Category Archives: Corona Virus

A robot introduces itself to patients in Kigali, Rwanda. The robots, used in Rwanda's treatment centers, can screen people for COVID-19 and deliver food and medication, among other tasks. The robots were donated by the United Nations Development Program and the Rwanda Ministry of ICT and Innovation. Cyril Ndegeya/Xinhua News Agency/Getty Images hide caption

In some places in the world right now, getting tested for COVID-19 remains difficult or nearly impossible. In Rwanda, you might just get tested randomly as you're going down the street.

"So whenever someone is driving a vehicle, bicycle, motorcycle or even walking, everyone is asked if you wish to get tested," says Sabin Nsanzimana, director general of the Rwanda Biomedical Center, which is the arm of the ministry of health that's in charge of tackling COVID-19. Health officials in personal protective equipment administer the test. Nsanzimana says the testing is voluntary, although some others say refusal is frowned upon.

The sample collection from a swab up the nose and filling out the contact information paperwork takes about five minutes.

"All these samples are sent that day to the lab," Nsanzimana says. "We have a big lab here in Kigali. We have also six other labs in the other provinces."

Despite being classified by the World Bank as a low-income country, and despite its limited resources, Rwanda has vowed to identify every coronavirus case. Anyone who tests positive is immediately quarantined at a dedicated COVID-19 clinic. Any contacts of that case who are deemed at high risk are also quarantined, either at a clinic or at home, until they can be tested.

Nsanzimana says health workers call or visit every potential contact of someone who tests positive.

"We really believe that doing so is important to make sure we detect and trace where the virus could be," he says.

Comprehensive contact tracing is a task that has overwhelmed countries with far more resources than Rwanda. Rwanda's per capita income is roughly $2,000 per year. Yet all testing and treatment for the virus is provided for free.

It costs the government between $50 and $100 to run a single coronavirus test, Nsanzimana says. In order to test thousands a day, Rwanda has started using a process called "pool testing." Material from 20-25 nasal swabs are all put into one vial and run through the machine. This allows them to test far more samples at once. If they get a positive result, then all the swabs that went into that initial vial are tested individually to pinpoint the person who's infected.

Nsanzimana says Rwanda's experience dealing with other infectious disease outbreaks is helping it now during the pandemic.

The country is using systems and equipment it already had in place to address HIV.

"The main machines we are using for COVID testing are the HIV machines that were (already) there," he says. "We are using the same structure, same people, same infrastructure and laboratory diagnostics, but applying it to COVID testing."

Since recording its first case in mid-March, the country of 12 million has recorded just over 1,200 cases. Ohio has a similar size population and has recently been reporting roughly 1,200 cases a day.

"Rwanda did a few things that are quite smart," says Sema Sgaier, the head of the Surgo Foundation, which has just launched a new data tool to analyze trends around COVID-19 across Africa. "One is they responded really early. They put some of the most stringent lockdowns in place compared to every other African country. In fact, we've been monitoring physical distancing data across the continent and Rwanda fares, I think, second; they've physical distanced the second most across Africa" a conclusion based on mobile phone movement data. South Africa is No. 1.

Rwanda mobilized community health care workers and police and college students to work as contact tracers. It set up national and regional command posts to track cases. It's even using human-size robots in the COVID-19 clinics to take patients' temperatures and deliver supplies.

Tolbert Nyenswah, who ran the Liberian ministry of health's response to Ebola in 2014, gives Rwanda high marks for how it has been handling COVID-19, even if at times it's heavy-handed.

"Rwanda, from all indications, is a success story for Africa," Nyenswah says. The strong leadership from President Paul Kagame, which Nyenswah says can even be authoritarian, has been effective during this crisis. Kagame demands accountability from his health ministry.

Whether the people trust or fear the government, Rwandans listen to their government and have been following the orders regarding masks, washing hands and staying home.

Nyenswah worries that the worst is yet to come in Africa with this pandemic.

"No country is out of the woods yet," he says. However, he adds that Rwanda is an example to other low-income countries that even with limited resources, this virus can be contained. "So what needs to be done is to follow the (prevention and containment) measures. Political leadership is very, very crucial. Rwanda should continue what it is doing now. And other countries should emulate Rwanda."

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Coronavirus Success Story: How Rwanda Is Curbing COVID-19 : Goats and Soda - NPR

With coronavirus spreading faster than ever in the U.S., two new studies are providing more evidence that universal face masking is an effective tool to help slow the spread of the virus. The new research comes just as Walmart, the nations biggest retailer, said it will require all customers to wear a mask.

This week, the director of the Centers for Disease Control and Prevention said that if everyone in America wore a mask, washed hands frequently and practiced social distancing, the spread of the virus would be under control in one to two months.

Cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus particularly when used universally within a community setting, Dr. Robert Redfield said in a statement. All Americans have a responsibility to protect themselves, their families and their communities.

Saskia Popescu, an infectious disease epidemiologist at the University of Arizona, said the plea from the CDC shows the U.S. needs to unite to make a collective effort on masking.

Now is the time for us to work together, and universal masking is one such effort that can make a huge impact, Popescu wrote in an email.

Two new, real-world studies showed how effective face coverings are in slowing coronavirus spread.

In the first, researchers at Massachusetts General Hospital in Boston monitored how wearing a mask affected transmission rates of SARS-CoV-2, the virus that causes COVID-19, among hospital health care workers.

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Researchers tracked the infection rates among staff before and after the mask mandate.

Before masking, the positivity rate of testing was increasing exponentially at a rate of 1.16 percent per day. After masks were required, the positivity rate among health care workers started to slowly decline at rate of 0.49 percent per day.

It's almost a stress test of masking, and it showed that masking is effective in terms of reducing infection from COVID, said Dr. Deepak Bhatt, lead author of the study and a professor at Harvard Medical School and the executive director of interventional cardiovascular programs at Brigham and Womens Hospital.

Bhatt hopes the research will help ease political resistance to wearing a mask.

What we're doing here is bringing out some science," Bhatt said. "This isn't politics. This isn't blaming anyone. This isn't us trying to second guess what's already happened, but rather allow a way hopefully for us all to move forward together and support masking."

A separate report released by the CDC Wednesday found that masks protected against the virus spread in a Springfield, Missouri, hair salon.

Two hair stylists at the salon developed respiratory symptoms but had continued working until they received positive test results for coronavirus.

Between the two stylists, 139 clients had been potentially exposed between the time the stylists developed symptoms to when they received the test results. Both of the stylists and their clients wore face coverings while they were in the salon.

Through contact tracing efforts, local officials found no symptomatic cases reported from exposure to the hair stylists. In addition, 67 of the clients who were exposed were tested and all of them were negative.

This is a beautiful experiment; you couldn't have designed a better one to show that masks work," Dr. Carlos del Rio, an infectious disease specialist and chair of the department of global health at Emory University, told NBC News.

According to Del Rio, one limitation of the study was that not all clients underwent testing, leaving a possibility of asymptomatic infections. Recent CDC estimates say that as many as 40 percent of infections may be asymptomatic.

Ideally you would have liked to test everybody," Del Rio said. "But the reality is, it shows pretty nicely that masks work.

Hair salons remain open in Texas, Arizona, and Florida where cases are surging and ICU bed capacity is dwindling.

Popescu, who resides in Arizona and is seeing the devastating effects of the epidemic in her state, has observed an increase in mask use and attributes this to the recent media attention and mask mandates in many states and communities.

Now is the time for us to rally around public health efforts, help reduce the strain on health care workers and hospitals, and keep ourselves and our loved ones safe, she said.

Akshay Syalis a medical fellow with the NBC News Health and Medical Unit.

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COVID-19 and masks: New evidence shows that cloth face coverings slow coronavirus spread - NBC News

While good ventilation can dilute aerosols, it is far less effective against droplets, which are much wider and heavier in the same way that a passing breeze would perturb the trajectory of a Ping-Pong ball, but not a cannonball.

The study points to a more important role for aerosolized flu transmission than some might assume, Dr. Marr said.

Determining the exact size of that role, however, is another matter entirely. Its very hard to conduct these human challenge studies and separate the different modes of transmission, Dr. Marr said. That problem applies across respiratory viruses, including the coronavirus.

Part of the problem is the continuum on which aerosols and droplets exist. Though they go by different names, the two categories really belong to the same group: globs of fluid that come in varying sizes. Blobs less than five micrometers in diameter are termed aerosols, which can exit the airway at the slightest breath and waft away; anything larger is a droplet, hefty enough to fall to the ground within a few feet of its source. The boundary between them is somewhat arbitrary, though generally speaking, the smaller the particle, the farther it travels.

When people expel fluid from their airway, it tends to manifest in a mixture, some bigger, some smaller and everything in between, said Seema Lakdawala, who studies influenza transmission at the University of Pittsburgh.

Updated July 15, 2020

Even after they exit an individual, these fluidic blobs remain dynamic. Large droplets, for instance, can disperse or evaporate into little aerosols in midair. Others might scatter onto a surface or a hand, lingering for minutes or hours before encountering someone new. And the rates at which all these events occur can shift, depending on the force with which someone, maybe a loud talker, expels these droplets or the amount of air flow in an area, Dr. Lakdawala said.

Everyone thinks transmission is a very binary concept, she added. The reality is that there is a continuum of aerosols.

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The Flu May Linger in the Air, Just Like the Coronavirus - The New York Times

CHICAGO The state has made Chicago into its own region during the coronavirus pandemic, hoping that will help experts better pinpoint where outbreaks are happening and where hospitals need help.

The state divided Illinois into four regions when Gov. JB Pritzker announced his coronavirus recovery plan this spring, grouping Chicago with Cook County and nearby suburbs. Data from the regions like how many coronavirus cases there were and how hospitals were doing was used to determine if a region could progress in the recovery plan and further reopen.

But Pritzker announced a change to the regions Wednesday, saying the state will now be sectioned into 11 areas, with Chicago on its own.

The move is being made because the growth in testing and contact tracing has given officials a much more surgical ability to manage outbreaks and address problems locally, Pritzker said.

Making the change will allow the state to better monitor where outbreaks are occurring, where communities are in danger and if a region has enough hospital capacity should there be an outbreak, Pritzker said.

The entire state is currently in Phase 4, which reopened bars, restaurants, salons and gyms but a recent rise in cases could lead the state to close businesses linked to the spread of COVID-19, officials said.

Chicago has seen an uptick in its positivity rate and its average number of new cases. Mayor Lori Lightfoot warned earlier Wednesday the city could take steps back if that increase continues.

Pritzker said he called Lightfoot last week to talk about the concerning uptick in [Chicagos] positivity rate, but outbreaks have been seen all across Illinois. They have been tied to Fourth of July parties, youth sports, bars, church services and more.

With cases rising throughout the state, the state will use COVID-19 data from the 11 regions to determine whether and where they need to close businesses or impose tighter restrictions.

When officials see trends that indicate a problem in a region, we need to start tightening mitigations in that region before its too late, Pritzker said.

Officials will take action if they see an increase in a regions seven-day average positivity rate for seven days out of a 10, as well as one of these indicators:

Currently, all regions have a positivity rate of 5 percent or lower with the highest rate in the Southern Region of the state.

The new regions:

Pritzker, joined by Public Health Director Dr. NgoziEzike, urged Illinois residents to wear face coverings every day, every time they leave their home. These measures will ensure Illinois does not end up back in Phase 1, when there was a mandatory lockdown, they said.

Pritzker said the state is trying to take a more targeted approach to outbreaks, and the new regions will allow officials to zero in on a county or town and make changes to prevent the spread of COVID-19 instead of shutting down an entire region.

Outbreaks are taking place consistently and in every region of the state, Pritzker said.

The state also released an outline of what businesses will be closed if a surge in cases continued. For example, if a region has a sustained increase in new cases, the state could reduce indoor dining capacity or suspend bar service.

In a worst-case scenario, the region could lose outdoor and indoor dining entirely.

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Chicago Now Its Own Region In Illinois' Coronavirus Recovery Plan And Businesses Will Close If Cases Spike, Gov Says - Block Club Chicago

Now the economy is traveling sideways, as business failures mount and the virus continues to maim and kill. New applications for unemployment insurance, for instance, are leveling off at more than 1 million a weekmore than double the highest rate reached during the Great Recession, a sign that more job losses are becoming permanent. After rising when the government sent stimulus checks and expanded unemployment-insurance payments, consumer spending is falling again, down 10 percent from where it was a year ago. Homebase, a provider of human-resources software, says that the rebound has hit a plateau, in terms of hours worked, share of employees working, and number of businesses open.

The next, terrifying phase of the coronavirus recession is here: a damaged economy, a virus spreading faster than it was in March. The disease itself continues to take a bloody, direct toll on workers, with more than 60,000 Americans testing positive a day and tens of thousands suffering from extended illness. The statistical value of American lives already lost to the disease is something like $675 billion. The current phase of the pandemic is also taking an enormous secondary toll. States with unmitigated outbreaks have been forced to go back into lockdown, or to pause their reopening, killing weakened businesses and roiling the labor market. Where the virus spreads, the economy stops.

That is not just due to government edicts, either. Some consumers have rushed back to bars and restaurants, and resumed shopping and traveling. Young people, who tend to get less sick from the coronavirus than the elderly, appear to be driving todays pandemic. But millions more are making it clear that they will not risk their life or the life of others in their community to go out. Avoidance of the virus, more so than shutdown orders, seems to be affecting consumer behavior. Places without official lockdowns have seen similar financial collapses to those with them, and a study by University of Chicago economists showed that decreases in economic activity are closely tied to fears of infection and are highly influenced by the number of COVID deaths reported in a given county.

Read: A devastating new stage of the pandemic

In other ways, the spread of COVID-19 is keeping Americans from going back to work. The perception of public transit as unsafe, for example, makes it expensive and tough for commuters to get to their jobs. Schools and day-care centers are struggling to figure out how to reopen safely, meaning millions of parents are facing a fall juggling work and child care. This is a disaster. The lingering uncertainty about whether in-person education will resume isnt the result of malfeasance, but utter nonfeasance, the former Department of Homeland Security official Juliette Kayyem has argued in The Atlantic. Four months of stay-at-home orders have proved that, if schools are unavailable, a city cannot work, a community cannot function, a nation cannot safeguard itself.

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The Terrifying Next Phase of the Coronavirus Recession - The Atlantic

In echoes of the early days of the Covid-19 pandemic, some American states and localities are reversing economic reopenings after spread of the coronavirus accelerated in some regions.

Americas Sun Belt, the region extending from southern California to Florida, has been particularly hard-hit, and now further flung and less populous states are joining the ranks rolling back reopenings.

New Mexico again banned indoor dining. Nevada closed bars in counties with major outbreaks. And Oregon, in the Pacific north-west, banned private indoor gatherings of more than 10 people. Arizona and Texas reimposed restrictions on indoor dining and bars in early July.

California, the most populous state, dramatically expanded restrictions. Indoor operations of theaters, wineries, restaurants and bars were all stopped this week. In addition, some of the nations largest school districts have announced classes will be virtual this fall. Students in Los Angeles, San Diego and Atlanta will not have in-person classes.

The reopening plan was great if everything went well, the Miami mayor, Francis X Suarez, told the Republican Florida governor, Ron DeSantis, at a public roundtable Tuesday. But I think the fact is things have not gone according to plan.

If things do not improve quickly I think were going to be under a significant amount of pressure to shut down, Suarez said.

Florida closed indoor dining in late June but has persisted with other reopening plans. DeSantis called on schools to reopen in a few weeks, and Disney World reopened some of its parks to thousands of visitors on Saturday.

Republican officials moved the national convention, where Donald Trump will formally accept the nomination of his party, from North Carolina to Florida to avoid social distancing and mask requirements. But with cases rising, officials moved the biggest events outdoors, the New York Times reported.

Louisiana, an early center of outbreaks after Mardi Gras this spring, has again seen a spike in Covid-19 cases. Vice-president Mike Pence traveled to the state on Tuesday but was not greeted by one of its top officials, attorney general Jeff Landry, who tested positive for Covid-19 despite showing no symptoms.

The governor, John Bel Edwards, enacted a statewide mask mandate for people aged eight and older, which took effect Monday. He also returned bars to takeout and delivery only. Restaurants, casinos, gyms, salons and other businesses remain open, with occupancy restrictions.

But Americas vast landscape and varied politics means even as many states across the south and west roll back reopening, places whose overburdened health systems became emblematic of the perils of Covid-19 have continued to reopen.

The New York governor, Andrew Cuomo, will allow malls to reopen in some parts of the state. New York City hit a hopeful milestone on Saturday: for the first time since 11 March, no one died of coronavirus.

Its something that should make us hopeful, but its very hard to take a victory lap because we know we have so much more ahead, said the mayor, Bill de Blasio, on Monday, according to NPR. This disease is far from beaten. While New York state announced only 677 new cases of coronavirus on Sunday, Florida reported more than 15,000.

In contrast to states in the south and west, some parts of the north-eastern economy never reopened. In New York City, Broadway shows are likely to remain closed until at least this winter, and indoor dining is still banned.

Across the river in New Jersey, gyms remain closed. Indoor dining in New Jersey was slated to reopen at very limited capacity, but the proposal was rolled back after photos emerged of unmasked crowds at beach bars on the Jersey shore.

Unlike in states such as New York, which has metrics that would trigger closures if the virus began to spread, Miami mayors said Florida had no such plan.

Renewed restrictions in the south and west have also brought renewed frustration. In New Mexico, businesses forced to close their doors again protested against the governors order. At some point you have to protect your livelihood, Kathy Diaz, owner of Monroes Restaurant, told local news station KOB4.

Parents of schoolchildren in Jacksonville, Florida, called for school reopenings, and anti-mask protesters have organized demonstrations against local mask mandates.

Marlyn Hoilette, a nurse who spent four months working in the Covid-19 unit of her Florida hospital until testing positive recently, said she worries about returning to work.

Nurses are getting sick, nursing assistants are getting sick and my biggest fear is that it seems we want to return folks to work even without a negative test, said Hoilette, who works at Palms West hospital in Loxahatchee, Florida. Its just a matter of time before you wipe the other staff out if youre contagious, so that is a big problem.

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'Things have not gone according to plan': America's coronavirus reopening falls apart - The Guardian

Most of the new cases are young people between the ages of 15 and 25, the Washtenaw County Health Department said in a press release Monday.

It is believed that the party took place between July 2 and 3, and health officials are now asking anyone who attended the party to self-quarantine and monitor themselves for symptoms of the virus for 14 days.

There were an additional 66 people who are believed to have had face-to-face contact with a confirmed case. That number does not include family members who are immediate household contacts of the newly identified cases, the release said.

Over the weekend, Louisiana Gov. John Bel Edwards said may new cases had been linked to casual gatherings in people's backyards. The governor issued a restriction mandating gatherings be under 50 people.

Local health officials said this cluster in Michigan highlights how easily and rapidly the virus can infect people.

Spread from the party has impacted people outside the county and even the state, according to the release.

The party and subsequent events have led to additional exposures at retail stores, restaurants, businesses, canoe rentals, clubs, camps, athletic teams and a retirement community, the release said.

"None of us wants to be the reason someone in our community or county becomes seriously ill or dies," says Brian Marl, mayor of the city of Saline. "We have the opportunity to work together and with our local health department to contain this as quickly as possible. We know what we need to do, and we can certainly do it."

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43 new coronavirus cases have been linked to one large house party in Michigan - CNN

Well, I was writing just the other day about what we dont know about the T-cell response to coronavirus infection, and as of today we know quite a bit more. And from what I can see, we have encouraging news, mixed with some things that were going to need to keep an eye on.

Heres a post from May on a paper in Cell that looked at T cell responses in recovering SARS CoV-2 patients and compared them to reports of people who had been infected with original SARS back in 2003, and to people who had never encountered either. It also has some background on T cells in general, which might be useful if you dont have that info right at the top of your brains queue. Thats the paper that showed that the T-cell response to this virus is less Spike-o-centric than it was to SARS. It also showed that there are, in fact, people who have both CD4+ and CD8+ T cells that recognize protein antigens from the new coronavirus even though they have never been exposed to SARS, MERS, or the new virus. The paper speculated that this might be due to cross-reactivity with proteins from the common cold coronaviruses, and raised the possibility that there might be a part of the population that has at least some existing protection against the current pandemic.

Now comes a new paper in press atNature. It confirms that convalescent patients from the current epidemic show T-cell responses (mostly CD4+ but some CD8+ as well) to various epitopes of the N (nucleocapsid) protein, which the earlier paper had identified as one of the main antigens as well (along with the Spike and M proteins, among others, with differences between the CD4+ and CD8+ responses as well). Turning to patients who had caught SARS back in 2003 and recovered, it is already known (and worried about) that their antibody responses faded within two or three years. But this paper shows that these patients still have (17 years later!) a robust T-cell response to the original SARS coronaviruss N protein, which extends an earlier report of such responses going out to 11 years. This new work finds that these cross-react with the new SARS CoV-2 N protein as well. This makes one think, as many have been wondering, that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between (1) antibody responses that seem to be dropping week by week in convalescent patients but (2) few (if any) reliable reports of actual re-infection. That would be good news indeed.

And turning to patients who have never been exposed to either SARS or the latest SARS CoV-2, this new work confirms that there are people who nonetheless have T cells that are reactive to protein antigens from the new virus. As in the earlier paper, these cells have a different pattern of reactivity compared to people who have recovered from the current pandemic (which also serves to confirm that they truly have not been infected this time around). Recognition of the nsp7 and nsp13 proteins is prominent, as well as the N protein. And when they looked at that nsp7 response, it turns out that the T cells are recognizing particular protein regions that have low homology to those found in the common cold coronaviruses but do have very high homology to various animal coronaviruses.

Very interesting indeed! That would argue that there has been past zoonotic coronavirus transmission in humans, unknown viruses that apparently did not lead to serious disease, which have provided some people with a level of T-cell based protection to the current pandemic. This could potentially help to resolve another gap in our knowledge, as mentioned in that recent post: when antibody surveys come back saying that (say) 95% of a given population does not appear to have been exposed to the current virus, does that mean that all 95% of them are vulnerable or not? Ill reiterate the point of that post here: antibody profiling (while very important) is not the whole story, and we need to know what were missing.

There are still major gaps in our knowledge: how many people have such unknown-coronavirus-induced T-cells? How protective are they? How long-lasting is the T-cell response in people who have been infected with the current SARS CoV-2 virus, and how protective is it in the declining-antibody situation that seems to be common? What sorts of T cell responses will be induced by the various vaccine candidates? We just dont know yet. But were going to find out.

Originally posted here:

New Data on T Cells and the Coronavirus - Science Magazine

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The River Crab, 1337 River Road, has confirmed to the health department that an employee tested positive for COVID-19.(Photo: Brian Wells/Times Herald)

An employee of a waterfront restaurant in St. Clair Township has tested positive for the coronavirus, theSt. Clair County Health Department confirms.

The county was notified of the confirmed COVID-19 case at the River Crab this week, and according to a health department news release, the management at the restaurant is "working very closely" with health officials.

Patrons who visited the restaurant along M-29 on July 5, 6, 7 or 8 may have been exposed, the health department stated, and are encouraged to self-monitor for symptoms over the next 14 days and seek testing if they becomesymptomatic.

The release states that River Crab, 1337 River Road, has COVID-19 procedures in place, including daily employee health screenings and required masking throughout the facility.

Late Wednesday afternoon, Melanie Lewis, the dining room's manager, confirmed that the restaurant maintains a binder to ensure adherence to coronavirus protocols, and after examination, the health department approved them to remain open.

"Every day before our servers or any of our staff are allowed to enter the building or clock in, (they have their) temperatures (checked)," she said. "... Not only do we have extra cleaning set up and in place where things are disinfected nightly and throughout the day, (but) we also have disinfecting stations throughout the restaurant."

Lewis said employees also aren't allowed to remove their masks until they leave, adding, "We feel confident this will be an isolated event."

Health officials have said they've begun to receive a lot of calls or complaints about potential COVID issues in area businesses. As of earlier this month, Dr. Annette Mercatante,the county's medical health officer, said they were still trying to standardize their response. She said they were open to releasing names of restaurants where enough complaints or instances of COVID arise.

"If you walk into an establishment and see there's no way you can safely sit six feet apart and have a drink, you're not safe to take your mask off yet," Mercatante said in the recent interview. "If everybody in the building's not wearing a mask, you're not safe to go in. That's one of the choices people have."

As of Monday, it is required for Michiganders to wear masks in public spaces and for establishments to refuse entry or service to those who don't comply.

General questions can be directed to the St. Clair County COVID-19 informational hotline (810) 966-4163.(Photo: Brian Wells/Times Herald)

Symptoms of COVID-19 can include fatigue, cough, fever, chills, shortness of breath, muscle aches, headaches, nausea or vomiting, congestion, sore throat, diarrheaand abdominal pain.

Extra precautions to avoid transmitting the virus to others have also been highly encouraged, as individuals may be able to spread the disease for up to 48 hours priorto symptoms and some may remain asymptomatic.

COVID can spread primarily from person to person through respiratory droplets produced when an infected person coughs, sneezes or talks, according to the U.S. Centers for Disease Control and Prevention. Droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs, and social distancing of at least six feet is encouraged.

Other ways to reduce the spread of the virus and to protect others includes:

For more information on testing locations, visitwww.michigan.gov/coronavirus. St. Clair County updates its dashboard daily atwww.stclaircounty.org/offices/healthand provides weekly graph updates every Friday online and through social media.General questions can be directed to the St. Clair County COVID-19 informational hotline (810) 966-4163 or email covid19@stclaircounty.org.

Contact Jackie Smith at (810) 989-6270 or jssmith@gannett.com. Follow her on Twitter @Jackie20Smith.

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River Crab employee tests positive for COVID-19; potential exposure reported around July 5-8 - The Times Herald

A coronavirus patient in Anahuac was flown by helicopter to a hospital in El Campo 120 miles away because closer facilities could not take him.

Ambulances are waiting up to 10 hours to deliver patients to packed Hidalgo County emergency rooms.

And short-staffed hospitals in Midland and Odessa have had to turn away ailing COVID-19 patients from rural West Texas facilities that cant offer the care they need.

As the tally of coronavirus infections climbs higher each day, Texas hospitals are taking extraordinary steps to make space for a surge of patients. Some facilities in South Texas say they are dangerously close to filling up, while hospitals elsewhere are taking precautionary measures to keep their numbers manageable.

Doctors warn of shortages of an antiviral drug that shows promise for treating COVID-19 patients. And epidemiologists say the states hospitals may be in for a longer, harder ride than places like New York, where hospitals were stretched to capacity in the spring and some parked refrigerated trailers outside to store bodies of people who died from COVID-19.

It used to [be that] if one hospital got kind of overwhelmed you would start transferring out ICU patients to other facilities that had ICU beds available, said Dr. Robert Hancock, president of the Texas College of Emergency Physicians. And there really is none of that now, because everybodys in the same boat and theyre struggling to get their own patients admitted.

Cases of the new coronavirus have surged in Texas since Memorial Day weekend at the end of May, one month after Gov. Greg Abbott allowed a phased reopening of businesses. In June, Abbott scaled back parts of that plan, first pausing elective procedures in the states biggest cities in an attempt to conserve hospital capacity for COVID-19 patients, then ordering bars to close and capping restaurant occupancy at 50%.

Last week, he expanded the ban on elective procedures to more than 100 counties across broad swaths of the state, a sign of the increasing urgency of the virus toll on Texas hospitals. Then he warned that if the trend continues, he might order another economic lockdown.

Its going to be a rough few weeks, said John Henderson, president of the Texas Organization of Rural and Community Hospitals. Most everything were seeing is worrisome or scary.

State data shows the hardest-hit regions include most of Texas biggest cities, as well as large swaths of South and Central Texas and the Gulf Coast.

Dr. John Zerwas, the executive vice chancellor for health affairs at the University of Texas System and a former state representative who is advising Abbott on coronavirus response, forecasted that July will be a month for peak activity related to the epidemic.

Probably toward the end of the month, well be seeing ourselves get into a bit more comfortable place, he said.

Local officials in urban centers throughout Texas say more restrictions are needed now to slow the virus spread and keep hospitals from being overwhelmed in the future. On Sunday, Houston Mayor Sylvester Turner called on the governor to shut down businesses for two weeks.

Many Texas hospitals have stopped accepting transfer patients in order to maintain space for a surge thats expected to come. In the Rio Grande Valley, that moment has already arrived, with hospital beds in short supply.

The tsunami is here, Hidalgo County Judge Richard Cortez said last week.

DHR Health, based in Edinburg, the county seat, is creating a third special COVID-19 ward in a facility normally used for physical therapy after spending more than $9 million to convert a hospice center and rehabilitation facility into COVID-19 units.

Were full to the gills, said Dr. Carlos J. Cardenas, chairman of the board at DHR Health.

In neighboring Cameron County, all of the hospitals were at or above capacity and holding patients in their emergency departments Monday, said Dr. James Castillo, the county health authority. Some were converting or eyeing areas not typically used for patient care, like conference rooms or lobbies, he said.

At Valley Baptist Medical Centers in Brownsville and Harlingen which keep opening new units to care for critically ill patients there were people waiting in the emergency room hallways for treatment this week, said Dr. Jamil Madi, medical director of the ICU in Harlingen. The hospitals are nearly out of ventilators and are starting to consider older models and disaster ventilators that are less optimal for treating the virus, he said.

Theres nothing else other than COVID. You treat COVID, you look at COVID, you see COVID, you smell COVID, you hear COVID. Everythings COVID, Madi said. There are two parallel worlds: The world inside the hospital and the world outside. We need people to understand that it is a dire situation going on inside the hospital.

Ambulances are sometimes waiting hours to deliver patients to the emergency rooms, said Mack Gilbert, chief operating officer of Med-Care EMS, which services most of Hidalgo County. Normally, the wait is less than 30 minutes, he said.

You cant blame the hospitals for being full. The ICUs are full, Gilbert said. But the longer [the patients are] with us, the longer it takes to get them the care they need. Were not really set up for long-term care like that, for four to six to eight hours.

The extended delay also leaves medics in the confined space of an ambulance with a COVID-19 positive patient for longer, increasing their risk of exposure to the virus even though they wear full protective gear, Gilbert said.

The state sent hundreds of medical personnel to South Texas earlier this month to alleviate staffing shortages. It also deployed a fleet of 10 ambulances to Hidalgo, of which Med-Care can use two for 12 hours a day.

Gilbert is grateful these guys are doing a great job. But in a 12 hour shift, they're only able to do three calls, because each call is taking four hours, he said.

In Houston, major hospitals have had to treat hundreds of COVID-19 patients in their emergency rooms as they await space in intensive care units. Data shows the dozen busiest hospitals in the area are increasingly telling emergency responders that they cannot safely accept new patients.

Ripple effects can be felt throughout the region, including at El Campo Memorial Hospital, about 75 miles southwest of Houston.

Under normal circumstances, hospitals in Houstons world-renowned Texas Medical Center would accept transfers of medically complex patients from smaller regional hospitals that are less equipped to handle them. But with many Houston hospitals diverting patients away, smaller facilities like the 49-bed El Campo Memorial Hospital have taken them on.

On Monday, the hospital was caring for 18 coronavirus patients, including at least two who were admitted from Houston and the Anahuac patient who was transported by helicopter, said Nathan Tudor, chief executive of the Mid Coast Health System, which includes the hospital.

Traditionally, if the complex cases need to go out, they do go to Houston, Tudor said. Were just praying that this virus gets behind us sooner rather than later.

In Dallas, some hospitals are gearing up for crisis as the number of admitted patients climbs. After requests from Abbott and Dallas Mayor Eric Johnson, federal medical teams are heading to Parkland Memorial Hospital, one of the citys biggest facilities, to help treat an onslaught of patients.

Additional staff is our primary need, said Donna Richardson, chief nursing officer for Parkland Health and Hospital System.

Similar teams were already sent to Houston and San Antonio.

And for the next two weeks, Medical City Healthcare is suspending elective surgeries at 10 of its 16 North Texas facilities, even though the governors order allows such surgeries to take place outside Dallas County.

The pause will enable us to safely and quickly expand capacity and staff to care for hospitalized patients, spokeswoman Janet St. James said. While we currently have adequate capacity, staff, and [personal protective equipment] we are concerned that there is a misconception in the community that this rate of growth can continue.

Meanwhile, short-staffed West Texas hospitals have been forced to turn away patients from rural areas, where small regional hospitals lack the resources to treat the sickest patients.

Earlier this month, Medical Center Health System in Odessa went on diversion meaning it did not accept transfer patients from regional hospitals outside the county as it faced severe staffing shortages. Currently, more than 20 staff members are out because either they or their family members have been exposed to COVID-19, said Trevor Tankersley, a spokesperson for the Medical Center Health System in Odessa.

When MCHS resumed accepting transfer patients, 15 arrived in one day, from West Texas towns as far-flung as Kermit and Alpine. Soon after, the citys other major hospital, Odessa Regional Medical Center, stopped accepting transfers.

Nearby Midland Memorial Hospital stopped accepting transfers of critical patients Thursday, spokeswoman Tasa Richardson said. At that point, the 286-bed hospital was treating 34 coronavirus patients. By Monday, the number had grown to 44.

Its important that the numerous rural hospitals in the region have somewhere to send their patients, hospital representatives said.

We know what its like to be in a small hospital outside of this area and not have the resources, and its difficult to turn down a request for a transfer to a higher level of care, said Dr. Rohith Saravanan, Odessa Regional Medical Centers chief medical officer. There is really no option for that patient at that point theres no care they can provide that would give these patients a good fighting chance.

But even larger hospitals face severe staffing limitations. At ORMC, nurses in the intensive care unit are working with twice as many patients as they normally would. In remote West Texas, there is a severe shortage of nurses, respiratory therapists, and radiology and medical technicians, he said. So the hospital is turning to more expensive contract labor.

We have the bed capacity, we have [personal protective equipment]. ... The capacity is limited mostly by staffing, Saravanan said. There isnt any talent in the area that we can tap into.

Farther west, El Pasos University Medical Center is doing OK on capacity and ... able to handle all patients under a surge planning process that was set up early on, said Ryan Mielke, the hospitals director of public affairs.

Neighboring El Paso Childrens Hospital is prepared to offer up a number of its own units for adult COVID-19 patients if that becomes necessary, but we are not close to reaching that right now, said Audrey Garcia, director of marketing for El Paso Childrens.

You just gotta pray that it stays on that curve, Garcia said.

Health care workers urged Texans to wear masks, wash their hands frequently and avoid contact with others as much as possible to help prevent new coronavirus infections.

The community has an expectation of us as a hospital. The expectation is that well have beds to take care of them, staff to take care of them, medications, Saravanan said. They need to have an expectation of themselves to say, Were gonna do everything we can so we dont have to utilize those resources. The only way we can do that is by preventing the spread of this disease.

Disclosure: The Texas College of Emergency Physicians, the University of Texas System, the Texas Organization of Rural and Community Hospitals, and Parkland Health and Hospital System have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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