World hits coronavirus milestones amid fears worst to come and Consider Rationing Health Care and the Effect of Virtual Classrooms and the Effect of All These Protests on Disease Management.

The world surpassed two sobering coronavirus milestones last Sunday—500,000 confirmed deaths, 10 million confirmed cases—and hit another high mark for daily new infections as governments that attempted reopenings continued to backtrack and warn that worse news could be yet to come.

“COVID-19 has taken a very swift and very dangerous turn in Texas over just the past few weeks,” said Gov. Greg Abbott, who allowed businesses to start reopening in early May but on Friday shut down bars and limited restaurant dining amid a spike in cases.

California Gov. Gavin Newsom rolled back reopenings of bars in seven counties, including Los Angeles. He ordered them to close immediately and urged eight other counties to issue local health orders mandating the same.

South Africa’s health minister warned that the country’s current surge of cases is expected to rapidly increase in the coming weeks and push hospitals to the limit. Health Minister Zwelini Mkhize said the current rise in infections has come from people who “moved back into the workplace. It was therefore inevitable that there would be cluster outbreaks as infections spilled over from communities into places of congregation such as mines, factories, taxis and buses.”

New clusters of cases at a Swiss nightclub and in the central English city of Leicester showed that the virus was still circulating widely in Europe, though not with the rapidly growing infection rate seen in parts of the U.S., Latin America and India.

Poland and France, meanwhile, attempted a step toward normalcy as they held elections that had been delayed by the virus.

Wearing mandatory masks, social distancing in lines and carrying their own pens to sign voting registers, French voters cast ballots in a second round of municipal elections. Poles also wore masks and used hand sanitizer, and some in virus-hit areas were told to mail in their ballots to avoid further contagion.

“I didn’t go and vote the first time around because I am elderly and I got scared,” said Fanny Barouh as she voted in a Paris school.

In Texas, Abbott appeared with Vice President Mike Pence, who cut campaign events from upcoming visits to Florida and Arizona because of rising virus cases in those states.

Pence praised Abbott for both his decision to reopen the state, and to roll back the reopening plans.

“You flattened the curve here in Texas … but about two weeks ago something changed,” Pence said.

Pence urged people to wear masks when unable to practice social distancing. He and Abbott wore face masks as they entered and left the room, taking them off while speaking to reporters.

HHS Secretary Alex Azar, meanwhile, defended the fact that President Donald Trump has rarely worn a mask in public, saying he doesn’t have to follow his own administration’s guidance because as a leader of the free world he’s tested regularly and is in “very different circumstances than the rest of us.”

Addressing spikes in reported coronavirus cases in some states, Azar said on NBC’s “Meet the Press” that people “have to take ownership” of their own behaviors by social distancing and wearing masks if possible.

A reported tally Sunday from Johns Hopkins University researchers said the death toll from the coronavirus pandemic had reached 500,108.

About 1 in 4 of those deaths—more than 125,000—have been reported in the U.S. The country with the next highest death toll is Brazil, with more than 57,000, or about 1 in 9.

The true death toll from the virus, which first emerged in China late last year, is widely believed to be significantly higher. Experts say that especially early on, many victims died of COVID-19 without being tested for it.

To date, more than 10 million confirmed cases have been reported globally. About a quarter of them have been reported in the U.S.

The World Health Organization announced another daily record in the number of confirmed coronavirus cases across the world—topping over 189,000 in a single 24-hour period. The tally eclipses the previous record a week earlier at over 183,000 cases, showing case counts continue to progress worldwide.

Overall, the U.S. still has far and away the most total cases. At more than 2,450,000—roughly twice that of Brazil. The number of actual cases worldwide is much higher.

New York, once the nation’s pandemic epicenter, is now “on the exact opposite end,” Gov. Andrew Cuomo said in an interview with “Meet the Press.”

The state reported five new virus deaths Saturday, its lowest reported daily death toll since March 15. During the state’s peak pandemic in April, nearly 800 people were dying every day. New York still leads the nation in COVID-19 deaths with nearly 25,000.

In the state of Washington, Gov. Jay Inslee put a hold on plans to move counties to the fourth phase of his reopening plan as cases continue to increase. But in Hawaii, the city of Honolulu announced that campgrounds will reopen for the first time in three months with limited permits to ensure social distancing.

Britain’s government, meanwhile, is considering whether a local lockdown is needed for the central English city of Leicester amid reports about a spike in COVID-19 among its Asian community. It would be Britain’s first local lockdown.

“We have seen flare-ups across the country in recent weeks,” Home Secretary Priti Patel told the BBC on Sunday.

Polish voters were casting ballots, in person and by mail, for a presidential election that was supposed to have taken place in May but was chaotically postponed amid the pandemic. President Andrzej Duda, a 48-year-old conservative backed by the nationalist ruling Law and Justice party, is running against 10 other candidates as he seeks a second five-year term. Iwona Goge, 79, was encouraged to see so many people voting in Warsaw. “It’s bad. Poland is terribly divided, and people are getting discouraged,” she said.

French voters were choosing mayors and municipal councilors in Paris and 5,000 towns and cities in a second round of municipal elections held under strict hygiene rules. Key battlegrounds include Paris, where the next mayor will preside over the 2024 Summer Olympics.

Italy was honoring its dead later Sunday with an evening Requiem concert in hard-hit Bergamo province. The ceremony in the onetime epicenter of the European outbreak came a day after Italy registered the lowest daily tally of COVID-19 deaths in nearly four months: eight.

European leaders were taking no chances in tamping down new clusters. German authorities renewed a lockdown in a western region of about 500,000 people after about 1,300 slaughterhouse workers tested positive. Swiss authorities ordered 300 people into quarantine after a “superspreader” outbreak of coronavirus at a Zurich nightclub.

Africa’s confirmed cases of COVID-19 continued to climb to a new high of more than 371,000, including 9,484 deaths, according to figures released Sunday by the African Centers for Disease Control and Prevention.

Justice Department Issues Warning About Fake Mask Exempt Cards

Jason Slotkin reported that The Department of Justice has issued an alert about a card circulating online falsely claiming that holders are legally exempt from wearing a mask. Public health officials overwhelmingly recommend wearing a mask when going out in public.

Public health experts overwhelmingly agree that one of the best ways to slow the spread of the coronavirus is to wear a mask. Still, the seemingly straightforward recommendation to secure a covering over one’s nose and mouth has proven one of the pandemic’s more partisan issues.

The Department of Justice is now warning that a card circulating online is falsely claiming its holder is lawfully exempt from wearing a mask.

A recently issued alert by the department is urging the public not to heed information printed on the fraudulent cards, which purport to carry the authority of the “Freedom to Breathe Agency,” which is neither a federal nor a state agency.

The fake card states that wearing a mask will incur mental or physical risk for the holder. The card also posits that the Americans with Disabilities Act forbids raising questions about the health condition aggravated by mask usage. Penalties are threatened if a business owner does not act accordingly.

“If found in violation of the ADA you could face steep penalties. Organizations and businesses can be fined up to $75,000 for your first violation and $150,000 for any subsequent violations. Denying access to your business/organization will be also reported to FTBA for further actions,” the card reads, according to images that have been posted online.

At least some versions of the card appear to bear an official looking Justice Department insignia. In its alert, the department disavowed any role in the card’s creation or dispersal, saying, “These postings were not issued by the Department and are not endorsed by the Department.”

The department also said not to rely on information included on the card and instead to visit the Americans with Disabilities Act website.

It’s unclear how many cards are in circulation, but it appears to have been spread via a Facebook page belonging to a group calling itself the Freedom to Breathe Agency.

The Centers for Disease Control and Prevention has been recommending people wear cloth or fabric face coverings since April. Many states and localities have gone on to require or urge their wearing in public — especially in enclosed spaces. Businesses large and small have also adopted the recommendation, requiring both staff and customers to wear them.

Masks have emerged as a major political flashpoint — often in response to stay-at-home orders that state and local governments put in place to slow the outbreak. Despite his own government’s guidance, President Trump has said he will not be wearing a face mask, and protesters in multiple states have been seen without masks as they amassed in defiance at coronavirus restrictions.

In many online videos, staffers at food and retail establishments have been seen contending with customers who refuse to cover their faces.

The CDC — still — recommends wearing a mask when going out in public.

Dr. Saphier on prolonged school and summer camp closures: The mental health effects for kids are real

David Montanaro of Fox NewsFox reported that news medical contributor Dr. NicoleSaphier said Wednesday that the mental health effects on children during the coronavirus shutdowns are a real concern, as many summer camps have declined to open this year.

Speaking on “Fox & Friends,” Saphier said “94 percent of superintendents” across the country are not ready to talk about plans for reopening schools in the fall, raising concerns about the effects on children.

“This conversation is being prompted by surveys out of Italy and China where they reported that children were experiencing anxiety up to 70 percent of the time, saying that they were having feelings of anxiety or difficulty breathing. Those surveys were done from March and April. I would like to see more modern ones or more up-to-date ones. Let me tell you, as a mother having three kids at home, the mental health effects of these shutdowns are real,” she said.

Saphier said she’s concerned that the negative impact on children will be long-lasting if they continue to be kept at home rather than going to school. “Going to school for children is not just the fundamental basics of education. It’s learning conflict resolution, socialization skills and building the very necessary relationships and my biggest concern is that the mental health effects are going to be here to stay,” she said, adding that doctors have learned more about COVID-19, including that children are “significantly less susceptible to illness” and they are less likely to transmit the virus than adults.

“There are smart ways that schools can come together and get those kids back in session.”

Sen. Lamar Alexander, R-Tenn., said last week that there is a “growing awareness” among Americans that kids need to go back to school as soon as possible and plans must be created to do that in a safe way.

In an interview on “America’s Newsroom” with hosts Sandra Smith and Ed Henry, the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee pointed out that while kids must be kept safe from coronavirus, both children and their parents are “about up to here with remote learning.” “Any teacher or parent can tell you [about] the emotional [and] the intellectual impact, especially among minority kids,” Alexander told the “Newsroom” hosts.

“I mean, this is a time when we’re all talking a lot about racial injustice and disproportionate effects on low-income and minority kids. The single best thing we can do to help minority children [and] low-income children is to get them back in school. That’s where they learn. That’s where they learn to deal with other children. That’s where many get one meal, sometimes two,” Alexander concluded.

Dr. Fauci says George Floyd protests provide ‘perfect recipe’ for new coronavirus surges

Brie Stimson of Fox News noted that recent protests across the U.S. over the death of George Floyd could lead to new surges in coronavirus cases, Dr. Anthony Fauci  warned Friday.

“It is the perfect set-up for the spread of the virus in the sense of creating some blips which might turn into some surges,” Fauci, a member of President Trump’s Coronavirus Task Force, told radio station WTOP-FM in Washington, D.C.

“It is the perfect set-up for the spread of the virus in the sense of creating some blips which might turn into some surges.”

— Dr. Anthony Fauci 

His comments came as the U.S. edged closer to 2 million confirmed infections and 110,000 virus-related deaths, and the globe neared 7 million infections and 400,000 deaths since the pandemic began, according to Johns Hopkins University.

After months of confinement due to governors’ stay-at-home orders, thousands across the country have taken to the streets for more than a week to protest the police-custody death of Floyd – a black man who succumbed after a white officer kneeled on his neck for nearly nine minutes on May 25 in Minneapolis.

“As I sat in front of the TV and watched the screen go from Washington, D.C., to New York City, to Los Angeles, to Philadelphia, I got really concerned,” Fauci told the Sunday Times of London. “I was going, ‘Oh my goodness. I hope this doesn’t set us back a lot.’ [After] all of the work in trying to maintain the physical distance and doing all the things, I became very concerned that we might see a resurgence.”

While some in the massive crowds have worn masks, others haven’t — and no one is social distancing, he said.

The protests bring together people from different areas, many of them virus hotspots, Fauci said. The participants then return home and create a “perfect recipe” for a resurgence of the virus.

Chanting and yelling, as people typically do during protests, also increases the risk of spread, he said. “I get very concerned, as do my colleagues in public health, when they see these kinds of crowds,” Fauci said. “There certainly is a risk. I can say that with confidence.”

The only thing public health officials can do is constantly remind people to be careful and always wear a mask, Fauci, the director of the National Institute for Allergy and Infectious Diseases, told WTOP.

Officials in cities with protests have urged demonstrators to get tested for the virus. Cities such as Seattle and San Francisco have set up mobile testing centers for protesters. “It’s a difficult situation. We have the right to peacefully demonstrate and the demonstrators are exercising that right,” Fauci added. “It’s a delicate balance because the reasons for demonstrating are valid and yet the demonstration itself puts oneself at an additional risk.”

Note Well-Arizona’s rules for rationing healthcare in the COVID-19 pandemic should terrify you

Michael Hilzik pointed out a scary fact regarding the rationing of healthcare.  You may think that the coronavirus and COVID-19, the disease it causes, are frightening enough. But Arizona has just activated a rulebook for rationing hospital care that is truly terrifying.

In brief, the rules allow hospitals to deny critical healthcare resources such as ventilators to patients based on medical judgments about their likelihood of living even five more years despite surviving COVID-19.

In practical terms, that means that on average, older adults are more likely to be denied care than younger persons. Those with medical conditions other than COVID-19 would be more vulnerable to denials than those judged to be healthier, whatever their age.

Health care planning must do everything possible never to need [Crisis Standards of Care].

National Academies of Science, Engineering and Medicine

Under the rules, doctors making triage judgments that deprive patients of necessary care will be immune from legal liability.

Arizona’s so-called crisis standards of care, or CSC, isn’t unique among the states. But it provides an up-to-the-minute look at the harsh choices facing medical personnel across the country thanks to our unfit and unprepared political leadership, if one can call it leadership at all.

From the federal government down through the states, the vacuum of leadership has exposed millions of Americans to sickness and death while reducing our healthcare system to a patchwork of overwhelmed facilities.

The lack of planning and preparedness is the outstanding failure of the response to the crisis in the United States. That’s the implicit judgment of the National Academies of Science, Engineering and Medicine.

The academies stated in an assessment of crisis standards of care in March that the primary principle was that “health care planning must do everything possible never to need CSC.”

The academies also specified that in the current pandemic, “public trust is essential.” That means that leaders would have to be “proactive, honest, transparent and accountable” when discussing the condition of their healthcare systems and institutions.

Has that happened? The answer obviously is no. President Trump and Republican governors such as Arizona’s Doug Ducey and Florida’s Ron DeSantis have suppressed statistics showing the true rate of infection in their states. Trump’s approach to the crisis has been focused in large part in trying to minimize its impact, even denying its existence.

States other than Arizona have similar rulebooks to be dusted off in a major emergency. Arizona, however, is the only state that has activated its crisis standard of care procedures — so far.

Arizona residents have been among the most resistant to wearing face masks in the coronavirus crisis. (Statista)

“A lot of states actually have activated their crisis standards of care plans,” Cara Christ, director of Arizona’s Department of Health Services, said during a press conference Monday with Ducey. That appears to be untrue. Though most states have prepared a crisis plan, no others have activated it.

Several, however, may be on the verge of doing so, at least regionally, since the surge in cases is placing immense stresses on local capacities. In California, for example, Riverside County’s ICU beds were reported to be 99% occupied over the weekend and Los Angeles County is projecting the possibility of running out of hospital beds in two to three weeks and exhausting its intensive care unit beds sometime in July.

In Imperial County, an agricultural county on the Mexican border where 23% of tests are coming back positive for COVID-19, 500 patients were transferred to adjoining counties to relieve the local pressure, Gov. Gavin Newsom said Monday.

California is one of several states ranking as leading hot spots of coronavirus infection, though its statewide test positivity average of 5.9% over the last seven days remains lower than other surging states such as Arizona (24.4%), Florida (15.6%) and Texas (14.1%).

All those states are guilty of having reopened commercial and retail establishments, as well as public facilities such as beaches, too soon — notably before it was clear that they had adequately clamped down on the community spread of the coronavirus.

Newsom has urged Californians to continue social distancing and mask-wearing throughout the crisis; his error was to give local officials too much latitude to decide for themselves when they could reopen their economies. Now Newsom is signaling that such deference may be coming to an end.

Newsom pressured Imperial County into rolling back its reopening, in part by threatening that “the state of California will assert itself and make sure that happens” if officials fail to do so. As my colleague Taryn Luna reports, he also has hinted at statewide orders aimed at imposing anti-virus rules, though he has not been specific.

In other states, governors have been more permissive and even interfered with local officials’ judgments. Until June 17, Ducey forbade cities and counties to impose stricter rules than the state. In practical terms, that prevented them from keeping bars, restaurants and retail establishments closed or requiring residents to wear masks in public.

Ducey relented under pressure from the mayors of Phoenix, Tucson and Flagstaff and in the face of an undeniable surge in COVID-19 cases.

The politicization of mask-wearing, a fundamental tool to defeat the virus, has hampered America’s response. (Yougov)

Ducey’s indulgent approach to social distancing measures probably contributed to his constituents’ failure to embrace them. Polls taken from late March through the end of April showed that only 30% to 40% of Arizona residents regularly wore face masks in public; in California, New York and New Jersey, the rate was as high as 60%.

Arizona waited until March 30 to issue a stay-at-home policy, long after other states. Ducey lifted the policy early, on May 15.

Ducey joined Trump at an indoor political rally in Phoenix on June 23 at which an estimated 3,000 persons were in attendance, crammed shoulder to shoulder and mostly maskless — even though a week earlier the city had ordered masks to be worn. Ducey wore a mask bearing the Arizona state seal, but Trump was maskless.

Not until Monday did Ducey reimpose anti-virus measures, prohibiting large gatherings, ceasing the issuance of new special event licenses, and closing bars, gyms, movie theaters, waterparks and tubing rentals. His order will remain in effect through the month. He didn’t order masks to be worn in public.

By then, the state already had activated its crisis standards of care, or rationing plan. Let’s take a look.

Like other states’ plans, Arizona’s relies chiefly on a metric known as a SOFA Score, for “sequential organ failure assessment.” The score is based on the condition of six major organ systems: lungs, circulatory, heart, kidney, liver and neurological.

Arizona assigns points to patients according to their SOFA score range, to a maximum of four points for the most severely affected. Then it adds up to four more points for a subjective assessment of a patient’s survivability: two points for those whose death is expected within five years despite successful treatment of COVID-19, and four for those whose death is expected within one year despite successful treatment. Priority for treatment is given to those with lower scores.

The guidelines state that judgments are to be made regardless of “race, ethnicity, color, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity, quality of life, or any other ethically irrelevant criteria.”

But several of these factors obviously will play into the point system. Black patients on average tend to suffer from more medical conditions than others, in part because their incomes are lower on average and their access to medical care more limited. Older residents also suffer from more health challenges. And how do medical personnel assess a patient’s “quality of life”?

Some of these factors are especially relevant in Arizona, where residents 65 and older constitute 23% of the adult population, above the national average of 20.7%. Florida skews even older, with 25.6% of its adult population 65 and older.

The prospects of subjective judgments creeping into triage judgments is great because the SOFA score itself, despite its apparent objectivity, is an imperfect tool.

The scores are “poor predictors of individual patients’ survival,” the National Academies found in its assessment of crisis standards. That’s especially true for patients suffering acute respiratory failure, one of the key symptoms of COVID-19.

As a result, “these scores are not suitable for excluding patients with acute respiratory failure… from receiving critical care” in the pandemic.

One can’t blame Arizona for implementing a rationing plan aimed at delivering crisis care to those judged most likely to benefit from it. But its leaders can be blamed for allowing the state to reach the point where rationing is deemed necessary. The seeds of its disaster were planted long ago.

Fauci says new mutation of coronavirus spreads quickly: report

Jack Hobbs in the New York Post reported that the country’s top infectious disease expert said Thursday that a more infectious strain of the coronavirus may be emerging.

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, made the claim Thursday in an interview with The Journal of the American Medical Association.

Fauci said research suggests Italy was devastated by a different strain of the coronavirus than the one that originated in Wuhan, China.

The main difference between the two, Fauci said, is that Italy’s version passes from person to person more effectively, making it even more difficult to contain.

“It just seems that the virus replicates better and may be more transmissible,” says Fauci.

The study he references, which was released by researchers affiliated with the Sheffield COVID-19 Genomics Group, states that the new strain “has become the most prevalent form in the global pandemic.”
However, the researchers also found no evidence that this new strain causes worse symptoms than the original.

As of Thursday, The United States had more than 2.7 million confirmed cases, the highest in the world and Dr. Fauci also is warning us that the U.S. could see 100,000 Coronavirus cases a day if this surge continues.

What do we do to protect ourselves and conquer this disease?

And remember to celebrate Independence Day, the Fourth of July! Remember why we celebrate this holiday!

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