Mayor-elect Eric Adams had planned a weeklong international trip thats now up in the air because of the new Omicron COVID-19 variant, sources familiar with his travel told The Post.

Adams was going to head out of the country to an unknown destination from Nov. 30 through Dec. 8, sources said. The trip had not previously been reported.

But hes now reconsidering the trip since the Omicron variant that originated in Africa has beenfound among travelersin the UK, Germany and the Czech Republic.

Adams itinerary was unclear even to people in his inner circle. Some told The Post he was headed to Europe while others said it was a mystery locale off the beaten path.

The mayor-elect, who will be sworn in at midnight on Jan. 1, is famously guarded about his private life. The retired NYPD captain told reporters through tears on the primary campaign trail in June that he never let his cop colleagues know he had a son fearing for the boys safety because of his status as a police department reformer.

The outgoing Brooklyn borough president last traveled abroad in August during the general election campaign. At the time his reps would only say he was on a personal trip to Europe with family. Politico later reported that he was vacationing in Monaco.

A spokesman for Adams did not return messages seeking comment about the upcoming trip.

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Eric Adams' planned international trip now up in the air due to COVID-19 Omicron variant - New York Post

Ahead of a U.S Food and Drug Administration advisory panel meeting, drugmaker Merck has revealed final analysis data from a Phase 3 trial testing its oral antiviral pill against COVID-19. The new data reveals the treatment is significantly less effective than early indications.

Two months ago, Merck announced promising early data for molnupiravir, its oral antiviral COVID-19 treatment. The interim Phase 3 trial analysis revealed the pill reduced a persons risk of hospitalization or death from COVID-19 by 50 percent when taken within five days of symptoms appearing.

However, the final trial analysis is now indicating the treatment is much less effective than first suggested. The new data, encompassing all the Phase 3 trial participants (1,433 subjects, instead of the earlier analysis that only looked at 775 subjects), found 9.7 percent of those in the placebo group experienced either hospitalization or death from COVID-19 compared to 6.8 percent in the group taking the new antiviral.

This means molnupiravir reduces a person's risk of hospitalization or death from COVID-19 by 30 percent, and not 50 percent, as was previously reported after the interim analysis. The new data also reports nine COVID-19 deaths were seen in the placebo group, compared to just one death in the molnupiravir group.

The new data comes ahead of this weeks Antimicrobial Drugs Advisory Committee (ADAC) meeting. The ADAC is an independent panel that publicly convenes to issue antimicrobial drug approval recommendations, and while the FDA generally follows ADACs advice, it is not compelled to do so.

Alongside evaluating the molnupiravir trial data, the FDA has issued two key questions for ADAC to discuss. One question asks if there should be any monitoring strategies put in place to track viral mutations that may be triggered through the use of molnupiravir.

Molnupiravir inhibits the replication of SARS-CoV-2 by increasing the frequency of viral RNA mutations. This essentially floods the viral genome with so many errors the virus can no longer effectively replicate. The FDAs question to ADAC is linked to some concerns that widespread use of molnupiravir could hasten the rise of dangerous SARS-CoV-2 variants.

The other key question the FDA is asking ADAC to consider is whether molnupiravir is safe for pregnant women. Hypothetically, mutagenic drugs such as molnupiravir could generate birth defects. Pregnant women were excluded from Mercks Phase 3 trial of molnupiravir, so the FDA is tasking ADAC with providing recommendations for what groups of people should be excluded from using the drug.

No serious adverse effects were detected in Mercks molnupiravir trial and it is likely the antiviral will be issued an Emergency Use Authorization by the FDA despite this reduced efficacy.

This will make it the first oral treatment designed specifically for COVID-19 to be approved for clinical use. Hot on its heels is a COVID-19 antiviral pill from Pfizer, which recently reported extraordinary interim results of reducing hospitalization or death in high-risk patients by 89 percent compared to placebo.

Source: Merck

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Promising COVID-19 pill is less effective than initially reported - New Atlas

By Heidi de Marco

It was Saturday morning at Southbay Tattoo and Body Piercing in Carson, California, and owner Efrain Espinoza Diaz Jr. was prepping for his first tattoo of the day a memorial portrait of a man that his widow wanted on her forearm.

Diaz, known as Rock, has been a tattoo artist for 26 years but still gets a little nervous when doing memorial tattoos, and this one was particularly sensitive. Diaz was inking a portrait of Philip Martin Martinez, a fellow tattoo artist and friend who was 45 when he died of covid-19 in August.

I need to concentrate, said Diaz, 52. Its a picture of my friend, my mentor.

Martinez, known to his friends and clients as Sparky, was a tattoo artist of some renown in nearby Wilmington, in Los Angeles South Bay region. A tattoo had brought Sparky and Anita together; Sparky gave Anita her first tattoo a portrait of her father in 2012, and the experience sparked a romance. Over the years of their relationship, he had covered her body with intertwining roses and a portrait of her mother.

Now his widow, she was getting the same photograph that was etched on Sparkys tomb inked into her arm. And this would be her first tattoo that Sparky had not applied.

It feels a little odd, but Rock has been really good to us, Anita Martinez said. Rock and Sparky grew up together. They met in the 1990s, at a time when there were no Mexican-American-owned tattoo shops in their neighborhood but Sparky was gaining a reputation. It was artists like Phil that would inspire a lot of us to take that step into the professional tattoo industry, Rock said.

After Sparky got sick, Anita wasnt allowed in her husbands hospital room, an isolating experience shared by hundreds of thousands of Americans who lost a loved one to covid. They let her in only at the very end.

The tattooed portrait of Philip Martin Martinez on Anitas arm. She chose to get it on her forearm so she could see it every day. (Heidi de Marco/KHN)

I got cheated out of being with him in his last moments, said Martinez, 43. When I got there, I felt he was already gone. We never got to say goodbye. We never got to hug.

I dont even know if Im ever going to heal, she said, as Diaz began sketching the outlines of the portrait below her elbow, but at least Ill get to see him every day.

According to a 2015 Harris Poll, almost 30% of Americans have at least one tattoo, a 10% increase from 2011. At least 80% of tattoos are for commemoration, said Deborah Davidson, a professor of sociology at York University in Toronto who has been researching memorial tattoos since 2009.

Memorial tattoos help us speak our grief, bandage our wounds and open dialogue about death, she said. They help us integrate loss into our lives to help us heal.

Covid, sadly, has provided many opportunities for such memorials.

Juan Rodriguez, a tattoo artist who goes by Monch, preps his clients arm for a memorial tattoo. (HEIDI DE MARCO / KHN)

Juan Rodriguez, a tattoo artist who goes by Monch, has been seeing twice as many clients as before the pandemic and is booked months in advance at his parlor in Pacoima, an L.A. neighborhood in the San Fernando Valley. Memorial tattoos, which can include names, portraits and special artwork, are common in his line of work, but theres been an increase in requests due to the pandemic. One client called me on the way to his brothers funeral, Rodriguez said.

Rodriguez thinks memorial tattoos help people process traumatic experiences. As he moves his needle over the arms, legs and backs of his clients, and they share stories of their loved ones, he feels he is part artist, part therapist.

Healthy grievers do not resolve grief by detaching from the deceased but by creating a new relationship with them, said Jennifer R. Levin, a therapist in Pasadena, California, who specializes in traumatic grief. Tattoos can be a way of sustaining that relationship, she said.

Its common for her patients in the 20-to-50 age range to get memorial tattoos, she said. Its a powerful way of acknowledging life, death and legacy.

Sazalea Martinez, a kinesiology student at Antelope Valley College in Palmdale, California, came to Rodriguez in September to memorialize her grandparents. Her grandfather died of covid in February, her grandmother in April. She chose to have Rodriguez tattoo an image of azaleas with I love you written in her grandmothers handwriting.

The azaleas, which are part of her name, represent her grandfather, she said. Sazalea decided not to get a portrait of her grandmother because the latter didnt approve of tattoos. The I love you is something simple and its comforting to me, she said. Its going to let me heal and I know she would have understood that.

Sazalea teared up as the needle moved across her forearm, tracing her grandmothers handwriting. Its still super fresh, she said. They basically raised me. They impacted who I am as a person, so to have them with me will be comforting.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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Memorial tattoos grow even more widespread in time of COVID-19 - oregonlive.com

Significance

Plastic waste causes harm to marine life and has become a major global environmental concern. The recent COVID-19 pandemic has led to an increased demand for single-use plastic, intensifying pressure on this already out-of-control problem. This work shows that more than eight million tons of pandemic-associated plastic waste have been generated globally, with more than 25,000 tons entering the global ocean. Most of the plastic is from medical waste generated by hospitals that dwarfs the contribution from personal protection equipment and online-shopping package material. This poses a long-lasting problem for the ocean environment and is mainly accumulated on beaches and coastal sediments. We call for better medical waste management in pandemic epicenters, especially in developing countries.

The COVID-19 pandemic has led to an increased demand for single-use plastics that intensifies pressure on an already out-of-control global plastic waste problem. While it is suspected to be large, the magnitude and fate of this pandemic-associated mismanaged plastic waste are unknown. Here, we use our MITgcm ocean plastic model to quantify the impact of the pandemic on plastic discharge. We show that 8.4 1.4 million tons of pandemic-associated plastic waste have been generated from 193 countries as of August 23, 2021, with 25.9 3.8 thousand tons released into the global ocean representing 1.5 0.2% of the global total riverine plastic discharge. The model projects that the spatial distribution of the discharge changes rapidly in the global ocean within 3 y, with a significant portion of plastic debris landing on the beach and seabed later and a circumpolar plastic accumulation zone will be formed in the Arctic. We find hospital waste represents the bulk of the global discharge (73%), and most of the global discharge is from Asia (72%), which calls for better management of medical waste in developing countries.

Plastics have an excellent strength to weight ratio, and they are durable and inexpensive, making them the material of choice for most disposable medical tools, equipment, and packaging (1, 2). The COVID-19 pandemic has demonstrated the indispensable role of plastic in the healthcare sector and public health safety (2). As of August 23, 2021, about 212 million people worldwide have been infected with the COVID-19 virus with the most confirmed cases in the Americas (47.6%) and Asia (31.22%) followed by Europe (17.26%) (3). The surging number of inpatients and virus testing substantially increase the amount of plastic medical waste (4). To sustain the enormous demand for personal protective equipment (PPE, including face masks, gloves, and face shields), many single-use plastic (SUP) legislations have been withdrawn or postponed (2). In addition, lockdowns, social distancing, and restrictions on public gathering increase the dependency on online shopping at an unprecedented speed, the packaging material of which often contains plastics (5, 6).

Unfortunately, the treatment of plastic waste is not keeping up with the increased demand for plastic products. Pandemic epicenters in particular struggle to process the waste (7), and not all the used PPEs and packaging materials are handled or recycled (8, 9). This mismanaged plastic waste (MMPW) is then discharged into the environment, and a portion reaches the ocean (10). The released plastics can be transported over long distances in the ocean, encounter marine wildlife, and potentially lead to injury or even death (1114). For example, a recent report estimated that 1.56 million face masks entered the oceans in 2020 (15). Earlier studies have also raised the potential problem of COVID-19 plastic pollution and its impact on marine life (1618). Some cases of entanglement, entrapment, and ingestion of COVID-19 waste by marine organisms, even leading to death, have been reported (19, 20). The plastic debris could also facilitate species invasion and transport of contaminants including the COVID-19 virus (2123). Despite the potential impacts, the total amount of pandemic-associated plastic waste and its environmental and health impacts are largely unknown. Here, we estimate the amount of excess plastic released during the pandemic that enters the global ocean and its long-term fate and potential ecological risk.

As of August 23, 2021, the total excess MMPW generated during the pandemic is calculated as 4.4 to 15.1 million tons (Fig. 1). We use the average of scenarios with different assumptions as our best estimate (Methods), which is about 8.4 1.4 million tons. A dominant fraction (87.4%) of this excess waste is from hospitals, which is estimated based on the number of COVID-19 inpatients (24) and per-patient medical waste generation for each country (25). PPE usage by individuals contributes only 7.6% of the total excess wastes. Interestingly, we find that the surge in online shopping results in an increased demand for packaging material. However, we find that packaging and test kits are minor sources of plastic waste and only account for 4.7% and 0.3%, respectively.

Global generation of mismanaged plastics from different sources (hospital medical waste, test kits, PPE, and online packaging) attributable to the COVID-19 pandemic. High- and low-yield scenarios are considered for each source (Methods).

Table 1 shows the distribution of COVID-19 cases across different continents (Asia, Europe, North America, South America, Oceania, and Africa). About 70% of COVID-19 cases are found in North and South America and Asia (Table 1). We find that MMPW generation does not follow the case distribution, as most MMPW is produced in Asia (46%), followed by Europe (24%), and finally in North and South America (22%) (Table 1 and Fig. 2E). This reflects the lower treatment level of medical waste in many developing countries such as India, Brazil, and China (range between 11.5 and 76% as the low- and high-end estimates) compared with developed countries with large numbers of cases in North America and Europe (e.g., the United States and Spain) (0 to 5%) (Fig. 2A). The MMPW generated from individual PPE is even more skewed toward Asia (Fig. 2C and SI Appendix, Table S1) because of the large mask-wearing population (26). Similarly, the MMPW generated from online-shopping packaging is the highest in Asia (Fig. 2D). For instance, the top three countries in the express-delivery industry of global share are China (58%), United States (14.9%), and Japan (10.3%) followed by the United Kingdom (4%) and Germany (4%) (27).

Percentage of the confirmed COVID-19 cases (as of August 23, 2021), the generated mass of pandemic-associated MMPW ending up in the environment, and the pandemic-associated MMPW that is transported to river mouths for different continents

Accumulated riverine discharge of pandemic-associated mismanaged plastics to the global ocean. Panels are for the discharges caused by (A) hospital medical waste, (B) COVID-19 virus test kits, (C) PPE, (D) online-shopping packaging material, and (E) the total of them. The background color represents the generated MMPW in each watershed, while the sizes of the blue circles are for the discharges at river mouths.

Based on the MMPW production from each country and a hydrological model (28), we calculate a total discharge of 25.9 3.8 (12.3 as microplastics [< 5 mm] and 13.6 as macroplastics [> 5 mm]) thousand tons of pandemic-associated plastics to the global ocean from 369 major rivers and their watersheds (Fig. 2E). We believe that the 369 rivers (account for 91% of the global riverine plastic discharge to the sea) considered here include a vast majority of the global pandemic-associated plastic discharge. The top three rivers for pandemic-associated plastic waste discharge are Shatt al Arab (5.2 thousand tons, in Asia), Indus (4.0 thousand tons, in Asia), and Yangtze River (3.7 thousand tons, in Asia) followed by Ganges Brahmaputra (2.4 thousand tons, in Asia), Danube (1.7 thousand tons, in Europe), and Amur (1.2 thousand tons, in Asia). These findings highlight the hotspot rivers and watersheds that require special attention in plastic waste management.

Overall, the top 10 rivers account for 79% of pandemic plastic discharge, top 20 for 91%, and top 100 for 99%. About 73% of the discharge is from Asian rivers followed by Europe (11%), with minor contributions from other continents (Table 1). This pattern is different from that of the generation of MMPW (Table 1) because of the different ability of rivers to export plastic load to the ocean, which is measured as the yield ratio (defined as the ratio between the plastic discharges at the river mouth and the total MMPW generation in the watershed). The yield ratio is influenced by factors such as the distribution of plastic release along rivers and the physical conditions of rivers (e.g., water runoff and velocity) (28). The top five rivers with the highest yield ratios are the Yangtze River (0.9%), Indus (0.5%), Yellow River (0.5%), Nile (0.4%), and Ganges Brahmaputra (0.4%). These rivers have either high population density near the river mouth, large runoff, fast water velocity, or a combination of them. The combination of high pandemic-associated MMPW generations and yield ratio for Asian rivers results in their high discharge of MMPW to the ocean.

We simulate the transport and fate of the 25,900 3,800 tons of pandemic-associated plastic waste by the Nanjing University MITgcm-Plastic model (NJU-MP) to evaluate its impact on the marine environment. The model considers the primary processes that plastics undergo in seawater: beaching, drifting, settling, biofouling/defouling, abrasion, and fragmentation (29). The model reveals that a large fraction of the river discharged plastics are transferred from the surface ocean to the beach and seabed within 3 y (Fig. 3). At the end of 2021, the mass fraction of plastics in seawater, seabed, and beach are modeled as 13%, 16%, and 71% respectively. About 3.8% of the plastics are in the surface ocean with a global mean concentration of 9.1 kg/km2. Our model also suggests that the discharged pandemic-associated plastics are mainly distributed in ocean regions relatively close to their sources, for example, middle- and low-latitude rivers distributed in East and South Asia, South Africa, and the Caribbean (Fig. 4 and SI Appendix, Fig. S2). The beaching and sedimentation fluxes are mainly distributed near major river mouths (Fig. 4 and SI Appendix, Fig. S2). This suggests that the short-term impact of pandemic-associated plastics is rather confined in the coastal environment.

Projection of the fate of discharged pandemic-associated plastics (including both microplastics and macroplastics) in the global ocean. (A) The mass fractions and average concentrations in the surface ocean. (B) The mass fractions in the seawater, seabed, and beaches.

Modeled spatial distribution of mass concentrations of COVID-19-associated plastics in the surface ocean (AC, JL), on the beaches (DF, MO), and the seabed (GI, PR) in 2021, 2025, and 2100, respectively. The black boxes on the Top panel indicate the five subtropical ocean gyres (North Pacific Gyre, North Atlantic Gyre, South Pacific Gyre, South Atlantic Gyre, and Indian Gyre). Panels AI are for the microplastics, while JR are for the macroplastics.

The model suggests the impact could expand to the open ocean in 3 to 4 y. The mass fraction of plastics in the seawater is predicted to decrease in the future while those in seabed and beach are modeled to gradually increase. At the end of 2022, the fractions of riverine discharged, pandemic-associated MMPW in seawater, seabed, and beach are modeled as 5%, 19%, and 76%, respectively, and the mean surface ocean concentration sharply decreases to 3.1kg/km2. In 2025, five garbage patches in the center of subtropic gyres merge, including the four in North and South Atlantic and Pacific and the one in the Indian Ocean (Fig. 4 and SI Appendix, Fig. S2). Hot spots for sedimentation fluxes are also modeled in the high-latitude North Atlantic and the Arctic Ocean in 2025 (Fig. 4 and SI Appendix, Fig. S2), reflecting the large-scale vertical movement of the seawaters (SI Appendix, Fig. S3).

We find a long-lasting impact of the pandemic-associated waste release in the global ocean. At the end of this century, the model suggests that almost all the pandemic-associated plastics end up in either the seabed (28.8%) or beaches (70.5%), potentially hurting the benthic ecosystems. The global mean pandemic-associated plastic concentrations in the surface ocean are predicted to decrease to 0.3 kg/km2 in 2100, accounting for 0.03% of the total discharged plastic mass. However, two garbage patches are still modeled over the northeast Pacific and the southeast Indian Ocean, exerting persistent risk for ecosystems over there. The fate of microplastics and macroplastics are similar but with a higher fraction of macroplastics ending up in the beaches due to their lower mobility (Fig. 4 and SI Appendix, Fig. S1).

The Arctic Ocean appears to be a dead-end for plastic debris transport due to the northern branch of the thermohaline circulation (30). About 80% of the plastic debris discharged into the Arctic Ocean will sink quickly, and a circumpolar plastic accumulation zone is modeled to form by 2025. In this year, the Arctic seabed accounts for 13% of the global plastic sedimentation flux, but this fraction will increase to 17% in 2100. The Arctic ecosystem is considered to be particularly vulnerable due to the harsh environment and high sensitivity to climate change (31, 32), which makes the potential ecological impact of exposure to the projected accumulated Arctic plastics of special concern.

It is speculated that the pandemic will not be completely controlled in a couple of years, and many of the containing policies will continue to be implemented (33). By the end of 2021, it is conservatively estimated that the number of confirmed cases will reach 280 million (34). The generated pandemic-associated MMPW will reach a total of 11 million tons, resulting in a global riverine discharge of 34,000 tons to the ocean. The MMPW generation and discharge are expected to be more skewed toward Asia due to record-breaking confirmed cases in India (3). Given the linearity between the discharge and ocean plastic mass, the fate and transport of the newly generated plastic discharge can be deduced from our current results.

There are substantial uncertainties associated with our estimate of pandemic-associated MMPW release due to the lack of accurate data (e.g., the number of used masks and online-shopping packages and the fraction of mismanaged waste under the over-capacity conditions). For example, our estimate for the discharge from face mask usage is much lower than that of Chowdhury etal. (35), which assumes that a person uses a single mask daily while we assume a mask lasts for 6 d based on survey data (Methods). We thus consider multiple scenarios to cap the actual situations (Methods). The estimated MMPW as hospital medical waste varies by 53%, while that from packaging and PPE vary by 25% and a factor of 3.5, respectively. The estimated amounts of riverine MMPW discharge to the ocean have also uncertainty as they are based on a coarse resolution (i.e., watershed-wise) hydrological model (28). In addition, factors such as the fragmentation, abrasion, and beaching rate of plastics in NJU-MP also have a substantial influence on the simulation results (29). Despite these uncertainties, the spatial pattern of the pandemic-associated releases and their relative fate in different compartments of the ocean is more robust.

The pandemic-associated plastic discharge to the ocean accounts for 1.5 0.2% of the total riverine plastic discharges (28, 36). A large portion of the discharge is medical waste that also elevates the potential ecological and health risk (37) or even the spreading of the COVID-19 virus (38). This offers lessons that waste management requires structural changes. The revoking or delaying of the bans on SUPs may complicate plastic waste control after the pandemic. Globally public awareness of the environmental impact of PPE and other plastic products needs to be increased. Innovative technologies need to be promoted for better plastic waste collection, classification, treatment, and recycling, as well as the development of more environmentally friendly materials (15, 39). Better management of medical waste in epicenters, especially in developing countries, is necessary.

We develop an inventory for the excess plastic waste generated due to the COVID-19 pandemic. We consider four categories of sources: hospital-generated medical waste, virus testing kits, PPE used by residents, and online-shopping packages.

For hospital-generated medical waste, we estimate the amount by the number of hospitalization patients (nH) and per-patient healthcare waste generation rates (HCWGR). The nH is estimated based on the number of COVID-19 infections (nI) and the global average hospitalization rate (HR) of this disease:nH=nIHR.[1]

The nI and HR data are based on the statistics of the World Health Organization (3). The HCWGR of COVID-19 patients is approximately two times higher than that of general patients (40), which is calculated as a function of life expectancy (LE) and CO2 emissions (CDE) based on Minoglou etal. (25):HCWGR=2(0.014LE+0.31CDE).[2]

This relationship was developed based on the statistical data from 42 countries worldwide and can explain 85% of the variability of the HCWGR data (25). The LE data are from Roser etal. (41), and the CDE data are from Worldometer (42).

The virus testing kitsgenerated medical waste is estimated based on the number of conducted tests and the amount of waste generated per test. The former data are from Ritchie etal. (43) while the latter is from Cheon (44) and ShineGene (45). Depending on the specifications of the testing kits, the waste generated per test ranges 21 to 28 g/test.

For the PPE used by residents, we consider only face masks, as other items such as gloves and face shields are less commonly used. We use two ways to estimate the number of used masks: consumption-based and production-based. For the former way, we first assume an ideal condition that each person uses a new mask every 6 d (46), and we assume that the actual mask usage lies 25 to 75% of this situation. The population data are from United Nations (26). For the latter way, we assume that all masks produced are used up. The global production (PW) is estimated based on the mask production in China (PC), which is the largest mask producing country (54 to 72%) in the world (47):PW=PCp,[3]where p is the share of Chinese-produced masks (47). We also consider two scenarios for the mass of waste generated by each mask (for surgical masks or N95 masks).

The online-shopping packaging (np) in this study refers to the excess part that is caused by lifestyle changes during the pandemic compared to the normal situation (no COVID-19 pandemic) (nno-covid):np=nactualnnocovid,[4]where nactual is the actual online package usages from 2020 to the first quarter of 2021 and is estimated based on the financial report of the top six e-commerce companies worldwide (Taobao, Tmall, Amazon, Jingdong, eBay, and Walmart) (4852). The nno-covid is calculated based on the package numbers in 2019 and an average annual growth rate in recent years (53). The mass of generated plastic waste (m) is then estimated based on the average mass of plastics in the packaging material (mp) (54):m=npmp.[5]

The amount of MMPW for each source (i) can be calculated based on the waste generation rate of the above four sources (Rw), the fraction of plastic waste in the total waste (Pp), and the fraction of mismanagement waste in the total waste (Pm):MMPW=i=14RwiPpiPmi.[6]

We consider the former two source categories as medical waste while the latter two as municipal waste. The Pm for each country is specified according to the waste type. The Pm of municipal waste is based on Schmidt etal. (28). There is no solid data for the Pm of medical waste, and we use the data of Caniato etal. (55) as a function of the economic status (56) and the level of treatment and disposal of waste for individual countries. The dataset includes two scenarios, and we consider an additional scenario that is 50% lower than the lower one to account for the uncertainty of this fraction.

We estimate the river discharge of pandemic-associated MMPW to the ocean based on the watershed model developed by Schmidt etal. (28), which calculates the yield ratio of plastic discharge at the river mouth to the total MMPW generated in the entire corresponding watershed. We assume this ratio is the same for pandemic-associated plastic waste and other wastes. We consider a total of 369 major rivers and their watersheds in this study. We split the country-specific, pandemic-associated MMPW data to each watershed based on the amount of regular MMPW (28).

The NJU-MP model has a resolution of 2 latitude 2.5 longitude horizontally with 22 vertical levels and is driven by ocean physics from the Integrated Global Systems Model with 4-h time step (29). The model considers five categories of plastics with different chemical composition, and the density of each category is predetermined: polyethylene (PE, 950 kg/m3), polypropylene (PP, 900 kg/m3), polyvinyl chloride (PVC, 1,410 kg/m3), polyurethane (PU, 550 kg/m3), and others (1,050 kg m3). The plastics densities are modeled to increase when biofouled but decrease when defouled (57). The densities determine their buoyancy as low-density polymers float, whereas high-density polymers sink to the sediment (58, 59). Each category has six size bins: four belong to microplastics: <0.0781 mm, 0.0781 to 0.3125 mm, 0.3125 to 1.25 mm, and 1.25 to 5 mm, and two belong to macroplastics: 5 to 50 mm and >50 mm. There is thus a total of 60 plastic tracers in the model. We assume all the plastic debris as spheres for simplicity. The pandemic-associated MMPW discharge from rivers are released as half 5 to 10 mm and half >50 mm for macroplastics, while the largest size bin (i.e., 1.25 to 5 mm) for microplastics. After their discharge into the ocean, the plastics undergo removal by beach interception (57) and sinking to the deeper ocean and eventually on the seafloor. Biofouling of light plastic types (PE and PP) is modeled following Kooi etal. (60) but adjusted for more realistic scenarios. Three types of plastics with different degrees of biological attachment are considered. In addition, the model considers the removal processes including ultraviolet degradation, fragmentation, and abrasion.

The MMPW generation and river discharge datafor all the countries are provided in the Environmental Biogeochemistry Modeling Group (EBMG), https://www.ebmg.online/plastics (61). All study data are included in the article and/or SI Appendix.

This research was funded by the National Natural Science Foundation of China (Grant Nos. 42177349 and 41875148), the Fundamental Research Funds for the Central Universities (Grant No. 0207-14380168), Frontiers Science Center for Critical Earth Material Cycling, Jiangsu Innovative and Entrepreneurial Talents Plan, and the Collaborative Innovation Center of Climate Change, Jiangsu Province. We are grateful to the High Performance Computing Center of Nanjing University for doing the numerical calculations in this paper on its blade cluster system.

Author contributions: A.T.S. and Y.Z. designed research; Y.P. and P.W. performed research; Y.P. and P.W. analyzed data; and Y.P., A.T.S., and Y.Z. wrote the paper.

The authors declare no competing interest.

This article is a PNAS Direct Submission.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2111530118/-/DCSupplemental.

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Plastic waste release caused by COVID-19 and its fate in the global ocean - pnas.org

COVID-19

The City ofPrescott is working closely with officials from Yavapai County Community HealthServices, and monitoring information from the Arizona Department of HealthServices (ADHS) to keep up to date on COVID-19 around the State.

This information is intended to help citizens stay informed with the latest updates at the Federal, State and County Level.

Mayor Mengarelli provides video updates twice per week- on Mondays and Thursdays, on the City of Prescott Facebook page. You can view these on this link, even if you do not have a Facebook account.

Vaccination Station CANCELLED Tomorrow January 26, 2021

No clinics are planned for Prescott Gateway Mall for Monday, January 25ththrough Wednesday, January 27thto give our teams time to support second vaccination clinics for members of Priority Group 1A who are already scheduled.

Appointments have opened for Thursday, January 28ththrough Sunday, January 31st, from 8:00 am to 5:00 pm, at Prescott Gateway Mall. The clinics are being held in the Sears Building, East Entrance, at 3400 Gateway Blvd., in Prescott.

Vaccinations are available by appointment only.Appointments can be scheduled via the Yavapai County Community Health Services website located at:https://www.yavapai.us/chs/Home/COVID-19/Vaccine

Greetings,

COVID-19 vaccination clinics are beginning to open around the community. Dignity Health, Yavapai Regional Medical Center will conduct clinics at the Prescott Gateway Mall beginning on Thursday, January 21st through Sunday, January 24th for priority groups 1A and 1B. The schedule is currently full for all four days and additional dates are planned. We expect to announce the new dates soon.

Spectrum Health is planning to conduct COVID-19 clinics at the Findlay Toyota Center beginning Monday, January 25th.

We also expect other sites to open in the community soon.

Yavapai County Community Health Services has launched a scheduling portal on their website, located at:https://www.yavapai.us/chs/Home/COVID-19/Vaccine. This website includes scheduling links for both the YRMC and Spectrum Health clinics. Scheduling links for other clinics will be added when the clinics open.

When you visit the YCCHS website, you will find a graph that lists the priority groups. You will need to click on the graph to open an interactive PDF. Once the PDF is open, click on the group you are part of for the scheduling links.

Yavapai County Community Health Services is operating a COVID-19 Hotline for anyone that has questions about the vaccination process. The number is (928) 442-5103.

The focus is currently on Priority Group 1A and Priority Group 1B, which include:

Priority Group 1A:

Healthcare Workers and Healthcare Support Occupations

Emergency Medical Services Workers

Long-Term Care Facility Staff and Residents

Priority Group 1B:

Education and Childcare Workers

Protective Service Occupations

Adults 65 Years of Age and Older

Essential Services/Critical Industry Workers

Adults with High Risk Conditions in Congregate Settings

Thank you.

YRMC Community Outreach

Rental Eviction Prevention Assistance

ADHS Vaccine Finder

City Managers Facebook Live Videos

Responsible Recreation:AOT has collaborated with outdoor recreation management agencies at the federal, state and local levels to createResponsible Recreation Across Arizona, a one-stop resource with guidelines on enjoying spectacular Arizona landscapes while adhering to COVID-19 physical distancing guidelines.

The latest responsible recreation updates includestatewide fire safetyand restriction information plus guidance onsummer recreationin the states deserts. With so many Arizonans turning to the outdoors as a great escape, its critical to approach these activities with a protective mindset, as these agencies remain committed to keeping all public lands open and accessible while protecting staff and visitors. This resource is updated regularly and can be shared with Arizonans and visitors alike.

The IRS has established a special phone line for taxpayers with questions about their Economic Impact Payments (EIP) 1-800-919-9835.

Consider other lending source options:

If you are not sure about your funding status with your lender, consider other alternate lender sources including online lending options which might provide easier access to the PPP loans.Some options to explore include Paypal, Square, Quickbooks/Intuit, Lendio, On-Deck, Blue Vine, and Kabbage, and others.Status and availability can change on a daily basis.

As you know, the Governor has made an executive order, closing public access to Bars, Restaurants, Movie Theaters and Gyms. In counties where a confirmed case of COVID-19 is reported.

As of March 21, 2020, these businesses should be closed in Yavapai County. Restaurants can serve food via carry out, curbside or delivery. The City will provide free 15 minute parking signs for any restaurant who wants one. Call 928-777-1126 for a sign.

Bar owners, who are unsure of whether they are allowed to serve alcohol to go, I suggest you go to AZGovernor.gov and search for Executive Order 2020-09

Virtual Town Hall for Faith Based and Mental Health Resources 4-17-20

Virtual Town Hall for Businesses 4-3-20

See the original post here:

COVID-19 City of Prescott

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case was identified in Wuhan, China, in December 2019. The disease has since spread worldwide, leading to an ongoing pandemic.

Symptoms of COVID-19 are variable, but often include fever, cough, fatigue, breathing difficulties, and loss of smell and taste. Symptoms begin one to fourteen days after exposure to the virus. Of those people who develop noticeable symptoms, most (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging), and 5% suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction).[6] At least a third of the people who are infected with the virus remain asymptomatic and do not develop noticeable symptoms at any point in time, but they still can spread the disease.[7][8] Some people continue to experience a range of effectsknown as long COVIDfor months after recovery, and damage to organs has been observed.[9] Multi-year studies are underway to further investigate the long-term effects of the disease.[9]

The virus that causes COVID-19 spreads mainly when an infected person is in close contact[a] with another person.[13][14] Small droplets and aerosols containing the virus can spread from an infected person's nose and mouth as they breathe, cough, sneeze, sing, or speak. Other people are infected if the virus gets into their mouth, nose or eyes. The virus may also spread via contaminated surfaces, although this is not thought to be the main route of transmission.[14] The exact route of transmission is rarely proven conclusively,[15] but infection mainly happens when people are near each other for long enough. People who are infected can transmit the virus to another person up to two days before they themselves show symptoms, as can people who do not experience symptoms. People remain infectious for up to ten days after the onset of symptoms in moderate cases and up to 20 days in severe cases.[16]Several testing methods have been developed to diagnose the disease. The standard diagnostic method is by detection of the virus' nucleic acid by real-time reverse transcription polymerase chain reaction (rRT-PCR), transcription-mediated amplification (TMA), or by loop-mediated isothermal amplification from a nasopharyngeal swab.

Preventive measures include physical or social distancing, quarantining, ventilation of indoor spaces, covering coughs and sneezes, hand washing, and keeping unwashed hands away from the face. The use of face masks or coverings has been recommended in public settings to minimise the risk of transmissions. Several vaccines have been developed and several countries have initiated mass vaccination campaigns.

Although work is underway to develop drugs that inhibit the virus, the primary treatment is currently symptomatic. Management involves the treatment of symptoms, supportive care, isolation, and experimental measures.

Symptoms of COVID-19 are variable, ranging from mild symptoms to severe illness.[17][18] Common symptoms include headache, loss of smell and taste, nasal congestion and rhinorrhea, cough, muscle pain, sore throat, fever, diarrhea, and breathing difficulties.[19] People with the same infection may have different symptoms, and their symptoms may change over time. In people without prior ears, nose, and throat disorders, loss of taste combined with loss of smell is associated with COVID-19.[20]

Most people (81%) develop mild to moderate symptoms (up to mild pneumonia), while 14% develop severe symptoms (dyspnea, hypoxia, or more than 50% lung involvement on imaging) and 5% of patients suffer critical symptoms (respiratory failure, shock, or multiorgan dysfunction).[21] At least a third of the people who are infected with the virus do not develop noticeable symptoms at any point in time.[22][23][24][25] These asymptomatic carriers tend not to get tested and can spread the disease.[25][26][27][28] Other infected people will develop symptoms later, called "pre-symptomatic", or have very mild symptoms and can also spread the virus.[29]

As is common with infections, there is a delay between the moment a person first becomes infected and the appearance of the first symptoms. The median delay for COVID-19 is four to five days.[30] Most symptomatic people experience symptoms within two to seven days after exposure, and almost all will experience at least one symptom within 12 days.[30][31]

COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus strain.

Coronavirus disease 2019 (COVID-19) spreads from person to person mainly through the respiratory route after an infected person coughs, sneezes, sings, talks or breathes.[33][34] A new infection occurs when virus-containing particles exhaled by an infected person, either respiratory droplets or aerosols, get into the mouth, nose, or eyes of other people who are in close contact with the infected person.[35] During human-to-human transmission, an average 1000 infectious SARS-CoV-2 virions are thought to initiate a new infection.[36][37]

The closer people interact, and the longer they interact, the more likely they are to transmit COVID-19. Closer distances can involve larger droplets (which fall to the ground) and aerosols, whereas longer distances only involve aerosols.[35] Larger droplets can also turn into aerosols (known as droplet nuclei) through evaporation.[38] The relative importance of the larger droplets and the aerosols is not clear as of November 2020; however, the virus is not known to spread between rooms over long distances such as through air ducts.[39] Airborne transmission is able to particularly occur indoors, in high risk locations[39] such as restaurants, choirs, gyms, nightclubs, offices, and religious venues, often when they are crowded or less ventilated.[38] It also occurs in healthcare settings, often when aerosol-generating medical procedures are performed on COVID-19 patients.[40]

Although it is considered possible there is no direct evidence of the virus being transmitted by skin to skin contact.[41] A person could get COVID-19 indirectly by touching a contaminated surface or object before touching their own mouth, nose, or eyes, though this is not thought to be the main way the virus spreads, and there is no direct evidence of this method either.[41] The virus is not known to spread through feces, urine, breast milk, food, wastewater, drinking water, or via animal disease vectors (although some animals can contract the virus from humans). It very rarely transmits from mother to baby during pregnancy.[41]

Social distancing and the wearing of cloth face masks, surgical masks, respirators, or other face coverings are controls for droplet transmission. Transmission may be decreased indoors with well maintained heating and ventilation systems to maintain good air circulation and increase the use of outdoor air.[42]

The number of people generally infected by one infected person varies.[41] Coronavirus_disease 2019 is more infectious than influenza, but less so than measles. It often spreads in clusters, where infections can be traced back to an index case or geographical location.[43] There is a major role of "super-spreading events", where many people are infected by one person.[41][44]

A person who is infected can transmit the virus to others up to two days before they themselves show symptoms, and even if symptoms never appear.[45] People remain infectious in moderate cases for 712 days, and up to two weeks in severe cases.[45] In October 2020, medical scientists reported evidence of reinfection in one person.[46][47]

Severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) is a novel severe acute respiratory syndrome coronavirus. It was first isolated from three people with pneumonia connected to the cluster of acute respiratory illness cases in Wuhan.[48] All structural features of the novel SARS-CoV-2 virus particle occur in related coronaviruses in nature.[49]

Outside the human body, the virus is destroyed by household soap, which bursts its protective bubble.[50]

SARS-CoV-2 is closely related to the original SARS-CoV.[51] It is thought to have an animal (zoonotic) origin. Genetic analysis has revealed that the coronavirus genetically clusters with the genus Betacoronavirus, in subgenus Sarbecovirus (lineage B) together with two bat-derived strains. It is 96% identical at the whole genome level to other bat coronavirus samples (BatCov RaTG13).[52][53] The structural proteins of SARS-CoV-2 include membrane glycoprotein (M), envelope protein (E), nucleocapsid protein (N), and the spike protein (S). The M protein of SARS-CoV-2 is about 98% similar to the M protein of bat SARS-CoV, maintains around 98% homology with pangolin SARS-CoV, and has 90% homology with the M protein of SARS-CoV; whereas, the similarity is only around 38% with the M protein of MERS-CoV.[54][55]

The many thousands of SARS-CoV-2 variants are grouped into clades.[56] Several different clade nomenclatures have been proposed. Nextstrain divides the variants into five clades (19A, 19B, 20A, 20B, and 20C), while GISAID divides them into seven (L, O, V, S, G, GH, and GR).[57]

Several notable variants of SARS-CoV-2 emerged in late 2020. Cluster 5 emerged among minks and mink farmers in Denmark. After strict quarantines and a mink euthanasia campaign, it is believed to have been eradicated. The Variant of Concern 202012/01 (VOC 202012/01) is believed to have emerged in the United Kingdom in September. The 501Y.V2 Variant, which has the same N501Y mutation, arose independently in South Africa.[58][59]

Three known variants of COVID-19 are currently spreading among global populations as of January 2021 including the UK Variant (referred to as B.1.1.7) first found in London and Kent, a variant discovered in South Africa (referred to as 1.351), and a variant discovered in Brazil (referred to as P.1).[60]

Using Whole Genome Sequencing, epidemiology and modelling suggest the new UK variant VUI 202012/01 (the first Variant Under Investigation in December 2020) transmits more easily than other strains.[61]

COVID-19 can affect the upper respiratory tract (sinuses, nose, and throat) and the lower respiratory tract (windpipe and lungs).[62] The lungs are the organs most affected by COVID-19 because the virus accesses host cells via the enzyme angiotensin-converting enzyme 2 (ACE2), which is most abundant in type II alveolar cells of the lungs.[63] The virus uses a special surface glycoprotein called a "spike" (peplomer) to connect to ACE2 and enter the host cell.[64] The density of ACE2 in each tissue correlates with the severity of the disease in that tissue and decreasing ACE2 activity might be protective,[65] though another view is that increasing ACE2 using angiotensin II receptor blocker medications could be protective.[66] As the alveolar disease progresses, respiratory failure might develop and death may follow.[67]

Whether SARS-CoV-2 is able to invade the nervous system remains unknown. The virus is not detected in the CNS of the majority of COVID-19 people with neurological issues. However, SARS-CoV-2 has been detected at low levels in the brains of those who have died from COVID-19, but these results need to be confirmed.[68] SARS-CoV-2 may cause respiratory failure through affecting the brain stem as other coronaviruses have been found to invade the CNS. While virus has been detected in cerebrospinal fluid of autopsies, the exact mechanism by which it invades the CNS remains unclear and may first involve invasion of peripheral nerves given the low levels of ACE2 in the brain.[69][70][71] The virus may also enter the bloodstream from the lungs and cross the blood-brain barrier to gain access to the CNS, possibly within an infected white blood cell.[68]

The virus also affects gastrointestinal organs as ACE2 is abundantly expressed in the glandular cells of gastric, duodenal and rectal epithelium[72] as well as endothelial cells and enterocytes of the small intestine.[73]

The virus can cause acute myocardial injury and chronic damage to the cardiovascular system.[74] An acute cardiac injury was found in 12% of infected people admitted to the hospital in Wuhan, China,[75] and is more frequent in severe disease.[76] Rates of cardiovascular symptoms are high, owing to the systemic inflammatory response and immune system disorders during disease progression, but acute myocardial injuries may also be related to ACE2 receptors in the heart.[74] ACE2 receptors are highly expressed in the heart and are involved in heart function.[74][77] A high incidence of thrombosis and venous thromboembolism have been found people transferred to intensive care unit (ICU) with COVID-19 infections, and may be related to poor prognosis.[78] Blood vessel dysfunction and clot formation (as suggested by high D-dimer levels caused by blood clots) are thought to play a significant role in mortality, incidences of clots leading to pulmonary embolisms, and ischaemic events within the brain have been noted as complications leading to death in people infected with SARS-CoV-2. Infection appears to set off a chain of vasoconstrictive responses within the body, constriction of blood vessels within the pulmonary circulation has also been posited as a mechanism in which oxygenation decreases alongside the presentation of viral pneumonia.[79] Furthermore, microvascular blood vessel damage has been reported in a small number of tissue samples of the brains without detected SARS-CoV-2 and the olfactory bulbs from those who have died from COVID-19.[80][81][82]

Another common cause of death is complications related to the kidneys.[79] Early reports show that up to 30% of hospitalized patients both in China and in New York have experienced some injury to their kidneys, including some persons with no previous kidney problems.[83]

Autopsies of people who died of COVID-19 have found diffuse alveolar damage, and lymphocyte-containing inflammatory infiltrates within the lung.[84]

Although SARS-CoV-2 has a tropism for ACE2-expressing epithelial cells of the respiratory tract, people with severe COVID-19 have symptoms of systemic hyperinflammation. Clinical laboratory findings of elevated IL-2, IL-7, IL-6, granulocyte-macrophage colony-stimulating factor (GM-CSF), interferon- inducible protein 10 (IP-10), monocyte chemoattractant protein1 (MCP-1), macrophage inflammatory protein 1- (MIP-1), and tumour necrosis factor- (TNF-) indicative of cytokine release syndrome (CRS) suggest an underlying immunopathology.[75]

Additionally, people with COVID-19 and acute respiratory distress syndrome (ARDS) have classical serum biomarkers of CRS, including elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and ferritin.[85]

Systemic inflammation results in vasodilation, allowing inflammatory lymphocytic and monocytic infiltration of the lung and the heart. In particular, pathogenic GM-CSF-secreting T-cells were shown to correlate with the recruitment of inflammatory IL-6-secreting monocytes and severe lung pathology in people with COVID-19 .[86] Lymphocytic infiltrates have also been reported at autopsy.[84]

Multiple viral and host factors affect the pathogenesis of the virus. The S-protein, otherwise known as the spike protein, is the viral component that attaches to the host receptor via the ACE2 receptors. It includes two subunits: S1 and S2. S1 determines the virus host range and cellular tropism via the receptor binding domain. S2 mediates the membrane fusion of the virus to its potential cell host via the H1 and HR2, which are heptad repeat regions. Studies have shown that S1 domain induced IgG and IgA antibody levels at a much higher capacity. It is the focus spike proteins expression that are involved in many effective COVID-19 vaccines.[87]

The M protein is the viral protein responsible for the transmembrane transport of nutrients. It is the cause of the bud release and the formation of the viral envelope.[88] The N and E protein are accessory proteins that interfere with the host's immune response.[88]

Human angiotensin converting enzyme 2 (hACE2) is the host factor that SARS-COV2 virus targets causing COVID-19. Theoretically the usage of angiotensin receptor blockers (ARB) and ACE inhibitors upregulating ACE2 expression might increase morbidity with COVID-19, though animal data suggest some potential protective effect of ARB. However no clinical studies have proven susceptibility or outcomes. Until further data is available, guidelines and recommendations for hypertensive patients remain.[89]

The virus' affect on ACE2 cell surfaces leads to leukocytic infiltration, increased blood vessel permeability, alveolar wall permeability, as well as decreased secretion of lung surfactants. These effects cause the majority of the respiratory symptoms. However, the aggravation of local inflammation causes a cytokine storm eventually leading to a systemic inflammatory response syndrome.[90]

The severity of the inflammation can be attributed to the severity of what is known as the cytokine storm.[91] Levels of interleukin 1B, interferon-gamma, interferon-inducible protein 10, and monocyte chemoattractant protein 1 were all associated with COVID-19 disease severity. Treatment has been proposed to combat the cytokine storm as it remains to be one of the leading causes of morbidity and mortality in COVID-19 disease.[92]

A cytokine storm is due to an acute hyperinflammatory response that is responsible for clinical illness in an array of diseases but in COVID-19, it is related to worse prognosis and increased fatality. The storm causes the acute respiratory distress syndrome, blood clotting events such as strokes, myocardial infarction, encephalitis, acute kidney injury, and vasculitis. The production of IL-1, IL-2, IL-6, TNF-alpha, and interferon-gamma, all crucial components of normal immune responses, inadvertently become the causes of a cytokine storm. The cells of the central nervous system, the microglia, neurons, and astrocytes, are also be involved in the release of pro-inflammatory cytokines affecting the nervous system, and effects of cytokine storms toward the CNS are not uncommon.[93]

COVID-19 can provisionally be diagnosed on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) or other nucleic acid testing of infected secretions.[94][95] Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection.[96] Detection of a past infection is possible with serological tests, which detect antibodies produced by the body in response to the infection.[94]

The standard methods of testing for presence of SARS-CoV-2 are nucleic acid tests,[94][97] which detects the presence of viral RNA fragments.[98] As these tests detect RNA but not infectious virus, its "ability to determine duration of infectivity of patients is limited."[99] The test is typically done on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab or sputum sample may also be used.[100][101] Results are generally available within hours.[94] The WHO has published several testing protocols for the disease.[102]

A number of laboratories and companies have developed serological tests, which detect antibodies produced by the body in response to infection. Several have been evaluated by Public Health England and approved for use in the UK.[103]

The University of Oxford's CEBM has pointed to mounting evidence[104][105] that "a good proportion of 'new' mild cases and people re-testing positives after quarantine or discharge from hospital are not infectious, but are simply clearing harmless virus particles which their immune system has efficiently dealt with" and have called for "an international effort to standardize and periodically calibrate testing"[106] On 7 September, the UK government issued "guidance for procedures to be implemented in laboratories to provide assurance of positive SARS-CoV-2 RNA results during periods of low prevalence, when there is a reduction in the predictive value of positive test results."[107]

Chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection but are not recommended for routine screening.[96][108] Bilateral multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are common in early infection.[96][109] Subpleural dominance, crazy paving (lobular septal thickening with variable alveolar filling), and consolidation may appear as the disease progresses.[96][110] Characteristic imaging features on chest radiographs and computed tomography (CT) of people who are symptomatic include asymmetric peripheral ground-glass opacities without pleural effusions.[111]

Many groups have created COVID-19 datasets that include imagery such as the Italian Radiological Society which has compiled an international online database of imaging findings for confirmed cases.[112] Due to overlap with other infections such as adenovirus, imaging without confirmation by rRT-PCR is of limited specificity in identifying COVID-19.[111] A large study in China compared chest CT results to PCR and demonstrated that though imaging is less specific for the infection, it is faster and more sensitive.[95]

In late 2019, the WHO assigned emergency ICD-10 disease codes U07.1 for deaths from lab-confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed COVID-19 without lab-confirmed SARS-CoV-2 infection.[113]

The main pathological findings at autopsy are:[84]

Preventive measures to reduce the chances of infection include staying at home, wearing a mask in public, avoiding crowded places, keeping distance from others, ventilating indoor spaces, washing hands with soap and water often and for at least 20 seconds, practising good respiratory hygiene, and avoiding touching the eyes, nose, or mouth with unwashed hands.[117][118]

Those diagnosed with COVID-19 or who believe they may be infected are advised by the CDC to stay home except to get medical care, call ahead before visiting a healthcare provider, wear a face mask before entering the healthcare provider's office and when in any room or vehicle with another person, cover coughs and sneezes with a tissue, regularly wash hands with soap and water and avoid sharing personal household items.[119][120]

The first COVID-19 vaccine was granted regulatory approval on 2 December by the UK medicines regulator MHRA.[121] It was evaluated for emergency use authorization (EUA) status by the US FDA, and in several other countries.[122] Initially, the US National Institutes of Health guidelines do not recommend any medication for prevention of COVID-19, before or after exposure to the SARS-CoV-2 virus, outside the setting of a clinical trial.[123][124] Without a vaccine, other prophylactic measures, or effective treatments, a key part of managing COVID-19 is trying to decrease and delay the epidemic peak, known as "flattening the curve".[125] This is done by slowing the infection rate to decrease the risk of health services being overwhelmed, allowing for better treatment of current cases, and delaying additional cases until effective treatments or a vaccine become available.[125][126]

A COVID19 vaccine is a vaccine intended to provide acquired immunity against severe acute respiratory syndrome coronavirus 2 (SARSCoV2), the virus causing coronavirus disease 2019 (COVID19). Prior to the COVID19 pandemic, work to develop a vaccine against coronavirus diseases like severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) established knowledge about the structure and function of coronaviruses; this knowledge enabled accelerated development of various vaccine technologies during early 2020.[127]

As of February2021[update], 66 vaccine candidates are in clinical research, including 17 in Phase I trials, 23 in Phase III trials, 6 in Phase II trials, and 20 in Phase III trials.[128] Trials for four other candidates were terminated.[128] In Phase III trials, several COVID19 vaccines demonstrate efficacy as high as 95% in preventing symptomatic COVID19 infections. As of February2021[update], ten vaccines are authorized by at least one national regulatory authority for public use: two RNA vaccines (the PfizerBioNTech vaccine and the Moderna vaccine), three conventional inactivated vaccines (BBIBP-CorV, Covaxin, and CoronaVac), four viral vector vaccines (Sputnik V, the OxfordAstraZeneca vaccine, Convidicea, and the Johnson & Johnson vaccine), and one peptide vaccine (EpiVacCorona).[128]

Social distancing (also known as physical distancing) includes infection control actions intended to slow the spread of the disease by minimising close contact between individuals. Methods include quarantines; travel restrictions; and the closing of schools, workplaces, stadiums, theatres, or shopping centres. Individuals may apply social distancing methods by staying at home, limiting travel, avoiding crowded areas, using no-contact greetings, and physically distancing themselves from others.[134] Many governments are now mandating or recommending social distancing in regions affected by the outbreak.[135]

Outbreaks have occurred in prisons due to crowding and an inability to enforce adequate social distancing.[136][137] In the United States, the prisoner population is aging and many of them are at high risk for poor outcomes from COVID-19 due to high rates of coexisting heart and lung disease, and poor access to high-quality healthcare.[136]

Self-isolation at home has been recommended for those diagnosed with COVID-19 and those who suspect they have been infected. Health agencies have issued detailed instructions for proper self-isolation.[138] Many governments have mandated or recommended self-quarantine for entire populations. The strongest self-quarantine instructions have been issued to those in high-risk groups.[139] Those who may have been exposed to someone with COVID-19 and those who have recently travelled to a country or region with the widespread transmission have been advised to self-quarantine for 14 days from the time of last possible exposure.[citation needed]

The WHO and the US CDC recommend individuals wear non-medical face coverings in public settings where there is an increased risk of transmission and where social distancing measures are difficult to maintain.[140][141] This recommendation is meant to reduce the spread of the disease by asymptomatic and pre-symptomatic individuals and is complementary to established preventive measures such as social distancing.[141][142] Face coverings limit the volume and travel distance of expiratory droplets dispersed when talking, breathing, and coughing.[141][142] A face covering without vents or holes will also filter out particles containing the virus from inhaled and exhaled air, reducing the chances of infection.[143] But, if the mask include an exhalation valve, a wearer that is infected (maybe without having noticed that, and asymptomatic) would transmit the virus outwards through it, despite any certification they can have. So the masks with exhalation valve are not for the infected wearers, and are not reliable to stop the pandemic in a large scale. Many countries and local jurisdictions encourage or mandate the use of face masks or cloth face coverings by members of the public to limit the spread of the virus.[144]

Masks are also strongly recommended for those who may have been infected and those taking care of someone who may have the disease.[145] When not wearing a mask, the CDC recommends covering the mouth and nose with a tissue when coughing or sneezing and recommends using the inside of the elbow if no tissue is available. Proper hand hygiene after any cough or sneeze is encouraged. Healthcare professionals interacting directly with people who have COVID-19 are advised to use respirators at least as protective as NIOSH-certified N95 or equivalent, in addition to other personal protective equipment.[146]

Thorough hand hygiene after any cough or sneeze is required.[147] The WHO also recommends that individuals wash hands often with soap and water for at least 20 seconds, especially after going to the toilet or when hands are visibly dirty, before eating and after blowing one's nose.[148] The CDC recommends using an alcohol-based hand sanitiser with at least 60% alcohol, but only when soap and water are not readily available.[147] For areas where commercial hand sanitisers are not readily available, the WHO provides two formulations for local production. In these formulations, the antimicrobial activity arises from ethanol or isopropanol. Hydrogen peroxide is used to help eliminate bacterial spores in the alcohol; it is "not an active substance for hand antisepsis". Glycerol is added as a humectant.[149]

Coronaviruses on surfaces die "within hours to days" depending on the type of surface, and factors such as temperature and humidity. On non-porous surfaces such as glass, plastic and stainless steel, the virus remains infective for 37 days.[150] On paper and cardboard, SARS-CoV-2 dies within hours to a few days.[151] Coronaviruses die faster when exposed to sunlight and warm temperatures.[152] Various jurisdictions have their own versions of deep clean procedure.

Surfaces may be decontaminated with a number of solutions (within one minute of exposure to the disinfectant for a stainless steel surface), including 6271 percent ethanol, 50100 percent isopropanol, 0.1 percent sodium hypochlorite, 0.5 percent hydrogen peroxide, and 0.27.5 percent povidone-iodine. Other solutions, such as benzalkonium chloride and chlorhexidine gluconate, are less effective. Ultraviolet germicidal irradiation may also be used.[153] The CDC recommends that if a COVID-19 case is suspected or confirmed at a facility such as an office or day care, all areas such as offices, bathrooms, common areas, shared electronic equipment like tablets, touch screens, keyboards, remote controls, and ATM machines used by the ill persons should be disinfected.[154] A datasheet comprising the authorised substances to disinfection in the food industry (including suspension or surface tested, kind of surface, use dilution, disinfectant and inocuylum volumes) can be seen in the supplementary material of.[155]

Disinfection of surfaces is key to control the spread of SARS-CoV-2, but entails also some drawbacks. Given the current evidence that the contact with inactivated surfaces is not the main driver of Covid-19,[156] several works have started to demand more optimised disinfection procedures to avoid major problems such as the increase of antimicrobial resistance.[155][157]

The WHO recommends ventilation and air filtration in public spaces to help clear out infectious aerosols.[153][158][159]

The Harvard T.H. Chan School of Public Health recommends a healthy diet, being physically active, managing psychological stress, and getting enough sleep.[160]

While there is no evidence that vitamin D is an effective treatment for COVID-19, there is limited evidence that vitamin D deficiency increases the risk of severe COVID-19 symptoms.[161] This has led to recommendations for individuals with vitamin D deficiency to take vitamin D supplements as a way of mitigating the risk of COVID-19 and other health issues associated with a possible increase in deficiency due to social distancing.[162]

There is no specific, effective treatment or cure for coronavirus disease 2019 (COVID-19), the disease caused by the SARS-CoV-2 virus.[163][164] Thus, the cornerstone of management of COVID-19 is supportive care, which includes treatment to relieve symptoms, fluid therapy, oxygen support and prone positioning as needed, and medications or devices to support other affected vital organs.[165][166][167]

Most cases of COVID-19 are mild. In these, supportive care includes medication such as paracetamol or NSAIDs to relieve symptoms (fever, body aches, cough), proper intake of fluids, rest, and nasal breathing.[168][164][169][170] Good personal hygiene and a healthy diet are also recommended.[171] The U.S. Centers for Disease Control and Prevention (CDC) recommend that those who suspect they are carrying the virus isolate themselves at home and wear a face mask.[172]

People with more severe cases may need treatment in hospital. In those with low oxygen levels, use of the glucocorticoid dexamethasone is strongly recommended, as it can reduce the risk of death.[173][174][175] Noninvasive ventilation and, ultimately, admission to an intensive care unit for mechanical ventilation may be required to support breathing.[176] Extracorporeal membrane oxygenation (ECMO) has been used to address the issue of respiratory failure, but its benefits are still under consideration.[177][178]

The severity of COVID-19 varies. The disease may take a mild course with few or no symptoms, resembling other common upper respiratory diseases such as the common cold. In 3-4% of cases (7.4% for those over age 65) symptoms are severe enough to cause hospitalization.[183] Mild cases typically recover within two weeks, while those with severe or critical diseases may take three to six weeks to recover. Among those who have died, the time from symptom onset to death has ranged from two to eight weeks.[52] The Italian Istituto Superiore di Sanit reported that the median time between the onset of symptoms and death was twelve days, with seven being hospitalised. However, people transferred to an ICU had a median time of ten days between hospitalisation and death.[184] Prolonged prothrombin time and elevated C-reactive protein levels on admission to the hospital are associated with severe course of COVID-19 and with a transfer to ICU.[185][186]

Some early studies suggest 10% to 20% of people with COVID-19 will experience symptoms lasting longer than a month.[187][188] A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath.[189] On 30 October 2020 WHO chief Tedros Adhanom warned that "to a significant number of people, the COVID virus poses a range of serious long-term effects". He has described the vast spectrum of COVID-19 symptoms that fluctuate over time as "really concerning." They range from fatigue, a cough and shortness of breath, to inflammation and injury of major organs including the lungs and heart, and also neurological and psychologic effects. Symptoms often overlap and can affect any system in the body. Infected people have reported cyclical bouts of fatigue, headaches, months of complete exhaustion, mood swings, and other symptoms. Tedros has concluded that therefore herd immunity is "morally unconscionable and unfeasible".[190]

In terms of hospital readmissions about 9% of 106,000 individuals had to return for hospital treatment within 2 months of discharge. The average to readmit was 8 days since first hospital visit. There are several risk factors that have been identified as being a cause of multiple admissions to a hospital facility. Among these are advanced age (above 65 years of age) and presence of a chronic condition such as diabetes, COPD, heart failure or chronic kidney disease.[191][192]

According to scientific reviews smokers are more likely to require intensive care or die compared to non-smokers,[193][194] air pollution is similarly associated with risk factors,[194] and pre-existing heart and lung diseases[195] and also obesity contributes to an increased health risk of COVID-19.[194][196][197]

It is also assumed that those that are immunocompromised are at higher risk of getting severely sick from SARS-CoV-2.[198] One research that looked into the COVID-19 infections in hospitalized kidney transplant recipients found a mortality rate of 11%.[199]

Children make up a small proportion of reported cases, with about 1% of cases being under 10 years and 4% aged 1019 years.[45] They are likely to have milder symptoms and a lower chance of severe disease than adults. A European multinational study of hospitalized children published in The Lancet on 25 June 2020 found that about 8% of children admitted to a hospital needed intensive care. Four of those 582 children (0.7%) died, but the actual mortality rate could be "substantially lower" since milder cases that did not seek medical help were not included in the study.[200]

Genetics also plays an important role in the ability to fight off the disease. For instance, those that do not produce detectable type I interferons or produce auto-antibodies against these may get much sicker from COVID-19.[201][202] Genetic screening is able to detect interferon effector genes.[203]

Pregnant women may be at higher risk of severe COVID-19 infection based on data from other similar viruses, like SARS and MERS, but data for COVID-19 is lacking.[204][205]

Complications may include pneumonia, ARDS, multi-organ failure, septic shock, and death.[206]Cardiovascular complications may include heart failure, arrhythmias, heart inflammation, and blood clots.[207]

Approximately 2030% of people who present with COVID-19 have elevated liver enzymes reflecting liver injury.[124][208]

Neurologic manifestations include seizure, stroke, encephalitis, and GuillainBarr syndrome (which includes loss of motor functions).[209][210] Following the infection, children may develop paediatric multisystem inflammatory syndrome, which has symptoms similar to Kawasaki disease, which can be fatal.[211][212] In very rare cases, acute encephalopathy can occur, and it can be considered in those who have been diagnosed with COVID-19 and have an altered mental status.[213]

Some early studies[187][214] suggest between 1 in 5 and 1 in 10 people with COVID-19 will experience symptoms lasting longer than a month. A majority of those who were admitted to hospital with severe disease report long-term problems including fatigue and shortness of breath.[189]

By a variety of mechanisms, the lungs are the organs most affected in COVID-19.[215] The majority of CT scans performed show lung abnormalities in people tested after 28 days of illness.[216]People with advanced age, severe disease, prolonged ICU stays, or who smoke are more likely to have long lasting effects, including pulmonary fibrosis.[217] Overall, approximately one third of those investigated after 4 weeks will have findings of pulmonary fibrosis or reduced lung function as measured by DLCO, even in people who are asymptomatic, but with the suggestion of continuing improvement with the passing of more time.[215]

The immune response by humans to CoV-2 virus occurs as a combination of the cell-mediated immunity and antibody production,[218] just as with most other infections.[219] Since SARS-CoV-2 has been in the human population only since December 2019, it remains unknown if the immunity is long-lasting in people who recover from the disease.[220] The presence of neutralizing antibodies in blood strongly correlates with protection from infection, but the level of neutralizing antibody declines with time. Those with asymptomatic or mild disease had undetectable levels of neutralizing antibody two months after infection. In another study, the level of neutralizing antibody fell 4 fold 1 to 4 months after the onset of symptoms. However, the lack of antibody in the blood does not mean antibody will not be rapidly produced upon reexposure to SARS-CoV-2. Memory B cells specific for the spike and nucleocapsid proteins of SARS-CoV-2 last for at least 6 months after appearance of symptoms.[220] Nevertheless, 15 cases of reinfection with SARS-CoV-2 have been reported using stringent CDC criteria requiring identification of a different variant from the second infection. There are likely to be many more people who have been reinfected with the virus. Herd immunity will not eliminate the virus if reinfection is common.[220] Some other coronaviruses circulating in people are capable of reinfection after roughly a year.[221]

Several measures are commonly used to quantify mortality.[222] These numbers vary by region and over time and are influenced by the volume of testing, healthcare system quality, treatment options, time since the initial outbreak, and population characteristics such as age, sex, and overall health.[223] The mortality rate reflects the number of deaths within a specific demographic group divided by the population of that demographic group. Consequently, the mortality rate reflects the prevalence as well as the severity of the disease within a given population. Mortality rates are highly correlated to age, with relatively low rates for young people and relatively high rates among the elderly.[224][225][226]

The case fatality rate (CFR) reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 2.2% (2,451,695/110,709,173) as of 20 February 2021.[5] The number varies by region.[227][228] The CFR may not reflect the true severity of the disease, because some infected individuals remain asymptomatic or experience only mild symptoms, and hence such infections may not be included in official case reports. Moreover, the CFR may vary markedly over time and across locations due to the availability of live virus tests.

Total confirmed cases over time

Total confirmed cases of COVID-19 per million people[229]

Total confirmed deaths due to COVID-19 per million people[230]

A key metric in gauging the severity of COVID-19 is the infection fatality rate (IFR), also referred to as the infection fatality ratio or infection fatality risk.[231][232][233] This metric is calculated by dividing the total number of deaths from the disease by the total number of infected individuals; hence, in contrast to the CFR, the IFR incorporates asymptomatic and undiagnosed infections as well as reported cases.[234]

A recent (Dec 2020) systematic review and meta-analysis estimated that population IFR during the first wave of the pandemic was about 0.5% to 1% in many locations (including France, Netherlands, New Zealand, and Portugal), 1% to 2% in other locations (Australia, England, Lithuania, and Spain), and exceeded 2% in Italy.[235] That study also found that most of these differences in IFR reflected corresponding differences in the age composition of the population and age-specific infection rates; in particular, the metaregression estimate of IFR is very low for children and younger adults (e.g., 0.002% at age 10 and 0.01% at age 25) but increases progressively to 0.4% at age 55, 1.4% at age 65, 4.6% at age 75, and 15% at age 85.[235] These results were also highlighted in a December 2020 report issued by the WHO.[236]

At an early stage of the pandemic, the World Health Organization reported estimates of IFR between 0.3% and 1%.[237][238] On 2July, The WHO's chief scientist reported that the average IFR estimate presented at a two-day WHO expert forum was about 0.6%.[239][240] In August, the WHO found that studies incorporating data from broad serology testing in Europe showed IFR estimates converging at approximately 0.51%.[241] Firm lower limits of IFRs have been established in a number of locations such as New York City and Bergamo in Italy since the IFR cannot be less than the population fatality rate. As of 10July, in New York City, with a population of 8.4million, 23,377 individuals (18,758 confirmed and 4,619 probable) have died with COVID-19 (0.3% of the population).[242] Antibody testing in New York City suggested an IFR of ~0.9%,[243] and ~1.4%.[244] In Bergamo province, 0.6% of the population has died.[245] In September 2020 the U.S. Center for Disease Control & Prevention reported preliminary estimates of age-specific IFRs for public health planning purposes.[246]

Early reviews of epidemiologic data showed gendered impact of the pandemic and a higher mortality rate in men in China and Italy.[248][249][250] The Chinese Center for Disease Control and Prevention reported the death rate was 2.8% for men and 1.7% for women.[251] Later reviews in June 2020 indicated that there is no significant difference in susceptibility or in CFR between genders.[252][253] One review acknowledges the different mortality rates in Chinese men, suggesting that it may be attributable to lifestyle choices such as smoking and drinking alcohol rather than genetic factors.[254] Sex-based immunological differences, lesser prevalence of smoking in women and men developing co-morbid conditions such as hypertension at a younger age than women could have contributed to the higher mortality in men.[255] In Europe, 57% of the infected people were men and 72% of those died with COVID-19 were men.[256] As of April 2020, the US government is not tracking sex-related data of COVID-19 infections.[257] Research has shown that viral illnesses like Ebola, HIV, influenza and SARS affect men and women differently.[257]

In the US, a greater proportion of deaths due to COVID-19 have occurred among African Americans and other minority groups.[258] Structural factors that prevent them from practicing social distancing include their concentration in crowded substandard housing and in "essential" occupations such as retail grocery workers, public transit employees, health-care workers and custodial staff. Greater prevalence of lacking health insurance and care and of underlying conditions such as diabetes, hypertension and heart disease also increase their risk of death.[259] Similar issues affect Native American and Latino communities.[258] According to a US health policy non-profit, 34% of American Indian and Alaska Native People (AIAN) non-elderly adults are at risk of serious illness compared to 21% of white non-elderly adults.[260] The source attributes it to disproportionately high rates of many health conditions that may put them at higher risk as well as living conditions like lack of access to clean water.[261] Leaders have called for efforts to research and address the disparities.[262] In the U.K., a greater proportion of deaths due to COVID-19 have occurred in those of a Black, Asian, and other ethnic minority background.[263][264][265] More severe impacts upon victims including the relative incidence of the necessity of hospitalization requirements, and vulnerability to the disease has been associated via DNA analysis to be expressed in genetic variants at chromosomal region 3, features that are associated with European Neanderthal heritage. That structure imposes greater risks that those affected will develop a more severe form of the disease.[266] The findings are from Professor Svante Pbo and researchers he leads at the Max Planck Institute for Evolutionary Anthropology and the Karolinska Institutet.[266] This admixture of modern human and Neanderthal genes is estimated to have occurred roughly between 50,000 and 60,000 years ago in Southern Europe.[266]

Most of those who die of COVID-19 have pre-existing (underlying) conditions, including hypertension, diabetes mellitus, and cardiovascular disease.[267] According to March data from the United States, 89% of those hospitalised had preexisting conditions.[268] The Italian Istituto Superiore di Sanit reported that out of 8.8% of deaths where medical charts were available, 96.1% of people had at least one comorbidity with the average person having 3.4 diseases.[184] According to this report the most common comorbidities are hypertension (66% of deaths), type 2 diabetes (29.8% of deaths), ischemic heart disease (27.6% of deaths), atrial fibrillation (23.1% of deaths) and chronic renal failure (20.2% of deaths).

Most critical respiratory comorbidities according to the CDC, are: moderate or severe asthma, pre-existing COPD, pulmonary fibrosis, cystic fibrosis.[269] Evidence stemming from meta-analysis of several smaller research papers also suggests that smoking can be associated with worse outcomes.[270][271] When someone with existing respiratory problems is infected with COVID-19, they might be at greater risk for severe symptoms.[272] COVID-19 also poses a greater risk to people who misuse opioids and methamphetamines, insofar as their drug use may have caused lung damage.[273]

In August 2020 the CDC issued a caution that tuberculosis infections could increase the risk of severe illness or death. The WHO recommended that people with respiratory symptoms be screened for both diseases, as testing positive for COVID-19 couldn't rule out co-infections. Some projections have estimated that reduced TB detection due to the pandemic could result in 6.3million additional TB cases and 1.4million TB related deaths by 2025.[274]

During the initial outbreak in Wuhan, China, the virus and disease were commonly referred to as "coronavirus" and "Wuhan coronavirus",[275][276][277] with the disease sometimes called "Wuhan pneumonia".[278][279] In the past, many diseases have been named after geographical locations, such as the Spanish flu,[280] Middle East Respiratory Syndrome, and Zika virus.[281]

In January 2020, the WHO recommended 2019-nCov[282] and 2019-nCoV acute respiratory disease[283] as interim names for the virus and disease per 2015 guidance and international guidelines against using geographical locations (e.g. Wuhan, China), animal species, or groups of people in disease and virus names in part to prevent social stigma.[284][285][286]

The official names COVID-19 and SARS-CoV-2 were issued by the WHO on 11 February 2020.[287] Tedros Adhanom explained: CO for corona, VI for virus, Dfor disease and 19 for when the outbreak was first identified (31 December 2019).[288] The WHO additionally uses "the COVID-19 virus" and "the virus responsible for COVID-19" in public communications.[287]

The virus is thought to be natural and has an animal origin,[49] through spillover infection.[289] There are several theories about where the first case (the so-called patient zero) originated.[290] Phylogenetics estimates that SARS-CoV-2 arose in October or November 2019.[291][292][293] Evidence suggests that it descends from a coronavirus that infects wild bats and spread to humans through an intermediary wildlife host.[294]

The first known human infections were in Wuhan, Hubei, China. A study of the first 41 cases of confirmed COVID-19, published in January 2020 in The Lancet, reported the earliest date of onset of symptoms as 1December 2019.[295][296][297] Official publications from the WHO reported the earliest onset of symptoms as 8December 2019.[298] Human-to-human transmission was confirmed by the WHO and Chinese authorities by 20 January 2020.[299][300] According to official Chinese sources, these were mostly linked to the Huanan Seafood Wholesale Market, which also sold live animals.[301] In May 2020, George Gao, the director of the CDC, said animal samples collected from the seafood market had tested negative for the virus, indicating that the market was the site of an early superspreading event, but it was not the site of the initial outbreak.[302] Traces of the virus have been found in wastewater that was collected from Milan and Turin, Italy, on 18 December 2019.[303]

By December 2019, the spread of infection was almost entirely driven by human-to-human transmission.[304][305] The number of coronavirus cases in Hubei gradually increased, reaching 60 by 20 December[306] and at least 266 by 31 December.[307] On 24 December, Wuhan Central Hospital sent a bronchoalveolar lavage fluid (BAL) sample from an unresolved clinical case to sequencing company Vision Medicals. On 27 and 28 December, Vision Medicals informed the Wuhan Central Hospital and the Chinese CDC of the results of the test, showing a new coronavirus.[308] A pneumonia cluster of unknown cause was observed on 26 December and treated by the doctor Zhang Jixian in Hubei Provincial Hospital, who informed the Wuhan Jianghan CDC on 27 December.[309] On 30 December, a test report addressed to Wuhan Central Hospital, from company CapitalBio Medlab, stated an erroneous positive result for SARS, causing a group of doctors at Wuhan Central Hospital to alert their colleagues and relevant hospital authorities of the result. That evening, the Wuhan Municipal Health Commission issued a notice to various medical institutions on "the treatment of pneumonia of unknown cause".[310] Eight of these doctors, including Li Wenliang (punished on 3January),[311] were later admonished by the police for spreading false rumours, and another, Ai Fen, was reprimanded by her superiors for raising the alarm.[312]

The Wuhan Municipal Health Commission made the first public announcement of a pneumonia outbreak of unknown cause on 31 December, confirming 27 cases[313][314][315]enough to trigger an investigation.[316]

During the early stages of the outbreak, the number of cases doubled approximately every seven and a half days.[317] In early and mid-January 2020, the virus spread to other Chinese provinces, helped by the Chinese New Year migration and Wuhan being a transport hub and major rail interchange.[52] On 20 January, China reported nearly 140 new cases in one day, including two people in Beijing and one in Shenzhen.[318] Later official data shows 6,174 people had already developed symptoms by then,[319] and more may have been infected.[320] A report in The Lancet on 24 January indicated human transmission, strongly recommended personal protective equipment for health workers, and said testing for the virus was essential due to its "pandemic potential".[75][321] On 30 January, the WHO declared the coronavirus a Public Health Emergency of International Concern.[320] By this time, the outbreak spread by a factor of 100 to 200 times.[322]

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Coronavirus disease 2019 - Wikipedia

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Our COVID Q&A with Watson is an AI-powered chatbot that addresses consumers' questions and concerns about COVID-19. It's built on the IBM Watson Ads Builder platform, which utilizes Watson Natural Language Understanding, and proprietary, natural- language-generation technology. The chatbot utilizes approved content from the CDC and WHO. Incidents information is provided by USAFacts.org.

To populate our Interactive Incidents Map, Watson AI looks for the latest and most up-to- date information. To understand and extract the information necessary to feed the maps, we use Watson Natural Language Understandingfor extracting insights from natural language text and Watson Discovery for extracting insights from PDFs, HTML, tables, images and more.COVID Impact Survey, conducted by NORC at the University of Chicago for the Data Foundation

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Prescott Valley, AZ Coronavirus Information - Safety Updates, News and Tips - The Weather Channel | Weather.com

There is no evidence that animals can spread COVID-19 or that infection would be serious for them. The virus spreads primarily from person to person. The health and safety of employees should be the focus of every veterinary practice both companion animal and large animal.

Wash your hands frequently for at least 20 seconds with soap and warm water before eating, after using the bathroom, coughing or sneezing, and touching surfaces. Use an alcohol-based hand sanitizer with at least 60% alcohol if soap and water are not available and there is no visible dirt on your hands.

Frequently sanitize common areas with EPA registered antimicrobial products for use against COVID-19 that are safe to use in and around the animals and clinic.

Employees who are sick or show signs of respiratory illness should not work until they are symptom-free.

Work with other clinics to help cover workload as needed.

Veterinary services have been deemed essential functions under Healthcare and Public Health Operations in Arizona Governors Executive Order 2020-12.

In this context, the World Organisation for Animal Health (OIE) and the World Veterinary Association (WVA) advocate for the specific activities of Veterinary Services to be considered as essential businesses. Maintaining the activities that are crucial to public health.

Veterinarians are an integral part of the global health community. Beyond the activities linked to the health and welfare of animals, they have a key role in disease prevention and management, including those transmissible to humans, and to ensure food safety for the populations.

In the current situation, it is crucial that, amongst their numerous activities, they can sustain those necessary to ensure that:

Below are some links to various informationon how to keep you and your staff safe during these changing times.

With respect to regulatory issues, currently no state or country is waiving import requirements for animals. Please check with states of destination for requirements to move animals into those states from Arizona. In most cases, this will require an examination, +/- testing or vaccination and a CVI.

We encourage veterinarians to evaluate on a case-by-case basis the public health importance of companion animal rabies vaccination relative to the need to amend their business operations because of COVID-19. If a veterinarian determines that it is necessary to postpone an individual animals rabies vaccination appointment due to business operation interruption, then we recommend prioritizing administration of the rabies vaccination once normal veterinary business operations resume. Veterinarians are reminded that companion animals that have never received a rabies vaccination pose the most significant public health threat.

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COVID-19: Information for Veterinarians | Arizona Department of Agriculture

February 19, 2021

Focus areas included shelters, jails, adult care homes, and teleworking

Auditor Jennifer McGuirk presented the first in a series of reports on the Countys response to COVID-19 Thursday, Feb. 18, shedding light on County operations during the first year of the pandemic.

The Auditors Office surveyed more than 3,300 employees, held 70 interviews with County leaders and management, conducted site visits, and researched County, state and federal guidance. Focus areas included the Countys response in congregate settings and implementation of countywide guidance. The time period covered spanned from June 1, 2020 to Dec. 18, 2020.

Specifically we looked at conditions in shelters, jails, juvenile detention, and adult care homes, McGuirk said. People in these settings also tend to represent vulnerable communities in our county, including seniors, people who have disabilities, people who are experiencing houselessness, and people in adult or juvenile custody.

The report found that the County acted quickly in response to the significant challenges presented by the pandemic in accordance to public health guidance. The audit also found the County had to also ensure buildings are safe and ready for employees while reducing the risks associated with the high number of teleworkers.

This report provides us with an opportunity to reflect on our achievements and incorporate insights that will help us improve our ongoing efforts to address what may be the greatest challenge to the countys operations in its history, Chair Deborah Kafoury said.

Auditors reported almost 80 percent of surveyed staff agreed the County has taken appropriate action to reduce staff on site and installed sufficient signage promoting public health guidance.

The survey found generally good compliance with the Countys face covering policy, with 64 percent of respondents saying they always wear face coverings and 33 percent saying they sometimes wear them. Almost 80 percent agreed the County has taken appropriate action to reduce staff on site and installed sufficient signage promoting public health guidance.

Adherence to the face covering policy was lower among Sheriffs Office employees, with 42 percent of those surveyed saying they always wear face coverings. At Donald E. Long Juvenile Detention, that number was 50 percent.

Since Sheriffs Office employees work in jail facilities where people live together in close quarters, we want to see the mask wearing to be higher, said Nicole Dewees, a principal auditor. We found that there needed to be more mask wearing at detention facilities by people in custody and employees, particularly in light of recent outbreaks.

Sheriff Mike Reese and Erika Preuitt, who directs the Department of Community Justice, attended Thursdays meeting. In response to follow up questions from Commissioners Lori Stegmann and Jessica Vega Pederson, they affirmed that all staff, along with adults and youth in custody, are expected to wear face coverings. Failure to follow guidelines, they said, is subject to investigation and discipline.

I think early on we did have challenges with getting compliance with our face covering policy, which I take very seriously, Sheriff Reese said. Im certain that we have improved dramatically in our adherence to the guidelines and will continue to enforce my expectations that everyone wear a mask as appropriate and as per policy.

Its an expectation that our juvenile custody service specialists wear face coverings, Preuitt said. We, similarly to the Sheriffs Office, are going down progressive discipline if people are not wearing masks or not wearing their face coverings, also if theyre not following up with youth not wearing their face coverings.

The audit also examined the Countys response in other congregate settings, including shelters and adult care homes.

The Joint Office of Homeless Services successfully added additional shelter capacity to support physical distancing, along with clear safety guidance to providers, auditors found. Moving forward, they said, staffing and shelter supply challenges should be expected as the pandemic causes an increase in homelessness.

With about 600 adult care homes in Multnomah County, the report found the Countys Adult Care Home Program adjusted quickly to the pandemic. However, auditors also found the program could improve communication with adult care homes to ensure compliance with federal, state, and local health requirements for the safety of staff and residents.

The state has allowed us to do outside visits, so we encouraged outside visits for folks so their family can come and visit with them outside, said Irma Jimenez, who directs the Aging, Disability and Veterans Services Division. And just most recently, theres a little bit of flexibility for indoor visits, so another thing that were doing is providing that information to the providers when those restrictions get lifted or put in place, we make sure the providers know that.

In response to the pandemic, the County had to shift quickly to large numbers of employees teleworking to reduce workplace virus transmission. The audit also explored how the County can strengthen, clarify, and improve teleworking moving forward.

The Countys teleworking rules were originally designed as a mutual agreement when an employee is interested in teleworking under certain circumstances. The COVID-19 pandemic has revealed how the County can continue to serve people in productive, creative ways. It also exposed problems with accessing work equipment, technical difficulties, and access to human resources policies.

This pandemic gave us the opportunity in many places to see actually we can continue as agovernment functioning and in many places we can actually be even more productive, said Travis Graves, interim director of Department of County Assets and chief Human Resources Officer. So Im interested in looking to the future in terms of post-pandemic. What do we look like as an organization and what are the implications for that?

Commissioners thanked the Auditor for offering ways to improve the Countys response in congregate settings and facilities, while also honoring the employees who have worked in person throughout the pandemic.

This survey was about the employees going into work every single day who dont have the option of working from home like a lot of us are here, Commissioner Vega Pederson said, and doing their jobs and wearing masks for everyones safety and that is a lot that we ask of our employees. So Im really grateful for all the work that they do

Upon issuance of report, county Public Health officials should revise guidance on the public facing website for nonprofit shelter providers within county boundaries to improve clarity, in line with state requirements.

Joint Office of Homeless Services management should include clauses to follow Public Health guidelines in new contracts with shelter providers and in new amendments to contracts with shelter providers.

To be consistent with CDC guidelines, MCSO should begin exchanging the cloth masks of adults in custody on a daily basis if they are used upon issuance of this report.

With normal no-cost visiting options suspended because of COVID-19 precautions, MCSO should either expand the use of free-phone calls or modify lobby video visit operations to allow for safe use as soon as possible and no later than 90 days within issuance of this report.

Immediately upon the issuance of this report, we recommend that managers consistently enforce face covering policies with their staff.

The ACH Program should perform a review of all recent communication with each ACH and ensure that each ACH has received sufficient information and is aware of requirements and guidelines pertaining to the pandemic. A particular focus is needed in the areas of exposure, infection control, physical distancing and reporting. A review should be performed as soon as possible and no later than 30 days from issuance of this report. If contact is needed the contact should be made within at least 90 days from the issuance of this report.

As soon as possible, the OR OSHA COVID-19 temporary rule implementation committee should complete all new OSHA requirements:

Risk assessment, infection control plan, protocols for potential exposure, and employee training.

Note: management reports that substantial work toward this recommendation has been completed. This work occurred between the time the report was written and when it was issued. We acknowledge that work has been done, but we did not audit that work. We are leaving the recommendation in the report, so we can follow up on the recommendation thoroughly.

By March 2021, Central Human Resources should develop a method for employees to provide COVID-19 related feedback anonymously.

By March 2021, the Chair or her designee should provide employees with a point of contact for COVID-19 safety coordination.

Based on responses to our offices employee survey, it appears that applying policies is an ongoing challenge. Upon issuance of the report and periodically thereafter, the Chair or her designee should reiterate to managers and employees her expectations that safety policies and recommendations are followed, including the requirement that employees telework as much as possible.

Prior to adding in-person capacity at county locations, we recommend that FPM ensure that necessary building modifications, including the installation of partitions, and filter upgrades in HVAC systems have been completed.

Prior to adding in-person capacity at county locations, we recommend that FPM work with its janitorial contractors to ensure that each location has sufficient staffing capacity to ensure the enhanced cleaning recommended by the CDC.

We are told that the county is currently in the process of adding COVID-19 specific cleaning and disinfecting requirements into its contracts with janitorial providers. We recommend that FPM complete these contractual requirements prior to programs adding substantial in-person capacity at county locations.

By July 2021, department directors should provide county-owned computers to employees who frequently telework and should emphasize using county-owned computers for employees who occasionally telework. The county should also provide employees with any other equipment typically used by one person to telework effectively, such as computer mice, computer monitors, and headsets. These examples are meant to be descriptive, not exhaustive.

By February 2022, Central Human Resources should ensure the maintenance of telework information electronically, preferably in Workday to allow:

Accessibility to approved or denied telework agreements at the employee, supervisory, departmental and central levels.

Electronic approvals and updating for better efficiency.

Monitoring of teleworking performance and equity.

Documentation of specific details, such as computer ID numbers, of all county equipment used to telework.

To help ensure fairness among employees, by February 2022, Central Human Resources should indicate potential telework eligibility in county job descriptions.

Continued here:

Board presented findings from first COVID-19 audit - Multnomah County

The West Virginia Department of Health and Human Resources (DHHR) reports as of February 19, 2021, there have been 2,099,685 total confirmatory laboratory results received for COVID-19, with 129,055 total cases and 2,248 total deaths.

DHHR has confirmed the deaths of a 51-year old male from Jefferson County, an 89-year old female from Mercer County, a 76-year old male from Kanawha County, a 92-year old male from Fayette County, an 87-year old male from Jackson County, an 85-year old male from Berkeley County, a 63-year old male from Wood County, an 88-year old male from Wayne County, a 91-year old female from Mercer County, a 92-year old female from Mercer County, an 87-year old male from Jackson County, and a 54-year old female from Marion County.

It is with great sadness that we announce more lives lost to this pandemic, said Bill J. Crouch, DHHR Cabinet Secretary. Our sympathies and thoughts go out to these families, and we ask that all West Virginians do their part to prevent further spread of this virus.

CASES PER COUNTY: Barbour (1,163), Berkeley (9,532), Boone (1,538), Braxton (769), Brooke (1,983), Cabell (7,646), Calhoun (218), Clay (370), Doddridge (460), Fayette (2,587), Gilmer (699), Grant (1,044), Greenbrier (2,371), Hampshire (1,491), Hancock (2,565), Hardy (1,257), Harrison (4,788), Jackson (1,638), Jefferson (3,560), Kanawha (11,795), Lewis (1,012), Lincoln (1,198), Logan (2,643), Marion (3,601), Marshall (2,967), Mason (1,746), McDowell (1,334), Mercer (4,138), Mineral (2,567), Mingo (2,082), Monongalia (7,716), Monroe (930), Morgan (909), Nicholas (1,154), Ohio (3,567), Pendleton (617), Pleasants (794), Pocahontas (580), Preston (2,499), Putnam (4,116), Raleigh (4,561), Randolph (2,356), Ritchie (604), Roane (488), Summers (696), Taylor (1,072), Tucker (495), Tyler (607), Upshur (1,640), Wayne (2,576), Webster (289), Wetzel (1,062), Wirt (341), Wood (6,908), Wyoming (1,716).

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. Such is the case of Cabell and Marshall counties in this report.

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COVID-19 Daily Update 2-19-2021 - West Virginia Department of Health and Human Resources

Chris Duncan, whose 75-year-old mother Constance died from COVID-19 on her birthday, photographs a COVID-19 Memorial Project installation of 20,000 American flags on the National Mall as the United States crosses the 200,000 lives lost in the COVID-19 pandemic on Sept. 22, 2020 in Washington, D.C. The U.S. will likely cross the mark of half a million lives lost to COVID-19 in the coming days. Win McNamee/Getty Images hide caption

Chris Duncan, whose 75-year-old mother Constance died from COVID-19 on her birthday, photographs a COVID-19 Memorial Project installation of 20,000 American flags on the National Mall as the United States crosses the 200,000 lives lost in the COVID-19 pandemic on Sept. 22, 2020 in Washington, D.C. The U.S. will likely cross the mark of half a million lives lost to COVID-19 in the coming days.

The U.S. death toll from COVID-19 is on track to pass a number next week that once seemed unthinkable: Half a million people in this country dead from the coronavirus.

And while the pandemic isn't over yet, and the death toll keeps climbing, artists in every medium have already been thinking about how our country will pay tribute to those we lost.

Poets, muralists, and architects all have visions of what a COVID-19 memorial could be. Many of these ideas are about more than just honoring those we've lost to the pandemic. Artists are also thinking about the conditions in society that brought us here.

Tracy K. Smith, a former U.S. poet laureate, has already written one poem honoring transit workers in New York who died of the disease. Smith says she wants to see a COVID-19 memorial that has a broader mission and invites people to bridge a divide.

Paul Farber runs Monument Lab, an organization that works with cities and states that want to build new monuments. He says he wants to see a COVID-19 monument that is collective experience and evolves over time. He also wants it to serve as a bridge to understanding.

Farber's list describes one of the most powerful memorials in recent American history: the AIDS quilt. Mike Smith, co-founder of that memorial, says that one focus of the AIDS quilt project that he would like to see in a COVID-19 memorial is inspiring communities to come together and not to isolate in processing and remembering those who died.

In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.

Email us at considerthis@npr.org.

This episode was produced by Lee Hale, Noah Caldwell and Jonaki Mehta. It was edited by Sami Yenigun with help from Sarah Handel, Courtney Dorning and Wynne Davis. Our executive producer is Cara Tallo.

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COVID-19 Deaths Near 500,000 In The US; Artists Discuss Future Memorials : Consider This from NPR - NPR

Austin, Texas All Austin Public Health (APH) COVID-19 testing and vaccination sites will remain closed Friday, Feb. 19 due to inclement weather. The sites have been closed since Saturday, Feb. 12 for the same reason.

APH staff have and continue to diligently monitor the vaccine to ensure it is safe and secure during the winter weather event.

We know these are challenging times as our staff, their families, and our entire community are grappling with issues caused by the weather, said APH Director Stephanie Hayden-Howard. We assure you that as soon as we can safely give the vaccine again, we will notify the public.

People with current vaccination appointments will receive a cancellation email or text.It is not known when vaccine operations will be able to resume. Anyone who receives a cancellation will be contacted by APH to reschedule. However, APH will not send out new appointments until we are confident that we can safely restart operations.

We greatly appreciate the communitys patience as we work through these unprecedented times, said Dr. Mark Escott, Interim Austin-Travis County Health Authority. While there may be several days between the time your appointment is canceled and your new appointment information is sent, it is important to remember that there is flexibility allowed between doses without losing effectiveness.

Dr. Escott reiterated: Your body works with the vaccine to make the first dose strongerover time. The second dose is a booster and a delay will not diminish its efficacy.

Both first and second doses are provided by appointment only. Pleasedo notshow up at the vaccine sites without an appointment as that will interfere with the vaccine operations.

Vaccine Sites:

Testing Sites:

As testing sites remain closed, continue to checkwww.austintexas.gov/covid-testinfofor updates.If you are experiencingsymptoms of COVID-19and are unable to get a test, continue to self-isolate for at least 10 days since symptom onset and at least 1 day following the resolution of fever and improvement of other symptoms.

COVID-19 Hotel Facility:

For additional COVID-19 information and updates, visitwww.AustinTexas.gov/COVID19.

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APH Provides Update on COVID-19 Testing and Vaccination Sites - AustinTexas.gov

Illinois has surpassed 2 million COVID-19 vaccinations, public health officials reported Friday. The state reached a total of 2,060,706 doses after 83,673 vaccinations were administered Thursday.

Over the past seven days, the state averaged 59,460 vaccinations administered daily, down from a high of 66,320 on Feb. 14. Vaccinations have been affected this week by the severe winter weather, as the state had warned earlier in the week.

The citys CARES Act spending drew an angry rebuke from activists and aldermen who said the money could have instead provided badly needed housing, health care and business lifelines to struggling residents.

Also on Friday, state officials announced 2,219 new confirmed and probable cases of COVID-19 and 63 additional fatalities, bringing the total number of known infections in Illinois to 1,170,902 and the statewide death toll to 20,192 since the start of the pandemic.

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

6:05 p.m.: Pritzkers tax plan: Closing corporate tax loopholes, or the best way to shoot yourself in the foot?

Gov. J.B. Pritzker wants to close $932 million of what he called corporate tax loopholes to help Illinois balance its budget after the fiscal ruins of COVID-19, but the controversial proposal comes as cities and states gear up to land relocating jobs and strengthen an economy battered by the pandemic.

Trade groups spoke out against Pritzkers plan after it wasannounced Wednesday, saying businesses are struggling even without new costs.

Real estate experts said Pritzkers proposal to phase out or eliminate some tax breaks could add a hurdle at an unprecedented moment, when swathes of corporations are rethinking their space needs.

Raising taxes during a pandemic is the best way to shoot yourself in the foot, when it comes to attracting jobs, said John H. Boyd, principal of The Boyd Co., a corporate site selection consulting firm. Its ill-timed and shortsighted.

5:50 p.m.: Far fewer COVID-19 deaths in Illinois nursing homes

In another promising sign Illinois is beating back the COVID-19 pandemic, cases and deaths at Illinois long-term care facilities have dropped to levels not seen since late summer, according to state data released Friday.

Following weeks of focused vaccination of long-term care residents and workers, the state reported 33 residents died from the virus over the past week. Thats the lowest reported tally since mid-August and exponentially lower than the 650 weekly deaths reported in early December.

Long-term care residents not only have seen a sizable drop in the number of deaths, they also now make up a far smaller share of those who are dying of COVID-19 each week going from roughly half or more of these deaths in Illinois to near 10 percent now.

Long-term care residents were among the first groups prioritized for vaccination, and advocates for seniors and industry officials credit the vaccines for reducing the viruss toll in long-term care facilities. But both groups cautioned that the pandemic remains far from over.

We still need to remember were in a crisis, even though were seeing positive trends, said Ryan Gruenenfelder, a director of advocacy and outreach for AARP Illinois.

In the past week the state recorded its 9,689th death of a long-term care resident, leaving the state just a few hundred shy of 10,000 deaths among nearly 75,000 cases.

5:40 p.m.: Younger Hispanic Kane County residents hit harder by COVID-19 deaths, new data shows

Younger Hispanic residents of Kane County have been hospitalized for COVID-19 and have died with the virus at disproportionately high rates, new health department data shows.

The data confirms what community advocates say they have long known: that Kane County has faced the same COVID-19 inequities that have played out across the country. But public information about the local communities most affected by COVID-19 deaths has been hard to come by.

The data also highlights the need to reach the countys Black and Hispanic communities with vaccines, Kane County Assistant Director of Community Health Michael Isaacson said, as small fractions of the countys doses to date have been administered to Black and Hispanic residents.

At the high level, these inequities show us that as a society we have a long way to go to get everybody better access to good health, Isaacson said. Specific to COVID, I think this data shows how important it is that we get vaccine to our Black and Latinx communities.

The information obtained by the Beacon-News shows vast divides in those who have died of COVID-19 when broken down by age.

In those under age 60, Hispanic residents made up about 68% of Kane County COVID-19 deaths through February 8 and about 64% of hospitalizations among younger residents for severe cases of the illness. That stands in contrast to the 32% of Kane Countys population that is Hispanic.

5:10 p.m.: Lightfoot joins mayors statewide in urging Illinois congressional delegation to back Bidens COVID-19 relief package

Illinois municipal groups and mayors, including Lori Lightfoot, have sent a letter to Illinois congressional delegation urging passage of President Joe Bidens COVID-19 relief plan and its $350 billion in direct aid to state and local governments nationally.

In a letter released Friday by the White House, the mayors and groups representing nearly 1,300 municipalities warned that without local recovery, there is no national economic recovery.

As mayors on the front line of the pandemic response, we have taken necessary steps to keep our communities safe and continue flattening the curve to save lives, the letter sent Thursday said. Undoubtedly, these steps have come with severe financial hardship. Not only have tax revenues been dropping drastically, but funding essential services critical to the health and safety of our residents has and continues to be challenged.

Of the $350 billion in direct relief to states and municipalities under the plan approved by the House Committee on Oversight and Reform, Illinois state government would receive $7.55 billion while municipalities in the state would get $5.7 billion. Of the municipal share, Chicago would get more than $1.8 billion.

While the letter was sent to all 18 members of Illinois House delegation and Democratic Sens. Dick Durbin and Tammy Duckworth, it was primarily aimed at the states five Republican congressmen: Reps. Adam Kinzinger of Channahon, Darin LaHood of Peoria, Rodney Davis of Taylorville, Mike Bost of Murphysboro and Mary Miller of Oakland. They have joined with other GOP members in opposing direct state and local pandemic relief funding.

2:13 p.m.: Suburbanites are getting COVID-19 vaccine appointments on Chicagos South and West sides. But should they?

Within the first couple days of vaccinating seniors and essential workers on the South Side of Chicago late last month, doctors at Howard Brown Health noticed something unusual: patients traveling from the North Side of the city to the clinics.

They werent the people that lived in the community, said Dr. Maya Green, Howard Browns regional medical director for the South and West sides. The fact is, the link (for appointments) was being communicated and shared faster on the North Side of Chicago, and not among Black and brown communities on the South and West sides of Chicago.

Its a scenario thats been playing out across the city in recent weeks since Illinois opened vaccinations to seniors and front-line essential workers Jan. 25. Many vaccine doses were sent to underserved parts of Chicago in an effort to make sure people in the communities hardest-hit by COVID-19 had access to shots. But with overall vaccines in short supply, people from outside those areas have been traveling to them to get vaccinated.

1:43 p.m.: Illinois surpasses 2 million COVID-19 vaccinations, but 7-day average down amid severe winter weather

The number of COVID-19 vaccinations administered in Illinois has surpassed 2 million, public health officials reported Friday.

The state reached a total of 2,060,706 doses after 83,673 vaccinations were administered Thursday. According to state records, that is the second-highest daily total, behind 95,375 doses on Feb. 11.

Over the past seven days, the state averaged 59,460 vaccinations administered daily, down from a high of 66,320 on Feb. 14. Vaccinations have been affected this week by the severe winter weather, as the state had warned earlier in the week.

The number of Illinois residents who have been fully vaccinated receiving both of the required two shots reached 507,862, or 3.99% of the total population. Over the past seven days, the state averaged 59,460 vaccines administered daily.

12:21 p.m.: Chicago Mayor Lori Lightfoot defends spending $281.5 million in federal COVID-19 relief money on police payroll, says criticism is just dumb

Mayor Lori Lightfoot defended Friday the citys decision to use $281.5 million in federal CARES Act money on Chicago police payroll costs, saying criticism from progressive aldermen and community groups on the issue is just dumb.

We saved taxpayers hundreds of millions of dollars by saying yes to the federal government. Should we have said no? No, no, no federal government, well incur this expense, well put this burden entirely on city of Chicago taxpayers and you can take your money elsewhere? Lightfoot said. That would be foolish and of course we didnt do that.

The city took advantage of the federal CARES Act funding, which provided reimbursement money for COVID-19 related expenses, to avoid an even bigger deficit, Lightfoot said.

Criticism comes with the job of mayor but this ones just dumb, Lightfoot said.

The citys CARES Act spending drew an angry rebuke from activists and aldermen who said the money could have instead provided badly needed housing, health care and business lifelines to struggling residents.

12:13 p.m.: 2,219 new confirmed and probable COVID-19 cases and 63 additional deaths reported

Officials also reported 85,963 new tests in the last 24 hours. The seven-day statewide rolling positivity rate for cases as a share of total tests was 2.8% for the period ending Thursday.

10:13 a.m.: Chicago reports improvement in COVID-19 vaccine distribution efforts among citys Black and Latino population

The number of vaccines going to Black and Latino people in Chicago has gone up but the city still has work to do in closing the equity gap, according to newly released data.

The city has improved its vaccination record among minority groups since December, when Chicago began receiving doses for distribution. White people initially were receiving roughly 60% of doses per week, a figure thats dropped to about 40% in the past week as city officials pushed efforts to promote the vaccine in Black and Latino neighborhoods, city officials said.

Over the past month, we have doubled down on our efforts to not only drive vaccines into communities that need them most but ensure that our vaccination rates match the demographics of our city, Lightfoot said in a statement touting the citys efforts.

News of improving vaccination distribution efforts comes a week after state data showed that Black and Hispanic Illinoisans so far have been vaccinated at half the rate of white residents, confirming fears of inequity in COVID-19 vaccinations and spurring calls to action.

7:01 a.m.: Lightfoot, city officials to give vaccine update

Mayor Lori Lightfoot and Chicago health officials were scheduled to give an update on vaccine distribution in the city Friday morning.

Lightfoot and city Health Commissioner Dr. Allison Arwady were to join other city officials at Ombudsman Chicago South high school in Englewood.

The news conference comes as Chicago-area counties have struggled to reach even the states low vaccination rates. The city, Cook and DuPage counties reported that less than 10% of their populations had received their first dose, while Kane, Lake, McHenry and Will counties each had vaccinated 8% or less.

The announcement also comes as state officials have tried to ramp up vaccine distribution in areas throughout the state with lower vaccination rates, opening mass vaccination sites, including by opening three new mass vaccination sites in central and southern Illinois this week.

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

Here are some recent stories related to COVID-19:

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

(KWWL) -- Iowa's COVID-19 dashboard is updating to reflect total positive tests in the state, rather than individuals who have tested positive.

This change was discussed by Gov. Reynolds and IDPH Director Kelly Garcia during a press conference on Wednesday.

Reynolds mentioned that back in October she said that "continuing to report results for individuals would become more complicated and less valuable overtime as repeat testing became the norm."

According to Garcia, the shift from individual tests to total tests means that their positivity rate will align with total test results.

Previously on the homepage of coronavirus.iowa.gov, the state showed individuals tested and individuals who tested positive. Now, they will show the total tests the state has administered and the total number of tests that have come back positive. The difference in these numbers is caused by individuals getting tested more than once.

The number of positive tests is not the same as the number of positive cases. COVID-19 positive people may be getting tested multiple times. Rather than just reporting the new positive tests, we want to continue to report how many new individual people have tested positive.

To see recoveries for the state you must also scroll down to the bottom of the homepage and look at the "grand total" row of the summary chart.

The number of individuals positive will still be available on the website's "Positive Case Analysis" page. KWWL will continue to add the individuals positive from PCR and Antigen tests, to give the total number of individuals who have tested positive. We will subtract that number from the previous day to provide the number of new cases within the 24 hour period.

KWWL will continue to draw statewide numbers and those for Johnson and Dubuque counties from coronavirus.iowa.gov. We will still be using the Black Hawk County and Linn County dashboards to report those numbers respectively.

Follow this link:

State COVID-19 dashboard changing to reflect total and positive tests - kwwl.com

New evidence from China is affirming what epidemiologists have long suspected: The coronavirus likely began spreading unnoticed around the Wuhan area in November 2019, before it exploded in multiple different locations throughout the city in December.

Chinese authorities have identified 174 confirmed Covid-19 cases around the city from December 2019, said World Health Organization researchers, enough to suggest there were many more mild, asymptomatic or otherwise undetected cases than previously thought.

Many of the 174 cases had no known connection to the market that was initially considered the source of the outbreak, according to information gathered by WHO investigators during the four-week mission to China to examine the origins of the virus. Chinese authorities declined to give the WHO team raw data on these cases and potential earlier ones, team members said.

In examining 13 genetic sequences of the virus from December, Chinese authorities found similar sequences among those linked to the market, but slight differences in those of people without any link to it, according to the WHO investigators. The two sets likely began to diverge between mid-November and early December, but could possibly indicate infections as far back as September, said Marion Koopmans, a Dutch virologist on the WHO team.

This, and other evidence, suggest the coronavirus might have jumped to humans sometime during or shortly before the second half of November, she said, sickening too few people to attract attention until it led to an explosive outbreak in Wuhan. By December, the virus was spreading much more widely, both among people who had a link to the market, as well as others with no tie.

More here:

Covid-19 Was Spreading in China Before First Confirmed Cases, Fresh Evidence Suggests - The Wall Street Journal

HAMPTON, Va. (WAVY) On Friday, 10 On Your Side met with Gov. Ralph Northam while he was at Fort Monroe in Hampton.

10 On Your Sides Andy Fox asked Northam some of the pressing questions, including why it took so long to launch a statewide vaccination registration system, and why some health districts still dont have directors during a pandemic.

And finally, the question that many Americans are also wondering: When can the masks come off?

There are 10 healthdistricts in Virginiawhere the director isforcedto dodouble duty and manage multiple departments.That includes Dr.Demetria Lindsay,who isdistrict health director for Virginia Beach and Norfolk.

There are nine other directors just like Lindsay. Hampton and Newport News share a district health director, as do Portsmouth and the Western Tidewater Health District, which covers 1,500 square miles.

This pandemicis the likes we have never seen in decades,so we have been stretched thin, the governor said when 10 On Your Side inquired about the shortage of directors.

Some critics argue everything appears thin,from vaccinations to leadership at the top of some health districts.

We asked thegovernor why,during the worst global health crisis of our lifetime, do we have so many health districts without their own director? Does it look like we are not prepared?

Well,wevemade a lot ofmodifications. Wearein a very good place now compared to a year ago. We still have alot of work to do, Northam acknowledged.

And why donthealth districts,especially larger urbanones, havetheir own leadership?

The governor did not give a why when asked by 10 On Your Side.

10 On Your Side also pressed Northamabout therocky start to the statewide pre-registration vaccination website that crashed the morning it was launched. People in droves complained to WAVY.com.

As the site crashed, those residents also couldnt get their answers because Virginialaunched a help hotlinethe day after they launched the pre-registrationsite.

What about those issues?

We have had over300,000who havesuccessfully enrolled,and wehave transferred information from those who haveenrolledpreviouslythroughthehealthdepartmentinto the new system, Northam said.

So, is therelight at the end of the long, dark COVID-19 tunnel?

We havebeen at this a year. Numbersshowwe are moving in the right direction.Our positivity rates are going down, our number of vaccinations are going up, he said.

What about thisquestion: When does he think the masks can comeoff?

Hopefully, byearlyor mid-summer, we willhave folksvaccinatedand getto the herd immunity that we need to put COVID-19 in the rear-view mirror, he said.

But when will we be able to not wear masks anymore?

As theGovernor walkedaway to the next meeting, he declined to say.

Ill call you and let you know, Andy.In themeantime,keep it on.he told Andy Fox.

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Gov. Northam takes questions on COVID-19 issues including about when he thinks masks can come off - WAVY.com

We're making this important information available without a subscription as a public service. But we depend on reader support to do this work. Please consider supporting independent journalism in Alaska, at just $1.99 for the first month of your subscription.

Coronavirus cases in Alaska have been steadily declining over the last few months after a surge of infections in November and early December that strained hospital capacity.

Hospitalizations in Alaska are now less than a quarter of what they were during November and December. By Friday, there were 33 people with COVID-19 in hospitals throughout the state, including four on ventilators. Another patient was suspected of having the virus.

The COVID-19 vaccine reached Alaska in mid-December. By Friday, 137,124 people nearly 19% of Alaskas population had received at least their first vaccine shot, according to the states vaccine monitoring dashboard. Thats far above the national average of 12.4%. Among Alaskans age 16 and older, 24% had received at least one dose of vaccine by Friday. The Pfizer vaccine has been authorized for use for people ages 16 and older, and Modernas has been cleared for use by people 18 and older.

Health care workers and nursing home staff and residents were the first people prioritized to receive the vaccine. Alaskans older than 65 became eligible in early January, and the state further widened eligibility criteria last week to include educators, people 50 and older with a high-risk medical condition, front-line essential workers 50 and older and people living or working in congregate settings like shelters and prisons.

Those eligible to receive the vaccine can visit covidvax.alaska.gov or call 907-646-3322 to sign up and to confirm eligibility. The phone line is staffed 9 a.m.-6:30 p.m. on weekdays and 9 a.m.-4:30 p.m. on weekends.

Despite the lower case numbers, public health officials continue to encourage Alaskans to keep up with personal virus mitigation efforts like hand-washing, mask-wearing and social distancing. A highly contagious variant of the virus reached Alaska in December.

Of the 185 cases reported among Alaska residents on Friday, there were 59 in Anchorage plus one in Chugiak and five in Eagle River; two in Kenai; one in Soldotna; one in Kodiak; 18 in Fairbanks plus one in North Pole; one in Big Lake; 11 in Palmer; one in Sutton-Alpine; 38 in Wasilla; two in Utqiagvik; six in Juneau; 15 in Ketchikan; one in Petersburg; two in Sitka; one in Wrangell; one in Unalaska; and one in Dillingham.

Among communities with populations under 1,000 not named to protect privacy, there were three in the Copper River Census Area; one in the southern Kenai Peninsula Borough; three in the Yukon-Koyukuk Census Area; one in Yakutat plus Hoonah Angoon region; and nine in the Bethel Census Area;

Twenty-five cases were also identified among nonresidents: one in Anchorage, one in Fairbanks, one in Juneau, and 22 in Unalaska.

While people might get tested more than once, each case reported by the state health department represents only one person.

The states data doesnt specify whether people testing positive for COVID-19 have symptoms. More than half of the nations infections are transmitted from asymptomatic people, according to CDC estimates.

Of all the tests conducted over the last seven days, an average of 2.27% came back positive.

Read more here:

Tracking COVID-19 in Alaska: 210 new infections and no deaths reported Friday - Anchorage Daily News

Posted: Feb 19, 2021 / 01:20 PM HST / Updated: Feb 19, 2021 / 01:26 PM HST

(AP Photo/Rogelio V. Solis)

HONOLULU (KHON2) Imposters claiming to be Hawaii County officials have recently been reported to be spreading false information about COVID-19 policies in the Puna area.

Get Hawaiis latest news sent to your inbox, click here to subscribe to News 2 You, a daily newsletter.

Hawaii County Mayor Mitch Roths office has received reports that claim two women were seen at multiple businesses in the Puna Kai Shopping Center telling employees and customers that face coverings are no longer necessary. The women also allegedly made false claims about social-distancing practices.

In one report, two imposters claimed to be from the Hawaii County Assembly of Health and Safety Commission. No such commission exists, the mayors office said in Fridays news release.

Its disheartening to think that there are folks out there who are trying to trick people into abandoning the practices that have allowed us to keep our [COVID-19] counts some of the lowest in the nation, said Roth. We have done a great job of keeping each other safe and caring for our community in these uncertain times, and I truly believe that we are close to the finish line. As those most vulnerable continue to receive their vaccinations and are deemed truly safe, we will begin to ease restrictions, but we arent there just yet.

On Feb. 12, Roth extended the state of emergency through April 12, which maintains all COVID-19 policies and procedures.

Hawaii County officials are currently investigating the situation. Anyone who has encountered similar activity is asked to call police at 808-935-3311.

Continue reading here:

Imposters posing as county officials reported to be spreading false COVID-19 info in Puna - KHON2

Houston Health Department to resume COVID-19 vaccinations following winter storm

February 18, 2021

UPDATE (Feb. 18) - Houston Health Department-affiliated United Memorial Medical Center COVID-19 testing sites resume normal operations on Friday, February 19. Visit HoustonEmergency.org/covid19 for details.

HOUSTON- The Houston Health Department will resume COVID-19 vaccinations this weekend with 4,784 second dose appointments on Saturday and Sunday, February 20-21.

People who received their first dose from the department during the week of January 18-23 will be contacted Friday and Saturday to schedule appointments. People who do not hear from the department by Saturday afternoon should contact the COVID-19 call center at 832-393-4220.

The department will schedule additional second and first dose appointments next week.

Area Agency on Aging WaitlistThe Houston Health Departments COVID-19 vaccine waitlist remains open for people age 65 and older, people age 60 and older with chronic health conditions, and people with disabilities.

Those who qualify may call the departments Area Agency on Aging at 832-393-4301 to leave a voicemail with their name and phone number. Calls will be returned for screening and scheduling as supply is available. People only need to leave one message.

Testing SitesHouston Health Department-affiliated COVID-19 testing sites will remain closed Friday, February 19. An announcement about reopening will be provided Friday.

View post:

Houston Health Department to resume COVID-19 vaccinations following winter storm - City of Houston

Some rural counties in Western New York have some of the lowest population percentages in terms of first dose vaccinations. Allegany County is last in the state.

BUFFALO, N.Y. Amid so many challenges with the vaccine rollout, a couple local counties are among the lowest in the state with getting residents vaccinated.

Some health officials believe where they're located has something to do with getting significantly fewer doses of COVID-19 vaccine.

According to New York State's Vaccine Tracker, Allegany County, has the lowest population percentage with at least one vaccine dose at 7.4 percent of the county's population.

"I don't think there's anything particularly different we're doing or not doing, we're involved in the same hub calls the western region is involved in," said Tyler Shaw, public health director in Allegany County, "As of right now, we have no additional first doses to go out the door."

Also low in that category: Orleans County at 7.9 percent. For some perspective, Erie County leads all WNY counties with nearly 13 percent of the population with at least one shot of vaccine.

"We understand the population divide and making sure allocations are based appropriately based on population, but ultimately we need increases in our local communities and not just Genesee and Orleans, but all the rural counties," said Paul Pettit, the public health director for Genesee and Orleans counties.

Pettit says vaccine allocation in both counties has been either cut or remained flat in recent weeks. This at a time, when the federal government and the state have been promising modest increases in supply.

"The challenges continue, we continue to hear about increased allocations from the state, we've been hearing that for weeks coming from the feds to the state, but that has not translated into increased local allocations for specifically rural counties," Pettit said.

Meantime, in Erie County, the county health department expects to see a modest increase from last week to this week.

"I guess the biggest thing, we just want to know is and we'd like to see is that that vaccine starting to come into the rural areas a little more readily and a little more parity with where that vaccine is going," Pettit said.

2 On Your Side asked the state health department and the governor's office about vaccine allocation to rural counties.

A spokesperson for the health department says this is all due to recent winter storms slowing down vaccine delivery.

Here's the full statement:

Nola Goodrich-Kresse, public information officer in Orleans County wrote in an email:"Based on the most recent data, Orleans County has received the third lowest allocation of vaccine in the Finger Lakes Region since it was initially distributed to date. There are also fewer healthcare providers in the county resulting in less eligible in the 1A prioritization groups early on. According to the 2020 County Health Rankings and Roadmaps, Orleans has a ratio of 13,660 patients to 1 provider. We have seen by the allocations to date that rural counties continue to receive less vaccine proportionally than larger urban counties. We're hopeful that as initial vaccination data is released, it will continue to show these disparities and lead towards increased allocations reaching our residents. Access to health care and transportation issues are very prevalent in the rural areas which limits the ability of our residents to reach current state run mass vaccination sites. Today, Genesee, Orleans and Wyoming Counties formally requested from the Governor a state run mass vaccination site at GCC to increase closer access and increased allocations of vaccine to our residents."

Assemblymember Steve Hawley writes in a statement:"The vaccination distribution to rural parts of the state has been concerning thus far, to say the least. While it's bad enough vaccine allocations have remained flat in recent weeks throughout rural areas of the state, here in Orleans County distribution has slowed since the amount of doses the county received was cut from 400 to 200 for the week of February 8th. We have reached out to the state Health Department regarding this shortage and, while they said they would look into it, we have not heard back. This shortage must be addressed immediately to stop the spread of COVID-19 through rural upstate New York and to save lives. Because we are all New Yorkers, no matter where we live."

State Senator Ed Rath issued a statement:"The Federal government has informed New York that nearly all COVID-19 vaccine doses allocated for Week 10 which were scheduled to be delivered between February 12th and February 21st are delayed due to the winter storms continuing to impact much of the country. Every dose that should have shipped on Monday was held back, and only a limited number of Pfizer vaccines left shipping facilities on Tuesday and Wednesday. This delay will undoubtedly pose a logistical challenge for New York but as we have shown over the last 350-plus days, we are New York Tough, and we are up to the challenge. The Department of Health is working closely with all providers, including local health departments, hospitals, pharmacies, and FQHCs to minimize the impact on their operations and reduce the number of appointments that must be rescheduled. The vaccine is the weapon that will win the war against COVID, and we will continue to work with our federal partners to expedite the delayed shipments and will keep New Yorkers updated over the coming days."

See the article here:

Rural counties concerned over lack of COVID-19 vaccine supply for their residents - WGRZ.com