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Sunday wasthe fourthconsecutiveday on which the Florida Department of Health has counted more than 3,000 new cases of COVID-19, with 3,494 new cases announced.

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We'll update this story each day with the latest statistics about the coronavirus from the Florida Department of Health.

Sunday wasthe fourthconsecutiveday on which the Florida Department of Health has counted more than 3,000 new cases of COVID-19 in the state, with 3,494 new cases announced. The total number of cases counted in Florida is now 97,291

Saturday's new case count set the record for the most in a single day since the pandemic began, with 4,049 new cases announced.

Phase 1 reopening of the state began May 18, followed by more openings in Phase 2 which began June 5.

The number of reported deaths increased to 3,144,an increase of 40 since Friday.

The total number of people who have been hospitalized is 12,939,though the Department of Health notes that figure does not reflect the number of COVID-19 patients currently in hospitals.

Here's a breakdown of the latest numbers in Florida:

Read or Share this story: https://www.tcpalm.com/story/news/2020/06/21/florida-coronavirus-cases-deaths-hospitalizations/3232790001/

June 20, 2020, 4:02 p.m.

June 19, 2020, 7:31 p.m.

June 20, 2020, 6:41 p.m.

June 19, 2020, 1:49 p.m.

June 20, 2020, 1:14 p.m.

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June 19, 2020, 1:19 p.m.

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Coronavirus in Florida: What you need to know Sunday, June 21 - TCPalm

The state Department of Health Services onSunday reported 173more confirmed cases of COVID-19, the lowest in almost two weeks.

The percentage of positive tests dropped sharply from previous days, down to 2.3% the lowest point ever.

Four more people have died from the virus,significantly fewer than the number announced in any of the past few days 71 total deaths were reported between Wednesday andSaturday.

In all, 592 people have died from COVID-19 in Wisconsin as of Sunday, according to the DHS.

Live Updates: The latest on coronavirus in Wisconsin

Daily Digest: What you need to know about coronavirus in Wisconsin

Share Your Story: We want to talk to doctors, nurses and others affected by coronavirus

The new confirmed cases bring the statewide's total to 18,403cases.More than 250,103people have tested negative for the virus.

Overall testing numbers droppedslightly7,368 results were announced Sunday, after a week that saw well over 10,000 test results on some days.

While deaths and the percentage of positive tests dropped, the number of people hospitalized for the virus remains high: 414were hospitalized as of Sunday; 133 of those patients were in intensive care.

In addition, 211 hospital patients are awaiting coronavirus test results, according to theWisconsin Hospital Association.

While the Centers for Disease Control and Prevention's national hospitalization data tracking about 10% of the population has shown a downward trend in hospitalization rates,Wisconsin's rate has crept slightly upward this month.

The number of people hospitalized hovered in the mid-300s even dipping below 300 for much of May before jumping to 422 last Tuesday. The number hasnot fallen below 400 since.

The breakdown of confirmed cases from DHS by county is as follows:

The statetotals are frozen once each day and might not match up-to-date county figures.

More than 6.1million cases of the virus have been confirmed across the globe, according to the Johns Hopkins University globalcasedashboard.

Contact Benita Mathew at (920) 309-3428 or bmathew@gannett.com. Follow her on Twitter at @benita_mathew.

Read or Share this story: https://www.greenbaypressgazette.com/story/news/2020/05/31/coronavirus-wisconsin-more-than-170-new-cases-reported-statewide/5300330002/

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Just 2.3% of new coronavirus test results in Wisconsin were positive the lowest on record - Green Bay Press Gazette

A woman is tested for the coronavirus at Harlem's Abyssinian Baptist Church in New York City. Angela Weiss/AFP via Getty Images hide caption

A woman is tested for the coronavirus at Harlem's Abyssinian Baptist Church in New York City.

Earlier in this pandemic, the shortage of tests for the coronavirus was a major problem in fighting the spread of COVID-19. The shortage was such that many hospitals and clinics would test only someone who had traveled to a country with an outbreak, had a known exposure to a positive case or showed symptoms of the disease.

But access to tests has improved significantly, and in some places, people can now get tested without having to show any symptoms at all. So if you can get tested, should you?

The answer is a little complicated. One point to clarify: We're talking here about the diagnostic or PCR test, used to diagnose people who are currently sick with COVID-19. We're not talking about antibody or antigen tests, which are different.

The short answer to the question is: Sure, get tested if you want. But the tests are not perfect, and the result will tell you only so much.

Let's say you test positive. Your doctor will likely instruct you to self-isolate at home. Since you're not showing symptoms, it could mean that you happened to be tested at just the right time and are infected with the virus but are asymptomatic. You could also be presymptomatic and develop symptoms in the coming days. The CDC says that if you continue to have no symptoms, you can end self-isolation 10 days after your test.

A positive result could also mean you were sick weeks earlier, fully recovered and are not infectious. The PCR test has sometimes shown positive results weeks after someone recovers, says Dr. Abraar Karan, a physician at Harvard Medical School: "The test could be detecting RNA [of the virus] even in people who are recovered but that doesn't mean that they're infectious."

Now let's say you test negative. That news would probably come as a relief. Perhaps you're hoping a negative result would free you to do certain activities without fear say, return to work or visit an older family member you haven't seen in months.

But Dr. Emily Landon, a hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine, warns that a negative test shouldn't be seen as your ticket to stop being cautious.

"We don't know how good these tests are in individuals who don't have symptoms," she says. "We know they're pretty good at picking up COVID when it's present in people who have symptoms. But we have no idea what a negative test means in an individual that doesn't have symptoms."

"We are certain that there are people who test negative even though they are definitely contagious," she says. "A positive test can make us relatively certain that you are shedding COVID. But a negative test does not mean the opposite." It could be that you were tested too early in the disease process or that the swab didn't pick up your infection.

Landon says it takes at least three to five days after exposure to test positive. What's more, some people test positive, then negative, then positive again. Hospitals often test people with symptoms twice to try to be more certain about the finding.

The imperfections in test results have made it difficult to know how often health care workers need to be tested, she says, because a negative test doesn't mean you don't have the virus or "that you can just stop wearing your mask and not worry about it anymore."

In other words, she says, if you're getting tested to get peace of mind, a negative test shouldn't give you much peace of mind.

Nonetheless, Robert Hecht, a professor of clinical epidemiology at Yale University, offers "an encouraging thumbs-up" to anyone who decides to get tested for the virus just because.

"This idea that you should be both concerned about your own status and recognize that you can be infected without symptoms and that states should try to make more testing capacity available for people like that," he says. "I think those are all good things in general."

From a public health perspective, Landon says, there is some value in the odd asymptomatic person being tested and finding out whether they are indeed infected with the coronavirus. "It gives you a better idea of how many people are sick. It helps us to understand the test dynamics better. And anytime somebody is positive, you can remove them from the equation [of transmission]," she says, by taking precautions so they don't infect others.

But since the negative test doesn't tell you for sure that you don't have the virus, it's not a 100% guarantee that it's safe to visit your 80-year-old grandparent.

Excerpt from:

Coronavirus Testing: Should I Go For It Even If I Have No Symptoms? : Goats and Soda - NPR

Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

For the past several months, the news cycle has been dominated by little other than the ongoing coronavirus pandemic. Over the past week, obviously, other issues have come to the forefront.

But the novel coronavirus does not take a break for issues of social justice.

On Sunday, the Utah Department of Health reported 264 new positive cases of COVID-19 in the state the fourth consecutive day of more than 200 new cases, and the third-highest single-day total recorded in Utah since the pandemic began.

UDOH also reported one new death a male adult younger than 65 years old from Wasatch County. That now lifts Utahs death total from COVID-19 to 113.

The bulk of the new cases, as usual, came from Salt Lake County, with 124 of them coming from the states most populous area. However, Utah County also saw a sizable increase, with 59 new cases beyond the figures provided Saturday.

Worryingly, the Two-Week Cumulative Incidence Rate is now showing previously unseen hot spots in places from Logan to St. George. High rates (more than 100 cases per 100,000 people) have been established in Blanding, Logan, Monticello, north Orem, Payson, west Provo, San Juan County, St. George, Wasatch County and Washington City.

The Bear River area has shot up from 102 cases to 218 in seven days.

There has been a significant spike in new cases since May 16, when most of the state moved to the low-risk yellow category for COVID-19 restrictions, encouraging more people to leave their homes. That trend has escalated further still over the past week.

Indeed, with those four consecutive days now of 200-plus new cases, the seven-day average of new cases in the state is 200.71 the highest it has been since the pandemic began. By way of comparison, just a week ago, on May 24, the seven-day average was 164.86. And a week before that, on May 17, the average was 141.

In all, Utah has seen 1,405 new cases this past week; that compares with 1,154 last week, and 987 the week before. The weekly number of deaths decreased by one from 17 a week ago to 16 this week.

One potentially positive development is that hospitalizations in Utah have not seen an increase corresponding with the new-case totals. As of Sunday, it was reported that there 98 positive COVID-19 cases currently hospitalized. On May 24, there were 95 hospitalizations; on May 17, there were 98.

Nationwide, the figures are staggering, but perhaps also promising.

Maryland Gov. Larry Hogan tweeted, Marylands #COVID19 positivity rate has dropped to 10.9%, down 54.49% from its peak on April 17. Our states current total COVID-19 hospitalizations one of the states key recovery metrics have dropped to 1,183, their lowest level since April 15.

Fifty days ago, on April 12th, we lost 800 people from COVID. Yesterday, we lost 56. Sixty days ago, we had 3,400 people come into our hospitals. Yesterday, we had 191, Cuomo said. The number of lives lost is down to 56, which is in this absurd reality we live in actually very, very good news. This reduction in the number of deaths is tremendous progress. Weve gone through hell and back, and were on the other side.

Of course, given all the mass demonstrations that have erupted across the country over the past week in response to the death of George Floyd at the hands of a Minneapolis police officer, The Associated Press wrote that health experts fear that silent carriers of the virus could unwittingly infect others at protests where people are packed cheek to jowl, many without masks, many chanting, singing or shouting. The virus is dispersed by microscopic droplets in the air when people cough, sneeze, sing or talk.

Whether theyre fired up or not, that doesnt prevent them from getting the virus," Bradley Pollock, chairman of the Department of Public Health Sciences at the University of California, Davis, told the AP about protesters.

By comparison, whites account for 78% of Utahs population, but just 37.2% of its COVID-19 cases as of Sunday.

And, finally, UDOH reported that the total number of Utahns tested is 213,914 meaning there is a 4.6% rate of positives. It also noted 6,137 of our cases are considered recovered. " A case with a diagnosis date of more than three weeks ago, who has not died, is considered recovered.

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Utah is averaging more than 200 new coronavirus cases a day over the past week as hot spots flare up from Logan to St. George - Salt Lake Tribune

Illustration by Joo Fazenda

There, yet again, were the flames. Before the furious conflagrations erupted in Minneapolis, the final weeks of May had already seemed like the answer to a grim math problem: What is the product of a crisis multiplied by a crisis? The official mortality count of the COVID-19 outbreak in the United States swept toward a hundred thousand, while the economic toll had left forty million people out of work. It was difficult to countenance how so much misery could come about so quickly. But on Memorial Day we became video witnesses to the horrific death of George Floyd, at the hands of the Minneapolis Police Department. By Friday, the looted shops, the charred buildings and cars, the smoldering Third Precinctthese were evidence of what the world looks like when a crisis is cubed.

These seemingly disparate American trials are not unrelated; theyre bound by their predictability and by the ways in which the Trump Administration has exacerbated them since they began. In March, the President claimed that nobody knew there would be a pandemic or epidemic of this proportion, and he has echoed that sentiment throughout the course of the emergency. But virtually everyone paying attention to public health saw something like the novel coronavirus coming. In less than two decades, we have seen epidemics of the SARS, MERS, Ebola, and H1N1 viruses. The Obama Administration created a National Security Council Directorate to mitigate the impact of such events; the Trump Administration largely disbanded it.

On Friday, Trump tweeted that the protesters in Minneapolis were thugsa term with deep-rooted racist connotationsand later noted that the military was present in the city. When the looting starts, he warned, the shooting starts. This situation, too, is part of a long-building problem whose warning signs have gone unheeded by the current Administration. Progressives have widely criticized the 1994 Crime Bill, which was spearheaded by Joe Biden, but an element of that legislation has been underappreciated. The 1992 Los Angeles riots broke out after the acquittal of four police officers who had violently assaulted Rodney King (an incident that was also captured on video). As has often been the case with riots, the chaotic fury in Los Angeles was not simply a response to one incident but an accretion of anger at innumerable issues with a police department which had gone unaddressed for years. The Crime Bill authorized the civil-rights division of the Department of Justice to intervene in the instance of chronically troubled departments, by negotiating consent decrees that laid out specific reforms to be followed, and provided for monitors to oversee their implementation. Like the precursors to the coronavirus, Los Angelesand later Ferguson and Baltimorewas an indicator of how such problems could play out without intervention. But, in this area as well, the Trump Administration has functioned like a building contractor who cant recognize a load-bearing wall.

In July, 2017, in an address to law-enforcement officers in Suffolk County, New York, Trump told them to use more force when taking suspects into custody. Like when you guys put somebody in the car and youre protecting the head, he said. You can take the hand away, O.K.? The following May, Attorney General Jeff Sessions, in a speech to the National Association of Police Organizations, said that the Justice Department will not malign entire police departments. We will not try to micromanage their daily work. That November, as one of his last acts on the job, Sessions issued a memorandum that severely curtailed the civil-rights divisions ability to pursue decrees with police departments. This meant that, in communities plagued with bad policing, resentments could accrue unchecked by any higher authority until they reached their detonation points. Those detonations tend to resemble the streets of Minneapolis this week.

On Thursday, in a press conference that was short on developments or new information, Erica MacDonald, the U.S. Attorney for the District of Minnesota, said, To be clear, President Trump as well as Attorney General William Barr are directly and actively monitoring the investigation in this case. But what, precisely, does that mean? Barr presides over a civil-rights division that has been stripped of its chief mechanism for creating compliance among police officers. In the past five years, the Twin Cities area has seen three other controversial police shootings: of Jamar Clark, in 2015; of Philando Castile, in 2016; and of Justine Damond, in 2017. Each of these fatal incidents featured a victim of a different racial background from the officers involved, and each was highlighted as an example of police misconduct. Like the COVID cases that emerged in Seattle at the beginning of the year, Minneapolis is a study in the importance of foresight and planning, and an example of what happens when neither of those things occurs.

The President posted his the shooting starts tweet early on Friday morning, just hours before Officer Derek Chauvin, who had knelt on George Floyds neck for eight minutes, was taken into custody and charged with third-degree murder and second-degree manslaughter. Twitter, in an unprecedented move, labelled Trumps tweet a violation of company policy against glorifying violence. A Presidential threat to have the United States military shoot civilians is the opposite of leadership, the antithesis of wisdoma comment as ill-advised and as detrimental to the public well-being as recommending injecting disinfectant or self-prescribing hydroxychloroquine.

Our problems generally do not stem from treacherous unknowns; theyre the result of a failure to make good use of what is known already. In July, 1967, after a brutal police raid at an after-hours bar in Detroit, that city exploded in retaliatory violence. A month later, Martin Luther King, Jr., gave a speech to the American Psychological Association, in which he described riots as durable social phenomena that arise in conjunction with discernible conditionsacts of lawlessness that mirror the excesses of those charged with upholding the law. Leaders cannot predict the future, but they can be cognizant of the immediate past, and the possible dangers it suggests. They cannot be clairvoyant. They need only be intelligent.

Excerpt from:

Minneapolis, the Coronavirus, and Trumps Failure to See a Crisis Coming - The New Yorker

A medical professional administers a coronavirus test at a drive-thru testing site run by George Washington University Hospital, on May 26, 2020 in Washington, D.C. Drew Angerer/Getty Images hide caption

A medical professional administers a coronavirus test at a drive-thru testing site run by George Washington University Hospital, on May 26, 2020 in Washington, D.C.

In April, New Orleans health officials realized their drive-through testing strategy for the coronavirus wasn't working. The reason? Census tract data revealed hot spots for the virus were located in predominantly low-income African-American neighborhoods where many residents lacked cars.

In response, officials have changed their strategy, sending mobile testing vans to some of those areas, says Thomas LaVeist, dean of Tulane University's School of Public Health and Tropical Medicine and co-chair of Louisiana's COVID-19 Health Equity Task Force.

"Data is the only way that we can see the virus," LaVeist says. "We only have indicators. We can't actually look at a person and tell who's been infected. So what we have is data right now."

Until a few weeks ago, racial data for COVID-19 was sparse. It's still incomplete, but now 48 states plus Washington D.C., report at least some data; in total, race or ethnicity is known for around half of all cases and 90% of deaths. And though gaps remain, the pattern is clear: Communities of color are being hit disproportionately hard by COVID-19.

Public health experts say focusing on these disparities is crucial for helping communities respond to the virus effectively so everyone is safer.

"I think it's incumbent on all of us to realize that the health of all of us depends on the health of each of us," says Dr. Alicia Fernandez, a professor of medicine at the University of California San Francisco, whose research focuses on health care disparities.

NPR analyzed COVID-19 demographic data collected by the COVID Racial Tracker, a joint project of the Antiracist Research & Policy Center and the COVID Tracking Project. This analysis compares each racial or ethnic group's share of infections or deaths where race and ethnicity is known with their share of population. Here's what it shows:

Major holes in the data remain: 48% of cases and 9% of deaths still have no race tied to them. And that can hamper response to the crisis across the U.S., now and in the future, says Dr. Utibe Essien, a health equity researcher at the University of Pittsburgh who has studied COVID-19 racial and ethnic disparities.

"If we don't know who is sick, we're not going to know in six months, 12 months, 18, however long it takes, who should be getting the vaccination. We're not going to know where we should be directing our personal protective equipment to make sure that health care workers are protected," he says.

A heavy toll of African-American deaths

NPR's analysis finds that in 32 states plus Washington D.C., blacks are dying at rates higher than their proportion of the population. In 21 states, it's substantially higher, more than 50% above what would be expected. For example, in Wisconsin, at least 141 African Americans have died, representing 27% of all deaths in a state where just 6% of the state's population is black.

"I've been at health equity research for a couple of decades now. Those of us in the field, sadly, expected this," says Dr. Marcella Nunez-Smith, director of the Equity Research and Innovation Center at Yale School of Medicine.

"We know that these racial ethnic disparities in COVID-19 are the result of pre-pandemic realities. It's a legacy of structural discrimination that has limited access to health and wealth for people of color," she says.

African-Americans have higher rates of underlying conditions, including diabetes, heart disease, and lung disease, that are linked to more severe cases of COVID-19, Nunez-Smith notes. They also often have less access to quality health care, and are disproportionately represented in essential frontline jobs that can't be done from home, increasing their exposure to the virus.

Data from a recently published paper in the Annals of Epidemiology reinforces the finding that African-Americans are harder hit in this pandemic. The study from researchers at amfAR, the Foundation for AIDS Research, looks at county-level health outcomes, comparing counties with disproportionately black populations to all other counties.

Their analysis shows that while disproportionately black counties account for only 30% of the U.S. population, they were the location of 56% of COVID-19 deaths. And even disproportionately black counties with above-average wealth and health care coverage bore an unequal share of deaths.

"There's a structural issue that's taking place here, it's not a genetic issue for all non-white individuals in the U.S.," says Greg Millett, director of public policy at amfAR and lead researcher on the paper.

Hispanics bear a disproportionate share of infections

Latinos and Hispanics test positive for the coronavirus at rates higher than would be expected for their share of the population in all but one of the 44 jurisdictions that report Hispanic ethnicity data (42 states plus Washington D.C.). The rates are two times higher in 30 states, and over four times higher in eight states. For example, in Virginia more than 12,000 cases 49% of all cases with known ethnicity come from the Hispanic and Latino community, which makes up only 10% of the population.

Fernandez has seen these disparities first-hand as an internist at Zuckerberg San Francisco General Hospital. While Latinos made up about 35% of patients there before the pandemic, she says they now make up over 80% of COVID-19 cases at the hospital.

"In the early stages, when we were noticing increased Latino hospitalization at our own hospital and we felt that no one was paying attention and that people were just happy that San Francisco was crushing the curve, it felt horrendous," she says. "It felt as if people were dismissing those lives. ... It took people longer to realize what was going on."

People get free COVID-19 tests without needing to show ID, doctor's note or symptoms at a drive-through and walk up Coronavirus testing center located in Arlington, Va., on May 26th. Olivier Douliery/AFP via Getty Images hide caption

People get free COVID-19 tests without needing to show ID, doctor's note or symptoms at a drive-through and walk up Coronavirus testing center located in Arlington, Va., on May 26th.

Like African-Americans, Latinos are over-represented in essential jobs that increase their exposure to the virus, says Fernandez. Regardless of their occupation, high rates of poverty and low wages mean that many Latinos feel compelled to leave home to seek work. Dense, multi-generational housing conditions make it easier for the virus to spread, she says.

The disproportionate share of deaths isn't as stark for Latinos as it is for African-Americans. Fernandez says that's likely because the U.S. Latino population overall is younger nearly three-quarters are millennials or younger, according to data from the Pew Research Center. But in California, "when you look at it by age groups, [older] Latinos are just as likely to die as African-Americans," she says.

Other racial groups

While data for smaller minority populations is harder to come by, where it exists, it also shows glaring disparities. In New Mexico, Native American communities have accounted for 60% of cases but only 9% of the population. Similarly, in Arizona, at least 136 Native American have died from COVID-19, a striking 21% of deaths in a state where just 4% of the population are Native American.

In several states Asian Americans have seen a disproportionate share of cases. In South Dakota, for example, they account for only 2% of the population but 12% of cases. But beyond these places, data can be spotty. In Iowa, Maine, Michigan, Oklahoma and Wisconsin, Asian Americans and Hawaiian and Pacific Islanders are counted together, making comparison to census data difficult.

Fernandez points out that if COVID-19 demographic reporting included language, public health officials might see differences among different Asian groups, such as Vietnamese or Filipino Americans. "That's what's going to allow public health officials to really target different communities," she says. "We need that kind of information."

Understanding the unknowns

Months into the pandemic, painting a national picture of how minorities are being affected remains a fraught proposition, because in many states, large gaps remain in the data.

For instance, in New York state until recently the epicenter of the the U.S outbreak race and ethnicity data are available for deaths but not for cases. In Texas, which has a large minority population and a sizable outbreak, less than 25% of cases and deaths have race or ethnicity data associated with them.

There are also still concerns about how some states are collecting data, says Christopher Petrella, director of engagement for the Antiracist Research and Policy Center at American University. For example, he says West Virginia which claims to have race data for 100% of positive cases and 82% of deaths only reports three categories: white, black and "other."

Also, some states appear to be listing Hispanics under the white category, says Samantha Artiga, director of the Disparities Policy Project at Kaiser Family Foundation.

"There's a lot of variation across states in terms of how they report the data that makes comparing the data across states hard, as well as getting a full national picture," Artiga says.

But experts fear that the available data actually undercounts the disparity observed in communities of color.

"I think we have the undercount anyway, because we know that minority communities are less likely to be tested for COVID-19," says Millett. NPR's own analysis found that in four out of six cities in Texas, testing sites were disproportionately located in whiter communities. Millet points to a recent study, released pre-peer review, that found that when testing levels went up in disadvantaged neighborhoods in Philadelphia, Chicago and New York City, so too did the evidence of the disproportionate impact of COVID-19 on these communities.

A registered nurse draws blood to test for COVID-19 antibodies at Abyssinian Baptist Church in the Harlem neighborhood of New York City on May 14. Churches in low income communities across New York are offering COVID-19 testing to residents. Angela Weiss/AFP via Getty Images hide caption

A registered nurse draws blood to test for COVID-19 antibodies at Abyssinian Baptist Church in the Harlem neighborhood of New York City on May 14. Churches in low income communities across New York are offering COVID-19 testing to residents.

Lawmakers have raised concern about the way the Centers for Disease Control and Prevention reports racial and ethnic data; the agency didn't report on demographics early on in the crisis, and even now it updates it weekly but with a one- to two-week lag. Democratic senators Patty Murray of Washington and Democratic Rep. Frank Pallone, Jr., of New Jersey called a recent report on demographics the CDC submitted to Congress "woefully inadequate."

"The U.S. response to COVID-19 has been plagued by insufficient data on the impact of the virus, as well as the federal government's response to it," Murray and Pallone wrote in a letter sent May 22 to Health and Human Services Secretary Alex Azar. They called on the Trump administration to provide more comprehensive demographic data.

A tailored public health response

Essien says he's heard concerns from colleagues that by focusing on race and ethnicity in the disease, "some of the empathy for managing and treating is going to go away."

"If people feel like, 'Well, this is a them problem and not a me problem ... then that may potentially affect the way that people think about the opening up of the country," he says.

But unless testing and other resources are directed now to communities that need them most, the pandemic will go on for everyone, says Nunez-Smith.

"This is important for everyone's health and safety," she says.

Nunez-Smith says race and ethnicity data is necessary for officials to craft tailored public health responses.

"For many people, physical distancing is a privilege," she says. "If you live in a crowded neighborhood or you share a household with many other people, we need to give messaging specific to those conditions. If you need to leave home for work every day, if you need to take public transportation to get to an essential frontline job, how can you keep safe?"

A tailored public health response is already happening in Louisiana, where LaVeist says his task force has recently recruited celebrities like Big Freedia, a pioneer of the New Orleans hip-hop subgenre called bounce, to counter misinformation and spread public health messages about COVID-19 to the African-American community.

Given the pandemic's disparate toll on communities of color, in particular low-income ones, Fernandez and Nunez-Smith say the public health response should include helping to meet basic needs like providing food, wage supports and even temporary housing for people who get sick or exposed to the virus.

"We have to guarantee that if we recommend to someone that they should be in quarantine or they should be in isolation, that they can do so safely and effectively," Nunez-Smith says.

Nunez-Smith says if you don't direct resources now to minority communities that need them most, there's a danger they might be less likely to trust and buy into public health messaging needed to stem the pandemic. Already, polls show widespread distrust of President Trump among African-Americans, and that a majority of them believe the Trump administration's push to reopen states came only after it became clear that people of color were bearing the brunt of the pandemic.

Fernandez notes that among Latinos, distrust could also hamper efforts to conduct effective contact tracing, because people who are undocumented or in mixed-status families may be reluctant to disclose who they've been in contact with.

"This is a terrible time for all of us who do health equity work," says Fernandez, "partly because this is so predictable and partly because we're standing here waving our arms saying, 'Wait, wait. We need help.' "

Connie Hanzhang Jin, Alice Goldfarb and Selena Simmons-Duffin contributed to this report.

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Growing Data Show Blacks And Latinos Bear The Brunt Of COVID-19 : Shots - Health News - NPR

Experts warn that coronavirus infections could begin to increase as businesses begin to reopen and stay-at-home orders slowly lift.

Experts are bracing for a second wave of the coronavirusExactly when it will happen, how it will happen and if we're already starting to see the effects are still unknown. But scientists, health officials and government leaders around the world have warned that new COVID1-19 cases could surge aslockdown restrictions liftand people come into closer contact with one another than they have in weeks. Because the coronavirus is a highly contagious pathogen that spreads through breath and saliva, experts are urging lawmakers to be on the lookout for a second "peak,"a sharp increase in cases that falls short of a full-blown second "wave."

There's still much that doctors and scientists don't know about the coronavirus that'sinfected nearly 6 million peopleand taken almost 400,000 lives, but most experts agree that until we have an effective coronavirus vaccine, the only way to slow the spread of the virus is by taking precautions likesocial distancing,wearing face masksin public and washing hands correctly and frequently.

Even so, some public health experts sayit's too soon to reopen businesses and resume social activities, such as going to the lake or beachand visiting amusement parks, even with limited capacity. Others argue that cities must reopen to keep the economy afloat, and that protective health measures will curb coronavirus transmissionin restaurants, schools, malls and on planes. The Centers for Disease Control and Prevention have also released guidelines to help local governments identify phases for reopening, and interim suggestions for restaurants, schools and industry.

Keep track of the coronavirus pandemic.

The full extent of short- and long-term effects of the coronavirus and the COVID-19 disease it causes are still unknown, including how long you may be immune after you recover and if it's possible to become reinfected. It also isn't clear how governments would respond to a surge in coronavirus infections, though some countries, such asLebanon and South Korea, have already reinstated lockdown orders in areas where the virus seems to be reemerging.

This story provides an overview to help keep you informed of the current discussion. It will update frequently in light of new and changing information provided by health officials, global leaders and the scientific community, and is not intended as a medical reference.

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As countries and states begin to ease lockdown restrictions, health officials around the globe are already on the lookout forrising infection ratesthat could signal a second wave of coronavirus-related illness. Most public health experts -- including the Director of the CDC,Dr. Robert Redfield, andDr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Disease --anticipate the next big uptickto happenthis fall or winter.

Why then? Flu casestend to drop off during the summer, which has led some health experts tohope COVID-19 cases go downwhen the weather gets warmer as well.Dr. Amesh Adalja, a pandemic preparedness expert at Johns Hopkins University,told the Los Angeles Timesthat other coronaviruses don't fare well during summer months because, once outside the body, both the hotter temperatures dry them out and the ultraviolet light from sunnier weather affects them.

Astudy published in the Canadian Medical Association Journal, however, offers data to suggest that this particular coronavirus,SARS-CoV-2, seems impervious to temperature differences and only slightly affected by humidity. Anoutbreak in MumbaiandIndonesia's ongoing struggleto contain the virus highlight how the pandemic isaffecting countries across climate zones, including many regions at or near the equator.

It may be that fall and winter upswings could occur as a result of economies reopening and people coming into closer contact, transmitting the infection anew, but that reasoning is pure speculation and not the result of scientific study. We'll need to wait to see what actually transpires.

Different parts of the country are lifting lockdown orders at their own pace, including deciding when to open nonessential businesses.

Generally speaking, a "wave" in a pandemic is a period of increasing disease transmission following an overall decline. Currently, although cases of the coronavirus continue to increase in some parts of the US, rates of new infections appear to be decliningin the country overall. That same mix of upward and downward trends can be seen globally, prompting executive director of the World Health Organization Mike Ryan to estimate that we are "right in the middle of the first wave." If and when infection rates have declined across the board, then begin to climb again, that will indicate the next or "second wave." The longer the pandemic goes on, the more waves are likely to occur.

Read more: 7 things to not do when coronavirus lockdown and quarantine end

The coronavirus pandemichasn't affected all parts of the country in the same way or at the same time. Cities and states went into lockdown and quarantine at different times, and that's also how the country is starting to get out of it, with different areaseasing restrictions in phases and at their own pace.

Some health experts have warned the lack of a unified reopening planmight help spread the coronavirus andcould actually fuel a second wave as people travel from the hardest hit areas to places with far fewer infections. Ali Khan, a former CDC official, said a second wave might comprisemany simultaneous, smaller outbreaks that, taken together, seem more like a singular wave.

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Spikes in new coronavirus cases have already been documented in areas emerging from lockdown. Wisconsin, for example, experienced its biggest single-day increase in new infections and deaths exactly two weeks after the state Supreme Court overturned the governor's stay-at-home order. Georgia, which was one of the first states to start lifting lockdown orders, is beginning to see an uptick in new cases after several weeks of plateau.

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Although some experts hope the coronavirus, like many other viruses, dissipates during hotter, sunnier weather, new research suggests temperature does not affect the virus.

If there is a second coronavirus wave, the severity of the outbreak would depend on multiple factors, like how well people maintain social distancing and howmany people wear face masks. The widespread availability of tests might also play a role, in addition to contract tracing for anyone who tests positive.

For example, a recent study and computer model developed under De Kai, a computer scientist with appointments at both the University of California at Berkeley and Hong Kong University, proposes that if 80% of the population wore face masks in public,coronavirus transmission rates would plummet(PDF) to about 8% compared to wearing no masks.

Basically, the more measures there are in place to help reduce disease transmission -- and the more effectively those measures are followed -- the lower the infection rate may be the second time around, according to the computer model.

Other factors that could come into play are any potentialgenetic mutations in the coronavirus that could make it more or less transmissible, thedevelopment of an effective vaccine, the development ofsafe, effective treatments for the COVID-19 disease and the ability to test a large number of the population, even people who don't appear to be sick.

Most experts agree that widespread testing will be necessary to help curb outbreaks while we wait for a coronavirus vaccine.

It's possible. Decisions about future quarantines are up to government leaders working with health officials, but there is an indication that the need could occur.

In some parts of the world that have experienced a second wave of coronavirus infections after lifting lockdown restrictions, such measures have been reinstated. About a month ago,Singapore, Hong Kong, theJapanese island of Hokkaido andsome areas of Chinaall brought back lockdown measures to combat a second instance of rising infection rates. More recently, Lebanon and South Korea have brought back such orders as well.

Until there's aneffective vaccine, it's possible that different parts of the world will see fluctuating degrees of lockdown as governments adjust their response in the ongoing battle against the coronavirus.

Perhaps the most pressing questions of all are what a second wave of coronavirus might mean for you. Here's how we think life will look after quarantine ends as the public braces for a second wave. If you do have to leave the house, here are some practical ways to stay safe when you go out. Finally, don't unlearn all the good habits you've developed during the pandemic -- like frequently washing your hands.

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A second wave of coronavirus: When it could come, how long it could last and more - CNET

When experts recommend wearing masks, staying at least six feet away from others, washing your hands frequently and avoiding crowded spaces, what theyre really saying is: Try to minimize the amount of virus you encounter.

A few viral particles cannot make you sick the immune system would vanquish the intruders before they could. But how much virus is needed for an infection to take root? What is the minimum effective dose?

A precise answer is impossible, because its difficult to capture the moment of infection. Scientists are studying ferrets, hamsters and mice for clues but, of course, it wouldnt be ethical for scientists to expose people to different doses of the coronavirus, as they do with milder cold viruses.

The truth is, we really just dont know, said Angela Rasmussen, a virologist at Columbia University in New York. I dont think we can make anything better than an educated guess.

Common respiratory viruses, like influenza and other coronaviruses, should offer some insight. But researchers have found little consistency.

For SARS, also a coronavirus, the estimated infective dose is just a few hundred particles. For MERS, the infective dose is much higher, on the order of thousands of particles.

The new coronavirus, SARS-CoV-2, is more similar to the SARS virus and, therefore, the infectious dose may be hundreds of particles, Dr. Rasmussen said.

But the virus has a habit of defying predictions.

Generally, people who harbor high levels of pathogens whether from influenza, H.I.V. or SARS tend to have more severe symptoms and are more likely to pass on the pathogens to others.

But in the case of the new coronavirus, people who have no symptoms seem to have viral loads that is, the amount of virus in their bodies just as high as those who are seriously ill, according to some studies.

And coronavirus patients are most infectious two to three days before symptoms begin, less so after the illness really hits.

Some people are generous transmitters of the coronavirus; others are stingy. So-called super-spreaders seem to be particularly gifted in transmitting it, although its unclear whether thats because of their biology or their behavior.

On the receiving end, the shape of a persons nostrils and the amount of nose hair and mucus present as well as the distribution of certain cellular receptors in the airway that the virus needs to latch on to can all influence how much virus it takes to become infected.

A higher dose is clearly worse, though, and that may explain why some young health care workers have fallen victim even though the virus usually targets older people.

The crucial dose may also vary depending on whether its ingested or inhaled.

People may take in virus by touching a contaminated surface and then putting their hands on their nose or mouth. But this isnt thought to be the main way the virus spreads, according to the Centers for Disease Control and Prevention.

That form of transmission may require millions more copies of the virus to cause an infection, compared to inhalation.

Coughing, sneezing, singing, talking and even heavy breathing can result in the expulsion of thousands of large and small respiratory droplets carrying the virus.

Its clear that one doesnt have to be sick and coughing and sneezing for transmission to occur, said Dr. Dan Barouch, a viral immunologist at Beth Israel Deaconess Medical Center in Boston.

Larger droplets are heavy and float down quickly unless theres a breeze or an air-conditioning blast and cant penetrate surgical masks. But droplets less than 5 microns in diameter, called aerosols, can linger in the air for hours.

They travel further, last longer and have the potential of more spread than the large droplets, Dr. Barouch said.

Updated May 28, 2020

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you arent being told to stay at home, its still a good idea to limit trips outside and your interaction with other people.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

More than 40 million people the equivalent of 1 in 4 U.S. workers have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.

There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.

The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people dont need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks dont replace hand washing and social distancing.

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.

Three factors seem to be particularly important for aerosol transmission: proximity to the infected person, air flow and timing.

A windowless public bathroom with high foot traffic is riskier than a bathroom with a window, or a bathroom thats rarely used. A short outdoor conversation with a masked neighbor is much safer than either of those scenarios.

Recently, Dutch researchers used a special spray nozzle to simulate the expulsion of saliva droplets and then tracked their movement. The scientists found that just cracking open a door or a window can banish aerosols.

Even the smallest breeze will do something, said Daniel Bonn, a physicist at the University of Amsterdam who led the study.

Observations from two hospitals in Wuhan, China, published in April in the journal Nature, determined much the same thing: more aerosolized particles were found in unventilated toilet areas than in airier patient rooms or crowded public areas.

This makes intuitive sense, experts said. But they noted that aerosols, because they are smaller than 5 microns, would also contain much less, perhaps millions-fold less, virus than droplets of 500 microns.

It really takes a lot of these single-digit size droplets to change the risk for you, said Dr. Joshua Rabinowitz, a quantitative biologist at Princeton University.

Apart from avoiding crowded indoor spaces, the most effective thing people can do is wear masks, all of the experts said. Even if masks dont fully shield you from droplets loaded with virus, they can cut down the amount you receive, and perhaps bring it below the infectious dose.

This is not a virus for which hand washing seems like it will be enough, Dr. Rabinowitz said. We have to limit crowds, we have to wear masks.

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Its Not Whether You Were Exposed to the Coronavirus. Its How Much. - The New York Times

Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.

For the third consecutive day, Utah recorded more than 200 new COVID-19 cases. Saturdays total of 269 is the second highest reported since the pandemic began and came after the state reported 343, the highest, on Friday.

In comparison, on Wednesday, shortly after the Memorial Day holiday, the number of new cases had been only 86.

The Utah Department of Health also reported four more deaths Saturday, bringing the states total to 112.

The big spikes in new cases come two weeks after most of the state moved on May 16 to the low-risk yellow category for COVID-19 restrictions, encouraging more people to leave their homes. But officials have cautioned against jumping to conclusions about blaming that for the spike.

Dr. Angela Dunn, the states epidemiologist, said Friday that it could be explained by catching up after a lull in testing attributed to the Memorial Day weekend and said the number of new cases this week is only a slight increase over the previous week.

Or, she said, there could be an actual uptick in cases, including outbreaks like the one happening at the Salt Lake Veterans Home. She has said the state was anticipating a rise in cases as restrictions loosened.

Jenny Johnson, spokeswoman for the state health department, said Saturday, What were seeing in our numbers is usually a lag from when an infection actually occurred . It could take up to 14 days for you to show symptoms of COVID-19 after youre infected.

With that, she said it is possible that moving to yellow status could be part of the reason for the jump in new cases. But she said a temporary drop in testing over the holiday weekend followed by an increase may be part of the reason, too. Were not totally sure.

New data also show that the Bear River Health Department which includes Box Elder, Cache and Rich counties saw a big increase cases in the past two days, from 117 on Thursday to 190 on Saturday.

As Dr. Dunn said yesterday, we expect as the economy opens to have potential localized outbreaks, which is what we might be seeing up in the Bear River area, Johnson said.

She said that underscores the need for residents to continue caution as the economy opens more.

We really need people to still be vigilant about good hand hygiene, social distancing, wearing a mask when you can't social distance appropriately when you're out in public. Those things are all really important, Johnson said.

If you have even mild symptoms of COVID-19 get tested so that we can identify cases quickly and help people understand how important it is to isolate or quarantine as appropriate.

The total number of confirmed cases in Utah since the pandemic began is now 9,533.

The four deaths reported Saturday include three Salt Lake County residents and one from Weber County all with underlying health conditions, and two were residents of long-term care facilities. Two were men and two were women. Two were older than 85, one was between ages 60-84, and one was younger than age 60.

Also added back into the state totals was a death that was earlier reported, but had been removed temporarily from totals for more investigation to ensure it had been caused by COVID-19.

The health department also reported on Saturday 10 more hospitalizations, for a total of 763 since the pandemic began. And 99 people are currently in hospital.

The state reported 4.250 more people received tests for COVID-19. That brings the total to 210,105, with a positive rate of 4.5%.

The state considers 5,995 cases recovered which is defined as still being alive three weeks since being diagnosed.

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Utah sees another spike in coronavirus cases, third big day in a row - Salt Lake Tribune

As the crisis has unfolded, scientists have discovered more evidence about a strange and worrying feature of the coronavirus. While many people who become infected develop a cough, fever and loss of taste and smell, others have no symptoms at all and never realise they're carrying Covid-19.

Researchers say it's vital to understand how many are affected this way and whether "silent spreaders" are fuelling the pandemic.

When people gathered at a church in Singapore on 19 January, no-one could have realised that the event would have global implications for the spread of coronavirus. It was a Sunday and, as usual, one of the services was being conducted in Mandarin. Among the congregation at The Life Church and Missions, on the ground floor of an office building, was a couple, both aged 56, who'd arrived that morning from China.

As they took their seats, they seemed perfectly healthy so there was no reason to think they might be carrying the virus. At that time, a persistent cough was understood to be the most distinctive feature of Covid-19 and it was seen as the most likely way to transmit it. Having no symptoms of the disease should have meant having no chance of spreading it.

The couple left as soon as the service was over. But shortly afterwards, things took a turn for the worse, and in a wholly confusing way. The wife started to become ill on January 22, followed by her husband two days later. Because they had flown in from Wuhan, the epicentre of the outbreak, that was no big surprise.

But over the following week, three local people also came down with the disease for no obvious reason, leading to one of Singapore's first and most baffling coronavirus cases. Working out what had happened would lead to a new and disturbing insight into how the virus was so successfully finding new victims.

"We were extremely perplexed," says Dr Vernon Lee, head of communicable diseases at Singapore's Ministry of Health. "People who didn't know one another somehow infected each other," while showing no sign of illness. This new batch of cases simply did not make sense, according to what was known about Covid-19 back then.

So Dr Lee and his fellow scientists, along with police officers and specialist disease trackers, launched an investigation, generating detailed maps showing who was where and when. This involved the very best of the process known as contact tracing - a version of which is getting under way now in the UK. It's seen as a vital system for tracking down everyone involved in an outbreak and helping to stamp it out, and Singapore is renowned for the skill and speed with which this is carried out.

Amazingly, within a few days, investigators had spoken to no fewer than 191 members of the church and had found out that 142 of them had been there that Sunday. They quickly established that two of the Singaporeans who became infected had been at the same service as the Chinese couple.

"They could have spoken to each other, greeted each other, during the usual activities of a church service," says Dr Lee.

That was a useful start and would explain in theory how the infection could have been passed on, apart from one key factor. It did not answer the crucial question of how the virus could have been transmitted by the two Chinese people when at that stage they had shown no indication of having the disease.

And on top of that was an even greater puzzle. It was confirmed that the third Singaporean to become infected, a 52-year-old woman, had not been at the same service as the others. Instead she had attended another event in the same church later that day, so how could she have picked up the virus?

Investigators resorted to going through the CCTV recordings made at the church that Sunday to search for clues. And they stumbled across something completely unexpected - the woman who'd attended the later service, after the Chinese couple had left, had sat in the seats they had used several hours earlier.

Somehow, despite having no symptoms and not feeling ill, the Chinese husband and wife had managed to spread the virus. Maybe they'd had it on their hands and touched the seats, maybe their breath carried the infection and it landed on a surface, it's not clear, but the implications were huge.

For Dr Lee, piecing everything together, there was only one possible explanation - that the virus was being passed by people who had it without even realising. This was a revelation that would be relevant the world over because the central message of all public health advice on coronavirus has always been to look out for symptoms in yourself and others.

But if the virus was also being spread by people without symptoms, silently and invisibly, how could the disease be stopped? He remembers the moment, while working in his office, when the reality dawned on him. "Every time you make a scientific discovery, it is like a 'eureka' moment when you realise that this is something important that you've uncovered, through the hard work of many individuals and teams."

What was revealed was what's known as "pre-symptomatic transmission" where someone is unaware of being infected because the cough, fever and other classic symptoms have yet to begin.

Along with many others, this study highlighted a critical period of 24-to-48 hours before the visible onset of the disease in which people can be highly infectious, perhaps even their most infectious.

Being aware of that is potentially invaluable, because as soon as you realise you're ill then everyone you've been in close contact with can be warned to stay at home.

That would mean that they would be isolating during the key phase of infection before their own symptoms start. But exactly how the disease can be transmitted without a cough to project droplets containing the virus is still open to debate.

One option is that simply breathing or talking to someone can do the job. If the virus is reproducing in the upper respiratory tract at that time then it's possible that some of it will emerge with each exhalation. Anyone close enough, especially indoors, could easily pick it up.

And another potential form of transmission is by touch - the virus gets onto someone's hands and they touch another person or a door handle - or a seat in a church. Whatever the route, the virus is clearly exploiting the fact that people are bound to be less vigilant if they're not aware that they might be infected.

This is an even more mysterious scenario, and one that scientists simply have no definitive answer to. It's one thing to know that people can be infectious before their symptoms show, quite another when they become infected but never have any sign of it.

This is what's known as being "asymptomatic" because you are a carrier of the disease but do not suffer in any way yourself. The most famous case is that of an Irish woman who was working as a cook in New York at the beginning of the last century.

Wherever Mary Mallon was employed, in house after house, people became ill with typhoid and at least three, maybe many more, died of it, but she was completely unaffected. Eventually a connection was established and it was confirmed that she was the unwitting spreader of the disease.

Reporters dubbed her "Typhoid Mary", a label she always resented, but the authorities took no chances and kept her in confinement for 23 years until her death in 1938.

Staff nurse Amelia Powell was shocked when she found out that she is asymptomatic. She was at work on her hospital ward at Addenbrooke's Hospital in Cambridge in April when a doctor rang to give her the result of a swab test.

She had been feeling normal and safe behind the personal protective equipment she had to wear while caring for patients with Covid-19. But suddenly all those assumptions were undermined because, to her horror, she had tested positive.

"It was a bit like hearing that someone in the family had passed, it was surreal. "I thought, 'This can't be right, not me, I'm absolutely fine,'" says 23-year-old Amelia.

She had to leave her post straightaway to go into isolation at home.

"I was worried because I've seen the other side, with patients deteriorating very quickly with it, so I did wonder if this would happen to me." But, to her surprise, at no point did she feel unwell. "I had nothing, literally - I was exercising indoors, eating normally, sleeping normally."

At the moment it's impossible to know how many cases of infection exist but remain hidden from view.

The discovery that Amelia was infected was only revealed because she was part of a study of all the staff at her hospital. It produced the surprising result that as many as 3% of more than 1,000 people were positive while showing no symptoms at the time of the test.

An even greater proportion of asymptomatic cases was found on the Diamond Princess cruise ship which had been sailing off the coast of Japan earlier this year. Later branded "a petri dish for infection", it had around 700 cases.

Researchers found that three quarters of the people who had tested positive had no symptoms.

And at a care home in Washington state more than half the residents were positive but had no sign of the illness.

Different studies suggest a huge range of possibilities for how many cases are asymptomatic stretching from 5% to 80% of cases. That was the conclusion of an analysis by Prof Carl Heneghan of the University of Oxford and colleagues who looked at 21 research projects.

The upshot, they said, was that "there is not a single reliable study to determine the number of asymptomatics". And they said that if the screening for Covid-19 is only carried out on people with symptoms - which has been the main focus of UK testing policy - then cases will be missed, "perhaps a lot of cases".

The biggest concern of Amelia, the nurse, was that she might have unwittingly transmitted the virus either to those she works with or to the patients who depend on her help.

"I don't think I passed it on because all the colleagues I work with tested negative but it was worrying to think how long I'd been positive for," she says. "But we still don't know if people who are asymptomatic are contagious or not - it's very bizarre and the information about it at the moment is minimal."

One study in China which found that the number of asymptomatic cases was actually greater than those with symptoms had a warning for the authorities. "As 'silent spreaders'," the scientists wrote, "asymptomatic carriers warrant attention as part of disease prevention and control."

The team that studied that Diamond Princess reckoned that asymptomatic cases were likely to be less infectious than people with symptoms but even so they're estimated to have caused a significant number of cases.

To try to get an answer, scientists in Norwich are pushing for the population of the entire city to be tested.

"Asymptomatic cases may be the 'dark matter' of the epidemic," according to Prof Neil Hall, head of the Earlham Institute, a life science research centre, who's leading the initiative. Dark matter is the invisible substance believed to make up most of the matter in the universe, and it's yet to be identified.

Prof Hall worries that asymptomatic cases may actually be driving the pandemic, keeping it going despite public health measures. "If you have people who don't know they're ill while using public transport and health care facilities, inevitably that's going to increase transmission," he says.

"Any intervention that's only based on people coming to primary health care when they have symptoms will only deal with half the problem."

A team of scientists in California believes that not knowing who's carrying the virus without symptoms is the "Achilles Heel" of the fight against the pandemic.

In their view, the only way to stop the disease from spreading is to find out who's infected regardless of whether they think they are or not. That was also the recommendation of MPs on the Commons Science and Technology Committee in a letter to the Prime Minister Boris Johnson.

They wrote that the risk of asymptomatic transmission has "a profound consequence for the management of the pandemic". And they said that anyone looking after vulnerable people - such as health workers or care workers - should be given regular testing.

A similar approach is being adopted on a far larger scale in the Chinese city of Wuhan, where the pandemic is thought to have begun.

As many as 6.5 million people there were tested in as little as nine days in a mass screening programme designed to detect the disease - including in those showing no symptoms.

As lockdown measures are eased and more people start to use public transport, return to work or go shopping, getting to grips with the invisible risk matters more than ever. At the moment, there is no way of telling who among the growing crowds may be carrying the virus without knowing.

That's why governments the world over say it's essential that everyone cooperates with efforts to trace the contacts of anyone infected and then quickly self-isolates. They also advise that the best defence remains social distancing - to keep apart wherever you can. But where that isn't possible, the recommendation is to cover your face, even with a mask that's homemade.

When the US government announced this policy, it highlighted the discoveries made in the church in Singapore back in January. The logic is that this is not about protecting yourself, it's about protecting others from you, in case you're infected but don't know it.

Many health professionals worry that masks might distract people from hand washing or social distancing, or increase the risk of contamination if they're clumsily handled. But more and more governments, most recently that of the UK, have become convinced of the benefits.

Not that face coverings will halt the pandemic on their own. But because there's still so little we know about asymptomatic transmission, almost anything is worth a try.

When you talk to intensive care doctors across the UK, exhausted after weeks of dealing with the ravages of Covid-19, one phrase emerges time after time: "We've never seen anything like this before."

They knew a new disease was coming, and they were expecting resources to be stretched by an unknown respiratory infection which had first appeared in China at the end of last year.

"It felt in some ways like we were trying to prepare for the D-Day landings," says Barbara Miles, clinical director of intensive care at Glasgow Royal Infirmary, "with three weeks to get ready and not a great deal of knowledge about what we would be facing".

Read a summary, often in their own words, of what doctors have learnt about how Covid-19 attacks the human body.

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Coronavirus: The mystery of 'silent spreaders' - BBC News