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COVID-19 Daily Update 4-18-2021 – West Virginia Department of Health and Human Resources

Posted: April 19, 2021 at 6:50 am

The WestVirginia Department of Health and Human Resources (DHHR) reportsas of April 18, 2021, there have been 2,611,346total confirmatory laboratory results receivedfor COVID-19, with 148,887 total cases and 2,785 total deaths.

DHHR hasconfirmed the deaths of a 63-yearold female from Kanawha County, an 81-year old male from Kanawha County, a 92-yearold female from Harrison County, a 63-year old female from Berkeley County, andan 88-year old male from Mineral County.

We are saddenedto report the loss of more West Virginians, said Bill J. Crouch, DHHR CabinetSecretary. We extend our sympathies to the affected families.

CASES PER COUNTY: Barbour(1,347), Berkeley (11,601), Boone (1,881), Braxton (861), Brooke (2,121),Cabell (8,610), Calhoun (271), Clay (454), Doddridge (548), Fayette (3,260),Gilmer (735), Grant (1,239), Greenbrier (2,615), Hampshire (1,715), Hancock(2,713), Hardy (1,436), Harrison (5,405), Jackson (1,912), Jefferson (4,345),Kanawha (14,083), Lewis (1,137), Lincoln (1,396), Logan (3,003), Marion(4,151), Marshall (3,274), Mason (1,935), McDowell (1,484), Mercer (4,565),Mineral (2,765), Mingo (2,421), Monongalia (8,949), Monroe (1,072), Morgan(1,088), Nicholas (1,507), Ohio (4,046), Pendleton (686), Pleasants (832),Pocahontas (640), Preston (2,809), Putnam (4,815), Raleigh (6,121), Randolph(2,494), Ritchie (659), Roane (579), Summers (765), Taylor (1,196), Tucker(523), Tyler (670), Upshur (1,816), Wayne (2,819), Webster (455), Wetzel(1,195), Wirt (381), Wood (7,575), Wyoming (1,912).

Delays maybe experienced with the reporting of information from the local healthdepartment to DHHR. As case surveillance continues at the local healthdepartment level, it may reveal that those tested in a certain county may notbe a resident of that county, or even the state as an individual in questionmay have crossed the state border to be tested. Such is the case of Grant and Taylor counties in thisreport.

West Virginians may pre-registerfor their COVID-19 vaccination at vaccinate.wv.gov. TheCOVID-19 dashboard located at http://www.coronavirus.wv.gov showsthe total number of vaccines administered. Please see the vaccine summary tabfor more detailed information.

Free pop-up COVID-19 testing is availabletoday in Boone, Doddridge, and Nicholas counties, and on Monday, April 19 in Barbour,Berkeley, Boone, Jefferson, Lincoln, Mineral, Monongalia, Morgan, Nicholas,Ohio, Wayne, and Wirt counties:

Boone County

1:00 PM 4:00 PM, Boone County HealthDepartment, 213 Kenmore Drive, Danville, WV (pre-registration:https://wv.getmycovidresult.com/)

Doddridge County

10:00 AM 5:00 PM, Doddridge County Park,1252 Snowbird Road, West Union, WV

Nicholas County

11:00 AM 3:00 PM, Richwood City Hall, 6White Avenue, Richwood, WV (pre-registration:https://wv.getmycovidresult.com/)

April 19

Barbour County

9:00 AM 11:00 AM, Barbour County HealthDepartment, 109 Wabash Avenue, Philippi, WV

1:00 PM 5:00 PM, Junior Volunteer FireDepartment, 331 Row Avenue, Junior, WV

BerkeleyCounty

10:00 AM 5:00 PM, 891 Auto Parts Place, Martinsburg,WV10:00 AM 5:00 PM, Ambrose Park, 25404 Mall Drive, Martinsburg, WV

Boone County

12:00 PM 6:00 PM, Boone County HealthDepartment, 213 Kenmore Drive, Danville, WV

JeffersonCounty10:00 AM 6:00 PM, Hollywood Casino, 750Hollywood Drive, Charles Town, WV

12:00PM 5:00 PM, Shepherd University Wellness Center Parking Lot, 164 UniversityDrive, Shepherdstown, WV

LincolnCounty

9:00 AM 3:00 PM, Lincoln County Health Department, 8008 Court Avenue, Hamlin, WV (pre-registration:https://wv.getmycovidresult.com/)

MineralCounty

10:00AM 6:00 PM, Mineral County Health Department, 541 Harley O. Staggers Drive,Keyser, WV

MonongaliaCounty

9:00AM 11:00 AM, WVU Recreation Center, lower level, 2001 Rec Center Drive,Morgantown, WV

Morgan County

11:00 AM 4:00 PM, Valley Health WarMemorial Hospital, 1 Health Way, Berkeley Springs, WV

Nicholas County

10:00 AM 2:00 PM, St. Lukes UnitedMethodist Church, 18001 West Webster Road, Craigsville, WV (pre-registration:https://wv.getmycovidresult.com/)

OhioCounty

11:00AM 4:00 PM, Wheeling Island Fire Station, Station #5, 11 North Wabash Street,Wheeling, WV

WayneCounty

10:00AM 2:00 PM, Wayne Community Center, 11580 Rt. 152, Wayne, WV

WirtCounty

11:00AM 5:00 PM, Matheny Funeral Home, 448 Juliana Street, Elizabeth, WV

For more free COVID-19 testingopportunities across the state, please visit https://dhhr.wv.gov/COVID-19/pages/testing.aspx.

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COVID-19 Daily Update 4-18-2021 - West Virginia Department of Health and Human Resources

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Covid-19: Fauci Expects Decision on Johnson & Johnson Vaccine This Week – The New York Times

Posted: at 6:50 am

Heres what you need to know:Dr. Anthony S. Fauci, the nations leading infectious disease expert, said he expected a panel to recommend some sort of either warning or restriction on the use of Johnson & Johnsons Covid-19 vaccine.Credit...Pete Marovich for The New York Times

A decision about whether to resume administering the Johnson & Johnson Covid-19 vaccine should come this Friday, when an expert panel that is advising the Centers for Disease Control and Prevention is scheduled to meet, according to Dr. Anthony S. Fauci, the nations leading infectious disease expert.

I think by that time were going to have a decision, Dr. Fauci said on Sunday on the CNN program State of the Union.

I dont want to get ahead of the C.D.C. and the F.D.A. and the advisory committee, he added, but said he expected experts to recommend some sort of either warning or restriction on the use of the vaccine.

Federal health agencies recommended putting injections of the vaccine on pause on Tuesday while they investigated whether it was linked to a rare blood-clotting disorder. All 50 states,Washington, D.C., and Puerto Rico have stopped administering the vaccine.

The unusual disorder includes blood clots in the brain combined with low levels of platelets, blood cells that typically promote clotting. The combination, which can cause clotting and bleeding at the same time, was initially documented in six women between the ages of 18 and 48 who had received the vaccine one to three weeks prior. One of the women died, and another was hospitalized in critical condition.

This pattern has prompted questions about whether vaccinations could resume in men or in older people. But because women fill more of the health care jobs for which vaccinations have been prioritized, it is not clear how much the problem might affect men, too. On Wednesday, two more cases of the clotting disorder were identified, including one in a man who had received the vaccine in a clinical trial.

About 131.2 million people in the United States have received at least one dose of a Covid-19 vaccine, or roughly half of all American adults, according to the C.D.C. More than seven million of those people have received Johnson & Johnsons shot. If there is a link between the vaccine and the clotting disorder, the risk remains extremely low, experts say.

Its an extraordinarily rare event, Dr. Fauci said on the ABC program This Week. The pause was intended to give experts time to gather more information and to warn physicians about the clotting disorder so that they can make more informed treatment decisions, said Dr. Fauci, who appeared on four TV news programs on Sunday morning.

European regulators have been investigating similar cases of the unusual clotting disorder in people who have received the AstraZeneca vaccine. Some European countries have since stopped administering that vaccine altogether, while others have restricted its use in younger people.

Dr. Fauci also expressed frustration that a disturbingly large proportion of Republicans, who have been critical of many coronavirus restrictions, have expressed a reluctance to be vaccinated. Its almost paradoxical, he said. On the one hand they want to be relieved of the restrictions, but on the other hand, they dont want to get vaccinated. It just almost doesnt make any sense.

The New York Times examined survey and vaccine administration data for nearly every U.S. county and found that both willingness to receive a vaccine and actual vaccination rates to date were lower, on average, in counties where a majority of residents voted to re-elect former President Donald J. Trump in 2020.

Dr. Fauci said that he expected all high school students to become eligible for vaccination before school begins in the fall, with younger children eligible no later than the first quarter of 2022.

Michigan may finally be starting to turn a corner, after enduring more than a month of explosive coronavirus spread, Gov. Gretchen Whitmer said on Sunday.

We are starting to see the beginning of what could be a slowdown, Ms. Whitmer said on the NBC program Meet the Press.

Michigan is still averaging more than 7,600 new cases a day, according to a New York Times database more than at almost any time during the holiday surge. But that figure hasnt increased by more than a few hundred for more than a week, suggesting that the current wave may be cresting. Hospitalizations and deaths, which usually lag behind new cases by several weeks, are still rising.

Governor Whitmer cited the states continuing mask mandates, capacity restrictions and her call for a voluntary two-week pause in indoor dining, youth sports and in-person schooling as factors that may have helped combat the surge. She defended her decision to not try to go further, with the kinds of closure and stay-at-home orders imposed early in the pandemic.

Fifteen months ago, we didnt know the virus could be contained by the simple act of wearing a mask, she said on Sunday. We didnt have the testing or the vaccines. Were now in a much different position.

The governor suggested that she probably could not have locked the state down again, in any case. In the waning months, I have been sued by my Legislature, I have lost in a Republican-controlled Supreme Court, and I dont have all of the exact same tools, she said.

Despite those things, we still have some of the strongest mitigation measures in the country, she added. Were still doing what we can.

Ms. Whitmer lauded the Biden administration for helping the state get more therapeutics and boots on the ground to help staff vaccination sites and hospitals. She said she had asked the federal government for even more help.

She said her states initial success in limiting the viruss spread had, paradoxically, made it more vulnerable to a later surge.

What we know is that our success at keeping Covid spread down for such a long period of time has left us with vast reservoirs of people who dont have antibodies, she said. That was a good thing until the variants came on stage.

She said that seasonal travel patterns, notably spring-break vacations and the return of snowbirds who spent the winter in warm states like Florida, had also played a role in seeding outbreaks in Michigan.

Health officials in Colorado are warning about another wave of infections as new coronavirus cases in the state jump to levels not seen since January and as counties start to loosen virus restrictions.

The state is reporting an average of 1,661 new cases a day, up by 18 percent in the past two weeks, according to a New York Times database. Hospitalizations have climbed by 19 percent in the same time period. Deaths from the virus, which tend to lag behind infections for several weeks, have slightly increased.

We are seeing what appears to be the beginning of a fourth wave of Covid-19 in Colorado, Scott Bookman, the states Covid-19 incident commander, said at a news briefing on Thursday. He urged people to remain vigilant about getting tested as more of the states population becomes vaccinated.

As in many parts of the country seeing caseloads rise, health officials say the increase has been fueled in part by the spread of more contagious variants of the virus, particularly the B.1.1.7 variant first found in Britain. That variant is estimated to be about 60 percent more contagious and 67 percent more deadly than the original version. B.1.1.7 is now the most common source of new coronavirus cases in the United States, and tracking by the Centers for Disease Control and Prevention suggests that variants of concern, including B.1.1.7 and a variant that emerged in California, CAL.20C, now make up more than half of all new coronavirus cases in Colorado.

Even as cases mount, the state on Friday ended its dial system that required counties to place capacity limits on restaurants, offices and gyms, depending on case counts, positive test percentages and hospitalizations in those areas. That change shifted control of pandemic regulations to local counties, prompting concerns from some public health experts that the move could result in cases and hospitalizations continuing to rise. Several counties experiencing an increase in cases and hospitalizations, like El Paso and Douglas Counties, have said they do not plan to impose restrictions beyond those mandated by the state.

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The state still requires counties to comply with its mask mandate which will stay in place through May 2 and with limits on indoor mass gatherings.

I am concerned that without policies and behaviors to slow transmission, said Elizabeth Carlton, an associate professor at the Colorado School of Public Health, we will continue to see increases in Covid-19 hospitalizations among those who are not yet vaccinated.

It worries me, Dr. Bill Burman, director of Denver Public Health, said about counties that were choosing to be more lax with restrictions. Denver eased some regulations on Friday but kept in place certain restrictions, like capacity limits on bars, offices and retail stores.

An analysis published this month and led by researchers at the Colorado School of Public Health found that delaying policy changes, at the state or local level, until mid-May would prevent large numbers of deaths and hospitalizations. According to the report, mobility in the state is also reaching its highest levels since the start of the pandemic.

State officials defended the change last week, pointing to the relatively low number of hospitalizations and deaths compared with the peaks seen in December. Gov. Jared Polis, a Democrat, said at a news briefing on Tuesday that he was confident that counties could take on greater responsibility, but he urged people to remain cautious.

I think that the number of cases and hospitalizations will sadly continue to go up before it goes down, Mr. Polis said, adding that he hoped it would be a short peak as more people get vaccinated.

About 41 percent of the states population has received at least one shot of a Covid-19 vaccine, and 25 percent have been fully vaccinated, according to data from the Centers for Disease Control and Prevention.

State officials said they would continue to monitor hospitalization levels. Under the governors public health order, the state could require counties to put in place additional restrictions if their resident hospitalizations threatened to exceed 85 percent of hospital capacity.

To some, Alaskas announcement that it would try to entice travelers by offering Covid-19 vaccinations at its airports might signal the states plucky resolve and determination to revive a tourism industry that has been devastated by the pandemic.

To others, its a sign of everything that is wrong with the way that the United States is distributing its vaccines, as calls for more doses in surge-stricken Michigan are rebuffed.

Its hard for me to believe that weve so maldistributed a vaccine as to make this necessary, said Dr. Larry Brilliant, an epidemiologist who was part of the effort to eradicate smallpox in the 1970s. You dont want to exchange a bad carbon footprint for a vaccination.

Starting on June 1, any tourist traveling to Alaska will be able to receive a Pfizer or Moderna vaccine at the Anchorage, Fairbanks, Juneau or Ketchikan airports. Its part of a larger multimillion-dollar marketing campaign, funded by federal stimulus money, to attract tourists back to the state, Gov. Mike Dunleavy of Alaska, a Republican, announced.

We believe theres a real opportunity to get folks to come to Alaska again, Mr. Dunleavy said at a news conference on Friday.

Alaska is the latest state to announce plans to extend vaccine eligibility to nonresidents as production and distribution have increased around the country. Twenty-one other states do not have residency requirements for vaccination, according to the Kaiser Family Foundation.

Some U.S. experts have worried for months about the growth in vaccine tourism Americans crossing state lines to get a vaccine where there are excess doses. Virologists like Dr. Brilliant say that rather than incentivizing people to fly to Alaska to get a shot from the states abundant vaccine supply, doses should be redistributed to states most in need and no longer be allocated strictly by population.

Alaska is not lacking vaccines, said Heidi Hedberg, the states director of public health. Health administrators will begin the airport vaccine program for tourists at the Ted Stevens Anchorage International Airport, with a five-day trial at the end of April to gauge interest. Some visitors may have to get their second dose of mRNA vaccines in their home states, depending on how long they remain in Alaska.

Almost 40 percent of Alaskans have received at least one dose of a coronavirus vaccine, according to a New York Times database. Thirty-two percent of the states population is fully vaccinated. The state has used 68 percent of its doses.

Alaska was the first state to open up vaccine eligibility to anyone 16 or older living or working in the state, on March 9. At the time of the announcement, Alaska had the highest vaccination rate in the country.

The United States has continued to speed up vaccination efforts, and is now averaging 3.2 million doses a day, up from roughly two million a day in early March. The Centers for Disease Control and Prevention said on Saturday that about 129.5 million people had received at least one dose of a Covid-19 vaccine.

Dr. Brilliant said states like Michigan, the center of the countrys worst surge, should be receiving larger allocations of doses.

The Biden administration and Gov. Gretchen Whitmer of Michigan, a Democrat, have been at odds over her calls for an increase in her states vaccine supply. But the Biden administration held fast to distributing vaccines by state population, not by triage.

The vaccine should go where it will do the most good, Dr. Brilliant said. Given the scarcity of vaccine in the world, every dose should be given in a way that is most effective at stopping this pandemic.

But the issue could be moot by the time that Alaskas tourist vaccination program begins in earnest on June 1: most Americans who want to be vaccinated might already have received at least one dose by then, said Dr. Peter Hotez, a vaccine scientist at the National School of Tropical Medicine at Baylor College of Medicine in Houston.

Were going to reach a point where people dont need to fly to Alaska to get vaccinated, he said. I think its going to be more of the case that, heres an opportunity to visit Alaska and its convenient to get vaccinated.

French authorities will tightly restrict who can travel to France from Brazil, Argentina, Chile and South Africa, and will impose a 10-day quarantine on those who do, in the hope of staving off worrisome coronavirus variants circulating in those countries, the government announced on Saturday.

The announcement adds to a shifting patchwork of international restrictions that have complicated travel around the world.

Prime Minister Jean Castex announced late on Saturday that, starting April 24, travelers arriving from any of the four countries will have to quarantine for 10 days. Police officers will check on them to ensure that they comply.

Entry from the four countries will be limited almost exclusively to French citizens and their families, citizens of other European Union countries, and foreigners with permanent homes in France. Travelers must have tested negative for the virus within a shorter time before takeoff, and will be given antigenic tests on arrival.

These are the countries that are most dangerous, Jean-Yves Le Drian, Frances foreign minister, told France 3 television on Sunday.

Nearly all flights between France and Brazil will remain suspended at least until the new rules take effect and possibly longer, the government said.

The tightened restrictions were necessary because of the uncontrolled spread of the virus in certain countries, including widespread transmission of virus variants like those first identified in Brazil and South Africa that appear to be more resistant to some current Covid-19 vaccines, Mr. Castex said in his statement.

Frances decision adds to a complex tangle of rules and policies about international travel that can vary widely from country to country and month to month.

Germany loosened some of its travel restrictions last week, removing Britain, Ireland, Finland and Barbados from its list of at-risk areas, meaning that travelers from those countries no longer need to quarantine upon arrival.

But Prime Minister Scott Morrison of Australia said that his country was in no hurry to reopen its borders, which have largely been closed to anyone other than returning Australian citizens.

I will not be putting at risk the way we are living in this country, which is so different to the rest of the world today, Mr. Morrison told reporters on Sunday.

Unlike the many European countries that have kept restaurants closed, travel restricted and face masks mandatory to combat a new wave of infections, Australia has its coronavirus epidemic largely under control and residents are mostly free to travel domestically and dine out.

More people are flying every day, as Covid restrictions ease and vaccinations accelerate. But dangerous variants have led to new outbreaks, raising fears of a deadly prolonging of the pandemic.

To understand how safe it is to fly now, The Times enlisted researchers to simulate how air particles flow within the cabin of an airplane, and how potential viral elements may pose a risk.

For instance, when a passenger sneezes, air blown from the sides pushes particles toward the aisle, where they combine with air from the opposite row. Not all particles are the same size, and most dont contain infectious viral matter. But if passengers nearby werent wearing masks, even briefly to eat a snack, the sneezed air could increase their chances of inhaling viral particles.

How air flows in planes is not the only part of the safety equation, according to infectious-disease experts. The potential for exposure may be just as high, if not higher, when people are in the terminal, sitting in airport restaurants and bars or going through the security line.

The challenge isnt just on a plane, said Saskia Popescu, an epidemiologist specializing in infection prevention. Consider the airport and the whole journey.

The National Institutes of Health is investing $33 million in research projects run by institutions around the United States that could help officials safely reopen schools serving vulnerable students and under-resourced rural, urban and Native American communities.

The projects focus on expanding coronavirus testing for children of color, children from low-income families and children with developmental disabilities or complex medical conditions. The projects are part of an N.I.H. program called Rapid Acceleration of Diagnostics Underserved Populations, or RADx-UP, and include initiatives among Native American communities.

Establishing frequent Covid-19 testing protocols for schools in vulnerable and underserved communities is essential to the safe-return-to-school effort, and these projects will inform decision makers on the best strategies to accomplish this, Dr. Eliseo J. Prez-Stable, director of N.I.H.s National Institute on Minority Health and Health Disparities and co-chair of the RADx-UP program, said in the announcement on Thursday.

Although remote schooling has been a challenge for many families, certain vulnerable populations have faced additional obstacles. Low-income families, for instance, may not have access to computers or high-speed internet connections, while children with developmental disabilities may miss out on speech therapy, occupational therapy and other services that are typically tied to in-person schooling.

The new research projects encompass a wide variety of schools, ranging in size from 50 to 3,500 students.

One study, led by researchers at Washington University in St. Louis, will survey parents of children with disabilities to identify the best communication strategies for promoting in-person learning and examine ways to increase participation in a weekly coronavirus testing program. Another will assess the feasibility of at-home and school-based coronavirus testing programs for children with complex medical needs.

A project based at Duke University will explore whether rapid coronavirus tests can reduce the spread of the virus in schools and help build trust with Black and Latino families, encouraging them to send their children back into the classroom.

The RADx-UP program plans to distribute more funding, and expand its efforts to more locations, in the months ahead, the N.I.H. said.

JERUSALEM Buoyed by its recent success in combating the coronavirus, Israel lifted its outdoor mask mandate on Sunday, while schools fully reopened for the first time since September.

The country has been taking rapid steps back to normalcy in the wake of its world-leading vaccination campaign and plummeting infection rates. About 56 percent of the Israeli population has been fully vaccinated, according to a New York Times database.

Finally, I can breathe again! Eli Bliach, 35, an entrepreneur, said while walking mask-free in downtown Jerusalem on Sunday morning.

With the sun out and temperatures rising, some people joked about avoiding mask tan lines.

But other Israelis were hesitant to remove the layer of protection that had felt so alien at first, but that many have since gotten used to.

I am not confident that the pandemic is over, said Ilana Danino, 59, a cosmetician and caregiver who was still wearing a mask while walking down an almost empty street in the city center. It is still out there all over the world.

Besides, she said, I feel good with this on, gesturing to the air around her and explaining that springtime could still bring allergies and the spread of other viruses.

Israels health minister, Yuli Edelstein, urged people to continue carrying masks with them for entry into indoor public spaces, where they are still required.

Daily new coronavirus infections in Israel have fallen from a peak of 10,000 in January to around 100 on some recent days. Prof. Eran Segal of the Weizmann Institute of Science said on Twitter last week that with 85 percent of people 16 and older in Israel either vaccinated or recovered from the virus, Life is close to pre-Covid.

As part of the transition, Israel has introduced a green pass system allowing people who are vaccinated or recovered to dine indoors in restaurants, stay in hotels and attend large cultural, sports and religious gatherings.

But there is some new concern after several cases of a virus variant with a double mutation first detected in India, B.1.617, were identified in Israel last week. Prof. Nachman Ash, Israels coronavirus czar, told the Hebrew news site Ynet on Sunday that the variant might have some characteristics that could make those who have been vaccinated vulnerable to infection.

Israel is working to prevent any further entry of the variant, he said, while trying to learn more about it and how it is behaving in other parts of the world.

Mayor Bill de Blasio of New York announced on Saturday that New Yorkers who are 50 or older could now walk in and receive the coronavirus vaccine at more than 30 city-operated sites.

No appointment necessary, the mayor said on Twitter. One person accompanying the over-50 walk-in candidate can also receive the shot. Mr. de Blasios aim is to fully vaccinate five million of the citys eight million residents by June.

Before Saturday, the city allowed walk-in vaccinations only for people 75 and over.

The city listed 31 locations across the five boroughs where walk-ins would be accepted, including three that usually operate 24 hours a day, seven days a week: Brooklyn Army Terminal, Bathgate Contract Postal Station in the Bronx and Citi Field in Queens. That list of locations will be updated weekly.

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Covid-19: Fauci Expects Decision on Johnson & Johnson Vaccine This Week - The New York Times

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Monday’s Twins game also postponed as team deals with positive COVID-19 tests – Minneapolis Star Tribune

Posted: at 6:50 am

ANAHEIM, CALIF. Instead of playing amid 80-degree afternoon heat before jetting off to Oakland in time for Monday's series opener with the Athletics, the Twins saw hardly much sun at all.

Maybe some muted rays from behind their hotel room windows, just a fraction of a perfect SoCal spring Sunday.

After calling off two of the three games against the Angels, Major League Baseball also postponed Monday's game at the Athletics while the Twins deal with COVID-19 issues. There are four positive cases on the Twins: one staff member and three players.

Shortstop Andrelton Simmons was the first to test positive ahead of the California trip and stayed back in Minnesota. A non-uniformed staff member then tested positive ahead of Friday's game, a 10-3 loss at Angel Stadium, and that sent a handful of other staff into contact-tracing quarantines. Before Saturday's scheduled game, two more players tested positive, including left fielder Kyle Garlick. All have either shown mild symptoms or been asymptomatic.

The Twins could potentially next play at Oakland on Tuesday as part of a straight doubleheader to make up for Monday's postponement. That would begin at 5:30 p.m., though it depends on what continued testing and contract-tracing reveal about the Twins' situation.

Derek Falvey, Twins president of baseball operations, said on WCCO Radio Sunday that the tests done Saturday evening "came back in a good direction." Everyone took two more tests Sunday morning, including a rapid-results one that is prone to false positives. Manager Rocco Baldelli and another staff member experienced false positives just before leaving for California, though further testing eventually cleared them.

The Twins received results Sunday evening that revealed no further positives. Falvey also said the team will test again Monday morning and that those results would affect whether the Twins can fly to Oakland on Monday or whether that series goes on at all.

The team is also testing its non-traveling party in Minnesota as a precaution, because it's unclear exactly when or how the virus infiltrated the clubhouse. A source said Saturday the team did not think Simmons' case caused the following three.

The three players who tested positive likely will have to stay in Anaheim and quarantine for 10 days, unless they're up for a very long drive to Minnesota. The players who tested positive Saturday even had to drive themselves individually back to the team hotel in last-minute rental cars. The staff put into precautionary quarantine Friday should be free to travel Monday, as long as tests remain negative.

Testing has revealed that the current version of COVID-19 making its way through the Twins is one of the variant strains.

"It does create a little bit more uncertainty about the go-forward and how long it takes for someone who may have been infected to turn positive," Falvey said on WCCO. "So there's a lot of things we're working with our medical staff on to determine how comfortable we would be 72 hours out, subsequent to that, another day, another day, another day after that."

Falvey is working on rescheduling the two Angels games, but finding corresponding off days has been a logistical nightmare, as that would likely be necessary with Oakland if the doubleheader doesn't get played. Being on the West Coast has also complicated the Twins' ability to call in reinforcements should more players test positive. They have a five-man taxi squad on the trip (an infielder, outfielder, catcher and two pitchers), but anyone from St. Paul would have to fly commercial four hours to meet the team.

Like the Twins, the A's are not quite to the 85% vaccination threshold that would allow for loosened COVID-19 protocols, manager Bob Melvin said Sunday. Many of the Twins' tier one personnel took the single-dose Johnson & Johnson vaccine April 8 and are not quite to the two weeks of developed immunity from that. It's also still unclear how the vaccines work against the various COVID-19 strains.

"There's not one person in our group who is not frustrated," Baldelli said Saturday. " We knew that with our vaccine effort going on just after we returned home for our first homestand, we were pretty close to getting where we needed to be. But obviously not close enough. And now we're going to have to deal with whatever comes our way. Things are not going to be easy because of it. We're going to have a great deal of challenges in addition to everything that we've already gone through."

So for now the Twins are left to persevere through the dark times, peering from behind the thin pane of glass separating them from the light.

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Monday's Twins game also postponed as team deals with positive COVID-19 tests - Minneapolis Star Tribune

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Jackson County reports fifth week in a row of increased Covid-19 cases – KDRV

Posted: at 6:50 am

MEDFORD, Ore--On Sunday, Jackson County Public Health reported 20 new cases of coronavirus, taking last week's total to around 280 cases. This means for the fifth week in a row, Jackson County has experienced a rise in new Covid-19 cases.

According to reports taken by Jackson County Public Health, Jackson County has seen a steady rise in new Covid-19 cases dating all the way back to the week of March 14.

In that time, going from March 14 till last week, Jackson County has reported 168, 195, 229, 267 and now 280 cases.

To find the last time that Jackson County experienced five weeks in a row of cases increasing, you'd have to go all the way back to October. During that streak, cases had increased every week over a six-week time frame and hit all-time Covid records for the county.

Jackson County is also 77 cases away from reaching 10,000 total cases since the start of the pandemic.

But even with new Covid-19 cases rising, vaccinations in Jackson County are increasing.

According to data collected by the Oregon Health Authority, Jackson County health officials have vaccinated almost 70,000 Oregonians throughout the county. That's more than one in every four residents have recieved at least one shot of a Covid-19 vaccine.

Jackson County is also making progress when it comes to getting people fully vaccinated. OHA says that of the 68,435 people in Jackson County that have been vaccinated, 43,389 of those people are fully vaccinated.

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Jackson County reports fifth week in a row of increased Covid-19 cases - KDRV

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The Buzzer: Canucks win in return from COVID-19 protocol (Sunday in NHL) – NHL

Posted: at 6:50 am

3 Stars for Sunday in the NHL1. Boston Bruins top line

Honestly, you could probably pick Brad Marchand, Patrice Bergeron, and David Pastrnak for each of the three stars for Sunday in the NHL and call it a night. Even if, uh, they played during the afternoon.

Either way, it isnt easy to distinguish the top star from the Bruins 6-3 win against the Capitals.

From a volume perspective, Brad Marchand led the way. He generated two goals and two assists for four points. Interestingly, its been feast-or-famine for Marchand lately. Over the last five games, Marchands been held pointless on three occasions, yet two outbursts put him at six points (4G, 2A) in his past five contests.

With Taylor Hall bolstering what now looks like a strong Bruins second line, Bostons in a better position to handle the occasional pointless night from one or more members of The Perfection Line.

Speaking of the others, Bergeron didnt get involved in a late empty-net goal, but ended up with three points (2G, 1A) and matched Marchands +4 rating. Pastrnak grabbed one of his assists on that ENG, yet was still prolific with three helpers and a +3 rating.

While 1,000 Games Club Member Nicklas Backstrom enjoyed a strong showing with two assists of his own, it wasnt enough as the Capitals fell to the Bruins and that Perfection Line.

For a significant chunk of Sundays OT loss to the Islanders, the Flyers likely believed they deserved better.

Through the first 40 minutes, the Flyers generated 23-15 shots on goal advantage, firing 15 on Sorokin during the second period alone. The Flyers couldnt beat Sorokin once, though, as the young goalie put together a 30-save shutout.

Going forward, the Islanders shouldnt hesitate to give Sorokin reps. Hes now won four of five games, allowing two goals or fewer in each of those appearances. A lot of the Islanders success comes down to their defensive system, but Sorokins looking solid in his own right.

No doubt about it, the Canucks came into Sundays return from a lengthy COVID-related absence with some self-doubt. They also faced a Maple Leafs team that would be a challenge under even the most optimal circumstances.

Now, the Canucks fighting through that COVID disruption isnt about one game. If anything, they might actually feel it more and more as the grind of their schedule truly sets in. But on Sunday night, Braden Holtby was absolutely brilliant in helping the Canucks squeeze out an OT win vs. the Maple Leafs.

Its not as if the Maple Leafs laid an egg in the Canucks COVID return. Toronto fired 39 shots on goal, testing Holtby often. The veteran goalie made 37 saves, including the highlight of the night for Sunday in the NHL.

If allowing two goals disqualifies Holtby in your mind, you could instead roll with Bo Horvat. The Canucks captain helped his team rally from a 2-0 deficit, scoring two goals (including the overtime game-winner) and an assist.

Braden Holtby left Wayne Simmonds (and the rest of us) stunned with a beautiful windmill save. Shades of Dominik Hasek here:

This is a quirky one from the NHL. That said, if the Rangers defy the odds and make the playoffs, theyll do so in part based on dominating the Devils:

Bruins 6, Capitals 3Rangers 5, Devils 3Sabres 4, Penguins 2Golden Knights 5, Ducks 2Islanders 1, Flyers 0 (OT)Canucks 3, Maple Leafs 2 (OT)

James OBrienis a writer forPro Hockey Talk on NBC Sports. Drop him a line atphtblog@nbcsports.comor follow him on Twitter@cyclelikesedins.

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COVID-19 Daily Update 4-16-2021 – West Virginia Department of Health and Human Resources

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The West Virginia Department of Health and Human Resources (DHHR) reports as of April 16, 2021, there have been 2,592,544 total confirmatory laboratory results received for COVID-19, with 148,071 total cases and 2,777 total deaths.

DHHR has confirmed the deaths of a 64-year old female from Jackson County, a 45-year old male from Harrison County, a 42-year old female from Logan County, a 95-year old female from Jackson County, and an 84-year old male from Wyoming County.

We offer our deepest sympathy to the families as our state grieves additional losses due to COVID-19, said Bill J. Crouch, DHHR Cabinet Secretary.

CASES PER COUNTY: Barbour (1,342), Berkeley (11,499), Boone (1,861), Braxton (860), Brooke (2,117), Cabell (8,594), Calhoun (271), Clay (451), Doddridge (542), Fayette (3,240), Gilmer (734), Grant (1,237), Greenbrier (2,598), Hampshire (1,686), Hancock (2,699), Hardy (1,431), Harrison (5,377), Jackson (1,891), Jefferson (4,312), Kanawha (13,971), Lewis (1,132), Lincoln (1,391), Logan (2,990), Marion (4,122), Marshall (3,261), Mason (1,931), McDowell (1,467), Mercer (4,548), Mineral (2,751), Mingo (2,409), Monongalia (8,931), Monroe (1,066), Morgan (1,073), Nicholas (1,483), Ohio (4,018), Pendleton (680), Pleasants (831), Pocahontas (638), Preston (2,803), Putnam (4,782), Raleigh (6,082), Randolph (2,490), Ritchie (655), Roane (577), Summers (751), Taylor (1,195), Tucker (524), Tyler (670), Upshur (1,815), Wayne (2,814), Webster (454), Wetzel (1,183), Wirt (378), Wood (7,564), Wyoming (1,899).

Delays may be experienced with the reporting of information from the local health department to DHHR. As case surveillance continues at the local health department level, it may reveal that those tested in a certain county may not be a resident of that county, or even the state as an individual in question may have crossed the state border to be tested.

Free COVID-19 testing is available today in Barbour, Berkeley, Boone, Grant, Greenbrier, Jefferson, Lincoln, Logan, Marshall, Monongalia, Morgan, Nicholas, Putnam, and Wayne counties:

Barbour County

9:00 AM 11:00 AM, Barbour County Health Department, 109 Wabash Avenue, Philippi, WV

1:00 PM 5:00 PM, Junior Volunteer Fire Department, 331 Row Avenue, Junior, WV

Berkeley County

10:00 AM 6:00 PM, 891 Auto Parts Place, Martinsburg, WV

10:00 AM 6:00 PM, Ambrose Park, 25404 Mall Drive, Martinsburg, WV

Boone County

12:00 PM 6:00 PM, Boone County Health Department, 213 Kenmore Dr, Danville, WV

Grant County

Greenbrier County

10:00 AM 5:00 PM, Dorie Miller Park, 396 Feamster Road, Lewisburg, WV

Jefferson County

10:00 AM 6:00 PM, Hollywood Casino, 750 Hollywood Drive, Charles Town, WV

10:00 AM 6:00 PM, Shepherd University Wellness Center Parking Lot, 164 University Drive, Shepherdstown, WV

Lincoln County

Logan County

Marshall County

Monongalia County

9:00 AM 11:00 AM, WVU Recreation Center, lower level, 2001 Rec Center Drive, Morgantown, WV

Morgan County

10:00 AM 6:00 PM, Valley Health War Memorial Hospital, 1 Health Way, Berkeley Springs, WV

Nicholas County

Putnam County

Wayne County

10:00 AM 2:00 PM, Wayne Community Center, 11580 Rt. 152, Wayne, WV

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COVID-19 Daily Update 4-16-2021 - West Virginia Department of Health and Human Resources

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40% of Wisconsin residents have received a COVID-19 vaccine, state lowers death toll – WSAW

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MADISON, Wis. (WBAY) The Wisconsin Department of Health Services (DHS) reports four out of every 10 residents in Wisconsin have received a COVID-19 vaccine. As of Sunday, the DHS reports 40.2% of the states population has received at least one dose of the vaccine, which equals 2,339,142 people. Thats an increase of 28,085 people from Saturdays report.

Meanwhile, the state says another 34,474 residents completed their vaccine series, bringing Wisconsins percentage of fully vaccinated people to 27.5%, or 1,603,795 residents.

So far, the DHS reports a total of 3,870,751 doses of the COVID-19 vaccine have been administered in Wisconsin. This comes on the same day the Centers for Disease Control announced that half of all adults in the United States have received at least one COVID-19 shot. Federal officials say almost 130 million people who are 18 or older have received at least one dose of a vaccine, which equals about 50.4% of the total adult population.

County by county vaccine rates will be found below.

Vaccinations by percentage of age group, as of Sunday:

Meanwhile, the DHS revised the states death toll by two, lowering it to 6,709 Sunday. State officials revised the death toll in Sawyer and Washington Counties, lowering each by one. The 6,709 deaths continue to make up 1.14% of all confirmed cases in Wisconsin. Although the state lowered the death toll, it wasnt enough to move Wisconsins seven day death average, which held steady from Saturday at five deaths per day.

The revision comes as the state crosses the 590,000 cumulative case total since February 5 of 2020. The agency reports another 518 new coronavirus cases were confirmed Sunday. New cases were reported in 43 of Wisconsins 72 counties. The state also revised case counts in seven other counties (Walworth, Vilas, Sheboygan, Shawano, Richland, Jefferson and Iowa).

According to the DHS, the new cases are out of 4,507 results from people testing positive or being tested for the first time, or 11.49% of those results. The 7-day average for the positivity rate, which includes those who have had more than one test done, dropped to 3.5% after holding steady at 3.6% for two straight days.

Wisconsin has now seen a cumulative total of 590,458 confirmed coronavirus cases, and is on pace to reach a milestone 600,000 confirmed cases in the next two weeks if the spread of the disease doesnt slow.

The state is averaging 736 new cases per day for the past week. After increasing to 823 on April 14, it has declined daily. The states percentage of active cases -- people diagnosed in the past 30 days who arent medically cleared dropped to 1.5%.

The number of hospitalizations in the past 24 hours is well below average, with 34 patients admitted for COVID-19. The 7-day hospital admission average increased to 60 after holding steady at 58 the past two days.

SUNDAYS COUNTY VACCINATION UPDATES

CLICK HERE to track vaccine data in Wisconsin

CLICK HERE for the First Alert Vaccine Teams guide to vaccine clinics and vaccinators, including phone numbers and websites to make appointments and information on free rides to appointments.

Since February 5, 2020, the DHS reports 3,390,910 people in Wisconsin were tested at least once for the coronavirus. Out of these:

HOSPITAL READINESS

The latest numbers from the Wisconsin Hospital Association (WHA) show there are 318 patients in 136 hospitals across the state, eight fewer than Saturday. However, the number of ICU patients in those same hospitals increased by nine, for a total of 91.

Fox Valley hospitals report they are treating 18 COVID-19 patients, with 6 in ICU. Thats two fewer overall patients and two new ICU patients than Saturday.

10 hospitals in the Northeast region are treating 27 COVID-19 patients, including 6 in ICU. Thats five fewer overall patients and one new ICU patient since Saturday.

For hospital readiness, the WHA reports 275 ICU beds were available in the states hospitals (18.75% of the states supply). A total 2,128 of all hospital beds are available -- ICU, intermediate care, medical surgical and negative-flow isolation (19.04%).

The Fox Valley regions 13 hospitals have 11 ICU beds available among them (10.55%), and 90 total open beds total (10.2%).

The 10 hospitals in the Northeast region had 41 ICU beds (19.8%) and 257 of all bed types (26.88%) open.

These beds are for all patients, not just COVID-19. We use terms like open or available, but a hospital can only put a patient in a bed if it has the staff to care for them, including doctors, nurses and food services.

SUNDAYS COUNTY CASE AND DEATH TOTALS (counties with new cases or deaths are indicated in bold) *

Wisconsin

Michigans Upper Peninsula **

* Cases and deaths are from the daily DHS COVID-19 reports, which may differ from local health department numbers. The DHS reports cases from all health departments within a countys boundaries, including tribal, municipal and county health departments; county websites may not. Also, public health departments update their data at various times, whereas the DHS freezes the numbers it receives by the same time every day to compile the afternoon report.

CDC GUIDANCE ON GATHERINGS

The Centers for Disease Control have announced that fully vaccinated Americans can gather with other vaccinated people indoors without wearing a mask or social distancing.

The CDCs recommendations also say vaccinated people can come together in the same way in a single household -- with people considered at low-risk for severe disease, such as in the case of vaccinated grandparents visiting healthy children and grandchildren.

The CDC is continuing to recommend that fully vaccinated people still wear well-fitted masks, avoid large gatherings, and physically distance themselves from others when out in public. The CDC also advised vaccinated people to get tested if they develop symptoms that could be related to COVID-19.

COVID-19 TRACING APP

Wisconsins COVID-19 tracing app, Wisconsin Exposure Notification, is available for iOS and Android smartphones. No download is required for iPhones. The Android app is available on Google Play. When two phones with the app (and presumably their owners) are close enough, for long enough, theyll anonymously share a random string of numbers via Bluetooth. If someone tests positive for the coronavirus, theyll receive a code to type into the app. If your phones pinged each other in the last 14 days, youll receive a push notification that you are at risk of exposure. The app doesnt collect personal information or location information, so you wont know from whom or where, but you will be told what day the exposure might have occurred so that you can quarantine for the appropriate amount of time.

SYMPTOMS

The Centers for Disease Control and Prevention identified these as possible symptoms of COVID-19:

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Spatiotemporal pattern of COVID-19 spread in Brazil – Science

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Abstract

Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We use daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures show that while no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.

Brazil is the only country that, with a population larger than 100 million, has a universal, comprehensive, and free of charge health care system. Over three decades, this system contributed to reducing inequalities in access to health care and outcomes (1). It also facilitated the management of previous public health emergencies, such as the HIV/AIDS pandemic (2). Despite recent cuts in the health budget (3), it was expected that Brazils health system would place the country in a good position to mitigate the COVID-19 pandemic. With national coordination and through a vast network of community health agents, actions adapted to existing local inequalities (i.e., regional distribution of physicians and hospital beds) could have been implemented (4). However, Brazil is one of the countries most severely hit by COVID-19. As of March 11, 2021, 11,277,717 cases and 272,889 deaths have been reported. Those represent 9.5% and 10.4% of the worldwide cases and deaths, respectively; yet, Brazil shares only 2.7% of the worlds population. In late May, 2020, Latin America was declared the epicenter of the COVID-19 pandemic, mainly because of Brazil. Since June 7, 2020, Brazil ranks 2nd in deaths worldwide.

In Brazil, the federal response has been a dangerous combination of inaction and wrongdoing, including the promotion of chloroquine as treatment despite a lack of evidence (5, 6). Without a coordinated national strategy, local responses varied in form, intensity, duration, and start and end times, to some extent associated with political alignments (7, 8). The country has seen very high attack rates (9) and disproportionally higher burden among the most vulnerable (10, 11), illuminating local inequalities (12). Following multiple introductions of SARS-CoV-2, Brazil had an initial epidemic phase (February 15 to March 18, 2020) with restricted circulation (13), preceded by undetected virus circulation (14). While the initial spread was determined by existing socioeconomic inequalities, the lack of a coordinated, effective, and equitable response likely fueled the widespread spatial propagation of SARS-CoV-2 (12). The goal of this study was to understand, measure, and compare the pattern of spread of COVID-19 cases and deaths in Brazil at fine spatial and temporal scales. We use daily data from State Health Offices covering the period from epidemiological week 9 (February 23-29) to week 41 (October 4-10).

In all states, it took less than a month between the first case and the first death; only 11 days in Amazonas and 21 in So Paulo (table S1). Epidemiological curves for Brazil (fig. S1) hide distinct patterns of initial reporting, propagation, and containment of SARS-CoV-2 across administrative units. As states and cities imposed and relaxed restrictive measures at different times, population mobility facilitated the circulation of the virus and acted as a trigger of disease spread (15). Figure 1, A and B, show that cumulative cases and deaths, respectively, per 100,000 people were not uniformly distributed across municipalities. We used the space-time scan statistic (16) to identify areas that significantly recorded a high number of cases (Fig. 1C and table S2) or deaths (Fig. 1D and table S3) over a defined period.

Cumulative number of COVID-19 cases (A) and deaths (B) per 100,000 people by municipality. Dark lines on the maps show state boundaries. State acronyms by region, North: AC=Acre, AP=Amap, AM=Amazonas, PA=Par, RO=Rondnia, RR=Roraima, and TO=Tocantins; Northeast: AL=Alagoas, BA=Bahia, CE=Cear, MA=Maranho, PB=Paraba, PE=Pernambuco, PI=Piau, RN=Rio Grande do Norte, and SE=Sergipe; Center-West: DF=Distrito Federal, GO=Gois, MT=Mato Grosso, and MS=Mato Grosso do Sul; Southeast: ES=Esprito Santo; MG=Minas Gerais; RJ=Rio de Janeiro; and SP=So Paulo; South: PR=Paran; RS=Rio Grande do Sul; and SC=Santa Catarina. Spatio-temporal clustering of cases (C) and deaths (D) across Brazilian municipalities. Color and number codes in the clusters and the table on the left are the same, and the table indicates the interval during which each cluster was statistically significant. The color gradient (dark red to dark blue) indicates the temporal change based on the initial date of the cluster, and the cluster number indicates the rank of the relative risk for each cluster (tables S2 and S3). Clusters were assessed with the space-time scan statistic (see supplementary materials).

Deaths clustered about a month before cases. This likely reflects problems in surveillance, data reporting, and low testing capacity. The first significant cluster of COVID-19 deaths started on May 18 (Fig. 1D, #5), centered around Recife (capital of Pernambuco). Five other clusters of deaths occurred before the first cluster of cases was observed on June 16 (Fig. 1C, #7). Among those are clusters around Fortaleza and Rio de Janeiro (capital cities of Cear and Rio de Janeiro, respectively), and in a large area including Amazonas, Par, and Amap, states that have a disproportionally lower hospital capacity. Amazonas (whose capital is Manaus) has the highest mortality per 100,000 people in the country, more than double the rate for Brazil. By October, about 76% of its population was estimated to have been infected (9, 17). Except for one cluster in August (Fig. 1D, #1), the duration of death clusters did not reduce over time, ranging from 10 to 13 days. This is different than what was observed in South Korea, where successful containment reduced the duration and the geographic extent of clusters over time (18). A similar pattern was observed for COVID-19 cases (Fig. 1C). In the center and southern areas, clusters occurred later (August and September), corroborating a regional pattern of propagation of SARS-CoV-2 (19).

To understand and compare how COVID-19 cases and deaths spread across Brazil we calculated the geographic center of the epidemic. Trajectories of the center by epidemiological week show that after the introduction in So Paulo, both cases (Fig. 2A and movie S1) and deaths (Fig. 2B and movie S2) progressively moved north until week 20 (starting May 10), when the epidemic started to recede in Amazonas and Cear, but gained force in Rio de Janeiro and So Paulo. Comparing trajectories in each state (fig. S2) we calculated a ratio of the distance the center moved each week to the distance between the capital city and the most distant municipality (tables S4 and S5). In eight states the median weekly ratio for deaths was larger than cases (Fig. 2C), suggesting a faster movement of the focus of deaths.

COVID-19 case- (A) and death-weighted (B) geographic centers by epidemiological week. Thick lines show the geographic center for Brazil, thin lines show the trajectory of the center in each state, and the black dot indicates the state capital city (see supplementary materials). The first case in each state was recorded in the capital city, except for Rio de Janeiro, Rondnia, Bahia, Minas Gerais, and Rio Grande do Sul, and thus the trajectory of the center starts in the interior. This was more common for deaths (14 states did not report the first death in the capital: Rio de Janeiro, Amazonas, Par, Piau, Rio Grande do Norte, Paraba, Esprito Santo, Paran, Santa Catarina, Mato Grosso do Sul, Mato Grosso, and Gois). Figure S2 shows detailed maps for each state. (C) Scatterplot of the median distance that the geographical center of cases (X-axis) and deaths (Y-axis) shifted weekly in each state (measured as the ratio of the distance that the geographical center of cases shifted weekly in each state to the distance between the capital city and the furthest municipality in the state). (D) Scatterplot of the number of days that it took for a state to reach 50 COVID-19 cases (X-axis) after the first case was reported and 50 deaths after the first COVID-19 confirmed death (Y-axis). (E) Scatterplot of the standardized number of cases per 100,000 people (X-axis) and deaths per 100,000 people (Y-axis) by state. The 45-degree lines in (C), (D), and (E) describe equal values for variables in the scatterplot.

On average, it took 17.3 and 32.3 days to reach 50 cases and deaths, respectively. However, in four states deaths accumulated to a 50-count first (Fig. 2D), and in Amazonas, Cear, and Rio de Janeiro the difference between the time it took for cases and deaths to reach a 50-count was 6, 1, and 3 days, respectively (table S1). This short interval suggests undetected (and thus unmitigated) introduction and propagation of the virus for some time. This was confirmed in Cear (20) where a retrospective epidemiological investigation revealed that the virus was already circulating in January. Also, if the initial cases occurred in high-income areas, it is possible that consultations in private practices were not reported into national systems of the Ministry of Health (20) and remained silent to the surveillance system. In addition, testing capacity in Brazil was limited, and the first diagnostic RT-PCR test kits started to be produced in the country only in March. Although efforts of retrospective investigation were not scaled-up in the country, a comparison of standardized rates of cases and deaths per 100,000 people (Fig. 2E) show that in 11 states the death toll was larger than incidence, including Amazonas, Cear, and Rio de Janeiro.

To quantitatively measure the intensity of the spread of COVID-19 cases and deaths over time we used the locational Hoover Index (HI) (21, 22). Values closer to 100 indicate concentration in few municipalities, while those close to zero suggest more homogeneous spreading. If containment measures were effective, we would expect the index to decline slowly, remaining relatively high over time. Also, if measures were effective to avoid a collapse of the hospital system, we would expect a higher index for deaths, compared to cases. Figure 3A shows the HI for Brazil, and a clear trend toward extensive spread for both cases and deaths until about week 30 (July 19-25). The pattern, however, varied across states. In the first week with reported events, Amazonas, Roraima, and Amap had HI below 50 for both cases and deaths. This suggests either undetected circulation of the virus before initial reports (and therefore when reporting started there was already a large fraction of the population that had been infected), or fast and multiple introductions of the virus immediately followed by rapid spatial propagation (tables S6 and S7).

(A) Locational Hoover index (see supplementary materials) for cases (blue line) and deaths (red line) by epidemiological week. The area around each curve indicates the maximum and minimum index observed across states. (B) States and weeks when the locational Hoover index for cases was bigger than the index for deaths, indicating a faster spread of deaths. Bivariate choropleth map of the locational Hoover Index for cases and deaths in epidemiological week 14 (March 29-April 4) (C) and epidemiological week 41 (October 4-10) (D). Since SARS-CoV-2 reached states at different epidemiological weeks, (C) shows data from week 12 for RJ and SP; week 13 for AM, PI, RN, PE, PR, SC, RS, and GO; week 15 for AC; and week 16 for TO. Similarly, (D) shows data for week 33 for MT, and week 39 for ES.

Overall, the spread of COVID-19 was fast. By week 24 (June 7-13) and 32 (August 2-8), all states had HI for cases and deaths, respectively, lower than 50. In nine states, including Amazonas, Amap, Cear, and Rio de Janeiro, the spreading of deaths was faster than cases over several weeks (Fig. 3B), with some overlap with the time when clusters were observed in those areas (Fig. 1, C and D). Figure 3, C and D, show the first and last weekly HI for cases and deaths by states and there are marked contrasts in HI trajectory (tables S6 and S7). By week 41 (October 4-10), COVID-19 deaths in Amap (HI=31.3) had moved to the interior faster than cases (HI=42.9). Rio de Janeiro had the most intense interiorization of both cases (HI=14.9) and deaths (HI=21.9), followed by Amazonas (HI cases=20.2, HI deaths=30.4). Both experienced a shortage of ICU beds, but Amazonas has smaller availability (about 11 ICU beds per 100,000 people vs 23 in Rio de Janeiro), all concentrated in the capital city, Manaus. As the virus moved to the interior a higher demand for scarce and distant resources intensified, not all of which were fulfilled in time to prevent fatalities (23). In Rio de Janeiro, political chaos compromised a prompt and effective response. Leaders were immersed in corruption accusations, the governor was removed from office and face an impeachment trial, and the Secretary of Health was changed three times between May and September, one of whom was arrested (24). In contrast, although Cear also experienced a near-collapse of the hospital system late April to mid-May, and had silent circulation of the virus more than a month before the first case was officially reported (20), it ranked 6th in movement of cases (HI=31.3), but was the antepenultimate in deaths (HI=64.5). This suggests that even with the continued spread of the virus, local actions were successful in preventing fatality. No state had HI for cases higher than 50 by week 41, revealing an extensive pattern of disease spread toward the interior.

Overall, a higher percentage of COVID-19 cases and deaths were observed outside capital cities in weeks 20 (May 10-16) and 22 (May 24-30), respectively (Fig. 4A), with varied patterns across states (table S1). Rio Grande do Sul, Santa Catarina, and Paran, all in the South region, had earlier and concurrent shifts in cases and deaths (in March), and this was the last region to show a major surge in COVID-19. In Rio de Janeiro and Amazonas, the shift in deaths was much later than cases, 10 and 8 weeks, respectively.

(A) Percentage of cases (blue lines) and deaths (red lines) in the state capitals (solid lines) and the remaining municipalities (dashed lines) by epidemiological week. (B) Percentage of reported COVID-19 cases and deaths, and selected variables by epidemiological week. Variables: Stringency Index (STR), Containment Index (CTN), Social Distancing Index (SD), locational Hoover Index for cases (HIc), locational Hoover Index for deaths (HId), percentage of cases in each epidemiological week (PCTc), percentage of deaths in each epidemiological week (PCTd), normalized distance by which the national geographical center of cases shifted in each week (DSTc), and normalized distance by which the national geographical center of deaths shifted in each week (DSTd). Distances were normalized to vary between 0 and 100. The subscript min indicates the minimum value of the index observed among all states in each week; the subscript max denotes the maximum value. (C) Correlation matrix (Pearson). Cells in shades of red or blue are statistically significant: * <0.05, ** <0.01, and *** <0.001. (D) Hierarchical clustering dendrogram by state based on five variables: cumulative deaths per 100,000 people, maximum percentage of deaths in a week, maximum SD, epidemiological week when HId became lower than 50, and the maximum value of effective Rt over the study period (see supplementary materials).

To better capture policies adopted at the national and local levels and their associations with movement of COVID-19 toward the interior of states, we used three indicators, the Stringency Index (STR), the Containment Index (CTN all policies in STR except for the use of masks), and the Social Distancing Index (SD based on mobile devices). Because states introduced measures at different times with various duration, national indices hide much variation (Fig. 4B). We observed expected correlations (table S8) between policy indicators and HI for cases and deaths (Fig. 4C), but a positive correlation between HI and the distance by which the national geographical center of cases shifted weekly. This suggests a pattern of progressive concentration of cases and deaths in few but widespread areas. Considering each state (fig. S3), Amap showed a negative correlation between STR and HI for deaths, indicating that policy measures failed to prevent the movement of deaths (this was the only state where deaths moved to the interior faster than cases by week 41; Fig. 3D).

We used hierarchical clustering analysis (25) in an attempt to group states into categories based on measures that captured the overall COVID-19 mortality burden, intensity of transmission, speed of COVID-19 deaths toward the interior of states, and adoption of distancing measures (Fig. 4D). Categories 3 and 4 include the top 10 states in deaths/100,000 people, as well as those that observed the first spatiotemporal clustering of deaths, and fast reporting and movement of deaths. Category 2 has the highest number of contiguous states and the lowest death burden by week 41. However, all categories combine states with different levels of inequality and distinct political alignment.

In summary, our results highlight the fast spread of both cases and deaths of COVID-19 in Brazil, with distinct patterns and burden by state. They demonstrate that no single narrative explains the propagation of the virus across states in Brazil. Instead, layers of complex scenarios interweave, resulting in varied and concurrent COVID-19 epidemics across the country. First, Brazil is large and unequal, with disparities in quantity and quality of health resources (e.g., hospital beds, physicians), and income (e.g., an emergency cash transfer program started only in June 2020, and by November 41% of the households were receiving it). Second, a dense urban network that connects and influences municipalities through transportation, services, and business (26) was not fully interrupted during peaks in cases or deaths. Third, political alignment between governors and the president had a role in the timing and intensity of distancing measures (7), and polarization politicized the pandemic with consequences to adherence to control actions (27). Fourth, SARS-CoV-2 was circulating undetected in Brazil for more than a month (20), a result of the lack of well-structured genomic surveillance (28). Fifth, cities imposed and relaxed measures at different moments, based on distinct criteria, facilitating propagation (15). Our findings speak to those issues, but also show that some states were resilient, such as Cear, while others that comparatively had more resources failed to contain the propagation of COVID-19, such as Rio de Janeiro.

In such a scenario, prompt and equitable responses, coordinated at the federal level, are imperative to avoid fast virus propagation and disparities in outcomes (12). Yet, the COVID-19 response in Brazil was neither prompt nor equitable. It still isnt. Brazil is currently facing the worst moment of the pandemic, with a record number of cases and deaths, and near collapse of the hospital system. Vaccination has started but at a slow pace due to limited availability of doses. A new variant of concern (VOC), which emerged in Manaus (P1) in December, is estimated to be 1.4-2.2 times more transmissible, and able to evade immunity from previous non-P1 infection (29). That variant is spreading across the country. It became the most prevalent in circulation in six of eight states where investigations were performed (30). As of March 11, 2021, Brazil already reported 40% of the total COVID-19 deaths that occurred in 2020. In January 2021, Manaus witnessed a spike in cases and hospitalizations, a collapse of the hospital system, including a shortage of oxygen for patients (31). The death toll is unbearable, as Manaus already recorded 39.8% more COVID-19 deaths in 2021 than in 2020. Without immediate action, this could be a preview of what is yet to happen in other localities in Brazil. Without immediate containment, coordinated epidemiological and genomic surveillance measures, and an effort to vaccinate the largest number of people in the shortest possible time, the propagation of P1 will likely resemble the patterns here demonstrated, leading to unimaginable loss of lives. Failure to avoid this new round of propagation will facilitate the emergence of new VOCs, isolate Brazil as a threat to global health security, and lead to a completely avoidable humanitarian crisis.

G. James, D. Witten, T. Hastie, R. Tibshirani, An Introduction to Statistical Learning with Applications in R (Springer, 2017).

Instituto Brasileiro de Geografia e Estatistica, Regies de Influncia das Cidades: 2018 (IBGE, Coordenao de Geografia, 2020).

N. R. Faria, T. A. Mellan, C. Whittaker, I. M. Claro, D. S. da Candido, S. Mishra, M. A. E. Crispim, F. C. Sales, I. Hawryluk, J. T. McCrone, R. J. G. Hulswit, L. A. M. Franco, M. S. Ramundo, J. G. de Jesus, P. S. Andrade, T. M. Coletti, G. M. Ferreira, C. A. M. Silva, E. R. Manuli, R. H. M. Pereira, P. S. Peixoto, M. U. Kraemer, N. Gaburo Jr., C. C. da Camilo, H. Hoeltgebaum, W. M. Souza, E. C. Rocha, L. M. de Souza, M. C. de Pinho, L. J. T Araujo, F. S. V. Malta, A. B. de Lima, J. P. do Silva, D. A. G. Zauli, A. C. S. de Ferreira, R. P. Schnekenberg, D. J. Laydon, P. G. T. Walker, H. M. Schlter, A. L. P. dos Santos, M. S. Vidal, V. S. Del Caro, R. M. F. Filho, H. M. dos Santos, R. S. Aguiar, J. L. P. Modena, B. Nelson, J. A. Hay, M. Monod, X. Miscouridou, H. Coupland, R. Sonabend, M. Vollmer, A. Gandy, M. A. Suchard, T. A. Bowden, S. L. K. Pond, C.-H. Wu, O. Ratmann, N. M. Ferguson, C. Dye, N. J. Loman, P. Lemey, A. Rambaut, N. A. Fraiji, M. P. S. S. do Carvalho, O. G. Pybus, S. Flaxman, S. Bhatt, E. C. Sabino, Genomics and epidemiology of a novel SARS-CoV-2 lineage in Manaus, Brazil. medRxiv 2021.2002.2026.21252554 [Preprint]. 3 March 2021. doi:10.1101/2021.02.26.21252554

A. D. Gordon, Null models in cluster validation, in From Data to Knowledge, W. Gaul, D. Pfeifer, Eds. (Springer, 1996), pp. 3244.

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Spatiotemporal pattern of COVID-19 spread in Brazil - Science

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A method to assess Covid-19 transmission risks in indoor settings – MIT News

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Two MIT professors have proposed a new approach to estimating the risks of exposure to Covid-19 under different indoor settings. The guideline they developed suggests a limit for exposure time, based on the number of people, the size of the space, the kinds of activity, whether masks are worn, and the ventilation and filtration rates. Their model offers a detailed, physics-based guideline for policymakers, businesses, schools, and individuals trying to gauge their own risks.

The guideline, appearing this week in the journal PNAS, was developed by Martin Z. Bazant, professor of chemical engineering and applied mathematics, and John W. M. Bush, professor of applied mathematics. They stress that one key feature of their model, which has received less attention in existing public-health policies, is providing a specific limit for the amount of time a person spends in a given setting.

Their analysis is based on the fact that in enclosed spaces, tiny airborne pathogen-bearing droplets emitted by people as they talk, cough, sneeze, sing, or eat will tend to float in the air for long periods and to be well-mixed throughout the space by air currents. There is now overwhelming evidence, they say, that such airborne transmission plays a major role in the spread of Covid-19. Bush says the study was initially motivated early last year by their concern that many decisions about policies were being guided primarily by the 6-foot rule, which doesnt adequately address airborne transmission in indoor spaces.

Using a strictly quantitative approach based on the best available data, the model produces an estimate of how long, on average, it would take for one person to become infected with the SARS-CoV-2 virus if an infected person entered the space, based on the key set of variables defining a given indoor situation. Rather than a simple yes or no answer about whether a given setting or activity is safe, it provides a guide as to just how long a person could safely expect to engage in that activity, whether it be a few minutes in a store, an hour in a restaurant, or several hours a day in an office or classroom, for example.

As scientists, weve tried to be very thoughtful and only go with what we see as hard data, Bazant says. Weve really tried to just stick to things we can carefully justify. We think our study is the most rigorous study of this type to date. While new data are appearing every day, and many uncertainties remain about the SARS-CoV-2 virus transmission, he says, We feel confident that weve made conservative choices at every point.

Bush adds: Its a quickly moving field. We submit a paper and the next day a dozen relevant papers come out, so we scramble to incorporate them. Its been like shooting at a moving target. For example, while their model was initially based on the transmissibility of the original strain of SARS-CoV-2 from epidemiological data on the best characterized early spreading events, they have since added a transmissibility parameter, which can be adjusted to account for the higher spreading rates of the new emerging variants. This adjustment is based on how any new strains transmissibility compares to the original strain; for example, for the U.K. strain, which has been estimated to be 60 percent more transmissible than the original, this parameter would be set at 1.6.

One thing thats clear, they say, is that simple rules, based on distance or capacity limits on certain types of businesses, dont reflect the full picture of the risk in a given setting. In some cases that risk may be higher than those simple rules convey; in others it may be lower. To help people, whether policymakers or individuals, to make more comprehensive evaluations, the researchers teamed with app developer Kasim Khan to put together an open-access mobile app and website where users can enter specific details about a situation size of the space, number of people, type of ventilation, type of activity, mask wearing, and the transmissibility factor for the predominant strain in the area at the time and receive an estimate of how long it would take, under those circumstances, for one new person to catch the virus if an infected person enters the space.

The calculations were based on inferences made from various mass-spreading events, where detailed data were available about numbers of people and their age range, sizes of the enclosed spaces, kinds of activities (singing, eating, exercising, etc.), ventilation systems, mask wearing, the amount of time spent, and the resulting rates of infections. Events they studied included, for example, the Skagit Valley Chorale in Washington state, where 86 percent of the seniors present became infected at a two-hour choir practice

While their guideline is based on well-mixed air within a given space, the risk would be higher if someone is positioned directly within a focused jet of particles emitted by a sneeze or a shout, for example. But in general the assumption of well-mixed air indoors seems to be consistent with the data from actual spreading events, they say.

When you look at this guideline for limiting cumulative exposure time, it takes in all of the parameters that you think should be there the number of people, the time spent in the space, the volume of the space, the air conditioning rate and so on, Bush says. All of these things are kind of intuitive, but its nice to see them appear in a single equation.

While the data on the crucial importance of airborne transmission has now become clear, Bazant says, public health organizations initially placed much more emphasis on handwashing and the cleaning of surfaces. Early in the pandemic, there was less appreciation for the importance of ventilation systems and the use of face masks, which can dramatically affect the safe levels of occupancy, he says.

Id like to use this work to establish the science of airborne transmission specifically for Covid-19, by just taking into account all factors, the available data, and the distribution of droplets for different kinds of activities, Bazant says. He hopes the information will help people make informed decisions for their own lives: If you understand the science, you can do things differently in your own home and your own business and your own school.

Bush offers an example: My mother is over 90 and lives in an elder care facility. Our model makes it clear that its useful to wear a mask and open a window this is what you have in your control. He was alarmed that his mother was planning to attend an exercise class in the facility, thinking it would be OK because people would be 6 feet apart. As the new study shows, because of the number of people and the activity level, that would actually be a highly risky activity, he says.

Already, since they made the app available in October, Bazant says, they have had about half a million users. Their feedback helped the researchers refine the model further, he says. And it has already helped to influence some decisions about reopening of businesses, he adds. For example, the owner of an indoor tennis facility in Washington state that had been shut down due to Covid restrictions says he was allowed to reopen in January, along with certain other low-occupancy sports facilities, based on an appeal he made based in large part on this guideline and on information from his participation in Bazants online course on the physics of Covid-19 transmission.

Bazant says that in addition to recommending guidelines for specific spaces, the new tools also provide a way to assess the relative merits of different intervention strategies. For example, they found that while improved ventilation systems and face mask use make a big difference, air filtration systems have a relatively smaller effect on disease spread. And their study can provide guidance on just how much ventilation is needed to reach a particular level of safety, he says.

Bazant and Bush have provided a valuable tool for estimating (among other things) the upper limit on time spent sharing the air space with others, says Howard Stone, a professor of mechanical and aerospace engineering at Princeton University who was not connected to this work. While such an analysis can only provide a rough estimate, he says the authors describe this kind of order of magnitude of estimate as a means for helping others judge the situation they might be in and how to minimize their risk. This is particularly helpful since a detailed calculation for every possible space and set of parameters is not possible.

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Evidence of COVID-19 airborne transmission overwhelming say experts – New Atlas

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A new review article published in The Lancet has presented 10 key scientific reasons why SARS-CoV-2, the virus that causes COVID-19, is predominantly spread though the air. The research adds to a growing chorus of experts saying the evidence for airborne transmission is overwhelming and the sooner global health authorities admit this, the sooner more effective measures to better protect the public can be implemented.

Perhaps one of the most vociferous debates over the past 12 months has been over exactly how most people catch COVID-19. As the pandemic spread across the globe in early 2020 the general perspective from most public health experts was that SARS-CoV-2 primarily spread by droplet transmission.

This belief hinged on a traditional binary between droplet and aerosol viral transmission. Aerosol particles have classically been defined as smaller than 5 micrometres (m). They can remain suspended in the air for extended periods of time and can travel significant distances from a source.

Respiratory droplets, on the other hand, are larger particles, often propelled from a source by coughing or sneezing. These particles fall to the ground in seconds and typically dont travel further than six feet (1.8 m) from a source.

The general presumption from early last year was that SARS-CoV-2 primarily spreads via respiratory droplets, and this led to public health advice recommending basic measures such as social distancing, hand washing and frequent cleaning of surfaces. However, as 2020 progressed, more and more case studies presented scenarios whereby large numbers of people were infected in superspreading events despite being significant distances away from a viral source.

A new review published in The Lancet, led by Trish Greenhalgh from the University of Oxford, is arguing there is consistent and strong evidence to suggest SARS-CoV-2 is predominantly transmitted through airborne routes. The researchers lay out 10 streams of evidence from the past year that overwhelmingly support this hypothesis. The review also claims respiratory droplet transmission of this novel virus is based on flawed and outdated models of viral transmission.

The assessment references a large volume of evidence from the past 12 months, including numerous cases studies documenting long-range transmission of the virus between people in adjacent hotel rooms and superspreading events in indoor venues that cannot be explained by droplet transmission. The researchers argue particles as large as 100 m are known to remain suspended in the air for extended periods of time and the old fixed definition of aerosol particles as less than 5 m has led to misunderstandings of how SARS-CoV-2 is spread.

The flawed assumption that transmission through close proximity implies large respiratory droplets or fomites was historically used for decades to deny the airborne transmission of tuberculosis and measles, the researchers write in the study. This became medical dogma, ignoring direct measurements of aerosols and droplets which reveal flaws such as the overwhelming number of aerosols produced in respiratory activities and the arbitrary boundary in particle size of 5 m between aerosols and droplets, instead of the correct boundary of 100 m.

The researchers are far from alone in their call for widespread acknowledgment of airborne SARS-CoV-2 transmission. In early February the editors of the prestigious science journal Nature criticized public health bodies and the World Health Organization for failing to effectively communicate the predominance of airborne transmission.

The editorial recognized a growing acceptance of COVID-19 being spread through the air while suggesting continued recommendations for surface disinfection and other droplet transmission prevention measures are confusing the public and leading to huge investments in expensive disinfection efforts that shift resources away from measures such as improving ventilation in indoor spaces.

This lack of clarity about the risks of fomites compared with the much bigger risk posed by transmission through the air has serious implications, the journal editors write. People and organizations continue to prioritize costly disinfection efforts, when they could be putting more resources into emphasizing the importance of masks, and investigating measures to improve ventilation. The latter will be more complex but could make more of a difference.

The Centers for Disease Control and Prevention (CDC) in the United States is a useful case in point. The CDC still suggests COVID-19 is primarily spread through respiratory droplets. Its current advice claims direct contact is the most common vector for infection, although its information has more recently been updated to note, COVID-19 can sometimes be spread by airborne transmission.

A recent case study published by the CDC described a COVID-19 cluster last year in an Australian church. The study reports 12 people were infected across two days of church services. The primary case patient was a member of the church choir and all the epidemiological evidence points to airborne spread as the best explanation. Nevertheless, the study also notes, this investigation only provides circumstantial evidence of airborne transmission.

Co-author on the new Lancet article Zeynep Tufekci, a writer and sociologist from the University of North Carolina, Chapel Hill, says many of our current precautions based on the droplet transmission hypothesis are still effective. Distancing and masks, for example, are vital tools to prevent infection, but she argues some key public health policies are diverting resources from implementing more useful measures.

Even after a whole year, we still see the widespread practice of unnecessary levels of cleaning to the detriment of public health, use of plexiglass indoors that is far from sufficiently protective and, depending on air flows, may even be contraindicated, instead of attention to ventilation and aerosol risks, says Tufekci. We cannot fix this situation without accurately informing the public so that people feel empowered to make decisions to better protect themselves across different contexts, and adjusting guidelines globally to fit the best available evidence.

A recent editorial published in The BMJ argues traditional scientific definitions of viral transmission need urgent revision. Co-authored by Linsey Marr, an expert in airborne transmission of viruses, the article agrees many of our current infection control measures are useful and shouldnt change even with a broader agreement over the predominance of airborne transmission.

However, a big problem with the current focus on droplet transmission is a lack of emphasis regarding indoor ventilation. Marr and colleagues suggest more attention needs to immediately be paid to ventilation and air filtration technologies for indoor spaces. This will help future-proof our indoor spaces from this and other viruses that may arise.

Covid-19 may well become seasonal, and we will have to live with it as we do with influenza, the researchers write in The BMJ. So governments and health leaders should heed the science and focus their efforts on airborne transmission. Safer indoor environments are required, not only to protect unvaccinated people and those for whom vaccines fail, but also to deter vaccine resistant variants or novel airborne threats that may appear at any time.

The new study was published in The Lancet.

Source: University of Colorado Boulder

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