Category Archives: Corona Virus

Cracking a window can help reduce the risk of indoor COVID transmission. Tanishka R./NPR hide caption

Cracking a window can help reduce the risk of indoor COVID transmission.

We regularly answer frequently asked questions about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions." See an archive of our FAQs here.

Over the past two years, we've all had a crash course in understanding how to prevent respiratory infections.

And we've learned that clean air via ventilation (i.e. fresh air flow via open windows and doors) and filtration (removing particles from the air with a filtering device) is really important for preventing COVID and other respiratory illnesses. It's something many experts knew all along. Now the public is catching on.

"Most of the air that we breathe in our lifetimes, we breathe indoors," says Richard Corsi, dean of the University of California Davis College of Engineering. And virus particles can linger in the air of unventilated places, increasing chances of getting sick.

Of course, those particles are not visible. "If people could see COVID in the air, it would make a lot more sense that what you need to do is clean the air in your house, exchange the air out, get fresh air in, improve ventilation so that you don't have a lot of air hanging around where other people can breathe it in and get infected," says Abraar Karan, an infectious disease physician at Stanford University.

So what can you do, as an individual at home, work, school, the gym to make the air cleaner and safer?

That's what we asked three experts.

What's the most basic way I can improve ventilation?

"Just getting more air flow into the house itself" helps, Karan says.

Open windows if you can, says Linsey Marr, professor of civil and environmental engineering at Virginia Tech. "Especially if you can open them on opposite sides of the room, so you get some cross-ventilation air coming in one and going out the other."

Even if you can't open all of the windows or can't open them all of the way, cracking windows a little bit is still very helpful. "They don't have to be wide open," Marr says.

Opening doors in shops and gyms also helps.

Marr worked with the owner of her local gym to improve ventilation early in the pandemic. The gym didn't have central air conditioning, so it couldn't rely on filtration. The easiest option was to open the doors. "I estimated how much benefit we would get from opening the doors and it was a ton, so we kept them open all winter," Marr says.

And there was no known transmission in the gym, says Marr, who advised the facility and kept track of COVID developments. Even when staff picked up the virus from other places, they don't seem to have passed it on at work, she says.

How can I improve my home filtration system?

If you have an HVAC system forced air heating/cooling/ventilation you can do two main things: run the fan more and upgrade the filter in order to catch more viral particles. Every HVAC system has replaceable filters that trap allergens and dust in the air and viral particles, too.

HVAC systems typically don't circulate air 24/7, only running part of the time when indoor temperatures drop or rise.

To make sure the air is getting filtered through the HVAC system, "if you can, run the fan continuously," Corsi says.

When the windows are open, you can also turn on other fans, like the bathroom and kitchen exhaust fans, to "help pull in that clean air from the outside and flush out the virus," Marr says. True, they can be noisy, but they can create some air flow by pulling the air up toward the ceiling and out of the room.

But when the windows are closed, most home HVAC systems simply recirculate the same indoor air, and the standard filters you use may not be effective at catching the tiny virus particles. So you can also look into replacing those filters with higher-quality options, like a filter with a minimum efficiency reporting value (MERV) of 13.

"If you can put a MERV-13 filter in your HVAC system and if the fan is recirculating continuously, then you're going to remove a lot of the aerosol particles," Corsi says.

The majority of school ventilation systems can also be upgraded to MERV-13 filters, he says.

But, he cautions, not all systems can handle the more effective filters, so it's a good idea to have an HVAC specialist inspect yours. You don't want your whole system to break down because it is too strained trying to pull air through incompatible filters.

HEPA is another kind of filter that is even more effective at removing viruses from the air, but most home HVACs don't work with HEPA filters. However, you can get a portable HEPA air purifier.

Can portable purifiers help?

"If it says HEPA, then it's going to filter out over 99% of the air that passes through it," Marr says. "In general, price goes with size in terms of how much air it moves through it." That means the bigger the unit, the more it costs.

It's important to find the right-sized unit to purify the air of a room in an hour or two. "There's a big difference between like a $50 one that can clean the air in a closet in a reasonable amount of time and a much bigger one that probably costs $200 or $300 and can clean the air in a bedroom in a reasonable amount of time," Marr says.

But, she says, there are cheaper options: for example, a do-it-yourself system involving a simple box fan a portable model that is typically square, has a propeller blade and can often fit in a window and MERV-13 filters. That "is actually more effective in many cases" than expensive HEPA units, says Marr.

Known as the Corsi-Rosenthal box after its creators, this DIY filter is easy and inexpensive to make: you create a square shape with four filters making up four sides and the fan, pointing up toward the ceiling, duct-taped on top. A piece of cardboard is taped to the bottom, and the homemade air purifier can be put anywhere a more expensive purifier might go.

Karan agreed. "The Corsi-Rosenthal box is basically a very low-cost way to get better ventilation."

Corsi also agreed and only partly because he was one of the inventors. When he first sketched out the idea early in the pandemic, he thought it might be a more cost-effective way to offer some air filtration. And it is the materials cost between $80 and $100.

"But I also didn't realize how incredibly effective it would be," Corsi says.

The boxes can be up to 2.5 times more effective than a $300 HEPA filtration unit, according to a study by other researchers.

No matter what portable filtration system you go with, make sure you position it carefully. Don't put the device in a corner, where it might just recirculate the same air. Keep your purifier a foot or so away from the wall for the same reason.

For larger rooms, two or more units can be a good idea, says Corsi, and you can put them across the room from each other so all the air in the room gets filtered well.

What about those little travel-size air filters? Any benefit?

You might have seen little HEPA purifiers about the size of a water bottle that you can stash in a purse or backpack. But do these small devices actually help?

"They should, and you'd want to direct the airflow," Marr says. "That can clean a small area of a small amount of air."

Just make sure you position the stream of clean air as close to your face as possible, setting it on the table or desk in front of you.

"If you're using them so that the air is right in front of you working at your desk and it's blowing the air up toward your face, it can reduce the concentrations of aerosols as you're breathing," Corsi says. "I wouldn't overemphasize their benefit, but there can be some benefit."

Such purifiers, which cost $30 to $50, can add another layer of protection while you're traveling, eating at restaurants or going to work or school.

Should I buy a CO2 monitor to check how good the ventilation is in different places I go?

"If you are a very cautious person, then that can be a good tool to help you gauge the risk in different spaces," Marr says.

CO2 monitors measure how much carbon dioxide is in the air. They can't tell how much COVID is in the air, but if there is a lot of CO2 in a space, then it's not well-ventilated.

"If the CO2 readout is under 1,000, that's pretty good. Anything over that is a warning sign that a space is poorly ventilated. At high rates, you're breathing in a lot of "other people's exhaled breath like drinking backwash," Marr says a nice way of saying drinking other people's spit while sharing a drink.

But these are loose rules that depend on how big the space is, how many people are there, whether they are masked, and how many cases are circulating in the community.

"I'm not a big fan of using CO2 monitors for very specific analysis," Corsi says. "They're not exact." But, he says, they are very useful for telling you when air quality is very good or very poor.

Does improving ventilation mean I can skip wearing a mask?

Improving air quality means you're less likely to get sick, because there's less virus in the air. But it's not 100% effective.

The experts all agreed that wearing a mask is one of the most effective ways to reduce your chances of getting sick even further, or if you're sick passing the virus on.

That means you should continue to mask up in indoor public places when cases are high, as they are in the U.S. right now.

And if you're sick or someone in your household is, wearing a mask can keep the virus from transmitting even at home.

"If you have someone who is sick, then you want to try, if it's reasonable, to have them wear a mask because that will reduce the amount [of virus] that gets into the air in the first place," Marr says. And it's a good idea to mask up when you are around them to protect yourself.

If a family member gets sick, will good ventilation keep me from catching COVID?

Yes! It may take a little work, but it is possible to stop transmission in the home.

As an infectious disease doctor, Karan has seen many patients who got sick at home from other family members. "That's the one thing that we have a really hard time with right now," he said.

But "I know that there are ways you can make the home safer I've done it myself," Karan says.

All of the advice the experts offer here is especially important to keep cases from spreading at home: open windows, have a fan blowing air out the windows, wear masks as source control, improve air filtration.

In the sick person's room, try to keep the door closed and face a fan to blow out the window, so "what they're emitting into their room doesn't get back into the rest of the house underneath the door and that kind of thing," Corsi says. "That'll actually go a long way to helping others in the house not get infected."

Should I press for better air quality in public spaces?

Sometimes you will be in places where you can't control air quality, like at work, school, restaurants or businesses.

But it doesn't hurt to ask what improvements such places have made to air quality. If you're worried about your kid returning to school in the fall, for instance, you can talk to the teacher about opening windows or using a portable air filter.

"We need to be holding businesses and then the government responsible," Karan says, to make sure they upgrade ventilation and establish new indoor air quality standards.

"It's not just about COVID," he says. Cleaning the air can reduce other respiratory viruses, like the flu and RSV, as well as mold and allergens.

It's easy to want to give up on COVID precautions, thinking this is the best we can do. But "people need to hear that there is a way to solve this problem," Karan says.

"We're not going to eliminate COVID. But what we can do is we can reduce COVID transmission significantly."

His verdict: "Ventilation is the way forward."

Melody Schreiber (@m_scribe) is a journalist and the editor of What We Didn't Expect: Personal Stories About Premature Birth.

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Tips to improve indoor air flow to reduce the risk of catching COVID : Goats and Soda - NPR

Health authorities need to act urgently to prepare for an autumn that could see further waves of Covid-19 cases spreading across the UK.

That is the clear warning from scientists and doctors after last weeks figures revealed another dramatic jump in cases. More than 2 million people across Britain were found to be infected for the week ending 24 June, a rise of more than 30% on the preceding week.

And while most experts said they expected the current wave driven by the Omicron BA4 and BA5 variants of the virus to peak in a few weeks, they also warned that it will inevitably be followed by another wave this autumn. Our current planning assumptions are that we will see at least one wave [of Covid] in the autumn-winter period once we have got through the current wave that were in right now, said Susan Hopkins, chief medical adviser at the UK Health Security Agency.

This view was backed by virologist Prof Lawrence Young of Warwick University. We need to prepare now for the autumn and winter months, when colder weather will drive people indoors, increasing the risk of infection, not only with new Covid variants but also with other respiratory virus infections.

A key component of these preparations will be the selection of those vaccines that will be best suited to counter the next big wave of the disease. Moderna, Pfizer and other drug companies are all working on vaccines that target different Omicron variants in different ways.

However, it will be up to the government to decides which of these versions will be best for country, said Prof Adam Finn of Bristol University. Officials are likely to be influenced not so much by data which shows which formulation looks the most promising in tackling the new variants as by the company which looks the most able to deliver the right number of vaccines on time.

This point was backed by Prof Francois Balloux, director of University College Londons Genetics Institute. Obviously, if you wait until the last moment, you will have the best chance of designing a vaccine that is best able to tackle the variant that is most widespread but you do not want to risk production failing to deliver sufficient doses in time.

Covid-19 is not the only health threat looming on the horizon, however. Scientists have warned that pandemic measures in particular the imposition of lockdown that were used to control Covid-19 are likely to have left the public vulnerable to other illnesses such as flu.

Finn said: Basically, we have not been infecting each other with flu for two years now and so we have not been building up immunity to it.

He added: As a result, we are now more vulnerable to flu and we are likely to see winter peaks, possibly big ones, this year. Indeed, flu may turn out to be a much bigger problem this winter than Covid-19. For this reason, I think it is crucial that we give the autumn Covid booster vaccine at the same time as we give the yearly flu vaccine for the over-65s.

Other factors that could affect the nations wellbeing this winter will include the cost of living crisis. It could inadvertently help to reduce the spread of the Covid-19 virus if people are less able to spend time in indoor crowded leisure spaces such as shopping centres and cinemas, said virologist Julian Tang of Leicester University. On the other hand, an inability to heat homes, together with an increased circulation of viruses will exacerbate hospitalisation rates from the disease.

Stephen Griffin of Leeds University also urged that a comprehensive plan for continued vaccination was needed for the UK, one that was aimed particularly at younger age groups.

While far less common than in adults, we can expect based on the previous wave that the very high prevalence of Omicron will sadly cause a considerable number of juvenile hospitalisations and long Covid, whose impact on a young life is soul-destroying.

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UK scientists warn of urgent need for action on vaccines to head off autumn Covid wave - The Guardian

To understand how Japan has fared better than most of the world in containing the dire consequences of the coronavirus pandemic, consider Mika Yanagihara, who went shopping for flowers this past week in central Tokyo. Even when walking outside in temperatures in the mid-90s, she kept the lower half of her face fully covered.

People will stare at you, Yanagihara, 33, said, explaining why she did not dare take off her mask. There is that pressure.

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Japan's secret to taming the coronavirus: peer pressure - The Japan Times

In yet another reflection of Oregons tentative transition out of the acute phase of the COVID-19 pandemic, health officials as of Friday will release coronavirus hospitalization totals only once a week, down from one update for every workday.

Considered a key metric throughout the pandemic, the Oregon Health Authoritys decision to provide fresh numbers only on Wednesdays reflects the states confidence that current trends dont augur a severe wave, as well as the agencys apparent desire to wind down work it believes is no longer necessary.

Oregons understanding of the pandemic has long been hitched to hospitalization counts. Predictions of surge peaks numbering in multiple thousands of occupied beds triggered anxious press events where officials begged Oregonians to save the health care system by masking up. Updates showing steady declines were served up as evidence that citizens efforts to protect each other had paid off.

But even as Oregons seventh COVID-19 wave continues with, as of Thursday, sharply rising hospitalizations, state officials and experts tracking pandemic trends dont believe hospitalizations are the vital data point they once were. Nor do they believe trends indicate the current surge will morph into a wave that could threaten the states health care system.

The Oregon Health Authority will continue to receive and track hospitalization statistics internally, a spokesperson for the agency said, and will resume more frequent publishing of the data if it deems it necessary.

As the pandemic changes, we are constantly balancing the response, information, and resource needs, spokesman Rudy Owens said in an emailed statement. The daily data release was necessary during the COVID-19 pandemic when information was quickly evolving and changing, and when the number of COVID-19 and other patients stretched the capacity of Oregons hospitals.

University of Washington Professor Ali Mokdad, who has been tracking and modeling cases and hospitalizations throughout the pandemic, said the health authoritys decision to reduce reporting is in line with what he has seen elsewhere.

Nationally and in Oregon, cases are leveling off or declining. Hospitalizations are still climbing because they always lag behind cases, but should soon start falling, too, Mokdad said.

Thats a lot of work on a daily basis, Mokdad said of the effort necessary to prepare and publish data.

The number of Oregonians hospitalized with positive coronavirus tests has climbed 26% in the past week but remains far below the nearly 1,200-person record during last years delta wave. Patients requiring intensive care remain comparatively low.

Coronavirus hospitalizations stood at nearly 420 as of Thursday, more than 90 occupied beds higher than what Oregons chief pandemic forecaster believed would be the current waves peak. Even now, that forecaster, Oregon Health & Science Universitys Peter Graven, has delayed release of new projections by a week in part because of difficulty incorporating new omicron subvariants into the model.

Like Mokdad, Graven was mostly unconcerned that OHA will now publish the data weekly as opposed to daily. In theory, he said, delayed data release could result in delayed behavior change, if people dont know about changes in hospitalization trends. But those potential issues could be dealt with if people know where else to find analogous data, including on Centers for Disease Control and Prevention and Oregon Association of Hospitals and Health Systems webpages, which dont precisely match previous state tallies but do indicate general trajectories.

That would require communication, Graven said of alternative sources needing to be more widely known.

And hospitalizations simply arent the statistic they once were. Graven said well over half of the COVID-19 patients at OHSU are incidental cases where the person is seeking care for something other than COVID-19 but tests positive upon admission, a pattern likely seen across hospital systems. He believes emergency department visits for COVID-like symptoms are becoming a more reliable indicator.

Along with the daily hospitalization count, the health authority will also stop daily releases of how many COVID-19 patients are in intensive care units and how many are on ventilators. The same applies to its hospitalization and hospital capacity statistics broken down by Oregon region and each facilitys seven-day hospitalization average.

OHA will continue to monitor these data, Owens said. If circumstances warrant it, OHA would resume more frequent public reporting of hospitalization data.

Fedor Zarkhin

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Oregon COVID-19 hospitalizations are rising; why did the state decide to stop disclosing daily patient number - OregonLive

Scrapping special Covid leave for NHS staff is completely unacceptable and will put patients and healthcare workers at significant risk, the British Medical Association has warned.

From 7 July the government plans to withdraw the special paid leave for Covid-related sickness and isolation for NHS staff in England, meaning they will revert to normal contractual sick pay arrangements.

Periods of absence due to Covid are fully paid for all NHS workers at the moment, regardless of their length of service.

Prof Raymond Agius, co-chair of the BMAs occupational medicine committee, said the decision to end it is completely unacceptable and will put patients and healthcare workers at significant risk.

NHS staff rely on this special Covid leave so that they can effectively recuperate and return to work safely, he said.

Removing this support is unsafe for patient care and pressuring people to return to work, which ultimately this will do, is appalling and demonstrates once again that the government doesnt care about the health and wellbeing of NHS staff.

He added that it will not only force many staff to continue working if symptomatic but may have a significant impact on their livelihoods if they develop long Covid.

At a time when we are seeing rapidly rising infection rates across the country, the risk to staff remains very high, Agius said. Yet the government has removed many of the routine protections within healthcare environments and are not offering adequate protection and support to doctors.

The Royal College of Nursing (RCN) also criticised the move.

Patricia Marquis, RCN England director, said: We know many of our members are suffering from long Covid, with their lives adversely affected, making them unable to work.

Facing the threat of losing full sick pay should they remain off sick from a condition some could argue is an occupational hazard, is neglectful and unfair. Its another indication of how little the UK government values its nursing staff.

Agius has called for a long-term strategy for dealing with Covid that is underpinned by adequate research, data collection and long-term investment which must include improved financial and wider support for those unable to work due to long Covid.

The BMA said it supports calls by the all-party parliamentary group for coronavirus for a compensation scheme for frontline workers.

The latest figures from the Office for National Statistics show an estimated 2.3 million people in the UK or one in 30 have the virus, a rise of 32% on the week before.

This increase is being driven by two new fast-spreading subvariants of Omicron called BA.4 and BA.5.

A spokesperson for the Department of Health and Social Care said: As we learn to live with Covid, we are withdrawing the temporary NHS staff sickness guidance that was put in place at the height of the pandemic, as part of plans to move back to the normal arrangements set out in the NHS terms and conditions.

This provides generous support for NHS staff with up to six months full pay and six months half-pay, depending on length of service.

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End of special Covid leave for NHS staff in England branded unacceptable - The Guardian

Whether heading for a scorching Mallorca beach or dancing beneath neon flags at a music festival, millions of people will be hoping for a Covid-free summer. But it isnt working out like that. With infections soaring once more, how can people make sure they stay safe and keep holiday plans on track?

Crowded spaces are ideal for spreading infection, and the dominant Omicron strains BA.4 and BA.5 are reported to evade antibody immunity effectively and are spreading about a third faster than previous variants. So you may feel dismayed at having to squeeze into your seat on the plane next to a stranger who keeps clearing their throat.

But planes have an unfair reputation as reservoirs of infection, experts say, and the actual risk is lower than in many indoor environments. For trains and other transport it depends on how busy they are and whether they have modern ventilation systems. Definitely consider wearing a mask in crowded areas, on public transport, and in the airport where theres a crowd, said Prof Ben Cowling, an epidemiologist at the University of Hong Kong. On the plane itself, ventilation is excellent so the risk is actually lower in your seat.

Masks may feel like a thing of the past to some in the UK, but this isnt the case in all countries, so check the rules before you set off. Italy, for instance, has retained a requirement to wear an FFP2 mask on public transport, with the exception of planes. Some airlines have also maintained a mandate.

You may also be motivated by wanting to be a responsible citizen, or by self-preservation. In this case, an FFP2 mask, which filters out potentially infectious particles in the air, is better than a cloth or disposable paper mask. If youre concerned, Id strongly advise a mask, said Dr Stephen Griffin, an associate professor at the University of Leeds. Its been turned into this token of freedom but its sensible and not much of a hassle. Its a no-brainer. Why spoil your holiday feeling rubbish?

This summer festivals are back, from Primavera in Spain to Tomorrowland, the worlds largest dance music festival, in the Belgium town of Boom. Do these huge gatherings lead to outbreaks? Anecdotally a lot of people reported testing positive for Covid after Glastonbury, but then 200,000 people attended and about one in 30 people in England had Covid last week. Its hard to pinpoint whether events like this make much difference to overall numbers at this stage.

If youre trying to assess your own risk, common sense applies: indoor, crowded places make transmission more likely. This scenario may be relevant at a festival or in a nightclub, but equally to highbrow holiday pursuits such as an afternoon in a stuffy museum or crowded art gallery, or exploring the vaults of a medieval church.

The one time Ive been abroad recently was a microbiology conference in Northern Ireland, where I got Covid, said Griffin. Id put all the provisions in place for the conference to be Covid safe, but came back with Covid. Im pretty sure I caught it in a restaurant.

Outdoor spaces are generally low risk and if anything people tend to have fewer social contacts while on holiday. Often people are with their families and theyre not usually making huge numbers of contacts outside their household, being off work and off school, said Prof John Edmunds, of the London School of Hygiene & Tropical Medicine. Actually being on holiday is not particularly high risk. Theres exceptions going clubbing and in bars but I dont want to stop people from having fun.

Again, check the rules for your destination. Many places in Europe no longer require you to arrive at the check-in anxiously clutching a bundle of paperwork, but testing requirements have not evaporated across the board. UK travellers to France need to show a vaccine certificate or show a negative result from a PCR test taken within 72 hours or an antigen test taken within 48 hours pre-departure. Spain and Portugal have similar requirements. Outside Europe there is a spectrum of strictness.

Beyond the rules, should travellers feel a moral duty to take a test? Edmunds says he does not want to tell people what to do, but notes that a well-established rule of medical screening is that theres no point in taking a test if youre not going to act on a positive result.

If someone tests themselves, finds out that theyre positive and goes anyway, whats the point of that? he said. Ideally if youre positive you shouldnt be getting on an aeroplane or public transport, you are putting other people at risk.

At a time when many are struggling financially, cancelling a flight is painful. But some airlines still have specific refund rules if a flight has to be changed due to Covid and offer more flexibility about changing flights than pre-pandemic.

In some places, including the US, vaccination is an absolute requirement. For other destinations, no vaccine means taking tests. For anyone eligible for a booster or children who havent had their first dose, it may be a particularly good time to get up to date. We know that booster doses give that top-up of protection against severe disease, but for a couple of months the dose also gives relatively good protection against infection, said Cowling. Its the time to get the jab if youre due for one.

Some countries, such as the UK, now have minimal legal isolation requirements. But France and Italy, for instance, still mandate seven days isolation after a positive test. At the extreme end, some countries require hotel or hospital-based quarantine. One of my PhD students ended up spending 18 days in an isolation room in hospital in Shanghai while travelling to visit family, said Cowling. It could be a different kind of holiday from what youd planned if you spend it in an isolation room.

Coronavirus cases have increased steeply in recent weeks, with the latest figures showing about 2.3m across the UK last week. But at this stage, with high overall prevalence and many countries scaling back surveillance, its hard to pinpoint with much certainty which countries are going to be the hotspots two months from now. Its difficult enough to predict whats going to happen in the UK, and weve got better data than everywhere else, said Edmunds. I dont think its possible to do that with any accuracy.

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Coronavirus and summer travel: how to stay safe on holiday - The Guardian

How likely is it for people to catch COVID from someone who is asymptomatic? Its not impossible and may be more common than people realize, health experts say.

With coronavirus cases currently stuck at a high level across California as fast-spreading offshoots of the omicron variant crowd out their competitors, that means the chances of getting COVID from an asymptomatic person are heightened.

An estimated 5%, or about 1 in 20, asymptomatic patients coming to UCSF for procedures unrelated to COVID are testing positive for the virus, said Dr. Bob Wachter, one of the universitys leading infectious disease experts.

UCSF asks patients who show symptoms of COVID to postpone their visits. Patients are routinely screened upon arrival, meaning that those who test positive are asymptomatic or pre-symptomatic.

Though its not a perfect sample pre-op patients are more likely to be older, have an illness and be vaccinated because theyre seeking other medical care its a convenient way to measure how many people in the community may be infected and go about their day-to-day lives, Wachter said.

Its been a very useful measure of something that otherwise is very hard to get your arms around, which is the probability that somebody standing next to you in line at a Safeway in the Bay Area would test positive for COVID if I could test them now, he said.

The math is sobering: At the current 5.5% rate of asymptomatic test positivity, In a group of 50 people, I think its a 95% chance that at least one person will be positive, Wachter said. On an airplane of 150 people, theres over 99% chance theres somebody on the plane who has it.

Asymptomatic infections are not uncommon. Many people who routinely test themselves for COVID have received positive test results, including Vice President Kamala Harris.

But guidance from the Centers for Disease Control and Prevention does not advise vaccinated people who have been exposed to COVID-19 to quarantine unless they develop symptoms.

So although many people may have come in close contact with someone diagnosed with the coronavirus, they may not take the same stringent measures for mitigating transmission that they would have two years ago.

We can get a sense there are probably more people asymptomatically infected with SARS-CoV-2 with omicron and its subvariants than there were with delta, said Dr. John Swartzberg, a UC Berkeley infectious disease expert.

A 2021 study in the JAMA Network Open medical journal found that as many as 60% of COVID infections were transmitted by an asymptomatic person.

From the public health standpoint, the public needs to understand you can feel perfectly well and be infected and transmit this virus, Swartzberg said.

Obviously, infected people who show signs of sickness may generate more aerosols by sneezing or coughing. But while asymptomatic people shed less virus, they can still spread the virus without knowing theyve got it.

Fortunately, someone who is vaccinated has less viral load in nasal and throat secretions and vaccination rates for most Bay Area counties are among the highest in the nation, according to state and federal data.

But its still possible to have high viral load without showing signs of sickness, said Dr. Abraar Karan, an infectious diseases expert at Stanford.

So what is responsible for driving the current surge? The recent variants of the coronavirus are many times more infectious than the original one back in 2020 and even more contagious than the omicron version last winter. Combine that with a relaxation of public health mandates on local, state and federal levels, and the opportunities to spread the virus, whether by symptomatic or asymptomatic people, are many times higher.

People who have very mild symptoms, such as a cough or sniffles, and who dont know that they have COVID may also be going out under the assumption that they have a cold or allergies, Wachter said.

How can people protect themselves? The high asymptomatic test rate combined with the plateau in infections in recent weeks has public health experts recommending outdoor dining, voluntary indoor masking and opting for a road trip versus a flight.

I prefer not to take those risks, Wachter said.

Gwendolyn Wu (she/her) is a San Francisco Chronicle staff writer. Email: gwendolyn.wu@sfchronicle.com

Excerpt from:

What are the odds you'll get COVID from someone who's asymptomatic? Here's how to measure the risk now - San Francisco Chronicle

New SARS-CoV-2 variants are expected since the virus is continually evolving. The Alpha variant first appeared in early 2021, and the Delta variant emerged later that summer. The Omicron variant, which spread quickly throughout the nation in late 2021 and early 2022, is now the most common variation circulating in the US today.

New research shows that people with weakened immune systems are more likely to get chronic infections and produce virus variants that bear multiple antibody-resistant mutations. However, there is good news. While many distinct variations develop in immunocompromised individuals, their likelihood of spreading is small.

Co-author Adi Stern, a professor at Tel Aviv University. Credit: Tel Aviv University

According to recent research from Tel Aviv University, immunosuppressed chronic COVID-19 patients are thought to be the source of several SARS-CoV-2 variants. The researchers hypothesize that a compromised immune reaction, particularly in the lower airways of these chronic patients, may delay complete recovery from the virus and cause the virus to evolve often during the course of prolonged infection. In other words, the researchers explain that the viruss unrestricted survival and reproduction in the body of the immunosuppressed patient result in the emergence of numerous variants.

Furthermore, the variations reported in chronically sick COVID-19 patients had many of the same mutations in their development as those found in variants of concern for severe illness, notably those linked with evading disease-killing antibodies. The new findings show that, although rapidly-spreading variations are rare among the numerous strains harbored by immunocompromised people, the likelihood increases and they do arise when global infection rates boom.

The study was led by Prof. Adi Stern and Ph.D. student Sheri Harari of the Shmunis School of Biomedicine and Cancer Research at the Wise Faculty of Life Sciences at Tel Aviv University, in collaboration with Dr. Yael Paran and Dr. Suzy Meijer of Tel Aviv Sourasky Medical Center (Ichilov). It was published in the prestigious journal Nature Medicine on June 20th, 2022.

Prof. Stern explains that since the outbreak of COVID-19, the rate at which the virus evolves has been somewhat puzzling. During the first year of the pandemic, a relatively slow but constant rate of mutations was observed. However, since the end of 2020, the world has witnessed the emergence of variants that are characterized by a large number of mutations, far exceeding the rate observed during the first year.

Various scientific hypotheses about the link between chronic COVID-19 patients and the rate of the accumulation of mutations have surfaced, but nothing definitive has been proven yet. In this new study, Prof. Stern and the team shed light on some pieces of this complex puzzle and try to answer the question of how variants are formed.

Prof. Stern explains: The coronavirus is characterized by the fact that in every population, there are people who become chronically infected. In the case of these patients, the virus remains in their body for a lengthy period of time, and they are at high risk for recurrent infection. In all of the cases observed so far, these were immunocompromised patients part of their immune system is damaged and unable to function. In biological evolutionary terms, these patients constitute an incubator for viruses and mutations the virus persists in their body for a long time and succeeds in adapting to the immune system, by accumulating various mutations.

The study involved an examination of chronic COVID-19 patients at the Tel Aviv Sourasky Medical Center (Ichilov Hospital). According to Prof. Stern, the results reveal a complex picture; on the one hand, no direct connection was found between anti-COVID-19 drug treatment and the development of variants. On the other hand, the researchers discovered that it is likely the weakened immune system of immunocompromised patients that creates pressure for the virus to mutate.

In fact, the researchers found that there were chronic patients who showed a pattern of apparent recovery, followed by recurring viral infection. In all of these patients, a mutated form of the virus emerged, suggesting that recovery had not been achieved; this is partially reminiscent of the modus operandi of HIV following inadequate drug treatment.

Upon closer examination of some patients, the researchers found that when such a pattern of apparent recovery is observed (based on negative nasopharyngeal swabs), the virus continues to thrive in the lungs of the patients. The researchers, therefore, suggest that the virus accumulates mutations in the lungs, and then traverses back to the upper respiratory tract.

Prof. Stern concludes: The complexity of coronavirus evolution is still being revealed, and this poses many challenges to the scientific community. I believe that our research has succeeded in peeling back a missing layer of the big picture, and has opened the door for further research efforts to discover the origins of the various variants. This study highlights the importance of protecting immunocompromised individuals, who are at high risk for the virus, yet may also be an incubator for the formation of the next variant, posing a risk to all of us.

Reference: Drivers of adaptive evolution during chronic SARS-CoV-2 infections by Sheri Harari, Maayan Tahor, Natalie Rutsinsky, Suzy Meijer, Danielle Miller, Oryan Henig, Ora Halutz, Katia Levytskyi, Ronen Ben-Ami, Amos Adler, Yael Paran, and Adi Stern, 20 June 2022, Nature Medicine.DOI: 10.1038/s41591-022-01882-4

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What Is the Origin of COVID-19 Variants Like Omicron? - SciTechDaily

The illness was mysterious. A 25-year-old graduate student had been hospitalized with a high fever, muscle and joint pain, a stiff neck, fatigue, sores in her throat, and a metallic taste in her mouth. She soon developed an angry rash. To make the diagnosis, her doctors had an important data point to consider: Days earlier, the woman had returned to the United States from a field expedition in South Sudan and Uganda, where she had been capturing and collecting the blood and tissue of bats and rodents. That information proved critical and is newly relevant given concerns that the pandemic may have come from a research accident. Three days after she was admitted to the hospital in 2012, tests determined that the student was infected with a novel virus that infects a type of fruit bat that lives in the rural areas of Uganda.

The graduate student recovered and left the hospital two weeks later. But the incident, which was written up in the journal Emerging Infectious Diseases in 2014, proved scientifically important. Not only did it allow for the identification of the Sosuga virus a paramyxovirus named for Southern Sudan and Uganda and the knowledge that the bat virus can infect and sicken people, the womans infection also pointed to the dangers posed by the kind of research she was doing: trapping, manipulating, and dissecting animals suspected of being infected with novel disease-causing viruses.

Biosafety experts have long worried over the possibility that scientists seeking dangerous viruses in the wild could inadvertently become infected in the course of either capturing or coming into contact with the saliva, urine, or feces of the animals. The case of the Sosuga virus shows that those concerns are well founded.

Virus hunter Michael Callahan, an infectious disease doctor who has worked for federal agencies on global disease outbreak and the tracking of wildlife pathogens, has vividly described the high risks faced by field researchers. Squirming, clawed and toothy animals bite and scratch during collection of body fluids. Teeth and talons easily penetrate the thin gloves required to maintain dexterity when handling fragile wildlife, he wrote in Politico in 2021. The fact that researchers are not infected every time they do a field collection is a question that continues to stump us.

With more than 6 million people now dead from Covid-19, the catastrophic potential of a researcher becoming infected with a wildlife pathogen has become inescapable. While the origins of the current pandemic are stillunclear, it remainspossible that virus hunting could have been the cause. Rocco Casagrande, a biochemist whowas hired bythe National Institutes of Healths Office of Science Policy to assess the risks of gain-of-function research, thinks anatural spillover of the virus from animals to people, a lab accident, or what he calls a prospecting based accident are equally likely potential causes of the initial outbreak.He imagined the prospecting scenarioas theresearchers in Wuhan looking for bat viruses found one and got infected outside of the lab.

Even as the very real chance remains that the search for new viruses led to this cataclysmic event, scientists hoping to prevent viral outbreaks continue toseek out newbat coronaviruses and other potential pandemic pathogens around the world.

The search for pathogens that infect animals is driven by the desire to prevent and prepare for their possible transmission to people. But that work, which spans the globe and is funded in large part by the U.S. government, can sometimes result in human infection exactly the outcome it is meant to prevent.

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Virus hunting or wildlife disease ecology, as DeeAnn Reeder prefers to call it is a field that has come under increasing scrutiny during the Covid pandemic. For Reeder, a professor of biology at Bucknell College who led the 2012 expedition on which the graduate student was infected, one of the central purposes of her research in Africa on bats immune responses to viruses is to understand how humans might react to the same infectious agents, knowledge she says can protect us if the pathogens jump from animals to humans. If you want to understand how to survive a coronavirus, or if you want to understand how to survive a filovirus Ebola fits within that context you need to ask the bats because they know how to do it, said Reeder.

Reeder, who put up her first bat net in South Sudan in 2008, continues to do wildlife research in Uganda. No one has previously reportedher connection to the work. Ive never been contacted by a reporter on that particular story, Reeder said, after being asked whether the Sosuga virus infection occurred during research on one of her projects. Ive always been surprised about that. Reeder would not confirm the identity of the researcher on her project who was sickened, citing privacy concerns.

The Sosuga case shows thatconcerns about viral transmission from wild animals to researchersare not just theoretical. It is still unclear exactly how the infection occurred. While the graduate student only occasionally used protective gear when working with animal specimens, when she visited the bat caves she wore a paper Tyvek suit thats become the hallmark of virus hunters, gum boots, bite-resistant gloves, and even an air-powered respirator known as a PAPR that looks like an astronauts helmet. The researcher did not report being bitten or scratched by any of the animals she encountered.

Maybe outside the cave before they put the respirators on, she leaned against a rock that had been peed on, because we know that it could be in the kidneys of this particular bat species, said Reeder. But thats just conjecture, which is the scary part.

CDC scientists approach Bat Cave in Queen Elizabeth National Park on Aug. 25, 2018, in Uganda.

Photo: Bonnie Jo Mount/The Washington Post via Getty Images

Reeder carries a card in her wallet she hopes medical professionals will read should she herself wind up in the emergency room with a mysterious infectious disease someday. It says, Attention medical personnel: I study wildlife disease. Heres all the things you should test me for should I present to you in the emergency room, she explained.

Reeder describes herself and other researchers in her field as a little bit like cowboys and cowgirls we go to a foreign place and we catch exotic things. Yet shes grown increasingly cautious during her years in the field. When I first started this work, nobody was wearing PPE. It just wasnt a thing, she said. I thought we were good if I didnt have my coffee cup on the same table when I was doing dissections.

Despite her growing concern about biosafety, Reeder has still had a few worrisome interactions with bats herself. I had one bite me. That big canine tooth went right into my knuckle, and for like two years, whenever it was cold, my knuckle would hurt, she recently recalled. And in 2017, Reeder was stuck with a needle that had just come out of a bat that she knew could have carried the deadly Ebola virus.

I was like, wow, OK. So I make notes in my notebook, started counting 21 days, which is the incubation period for Ebola, said Reeder. Im mostly kind of flippant about that. But I can tell you I knew when that 21 days was up.

Yet even after these experiences, Reeder said there are rare times when she still eschews personal protective equipment: If Ive got a live bat, I cant go into a village and show up in my space suit.

Most interactions with bats dont cause disease. But the risk of viral infections remains and many professional scientists and hobbyists dont even take the basic precautions to protect themselves from it, according to a study published in 2021 in Biodiversity Data. The authors, who include Reeder, analyzed 759 of the more than 43,000 photos of people holding bats taken that were uploaded since the 1980s to iNaturalist, a popular biodiversity tracking app. While the percentage of the apps users who wore gloves when they held bats has increased over time, even in 2021, less than half of the people holding bats, both dead and live, were wearing gloves.

This lack of adherence to even minimal biosafety practices may jeopardize both the safety of the bat and the handler, the authors concluded.

Reeder said those who continue to openly flout the recommendations to wear protective gear are increasingly met with disapproval within her scientific community. If somebody is at a conference and they show pictures of themselves in the field not wearing a face mask, and not wearing gloves, even latex gloves, theres a little bit of criticism, she said. A sort of public shaming.

As a recent report from the World Health Organization makes clear, there is still no definitive proof of how Covid-19 originated. And an infection that occurred during the collection of dangerous new coronaviruses frombats is among the possible explanations forthe initial coronavirus outbreak in Wuhan in 2019. There is no question that the National Institutes of Health, which indirectly funded bat coronavirus research at the Wuhan Institute of Virology in China, is still struggling to fully understand the biosafety precautions taken around that research. Yet the U.S. government continues tosupport similar research around the world, with grants to numerous organizations including EcoHealth Alliance, the NIH grantee that worked with the Wuhan institute.

EcoHealth Alliance, a nonprofit research group based in New York, received a $3.1 million grant in 2014 from the NIH, some of which was spent on the collection of novel bat coronaviruses in rural China. Specifically, the organization awarded a subgrant of some $750,00 to researchers at the Wuhan Institute of Virology. In April 2020, at the request of President Donald Trump, the NIH suspended that grant. But four months later, the NIH awarded EcoHealth Alliance another, larger grant. (The Intercept obtained the grant documents via a Freedom of Information Act lawsuit with the NIH.)

Like the first grant, the second grant titled Understanding the Risk of Zoonotic Virus Emergence in Emerging Infectious Disease Hotspots of Southeast Asia pays for the collection of what it calls high zoonotic potential viruses from remote locations in Southeast Asia. It also funds experiments involving the infection of humanized mice with hybrid viruses created from the new viruses, which are designed to gauge the threat those viruses pose to humans. The grant is funded through 2025.

Other branches of the U.S. government also continue to fund the collection and study of novel viruses that could infect humans, including DEEP VZN, a $125 million project funded by the U.S. Agency for International Development, and the Ecology and Evolution of Infectious Diseases Program, which is jointly funded by NIH, the U.S. Department of Agriculture, and the National Science Foundation.

Everybody has been just kind of winging it.

Despite concerns about biosafety lapses in U.S.-funded research in Wuhan and a lack of oversight from both NIH and EcoHealth Alliance, thereareno agreed-upon standards for ensuring the safety of ongoing research.

There is currently very little biosafety guidance specifically for this kind of biological fieldwork, Filippa Lentzos, a biosecurity expert who works at Kings College London, wrote in an email to The Intercept. This is a major gap in biorisk management that urgently needs to be addresses both nationally and internationally, not least because this kind of fieldwork is on the rise.

During the pandemic, David Gillum, assistant vice president for environmental health and safety at Arizona State University, began meeting with a small group of experts over Zoom to discuss biosafety practicesfor researchers working with bats in the wild. Its guidance on what to wear as personal protective equipment, what vaccinations should you have before you go to a certain area, what medications should you bring, said Gillum.The groups recommendations are expected to published soon in the journalApplied Biosafety. Up until now, he said, Everybody has been just kind of winging it.

While Gillum and other biosafety experts say they hope national and international field work guidelines will ultimately be put in place, they expect the process to take years.

In the absence ofsuch clear recommendations and with institutions coming up with their own varied approaches to biosafety a range of researchersfacethe riskof infection from pathogens in wildlife, according to Casagrande,the biochemist. And that includes people specifically trying to find viruses but also people who arent, he said. Plenty of biologists who work with wildlifealso dont take precautions. And many times they get infected by things.

Researchers from the Thai Red Cross Emerging Infectious Diseases Health Science Center take a saliva swab from a bat caught at Khao Chong Pran Cave, inside a makeshift lab set up nearby during a catch and release program in Photharam, Thailand, on Dec. 11, 2020.

Photo: Andre Malerba/Bloomberg via Getty Images

While the pandemic has sparked a debate about the safety of studying dangerous viruses, most scientists agree on the need for at least some viral surveillance. To Reeder, the emergence of SARS-CoV-2 has made the value of her work only clearer. Our understanding of the extraordinary diversity of SARS-related coronaviruses in bats in Southeast Asia is really critical for our pandemic preparedness, for our ability to predict whats going to bind to human receptors, she said. We need to understand whats there.

As she sees it, that benefit is worth whatever risk it entails. And, in the case of the graduate student infected with the Sosuga virus, the cost wasnt great. The virus didnt kill her and, critically, it didnt spread from her to other people. Looking ahead, Reeder said, improved adherence to protective gear should protect against future viral jumps from animals to researchers.

I think you just do your best, right? said Reeder. You try to look for those gaps. You put your gloves on, then you put your Tyvek suit on over those, and then you take Gorilla tape, and you wrap your wrist with Gorilla tape to make sure that you dont have a gap as you move your arms, she said, noting that colleagues in the field tend to help one another. You can call each other out on stuff. You know, Hey, it looks like your mask has slipped. But its never perfect, and this case just sort of illustrates that for us.

The case of the woman who was infected working with bats in Uganda also taught Reeder how, at least that time, luck was on her side: This could have been really, really ugly.

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Infection of Wildlife Biologist Highlights Risks of Virus Hunting - The Intercept

Continuing their rapid march across the United States, the Omicron subvariants known as BA.4 and BA.5 have together become dominant among new coronavirus cases, according to new estimates on Tuesday from the Centers for Disease Control and Prevention.

As of the week ending Saturday, BA.4 made up 15.7 percent of new cases, and BA.5 was 36.6 percent, accounting for about 52 percent of new cases in the United States, numbers that experts said should rise in the weeks to come.

The statistics, released Tuesday morning, are based on modeling and can be revised as more data comes in, which happened in late December, when the agencys estimates missed the mark.

In the less than six months since BA.4 and BA.5 were first detected in South Africa, the two subvariants appeared in the United States to be overtaking two earlier Omicron subvariants, including BA.2, which was the prevailing version for a time earlier this spring. The other, BA.2.12.1, was dominant alone as of the week ending June 18, according to C.D.C. estimates. Over the winter, the form of Omicron that first emerged in the United States sent case counts soaring. Before that, the Delta variant had been dominant in the United States since early summer.

BA.4 and BA.5 exhibit the qualities of escape artists, able to elude some of the antibodies produced after coronavirus vaccinations and infections, including infections caused by some earlier versions of Omicron. That may explain why these subvariants have spread even faster than others in the Omicron family. But there is not yet much evidence that they cause more severe disease.

The BA.4 and BA.5 subvariants have been detected throughout the world, and they fueled a surge of cases in South Africa in the spring, despite widespread pre-existing immunity to the virus. The wave was not as high as South Africas earlier waves, and deaths did not rise as sharply. Just last week, South Africa repealed its rules that required masks in indoor public spaces.

In recent weeks, more than 100,000 new coronavirus cases have been reported each day on average in the United States, according to a New York Times database, a figure that captures only a portion of the true number. Many infections go uncounted in official reports. Some scientists estimate that the current wave of cases is the second-largest of the pandemic.

As of Monday, hospitalizations in the United States were up 6 percent in the last two weeks, to an average of more than 31,000 each day, according to federal data. New deaths have stayed below 400 per day on average, data from state and local health agencies show. That is a fraction of the thousands seen daily during the winter Omicron peak.

But in my mind, 250 deaths a day is still too many, Dr. Rochelle Walensky, the C.D.C. director, said last week in Aspen, Colo. The deaths that were seeing are generally among people who are either elderly, frail, many comorbidities, whove had a lot of vaccine shots or people who are unvaccinated.

Many Americans with risk factors have said that they feel ignored and abandoned as their governments and neighbors have sought a return to normal.

As always, the spread of the virus is a regional affair. In the Northeast and Midwest, known cases have been declining for weeks, while in the South and West, cases are increasing.

Across the nation, public health rules continue to be lifted, including the ending on Saturday of an indoor mask mandate for Alameda County, the San Francisco Bay Areas second-most populous county. In New York City, Broadway theaters save for one are retiring their mask requirements beginning Friday. Even the longstanding requirement to test for the coronavirus before flying to the United States from abroad was dropped this month.

While the recent availability of vaccines for children ages 6 months to 5 years was a welcome development for many parents and day care centers, experts do not expect the availability of pediatric doses to change the overall trajectory of the pandemic in the United States.

The natural waning of vaccine protection against infection over time, along with the immune evasiveness of BA.4 and BA.5, might explain why these subvariants have been able to spread quickly. It has also lent urgency to the development of Omicron-targeted boosters. While vaccine manufacturers have raced to develop these, they are based on other versions of Omicron, and it was not yet clear how well they could protect against infection with BA.4 and BA.5.

Preliminary evidence from laboratory research suggests that unvaccinated people who were infected with the version of Omicron, known as BA.1, might be easily reinfected by BA.4 or BA.5. Vaccinated people are likely to fare somewhat better, the study suggests.

But as the virus evolves, no one can tell whether retooled vaccines could become outdated by the time they become available.

What we dont know is whats going to happen with a new vaccine in the fall, Dr. Walensky said while in Aspen. I do think were going to need more vaccines.

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The Omicron subvariants BA.4 and BA.5 have together become dominant in the U.S., the C.D.C. estimates. - The New York Times