Category Archives: Covid-19

A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people. Marcelo Hernandez/Getty Images hide caption

A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people.

Chile looked as if it were well prepared to deal with the new coronavirus.

It's a rich country classified as high income by the World Bank. Life expectancy is roughly 80 years better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening.

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Catlica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network.

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States.

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile?

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity.

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."

By this she means she has access to high-quality private hospitals and clinics.

But there's another Chile.

"And that Chile is poor and you depend on the public health [system]," says Insunza.

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents.

The protests became about far more than the price of a subway ride. Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited.

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles.

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and don't see poverty. Never."

Chile's initial plan to deal with the coronavirus outbreak which at first affected mainly the elite in Santiago failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low.

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

"One thing that's interesting about Chile is that it probably has more state capacity in a technical way than any place in Latin America," says James Robinson, a professor at the University of Chicago and co-author of Why Nations Fail. He has written extensively about Latin America and, in particular, Chile.

"It's good at raising taxes and building roads and infrastructure," he says. "And there's not much corruption and things like that, but it's also a very polarized place."

Robinson says large segments of the public don't trust the state. They are wary of cooperating with government, which may be part of what has hindered Chile's response to the coronavirus outbreak.

In June, the health minister stepped down over his handling of the crisis and discrepancies over the case numbers he reported domestically, which were lower than the counts given to the World Health Organization.

President Sebastin Piera caused an uproar last week when he attended the funeral of his uncle along with more than 30 other people, while the government's coronavirus rules allow only 20 people at funerals.

Despite the government offering cash support and food to people who've lost work because of the lockdowns, Robinson says many Chileans feel that the system is stacked against them. And that's impeding the country's ability to tackle this virus.

"There's a real problem with the social contract in Chile," he says. "And the way they tried to manage this thing just seems to have sort of exacerbated a lot of those problems."

Chile has now extended lockdowns to more areas and put in tougher limits on movement to try to rein in the surging outbreak. In Santiago, residents who are not deemed essential workers are only being allowed to leave their houses twice a week, including trips for grocery shopping.

The regional office of the World Health Organization, the Pan American Health Organization, predicts that cases will continue to rise in Chile at least into the middle of July.

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Social Divisions Drive Astronomical COVID-19 Rate In Chile : Goats and Soda - NPR

Insurers must cover coronavirus testing, according to federal law, but medical visits to discuss symptoms may not be covered, unless a test is ordered at that time. ER Productions Limited/Getty Images hide caption

Insurers must cover coronavirus testing, according to federal law, but medical visits to discuss symptoms may not be covered, unless a test is ordered at that time.

Carmen Quintero works an early shift at a distribution warehouse that ships N95 masks and other products to a nation under siege from the coronavirus. On March 23, she had developed a severe cough, and her voice, usually quick and enthusiastic, was barely a whisper.

A human resources staff member told Quintero she needed to go home.

"They told me I couldn't come back until I was tested," said Quintero, who was also told that she would need to document that she didn't have the virus.

Her primary care doctor directed her to the nearest emergency room for testing because the practice had no coronavirus tests.

The Corona Regional Medical Center is just around the corner from her house in Corona, Calif. They didn't have any tests either, but there a nurse tested her breathing and gave her a chest X-ray. For testing, the nurse told her to go to Riverside County's public health department. There, a public health worker gave her an 800 number to call to schedule a test. The earliest the county could test her was April 7, more than two weeks later.

Carmen Quintero works at a distribution center that ships N95 masks and other products. She owes $1,840 for other care she received when she tried to get a coronavirus test. Heidi de Marco/KHN hide caption

Carmen Quintero works at a distribution center that ships N95 masks and other products. She owes $1,840 for other care she received when she tried to get a coronavirus test.

At the hospital, Quintero got a doctor's note saying she should stay home from work for a week and she was told to behave as if she had COVID-19, the disease caused by the coronavirus, and to isolate herself from vulnerable household members. That was difficult Quintero lives with her grandmother and her girlfriend's parents but she managed. No one else in her home got sick, and by the time April 7 came, she felt better and decided not to get the coronavirus test.

Then the bill for the ER visit came.

The patient: Carmen Quintero, 35, who works at a warehouse that distributes N95 masks and other products, and lives in Corona, Calif. She has an Anthem Blue Cross health insurance plan through her job with a $3,500 annual deductible.

Total bill: Corona Regional Medical Center billed Quintero $1,010, and Corona Regional Emergency Medical Associates billed an additional $830 for physician services for her visit attempting to get a test. She also paid $50 at Walgreens to fill a prescription for an inhaler.

Service provider: Corona Regional Medical Center, a for-profit hospital owned by Universal Health Services, a company based in King of Prussia, Pa., which is one of the largest health care management companies in the nation. The hospital contracts with Corona Regional Emergency Medical Associates, part of Emergent Medical Associates.

Medical service: Quintero was evaluated in the emergency room for symptoms consistent with COVID-19: a wracking cough and difficulty breathing. She had a chest X-ray and a breathing treatment and was prescribed an inhaler.

What gives: Quintero knew she had a high-deductible plan yet felt she had no choice but to follow her doctor's advice and go to the nearest emergency room to get tested. She assumed she would get the test and not have to pay. Congress had passed the CARES Act just the week before, with its headlines saying coronavirus testing would be free.

That legislation turned out to be riddled with loopholes, especially for people like Quintero who needed and wanted a coronavirus test but couldn't get one early in the pandemic.

Insurers do have to cover tests, but when a patient goes to see a doctor to be checked out for COVID-19 symptoms, if no test is ordered or administered, insurers aren't required to cover the appointment without cost sharing.

So Quintero was on the hook for the copay.

"I just didn't think it was fair because I went in there to get tested," she said.

Some insurance companies are voluntarily reducing copayments for coronavirus-related emergency room visits. But Quintero said her insurer, Anthem Blue Cross, would not reduce her bill. Anthem would not discuss the case until Quintero signed its own privacy waiver; it would not accept a signed standard waiver KHN uses. The hospital would not discuss the bill with a reporter unless Quintero could also be on the phone, something that has yet to be arranged around Quintero's work hours.

Three states have gone further than Congress to waive cost sharing for testing and diagnosis of pneumonia and influenza, given these illnesses are often mistaken for COVID-19. California is not one of them, and because Quintero's employer is self-insured the company pays for health services directly from its own funds it is exempt from state directives anyway. The U.S. Department of Labor regulates all self-funded insurance plans. In 2019, nearly 2 in 3 covered workers were in these types of plans.

Related health care hurdle: On that day in late March when her body shook from coughing, Quintero's immediate worry was infecting her family, especially her girlfriend's parents, both older than 65, and her 84-year-old grandmother.

"If something was to happen to them, I don't know if I would have been able to live with it," said Quintero.

Quintero wanted to isolate in a hotel, but she could hardly afford to for the week that she stayed home. She had only three paid sick days and was forced to take vacation time until her symptoms subsided and she was allowed back at work. At the time, few places provided publicly funded hotel rooms for sick people to isolate, and Quintero was not offered any help.

As lockdown restrictions ease and coronavirus cases rise around the country, public health officials say quickly isolating sick people before the virus spreads through families is essential.

But isolation efforts have gotten little attention in the U.S. Nearly all local health departments, including Riverside County where Quintero lives, now have these programs, according to the National Association of County and City Health Officials. Many were designed to shelter people experiencing homelessness but can be used to isolate others.

Raymond Niaura, interim chairman of the Department of Epidemiology at New York University, said these programs are used inconsistently and have been poorly promoted to the public.

"No one has done this before and a lot of what's happening is that people are making it up as they go along," said Niaura. "We've just never been in a circumstance like this."

Resolution:

The bills have been a constant worry. Quintero called the hospital and her insurance company and complained that she should not have to pay since she was seeking a test on her doctor's orders. Neither budged, and the bills labeled "payment reminders" soon became "final notices." She reluctantly agreed to pay $100 a month toward her balance $50 to the hospital and $50 to the doctors.

"None of them wanted to work with me," Quintero said. "I just have to give the first payment on each bill so they wouldn't send me to collections."

On top of that, Quintero still worries about bringing the virus home to her family and fears being in the same room with her grandmother. Quintero works at a warehouse that distributes 3M products including personal protective equipment and other companies' products. When she returns from work every day now, she puts her clothes in a separate hamper and diligently washes her hands before she interacts with anyone.

The takeaways:

At this point in the pandemic, tests are more widely available and federal law is very clearly on your side: You should not be charged any cost sharing for a coronavirus test.

Be wary, though, if your doctor directs you to the emergency room for a test, because any additional care you get there could come at a high price. Ask if there are any other testing sites available.

If you do find yourself with a big bill related to suspected coronavirus, push beyond a telephone call with your insurance company and file a formal appeal. If you feel comfortable, ask your employer's human resources staff to argue on your behalf. Then, call the help line for your state insurance commissioner and file a separate appeal. Press insurers and big companies that offer self-insured plans to follow the spirit of the law, even if the letter of the law seems to let them off the hook.

If you suspect you have COVID-19 and need to isolate to protect vulnerable members of your household, call your local public health department. Most counties have isolation and quarantine programs, but these resources are not well known. You may be placed in a hotel, recreational vehicle or other type of housing while you wait out the infection period. You do not need to have a positive coronavirus test to qualify for these programs and can use these programs while you await your test result. But this is an area in which public health officials repeatedly offer clear guidance 14 days of isolation which most people find impossible to follow.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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She Tried To Get A Coronavirus Test. Now She Owes $1,840 : Shots - Health News - NPR

But my family, as a social and economic unit, cannot operate forever in the framework authorities envision for the fall. There are so many ways that the situation weve been thrust into, in which businesses are planning to reopen without any conversation about the repercussions on families with school-age children, is even more untenable for others.

Updated June 30, 2020

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.

A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise comes with issues of potential breathing restriction and discomfort and requires balancing benefits versus possible adverse events. Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. In my personal experience, he says, heart rates are higher at the same relative intensity when you wear a mask. Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.

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.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

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.)

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.

Under the best of circumstances, the impact on children will still be significant. Students will lose most of a year of learning as parents their new untrained teachers cannot supervise in any meaningful way while Zooming into the office. At best, the kids will be crabby and stir-crazy as they dont get enough physical activity because theyre now tethered to their parents work spaces all day, running around the living room in lieu of fresh air. Without social interactions with other children, they constantly seek parental attention in bad ways, further straining the mood at home. And these are ideal scenarios.

But what about kids who cannot learn remotely? What about kids who need services that are tied to schools? Or those who are at higher risk for complications if they get the virus and might not be able to go back even one week out of the three?

When learning plans for children with special needs could not be followed appropriately this year, academic gains for many students were quickly wiped out. Remote learning has already widened racial and socioeconomic achievement gaps because of disparities in access to technology tutors. As parents are crushed by the Covid economy, so are the children who need the most support. Its no wonder the American Academy of Pediatrics released a statement this weekend urging that students be physically present in school as much as possible this fall.

The long-term losses for professional adults will be incalculable, too, and will disproportionately affect mothers. Working mothers all over the country feel that theyre being pushed out of the labor force or into part-time jobs as their responsibilities at home have increased tenfold.

Even those who found a short-term solution because they had the luxury to hit the pause button on their projects and careers this spring to manage the effects of the pandemic predicated on the assumption that the fall would bring a return to school and child care may now have no choice but to leave the work force. A friend just applied for a job and tells me she cannot even imagine how she would be able to take it if her children arent truly back in school. Theres an idea that people can walk away from careers and just pick them up where they left off, even though we know that women who drop out of the work force to take care of children often have trouble getting back in.

And lest you think its everyone vs. teachers, I cannot imagine a group this situation is less fair to. Teachers are supposed to teach in the classroom full-time but simultaneously manage remote learning? Even in non-pandemic times, teachers would tell you that they already work unpaid overtime on nights and weekends, just planning and grading. Where, exactly, will the extra hours come from? For teachers with their own school-age children, the situation isnt just untenable, its impossible.

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In the Covid-19 Economy, You Can Have a Kid or a Job. You Cant Have Both. - The New York Times

Even before a coronavirus vaccine becomes available, some activists are ready to attack it; this woman attended a Reopen Virginia protest in Richmond in April.

By Warren CornwallJun. 30, 2020 , 4:25 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

Within days of the first confirmed novel coronavirus case in the United States on 20 January, antivaccine activists were already hinting on Twitter that the virus was a scampart of a plot to profit from an eventual vaccine.

Nearly half a year later, scientists around the world are rushing to create a COVID-19 vaccine. An approved product is still months, if not years, away and public health agencies have not yet mounted campaigns to promote it. But health communication experts say they need to start to lay the groundwork for acceptance now, because the flood of misinformation from antivaccine activists has surged.

Such activists have kicked into overdrive, says Neil Johnson, a physicist at George Washington University who studies the dynamics of antivaccine groups on social networks. He estimates that in recent months, 10% of the Facebook pages run by people asking questions about vaccines have already switched to antivaccine views.

Recent polls have found as few as 50% of people in the United States are committed to receiving a vaccine, with another quarter wavering. Some of the communities most at risk from the virus are also the most leery: Among Black people, who account for nearly one-quarter of U.S. COVID-19 deaths, 40% said they wouldnt get a vaccine in a mid-May poll by the Associated Press and the University of Chicago. In France, 26% said they wouldnt get a coronavirus vaccine.

The Centers for Disease Control and Prevention (CDC) is now working on a plan to boost vaccine confidence as part of the federal effort to develop a vaccine, Director Robert Redfield told a Senate committee this week. Advocates urge campaigns that include personal messages and storytelling. We better use every minute we have between now and when that vaccine or vaccines are ready, because its real fragile ground right now, says Heidi Larson, an anthropologist and head of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine (LSHTM).

Even before the pandemic, public health agencies around the world were struggling to counter increasingly sophisticated efforts to turn people against vaccines. With vaccination rates against measles and other infectious diseases falling in some locations, the World Health Organization (WHO) in 2019 listed vaccine hesitancy as one of 10 major global health threats.

Any coronavirus vaccine will face additional hurdles, especially the lack of a long-term safety record, Johnson says. The frenetic pace of vaccine development may play into that concern. Even advocates have worried that the rush for a vaccine raises the risk it could be ineffective or have harmful side effects. Consider the very name for the U.S. vaccine initiative, Operation Warp Speed, says Bruce Gellin, president of the nonprofit Sabin Vaccine Institute. What is a worse name for something thats supposed to give you trust in a product that you want everybody to take?

For some in the United States, the answer is no, according to a survey of 1056 people in mid-May.

OverallUnder age 60Age 60 and olderWhiteBlackHispanic493120403523672112562716253240373723YesNot sureNoDid not answer

(GRAPHIC) V. ALTOUNIAN/SCIENCE; (DATA) Associated PressNORC Center for Public Affairs Research at the University of Chicago

Del Bigtree, a U.S.-based vaccine critic, claims scientists are pursuing one of the most dangerous vaccines ever attempted, for a virus that poses little risk to most people. He says he spreads his message through an online talk show, Twitter, and presentations, and that we have seen incredible growth since the pandemic started.

In addition to safety concerns, activists have embraced a plethora of other antivaccine messages. In May, a documentary-style video, Plandemic, purporting that COVID-19 related deaths were exaggerated and a vaccine could kill millions, got more than 7 million views on YouTube before it was removed because of its unsubstantiated claims. U.S. activists in late April hosted an online Freedom Health Summit featuring antivaccine leaders and railing against medical tyranny during shutdowns. Other outlandish claims include that vitamin C can cure COVID-19 and that the disease is a conspiracy involving philanthropist Bill Gates. Statements by French doctors that coronavirus vaccines might be tested in Africa led to fears of Africans being exploited in trials.

Social media posts that create the impression of a real debate over vaccine safety can tap into psychological habits that make people think doing nothing is safer than taking action, says Damon Centola, a sociologist at the University of Pennsylvania. He fears such concerns could spread more easily among people already suspicious of medical authority, including minority communities. For example, many Black people are keenly aware of the history of medical experiments such as the infamous federal Tuskegee Study, which failed to treat Black men with syphilis. That, to me, is the major issue of the day that Im very worried about, Centola says.

Accuracy and authority are at a disadvantage in a media environment that favors speed, emotion, and memorable stories, says Peter Sheridan Dodds, a complex systems scientist at the University of Vermont who studies how ideas move through social media. Antivaccine activists have used those factors to attract followers, Dodds says. In the end, its story wars.

Vaccine promoters say they need to start now to counter all this, because epidemiologists estimate that to break the pandemic, 70% of the population may need to develop immunity, either by getting a vaccine or becoming infected. Health communication experts suggest taking some pages from the antivaccine playbook. When more than40 experts from around the world gathered online for a strategy session organized by experts with the City University of New York and LSHTM, a top recommendation was to develop faster, more creative ways to communicate with the public that speak more directly to the emotions.

Traditional messages promoting vaccinationauthoritative and fact-filledjust dont cut it with people worried about vaccine safety, says Larson, who helped organize the 20 May meeting. We dont have enough flavors of messages, adds Larson, whose book about vaccine rumors is about to be released. Ive had people say to me, All these social media platforms can send us to WHO or CDC. Weve been there, but it doesnt have the answers to the questions we have.

Some current initiatives have pioneered a more story-based approach. The National HPV Vaccination Roundtable, which promotes vaccination against the human papillomavirus, a leading cause of cervical cancer, uses YouTube videos of women who survived cervical cancer. We need to get better at storytelling, says Noel Brewer, a behavioral scientist at the University of North Carolina, Chapel Hill, and chair of the HPV roundtable. We need to carry positive stories and also negative stories about the harms of not vaccinating. The downsides of refusing a coronavirus vaccine might include not visiting grandparents and continuing to traverse the produce aisle as if it were a minefield.

In West Africa, officials are deploying the same tools that spread rumors about vaccines to counter them, says Thabani Maphosa, who oversees operations in 73 countries for Gavi, the Vaccine Alliance, which supplies and promotes vaccines around the world. In Liberia, for example, officials are using Facebooks WhatsApp messaging app to survey people and to address the rumors behind a drop in routine vaccinations. We need to use this as a teachable moment, Maphosa says.

In the United States, the nonprofit Public Good Projects plans to recruit volunteers to swarm outbreaks of vaccine misinformation online and eventually develop memes and videos, says CEO Joe Smyser.

But the most effective tools may lie outside the digital realm. Real-world nudges and infrastructure, such as phone call reminders to come in for a shot, may be more powerful than any social media campaign, Brewer says. Social media doesnt have as much of an effect as you would imagine from the noise its generating, he adds.

Public health agencies should consider taking vaccinations out of medical settings and into places where people work or shop, adds Monica Schoch-Spana, a medical anthropologist at Johns Hopkins University. That also means talking to leaders in various communities to understand their views. Such outreach could prove particularly important with minority communities. You really do have to meet people where they are both figuratively and literally, she says.

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Just 50% of Americans plan to get a COVID-19 vaccine. Here's how to win over the rest - Science Magazine

Read Stateline coverage of the latest state action on coronavirus.

COVID-19 has raged throughout U.S. jails and prisons, where people live together in close quarters and there is little opportunity for social distancing, a lack of basic sanitary supplies and high rates of chronic disease.

While inmates mostly stay behind concrete walls and barbed wire, those barriers cant contain an infectious disease like COVID-19. Not only can the virus be brought into jails and prisons, but it also can leave those facilities and spread widely into surrounding communities and beyond.

The effect may be most pronounced in jails, which mainly house those who are awaiting trial or inmates serving short sentences. Those facilities tend to have more churn than state and federal penitentiaries, with greater numbers of people entering and leaving, thereby increasing opportunities for the disease to disseminate.

Two new studies show that jails can contribute enormously to coronavirus case totals outside their walls. While COVID-19s spread inside the facilities has been widely reported, the research demonstrates just how great an impact it can have in communities outside.

Depending on the social distancing measures put in place, community spread from infections in jails could add between 99,000 and 188,000 people to the virus U.S. death toll, according to a modeling study recently published by the American Civil Liberties Union in conjunction with researchers from the University of Pennsylvania, the University of Tennessee and Washington State University.

The report was released in April, when some experts were predicting that the U.S. death toll would remain below 100,000. As of June 30, more than 125,800 people have died of COVID-19 in the United States.

A peer-reviewed study set to appear in the health policy journal Health Affairsechoes that finding. The researchers found that cycling through Cook County Jail was associated with 15.9% of COVID-19 cases in Chicago and 15.7% in Illinois as of late April.

Although currently available data are inadequate to establish a clear causal relation, the studys authors write, these provisional findings are consistent with the hypothesis that arrest and jailing practices are augmenting infection rates in highly policed neighborhoods.

Cook County officials, including officials from the Chicago Department of Public Health, have pushed back hard on the report, calling it a fantasy filled with assumptions bordering on lies. They say it is based on old data that did not account for changes the jail had made to stop the spread of the virus, including testing and allowing for quarantining.

According to the county sheriffs office, as of last week, 778 inmates at the county jail and 362 of its workers tested positive for the virus. Seven inmates and three employees have died.

The authors of the Health Affairs paper said they stand by their conclusions.

COVID-19 already has infected about 60,000 prisoners and correctional staff and killed more than 600 of them, according to the Marshall Project, which tracks the virus toll in correctional facilities. Many jails and prisons have reduced their inmate populations to reduce exposures.

The results of the ACLU and Health Affairs studies underline a point that many in public health have long advanced: Public health in the wider world is tethered to the health of those who are incarcerated.

This is why public health officials say correctional health is public health, said Dr. Brie Williams, a professor and researcher at the University of California San Francisco School of Medicine and director of Amend, a group that works to improve inmate health.

Stateline Story June 29, 2020

Its not only released inmates, many of whom end up in crowded homeless shelters, who might carry the virus into communities. There are also risks of infection from inmates making court appearances or receiving medical care at hospitals in the community.

Infectious diseases move back and forth between communities and prisons. That was the case with tuberculosis in the 19th and 20th centuries and with HIV/AIDS in the 1980s and beyond.

In recent years, that point was made again in relation to hepatitis C, a communicable disease with high rates of infection in prisons because of the large numbers of incarcerated intravenous drug users. Sharing needles is one of the primary means of hepatitis C transmission.

One of the arguments public health experts used to urge local, state and federal governments to treat inmates with hepatitis Cwith highly effective but expensive medications was that knocking out the infection in prisons would prevent its spread beyond those walls. The difference between this pandemic and those other diseases, epidemiologists say, is that because COVID-19 is transmitted through respiratory droplets in the air, it spreads much more easily.

The United States is particularly vulnerable to diseases spreading near correctional institutions. Its incarceration rate is the highest in the world, at 655 people out of every 100,000, according to World Prison Brief. With 2.1 million inmates, the United States also imprisons more people than any other country, nearly 412,000 more than China, which ranks second.

About 738,000 of those prisoners are in local jails, according to the federal Bureau of Justice Statistics. But that number is just a point-in-time snapshot. During the course of a year, 4.9 million people cycle through local jails, according to the Prison Policy Initiative, a Massachusetts think tank.

Additionally, federal labor statistics show that jails employ about 151,000 correctional officers who can bring infections into facilities or take them home.

Stateline Story September 25, 2018

Most cases in jails have not originated with inmates, said Dr. Alysse Wurcel, an infectious disease physician at Tufts Medical Center who sees patients at six area jails and is a consultant to the Massachusetts Sheriffs Association. Weve discussed with the sheriffs association that early on, clusters were initiated by people working in the jails, not by those newly incarcerated.

There is a racial component to the concern about prisons and the pandemic. Disproportionate numbers of inmates are people of color, and the coronavirus is killing Blackand Hispanic people at higher rates than their shares of the overall population. Those two data points have not escaped the notice of public health experts.

Were in an epidemic of mass incarceration of Black people at the same time as a disease epidemic that is disproportionately affecting minorities, said Dr. Liz Barnert, an assistant professor of pediatrics at the UCLA David Geffen School of Medicine, who studies correctional health.

The pandemic has lent impetus to the growing movement to depopulate jails and prisons. Since the pandemic began, many states and local jurisdictions have taken steps to reduce inmate populations, releasing nonviolent offenders, granting more compassionate-releases and issuing citations rather than arresting alleged offenders.

Jails in California, Michigan, Massachusetts and North Dakota have released hundreds of prisoners. So have state prisons in those and other states. Many jurisdictions report large decreases in arrests.

Other states have done relatively little. Just last week, the Omaha World-Herald reported that the Nebraska prison system is 51% above capacity.

Public health experts insist that reducing jail and prison populations must continue, for the greater good of all.

Decreasing the risk of spread of COVID-19 in jails and prisons decreases the risk of spread out in communities, Williams said. And increasing the spread in jails and prisons increases the risk of spread in communities.

Read more here:

How COVID-19 in Jails and Prisons Threatens Nearby Communities - The Pew Charitable Trusts

Story Highlights

WASHINGTON, D.C. -- As coronavirus infections are spiking in U.S. states that previously had not been hard-hit, a new high of 65% of U.S. adults say the coronavirus situation is getting worse. The percentage of Americans who believe the situation is getting worse has increased from 48% the preceding week, and from 37% two weeks prior.

Line graph. A new high of 65% of US adults say the coronavirus situation in the U.S. is getting worse. 23% say it is getting better.

The latest results, from June 22-28, are based on Gallup's online COVID-19 tracking survey, which interviews weekly random samples from Gallup's probability-based panel. Last week, governors in many states paused or rolled back plans to ease restrictions on economic activity as states in the South and West dealt with a surge in coronavirus infections and hospitalizations.

Gallup first asked Americans in early April to say whether they thought the coronavirus situation was getting better or worse. At that time, 56% said it was getting worse and 28% better, the most negative assessment prior to the latest reading. From late April through early June, there were several weeks in which more Americans said the situation was getting better than getting worse.

Today, there is widespread agreement among Americans in all parts of the country that the situation is getting worse. Between 62% and 68% of those living in the four major regions of the U.S. say it is worsening. These rates represent heightened concern over the prior week in all four regions, including increases of 13 percentage points for those living in the South and Midwest, 19 points for those in the West and 22 points for those in the Northeast.

Additionally, all major party groups are more inclined than they were the previous week to see the situation as getting worse, including an eight-point increase among Republicans, 18 points among independents and 15 points among Democrats. But the partisan gap remains vast, as 90% of Democrats, 63% of independents and 28% of Republicans believe the situation is getting worse. A majority of Republicans, 54%, say the situation is getting better.

Americans' greater pessimism is also apparent in the 74% who expect the level of disruption to travel, school, work and public events in the U.S. to persist through the end of this year (37%) or beyond that (37%). This represents a 10-point increase from the prior week in the percentage of U.S. adults who think the coronavirus situation will last at least until the end of the year. In early May, less than half of Americans expected the situation to last that long.

Line graph. Nearly three quarters of Americans expect the disruption brought about the coronavirus will last until the end of the year or longer than that. Nineteen percent believe it will last a few more months and 7% say it will last a few more weeks.

Ninety percent of Democrats, 75% of independents and 48% of Republicans expect disruptions to continue through the end of the year or longer.

The percentage of Americans who say they are very or somewhat worried about getting the coronavirus has increased from 48% to 56%, a level not seen since late April. It is also one point off the trend's record high of 57%, registered in the initial measurement the week of April 6-12.

A majority of 56% of Americans are worried about getting the coronavirus.

Worry about getting the virus has increased most among Northeastern residents (up 19 points, to 60%) and Western residents (up 15 points, to 58%), with little change among those living in the Midwest or South.

Democrats (74%) remain far more worried about getting COVID-19 than independents (50%) or Republicans (30%) -- but Republicans show the greatest increase in worry compared with the prior week, up from 22%.

The poll also finds a significant increase in the percentage of Americans who say the better advice for healthy people is to stay home as much as possible. Seventy-two percent now hold this view, up from 66% the previous week. This is the first time since the initial measurement of this question in late March -- during the initial surge in U.S. cases -- that there has been a meaningful increase in the percentage who say it is better for healthy people to stay home. Still, it remains lower than the 91% who advocated that course of action in March.

Twenty-eight percent now hold the opposing view -- that it is better for healthy people to lead their normal lives as much as possible to avoid interruptions to work and business.

Line graph. Seventy-two percent of Americans, up from 66%, a week ago, say the better advice for healthy people is to stay home as much as possible. Twenty eight percent say the better advice is to for healthy people to lead their normal lives as much as possible.

Relatedly, fewer Americans now (25%) than the prior week (32%) say they would resume their normal day-to-day activities "right now" if it were up to them. About the same percentage, 26%, now say they would resume their normal activities after the number of cases in their state declines significantly. This leaves about half of Americans indicating they would be more cautious about returning to normal -- with 30% saying they would do so when there are no new cases in their state, and 19% waiting for the development of a vaccine.

Americans may dispute whether the recent increase in new daily coronavirus cases represents a continuation of the first wave or the start of a second wave of infections -- but there is a growing public consensus that the situation is getting worse. An increase in new daily cases was not unexpected as business restrictions were eased, but the size of the increase in states like California, Texas, Florida and Arizona has caused governors there to rethink the pace of loosening those restrictions, if not reverse course on some of them.

The recent developments are a grim reminder that even as the number of new daily cases declined in recent months, the virus never went away. Consequently, Americans are increasingly likely to think the disruptions to daily life will persist in the U.S. through at least the end of this year.

Learn more about how the Gallup Panel works.

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Assessment of US COVID-19 Situation Increasingly Bleak - Gallup

Carson City Health and Human Services

Carson City Health and Human Services is reporting seven new positive cases and three additional recoveries of COVID-19 in the Quad-County region on Thursday, July 2, 2020. This brings the total number of cases to 361, with 258 recoveries, seven deaths and 96 cases active.

The new cases are: A male Lyon County resident under the age of 18 with no connection to a previously reported case.

Carson City Health and Human Services is working to identify close risk contacts to prevent further spread of the disease. Due to medical privacy requirements and to protect their identity, no further information about the cases will be released.

Carson City-166 Total (+5 from 7/1)-47 Active (+3 from 7/1)-114 Recovered (+2 from 7/1)-5 Deaths

Douglas County-70 Total (+0 from 7/1)-20 Active (+0 from 7/1)-50 Recovered (+0 from 7/1)

Lyon County-123 Total (+2 from 7/1)-28 Active (+1 from 7/1)-93 Recovered (+1 from 7/1)- 2 Deaths

Storey County-2 Total (+0 from 7/1)-1 Active (+0 from 7/1)-1 Recovery (+0 from 7/1)

TOTAL-361 Total Cases (+7 from 7/1)-96 Active (+4 from 7/1)-253 Recovered (+3 from 7/1)-7 Deaths (+0 from 7/1)-10 Hospitalizations (+0 from 7/1)

Gender and age break down of the cases by county as well as the cases by zip code is available at https://gethealthycarsoncity.org/novel-coronavirus-2019/

Statewide numbers and testing numbers can be found at the Nevada Health Response website: https://nvhealthresponse.nv.gov

Fourth of July Holiday CelebrationsWith the Fourth of July holiday weekend approaching, CCHHS wants to remind everyone to continue following preventative actions such as keeping 6 feet of space between you and others, wearing a face covering, washing your hands often with soap and water for 20 seconds, staying home in you are sick, and avoiding large group gatherings to slow the spread of COVID-19.

If you are planning to host a small group gathering to celebrate the holiday, host it outdoors if possible. Remind guests to stay home if they are sick and keep a list of attendees in case it is needed for contact tracing purposes in the future. Require guests to wear a cloth face covering and encourage them to bring their own food and beverages.

More tips can be found at https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/personal-soc...

In observance of Independence Day, the Quad-County COVID-19 Hotline will be closed Friday July 3 and Saturday July 4. It will reopen Monday July 6 at 8 a.m. The phone number is (775) 283-4789.Stay informed.

For updates and more information on COVID-19 visit https://gethealthycarsoncity.org/novel-coronavirus-2019/

Go here to read the rest:

Quad area COVID-19 briefing for July 2: Five new Carson City cases, 2 in Lyon; 3 recoveries - Carson Now

n

In addition to the selected guidance included below, all of WHOs technical guidance on COVID-19 can be found online here.

All events listed below are in the Geneva, Switzerland time zone (CET/CEST). Note that the dates listed for documents are based on when they were finalised and timestamped.

WHOs Country Office in the Peoples Republic of China picked up a media statement by the Wuhan Municipal Health Commission from their website on cases of viral pneumonia in Wuhan, Peoples Republic of China.

The Country Office notified the International Health Regulations (IHR) focal point in the WHO Western Pacific Regional Office about the Wuhan Municipal Health Commission media statement of the cases and provided a translation of it.

WHOs Epidemic Intelligence from Open Sources (EIOS) platform also picked up a media report on ProMED (a programme of the International Society for Infectious Diseases) about the same cluster of cases of pneumonia of unknown cause, in Wuhan.

Several health authorities from around the world contacted WHO seeking additional information.

WHO requested information on the reported cluster of atypical pneumonia cases in Wuhan from the Chinese authorities.

WHO activated its Incident Management Support Team (IMST), as part of its emergency response framework, which ensures coordination of activities and response acrossnthe three levels of WHO (Headquarters, Regional, Country) for public health emergencies.

The WHO Representative in China wrote to the National Health Commission, offering WHO support and repeating the request for further information on the cluster of cases.

WHO informed Global Outbreak Alert and Response Network (GOARN) partners about the cluster of pneumonia cases in the Peoples Republic of China. GOARN partners include majornpublic health agencies, laboratories, sister UN agencies, international organizations and NGOs.

Chinese officials provided information to WHO on the cluster of cases of viral pneumonia of unknown cause identified in Wuhan.

WHO tweeted that there was a cluster of pneumonia cases with no deaths in Wuhan, Hubei province, Peoples Republic of China, and that investigations to identify the cause were underway.

WHO shared detailed information about a cluster of cases of pneumonia of unknown cause through the IHR (2005) Event Information System, which is accessible to all Member States. The event notice provided information on the cases and advised Member States to take precautions to reduce the risk of acute respiratory infections.

WHO also issued its first Disease Outbreak News report. This is a public, web-based platform for the publication of technical information addressed to the scientific and public health communities, as well as global media. The report contained information about the number of cases and their clinical status; details about the Wuhan national authoritys response measures; and WHOs risk assessment and advice on public health measures. It advised that WHOs recommendations on public health measures and surveillance of influenza and severe acute respiratory infections still apply.

WHO reported that Chinese authorities have determined that the outbreak is caused by a novel coronavirus.

WHO convened the first of many teleconferences with global expert networks, beginning with the Clinical Network.

The Global Coordination Mechanism for Research and Development to prevent and respond to epidemics held its first teleconference on the novel coronavirus, as did the Scientific Advisory Group of the research and development (R&D) Blueprint, a global strategy and preparedness plan that allows the rapid activation of research and development activities during epidemics.

The Director-General spoke with the Head of the National Health Commission of the Peoples Republic of China. He also had a call to share information with the Director of the Chinese Center for Disease Control and Prevention.

WHO published a comprehensive package of guidance documents for countries, covering topics related to the management of an outbreak of a new disease:

Chinese media reported the first death from the novel coronavirus.

WHO convened the first teleconference with the diagnostics and laboratories global expert network.

The Ministry of Public Health in Thailand reported an imported case of lab-confirmed novel coronavirus from Wuhan, the first recorded case outside of the Peoples Republic of China.

WHO publishes first protocol for a RT-PCR assay by a WHO partner laboratory to diagnose the novel coronavirus.

14 January 2020

WHO held a press briefing during which it stated that, based on experience with respiratory pathogens, the potential for human-to-human transmission in the 41 confirmed cases in the Peoples Republic of China existed: it is certainly possible that there is limited human-to-human transmission.

WHO tweeted that preliminary investigations by the Chinese authorities had found no clear evidence of human-to-human transmission. In its risk assessment, WHO said additional investigation was needed to ascertain the presence of human-to-human transmission, modes of transmission, common source of exposure and the presence of asymptomatic or mildly symptomatic cases that are undetected.

The Japanese Ministry of Health, Labour and Welfare informed WHO of a confirmed case of a novel coronavirus in a person who travelled to Wuhan. This was the second confirmed case detected outside of the Peoples Republic of China. WHO stated that considering global travel patterns, additional cases in other countries were likely.

The Pan American Health Organization/WHO Regional office for the Americas (PAHO/AMRO) issued its first epidemiological alert on the novel coronavirus. The alert included recommendations covering international travellers, infection prevention and control measures and laboratory testing.

WHO convened the first meeting of the analysis and modelling working group for the novel coronavirus.

The WHO Western Pacific Regional Office (WHO/WPRO) tweeted that, according to the latest information received and WHO analysis, there was evidence of limited human-to-human transmission.

WHO published guidance on home care for patients with suspected infection.

WHO conducted the first mission to Wuhan and met with public health officials to learn about the response to the cluster of cases of novel coronavirus.

WHO/WPRO tweeted that it was now very clear from the latest information that there was at least some human-to-human transmission, and that infections among health care workers strengthened the evidence for this.

The United States of America (USA) reported its first confirmed case of the novel coronavirus. This was the first case in the WHO Region of the Americas.

WHO convened the first meeting of the global expert network on infection prevention and control.

The WHO mission to Wuhan issued a statement saying that evidence suggested human-to-human transmission in Wuhan but that more investigation was needed to understand the full extent of transmission.

The WHO Director-Generalconvenedan IHR Emergency Committee (EC) regarding the outbreak of novel coronavirus. The EC was comprised of 15 independent experts from around the world and was charged with advising the Director-General as to whether the outbreak constituted a public health emergency of international concern (PHEIC).

The Committee was not able to reach a conclusion on 22 January based on the limited information available. As the Committee was not able to make a recommendation, the Director-General asked the Committee to continue its deliberations the next day. The Director-General held a media briefing on the novel coronavirus, to provide an update on the Committees deliberations.

The EC met again on 23 January and members were equally divided as to whether the event constituted a PHEIC, as several members considered that there was still not enough information for it, given its restrictive and binary nature (only PHEIC or no PHEIC can be determined; there is no intermediate level of warning). As there was a divergence of views, the EC did not advise the Director-General that the event constituted a PHEIC but said it was ready to be reconvened within 10 days. The EC formulated advice for WHO, the Peoples Republic of China, other countries and the global community.

The Director-General accepted the advice of the Committee and held a second media briefing, giving a statement on the advice of the EC and what WHO was doing in response to the outbreak.

France informed WHO of three cases of novel coronavirus, all of whom had travelled from Wuhan. These were the first confirmed cases in the WHO European region (EURO).

WHO held an informal consultation on the prioritization of candidate therapeutic agents for use in novel coronavirus infection.

The Director of the Pan American Health Organization (PAHO) urged countries in the Americas to be prepared to detect early, isolate and care for patients infected with the new coronavirus, in case of receiving travelers from countries where there was ongoing transmission of novel coronavirus cases. The Director spoke at a PAHO briefing for ambassadors of the Americas to the Organization of American States (OAS) in Washington.

The WHO Regional Director for Europe issued a public statement outlining the importance of being ready at the local and national levels for detecting cases, testing samples and clinical management.

WHO released its first free online course on the novel coronavirus on its OpenWHO learning platform.

The WHO Regional Director for South-East Asia issued a press release that urged countries in the Region to focus on their readiness for the rapid detection of imported cases and prevention of further spread.

A senior WHO delegation led by the Director-General arrived in Beijing to meet Chinese leaders, learn more about the response in the Peoples Republic of China, and to offer technical assistance. The Director-General met with President Xi Jinping on 28 January, and discussed continued collaboration on containment measures in Wuhan, public health measures in other cities and provinces, conducting further studies on the severity and transmissibility of the virus, continuing to share data, and a request for China to share biological material with WHO. They agreed that an international team of leading scientists should travel to China to better understand the context, the overall response, and exchange information and experience.

On his return to Switzerland from China, the Director-General presented an update to Member States on the response to the outbreak of novel coronavirus infection in China, at the 30th Meeting of the Programme, Budget and Administration Committee (PBAC) of the Executive Board. He informed the PBAC that he had reconvened the Emergency Committee on the novel coronavirus under the IHR (2005), which would meet the following day to advise on whether the outbreak constituted a PHEIC.

The Director-General also held a press briefing on his visit to China and announced the reconvening of the EC the next day. The Director-General based the decision to reconvene on the deeply concerning continued increase in cases and evidence of human-to-human transmission outside China, in addition to the numbers outside China holding the potential for a much larger outbreak, even though they were still relatively small. The Director-General also spoke of his agreement with President Xi Jinping that WHO would lead a team of international experts to visit China as soon as possible to work with the government on increasing the understanding of the outbreak, to guide global response efforts.

WHO held the first of its weekly informal discussions with a group of public health leaders from around the world, in line with its commitment to conducting listening exercises and outreach beyond formal mechanisms.

The United Arab Emirates reported the first cases in the WHO Eastern Mediterranean Region. The Regional Director affirmed that the Regional Office continued to monitor disease trends and work with Member States to ensure the ability to detect and respond to potential cases.

The Pandemic Supply Chain Network (PSCN) created by WHO, in collaboration with the World Economic Forum, held its first meeting. The mission of PSCN is to create and manage a market network allowing for WHO and private sector partners to access any supply chain functionality and asset from end-to-end anywhere in the world at any scale.

WHO published advice on the use of masks in the community, during home care and in health care settings.

WHO held a Member State briefing to provide more information about the outbreak.

The WHO Director-General reconvened the IHR Emergency Committee (EC).

The EC advised the Director-General that the outbreak now met the criteria for a PHEIC. The Director-General accepted the ECs advice and declared the novel coronavirus outbreak a PHEIC. At that time there were 98 cases and no deaths in 18 countries outside China. Four countries had evidence (8 cases) of human-to-human transmission outside China (Germany, Japan, the United States of America, and Viet Nam).

The EC formulated advice for the Peoples Republic of China, all countries and the global community, which the Director-General accepted and issued as Temporary Recommendations under the IHR. The Director-General gave a statement, providing an overview of the situation in China and globally; the statement also explained the reasoning behind the decision to declare a PHEIC and outlined the EC's recommendations.

WHOs Regional Director for Africa sent out a guidance note to all countries in the Region emphasising the importance of readiness and early detection of cases.

First dispatch of RT-PCR lab diagnostic kits shipped to WHO Regional Offices.

WHO finalised its Strategic Preparedness and Response Plan (SPRP), centred on improving capacity to detect, prepare and respond to the outbreak. The SPRP translated what had been learned about the virus at that stage into strategic action to guide the development of national and regional operational plans. Its content is structured around how to rapidly establish international coordination, scale up country preparedness and response operations, and accelerate research and innovation.

The WHO Director-General asked the UN Secretary-General to activate the UN crisis management policy, which held its first meeting on 11 February.

During the 146th Executive Board, WHO held a technical briefing on the novel coronavirus. In his opening remarks, the Director-General urged Member States to prepare themselves by taking action now, saying We have a window of opportunity. While 99% of cases are in China, in the rest of the world we only have 176 cases.

Responding to a question at the Executive Board, the Secretariat said, it is possible that there may be individuals who are asymptomatic that shed virus, but we need more detailed studies around this to determine how often that is happening and if this is leading to secondary transmission.

WHO's headquarters began holding daily media briefings on the novel coronavirus, the first time that WHO has held daily briefings by the Director-General or Executive Director of the WHO Health Emergencies Programme.

WHO deployed an advance team for the WHO-China Joint Mission, having received final sign-off from the Peoples Republic of China that day. The mission had been agreed between the Director-General and President Xi Jinping during the WHO delegations visit to China at the end of January. The advance team completed five days of intensive preparation for the Mission, working with Chinas National Health Commission, the Chinese Center for Disease Control and Prevention, local partners and related entities and the WHO China Country Office.

WHO announced that the disease caused by the novel coronavirus would be named COVID-19. Following best practices, the name of the disease was chosen to avoid inaccuracy and stigma and therefore did not refer to a geographical location, an animal, an individual or group of people.

WHO convened a GlobalResearch and Innovation Forum on the novel coronavirus, attended in person by more than 300 experts and funders from 48 countries, with a further 150 joining online.Participants came together to assess the level of knowledge, identify gaps and work together to accelerate and fund priority research, with equitable access as a fundamental principle underpinning this work.

Topics covered by the Forum included: the origin of the virus, natural history, transmission, diagnosis; epidemiological studies; clinical characterization and management; infection prevention and control; R&D for candidate therapeutics and vaccines; ethical considerations for research; and the integration of the social sciences into the outbreak response.

The Forum was convened in line with the WHO R&D Blueprint, which was activated to accelerate diagnostics, vaccines and therapeutics for this novel coronavirus.

Supplementing the SPRP with further detail, WHO published Operational Planning Guidelines to Support Country Preparedness and Response, structured around the eight pillars of country-level coordination, planning, and monitoring; risk communication and community engagement; surveillance, rapid response teams, and case investigation; points of entry; national laboratories; infection prevention and control; case management; and operational support and logistics. These guidelines operationalised technical guidance, such as that published on 10-12 January.

WHOs Digital Solutions Unit convened a roundtable of 30 companies in Silicon Valley to help build support for WHO to keep people safe and informed about COVID-19.

Based on lessons learned from the H1N1 and Ebola outbreaks, WHO finalised guidelines for organizers of mass gatherings, in light of COVID-19.

The Director-General spoke at the Munich Security Conference, a global forum dedicated to issues of international security, including health security, where he also held several bilateral meetings

In his speech, the Director-General made three requests of the international community: use the window of opportunity to intensify preparedness, adopt a whole-of-government approach and be guided by solidarity, not stigma. He also expressed concern at the global lack of urgency in funding the response.

The WHO-China Joint Mission began its work. As part of the mission to assess the seriousness of this new disease; its transmission dynamics; and the nature and impact of Chinas control measures, teams made field visits to Beijing, Guangdong, Sichuan and Wuhan.

The Mission consisted of 25 national and international experts from the Peoples Republic of China, Germany, Japan, the Republic of Korea, Nigeria, the Russian Federation, Singapore, the United States of America and WHO, all selected after broad consultation to secure the best talent from a diversity of geographies and specialties. It was led by a Senior Advisor to the WHO Director-General, with the Head of Expert Panel of COVID-19 Response at the China National Health Commission (NHC) as co-lead.

Throughout the global outbreak, WHO has regularly sent missions to countries to learn from and support responses, at the request of the affected Member State. Particularly in the early stages of the worldwide COVID-19 response, missions went to countries facing relatively high levels of community transmission, such as the Islamic Republic of Iran, Italy, and Spain.

Weekly WHO Member State Briefings on COVID-19 began, to share the latest knowledge and insights on COVID-19.

The WHO Director-General appointed six special envoys on COVID-19, to provide strategic advice and high-level political advocacy and engagement in different parts of the world:

The Team Leaders of the WHO-China Joint Mission on COVID-19 held a press conference to report on the main findings of the mission.

The Mission warned that "much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China.

The Mission stressed that to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures, such as case detection and isolation, contact tracing and monitoring/quarantining and community engagement.

Major recommendations were developed for the Peoples Republic of China, countries with imported cases and/or outbreaks of COVID-19, uninfected countries, the public and the international community. For example, in addition to the above, countries with imported cases and/or outbreaks were recommended to "immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19".

Success was presented as dependent on fast decision-making by top leaders, operational thoroughness by public health systems and societal engagement.

In addition to the Mission press conference, WHO published operational considerations for managing COVID-19 cases and outbreaks on board ships, following the outbreak of COVID-19 during an international voyage.

Confirmation of the first case in WHO's African Region, in Algeria. This followed the earlier reporting of a case in Egypt, the first on the African continent. The Regional Director for Africa called for countries to step up their readiness.

WHO published guidance on the rational use of personal protective equipment, in view of global shortages. This provided recommendations on the type of personal protective equipment to use depending on the setting, personnel and type of activity.

The Report of the WHO-China Joint Mission was issued, as a reference point for countries on measures needed to contain COVID-19.

WHO published considerations for the quarantine of individuals in the context of containment for COVID-19. This described who should be quarantined and the minimum conditions for quarantine to avoid the risk of further transmission.

WHO issued a call for industry and governments to increase manufacturing by 40 per cent to meet rising global demand in response to the shortage of personal protective equipment endangering health workers worldwide.

This call fits within a broader scope of ongoing engagement with industry, through WHOs EPI-WIN network and via partners, such as the International Chamber of Commerce and World Economic Forum, the latter of which has supported COVID-19 media briefings at the regional level.

WHO published the Global Research Roadmap for the novel coronavirus developed by the working groups of the Research Forum.

The Roadmap outlines key research priorities in nine key areas. These include the natural history of the virus, epidemiology, diagnostics, clinical management, ethical considerations and social sciences, as well as longer-term goals for therapeutics and vaccines.

To mark the number of confirmed COVID-19 cases surpassing 100 000 globally, WHO issued a statement calling for action to stop, contain, control, delay and reduce the impact of the virus at every opportunity.

WHO issued a consolidated package of existing guidance covering the preparedness, readiness and response actions for four different transmission scenarios: no cases, sporadic cases, clusters of cases and community transmission.

The Global Preparedness Monitoring Board, an independent high-level body established by WHO and the World Bank, responsible for monitoring global preparedness for health emergencies, called for an immediate injection of $8 billion for the COVID-19 response to: support WHO to coordinate and prioritize support efforts to the most vulnerable countries; develop new diagnostics, therapeutics, and vaccines; strengthen unmet needs for regional surveillance and coordination; and to ensure sufficient supplies of protective equipment for health workers.

WHO, UNICEF and the International Federation of Red Cross and Red Crescent Societies (IFRC) issued guidance outlining critical considerations and practical checklists to keep schools safe, with tips for parents and caregivers, as well as children and students themselves.

Deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction, WHO made the assessment that COVID-19 could be characterized as a pandemic.

See the rest here:

Timeline of WHO's response to COVID-19 - World Health Organization

A retrospective study of 57 adult COVID-19 patients published yesterday in Respiratory Research found significant lung impairment in the recovery phase, particularly in patients with severe disease.

Researchers conducted serial assessments of patients 30 days after they were released from the Fifth Affiliated Hospital of Sun Yat-sen University in Zhuhai, China. They found that, of the 40 non-severe and 17 severe cases, 31 patients (54.4%) still had abnormal findings on chest computed tomography (CT). The rate of abnormalities was much higher in severe (16 or 17, or 94.1%) than in mild illness (15/ 31, 37.5%).

Forty-three (75.4%) of the 57 patients had abnormal pulmonary function tests. The percent of patients who had results less than 80% of predicted values was 10.5% for forced vital capacity (FVC, amount of air forcibly exhaled after taking a deep breath), 8.7% for forced expiratory volume (FEV1, amount of air forcibly expelled in 1 second), 43.8% for FEV1/FVC ratio, 12.3% for total lung capacity (TLC), and 52.6% for diffusing capacity for carbon monoxide (DLCO) (amount of oxygen traveling from lungs to the blood).

Twenty-eight (49.1%) and 13 patients (22.8%) had maximum inspiratory pressure and maximum expiratory pressure values less than 80% of predicted values an indication of weakened respiratory muscles.

Twenty-six patients (86.7%) had mildly impaired DLCO, while the other 4 (13.3%) had moderate impairment. There was a significant difference in impaired DLCO between the two groups, accounting for 42.5% of patients with mild disease and 75.6% of those with severe illness.

Patients with severe COVID-19 had more DLCO impairment than those with less severe disease (75.6% vs 42.5%,P=0.019), as well as higher lung total severity scores (TSS) and total airway resistance and significantly lower percentage of predicted TLC and 6-minute walking distance (6MWD). The 6MWD of patients with severe illness was only 88.4% of predicted values, significantly lower than in those with mild illness.

Most patients in the severe group (70.6%) were men and were older than patients with milder disease. No significant correlation between TSS and pulmonary function was evident at follow-up.

Mean ratio of partial pressure of oxygen (Pa02) to fraction of inspired oxygen (FiO2) was significantly lower in patients with milder illness than in those with severe disease. Pa02 reflects how well oxygen is able to travel from the lungs to the blood, while FiO2 is the percentage of oxygen inhaled.

Patients with severe COVID-19 had higher serum lactate dehydrogenase (indicating tissue damage), C-reactive protein peaks (indicating inflammation), and lower counts of infection-fighting lymphocytes than those with milder illnesses. No significant differences were found in values of white blood cells, creatinine kinase (measuring muscle inflammation), lactic acid peaks (measures of levels of oxygen in the muscles), or length of hospital stay between the two groups.

At 30-day follow-up, 6 of 57 patients (10.5%) reported a mild cough, 4 (7.0%) had shortness of breath, and 3 (5.3%) said they sometimes wheezed.

Of 57 patients, 46 (80.7%) had a history of direct contact with Wuhan, Hubei province, the epicenter of China's coronavirus outbreak, while 9 (15.7%) had a history of smoking. Mean patient age was 47 years, and 31 patients were women.

Twenty-one patients (36.8%) had underlying illnesses, the most common of which were high blood pressure (11 patients), diabetes (4), cancer (3), and cardiovascular disease (3). All these conditions were either believed cured or well controlled at testing. None of the patients had a chronic respiratory disease.

The authors said they were surprised that the lung total severity score was not significantly correlated with FEV1, FVC, or DLCO, meaning that impaired lung function did not necessarily reflect severity of illness or changes on CT.

"We speculate that it was because most severe patients used glucocorticoid during hospitalization, suggesting that corticosteroids may improve the prognosis of patients with COVID-19," they wrote, cautioning that small sample size and selection bias may have affected the results. Corticosteroids are given to reduce inflammation.

The researchers called for future studies to include longer follow-up and exercise cardiopulmonary function testing.

More here:

Study finds lung impairment in recovering COVID-19 patients - CIDRAP

Victoria has announced 66 new cases of Covid-19 as the states health minister revealed Melbournes wave of new cases could potentially be traced back to a single super spreader of the virus.

On Tuesday, I received a briefing of a genomic sequencing report that seemed to suggest that there seems to be a single source of infection for many of the cases that have gone across the northern and western suburbs of Melbourne, the minister, Jenny Mikakos, said on Friday. It appears to be even potentially a super spreader that has caused this upsurge in cases.

The premier has previously stated that a significant portion of new cases are linked to breaches in the hotel quarantine system, which is now the subject of judicial inquiry.

We dont have the full picture yet, Mikakos said.

Not all of these cases have yet been subject to genomic sequencing. We need to enable that process to be completed and to be provided to the judicial inquiry in the fullness of time.

Deputy chief health officer Annalise van Dieman said the possibility of a super spreader was one of several possibilities.

This is a possible epidemiological theory about one of the things that may have caused this outbreak. There is not an identified super spreader at this point in time. It is one of the options, one of the possibilities, looking at the data, she said.

We dont have definitive evidence that it has been a single super spreader. What we have [is] evidence that the current outbreak is possibly looking more like what we call a point-source outbreak, where there was a tapering off of cases and then now the cases have gone up One of the possibilities that can do that is a person who is particularly infectious who attends multiple areas or multiple places.

On Friday, the Victorian premier, Daniel Andrews, said he was tentatively encouraged by a fourth day of stable case numbers.

While it may be too early for us to be talking about trends, a day with 66 is obviously far preferable to seeing a doubling and then a doubling again certainly, to see these numbers relatively consistent is very pleasing, he said.

Andrews declined to answer questions relating to his role in the decision by the government to use private security contractors rather than police or the Australian Defence Force to run hotel quarantine.

Ive not established a judicial inquiry chaired by a very well respected and highly qualified person to stand here and try to run her inquiry for her, he said. I understand why questions are asked the best way to answer those questions is to have a rigorous review, then provide a report with findings, with recommendations I am the leader of this government and Id take responsibility and have accountability for these and all matters.

More than 95,000 hotspot homes have now been knocked as part of the community testing blitz, but Miakaos said that disappointingly more than 10% of people have refused testings.

That might be for a range of reasons, including that they may have already been tested in a different location, she said.

We are analysing that data to see exactly why people are refusing, but it is concerning that some people believe that coronavirus is a conspiracy or that it wont impact on them, so what I want to stress here is that coronavirus is a very contagious virus. It can go through your family very quickly, it can affect your neighbours, your loved ones and your entire community.

Additional cases were added to the Al-Taqwa college cluster in Truganina, bringing the total to 23. The entire school, including all staff and students, have now been asked to quarantine for two weeks.

Cases were also added to the Stamford Plaza cluster and the Albanvale primary school cluster, along with additional close contacts from the Orygen youth mental health facility and the Villa Bambini childcare centre in Essendon.

Mikakos highlighted four postcodes with the highest rates of active cases as of Thursday night. These were 3,064 (Craigieburn, Donnybrook, Mickleham, Roxburgh Park and Kalkallo) with 52; 3,047 (Broadmeadows, Dallas, Jacana) with 25; and 3,060 (Fawkner) with 11.

The fourth postcode was 3031 (Flemington, Kensington), which is currently not a designated hotspot, but the deputy chief health officer said authorities would not be announcing further lockdowns today.

Any single days worth of data or cases in isolation is not necessarily going to be enough to cause lockdown or not, van Dieman said. Were going to looking at trends week by week and trends not based just on absolute numbers but also rates, as the premier mentioned.

The deputy chief health officer was asked on Friday why a NSW man who tested positive in Melbourne hotel quarantine was not tested a second time before being released and returning to Sydney.

There is a standard set of release from isolation criteria that is agreed upon nationally and it is consistent When a patient has had more than 10 days since the onset of symptoms, including 72 hours being symptom- and fever-free, they are released from isolation and clinically declared to be released from isolation, she said.

The reason that doesnt include a clearance test is because people can shed this virus, weeks to months, and the shedding virus is not the same as being infectious.

Van Dieman said she was confident the man did not pose a public health risk.

The man met the criteria and stayed for another two days on top of having the criteria because he was in hotel quarantine. He would have been released from any hotel quarantine in the country based on the criteria, including any hotel in Sydney with a person coming from Melbourne.

The NSW government has isolated more than 50 workers at the Balmain Woolworths supermarket, where the man worked while still displaying some symptoms. The NSW chief health officer, Kerry Chant, said it was unlikely the man was still infectious.

On Friday the ACT moved to make it a requirement that anyone travelling to the territory who is believed to have been in a hotspot must quarantine for 14 days at their own expense or return home immediately.

As national institutions reopen to the public in Canberra, the territory government has issued a new public health direction.

Anyone already in the ACT who has been in a Melbourne hotspot has been told to quarantine for two weeks, even if they do not have coronavirus symptoms. This is the first time during the pandemic that the ACT has closed its borders to anyone from Victoria.

People coming into Canberra from Melbourne must monitor themselves for signs of the virus and passengers on inbound flights must show identification on arrival. Anyone who refuses to comply will face fines.

Canberra residents have been told not to plan any visits to the Melbourne suburbs under a reinstated coronavirus lockdown, and to reconsider all non-essential travel to the city for the foreseeable future.

On Friday Andrews also announced a boost to funding for mental health care in order to support those in hotspot suburbs.

I can announce today just under $2m in additional funding, on top of the just under $60m we have already provided for targeted and localised mental health support for those who are really doing it very, very tough, he said. That extra funding will go to mental health service providers and mental health support, with a real focus on those hotspot suburbs.

On Friday Mikakos stressed it was permissible for residents in hotspot suburbs to leave their home to seek mental health support.

Andrews made a point of thanking the more than 300,000 people now in lockdown in the 36 hotspot suburbs across the city.

You are making enormous sacrifices its about your safety of course but its also about the safety of the entire state. And I cant say how grateful and how proud I am to think that people in those 10 postcodes are following the rules, are doing the right thing. From my government to you, for my family to yours, I say thank you. Thank you so very much.

Read the rest here:

Victoria Covid-19: one 'super spreader' could be responsible for Melbourne spike in cases, government says - The Guardian