unless you actually do get re-infected.

See the rest here:

How Long Are You Immune After Covid-19 Coronavirus? Here Is What CDC Says - Forbes

A study by researchers in South Korea last month suggested that children between the ages of 10 and 19 spread the coronavirus more frequently than adults a widely reported finding that influenced the debate about the risks of reopening schools.

But additional data from the research team now calls that conclusion into question; its not clear who was infecting whom. The incident underscores the need to consider the preponderance of evidence, rather than any single study, when making decisions about childrens health or education, scientists said.

Some of the household members who appeared in the initial report to have been infected by older children in fact were exposed to the virus at the same time as the children. All of them may have been infected by contacts they shared.

The disclosure does not negate the overall message of that study, experts said: Children under age 10 do not spread the virus as much as adults do, and the ability to transmit seems to increase with age.

The most important point of the paper is that it clarifies the care with which we need to interpret individual studies, particularly of transmission of a virus where we know the dynamics are complex, said Dr. Alasdair Munro, clinical research fellow in pediatric infectious diseases at University Hospital Southampton in Britain.

The earlier study was not intended to demonstrate transmission from children to adults, only to describe contact tracing efforts in South Korea, said Dr. Young June Choe, assistant professor of social and preventive medicine at Hallym University College of Medicine and an author of both studies.

Most studies of childrens transmissibility have been observational and have not directly followed infected children as they spread the virus. The few studies to have done so are not directly comparable their methods, the policies regarding prevention, and the transmission levels in communities all vary widely.

Many studies have grouped together children of widely varying ages. Yet a 10-year-old is likely to be very different from a 20-year-old in terms of infection risk and transmission, as well as in type and level of social activity, Dr. Munro said.

The first study from South Korea did try to document transmission from children directly, but it grouped them in 10-year ranges. Tracing the contacts of 29 children aged 9 or younger, it found that the children were about half as likely as adults to spread the virus to others, consistent with other research.

But Dr. Choe and his colleagues reported an odd finding in the group of 124 children aged 10 to 19: They appeared significantly more likely than adults to spread the coronavirus. Experts told The Times at the time that the finding was likely to be a fluke.

The group of older children was not the same in both studies, but many appeared in both reports, Dr. Choe said. In the latest study, the researchers found only one undebatable case of transmission among older children, from a 16-year old girl, who had returned from Britain, to her 14-year-old sister.

The remaining 40 infected contacts of the older children could all be explained by a shared exposure.

The children with confirmed infections were isolated in hospitals or community treatment centers, and caregivers who had contact with them were required to wear masks, gloves, a full body suit and goggles. The low rate of transmission from older children observed here may not represent what happens in the real world.

The new report does suggest that older children are at least unlikely to transmit more than adults, said Natalie Dean, a biostatistician at the University of Florida, as had been originally claimed.

Theres no biological explanation for that, she said. It didnt make any sense to me. Over all, Dr. Dean added, Were not seeing a lot of real transmission from children.

But that may be because most studies have been too small to adequately distinguish between age groups, and because children have been kept at home, away from potential exposures.

Even if the risk of transmission from children is lower, they usually have contact with a great number of other people more so than the average adult. When schools reopen, these increased exposures create more opportunities to transmit the virus, which may counterbalance their lower propensity to transmit the virus.

Updated Aug. 14, 2020

The latest highlights as the first students return to U.S. schools.

Dr. Dean and other experts cautioned against interpreting the scientific evidence so far as saying that children under age 10 simply cannot spread the coronavirus.

But its not true to say that they do not transmit, said Bill Hanage, an epidemiologist at the Harvard T.H. Chan School of Public Health. You hear people say this, and its wrong.

All available evidence so far makes it clear that older children, particularly those closest to adulthood, may spread the virus as much as adults, he added.

Its indisputable that the highest risk of becoming infected and being detected as being infected is in older age groups, Dr. Hanage said. I think you have to be really careful before you decide to open high schools.

Conversations about reopening schools are complicated because so much depends on the level of community transmission and on socioeconomic factors, he and other experts said.

Schools can fuel the influenza viruss spread to a disproportionate degree, compared with restaurants, bars or places of worship. Children may drive those outbreaks, so closing schools during flu outbreaks makes sense, Dr. Hanage said.

But with the coronavirus, Dr. Hanage said, closing schools is not expected to provide more bang for the buck than closing other parts of society. Instead of reopening bars and restaurants along with schools, he said, schools should be prioritized, while bars and restaurants should be closed in order to reduce community transmission and make school reopenings possible.

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Older Children and the Coronavirus: A New Wrinkle in the Debate - The New York Times

At some hospitals, officials have been able to use existing facilities. In Tyler, Texas, the UT Health North Campus medical center is an old tuberculosis hospital, with rooms that use negative air pressure to prevent viruses from spreading.

But in other locations, like Holy Cross Hospital in Fort Lauderdale, Fla., finding the right spot has been a struggle. Dr. Joshua Purow, who is overseeing the Eli Lilly outpatient trial at the hospital, rushed to get his site ready once he saw that infections were rising in the area.

Updated August 12, 2020

But Holy Cross turned down his first choice, a corner of the emergency department, out of fears that the space would be needed for more severe Covid-19 patients. The idea of installing an outdoor tent was deemed too complicated, and refurbishing a room in a nearby office building would take precious weeks.

Weeks passed before Dr. Purow finally secured a place to run the trial. It was in the emergency department, the first place he had requested.

We finally have it all set up to go, Dr. Purow said. But now, our numbers are declining a little bit. Were not seeing as much as we thought we would.

So far, he said, he has enrolled just one participant, out of a hoped-for 25. Over all, the Eli Lilly outpatient trial is aiming for including 400 patients. The similar Regeneron study has a goal of enrolling about 1,500 patients.

Not every trial site is seeing such hurdles. Dr. Jason Morris, who is overseeing the Eli Lilly study at his physician practice, Imperial Health, in Lake Charles, La., has already exceeded his goals and has enrolled about 45 patients. Dr. Morris said he or another doctor calls each person who tests positive for the virus at the groups urgent care clinic and tells them about the study.

The rest is here:

Coronavirus Antibody: Clinical Trials of Drugs Are Taking Longer Than Expected - The New York Times

Amid a flurry of concern over reports that frozen chicken wings imported to China from Brazil had tested positive for the coronavirus, experts said on Thursday that the likelihood of catching the virus from food especially frozen, packaged food is exceedingly low.

This means somebody probably handled those chicken wings who might have had the virus, said Angela Rasmussen, a virologist at Columbia University. But it doesnt mean, Oh my god, nobody buy any chicken wings because theyre contaminated.

Guidelines from the Centers for Disease Control and Prevention maintain that there is no evidence to suggest that handling food or consuming food is associated with Covid-19. The main route the virus is known to take from person to person is through spray from sneezing, coughing, speaking or even breathing.

I make no connection between this and any fear that this is the cause of any long-distance transmission events, said C. Brandon Ogbunu, a disease ecologist at Yale University. When the virus crosses international boundaries, its almost certainly chauffeured by people, rather than the commercial products they ship.

The chicken wings were screened on Wednesday in Shenzhens Longgang district, where officials have been testing imports for the presence of coronavirus genetic material, or RNA. Several samples taken from the outer packaging of frozen seafood, some of which had been shipped in from Ecuador, recently tested positive for virus RNA in Chinas Anhui, Shaanxi and Shandong provinces as well.

Laboratory procedures that search for RNA also form the basis of most of the coronavirus tests performed in people. But RNA is only a proxy for the presence of the virus, which can leave behind bits of its genetic material even after it has been destroyed, Dr. Ogbunu said. This is just detecting the signature that the virus has been there at some point, he said.

To prove that a dangerous, viable virus persists on food or packaging, researchers would need to isolate the microbe and show in a lab that it can still replicate. These experiments are logistically challenging and require specially trained personnel, and arent a part of the typical testing pipeline.

After samples taken from the surface of the meat came up positive, officials performed similar tests on several people whom they suspected had come into contact with the product. They also tested a slew of other packaged goods. All samples analyzed so far have been negative for coronavirus RNA, according to a statement released by the Shenzhen Epidemic Prevention and Control Headquarters Office.

But the same statement cautioned consumers about imported frozen products, and early reports of the news sparked alarm on social media. In New Zealand, where a new outbreak has set off another lockdown, officials are tentatively exploring the possibility that the virus might have reentered the country via frozen products imported from abroad.

Both Dr. Ogbunu and Dr. Rasmussen said that an extraordinarily unusual series of events would need to occur for the virus to be transmitted via a frozen meat product. Depending on where the virus originated, it would need to endure a potentially cross-continental journey in a frozen state likely melting and refreezing at least once along the way then find its way onto someones bare hands, en route to the nose or mouth.

Even more unlikely is the scenario that a virus could linger on food after being heated, survive being swallowed into the ultra-acidic human digestive tract, then set up shop in the airway.

The risks of that happening are incredibly small, Dr. Rasmussen said.

Some viruses might be able to weather such an onerous pilgrimage. But the coronavirus probably isnt one of them because its a so-called enveloped virus, shrouded in a fragile outer shell thats vulnerable to all sorts of environmental disturbances, including extreme changes in temperature.

Viruses are often frozen in laboratories that maintain stocks of pathogens for experiments. But virologists must monitor that process carefully to avoid destroying the vulnerable bugs.

Updated August 12, 2020

The act of freezing and unfreezing is a kind of violent thermodynamic process, Dr. Ogbunu said. A virus, for all its toughness and robustness, is a very delicate instrument of infection.

The C.D.C. has noted that it is possible that the coronavirus can spread through contaminated surfaces, including food or food packaging. But thats not known to be among the main ways the virus gets around.

If you dont want get infected, avoiding direct contact with other people is probably a better use of your time, Dr. Ogbunu said.

Yes, we should continue to wash our hands and be mindful of surfaces where a lot of individuals are, he said. But its close proximity to others that can really facilitate transmission.

More:

You Probably Wont Catch the Coronavirus From Frozen Food - The New York Times

Through the first seven months of 2019, Dr. Joyce DeJong reported 95 opioid-related deaths across the 12 Michigan counties she serves as medical examiner.

During the same period this year, her office has tallied 137 such deaths -- an increase of 44 percent -- with another 22 suspected/pending cases that have yet to be finalized.

DeJong, who founded the Western Michigan University Homer Stryker School of Medicine, said she cant be certain that the coronavirus pandemic has played a role in the spike in overdose deaths, but she cant help but notice the parallel tracks they appear to be on either.

All I know is theyre happening at the same time, DeJong said. It makes me think the pandemic likely has something to do with it.

Michigan health officials say its too early to evaluate 2020 mortality data. A spokesperson for Department of Health and Human Services said they dont have statewide data yet. But they have seen a deeply concerning trend in the rising number of 911 calls related to opioid use during the pandemic.

From April to June 2020, EMS responses for overdoses in Michigan were 26% higher than the same period in 2019, according to statewide data compiled by MDHHS. Responses increased in all regions of the state and in every age demographic except for those aged 65 and older.

Andrea Taverna is Michigans senior advisor on opioid strategies. She said stress and anxiety related to COVID-19 and the coinciding economic recession could be factors in the rise in substance use.

In addition to worries over catching and spreading coronavirus, or caring for loved ones who have fallen ill, many Michiganders have had to deal with stresses associated with job loss, business closures, and overall isolation.

Its been an incredible stressful time for everyone with a lot of uncertainty, a lot of change and a lot of difficulty, Taverna said. Theres also a very severe and sudden economic recession. All that together, that acute level of stress is a huge risk factor for increasing substance use.

Michigan residents were ordered to stay home unless they were partaking in essential business or activities between March 23 and June 1. Even after the stay-home order was lifted, many have remained isolated to avoid catching or spreading the virus.

Using controlled substances alone is a huge risk factor because no one can revive you if you overdose, Taverna said. One of her theories around the increase in overdoses pertains to a riskier use of substances without supervision.

Taverna cautioned against determining statewide trends by looking at a few months of data from a handful of counties. But DeJongs data from Allegan, Barry, Berrien, Calhoun, Grand Traverse, Kalamazoo, Leelanau, Mason, Muskegon, Osceola, St. Joseph and Van Buren counties does sound alarms for the medical examiner.

With COVID, a lot of the attention has been driven away from opioid abuse, DeJong said. Were saying wait, wait, we still need help here. For whatever reason, opioid deaths are going up and if it wasnt for COVID, I dont think they would be going up.

In January and February, before the pandemic struck Michigan, DeJongs office reported 12 and 13 opiod-related deaths, respectively. The 25 total deaths was similar to the first two months of 2019.

But over the next four months, the average opioid-related deaths per month from the prior year jumped from 14.75 per month to 27.75. And thats not including any potential lag in death reporting for the latter months.

If the state as a whole is experiencing an increase in opioid-related mortality, it wouldnt be alone. According to a July 20 brief from the American Medical Association, more than 35 states have reported increases in opioid overdoses during the COVID-19 pandemic.

To combat substance use disorders and opioid use disorders, the U.S. Health Resources and Services Administration announced last week that it would be providing $101.5 million in federal funding to support 116 organizations across 42 states. Many of the organizations target high-risk, rural communities.

The pandemic has created particular stresses for many Americans struggling with substance use disorders, and these HRSA awards will help strengthen prevention, treatment, and recovery services, especially in rural America, at this difficult time, said Health and Human Services Secretary Alex Azar in a prepared statement.

Five Michigan communities that will each receive $1 million to use over the next three years. Award recipients include the Emma L. Bixby Medical Center in Adrian, Ferris State University in Big Rapids, Luce Mackinac Health Department in Newberry, Michigan Center for Rural Health in East Lansing, and Sanilac County Health Department in Sandusky.

Opioid deaths have already been on a significant rise over the last two decades, according to data from the U.S. Centers for Disease Control and Prevention.

The number of drug and opioid-involved overdose deaths in Michigan, by category, per year, according to the U.S. Centers for Disease Control and Prevention. (Courtesy | National Institute on Drug Abuse)

MDHHS is encouraging individuals who have or know someone with opioid use disorder to keep naloxone - a medication used to reverse effects of opioid overdoses - on hand.

Syringe Service Programs and opioid treatment centers are open for those who are seeking access to sterile supplies or treatment during the pandemic. The state department is also encouraging those who are not ready to access treatment to practice safer drug use.

Individuals can request free naloxone online from Naloxone for All, and community organizations can request free naloxone through MDHHS.

People struggling or seeking additional help can call 211, a free hotline that connects Michigan residents with health resources, or visit Michigan.gov/staywell for a list of other phone lines and resources.

COVID-19 PREVENTION TIPS

In addition to washing hands regularly and not touching your face, officials recommend practicing social distancing, assuming anyone may be carrying the virus.

Health officials say you should be staying at least 6 feet away from others and working from home, if possible.

Use disinfecting wipes or disinfecting spray cleaners on frequently-touched surfaces in your home (door handles, faucets, countertops) and carry hand sanitizer with you when you go into places like stores.

Michigan Gov. Gretchen Whitmer has also issued executive orders requiring people to wear face coverings over their mouth and nose while in public indoor and crowded outdoor spaces. See an explanation of what that means here.

Additional information is available at Michigan.gov/Coronavirus and CDC.gov/Coronavirus.

Read more on MLive:

Michigan school leaders in support of fall season say high school athletics are safer than college

Thursday, Aug. 13, coronavirus data by Michigan county: Fourth U.P. county in higher-risk category

Michigan groups get money to combat opioid crisis

Michigans opioid crisis: Billions of pills and aggressive suppliers

Link:

Opioid-related deaths surge in parts of Michigan during coronavirus pandemic - MLive.com

As Massachusetts fights to control upticks in the coronavirus, a few other New England states, like Vermont, are reporting steady COVID-19 positive case numbers.

Some states, such as New Hampshire, are even reporting declines in their positive cases as they continue cautiously re-opening their economies.

Two state health commissioners from New England Mark Levine of Vermont and Lori Shibinette of New Hampshire joined WBUR's Morning Edition to talk about why their states are faring well while others falter.

Here are highlights from the interview, lightly edited for clarity.

On their respective states' low COVID numbers:

Mark Levine: "I think it's Vermontans cooperation, their compliance and their prioritization of health that has gotten us to where we are. That is really essential. Beyond that, Vermont was very deliberate in our re-opening until we felt we had a sufficient level of suppression of the virus in our state. And then finally, we've kind of had tourism and travel open up, if you will, on our terms, trying to make sure that we invite people but if there's a need for them to quarantine, we're very specific about that. And we've set very stringent levels."

Lori Shibinette: "We've had a significant amount of our focus on long-term care. It's our most vulnerable population. ... Our contact tracing is really spot on. We never stopped doing 100% contact tracing and even escalated it to a point where if we're not able to get in contact with someone that is COVID positive or is a close contact of someone that's COVID positive, we have a mobile team that we will send out to go to someone's house or try to find them in whatever way possible and get them in quarantine."

On mask polices and travel restrictions:

Shibinette:"There is definitely a strong recommendation for masks, but not a statewide mask mandate. So when we look at how are we going to be most effective in stopping the transmission, we're looking at some of those bigger events like Old Home Day or Motorcycle Week, where there is no assigned seating and people are in each other's space and you can't socially distance. That's where we're saying we're going to mandate a mask for a scheduled event like that that has over 100 people."

Levine:"We probably have the most restrictive travel map of anywhere because we do it on a county level throughout New England, throughout the Northeast, even a few states beyond that. ... We have a mask mandate in place now, but for the longest time, it was very strongly recommended. It was really, with a look towards the future, knowing that college students are returning to town, knowing that schools are going to be reopening, knowing that the fall foliage season, which is really critical to our economy, is going to happen with an influx of tourists. That's why we really wanted to implement the mass mandate to be very proactive at that point in time."

On Vermont loosening distancing restrictions in elementary schools:

Levine:"It's a 3- to 6-foot range for the younger grades. And the reason for that, number one, it's based in science. Number two, we feel very, very strongly in Vermont that the harms that could potentially be done to students at that age range for not resuming in-person instruction are greater than any harm that could come from resuming in-person instruction. We felt that we could very comfortably relax the range to 3 to 6 feet and make it easier for the school to have their students in the classroom but not compromise on public health."

How their states are preparing for a second wave:

Levine:"We're not relaxing immediately our emphasis on telework for those who are able to do that. We will continue that at least through the end of this calendar year and then we'll reevaluate. We haven't really overdone the reopening of bars and restaurants. Making sure that people have very simple guidance, understanding the four basic fundamentals of staying away if you're sick, washing your hands a lot, physically distancing and wearing a mask, certainly indoors and outdoors when you're unable to physically distance."

Shibinette: "We started a ventilation evaluation project for our nursing homes. We wanted to really evaluate whether some of the outbreaks that we've seen, was there a relationship to the sophistication of the ventilation system? So we're in the midst of that. From the very beginning, in March and April, we focused on ensuring we had hospital capacity. So we feel like we're in a very good position to increase capacity if we need to. And then right now, our focus is really on figuring out the logistics on how to be able to do vaccinations across the state when they're made available to us."

On why Massachusetts is struggling to contain the virus:

Levine:"I think one of the biggest 'dangers' and some of the Massachusetts experience bore this out had to do with travel. Neither of our states has a Logan Airport. So we didn't have to deal with that, even though we have an international airport in Burlington, certainly much lower traffic volume than would occur in Boston. And certainly Vermont at least doesn't have the population density in a city like Boston or a city like Springfield and Worcester."

Shibinette: "I think population density does have something to do with it. Boston is probably more poised to have to deal with that than some of the smaller states where two-thirds of New Hampshire are really rural areas where you don't have the population density that you have. You know, even some of your smaller areas in Massachusetts still have more population density than a number of areas in New Hampshire. ...But I will tell you, I was in Boston on Friday and I did not see a single person without a mask on."

See the rest here:

How Vermont And New Hampshire Are Keeping Coronavirus At Bay - WBUR

Going to stay with family means exposing more than one household. Can testing in advance keep everyone safe? Noel Hendrickson/Getty Images hide caption

Going to stay with family means exposing more than one household. Can testing in advance keep everyone safe?

Let's face it, if you've been staying home a lot, you're probably pretty tired of looking at the same faces. Love them as we do, it feels like well past time to start seeing other people, to visit or host relatives and dear friends. So how can you do this without unknowingly spreading the virus or getting exposed?

Recently my husband and I debated this when our son, who lives in another state, said he'd like to come home for a visit. He lives with roommates in a city with a high rate of infection, and he works in a restaurant. We thought of having him get a diagnostic test to find out if he is infected. That way, if he got back a negative test, our problems would be solved, right?

Well, when I called up a few infectious disease specialists to ask if this all made sense, I discovered that using a diagnostic test for the coronavirus this way can be problematic. Here's what I learned.

First, which test are we talking about?

Currently the most commonly available test that can detect an active infection is the molecular or PCR test, typically collected via a swab in the nose or the back of the throat. These tests look for the virus's genetic material and are highly sensitive. Another kind of diagnostic test is an antigen test that can detect the coronavirus's proteins these are less sensitive, says Daniel Green, a pathologist at Columbia University Irving Medical Center, and can be less accurate. And finally there are tests that show if your body has developed antibodies because it fought an infection from the coronavirus. Those tell you about an infection you had in the past, not what you have right now.

If I get a negative result on a PCR diagnostic test, can I be certain I won't infect someone I want to spend time with?

Like everything with this pandemic, the answer is complicated. The infectious disease experts I spoke to told me there are two reasons why testing might not be very helpful. The first has to do with the length of time it takes to get your test results back these days up to a week or more in some places for PCR tests. By the time you get your results back, you could have unknowingly been exposed to the virus, making the original test irrelevant.

The next big reason has to do with accuracy. While the PCR test is highly accurate in a laboratory setting, out in the real world it can produce some false positives and a lot of false negatives. In fact studies show a negative diagnostic test result can be wrong between 5% and 40% of the time, depending on the circumstances.

Some of this variation has to do with how well the sample was collected whether an adequate amount of mucous made it onto the swab, for example. But it also has to do with timing. You see, the diagnostic test tells you whether or not you have the virus on the day you took it. It reflects a single "pinpoint in time," says Dr. Henry Anyimadu, an infectious disease specialist with Hartford HealthCare Medical Group at the Hospital of Central Connecticut.

"Suppose that I was exposed on the 1st of August and I didn't know it," says infectious disease specialist Dr. Aileen Marty of Florida International University. "And I took the test on the 2nd of August. My test result will probably be negative." That's because the virus typically has at least a four- to five-day incubation period, so in the first few days after exposure, there may not yet be "enough virus in the upper respiratory system to be detectable," Marty says.

Wait, up to 40% false negative sounds like a lot is there anything I can do to ensure my results are more reliable?

Yes, there are some things you can do. But first remember this, for many of us that false negative rate could be much lower than 40%, says Green, who was a coauthor on one of the studies about test reliability. He points out that many of the people in his study were sampled too early, before the diagnostic test could detect the presence of the virus. So if you want to make sure your test is as reliable as possible, wait several days from the last point you think you could have been exposed before getting the test and while you wait, self-quarantine to avoid further exposures.

Marty agrees, saying, before you take the test, "be in a bubble for at least four or five days." Don't go to bars and restaurants and scale back grocery story visits or have food delivered. Bottom line, limit your exposure as much as possible leading up to test day. And then, Marty adds, "Stay in the bubble until you get your results back." That's because if you aren't careful, you could be exposed to the virus while waiting for results, and if you do have the virus even if you don't have symptoms you could spread it to others.

So if negative results are iffy, is it ever worth getting a diagnostic test?

Yes. There are definitely times when one should get a test, Anyimadu says. "If you're worried you have COVID-19 based on symptoms, you should get a test." Or, if you think you might have been exposed for instance, if your roommate, housemate or someone close to you is infected get a test.

And you should consider a test if you've traveled to an area with a high rate of coronavirus infection, Anyimadu says. To find out if your county or one you've spent time in recently has a high rate of infection, check this county-level map. If the county has more than 10 new daily cases per 100,000 residents, that's considered high risk.

If I test positive, but I don't have any symptoms, what should I do?

If you get a positive test result, our experts say, this is not the time to expand your bubble! Even If you don't have any symptoms, you are possibly contagious, and you could still develop symptoms. Marty says you should isolate yourself for 14 days, learn the symptoms of COVID-19 and monitor yourself. If you do get sick and your symptoms are getting worse, call your health care provider. And don't forget all those folks who live with you. They too need to be tested whether they have symptoms or not, Marty says, and should self-quarantine.

Marty also suggests people "connect with their department of health to assist with contact tracing," and help health workers reach out to anyone else who might have been exposed to you.

If you develop any symptoms, keep track of when they kick in so that you will know when you're no longer contagious. According to the Centers for Disease Control and Prevention, you should isolate yourself for at least 10 days after your first symptom appears. At that point, as long as you haven't had a fever for at least 24 hours and you're feeling better, you should be able to mix with others.

If I can't rely on negative test results, what do I do instead to visit someone safely or merge social bubbles?

The safest and simplest thing to do if you want complete peace of mind is to quarantine yourself for 14 days before the visit this is especially important if you're hoping to visit someone who is older or has an underlying condition.

But short of that, experts say testing can play a role in your decision-making as long as you "don't treat a negative test as a get-out-of-jail free card," Green says.

Think of it as one more piece of imperfect information that you can add together with the most important factor, your own behavior. Have you been able to isolate as much as possible before the potential visit with a friend? If you have gone out, did you carefully socially distance and wear a mask? Have you been avoiding bars and restaurants and indoor gatherings?

If the answer to these questions is yes, and if you are certain you haven't been around someone with a possible or confirmed case of COVID-19, then a negative test could be helpful. "If you aren't sick or don't have any particular reason to believe you're infectious," says epidemiologist Justin Lessler from Johns Hopkins University, "then getting that negative test should increase your confidence."

And remember, before you head off on your trip or join friends for an indoor gathering, ask the people you're visiting about their own behaviors and whether or not they've also gotten a test. Remember, you can spread the virus, but you can receive it as well.

"There's no way to bring your risk down to zero," Anyimadu says. But the recommended measures of mask-wearing, social distancing and thorough hand washing are still the most important defense against the virus. And that is true whether you've had a negative test, a positive test or not even gotten a test at all.

Rob Stein and Carmel Wroth contributed to this report.

Link:

Should You Get Tested For Coronavirus Before You Travel To Visit Family? : Shots - Health News - NPR