Daily Archives: August 26, 2020

A review of COVID-19 studies reveals a troubling connection between two health crises: coronavirus and obesity.

From COVID-19 risk to recovery, the odds are stacked against those with obesity, and a new study led by the University of North Carolina at Chapel Hill raises concerns about the impact of obesity on the effectiveness of a future COVID-19 vaccine.

Researchers examined the available published literature on individuals infected with the virus and found that those with obesity (BMI over 30) were at a greatly increased risk for hospitalization (113%), more likely to be admitted to the intensive care unit (74%), and had a higher risk of death (48%) from the virus.

A team of researchers at UNC-Chapel Hills Gillings School of Global Public Health, including lead author Barry Popkin, a professor in the Department of Nutrition and member of the Carolina Population Center, collaborated with senior author Meera Shekar, a World Bank health and nutrition specialist, on the paper published in Obesity Reviews.

For the paper, researchers reviewed immunological and biomedical data to provide a detailed layout of the mechanisms and pathways that link obesity with increased risk of COVID-19 as well as an increased likelihood of developing more severe complications from the virus.

Obesity is already associated with numerous underlying risk factors for COVID-19, including hypertension, heart disease, Type 2 diabetes, and chronic kidney and liver disease.

Metabolic changes caused by obesity such as insulin resistance and inflammation make it difficult for individuals with obesity to fight some infections, a trend that can be seen in other infectious diseases, such as influenza and hepatitis.

During times of infection, uncontrolled serum glucose, which is common in individuals with hyperglycemia, can impair immune cell function.

All of these factors can influence immune cell metabolism, which determines how bodies respond to pathogens, like the SARS-CoV-2 coronavirus, said co-author Melinda Beck, professor of nutrition at Gillings School of Global Public Health. Individuals with obesity are also more likely to experience physical ailments that make fighting this disease harder, such as sleep apnea, which increases pulmonary hypertension, or a body mass index that increases difficulties in a hospital setting with intubation.

Previous work by Beck and others has demonstrated that the influenza vaccine is less effective in adults with obesity. The same may be true for a future SARS-CoV-2 vaccine, said Beck.

However, we are not saying that the vaccine will be ineffective in populations with obesity, but rather that obesity should be considered as a modifying factor to be considered for vaccine testing, she said. Even a less protective vaccine will still offer some level of immunity.

Roughly 40% of Americans are obese and the pandemics resulting lockdown has led to a number of conditions that make it harder for individuals to achieve or sustain a healthy weight.

Working from home, limiting social visits and a reduction in everyday activities all in an effort to stop the spread of the virus means were moving less than ever, said Popkin.

The ability to access healthy foods has also taken a hit. Economic hardships put those who are already food insecure at further risk, making them more vulnerable to conditions that can arise from consuming unhealthy foods.

Were not only at home more and experience more stress due to the pandemic, but were also not visiting the grocery store as often, which means the demand for highly processed junk foods and sugary beverages that are less expensive and more shelf-stable has increased, he said. These cheap, highly processed foods are high in sugar, sodium and saturated fat and laden with highly refined carbohydrates, which all increase the risk of not only excess weight gain but also key noncommunicable diseases.

Popkin, who is part of the Global Food Research Program at UNC-Chapel Hill, said the findings highlight why governments must address the underlying dietary contributors to obesity and implement strong public health policies proven to reduce obesity at a population level. Other countries, like Chile and Mexico, have adopted policies from taxing foods high in sugar to introducing warning labels on packaged foods that are high in sugar, fats and sodium and restricting the marketing of junk foods to children.

Given the significant threat COVID-19 represents to individuals with obesity, healthy food policies can play a supportive and especially important role in the mitigation of COVID-19 mortality and morbidity, Popkin said.

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Obesity linked with higher risk for COVID-19 complications | UNC-Chapel Hill - UNC Chapell Hill

Volunteer Ekebar Emet, a 21-year-old student, publicizes epidemic prevention measures in Urumqi in northwest China's Xinjiang region on Aug. 3. His messaging reaches an estimated 78 households each day. Zhao Ge/Xinhua News Agency via Getty Images hide caption

Volunteer Ekebar Emet, a 21-year-old student, publicizes epidemic prevention measures in Urumqi in northwest China's Xinjiang region on Aug. 3. His messaging reaches an estimated 78 households each day.

Across China, life has largely returned to normal. Domestic travel is picking back up as a coronavirus pandemic brought under control recedes from memory. Businesses and factories have reopened.

Except in Xinjiang. A sweeping, western region nearly four times the size of California, Xinjiang remains largely cut off from the rest of the country and its some 22 million residents under heavy lockdown, an effort officials say is needed to contain a cluster of more than 800 officially diagnosed cases.

In mid-July, officials declared a "wartime mode" for the region. Community officials continue to go door to door, sealing doors with paper strips, tape and in some cases metal bars, to prevent residents from leaving their homes.

The region has effectively been penned off from the rest of the country, meaning scant information about the lockdown has emerged. In July, Xinjiang's train stations were closed, intercity bus routes canceled, and centralized quarantine imposed on residents returning to the region.

"It has been more than a week since we last had a case, but that does not mean we should relax," said Tang Shan, a Communist Party official who oversees Xinjiang's Ganquanbao district, an industrial zone just outside the region's capital of Urumqi. "We still ask our residents and the society at large, including our government organs, to work together in order to maintain the success we have achieved so far."

The monthlong lockdown has angered residents, thousands of whom took to social media this week to complain about what they said are heavy-handed quarantine and testing policies out of sync with the severity of the outbreak. The region's last new COVID-19 case was diagnosed on Aug. 17.

"The government has used an ax where a scalpel was needed," said a 21-year-old resident of Urumqi, where the vast majority of cases have occurred. He asked to remain anonymous because of potential legal retribution for talking to foreign media. "I just want government officials to refrain from lazy policymaking and combat the outbreak with scientific, reasonable measures."

Xinjiang is home to about 11 million Uighurs, a Turkic ethnic minority. Since 2017, local authorities with backing from the country's leader, Xi Jinping, have extralegally detained or imprisoned hundreds of thousands of Uighurs and other historically Muslim ethnic minorities. Those not detained live under heavy government surveillance and a web of restrictions that forbid most religious activities and travel.

Xinjiang's police state has mobilized over the last month to contain the latest coronavirus outbreak. Urumqi residents told NPR that they had been given mandatory tests for the coronavirus as many as three times in the last month and their temperature taken by local officials three times a day.

This past weekend, frustration from Xinjiang residents spilled over to social media, as the hashtag "Xinjiang refugees" briefly began trending on China's Twitter-like platform, Weibo. Most of the posts were soon deleted, and several accounts suspended. Videos shared on the platform by frustrated residents show Xinjiang residents cuffed to window bars and balcony railings outside their homes, a punishment for violating home quarantine rules.

"I want to strongly emphasize to everyone to now open your front door. Those who are discovered [outside their homes] by neighborhood officials will be reported to the nearest police station," read a warning sent to a chat group of residents in Urumqi's Tianshan district, according to screenshots sent to NPR by one of the group's participants.

The policy is similar to strict lockdown policies adopted for weeks at a time in other Chinese cities such as Wuhan and in coastal Zhejiang province during the height of the epidemic. To feed trapped residents, community officials and volunteers rallied to deliver daily essentials to each household several times a week.

With comparatively less-developed community services, residents in Xinjiang said they have been left hungry in their own homes. One woman in Kashgar, a former Silk Road oasis town, said she had been sealed into her house with a random assortment of groceries sent by community officials once a week usually basic vegetables such as potatoes, carrots and cabbage.

Four Uighur residents NPR spoke to said they had also been forced to drink a brown, herbal Chinese traditional medicine packaged by a company called Beijing Donghuayuan Medical. China's state news agency has said asymptomatic cases in Xinjiang were given an "herbal concoction" to prevent symptoms from appearing and that participation in traditional Chinese medicine treatment had "reached one hundred percent" in Xinjiang, though there is no medical evidence proving its efficacy against the virus.

On Monday, the regional government softened its lockdown policy slightly, allowing residents living in compounds with no cases to leave their homes so long as they are wearing a mask.

To further quell public outrage this week, state media also published the mobile phone numbers for about a dozen senior officials and party members at the provincial and city level, encouraging irate residents to reach out directly with recommendations.

"There has been an endless queue of complaints coming in," said Ye Hailong, a county-level Urumqi official.

On Monday, the Xinjiang regional government softened its stance and said it would allow residents without diagnosed cases in their compounds to leave their homes.

But when asked when Xinjiang's "wartime mode" would be entirely lifted, officials declined to offer a specific date. "Our lockdown policies have to follow the timeline of the epidemic and when the epidemic ends," said Chen Xinjian, an Urumqi district official.

Amy Cheng contributed research from Beijing.

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China's Coronavirus Lockdown In Xinjiang Is Severe And Controversial : Goats and Soda - NPR

TheWest Virginia Department of Health and Human Resources (DHHR) reports as of 10:00 a.m., on August 24,2020, there have been 398,479 total confirmatorylaboratory results received for COVID-19, with 9,312 totalcases and 179 deaths.

DHHR has confirmed the death of a 59-yearold male from Lincoln County. We mourn the tragic loss of this West Virginianand send our deepest sympathies to the family, said Bill J. Crouch, DHHRCabinet Secretary.

CASESPER COUNTY: Barbour (33), Berkeley (767), Boone(128), Braxton (9), Brooke (85), Cabell (490), Calhoun (8), Clay (19),Doddridge (6), Fayette (187), Gilmer (18), Grant (133), Greenbrier (98),Hampshire (92), Hancock (118), Hardy (63), Harrison (256), Jackson (190),Jefferson (324), Kanawha (1,225), Lewis (32), Lincoln (115), Logan (439),Marion (208), Marshall (135), Mason (84), McDowell (66), Mercer (276), Mineral(131), Mingo (213), Monongalia (1,060), Monroe (65), Morgan (37), Nicholas(43), Ohio (288), Pendleton (48), Pleasants (14), Pocahontas (42), Preston(135), Putnam (247), Raleigh (325), Randolph (219), Ritchie (3), Roane (25),Summers (18), Taylor (101), Tucker (11), Tyler (15), Upshur (40), Wayne (227),Webster (7), Wetzel (45), Wirt (7), Wood (291), Wyoming (51).

Pleasenote that delays may be experienced with the reporting of information from thelocal health department to DHHR. As case surveillance continues at the localhealth department level, it may reveal that those tested in a certain countymay not be a resident of that county, or even the state as an individual inquestion may have crossed the state border to be tested.Such is the case of Greenbrierand Randolph counties in this report.

Pleasevisit the dashboard located at http://www.coronavirus.wv.gov for more information.

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COVID-19 Daily Update 8-24-2020 - West Virginia Department of Health and Human Resources

Following individual human stories in a sprawling event like a global pandemic is a challenging task. Making thoughtful connections between the two is even harder. But this long read from The California Sunday Magazine on Americas first COVID-19 epicenter, a nursing home in Washington state, does the job with compelling and tragic precision.

It focuses on two inhabitants of a single room in the nursing facility, the Life Care Center of Kirkland, part of the largest privately held chain of long-term care centers in the US. It tracks how the coronavirus spread through the facility like a spectral haunting, and how underpaid and overworked staff battled against the odds to bring it under control.

Around the world, nursing homes have been hit hard by the pandemic, which is no surprise considering that their residents are some of the most vulnerable in society. In the US alone, as of mid-August, 177,129 nursing home residents have tested positive for COVID-19 and 45,958 have died from the disease. This means that nursing-home residents account for more than a quarter of total pandemic deaths, writes journalist Katie Engelhart.

In America, though, these individual tragedies connect to larger trends. As Engelhart lays out in rigorous detail, the financial and regulatory landscape of the US has seriously diminished the quality of care in nursing homes. The freakish architecture of health insurances is one issue, incentivizing management to treat patients with profit in mind:

At one Life Care facility in Florida, the entire rehab staff had signed a letter declaring that they had been encouraged to maximize reimbursement even when clinically inappropriate.

And the financialization of the industry is another. Nursing homes are lucrative businesses thanks to a regular supply of customers. This has attracted buyouts from private equity firms and owners concerned only with making money. Nursing homes are folded into complicated company structures that make it harder for patients to sue, while middle managers are brought in on bloated salaries, draining funds from frontline staff.

The results are grimly predictable, explains Engelhart:

Earlier this year, a Wharton SchoolNew York UniversityUniversity of Chicago research team found robust evidence that private-equity buyouts lead to declines in patient health and compliance with care standards. When nursing homes are bought by private-equity groups, the team concluded, frontline nursing staff are cut, and residents are more likely to be hospitalized.

Lax government regulations have also played a part. One study found that three-quarters of US nursing homes were understaffed before the pandemic, while 82 percent had been cited by the Government Accountability Office for failing to control the spread of infections between 2013 and 2017. These conditions were ripe for the pandemic to move in.

Engelharts piece is extremely affecting when detailing the plight of nursing home residents themselves. These are mothers and fathers, daughters and sons, whose tragedy is simply aging in a country that does not provide for them. As Engelhart puts it, many people see the tens of thousands of deaths in US nursing homes as evidence of a cultural abdication on the part of society. Weve failed to look after our elders and the human cost is staggering. Perhaps this pandemic can at least wake people up to the change that is needed.

Go read Engelharts full story right here.

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Go read this damning story about the spread of COVID-19 in Americas first pandemic hotspot - The Verge

At a Sunday press conference, U.S. President Donald Trump (right) announced that Food and Drug AdministrationCommissioner Stephen Hahn (left) had approved an emergency use authorization for using plasma from recovered COVID-19 patients to treat new patients with the disease.

By Kai Kupferschmidt, Jon CohenAug. 24, 2020 , 9:00 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

At a highly unusual Sunday night press conference, U.S. President Donald Trump revealed what he described as a very historic breakthrough in the fight against COVID-19that would save countless lives: The U.S. Food and Drug Administration (FDA) had issued an emergency use authorization (EUA) for convalescent plasma to treat people with severe COVID-19.

The authorization could allow more hospitalized patients to receive the antibody-rich plasma, which is donated by people who have recovered from the disease. But in the wake of Trumps announcement, which came a day before the start of the Republican National Convention, researchers struggled to sort the politics from the medical and scientific import of the EUA.

Trump, flanked by FDA Commissioner Stephen Hahn, claimed that convalescent plasma was safe and very effective, and had proven to reduce mortality by 35%what he called a tremendous number. But that number has received a tremendous amount of scrutiny. It surprised even the researchers who conducted the study on which Trump apparently based declaration. I dont know where the 35% number comes from, says Arturo Casadevall of Johns Hopkins Universitys Bloomberg School of Public Health, the last author of the study, which has been posted as a preprint but has yet to be peer reviewed.

Randomized, controlled trials (RCTs), the gold standard for assessing therapies, havent yet shown any benefit of convalescent plasma on COVID-19 patients. One such study, which includes thousands of patients, is underway as part of the Recovery trial in the United Kingdom. An FDA review of the request for the EUAmade by a branch of FDAs parent agency, the Department of Health and Human Services (HHS)notes an RCT with small numbers of participants in China and another in the Netherlands. Both were stopped early and failed to show the benefits of convalescent plasma.

But the EUA rests heavily on data from the COVID-19 Plasma Consortium, funded by HHS to provide access to the treatment and assess its safety. The group has treated more than 90,000 patients at nearly 3000 sites in the United States and its territories. That study has no untreated control group, however, so it cannot ultimately address whether convalescent plasma has any risks that outweigh benefits.

The treatment was allowed under FDAs Expanded Access program, which gives patients access to experimental treatments. Casadevall says this program requires burdensome, time-consuming paperwork that the EUA will do away with. That will be particularly helpful for understaffed hospitals that treat underserved populations, he says. I think the FDA made the right call. The political noise is unfortunate.

Others say the political noise is drowning out the science.

Hahn claimed at the press conference that Trumps 35% figure translates to 35 lives saved per 100 sick people. Casadevall and others suspect both numbers are based on a small subset ofpatients, and the closest data that fit seem to be from a group that was analyzed together because of the specific test that assessed the COVID-19 antibody levels in the plasma they received. In this group of about 3000 people, 8.9% of those who received plasma containing high antibody levels died within 7 days, versus 13.7% of those who received plasma with low levels. Although that is a 35% relative difference between the groups, the absolute difference, 4.8%, amounts to 4.8 lives saved per 100 sick peoplenot 35. And after 30 days, the relative difference between the groups had dropped to 25%. At that point, the mortality rates were 22.3% and 29.6% respectively among recipients of plasma with high and low levels of antibodieshardly a historic breakthrough. (On Monday evening, after this story was posted, Hahn acknowledged he had made a mistake, tweeting that the criticism of his remark was entirely justified. What I should have said better is that the data show a relative risk reduction not an absolute risk reduction.)

Luciana Borio, a former chief scientist at FDA, calls the data presented yesterday statistical acrobatics. If the treatment effect was real and meaningful, we would probably have detected it by now, says Borio, who formerly worked on the Trump White Houses National Security Council and now is a vice president at In-Q-Tel, a not-for-profit that invests in high-tech companies.

Nicole Bouvier, a virologist and infectious disease clinician at the Icahn School of Medicine at Mount Sinaiand a participant in the Mayo Clinicled consortiumsays the data gathered so far do suggest convalescent plasma may help some COVID-19 patients. There is probably a benefit to it, but its probably not a major breakthrough as it was described, Bouvier says. She wishes the U.S. government had organized large-scale RCTs for the intervention, although they would have been costly and difficult to run. Were trying to build a wall of evidence and were putting in pebbles, she says. It would have been nice to have a great big boulder of an RCT. But it just has not evolved in that way, and I dont see it evolving that way anytime soon.

Borio and others worry the EUA may make it harder to gather that kind of evidence for other treatments. Convalescent plasma contains a mixture of different antibodies, only some of which hinder the virus that causes COVID-19, and Borio and many others have high hopes for a more targeted and standardized intervention: monoclonal preparations that contain high levels of the most potent antibodies only. But now that the EUA has put convalescent plasma within reach of more patients, it may become harder to enroll people in RCTs for monoclonal antibodies, Borio says.

Myron Cohen of the University of North Carolina, Chapel Hill, who oversees large-scale RCTs of monoclonals now taking place under the aegis of the U.S. National Institutes of Health, agrees. If potential study participants for a COVID-19 treatment intervention in a randomized controlled trial believe there is a beneficial and safe agent they can receive without randomization to a placebo, they may logically and often chose that path, Cohen says.

Given that the tens of thousands of Americans have already received convalescent plasma through FDAs Expanded Access program, its unclear how many more people the EUA will actually benefit. Bouvier says her hospital may not even be able to use the EUA, because it requires that convalescent plasma be first characterized with a specific antibody test that it does not have. How do you even do what the FDA is mandating in the EUA right now? Bouvier asks.

Over the past week, several U.S. government health officials had urgedFDA not to issue an EUA on plasma for COVID-19, which led Trump to post a tweet accusing them of being part of the deep statea supposed inside movement against himand trying to delay approvals until after the 3 November presidential election. He repeated those accusations last night. I think that there are people in the FDA and actually in your larger department that can see things being held up and wouldnt mind so much, Trump said, addressing Hahn. Thats my opiniona very strong opinion. And thats for political reasons.

Eric Topol, a cardiologist who directs the Scripps Research Translational Institute, says the EUA again represents the FDA caving directly to Trump pressure, as he believes it did when it issued an EUA (later rescinded) for hydroxychloroquine treatment for COVID-19. It sadly and unacceptably exemplifies loss of independent FDA assessment of evidence and data overridden by political pressure, Topol says. Many scientists worry the same could happen in future decisions about EUAs for COVID-19 vaccineswith far greater potential consequences because vaccines presumably will be given to hundreds of millions of healthy people.

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In FDA's green light for treating COVID-19 with plasma, critics see thin evidenceand politics - Science Magazine

The coffins are a better place to scream than at Japanese theme parks, which have encouraged visitors to keep their mouths shut on roller coasters to prevent virus transmission through droplets. (Please scream inside your heart, the Fuji-Q Highland amusement park suggested in June in a video demonstration by two of its executives, who inspired social media users to try the serious face challenge on their own roller coaster rides.)

Kenta Iwana, founder of Kowagarasetai, said he wanted to give people a way to express themselves without holding back.

There are no places to scream, Mr. Iwana, 25, told Agence France-Presse this summer as he introduced another one of his socially distanced productions, a drive-in haunted house. In addition to providing people with an emotional outlet, he said, his company creates job opportunities for performers who normally work at theme parks.

Japan, which has been fighting a resurgence of the virus in recent weeks, reported 740 new cases nationwide on Sunday, including 212 in Tokyo.

Reporting was contributed by Sarah Almukhtar, Gillian R. Brassil, Alexander Burns, Stephen Castle, Choe Sang-Hun, Abdi Latif Dahir, Richard Faussett, Sheri Fink, Michael Gold, Jenny Gross, Javier C. Hernndez, Shawn Hubler, Mike Ives, Annie Karni, Isabella Kwai, David Leonhardt, Apoorva Mandavilli, Jonathan Martin, Tiffany May, Patricia Mazzei, Claire Cain Miller, Heather Murphy, Eshe Nelson, Amelia Nierenberg, Adam Pasick, Elian Peltier, Monika Pronczuk, Dana Rubinstein, Eliza Shapiro, Mitch Smith, Eileen Sullivan, Katie Thomas, Tracey Tully, Katherine J. Wu and Elaine Yu, Carl Zimmer.

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C.D.C. Changes Testing Guidance to Exclude People Without Covid-19 Symptoms, Worrying Experts - The New York Times

As hundreds of thousands of students return to classrooms across Wisconsin, the state has no plans to publicize details about COVID-19 outbreaks when they occur at schools.

Freedom of information advocates say that information should be available to the broader public, and some researchers say data could help schools learn from one another. But others worry about protecting students, parents and communities from stigma if information about outbreaks is shared widely.

Without a state-level source of information, what you know about outbreaks in your schools may depend on the openness of local school districts and health departments.

The Wisconsin Department of Health Services confirmed last week it will publish only the number of schools in the state with COVID-19 investigations, which launch when as few as two cases are identified in a given space.The departmentdoesn't plan to name the schoolsor describe the severity of the outbreaks.

This is similar to how the state treats other facility-wide investigations, which it tracks by category, like outbreaks in group housing, health care settings and other workplaces. One exception is nursing homes, which are regulated by the state and federal governments andare named on the DHS site when an investigation occurs.

Bill Lueders, president of the Wisconsin Freedom of Information Council, said the location and size of school outbreaks should be made public, just as he believes the state health agency should post thenames of businesses and other establishments connected to at least two cases of COVID-19, as it had initially planned.

"I think it's tragic that the Department of Health Services is being so secretive of COVID cases, and I think it's contrary to public interest and public health," he said. "They consistently have shown they don't particularly trust the people of Wisconsin to make reasonable and rational use of public information. Instead they just assume people are going to flip out if a school or business has some experience with COVID."

School teachers and staff across the state also are wonderingwhat information will be available to them, since most school decisions are made at the district level, said Ron Duff Martin, president of the Wisconsin Education Association Council, which represents about 50,000 members across the state.

While schools are bound by privacy laws, he said, teachers and staff have concerns about keeping themselves, their families and their students safe.

"Isn't this just a prime example of how this is the Wild West in Wisconsin, that we don't have one consistent policy for all of our schools?" Martin said.

"There's a difference between local control and being able to give the direction and guidance from state level," he said. "There are certain things that should be consistent from school district to school district and county to county."

Jenni Hofschulte of the Wisconsin Public Education Network saidthe education advocacy organization supports local control in school districtsbutwould prefer districts follow a common set of rules and practices so families can better understand how theyll be applied in their communities.

Were disappointed as a network in some of the guidance thats come out and that so many of these decisions big decisions with big consequences have been put onto local schools in a way thats not something like choosing a textbook for a class, she said. Its about how to handle a global pandemic.

Schools are often the heart of their communities, Hofschulte said, meaning everyone should have access to information about outbreaks.

How many people have contact with a school building in a day? Its far more than students, parents, teachers or school staff. It's volunteers, grandparents and so much more, she said. People deserve the right to know.

Across the country, schools have cited medical and educational privacy laws in keeping outbreak numbers confidential. But legal experts recently told USA TODAY that these laws don't bar schools from sharing this information, as long as it can't be used to identify specific people.

Standing guidance from the U.S. Department of Health and Human Services says that the Health Insurance Portability and Accountability Act, or HIPAAwhich prohibits medical providers from releasing identifying information about a patient doesn't apply to elementary or secondary schools.

Educational records are kept private by the Family Educational Rights and Privacy Act, or FERPA, but the U.S. Department of Education said in March that the law doesn't prevent schools from sharing non-identifying details about COVID-19 cases.

Wisconsin statute requires schools to notify local health officials if they know or suspect a communicable disease is present in a building, either among students, teachers or other staff.

New DHSguidance issued to schools last week says administrators should track cases, other illnesses and student absences. In the event of a confirmedor probable case of COVID-19, DHS said administrators shouldnotify families and all teachers and staff.

But no recommendations are given as to how or whenWisconsin schools should inform the public about the size and location of outbreaks.

Other states have similarly shielded details about specific school outbreaks fromthe public,including Michigan and Tennessee. In Oklahoma, school districts aren't even required to report COVID-19 cases to local public health officials,according to aNew York Times report.

In the absence of a federal system to track school outbreaks, Emily Oster, an economist at Brown University, has teamed up with national school superintendents and principals' associations to collect data on school COVID-19 casesfrom as many schools across the countryas possible.

Their dashboard, which is expected to go live about a week after data collection starts in early September, will provide the public with basic information like enrollment numbers, the school'sreopening plans and precautions taken, as well as suspected and confirmed COVID-19 cases, and absences.

Schools can choose to participate, Oster said, but she's hopeful thatsupport from the superintendents and principalswill persuade many districts to opt in.

"The best thing we can do is just be honest about what we see as the value here," Oster said. "There's a lot of enthusiasm about having these data, and I think we're going to have to rely on making clear to people:'If you want this data to exist, then we do need participation.'"

The value of the data, she said, would be as a tool for more informed decision-making. With this data in hand, schools can look to one another to determine what mix of precautions and COVID-19 prevalencecreates the safest situation to open schools, and they also can track differences in outbreaks across age groups.

It also rids parents, teachers and families of uncertainty, she said.

"When we report on outbreaks without doing a comprehensive data collection, it can be hard for people to understand: Was that just one outbreak, or is every school like that?" Oster said. "This effort can answer those questions and allay some fears or, maybe, tell us it's not safe."

For many school officials and families, the benefits of having information about an outbreak are clear. But somedisagree on whether the general public needs to see it, too.

Dr. Maggie Nolan, a preventative medicine physician in Madison whose oldest child is starting first grade this year at Madison Country Day School in Waunakee, said she's asked the school to provide parents with the number of students absent from school on a given day.

Because COVID-19 has a wide range of symptoms and may not present the same way in all children, she said, she might opt for virtual learning if several of her daughter's classmates are out sick whether or not they've been confirmed COVID-positive.

She served on a medical advisory board to help guide the school's reopening, and said she feels like she's gotten "a strong commitment" from school leaders that they'll tell parents what they want to know about outbreaks.

Still, Nolan said she doesn't believe that information necessarily needs to be shared with the broader public. Especially within smaller schools, she said, even de-identified information about cases could be enough to make someone's identity known.

"There will be talk of it in the community enough to make people aware," Nolan said. "But adding stigma to certain schools or communities (with outbreaks) is really a slippery slope."

What no one wants, she said, is a situation where parents are discouraged from getting their kids tested if they feel a positive COVID test will stigmatize them in some way.

But Patrick Remington, an epidemiologist at the University of Wisconsin-Madison, said people like day care providers andcoaches also need to beinformed about an outbreak involving students.

He recommends schools to go beyond sending a letter home to families and operate some sort of dashboard to track outbreaks.

"In my mind, I can't imagine any information that parents need to know that a community wouldn't also be interested in knowing," he said.

It's critical, Remington said, that schools take control of the message and share information on outbreaks transparently rather than letting rumors proliferate on social media.

"You've seen schools where (they'll say), 'Ms. Johnson isn't going to be here tomorrow. She'll be gone for two weeks,'" he said. "You think a parent doesn't know what's going on?"

Without outbreak details from DHS, the responsibility falls to local health departments and the school districts themselves to decide what information to share, and how.

Martin said the state teacher'sunion has been holding town halls with its members and state and local officials trying to address their concerns.

"What really has our educators anxious." he said, "is if there's an outbreak, what can we know? What can't we know? ... They're very anxious about what's happening in their districts and beyond.

"And the onus of tracking down information, on top of getting ready for an uncertain school year, just places another layer of stress on them."

It's not clear how much more transparency there will be atthe local level.

Twohealth departments in Milwaukee County in Milwaukee and Greenfield said they have no plans to publicly list numbers of COVID-19 cases by school or school district.

The Milwaukee Health Department said in an email to USA TODAY NETWORK-Wisconsinthatschools will be required to notify all parents in a school about positive cases, but the health department will not reportnumbers publicly by school or district. It said it doesnot provide information about positive cases for companies or organizations in any other sector and that it would not treat schools differently.

"Sharing specific, small-scale, demographic information with the public does not aid in the publichealthmitigation strategies," the department said in an email.

But Milwaukee Health Commissioner JeanetteKowalik, in her regularly scheduled Tuesday briefing, appeared to suggest that listing cases by school might happen eventually. She called it "a sensitive topic" and said any decision would have to be made in collaboration with districts, teachers unions and the Department of Public Instruction.

"Most schools are virtual in the city of Milwaukee, so it gives us a little time to figure this out," she said.

In the city of Greenfield, in southwestern Milwaukee County, Health Officer Darren Rausch said his office has not yet thought through whether and how it will release information about schools to the general public. But he said his officedoesn't typically release public health data in small numbers because that can identify individuals. And schools would likely be treated the same way, he said.

"Disease is all around us," Rausch said. "I'm not any more concerned because there's a case in my school, because I know there are other settings that my child is in or could be in where I could get COVID."

In Waukesha County, west of Milwaukee, health officials added a map to their COVID-19 dashboard showing the number of active cases involving children under 18 by school district geographic area. But it does not cite numbers by school or district, and it includes all children, regardless of where they go to school, including those in private and charter schools and those who are home-schooled.

Nicole Armendariz, spokeswoman for Waukesha County Executive Paul Farrow, said it will be up to schools and districts to determine whether to notify anyone, including parents and staff, "who are not close contacts of a positive COVID-19 case."

RELATED:Here's how Wisconsin health officials say schools should respond to a COVID-19 outbreak

RELATED:'What do we do now?': With federal support running out, Wisconsin child care providers struggle to survive the pandemic

Contact Madeline Heim at 920-996-7266 or mheim@gannett.com. Follow her on Twitter at @madeline_heim.Contact Annysa Johnson atanjohnson@jrn.comor 414-224-2061. Follow her on Twitter at@JSEdbeat.Contact Samantha West at 920-996-7207 or swest@gannett.com. Follow her on Twitter at @BySamanthaWest.

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Wisconsin officials won't name schools that have COVID-19 outbreaks, or say how big they are - Appleton Post Crescent

A new national study of four Maine summer camps details how the overnight camps prevented outbreaks of COVID-19, while similar camps in other states suffered through major outbreaks.

Dr. Laura Blaisdell, a pediatrician from South Portland and also a medical director at one of the camps, said the four camps coordinated to devise similar prevention strategies. The strategies included testing, masking, quarantine, physical distancing and making sure students stayed in small groups of 10-20 to prevent outbreaks.

We needed to throw the entire kitchen sink of public health intervention to prevent the spread of a disease like COVID-19, said Blaisdell, the lead author of the study.

The study was published by the U.S. Centers for Disease Control on Wednesday, with Blaisdell and four other scientists as authors.

The Maine prevention strategy stands in contrast to summer camp outbreaks reported across the country, including in Texas, Missouri and Georgia. In the Georgia outbreak, more than 260 campers out of 344 tested were positive for COVID-19.

In Maine, through a combination of pre-screening, testing prior to starting camp and testing 1,022 campers and staff while they were at the overnight camps, a total of seven campers and staff tested positive. One of the tests of a camper ended up being a false positive.

Campers were told to quarantine with their families prior to arrival, and 15 attendees of one camp were instructed to quarantine while waiting for pre-screening test results to come back. When the tests came back negative a few days into camp, they were released from quarantine.

The four camps that were part of the study are not being identified to protect patient privacy, Blaisdell said.

Blaisdell said all of the staff and campers who tested positive for COVID-19 were asymptomatic.

She said thats different from other infectious diseases, such as the flu. When people are most contagious from influenza, they feel sick and tend to stay home. She said what makes COVID-19 so difficult to contain is that people who feel healthy can have the disease and be contagious.

You cant pick or choose one strategy. You have to layer several strategies all day every day, every layer to have the best success. We know we cant provide a COVID-free environment, Blaisdell said.

She said by keeping students in groups of 10-20, that means just that group would go into quarantine when one person tested positive, rather than the entire camp.

Dr. Jeff Vergales, a Virginia pediatrician who was the medical director at two Maine summer camps and one of the authors of the study, said once the campers and staff arrived and tested negative, each camp turned into a bubble.

From an epidemiological standpoint, we could control who was coming in and out, Vergales said. We had an advantage of knowing about what these kids were doing day in and day out.

This story will be updated.

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Study shows how 4 Maine summer camps avoided COVID-19 infections - The Bethel Citizen

The Illinois Department of Public Health announced 2,157 new confirmed cases of COVID-19 and 37 deaths on Wednesday.

The spike comes as new restrictions on public gatherings go into effect in Will and Kankakee counties, due to the rising number of people testing positive for the coronavirus.

There will be no indoor service for bars or restaurants, outside bar and food service must close at 11 p.m., and gatherings are capped at 25 people or 25% of the overall room capacity. Casinos also must close at 11 p.m. and are limited to 25% capacity.

The stricter rules come after counties posted an 8% positivity rate for three consecutive days, becoming the second of the states 11 regions to be sent backward from the phase four rules that are widely in place throughout the state.

Counties in the Metro East area near St. Louis have also been placed under the restrictions, and could face tighter limits if their positivity rate stays high.

On Tuesday, Gov. J.B. Pritzker announced a new statewide restaurant and bar policy requiring all patrons to wear a mask while interacting with wait staff and other employees, when food and beverages are brought to the table and when picking up carry-out orders.

Heres whats happening Wednesday with COVID-19 in the Chicago area and Illinois:

2:24 p.m.: Indiana governor extends statewide mask order for 30 days; Lake County, Ind., nears 8,800 cases

Indianas governor extended the statewide face mask order Wednesday that he first issued a month ago aimed at slowing the coronavirus spread.

Republican Gov. Eric Holcomb announced he was keeping the mask mandate in place for another 30 days.

Holcomb said he was also extending the states limits crowd sizes for restaurants, bars and public events. Those orders were all set to expire late Wednesday unless the governor acted.

Holcomb said he was pleased the states rates of new coronavirus cases have been holding steady and he does not want to see it trending up again.

1:45 p.m.: The stress of dealing with COVID-19 is causing decision fatigue. Heres how to cope.

Even before the pandemic, making constant decisions daily could create stress.

COVID-19 has added weight to small and big decisions alike. Should I pick up takeout? Do I send my child to school? Do we allow a babysitter to come over? Should we attend a birthday party? Is one item from the grocery store worth the trip?

The concept of exhaustion and stress after making choices is known as decision fatigue. After months of assessing the risk and benefit of daily choices during the coronavirus crisis, people are tired. Especially as school begins, many families have been agonizing over whether to send their children to school or how to manage remote learning.

12:12 p.m.: 2,157 new known COVID-19 cases, 37 additional deaths

The Department of Public Health on Wednesday announced 2,157 new confirmed cases of COVID-19 and 37 deaths. Overall, Illinois has reported 225,627 cases, including 7,954 deaths.

11:42 a.m.: Jobless workers could get an extra $300 a week in benefits. Pritzker says Illinois is applying for Trumps benefits program.

Illinois is applying for the $300 weekly unemployment benefits supplement President Trump ordered earlier this month to provide financial assistance to jobless workers during the coronavirus pandemic.

On Aug. 8, President Trump authorized the federal supplement, which is being doled out to states by the Federal Emergency Management Agency, as a temporary fix to replace the extra $600-a-week in federal benefits that expired last month. Congress remains at a standstill on negotiations for an additional coronavirus relief package, which could restore some, if not all, of those benefits.

At a news conference Tuesday, Gov. J.B. Pritzker was asked to respond to President Trumps comment that Illinois is one of the states that has not applied for the benefits.

Pritzker said We have begun that process, indeed. It takes a lot of setup on an internal basis for us to move forward with that and so thats what weve been doing.

More than 30 states have received approval for the benefits program as of Tuesday, according to FEMA. The agency, which typically handles disaster relief, will provide up to $44 billion from the Disaster Relief Fund for lost wage payments, and states will administer those funds.

10:11 a.m.: Theres been an awful lot of partying: Northwestern University asks Evanston residents to report students who ignore COVID-19 precautions in off-campus gatherings

Northwestern Universitys campus in Evanston is going to feel less crowded this fall, with residence hall capacity reduced to about 70% and more than half of all employees still working from home, school officials said Tuesday.

But those estimates didnt fully assuage concerns from residents that students will instead move into neighborhood apartments and throw raucous parties, potentially accelerating the spread of COVID-19 in a suburb that has so far avoided an uncontrollable outbreak.

Residents raised the issue Tuesday evening during a 90-minute Zoom meeting, billed as a community town hall, to discuss NUs plan for repopulating its suburban campus when classes begin next month.

9:55 a.m.: CDC advice to retail workers: Dont argue with anti-mask shoppers

The Centers for Disease Control and Prevention has issued a warning about a new coronavirus health risk you probably didn't expect: getting slapped, choked or kicked in the workplace by angry customers. And the best way to avoid it is not to engage.

The health agency issued guidance this week for retail and service workers suggesting ways consumer-facing companies can limit violence toward workers that may occur when businesses implement policies to stop the spread of the virus. Or in other words, how to protect workers tasked with the unenviable job of asking shoppers to wear masks, keep 6 feet apart or wait their turn before entering a capacity-limited store.

The new CDC page gives a series of actions companies can take to protect workers, from installing panic buttons to having staff enforcing mask-wearing operate in teams of two. Above all, workers shouldnt put themselves in the direct line of danger, according to the federal agency that usually focuses on disease prevention.

7 a.m.: CDC now says people exposed to coronavirus may not need to be tested

The Centers for Disease Control and Prevention has changed its COVID-19 guidelines, no longer recommending testing for most people without symptoms, even if theyve been in close contact with someone known to have the virus.

The CDC had said that viral testing was appropriate for people with recent or suspected exposure, even if they were asymptomatic. Its previous guideline had said, Because of the potential for asymptomatic and pre-symptomatic transmission, it is important that contacts of individuals with (COVID-19) infection be quickly identified and tested.

The guideline now reads, "If you have been in close contact (within 6 feet) of a person with a COVID-19 infection for at least 15 minutes but do not have symptoms, you do not necessarily need a test unless you are a vulnerable individual or your health care provider or State or local public health officials recommend you take one."

The CDC guidelines still say people should get tested if they have symptoms and that someones health care provider may advise a COVID-19 test.

6:45 a.m.: COVID-19 tracking apps, supported by Apple and Google, begin showing up in app stores

They work by sharing anonymous Bluetooth beacons with nearby devices running the same software, tagging those that suggest extended and close contact associated with coronavirus spread, and saving the last 14 days of these records.

A positive test for COVID-19 in one of those states should include a code you enter into the app to upload its close-contact records to a health-authority server that then makes this anonymized data available to all these apps at their daily check-ins. If the app sees one of these reports match its saved list of close contacts, it warns of possible exposure and advises testing and quarantine.

Stay up to date with the latest information on coronavirus with our breaking news alerts.

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COVID-19 in Illinois updates: Heres whats happening Wednesday - Chicago Tribune

In a special virtual town hall, House Speaker Nancy Pelosi joined UC San Francisco Chancellor Sam Hawgood, MBBS, to discuss the role of science and science advocacy in shaping federal policy during a global pandemic, her leadership during these turbulent times, and lessons learned during her long tenure as the first and only female Speaker of the House of Representatives.

The Democratic Congresswoman, whose district covers a large portion of San Francisco, began the event on Tuesday by thanking UCSF for being a longtime partner and leader in science and health, both in San Francisco and worldwide. She recalled how decades earlier, UCSFs work in community-based research, prevention and care during the HIV/AIDS epidemic helped lead to the Ryan White CARE act.

Asked about the national response to the COVID-19 pandemic, Pelosi said denial and distortion of the reality of the pandemic had prevented a more coordinated national response. There are two things here at work that are not so good: One is an anti-science attitude, and the other is an anti-government attitude, she said. So lets just hope that rather than looking back, that we can look forward and hope that the public awareness of all of this will take us to a place where we have unity around science.

Hawgood said the pandemic had raised the question of how research universities like UCSF could contribute to preparing for and responding to future pandemics. History tells us that COVID-19 will definitely not be the last pandemic that we experience in our lifetimes, he said. And Ive been thinking and speaking to my peers across the country about how we could perhaps create a more unified research university academic response in working with the federal government to prepare the country for what we know will come.

Pelosi said that support from universities would be critical for legislative funding, such as when leading institutions came together in the 1990s to help double the National Institutes of Health budget.

The conversation then turned to how the pandemic has affected early career scientists and how the federal government could help. Hawgood described the risk of losing a generation of early career scientists, particularly women, due to lack of support for caregivers, as an existential challenge.

Pelosi said that a massive investment in childcare, more debt forgiveness for students, and expanding access to healthcare was needed on a national level.

She said that evidence-based research, including UCSFs work in COVID-19 testing in the Mission District which showed that the Latinx community was disproportionately affected by the disease was critical to getting Congress to recognize and redress health disparities.

Its immoral for us to proceed with this without recognizing the disparity in the communities of color you know that better than anyone, she said to Hawgood. But we have to kind of convey that to some people who, shall we say, are not as close to the public experience as some of the rest of us are.

We just have to recognize that if were going to crush this virus, which we must do, it is going to take resources scientifically spent, she said.

Finally, asked how her approach to leadership has changed over time and lessons learned for aspiring leaders, Pelosi said the best advice was to be authentic and to know your own motivations. But to women, especially, I say, be ready. Because I didnt think for a minute I would be going to Congress and never thought I would run for leadership, but I was ready.

Join our students, faculty, staff, alumni and supporters who stand up for values and policies fundamental to UCSFs mission of advancing health worldwide.

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Pelosi closed out her portion of the town hall with a question-and-answer segment, facilitated by Francesca Vega, Vice Chancellor of Community and Government Relations. Asked how the UCSF community could help the democratic process during the pandemic, Pelosi encouraged people to vote early. Right now the most important thing is for people to vote and to do so early enough so that their vote is counted as cast, she said.

The town hall continued with brief presentations by Keith Yamamoto, PhD, Special Advisor to the Chancellor for Science Policy and Strategy, and Natalie Alpert, Executive Director of Federal Government Relations, discussing the continued need for advocacy at the federal level.

Vega ended the event by bringing attention to various voter engagement efforts across UCSF, including the UCSF Votes initiative to update addresses for mailed ballots. Now is the ask of all of you, she said. And thats ensuring that our voice is indeed heard and that we are aware of all the opportunities that we have within the UCSF community to get engaged.

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House Speaker Nancy Pelosi Joins UCSF Town Hall to Discuss COVID-19, The Role of Science in Turbulent Times - UCSF News Services