Category Archives: COVID-19

Coronavirus update: Florida spike raises doubts over reopening strategy; mask debate gets more political. Then there is the Brazil and Sweden Experience! When will we Learn?

Senior reporter Anjalee Khemlani reported that recently Florida became the focus of rising fears it could become the next U.S. coronavirus hotspot, with surging cases in the West and South leading to increased safety measures, and fanning doubts about nationwide plans to reopen.

Globally cases have surged past 8.5 million, and more than 454,000 have died. In the U.S. nearly 2.2. million cases have been reported, and more than 118,000 are dead. On Friday, the Sunshine State reported a rise in COVID-19 cases of 4.4%, sharply higher than the previous 7-day average of 3.2%.

The relentless climb in domestic cases prompted California’s governor to require mask-wearing in public, while Texas and Arizona recently began to ok enforcing masks in public, amid a spike in new diagnoses in those states. The question is who is going to enforce these regulations? More to come.

Meanwhile, the economy has sent mixed signals about the trajectory of a recovery, according to Morgan Stanley data, underscoring volatility in markets hopeful for a “V-shaped” rebound.

“We note a continuous upward inflection in eating out in restaurants to 26% (from 17% two weeks ago), mainly driven by the South region and rural areas. Visits to the mall, albeit still low, are up to 13% from 8% a month ago,” the bank wrote on Friday.

Political debate over masks

As the debate over wearing face coverings in public gets increasingly political, critics point out that several areas have been lax with mask and distancing measures. The mask controversy — which took center stage in a debate over President Donald Trump’s weekend rally in Tulsa — is rooted in a perceived infringement on individual freedom, and disputed claims about face masks reducing the intake of oxygen.

Yet public health experts point to the success in New York and New Jersey, two former epicenters that are now relaxing stay-at-home orders, in implementing such measures to control the outbreak. Actually, if you want to see success, look at the Maryland strategy regarding the management, restrictions, etc. of the coronavirus complexities.

Public health experts expressed concerns with AMC’s (AMC) plan to reopen theaters without enforcing masks Thursday. The company’s CEO explained he wanted to avoid the politically controversial topic of mask-wearing — a decision that sparked more debate.

The company reversed the decision Friday, announcing in a statement that moviegoers will be required to wear masks.

Dr. Ashish Jha, director of Harvard’s Global Public Health Institute, said on Twitter the politicizing of masks will create more confusion and a “dilemma” for businesses eager to return to normal.

“It may feel easier to let customer choose. But long run success requires companies courageously undertake evidence-based actions that keep customers safe,” Jha said.

Separately, Japan has lifted all coronavirus restrictions for businesses, marking another country’s full reopening this month. The country has had fewer than 100 cases daily in the past month.

Vaccine coverage

China appeared to gain a leg up in the worldwide race for a COVID-19 vaccine, announcing on Friday that one of its pharmaceutical companies could begin the next phase of human tests as early as the fall.

Senior U.S. government officials said this week that any successful COVID-19 vaccine was likely to be free to “vulnerable” individuals who can’t afford them.

In addition, health plans are likely to cover at no cost to members— similar to the coverage of testing and inpatient services, which has seen bills as high as $1.1 million settled between insurers and funding from Congress.

Vulnerable individuals, those without insurance or on Medicaid, belong to a largely underserved population. Some providers refuse to accept Medicaid because of its traditionally low reimbursement for care.

The CARES Act has provisions, along with the preventative coverage mandates of the Affordable Care Act, that could address some pockets of accessibility. The bill includes language “to cover (without cost-sharing) any qualifying coronavirus preventive service” for commercial insurers.

For Medicare, in addition to the flu vaccine, the law now includes “COVID–19 vaccine and its administration,” and for Medicaid, states are required to cover “any testing services and treatments for COVID– 19, including vaccines, specialized equipment, and therapies” without cost-sharing.

But it still leaves out self-insured and uninsured — which make up more than half of the U.S. population. At least 56% of the population is on self-insured plans, which have had the option to cover. members’ COVID-19 testing and hospital visits during the pandemic.

As states see coronavirus surges, health officials say combination of factors responsible

So, what is the cause of these surges? Bryn McCarthy reported that this past week, states throughout the nation have seen surges in coronavirus cases, with the average number of new cases per day increasing by about 20 percent to nearly 24,000 cases per day. Health officials say a combination of factors is likely responsible for these increases.

“It’s multifactorial,” said Dr. Janette Nesheiwat, family and emergency medicine physician and medical director of CityMD, said. “The initial wave of COVID-19 is still with us, hitting each state at different points in time. We see more cases because we are doing more testing. Also, the country is reopening, which means an increase in mobility of people, which by nature means we will have more cases.”

States reopening, increased testing and “quarantine fatigue” are largely responsible for these surges, according to experts. Dr. Marty Makary, professor of surgery, health policy and management at Johns Hopkins and Fox News medical contributor, said the disregard for distancing and use of masks in some parts of the country has greatly influenced the hospitalization highs of late. “We are seeing increases in hospitalizations in Texas, North Carolina, South Carolina, Arizona, Florida, Arkansas and other states resulting not from institutional spread, such as nursing homes and meatpacking outbreaks,” Makary said, “but instead from daily activity.”

Health officials stress the importance of hospitalization rates and number of deaths over the number of positive cases. Over the past week, there were, on average, about 660 deaths due to COVID-19 in the U.S. Over the past three days there were on average about deaths 770. “This is very concerning because we are seeing these increases amidst an expected seasonal decline associated with entering the summer,” Makary said. “I’m concerned we’ll have a lot of cases seeding the next wave in the fall. If you think about it, the current wave was seeded by a few dozen cases in January and early February. We may be seeding the next wave with 100,000-200,000 cases going into the next cold season.”

A model produced by the University of Washington predicts that the United States will have over 201,000 COVID-19 deaths by Oct. 1. Nesheiwat feels this prediction is accurate. “We have roughly 600 to 700 cases per day,” Nesheiwat said. “Mobility increases transmission of COVID, for example, the protests where we had massive large crowd gatherings with people shouting and screaming spewing viral particles into the air close in contact with each other, or Mother’s Day church gatherings, or states that opened without following recommended guidelines.”

So how can we bring these numbers back down? “Aggressive case management is the way to bring down case numbers and hospitalizations,” said Dr. Amesh Adalja, infectious disease doctor and senior scholar at the Johns Hopkins Center for Health Security. “The virus is with us. People need to take actions realizing that there is nothing that is without risk. It will be important to think about social distancing as we go through this pandemic without a vaccine.” He says the best way for people to decrease their risk of becoming infected is by decreasing their physical interaction with others, observing social distancing norms, handwashing frequently, avoiding highly congregated places and possibly wearing face shields.

Makary said it’s all about slowing the spread. “More important than creating new regulations is convincing people to practice good behavior around best practices,” Makary said. “I would say that complacency is our greatest threat going into the fall.”

Health experts are urging people to reconsider nonessential activities in areas where cases and hospitalizations are on the rise. “For example, schools can hold classes but should consider postponing nonessential field trips and contact sports this year in areas with active infections,” Makary said. “National organizations should postpone their in-person conferences since travel is a well-known vector of transmission. Retail should attempt to move their activities outdoors if feasible to do so.”

While health officials recognize that humans are, by nature, social creatures who crave interaction with others, the novel virus and its deathly effects are not exaggerated, as some have started to believe. “COVID is not an exaggeration,” Nesheiwat said. “I have seen firsthand patients dying in my arms. It is heart-wrenching to see someone’s life taken too soon. The virus can affect anyone at any age. It is still here and it’s deadly.”

Makary agreed, reiterating how the virus affects all of society, especially the most vulnerable members, such as children, those with disabilities and the elderly. But nonetheless he remains optimistic and urges others to do the same. “This is not a fate we have to accept, but one we can impact,” Makary said.

Brazil’s coronavirus cases top 1 million as the virus spreads

Caitlin McFall noted that Brazil’s government announced Friday that its coronavirus outbreak has surpassed a million cases, making it second-leading nation in the world to the United States in coronavirus infection rates. “Almost half of the cases reported were from the Americas,” World Health Organization General-Director Tedros Adhanom Ghebreyesus told a virtual briefing. “The world is in a new and dangerous phase … the virus is still spreading fast, it is still deadly, and most people are still susceptible.”

The Brazilian President Jair Bolsonaro maintains that the repercussions from social distancing measures still outweigh the severity of the virus in the country. Bolsonaro has repeatedly downplayed the virus, referring to the coronavirus as a “little flu,” and told reporters earlier this month that he “regret[s] all the dead but it is everyone’s destiny.”

The United States, which has a population 56 percent bigger than Brazil, has reported over 2.2 million cases. But health experts believe that the infection rate could be as much as seven times higher in Brazil. Johns Hopkins University has reported that Brazil is conducting 14 tests a day for every 100,000 people, but medical officials say the number of tests is up to 20 percent less than what they should be to accurately track the virus. Although data shows that the virus is reaching a plateau in the cities near the Atlantic in the north, the rural countryside towns, which are less equipped to deal with the crisis, are seeing a spike in cases.

“There is a lot of regional inequality in our public health system and a shortage of professionals in the interior,” Miguel Lago, executive director of Brazil’s Institute for Health Policy Studies. said. “That creates many health care deserts, with people going long distances to get attention. When they leave the hospital, the virus can go with them,” Lago added.

Brazil, which has seen 50,000 deaths according to their Ministry of Health, has struggled to maintain a health minister during the crisis. Former Health Minister Dr. Nelson Teich resigned in May, after serving in office for only month. Reports later surfaced of his disagreements with Bolsonaro on social distancing measures and whether or not the anti-malaria drug, chloroquine, should be distributed. Teich referred to the drug as “an uncertainty” and differed with the president over how to balance the economy with the crisis.

His predecessor, Luiz Henrique, was fired from his position of health minister after also disagreeing with the president on how to handle the pandemic. Bolsonaro has not yet filled the health minster role, even as the country has evolved into the new epicenter of the coronavirus.

California county sheriff says he won’t enforce Newsom’s coronavirus mask order

Remember my question at the beginning of this post, who will enforce the mask and then stay-at home orders? Nick Givas reported that the sheriff’s office for Sacramento County announced on Friday that it will not enforce Gov. Gavin Newsom’s coronavirus order, which requires residents to wear masks or facial coverings while they are out in public. Can you blame them?

The announcement came just one day after Newsom, a Democrat, issued the statewide order mandating the use of facemasks.

In a statement posted to Facebook, the sheriff’s office said residents should be “exercising safe practices” in the face of COVID-19, including the use of masks, but it also deemed the idea of enforcement to be “inappropriate,” because it would criminalize average Americans for a relatively small infraction.

“Due to the minor nature of the offense, the potential for negative outcomes during enforcement encounters, and anticipating the various ways in which the order may be violated, it would be inappropriate for deputies to criminally enforce the Governor’s mandate,” Sheriff Scott Jones’ statement read. Deputies will instead work “in an educational capacity,” alongside health officials, to avoid any further escalation between bystanders and law enforcement.

Jones added, however, that employees will comply with the governor’s order as much as is pragmatically possible. “As for the Sheriff’s Office and its employees, we will comply with the Governor’s mask recommendations to the extent feasible,” the message concluded.

Newsom said in his initial statement that, “Science shows that face coverings and masks work,” and “they are critical to keeping those who are around you safe, keeping businesses open and restarting our economy.” This news comes as California gets ready to broadly reopen the state economy. People can now shop, dine in at restaurants, get their hair done and go to church in most counties. Overall, there have been 157,000 reported cases of coronavirus in the state and more than 5,200 deaths, as of Thursday.

New Study Casts More Doubt on Swedish Coronavirus Immunity Hopes

Johan Ahlander reported that Sweden’s hopes of getting help from herd immunity in combating the coronavirus received a fresh blow on Thursday, when a new study showed fewer than anticipated had developed antibodies.

Sweden’s has opted for a more liberal strategy during the pandemic, keeping most schools, restaurants, bars and businesses open as much of Europe hunkered down behind closed doors.

While Health Agency officials have stressed so-called herd immunity is not a goal in itself, it has also said the strategy is only to slow the virus enough for health services to cope, not suppress it altogether.

However, the study, the most comprehensive in Sweden yet, showed only around 6.1% of Swedes had developed antibodies, well below levels deemed enough to achieve even partial herd immunity.

“The spread is lower than we have thought but not a lot lower,” Chief Epidemiologist Anders Tegnell told a news conference, adding that the virus spread in clusters and was not behaving like prior diseases.

“We have different levels of immunity on different parts of the population at this stage, from 4 to 5% to 20 to 25%,” he said.

Herd immunity, where enough people in a population have developed immunity to an infection to be able to effectively stop that disease from spreading, is untested for the novel coronavirus and the extent and duration of immunity among recovered patients is equally uncertain as well.

Sweden surpassed 5,000 deaths from the coronavirus on Wednesday, many times higher per capita than its Nordic neighbors but also lower than some countries that opted for strict lockdowns, such as Britain, Spain and Italy.

Now No-lockdown Sweden is compelling parents to send their children to school. Some fear their kids could ultimately be taken away if they refuse.

Sweden has kept schools open for children under 15, part of its policy of avoiding a widespread lockdown during the coronavirus pandemic. Its policy is that students must physically attend school in almost all circumstances, including students with conditions that some evidence suggests may make them more at risk of catching COVID-19.

Business Insider spoke to parents across Sweden who are disobeying the rules to keep their kids home. Many say local officials have threatened to involve social services if the parents do not relent and send their children to school. Some parents say their ultimate fear is having their children taken away.

Swedish officials told Business Insider they would not usually resort to such an extreme measure, though did not deny that it is a possibility. Sweden is compelling parents to keep sending their children to school — including students with conditions that some evidence suggests may make them more at risk of catching COVID-19 — as part of its policy to avoid a full scale lockdown in response to the coronavirus.

While school systems in other countries have ceased or greatly restricted in-person learning, Sweden says that anyone under 15 should keep going to school. There are almost no exceptions. Some parents have refused to comply, sparking a stand-off with state officials. They worry this could eventually end with their children being taken away — the ultimate reprisal from the government — though officials stress that this would only happen in extreme scenarios.

Business Insider spoke to seven parents and teachers across Sweden, many of whom have decided to keep their children home despite instructions from the government to the contrary. For some, it is their children who they believe are at elevated risk for COVID-19, while others consider themselves vulnerable and fear their children could bring the disease home. In each case, Business Insider contacted officials responsible for the child’s education, but none offered a response by the time of publication. Mikaela Rydberg and Eva Panarese are both mothers in Stockholm who are keeping their children home.

Ryberg’s son Isac, who is eight years old, has cerebral palsy and suffers badly from respiratory illnesses. Rydberg said he had been hospitalized before with colds and flu. However, her efforts to persuade his school that he should be kept home to shield from COVID-19 have not been successful.

Swedish health officials do not consider children as a group to be at risk from the coronavirus — even children like Isac. As this is the official advice, doctors have declined to give Isac a medical exemption from school. Instead, Rydberg has kept him home since March against the school’s instructions, which she said prompted local government officials to tell her that they may have to involve social services. 

The school did not respond to Business Insider’s request for comment, while the local government, Upplands Väsby, said, “We follow the recommendations from our authorities and we do not give comments on individual cases.” She said that because it is a question of her child’s welfare, she is not worried about what could follow. “I am so certain myself that I am right, I am not worried about what they threaten me with,” she said.

“Unless you can 100% reassure me that he won’t be really, really sick or worse by this virus, then I will not let him go to school.”

‘School is compulsory’- This is lunacy!!

Eva Panarese is a mother of two. She is keeping her son home to minimize exposure to her husband, who has recently suffered from pneumonia. Panarese said she reluctantly sent her daughter back to school because exam seasons is approaching and she felt there was no other option.

Emails from the child’s school reviewed by Business Insider insist that children come to school during the pandemic, citing government policy. One message, sent in April, said: “We need to emphasize again that school is compulsory.”

Panarese said her situation shows that it isn’t possible to protect some members of a household if others are still obliged to go to school and risk infection. “I don’t know who will be right or wrong but I don’t want the risk,” she said. “I don’t want to be part of a grand experiment.” The school did not respond to Business Insider’s request for comment.

No exceptions

Sweden’s Public Health Agency says there is “no scientific evidence” that closing schools would help mitigate the spread of the virus. The agency said doing so “would have a negative impact on society” by leaving essential workers struggling to find childcare. It said such a policy might put other groups of people — like grandparents — at increased risk if they care for children.

Sweden has strong beliefs in the rights of the child, which includes the right to education, and typically does not allow that learning to take place outside of school. Only staff or children with symptoms should stay home, the Public Health Agency says.

Sweden does not include children as an at-risk group, even children who have conditions that they acknowledge increase the vulnerability of adults, like diabetes, blood cancers, immunosuppressive conditions, or ongoing cancer treatments.

Studies suggest children are generally less at-risk than other groups, but most countries have nonetheless closed schools, or radically changed the way they operate. New effects of the virus on children are also being discovered as the pandemic progresses.

The government is continuing its usual policy, which says that when children are repeatedly absent, schools are supposed to investigate and, in some cases, report the situation to local authorities, which can involve social services. Fears over the coronavirus is not considered a valid reason for keeping children home.

Afraid of losing their kids

Ia Almström lives in Kungälv, around half an hour’s drive from Sweden’s second-largest city, Gothenburg. Authorities there have threatened to take her to court if her kids remain out of school. Almström has three children, whom she has kept home since April because she faces an increased risk from the virus because of her asthma. She received a letter from the local government on May 5, seen by Business Insider, which said that she could be referred to social services, where she could face a court order or a fine.

The authority in question, Kungälvs Kommun, declined to comment on Almström’s case. Almström said: “It is heartless how Sweden treats us. They do not take our fears seriously. We get no help, only threats.” Almström said she and many parents “are afraid to lose our children or something.” “That is what they do when they think that parents [cannot] take care of the children. Then they move the children away. So that’s something we are afraid of.”

Last resort. Read on This is more than lunacy!!

A spokeswoman for Sweden’s National Board of Health and Welfare said that taking a child away is the government’s last resort. She said: “Normally, the social services will talk to the child, parents, and the school – trying to find out the underlying problem.” “It is a big step to take a child away from the parents – not only school absence will normally be a reason to place a child in residential care or in foster home,” she said, implying that other issues with how the children are being treated or raised would need to be found for the action to take place.

However, escalation is not the only way out — some parents reach a compromise with their schools. Jennifer Luetz, who is originally from Germany, lives some 100 miles from Stockholm in the town of Norrköping. She said she contacted her children’s school on March 12 to say they would be staying home, as she has a weakened immune system.

She said the school was “understanding” and helped her children to work at home. The officials, she said, decided not to escalate her case as she what she described as a “valid reason” to keep her them at home.

Other parents have struggled to reach similar agreements. And Luetz said she is still worried by Sweden’s public health approach, and has faced social consequences for her decision. “My Swedish support network basically dried up overnight,” she said. “My Swedish friends stopped talking to me.” 

Teachers worry, too

One teacher in Stockholm, who asked to remain anonymous as they were not authorized to speak, said that they agree with many of the parents keeping their children away.

The teacher told Business Insider: “I do not believe that a good epidemiologist would make us send our children to school when many homes have at-risk people living in the same household.” The teacher is originally from the US but has lived in Stockholm for six years, and said their spouse is in a risk group. The teacher said they worry for the health of older teachers and parents who are elderly or otherwise vulnerable. 

Andreia Rodrigues, a preschool teacher who also works in Stockholm, called the government’s plan “unacceptable.” She said it leaves parents having “to decide if they want to take on a fight with the school and then take the consequences.” “Even if kids have parents who are confirmed to have COVID-19 at home, they are still allowed to be there,” she said. “We cannot refuse taking kids, even if the parents come to us and admit ‘I have COVID-19.'” ‘We have been lucky not to be reported yet’

Lisa Meyler, who lives in Stockholm, said she has been keeping her 11-year-old daughter home since March. Meyler has an autoimmune disease while her husband is asthmatic. “We refuse to knowingly put our daughter’s health and life at risk,” Meyler said, saying she will “not let her be a part of this herd immunity experiment.” “We have been lucky not to be reported yet, but it has been made clear that it is not an option to let her stay home after the summer holidays.”

The school that her daughter attends did not respond to Business Insider’s request to clarify its policy. She said having “children taken away is the ultimate fear” for parents.

Fauci: Next Few Weeks ‘Critical’ in COVID Fight

I think that Dr. Fauci is correct in his comments before the House panel. Dr. Anthony Fauci testified before a House panel Tuesday, and his assessment of the coronavirus fight is notably darker than President Trump’s. Fauci summed it up as a “mixed bag,” citing progress in states such as New York but a “disturbing surge in infections” elsewhere, in part because of “community spread.” That’s in contrast to statements from Trump and Mike Pence chalking up the rise to increased testing, reports the Washington Post. Fauci’s warning: “The next couple of weeks are going to be critical in our ability to address those surges we are seeing in Florida, Texas, Arizona, and other states,” he said, per the New York Times.

3 States See Record High in Daily Coronavirus Infections After Reopening; and What About the Rest of the World?

Many were waiting whether lockdowns were the answer to this pandemic, especially when we learned that Sweden didn’t mandate lockdowns or self-quarantines. But low and behold we learn of the spike in infections and deaths at the end of last week. In the article by Meghan Roos, 6/12/2020, In Sweden, Where No Lockdown was Ever Implemented, there was an increase one day spike of 1,474 on Thursday, 6/11/2020. Swedish health officials reported 49,684 infections and 4,854 deaths by Friday 6/12/2020. This country now has one of the highest per capita fatality rates in the world with an estimate 10 per cent of all COVID-19 cases resulting in death, accounting to date from John Hopkins University.

Now, as Nick Visser reported that Texas, Arizona and Florida all reported their highest daily increases in new coronavirus cases on Tuesday, even after all three states implemented and later lifted stay-at-home orders meant to stop the spread of infections.

State officials in Florida reported 2,783 new cases, in Texas, 2,622, and in Arizona, 2,392. All three states have seen social distancing regulations relaxed for weeks, and most businesses have been allowed to reopen in some capacity.

The figures come amid ongoing efforts by President Donald Trump and other Republican leaders to downplay the ongoing spread of the virus. At least 21 states have seen rates of new cases increase over the last two weeks as a majority of the country reopens.

At the same time, Trump has been pushing misleading claims that infections are only increasing because there’s more testing, going so far as to claim Monday, without evidence, that “if we stop testing right now, we’d have very few cases, if any.”

The president is also preparing to hold a massive rally in Oklahoma this weekend with 20,000 attendees at an indoor arena, despite pleas from local officials and health professionals that the event could quickly lead to a renewed outbreak in the state. Infection rates in Oklahoma rose 68% in the second week of June. 

“I’m extremely concerned,” Bruce Dart, the executive director of the Tulsa health department, told the Tulsa World. “I think we have the responsibility to stand up when things are happening that I think are going to be dangerous for our community, which it will be. It hurts my heart to think about the aftermath of what’s going to happen.”

Other state leaders have pushed back their own reopening efforts as cases have surged, including the governors of Utah and Oregon.

But in Florida, Gov. Ron DeSantis (R) said he was not considering another shutdown despite the surge in cases. He also rolled out the White House’s misleading talking point that cases were rising only because of increased testing.

“We’re not rolling back,” DeSantis said during a press briefing, according to the Miami Herald. “The reason we did the mitigation was to protect the hospital system.”

“You have to have society function,” he added. “To suppress a lot of working-age people at this point I don’t think would be very effective.”

In Arizona, some health officials were already reporting a strain on hospitals’ intensive care capacity due to a spike in coronavirus cases, even as Gov. Doug Ducey (R) said any concern was “misinformation” and said the facilities were prepared to handle an influx in patients.

And in Texas, Gov. Greg Abbott (R) said that, despite his own state’s figures, hospital capacity remained “abundant.”

“The more Texans protect their own health, the safer our state will be and the more we will be able to open up for business,” he said Tuesday.

Dr. Anthony Fauci, the country’s top infectious disease expert, said that, despite the attempts to alleviate any concern, some states jumped the gun on reopening before meeting White House criteria on case levels.

“There certainly were states that did not strictly follow the guidelines that we put out about opening America again,” Fauci said in an interview with NPR. “Clearly there were states that ― left to their own decision about that ― went ahead and opened to a varying degree … certainly before they got to the benchmarks that they needed to get.”

Recent news report is that multiple Florida hospitals have run out of ICU beds as the Coronavirus cases continue to spike.

In This State, the Virus Is ‘Spreading Like Wildfire’

Jenn Gidman noted that as states start to reopen, as well as the recent ongoing protests, amid the pandemic, there’s a red flag rising out of the Southwest. Business Insider reports the coronavirus outbreak “is going very badly” in Arizona, with more than 4,400 new cases over the weekend, bringing the total number of cases in the state to more than 37,500 as of Sunday, with nearly 1,200 deaths. Per Healthline, there’s been a 300% increase in reported cases since May 1. Tucson.com reports that in just one week (from May 31 to June 6), the state saw its biggest week-to-week increase yet: 7,121 new coronavirus patients, or about a 54% increase from the previous week. Meanwhile, the Arizona Republic reports that hospitalizations are on the rise as well, with two straight weeks of statewide hospitalizations surpassing 1,000 daily—the highest number since state reporting began in the beginning of April. Will Humble, a former director of the state’s Department of Health Services, says the spike is “definitely related” to the state’s stay-at-home order being dropped on May 15, per Newsweek. More on the Grand Canyon State:

Eyewitness to tragedy: CBS 5 talked to one doctor who works at two Phoenix hospitals, and he described what he’s been seeing in ERs and ICUs. “He asked if he could make a call in the hospital,” he says of one elderly patient. “It was very tragic to hear him say goodbye to his godkids and grandchildren, who you could really tell loved him.”

Texas Governor Says ‘No Reason Today to Be Alarmed’ As Coronavirus Cases Set Record

One question that I have is if states or cities declare a lockdown whether people will adhere to the lockdown?  Laurel Wamsley reported that Texas has seen a recent uptick in the number of COVID-19 cases, with a record level of new cases and hospitalizations announced Tuesday. People are seen here Monday along the San Antonio River Walk.

Texas Gov. Greg Abbott announced on Tuesday the state’s highest-ever number of new COVID-19 cases: 2,622.

He also reported a second record high: 2,518 people hospitalized with the virus in Texas, up from 2,326 a day earlier.

Despite the concerning uptick in people sick with the virus, Abbott said that the reason for his news conference was to let Texans know about the “abundant” hospital capacity for treating people with COVID-19. He and other officials spent much of the briefing touting the state’s hospital bed availability.

Disclosing the new record high number of hospitalizations related to COVID-19, Abbott emphasized that figure is “really a very small percentage of all the beds that are available.” Texas has so far been spared the high case numbers in other populous states. While it’s the second-largest state by population, Texas currently ranks sixth in terms of cumulative case numbers.

Before releasing the number of new cases, Abbott delved into what he said accounted for the previous daily high on June 10, which had 2,504 new cases. The governor said that spike could be largely attributed to 520 positive tests of inmates in Texas prisons being reported at once as well as a data error in a rural county.

He said there are also reasons for why Tuesday’s new case count was so high: tests results coming from an assisted living facility near Plano; a county south of Austin where positive cases seemed to be reported in batches; and 104 cases in one East Texas county that appear to be primarily from tests at a prison.

But he also pointed to uncareful behavior as a possible driver in some of the new cases. Abbott said there were a number of counties where a majority of those who tested positive for the coronavirus were under the age of 30, which he attributed to people going to “bar-type” settings or Memorial Day celebrations and not taking health precautions.

Abbott said that measures such as wearing masks, hand sanitizing and social distancing are what make it possible to reopen the state’s economy and Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, struck the same note.

“The message is we are seeing some increase in the number of COVID patients in the state. We expected this,” he said. “But we are seeing it occurring at a manageable level. I really want to stress that the continued success is up to the people of the state of Texas.”

Despite Abbott’s emphasis on the importance of masks, he has barred Texas cities from implementing any rules that would require face coverings. Abbott signed an executive order on April 27 that says while individuals are encouraged to wear face masks, “no jurisdiction can impose a civil or criminal penalty for failure to wear a face covering.”

On Tuesday, the mayors of nine Texas cities — including Houston, Dallas, San Antonio, Austin, Fort Worth and El Paso — sent a letter to the governor asking for the authority to set the rules and regulations on the use of face coverings.

“A one-size-fits-all approach is not the best option. We should trust local officials to make informed choices about health policy. And if mayors are given the opportunity to require face coverings, we believe our cities will be ready to help reduce the spread of this disease,” they wrote. “If you do not have plans to mandate face coverings statewide, we ask that you restore the ability for local authorities to enforce the wearing of face coverings in public venues where physical distancing cannot be practiced.”

Abbott said Tuesday that judges and local officials have other tools available for enforcement such as issuing fines for gatherings that don’t follow state protocols.

Austin Mayor Steve Adler extended a stay-at-home warning on Monday amid the news of rising cases – but that warning could only be advice to residents and not an order due to the state’s preemption.

“People are confused,” Adler told NPR’s Steve Inskeep on Tuesday. “They just don’t know at this point if it’s really important to wear face coverings or not, because I think they’re feeling like they’re getting mixed messaging — not only from state leadership but from national leadership. So, we’re just not getting the vigilance that we need on these efforts.”

And the Surges In COVID-19 Cases Cause Friction Between Local Leaders, Governors

In Austin, Adler said, you’ll see most everyone wearing a mask in grocery stores but not in restaurants or music clubs: “When we started opening up the economy and when the governor took away from cities the ability to make it mandatory, more and more people stopped wearing them.”

Adler said he agreed with Abbott that face coverings are key to reopening parts of the economy, even if they’re unpleasant for wearers.

“I know it’s inconvenient. I know it’s hot. I know it’s a nuisance,” Adler said. “And it’s hard to do, and people don’t like it. But at the same time, our community has to decide just how much we value the lives of folks in our community that are over 65 and older. We have to decide how much we value the lives of the communities of color that are suffering disproportionately because of this virus.”

Florida Officials Spar Over Rising COVID-19 Cases

Greg Allen reported that in Florida, where there’s a surge of new COVID-19 cases, officials are divided over what to do about it. The state saw 2,783 new cases Tuesday. It was the third time in the past seven days that Florida set a new daily record.

Florida Gov. Ron DeSantis and other Republican officials, including President Trump, say the rising number of new cases was expected and is mostly the result of increased testing. Florida is now testing more than 200,000 people a week, more than double the number tested weekly in mid-May.

But local officials and public health experts are concerned about other statistics that show that the coronavirus is still spreading in Florida. The state’s Department of Health reports that the number of people showing up in hospital emergency rooms with symptoms of the flu and COVID-19 is rising. Also, worrisome — the percentage of people who are testing positive for the virus is going up, total positive residents are 63,374 with 11,008 hospitalizations and 2,712 deaths.

In Palm Beach County, health director Alina Alonso says the rising positivity rate is a clear sign that the new cases can’t just be attributed to increased testing. Since Palm Beach County began allowing businesses to reopen, Alonso says, the percentage of people testing positive has jumped from 4.9% to 8.9%. “The fact that these are going up means there’s more community spread,” she says. “The virus now has food out there. It has people that are out there without masks, without maintaining distancing. So, it’s infecting more people.”

Alonso say the number of people hospitalized for the coronavirus has also gone up in Palm Beach County. “The numbers are very concerning to the hospitals,” she says. So far, the number of deaths from COVID-19 has remained low. But Alonso says deaths lag behind new recorded cases by about six weeks. She thinks the number of deaths will also rise. “We need to be cautious at this time. Wait a little bit until we see whether or not that happens,” she says. “If we go forward without waiting to see what is going on … by the time we get those deaths, it will be too late.”

Palm Beach County currently isn’t requiring residents to wear face coverings when in public places. County commissioners are now considering following the lead of Broward and Miami-Dade counties and making face masks mandatory.

In Tallahassee, DeSantis held a news conference where he responded to concerns about the rising positivity rate. Much of it, he said, is related to outbreaks among farmworkers and people in prison. Among the incidents he highlighted — a watermelon farm near Gainesville where, out of 100 workers tested, 90 were positive. DeSantis said, “When you have 90 out of 100 that test positive, what that does to positivity — that’s huge numbers.” Some of the other localized outbreaks among farmworkers, he noted, were in Palm Beach County.

DeSantis said there’s no reason to consider rolling back the rules allowing businesses to reopen at the moment. He has encouraged the resumption of sports events and attended a NASCAR race in Homestead, Fla., on Sunday with a few hundred other spectators. And he successfully lobbied for Florida to host President Trump’s acceptance speech at a Republican National Convention event in Jacksonville. That gathering is expected to draw thousands.

Democrats have become increasingly critical, saying DeSantis is ignoring important data that favor a more cautious response. Florida’s top elected Democrat, Agriculture Commissioner Nikki Fried, said, “Refusing to acknowledge the alarming patterns in cases, hospitalizations and positivity is not only arrogant but will cost lives, public health and our economy.”

Asymptomatic coronavirus transmission appears worse than SARS or influenza — a runner can leave a ‘slipstream’ of 30 feet

Quentin Fottrell reported that the WHO currently estimates that 16% of people are asymptomatic and can transmit the novel coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness. One study says that asymptomatic transmission “is the Achilles” heel of COVID-19 pandemic control. How worried should you be about asymptomatic transmission of COVID-19?

 hours earlier that transmission of the novel coronavirus in carriers who don’t show apparent symptoms happened in “very rare” cases.

Maria Van Kerkhove said it was a “misunderstanding to state that asymptomatic transmission globally is very rare,” and that her comments during a WHO news briefing had been based on “a very small subset of studies.” “I was just responding to a question; I wasn’t stating a policy of WHO,” she said.

The WHO currently estimates that 16% of people with COVID-19 are asymptomatic and can transmit the coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness.

Public-health officials have advised people to keep a distance of six feet from one another. Face masks are designed to prevent the wearer, who may be infected with COVID-19 but have very mild or no symptoms, from spreading invisible droplets to another person and thereby infecting them too. But “there’s nothing magic about six feet,” said Gregory Poland, who studies the immunogenetics of vaccine response in adults and children at the Mayo Clinic in Rochester, Minn., and is an expert with the Infectious Diseases Society of America.

“The virus can’t measure,” he told MarketWatch. “For example, the viral cloud while speaking will extend 27 feet and linger in the air for about 30 minutes. This is more like influenza in the sense that people transmit the virus prior to experiencing any symptoms and some people, of course, will not get sick.”

Asymptomatic transmission “is the Achilles’ heel of COVID-19 pandemic control through the public-health strategies we have currently deployed,” according to a study by researchers at the University of California, San Francisco published May 28 in the New England Journal of Medicine.

“Symptom-based screening has utility, but epidemiologic evaluations of COVID-19 outbreaks within skilled nursing facilities … strongly demonstrate that our current approaches are inadequate,” researchers Monica Gandhi, Deborah Yokoe and Diane Havlir wrote.

Brazil is on track to lead the world in coronavirus cases and deaths, and it still doesn’t have a plan for tackling the outbreak

Amanda Perobelli reported that Brazil could surpass the US in coronavirus cases and deaths by the end of July, according to estimates from the University of Washington.

The country recorded a daily record of 34,918 new coronavirus cases on Tuesday, according to Reuters. And despite the growing number of cases, the country has not created a plan to tackle the outbreak. Brazil could surpass the US in both coronavirus infections and deaths by the end of July, according to the main coronavirus tracking model from the University of Washington.

The country, which has yet to impose a national coronavirus lockdown, is on its way to registering more than 4,000 daily deaths, The Washington Post reported, citing the university. As of Tuesday, Brazil had more than 923,000 coronavirus infections and more than 45,000 deaths. Experts told Reuters the true number of cases was most likely higher.

As The Post noted, the country doesn’t have the same infrastructure to help it handle such a large outbreak as the US. But that hasn’t stopped President Jair Bolsonaro from largely dismissing the crisis the novel coronavirus is causing. In fact, he’s even attacked governors who chose to impose restrictions and threatened to host large barbecues in spite of public-health advice, The Post reported.

Brazil has not initiated a national testing campaign, has not implemented a national lockdown, and is dealing with insufficient healthcare expansion. Reuters reported that that country counted 34,918 new daily coronavirus cases on Tuesday.

In a report in early May, Carlos Machado, a senior scientist with Brazil’s Oswaldo Cruz Foundation, and his team warned that without a lockdown in Rio de Janeiro, the outcome would be “in a human catastrophe of unimaginable proportions.” He now says had his warnings been taken seriously, the outcome would not have been so bleak.

“From the point of view of public health, it’s incomprehensible that more-rigorous measures weren’t adopted,” Machado told The Post. “We could have avoided many of the deaths and cases and everything else that is happening in Rio de Janeiro. It was an opportunity lost.”

Scientists in the country told The Post that the country was veering into unknown territory. “We are doing something that no one else has done,” Pedro Hallal, an epidemiologist at the Federal University of Pelotas, told The Post. “We’re getting near the curve’s peak, and it’s like we are almost challenging the virus. ‘Let’s see how many people you can infect. We want to see how strong you are.’ Like this is a game of poker, and we’re all in.”

Bolsonaro’s approach has been to ignore the problem and sideline health experts

Reuters reported that senior officials leading Brazil’s coronavirus response had claimed the outbreak was under control.

“There is a crisis, we sympathize with bereaved families, but it is managed,” said Braga Netto, who spoke during a webinar held by the Commercial Association of Rio de Janeiro.

The World Health Organization’s regional director Carissa Etienne said Brazil was a major concern, Reuters reported. “We are not seeing transmission slowing down” in Brazil, Etienne said. Etienne said the country accounted for about 4 million coronavirus cases in the Americas and about 25% of the deaths.

The Post described Bolsonaro’s approach as being to ignore and sideline health experts. The Brazilian president fired Luiz Henrique Mandetta, his first health minister, after disagreements on social distancing, and then he fired his replacement, Nelson Teich, because he disagreed with the use of chloroquine as a treatment for coronavirus.

Similar to US President Donald Trump, Bolsonaro has boosted the use of hydroxychloroquine in the past. On Monday, the US Food and Drug Administration revoked the emergency-use authorization issued for the antimalarial drug.

One expert said even the public in Brazil did not heed public-health advice to limit the spread of the virus and continued to congregate without any safety measures implemented.

“It was a failure,” Ligia Bahia, a professor of public health at the Federal University of Rio de Janeiro, told The Post. “We didn’t have enough political force to impose another way. The scientists alone, we couldn’t do it. There’s a sense of profound sadness that this wasn’t realized.”

Presently there is only one country that has declared it COVID-19 cleared, that is Montenegro. New Zealand has declared their country COVID-19 free and then two cases turned up as two people from Europe who traveled to New Zealand tested positive and are now quarantined.

Look at the recent world numbers where the total cases are 8,174,327 with 443,500 deaths. Way too many!

When will it all be over?

Mood darkens in Sweden as high death rate raises tough questions over lack of lockdown, and Now A Second Wave and a Possible Kids’ Epidemic!

Richard Orange noted that Sweden, in deference to the rest of the countries believing in the strategy to lockdown their populace, decided not to use stay-at-home or lockdowns except for the elderly.  Sweden’s opposition has attacked the government for its handling of the coronavirus pandemic, with the stubbornly high death rate fueling questions over the decision not to impose a lockdown. 

Jimmie Akesson, the leader of the populist Sweden Democrats, first called for Anders Tegnell, the architect of Sweden’s less restrictive coronavirus strategy, to resign. The attacks continued in heated televised leaders’ debate on Sunday night.  

“The strategy in Sweden was not to try to hold back the infection, but instead to try to limit it at the same time as protecting risk groups,” Mr Akesson wrote in a debate article in the Dagens Nyheter newspaper.

“By that measure, it has failed miserably. Anders Tegnell should therefore resign. Only then will he show the Swedish people that he takes responsibility for the mistakes FHM [Public Health Agency of Sweden] has made.”

During a party leaders’ debate on Sunday evening, Ebba Busch-Thor, leader of the Christian Democrat party, blamed Sweden’s strategy – and by extension the government that allowed it – for some of the 4,659 deaths due to the virus. 

“What we can say about Sweden is that many of those who are mourning over those they have lost this spring are doing so because Sweden knowingly and deliberately allowed a large spread of the infection,” she said.  

Ulf Kristersson, the leader of the Moderate Party, the biggest party on the Centre-Right, held back from joining Mrs. Busch-Thor’s attack on the strategy, instead attacking the implementation of it.

“I had no problem with the strategy. It was a bit slow but, when it was in place, I had nothing against it,” he said. “But the government didn’t put any power behind the words.”

The Prime Minister, Stefan Lofven, continued to back Sweden’s strategic decision not to impose a lockdown, instead laying the blame for the death rate on failures within elderly care. 

“I think the strategy is the right one,” he said. “But it has transpired that that very many people, in certain areas, have died in elderly care. There’s no doubt that elderly care needs to be improved.” 

Mr Akesson faced an immediate counter-attack from Johan Carlsson, the director of FHM, who dismissed his call as “almost pathetic”. 

Dagens Nyheter’s political commentator Ewa Stenberg wrote on Sunday that the debate marked an end to the “borgsfred”, or “castle truce”, in Sweden.

“The tone was harsh and quite contrary to how it was when the virus hit the country. Then all the parties backed the government’s decision to let the Public Health Authority take the lead,” she wrote.

However, the return of political opposition does not yet seem to reflect a loss of support for the government among the public.

Kids During Lockdown: Is Another Epidemic About to be Revealed?

Ingrid Walker-Descartes noted that even in non-pandemic years, the summertime “back-to-school” rush of appointments in many pediatric practices can be a logistical challenge. This year could be even more hectic after many families delayed routine appointments during quarantine. Hoping to return to their routines, children and teens will need vaccines, physical exams for sports clearances and school forms, and all the regular developmental and emotional surveillance that is so important to keep them healthy.

As pediatricians, we should be adding another layer to our checklists in these visits this year. For many children, this visit may be the first time in weeks or months that someone outside their immediate family has had eyes on them.

We must be careful to listen, very carefully, to what the children and parents tell us, both in their words and in other signs. How has the family coped with the stress of being stuck at home? Are there financial struggles? Food insecurity? Other stresses? As a child abuse pediatrician, I know all of these things can put tremendous stress on a family, and ultimately can lead to a child being maltreated or abused. We have a real opportunity right now to intervene and provide critical support to families, and to protect children.

Sadly, we know from previous disasters that during these times of intense emotional and economic stress, rates of child abuse and neglect increase. Injuries and deaths among infants due to abusive head trauma increase during times of economic stress, and scattered reports among physicians at children’s hospitals in various states are reporting that is happening now, too. For example, a hospital in Fort Worth, Texas, and a hospital in Philadelphia, are reporting an increase in the number of severe physical abuse cases. Many times, this abuse occurs when a parent or caregiver is frustrated or at the “end of their rope,” and in a moment of anger, makes a devastating choice that injures a child.

For the past few months, during sheltering in place, children have lacked many of the people who often step forward as protectors — the aunt they may confide in, a teacher who sees a bruise, or a physician who notices an injury where there reasonably should be none. Reports to child abuse hotlines and child protective services have declined during the pandemic, but this is not necessarily because fewer children are being injured. We know that teachers and school counselors are the most frequent reporters of suspected abuse, and for months children have not had access to these trusted protectors. Many of them have not seen their pediatrician, either. These combined realities have left some of our most vulnerable children without several much-needed layers of protection.

As a pediatrician who specializes in diagnosing abuse and protecting children from further abuse, I am well versed in talking with children to understand what happened to cause their injuries. Some may convey lessons learned from their choices made due to curiosity or naivete. Others struggle to elaborate on marks or scars made in anger by a caregiver. Post COVID-19, it will be important for all pediatricians to have a careful approach as they are talking with families, listening and observing to understand what children experienced during the pandemic, and how we can help them and their families be safe and healthy.

Some families may benefit from a referral to a nutrition program, caregiver support program, parental counseling, or other resources. In other cases, a pediatrician may notice a sign of potential abuse that should be reported to the relevant child protection agencies. This is always difficult, but it can be the first step to making sure a child is safe and protected while a family gets the support they need.

The American Academy of Pediatrics (AAP) recently provided a webinar guide on how to identify child abuse during the pandemic, and additional resources are provided on the AAP website, including a list of child abuse programs across the country to help support you in this difficult role.

The stress on families and children will not end when the stay-at-home orders lift. Let’s be prepared to help all our children emerge healthy and strong, and ready to learn.

CDC wants states to count ‘probable’ coronavirus cases and deaths, but most aren’t doing it

Reinhard, Emma Brown Reis Thebault and Lena H. Sun reported that fewer than half the states are following federal recommendations to report probable novel coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.

A Washington Post review found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York. That is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths — benchmarks that shape policymaking and public opinion on the pandemic.

The U.S. Centers for Disease Control and Prevention works closely with a group of health officials called the Council of State and Territorial Epidemiologists to issue guidelines for tracking certain illnesses. The guidelines are voluntary, though states generally comply. The goal: solid comparisons between states and accurate national statistics that inform public health decision-making.

In April, as coronavirus infections multiplied and laboratory testing was limited, the CSTE and the CDC advised states to count both probable cases and deaths — where symptoms and exposure pointed to infection — along with those confirmed by tests.

Yet weeks after the guidance was handed down to standardize coronavirus reporting, a Post review found states as of early June counting cases and deaths in all sorts of ways.

At least 24 states are not heeding the national guidelines on reporting probable cases and deaths, despite previously identifying probable cases in other national outbreaks, including H1N1 flu during the country’s last pandemic in 2009.

The failure of many states to document probable coronavirus cases and deaths is “historic in many ways because there are lots of probable case classifications and probables are regularly and normally reported on,” said Janet Hamilton, the CSTE executive director. “We are definitely concerned about the undercounting of covid-19 deaths and cases.”

New Jersey says it began reporting probable cases and deaths to the CDC on May 15 but does not disclose them publicly on its website. Georgia says it tracks the information internally but is not reporting those numbers on its website or to the CDC.

“We do have intentions of sharing them but not yet,” said Nancy Nydam, a spokeswoman for the Georgia Department of Public Health, who said as of late May the department had tracked 1,658 probable cases and potentially dozens of probable deaths.

Officials in Montana, Rhode Island and the District of Columbia say they haven’t reported any probable cases or deaths because they have not had any, citing low numbers or the wide availability of testing.

Seven states did not respond to The Post’s requests for a breakdown of cases and death counts. Five of those are not reporting probable cases or deaths, according to data the CDC began publishing June 2. South Dakota reports probable deaths but not cases.

Officials in the remaining 17 states say they are reporting probable and confirmed coronavirus cases and deaths on their websites and to the CDC. Some states distinguish between probable and confirmed while others group them.

In some states not reporting probable cases, officials cite the demands of an unprecedented crisis in which Americans press for daily updates from public health data systems that are chronically underfunded and outdated.

In Washington state, where many of the nation’s first deaths occurred, health department spokeswoman Lisa Stromme Warren said documenting probable cases and deaths “is one of many urgent priorities.” The state has identified about 100 people whose death certificates list covid-19 but were never tested, so they are not included in the public death count or reported to the CDC.

“We suspect that we are actually more likely to be undercounting deaths than overcounting them,” Katie Hutchinson, the health department’s health statistics manager, said during a recent briefing.

CDC spokeswoman Kristen Nordlund said that the agency is working with health departments to improve the flow of data. “In pandemic circumstances, such as with covid-19, collecting complete information on each case is challenging,” Nordlund said. “The current case and deaths counts reported to CDC are likely an undercount.”

During the H1N1 flu pandemic, states initially counted probable and confirmed cases individually. But about three months into the outbreak, the CDC said those individual counts represented “only a fraction of the true burden” of the disease. The agency stopped collecting individual case reports and instead began publishing estimates based on hospitalizations, symptoms and other data.

The CDC is planning to come up with similar estimates for the coronavirus but has no immediate plans to stop counting individual cases. “CDC is actively working on a model to address and assess the true burden of covid-19 in the U.S.,” Nordlund said.

All eyes on numbers

For government officials assessing how quickly to reopen the economy and individuals deciding what risks to take, their daily judgment calls are based, in part, on the case and death counts publicized on television and computer screens.

That has propelled the pandemic counts into the contentious political arena, where some allies of President Trump and conservative voices on social media have claimed that the covid-19 death toll is inflated. The debate over whether counts of probables are crucial or misleading extends beyond the nation’s capital.

In Illinois, two Republican lawmakers and three businesses have sued the Democratic governor over coronavirus disaster orders. A spokeswoman for the health department, Melaney Arnold, said the state is not divulging probable deaths on its website “because there is concern from the public that the number of deaths is being inflated. . . . We need the public to have confidence in the data and therefore are reporting only those deaths that are laboratory confirmed.”

The state website lists about 5,700 deaths as of June 5, excluding the approximately 185 probable deaths tracked internally as of that day and reported to the CDC.

But a resident looking at a state chart and then turning to the CDC might not find the same numbers. The newly posted CDC table does not reflect the probables that officials in some states said they have reported. Officials say that’s because the reports sent to the CDC include those with confirmed cases in one figure and because the national update can run slightly behind state websites.

Since the 1950s, CSTE has recommended which diseases states should track and what those reports to the federal government should look like. The CDC works closely with the epidemiologists’ council and adopts its guidelines to “enable public health officials to classify and count cases consistently across reporting jurisdictions,” according to the CDC website.

States usually follow these recommendations and report the incidence of dozens of different diseases to the CDC, with some exceptions. A state may not report cases of a disease that does not occur within its borders, yet may track another illness found only in its part of the country.

Hawaii, for example, does not report Lyme disease, as every other state does, but it does report hallucinogenic fish poisoning.

“It’s more of a handshake agreement between the states and CDC that we will send you the data in this way so that you can then aggregate it,” said Kathy Turner, Idaho’s deputy epidemiologist. “In general, there’s no argument. We all do it because we realize the importance of being able to look at a disease on a national level.”

Some reportable diseases rarely result in deaths, so CSTE directives have typically focused on how to count cases, not fatalities. Then came the coronavirus and a mushrooming death toll. The CDC acknowledged in early April that the death count was an “underestimation” because it included only fatalities in which the virus was laboratory confirmed. Testing shortages, people dying at home or in nursing homes, and spotty postmortem testing meant victims were overlooked.

“When the outbreak first started and we were all just counting lab-confirmed cases by default, it became clear that we were not going to be able to describe the burden of the pandemic because so many people were not being tested,” said Turner, lead author of the CSTE statement on covid-19.

“We usually don’t approach a death separately from a case, but in this situation, we decided it was needed,” she said.

The CSTE recommended reporting probable and confirmed cases and deaths on April 5. The CDC’s written response to the recommendations, which was shared with The Post, said the agency “concurs” and that adoption by states is “very important” for covid-19 record-keeping. On April 14, the CDC noted on its website that the national tally includes probables, although the agency did not at that time provide a state-by state breakdown. The CDC also modified the form states use for coronavirus reports, adding boxes that can be checked to indicate a “lab-confirmed” case or “probable” case.

Probable cases were defined as showing symptoms and having contact with an infected person, or meeting one of those criteria and testing positive for coronavirus antibodies, rather than for the virus itself. Probable deaths meant those who were never tested for the virus but whose death certificates listed covid-19 as the cause of death or a significant condition contributing to death.

The CSTE statement also says that confirmed and probable counts should be included in the tallies “released outside the public health agency,” which could mean a state website or written report, according to the organization.

“When states are using different approaches, it always begs the question: ‘Why does one state choose one over another? Why a more conservative approach over a more sensitive one?’’’ asked Lorna Thorpe, director of the division of epidemiology at NYU Grossman School of Medicine. “That’s the reason we have standards and guidance that are technically sound.”

Information varies

The erratic reporting of coronavirus cases and deaths means that what residents can learn about the extent of the pandemic in their community varies widely.

Ohio was one the first states to begin disclosing probable cases and deaths in early April. “It usually is a given when CSTE makes a recommendation like that,” said Brian Fowler, chief data officer for the Ohio Department of Health. “When they made that recommendation, we looked at it and said, okay, well this is what we need to use.”

As of June 5, Ohio’s website showed 2,117 confirmed deaths and 222 probables. By breaking out the numbers separately, Fowler said, “you can’t be accused of hiding information and you can’t be accused of inflating numbers — it’s all out there.”

The transition to counting probables was not “a huge lift,” Fowler said. Epidemiologists at the health department were already reviewing all suspected coronavirus cases.

Some health officials were candid about how adding probable deaths would boost the overall tally. “I want to make sure that everyone understands that these are not new deaths,” Indiana Health Commissioner Kristina Box said at an April 20 news conference. “Rather, we are capturing the deaths that have occurred really since this pandemic began.” Box suggested other states would do the same: “Indiana — like every other state — will include these deaths in our reporting in order to better capture the toll that covid-19 has truly taken.”

One week earlier, Michigan officials had said they intended to begin disclosing probable cases and deaths. When the state finally began doing that on June 5, more than 5,000 cases and 200 deaths were added to coronavirus totals.

California’s state health department is reviewing the process to track probable deaths and “working to provide as much data as possible about COVID 19 while ensuring that the data are valid and useful for understanding the pandemic,” according to a May 20 email to The Post.

Hilda Solis, a supervisor in Los Angeles County who represents a heavily Hispanic and impoverished district, said she was surprised that the state is not following national recommendations on counting coronavirus deaths. She has called for more post-mortem testing by the medical examiner. “A lot of people are dying at home. Poor people are dying at home. Homeless people are dying,” said Solis, a former U.S. labor secretary under President Barack Obama. “I do believe covid-19 is being underreported and that we need to take more responsibility.”

The scale of undercounting that results from reporting only confirmed cases became clear when New York City on April 14 added more than 3,700 probable deaths to its numbers, sending the city’s tally over 10,000.

The city that sits at the epicenter of the pandemic in the United States still is not counting probable cases, however. New York Gov. Andrew M. Cuomo, a Democrat praised for his command of daily news briefings during the pandemic, has indicated skepticism about recording probable cases. “Probable is different than confirmed,” he said at a news conference in late May. “Probable is ‘probable, but I have to check, I don’t know, I have to do further testing.’ We’ve had many cases that were probable coronavirus and turned out not to be coronavirus and that’s why they call them probable.” Covid-19 websites for New York and New Jersey include probable deaths at nursing homes, but those numbers are not included in the states’ overall death totals. A spokesperson for North Carolina’s health department said the state is not reporting probables because of wariness about the reliability of antibody tests, and because of concerns that the CSTE’s definition of a probable case is overly broad. Officials in Florida did not respond to repeated requests for comment about why the state isn’t following federal guidelines.

People behind ‘probables’

Behind each probable death is a person. Barnes O’Neal, 83, checked into the Brightmoor Nursing Center in Georgia in March to recover from a 10-day hospitalization. Less than a month into his stay at the facility about 40 miles south of Atlanta, a coronavirus outbreak forced a lockdown. O’Neal developed a fever and pneumonia. His daughter, Natalie Turner, pleaded with her father’s caretakers and the state health department for a coronavirus test. She said she wanted his illness on the record.

On April 20, just hours after Turner had spoken with him by phone, O’Neal died. He was never tested, but Turner said his doctor told her there was “zero doubt” it was covid-19 and wrote it on her father’s death certificate.

Still, her father, a frequent volunteer at the local soup kitchen, would not be included in the death toll on the state website because he was never tested. “It’s just important to me because my dad’s life counted,” Turner said. “I feel like there’s a face behind every statistic, and that’s forgotten many times.”

And now the pandemic’s overall death toll in U.S. has exceeded 100,000, but what are the real numbers?

Second U.S. Virus Wave Emerges as Cases Top 2 Million

Emma Court and David Baker noted that a second wave of coronavirus cases is emerging in the U.S., raising alarms as new infections push the overall count past 2 million Americans. Texas on Wednesday reported 2,504 new coronavirus cases, the highest one-day total since the pandemic emerged. A month into its reopening, Florida this week reported 8,553 new cases — the most of any seven-day period. California’s hospitalizations are at their highest since May 13 and have risen in nine of the past 10 days.

A fresh onslaught of the novel coronavirus is bringing challenges for residents and the economy in pockets across the U.S. The localized surges have raised concerns among experts even as the nation’s overall case count early this week rose just under 1%, the smallest increase since March.

“There is a new wave coming in parts of the country,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “It’s small and it’s distant so far, but it’s coming.”

Though the outbreaks come weeks into state reopenings, it’s not clear that they’re linked to increased economic activity. And health experts say it’s still too soon to tell whether the massive protests against police brutality that have erupted in the past two weeks have led to more infections.

In Georgia, where hair salons, tattoo parlors and gyms have been operating for a month and a half, case numbers have plateaued, flummoxing experts.

Puzzling differences show up even within states. In California, which imposed a stay-at-home order in late March, San Francisco saw zero cases for three consecutive days this week, while Los Angeles County reported well over half of the state’s new cases. The White House Coronavirus Task Force has yet to see any relationship between reopening and increased cases of Covid-19, Food and Drug Administration Commissioner Stephen Hahn said on a podcast.

But in some states, rising numbers outpace increases in testing, raising concerns about whether the virus can be controlled. It will take a couple of weeks to know, Toner said, but by then “it’s going to be pretty late” to respond.

Since the pandemic initially swept the U.S. starting early this year, 2 million people have been infected and more than 112,000 have died.

After a national shutdown that arrested the spread, rising illness had been expected as restrictions loosened. The trend has been observed across 22 states in recent weeks, though many increases are steady but slow.

In New York, the state hardest hit by Covid-19, Governor Andrew Cuomo only recently started reopening by region. New York City, the epicenter, began the first of four phases Monday.

“We know as a fact that reopening other states, we’re seeing significant problems,” Cuomo said Tuesday. “Just because you reopen does not mean you will have a spike, but if you are not smart, you can have a spike.”

Experts see evidence of a second wave building in Arizona, Texas, Florida and California. Arizona “sticks out like a sore thumb in terms of a major problem,” said Jeffrey Morris, director of the division of biostatistics at University of Pennsylvania’s Perelman School of Medicine.

Arizona Spike

Arizona’s daily tally of new cases has abruptly spiked in the last two weeks, hitting an all-time high of 1,187 on June 2.

This week, its Department of Health Services urged hospitals to activate emergency plans. Director Cara Christ, told a Phoenix television station that she was concerned about the rising case count and percentage of people tested who are found to be positive.

Valleywise Health, the public hospital system in Phoenix, has seen an increase in Covid-19 cases during the past two weeks. It’s expanded its intensive-care capacity and those beds are 87% full, about half with Covid patients, according to Michael White, the chief medical officer.

White said Valleywise has adequate protective gear for staff, but hospitals aren’t getting their entire orders. A surge in Covid cases could put that supply under stress, he said.

The increase in transmission follows steps to resume business and public life as well as the riots and protests.

“Within Phoenix, we’ve been more relaxed than I’ve seen in some of the other parts of the country,” White said, with some people disregarding advice to wear masks and maintain six feet of distance from others. “People are coming together in environments where social distancing is challenging.”

Texas on Wednesday reported a 4.7% jump in hospitalizations to 2,153, the fourth consecutive daily increase. The latest figures showing an escalation came as Governor Greg Abbott tweeted a public service announcement featuring baseball legend Nolan Ryan urging Texans to wash their hands and to not be “a knucklehead.”

Abbott was criticized for an aggressive reopening last month. Mobile-phone data show activity by residents is rebounding toward pre-Covid levels, according to the Children’s Hospital of Philadelphia’s PolicyLab.

That could reflect a perception that the virus wasn’t “ever a big threat,” said Morris, who recently moved to Philadelphia after 20 years in Houston.

Florida’s health department said in a statement that it attributes the increase in cases to “greatly expanded efforts in testing,” and noted that overall positivity rates remain low, at about 5.5%.

Bucking the trend is Georgia, which was the first U.S. state to reopen. Covid cases there have plateaued. Despite local outbreaks in the state, “their sea levels did not rise,” said David Rubin, director of the PolicyLab, which has been modeling the virus’ spread. “They’ve kind of held this fragile equilibrium.”

Creeping In

California was the earliest state to shut down its economy over the coronavirus, after one of the nation’s first outbreaks in the San Francisco Bay Area. It has been slower than most to reopen.

Even so, the state has also seen the number of people hospitalized with Covid-19 rebound in the past two weeks, as commerce accelerates. Case counts are climbing too, although officials attribute that to increased testing and say it’s a sign of preparation.

In part, rising numbers represent the virus spreading into places that largely avoided the first round of infections, including rural Imperial County in California’s southeastern desert. Yet the contagion remains present in places that bore the brunt of the first wave, including Los Angeles County. Hospitalizations there are lower than at the start of May, but deaths remain stubbornly high, with 500 in the past week alone.

Barbara Ferrer, Los Angeles County public health director, said the region has likely not seen the end of the first wave. And despite concerns about infections coming out of mass demonstrations in the sprawling city, she thinks the reopening of the economy will have a bigger impact.

“We’re not at the tail end of anything,” Ferrer said. “We never had a huge peak. We’ve kind of been within this band. We’re not in decline, we’re kind of holding our own in ways that protect the health-care system.” But, she added, “go to Venice and see the crowds, and you’ll understand why I have concerns.”

Another Onslaught

The U.S. has long been bracing for another wave, but future outbreaks are likely to take a different shape. Social distancing and mask-wearing, as well as careful behavior by individuals, are likely to have staying power even as economies reopen.

Experts are steeling for autumn, when changes in weather and back-to-school plans could have damaging repercussions.

“The second wave isn’t going to mirror the first wave exactly,” said Lance Waller, a professor at Emory University’s Rollins School of Public Health in Atlanta. “It’s not snapping back to exactly the same thing as before, because we’re not exactly the way we were before.”

Daniel Lucey, a fellow at the Infectious Diseases Society of America, compared the virus’ new paradigm with a day at the beach: The U.S. has been bracing for another “high tide” like the one that engulfed New York City. Today is a low tide, but “the waves are always coming in.”

ICU doctor warns: ‘We could lose control of the virus again’, Especially with the George Floyd protests! What About AI to Help in the Post Pandemic Planning!

I am concerned about what I see in society, what I am calling pandemic fatigue and its effect on the behavior of the average bored, anxious and moderately depressed citizens. Adriana Belmonte reported that the U.S. has the highest number of coronavirus cases around the world, but the rate of infections has declined in several parts of the country as a result of social distancing restrictions.

Dr. Lakshmana Swamy, an ICU physician at Boston Medical Center, warned what could happen if people take too much of a lackadaisical approach towards the pandemic.

“What are people seeing across the country in our numbers?” Swamy said on Yahoo Finance’s The Ticker recently. “They’re seeing coronavirus cases go down. That’s fantastic.” 

But, he added, “what you’re not seeing is that the hospital is still jam-packed with people that were deferring care, who were staying at home, scared of coming in. So, the hospital is still really busy. No one’s getting a break here. It’s terrifying to think that now on top of this, as we start to reopen, we could lose control of the virus again.”

‘What I’m seeing in Alabama … terrifies me’

There are currently 20 states experiencing an increase in the number of coronavirus cases. Most of these states — including Alabama, Florida, and Georgia — were among the first ones to reopen their economies over the last month. 

“What I’m seeing in Alabama, of course, terrifies me, as it does so many people,” Swamy said. “We’re all suffering from lockdown. It’s a huge hit, of course, to the economy, to individual people, to health, to everything. But it pales in comparison to the cost that the virus takes when it runs free.” 

Although many are calling for an end to social distancing restrictions because of its impact on the economy, research from the National Bureau of Economic Research (NBER) has indicated that reopening the economy “will have a much smaller-than-expected impact.”

“You look across the country where people haven’t been hit as hard, thank god,” Swamy said. “But you see that people don’t get it. It’s a really abstract concept. It’s hard to believe in that, right? It takes a lot of trust to believe what you’re seeing and hearing.”

“The masks are sort of a symbol of it,” he continued. “The bigger thing is social distancing. I mean, crowds together in open spaces, or especially in closed spaces, it’s terrifying. And it takes weeks to see the effects of that. So people will feel like ‘oh, look, we did that. It’s no problem. Hey, look, they did it over there. We can do it here, too.’”

Although there is still a lot to be known about the coronavirus, one thing that Swamy said he pretty much knows for certain is that there doesn’t seem to be herd immunity, which would mean that enough people had the coronavirus that they wouldn’t be able to get it and transmit it again.

“It’s a lot of science that’s unknown there,” he said. “But I think what we know is that we can’t rely on the virus not being able to hop around and catch like wildfire, even in Boston.” 

‘We’re going to see a spike in COVID-19’

Adding to the stress are the recent protests against police brutality that have taken place over the past week in response to the killing of George Floyd by a Minneapolis police officer, Derek Chauvin. 

Large crowds amassed in major cities across the country, and although many of the participants wore face masks, they were still in close proximity to others protesting. Some health officials worry this could cause a new spike in coronavirus cases.

“I am deeply concerned about a super-spreader type of incident,” Minnesota Gov. Tim Walz said on Saturday. “We’re going to see a spike in COVID-19. It’s inevitable.”

Gov. Andrew Cuomo (D-NY) and NYC Mayor Bill DeBlasio voiced similar concerns during recent press conferences, with Cuomo urging people to “demonstrate with a mask on.”

“It’s heartbreaking, because what we see over and over again is two to three weeks later, the cases start hitting and you see a surge and you see spikes,” Swamy said. “I hope that doesn’t happen anywhere else. But the virus is here. It’s everywhere. So it’s heartbreaking. I hope we can get to people before the virus does.”

Health officials worry about second coronavirus wave after George Floyd

Edmund DeMarche of Fox News was also concerned about another spike in the pandemic especially in light of the George Floyd protests. Health officials in the U.S. have new concerns that the nationwide protests over the George Floyd death in police custody could spark a wider spread of the coronavirus after many cities reported bringing the virus under control.

Scott Gottlieb, the former Food and Drug Administration commissioner, told CBS News’ “Face the Nation” that there are still some “pockets of spread” in communities. He said there has been an uptick in new coronavirus cases in recent days at the epicenter of the protests.

Minnesota Health Department Spokesman Doug Schultz said Sunday that any spike from the protests will not be seen until six to 10 days after its transmission, the Star Tribune reported. The report pointed out that the Minneapolis provided hundreds of masks for protesters.

Gov. Tim Walz said, according to the paper, that he is “deeply concerned about a super-spreader type of incident … after this. We are going to see a spike in COVID-19. It’s inevitable.”

The U.S. has seen more than 1.7 million infections and over 104,000 deaths in the pandemic, which has disproportionately affected racial minorities. Protests over Floyd’s death have shaken the U.S. from New York to Los Angeles.

“There’s no question that when you put hundreds or thousands of people together in close proximity, when we have got this virus all over the streets … it’s not healthy,” Maryland Gov. Larry Hogan said Sunday on CNN’s “State of the Union.”

Demonstrators are packed, many without masks, many chanting, shouting or singing. The virus is dispersed by microscopic droplets in the air when people cough, sneeze, talk or sing.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University, told the New York Times that the “outdoor air dilutes the virus and reduces the infectious dose that might be out there, and if there are breezes blowing, that further dilutes the virus in the air. There was literally a lot of running around, which means they’re exhaling more profoundly, but also passing each other very quickly.”

Despite much of the protest and riots taking place outdoors, looters ransacked stores in various cities. The virus is notoriously transmitted by asymptomatic carriers. The Times reported that Keisha Lance Bottoms, the mayor of Atlanta, told those out protesting to “go get a COVID test this week.”

Fauci Estimates That 100,000 To 200,000 Americans Could Die From The

And now look at Dr. Fauci’s prediction for ultimate mortality rate. Bobby Allyn reported that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Sunday that 100,000 to 200,000 Americans could die of COVID-19, the disease caused by the novel coronavirus.

The nation’s leading expert on infectious diseases and member of the White House’s coronavirus task force says the pandemic could kill 100,000 to 200,000 Americans and infect millions.

Dr. Anthony Fauci said based on modeling of the current pace of the coronavirus’ spread in the U.S., “between 100,000 and 200,000” people may die from COVID-19, the disease caused by the novel coronavirus.

Fauci’s comments on CNN’s State of the Union underscore just how far away the U.S. is from the peak of the outbreak based on predictions from top federal officials. As of early Sunday afternoon, there were 125,000 cases in the U.S. and nearly 2,200 deaths, according to data from Johns Hopkins University.

Public health experts say that because of undocumented chains of transmission in many parts of the country, the number of new coronavirus cases in the U.S. is set to keep surging as more and more test results become known.

Dr. Anthony Fauci says there could potentially be between 100,000 to 200,000 deaths related to the coronavirus and millions of cases. “I just don’t think that we really need to make a projection when it’s such a moving target, that you could so easily be wrong,” he

Fauci said the 100,000-to-200,000 death figure is a middle-of-the-road estimate, much lower than worse-case-scenario predictions.

He said preparing for 1 million to 2 million Americans to die from the coronavirus is “almost certainly off the chart,” adding: “Now it’s not impossible, but very, very unlikely.”

However, Fauci cautioned people not to put too much emphasis on predictions, noting that “it’s such a moving target that you could so easily be wrong and mislead people.”

What we do know, he says, is that “we’ve got a serious problem in New York, we’ve got a serious problem in New Orleans and we’re going to have serious problems in other areas.”

Fauci’s coronavirus fatality estimate comes as the White House considers ways to reopen the economy, including easing social distancing guidelines that officials have set forth to curb the spread of the fast-moving virus.

One in three Americans is now being asked to stay indoors as new cases soar, especially in New York, which accounts for nearly half of the country’s cases.

When asked if it is the right time to begin relaxing some of the social distancing measures, Fauci said not until the curve of new infections starts flattening out.

He refused to guess when exactly that may occur.

“The virus itself determines that timetable,” Fauci said.

According to the Centers for Disease Control and Prevention, the seasonal flu has killed between 12,000 and 61,000 people a year since 2010. The coronavirus death rate is far greater than the flu’s. For the elderly population, the coronavirus has been found to be six times as deadly.

There is currently no vaccine for the coronavirus. Experts say developing a vaccine for the virus could take at least a year.

Artificial Intelligence in Healthcare: A Post-Pandemic Prescription

David Nash noted that in what now seems a distant pre-pandemic period, excitement about the potential of artificial intelligence (AI) in healthcare was already escalating. From the academic and clinical fields to the healthcare business and entrepreneurial sectors, there was a remarkable proliferation of AI — e.g., attention-based learning, neural networks, online-meets-offline, and the Internet of Things. The reason for all this activity is clear — AI presents a game-changing opportunity for improving healthcare quality and safety, making care delivery more efficient, and reducing the overall cost of care.

Well before COVID-19 began to challenge our healthcare system and give rise to a greater demand for AI, thought leaders were offering cautionary advice. Robert Pearl, MD, a well-known advocate for technologically advanced care delivery, recently wrote in Forbes that because technology developers tend to focus on what will sell, many heavily marketed AI applications have failed to elevate the health of the population, improve patient safety, or reduce healthcare costs. “If AI is to live up to its hype in the healthcare industry the products must first address fundamental human problems,” Pearl wrote.

In a December 2019 symposium addressing the “human-in-the-middle” perspective on AI in healthcare, internationally acclaimed medical ethicist Aimee van Wynsberghe made the case that ethics are integral to the product design process from its inception. In other words, human values and protections should be central to the business model for AI in healthcare.

Health equity should be a driving principle for how AI is designed and used; however, some models may inadvertently introduce bias and divert resources away from patients in greatest need. Case in point, a predictive AI model was built into a health system’s electronic health record (EHR) to address the issue of “no-show” patients by means of overbooking. Researchers determined that the use of personal characteristics from the EHR (ethnicity, financial class, religion, body mass index) could result in systematic diversion of resources from marginalized individuals. Even a prior pattern of “no-show” was likely to correlate with socioeconomic status and chronic conditions.

Fast forward to today when AI seems to be a permanent fixture in national news coverage. Noting that journalists often overstate the tasks AI can perform, exaggerate claims of its effectiveness, neglect the level of human involvement, and fail to consider related risks, self-professed skeptic Alex Engler offered what I believe are important considerations in his recent article for the Brookings Institution. Here are a few:

  • AI is only helpful when applied judiciously by subject-matter experts who are experienced with the problem at hand. Deciding what to predict and framing those predictions is key; algorithms and big data can’t effectively predict a badly defined problem. In the case of predicting the spread of COVID-19, look to the epidemiologists who are building statistical AI models that explicitly incorporate a century of scientific discovery.
  • AI alone can’t predict the spread of new pandemics because there is no database of prior COVID-19 outbreaks as there is for the flu. Some companies are marketing products (e.g., video analysis software, AI systems that claim to detect COVID-19 “fever”) without the necessary extensive data and diverse sampling. “Questioning data sources is always a meaningful way to assess the viability of an AI system,” Engler wrote.
  • Real-world deployment degrades AI performance. For instance, in evaluating CT scans, an AI model that can differentiate between healthy people and those with COVID-19 might start to fail when it encounters patients who are sick with the regular flu. Regarding claims that AI can be used to measure body temperature, real-world environmental factors lead to measurements that are more imperfect than laboratory conditions.
  • Unintended consequences will occur secondary to AI implementation. Consolidation of market power, insecure data accumulation, and surveillance concerns are very common byproducts of AI use. In the case of AI for fighting COVID-19, the surveillance issues have been pervasive in countries throughout the world.
  • Although models are often perceived as objective and neutral, AI will be biased. Bias in AI models results in skewed estimates across different subgroups. For example, using biomarkers and behavioral characteristics to predict the mortality risk of COVID-19 patients can lead to biased estimates that do not accurately represent mortality risk. “If an AI model has no documented and evaluated biases, it should increase a skeptic’s certainty that they remain hidden, unresolved, and pernicious,” said Engler.

Based on what we’ve learned about the limitations and potential harms of AI in healthcare — much of which has been amplified by COVID-19 — what treatment plan would I prescribe going forward? First, I would encourage all healthcare AI developers and vendors to involve ethicists, clinical informatics experts, and operational experts from the inception of product development.

Second, I would recommend that healthcare AI be subjected to a higher level of scrutiny. Because AI is often “built in” by a trusted business partner and easily implemented, objective evaluation may be waived. As data science techniques become increasingly complex, serious consideration must be given to multidisciplinary oversight of all AI in healthcare.

Another paper that I am working reviews the need for a more complete method to contact trace and follow-up the recovered as well as those not infected on a large scale so that we can predict the next spike early. This way we can avoid the horrid effect of a second pandemic and the ultimate effect on healthcare and the economy.

Dr. Atlas and Others on coronavirus lockdowns: ‘The policy … is killing people’ and Not from the Corona virus!

As a physician I only stopped seeing my patients for two weeks during the pandemic. Why? I considered my patients cancer care a necessary demand. My cancer patients needed surgical procedures and the hospital didn’t consider those procedures urgent. So, I offered to do their surgical procedures in my office surgical suite under local anesthesia. If I didn’t the tumors would continue to grow and possibly metastasize or spread reducing their chances for cure. This brings up the important consideration that this pandemic is allowing our regular medical and surgical patient to result in delayed diagnoses and treatment. Victor Garcia reported that the Coronavirus lockdowns may be “killing” just as many people as the virus because as I mentioned, many people with serious conditions unrelated to the virus have been skipping treatment, Hoover Institution senior fellow Dr. Scott Atlas said Saturday on “Fox Report.”

“I think one thing that’s not somehow receiving attention is the CDC just came out with their fatality rates,” Atlas said. “And lo and behold, they verify what people have been saying for over a month now, including my Stanford epidemiology colleagues and everyone else in the world who’s done this analysis — and that is that the infection fatality rate is less than one-tenth of the original estimate.”

Even White House coronavirus task force member Dr. Anthony Fauci is acknowledging the harm caused by the lockdown, Atlas said. “The policy itself is killing people. I mean, I think everyone’s heard about 650,000 people on cancer, chemo, half of whom didn’t come in. Two thirds of cancer screenings didn’t come in. 40 percent of stroke patients urgently needing care didn’t come in,” Atlas said. “And now we have over half the people, children in the United States not getting vaccinations. This is really what [Fauci] said was irreparable harm.”

More on Dr. Fauci later in this post.

“And I and my colleagues from other institutions have calculated the cost of the lockdown in terms of lives lost,” Atlas said. “Every month is about equal to the entire cost of lives lost during the COVID infection itself. This is a tragic, misguided public policy to extend this lockdown, whether or not it was justifiable in the beginning.”

Many states are currently reopening their economies slowly, while a few have pledged to extend the lockdowns through the summer.

The doctor also argued against keeping children out of schools, saying there’s no reason they can’t go back. “There’s no science whatsoever to keep K-through-12 schools closed, nor to have masks or social distancing on children, nor to keep summer programs closed,” Atlas said. “What we know now is that the risk of death and the risk of even a serious illness is nearly zero in people under 18.”

Lockdown measures have kept nearly 80 million children from receiving preventive vaccines

Caitlin McFall of Fox News reported that the coronavirus pandemic has resulted in stay-at-home orders that are putting young children at risk of contracting measles, polio and diphtheria, according to a report released Friday by the World Health Organization (WHO).

Routine childhood immunizations in at least 68 countries have been put on hold due to the unprecedented spread of COVID-19 worldwide, making children under the age of one more vulnerable.

More than half of 129 counties, where immunization data was readily available, reported moderate, severe or total suspensions of vaccinations during March and April.

“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Disruption to immunization programs from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”

The WHO has reported the reasons for reduced immunization rates vary. Some parents are afraid to leave the house due to travel restrictions relating to the coronavirus, whereas a lack of information regarding the importance of immunization remains a problem in some places.

Health workers are also less available because of COVID-19 restrictions.

The Sabin Vaccine Institute, the United Nations Children’s Fund (UNICEF) and GAVI, The Vaccine Alliance also contributed to the report.

Experts are worried that worldwide immunization rates, which have progressed since the 1970s, are now being threatened.

“More children in more countries are now protected against more vaccine-preventable diseases than at any point in history,” said Gavi CEO Dr. Seth Berkley. “Due to COVID-19 this immense progress is now under threat.”

UNICEF has also reported a delay in vaccine deliveries because of coronavirus restrictions and is now “appealing to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for these life-saving vaccines.”

Experts say that children need to receive their vaccines by the age of 2. And in the case of polio, 90 percent of the population need to be immunized in order to wipe out the disease. Polio is already making a comeback in some parts of the world, with more than a dozen African countries reporting polio outbreaks this year.

“We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases,” said UNICEF’s Executive Director Henrietta Fore. “We have effective vaccines against measles, polio and cholera,” she said. “While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible or we risk exchanging one deadly outbreak for another.”

Six Social Health System Teams to Encourage People to Seek Healthcare

Alexandra Wilson Pecci noted that the campaign, which aims to encourage people to get healthcare when they need it, comes as providers across the country have seen a dramatic drop in visits and revenue during the COVID-19 pandemic.

Six of Los Angeles County’s largest nonprofit health systems with hospitals, clinics, and care facilities are teaming for BetterTogether.Health, a campaign that aims to encourage people to get healthcare when they need it, despite the current pandemic.

The campaign, from Cedars-SinaiDignity HealthProvidenceUCLA HealthKeck Medicine of USC, and Kaiser Permanente, comes as hospitals and healthcare provider offices across the country have seen a dramatic drop in visits and revenue.

“We know many patients who in the past dialed 911 for life-threatening emergencies are now not accessing these vital services quickly,” Julie Sprengel, President, Southwest Division of Dignity Health Hospitals, CommonSpirit Health, said in a statement. “We are instead seeing patients that delayed, postponed or cancelled care coming to emergency departments with serious conditions that should have been treated far earlier.”

Indeed, outpatient hospital visits experienced a record one-week 64% decline during the week of April 5-11, compared to pre-COVID-19 volumes, according to research from TransUnion Healthcare. In addition, hospital visit volumes further declined 33%-62% between the weeks of March 1-7 and April 12-18.

Those stats were echoed in a Medical Group Management Association (MGMA) survey last month showing that physician practices reported a 60% average decrease in patient volume and a 55% average decrease in revenue since the beginning of the public health emergency. 

In addition, nearly two-thirds of hospital executives expect full year revenues will decline by at least 15% due to the coronavirus disease 2019 (COVID-19) outbreak, according to a Guidehouse analysis of a survey conducted by the Healthcare Financial Management Association (HFMA).

The campaign’s website and PSAs communicate messages like “Life may be on pause. Your health isn’t.,” “Thanks L.A. for doing your part.,” and “Get care when you need it.”

In addition to lost revenue, healthcare providers are warning of a “silent sub-epidemic” of those who are avoiding getting medical care when they need it, which could result in serious, negative health consequences that could be avoided.

“There is concern that patients with serious conditions are putting off critical treatments,” Tom Jackiewicz, CEO of Keck Medicine of USC, said in a statement. “We know that seeking immediate care for heart attacks and strokes can be life-saving and may minimize long-term effects. Our hospitals and health care providers are ready and open to serve your needs.”

The BetterTogether.Health public service effort combines those health systems’ resources to create a joint message that will include multi-language television and radio spots, and billboards, messages in newspapers, magazines, digital, and social media; online information, and links to healthcare resources.

It’s reminding people to seek care for things ranging from heart attack symptoms to keeping up with children’s immunization schedules.

“Receiving timely treatment by skilled medical professionals is essential to helping us achieve for our patients and communities the best possible outcomes,” Tom Priselac, President and CEO of Cedars-Sinai Health System. “Please do not delay getting your health care. We encourage you to call a trusted health care provider like your doctor’s office, hospital or urgent care center.”

Doctors raise alarm about health effects of continued coronavirus shutdown: ‘Mass casualty incident’

Furthermore, Tyler Olson reported something that most of us physicians realized as this pandemic continued that and that more than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the “national shutdown” aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a “mass casualty incident” with “exponentially growing health consequences.”

The letter what I stated in the beginning of this post, which outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to “poverty and financial uncertainty,” which “is closely linked to poor health.”

“We are alarmed at what appears to be the lack of consideration for the future health of our patients,” the doctors say in their letter. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.”

The letter continues: “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.”

The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable “suffering and death.”

But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home. The doctors’ letter lists a handful of patients by their initials and details their experiences.

“Patient E.S. is a mother with two children whose office job was reduced to part-time and whose husband was furloughed,” the letter reads. “The father is drinking more, the mother is depressed and not managing her diabetes well, and the children are barely doing any schoolwork.”

“Patient A.F. has chronic but previously stable health conditions,” it continues. “Her elective hip replacement was delayed, which caused her to become nearly sedentary, resulting in a pulmonary embolism in April.”

 Dr. Mark McDonald, a psychiatrist, noted in a conversation with Fox News that a 31-year-old patient of his with a history of depression who was attending school to get a master’s degree in psychology died about two weeks ago of a fentanyl overdose. He blames the government-imposed shutdown.

“She had to stay in her apartment, essentially in-house arrest as most people here in [Los Angeles] were for weeks and weeks, she could not see her therapist — she could speak to the therapist over the phone but she couldn’t see her in person. She could not attend any of her group meetings, which were helping to maintain her abstinence from opiates … and she relapsed into depression.

“She was just too withdrawn to ask for help,” McDonald continued before noting that due to regulations only six people could be at her funeral. “She was simply trying to escape from her pain… I do blame these actions by the government for her death.”

Fox News asked McDonald, as well as three other doctors who were involved with the letter, if they thought the indirect effects of the shutdowns outweighed the likely direct consequences of lifting them — the preventable “suffering and death” Fauci referred to in last week’s Senate hearing. All four said that they believe they do.

“The very initial argument … which sounded reasonable three months ago, is that in order to limit the overwhelmed patient flux into hospitals that would prevent adequate care, we needed to spread out the infections and thus the deaths in specific locales that could become hotspots, particularly New York City… It was a valid argument at the beginning based on the models that were given,” McDonald said. “What we’ve seen now over the last three months is that no city — none, zero — outside of New York has even been significantly stressed.”

McDonald is referring to the misconception that business closures and stay-at-home orders aimed at “flattening the curve” are meant to reduce the total number of people who will fall ill because of the coronavirus. Rather, these curve-flattening measures are meant largely to reduce the number of people who are sick at any given time, thus avoiding a surge in cases that overwhelms the health care system and causes otherwise preventable deaths because not all patients are able to access lifesaving critical care.

McDonald said that “hospitals are not only not overwhelmed, they’re actually being shut down.” He noted that at one hospital in the Los Angeles area where Dr. Simone Gold, the head organizer of the letter, works “the technicians in the ER have been cut by 50 percent.”

Gold also said the effects of the shutdown are more serious for the vast majority of people than the potential virus spread if it is quickly lifted.

“When you look at the data of the deaths and the critically ill, they are patients who were very sick to begin with,” she said, “There’s always exceptions. … But when you look at the pure numbers, it’s overwhelmingly patients who are in nursing homes and patients with serious underlying conditions. Meaning, that that’s where our resources should be spent. I think it’s terribly unethical… part of the reason why we let [the virus] fly through the nursing homes is because we’re diverting resources across society at large. We have limited resources we should put them where it’s killed people.”

People of all ages, of course, have been shown to be able to catch the coronavirus. And there have been reported health complications in children that could potentially be linked to the disease. Fauci also warned about assuming that children are largely protected from the effects of the virus.

“We don’t know everything about this virus … especially when it comes to children,” Fauci said in a Senate hearing last week. “We ought to be careful and not cavalier.”

Newport Beach, Calif., concierge doctor Dr. Jeffrey Barke, who led the letter effort with Gold, also put an emphasis on the disparity in who the virus effects.

“There are thousands of us out there that don’t agree with the perspective of Dr. Fauci and [White House coronavirus response coordinator] Dr. Deborah Birx that believe, yes, this virus is deadly, it’s dangerous, and it’s contagious, but only to a select group of Americans,” he said. “The path forward is to allow the young and healthy, the so-called herd, to be exposed and to develop a degree of antibodies that both now is protective to them and also prevents the virus from spreading to the most vulnerable.”

Dr. Scott Barbour, an orthopedic surgeon in Atlanta, reflected the comments the other doctors made about how the medical system has been able to handle the coronavirus without being overwhelmed, but also noted that the reported mortality rates from the coronavirus might be off.

“The vast majority of the people that contract this disease are asymptomatic or so minimally symptomatic that they’re not even aware that they’re sick. And so the denominator in our calculation of mortality rate is far greater than we think,” he said. “The risk of dying from COVID is relatively small when we consider these facts.”

Gold, an emergency medicine specialist based in Los Angeles, led the letter on behalf of a new organization called A Doctor a Day.

A Doctor a Day has not yet formally launched but sent the letter, with hundreds of signatures from physicians nationwide, to the White House on Tuesday. Gold and the group’s co-founder, Barke, said they began the organization to advocate for patients against the government-imposed coronavirus shutdowns by elevating the voices of doctors who felt that the negative externalities of the shutdowns outweigh the potential downside of letting people resume their normal business.

To gather signatures for the letter, Gold and Barke partnered with the Association of American Physicians and Surgeons (AAPS), a doctors’ group that advocates for less government interference in the relationship between doctors and patients, and notably has taken part in legal challenges against the Affordable Care Act and advocated to allow doctors to use hydroxychloroquine on themselves and their patients.

Gold, in a conversation with Fox News, lamented that the debate around hydroxychloroquine has become politicized, noting that it is taken as a preventative measure for other diseases and that the potentially harmful effects of the drug mainly affect people with heart issues.

The drug is approved to treat malaria, lupus and rheumatoid arthritis, but the Food and Drug Administration has said that “hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.”

The FDA has also warned health professionals that the drug should not be used to treat COVID-19 outside of hospital or research settings.

Gold said she has direct knowledge of physicians who are taking hydroxychloroquine and said that although “we will see” about its efficacy as it is studied more, there have been some indicators that it could be effective at preventing or mitigating COVID-19 and she could therefore understand why doctors might take the drug themselves or prescribe it to their patients.

There is also other research that appears to indicate hydroxychloroquine is not an effective treatment for the coronavirus, which has largely informed the consensus that the risks of the drug outweigh the potential benefits.

Gold, who is a member of the national leadership council for the Save Our Country Coalition — an assortment of conservative groups that aim “to bring about a quick, safe and responsible reopening of US society” — also said she was concerned that her message about the harms of shutdowns is becoming politicized. She said that she agreed with the general principles of the coalition and decided to sign on when asked, but hasn’t done much work with it and is considering asking to have her name removed because people are largely associating her message on reopening the country with a conservative political point of view.

“I haven’t done anything other than that,” she said. “It’s causing a big misunderstanding about what I’m doing so I actually think I’m just going to take my name off because it’s not really supposed to be political.”

Gold also said she is not associated with the Trump reelection campaign in any way, referring to her inclusion in an Associated Press story about the Trump campaign’s efforts to recruit doctors to support the president’s message on lifting coronavirus restrictions. The AP story details a call organized CNP Action, also part of the Save Our Country Coalition, which involved a senior Trump campaign staffer and was aimed at recruiting “extremely pro-Trump” doctors to make television appearances calling for the reopening of the economy as quickly as possible.

Fauci says extended stay-home orders could cause ‘irreparable damage’

Just recently Dr. Fauci changed his view on stay-home orders. Dom Calicchio reported that stay-home orders that extend too long could cause the U.S. “irreparable damage,” Dr. Anthony Fauci finally warned Friday.

Strict crackdowns on large gatherings and other orders, such as for home quarantines, were needed when the coronavirus first hit the nation, but those rules can now begin to be lifted in many parts of the country, Fauci said during an interview on CNBC.

“I don’t want people to think that any of us feel that staying locked down for a prolonged period of time is the way to go,” the member of the White House coronavirus task force said.

“But now is the time, depending upon where you are and what your situation is, to begin to seriously look at reopening the economy, reopening the country to try to get back to some degree of normal.” He warned, however, against reckless reopenings and called for the use of “very significant precautions” as restrictions are lifted.

Fauci told CNBC that staying closed for too long could cause “irreparable damage.” He said the US had to institute severe measures because #Covid19 cases were exploding “But now is the time, depending upon where you are and what your situation is” to open.

“In general, I think most of the country is doing it in a prudent way,” he said. “There are obviously some situations where people might be jumping over that. I just say, ‘Please, proceed with caution if you’re going to do that.’”

Fauci’s comments came one day after two top Republicans – Sen. Rand Paul of Kentucky and Rep. Andy Biggs of Arizona – wrote in an op-ed that Fauci’s initial safety recommendations had “emasculated” the nation’s health care system and “ruined” its economy.

“Fauci and company have relied on models that were later found to be deficient. He even has suggested that he can’t rely, on any of the models, especially if the underlying assumptions are wrong,” the pair wrote in USA Today. “Yet, Fauci persists in advocating policies that have emasculated the medical care system and ruined the economy.”

They also pointed to Fauci’s testimony last week before a Senate committee that opening too soon would “result in needless suffering and death.”

“What about the countless stories of needless suffering and death produced by Fauci’s one-size-fits-all approach to public health?” Paul and Biggs asked.

They called for policies based on trusting the risk assessment of the American people rather than a federal government mandate.

Earlier Friday, Fauci said it was “conceivable” that the U.S. could begin to distribute a coronavirus vaccine by December. “Back in January of this year when we started the phase 1 trial, I said it would likely be between a year and 18 months before we would have a vaccine,” Fauci said during an interview on NPR. “I think that schedule is still intact.

“I think it is conceivable,” he continued, “if we don’t run into things that are, as they say, unanticipated setbacks, that we could have a vaccine that we could be beginning to deploy at the end of this calendar year, December 2020, or into January, 2021.”

My question is what does the future of medicine look like going forward from this pandemic and how do we plan for a better healthcare system and assist in the recovery of our economy?

More on that in future posts.

People are Truly Stupid- People are furious over 2020 graduation ceremonies, the latest coronavirus political battleground

Lilly Altavena reported that people are furious about not being able to have their graduation ceremonies. How silly! Keiv Soliman doesn’t want to receive his diploma joined on-stage by a hologram of his principal. 

But as the coronavirus continues to cast a shadow on American traditions, making large gatherings like graduation ceremonies dangerous, a virtual ceremony might be the Highland High School senior’s only chance at pomp and circumstance. 

Soliman’s school, in Gilbert, Arizona, is staging an elaborate virtual graduation ceremony, where Highland seniors will be filmed walking across a stage to receive their diploma.

Their principal will read student names from a different room. Using “holographic technology,” video editors will then edit the ceremony to make it appear as if everyone was in the same room together.

But Soliman’s friends don’t want a studio-produced graduation, he said. They want a real ceremony. Soliman started a petition, which has more than 600 signatures so far, asking for an in-person ceremony — with masks and social distancing.

“You can’t really replace the real thing with anything but the real thing,” Soliman said. 

Graduation ceremonies have become a political battleground for schools, students and parents in the wake of school closures caused by the coronavirus. Some believe they can have a ceremony safely while others are accusing the high-schoolers and their parents of being selfish during a global pandemic.

“This is much bigger than a graduation ceremony,” said Reed Burris, a Gilbert resident opposed to in-person ceremonies. “You should be pushing for people to stay inside.” 

Soliman’s petition is one of more than 500 on Change.org, pleading for the preservation of in-person ceremonies across the U.S. 

Not the real thing, but… Students will cross the finish line to high school with a lap at the Daytona 500In Knoxville, Tennessee, district leaders backpedaled on a plan to hold graduation without guests when parents revolted. 

“There’s a lot more involved in these ceremonies than a student getting a paper diploma and turning their tassel,” Knox County Mayor Glenn Jacobs said.

The discourse shares similarities with the fervent demonstrations staged for and against reopening America’s businesses, as well as the debate over the use of masks in public places. The rancor underscores an increasingly fractured conversation around COVID-19. 

Uncertainty looms over ceremonies

Arizona’s stay-at-home order expires Friday. The governor isstill encouraging social distancing, but nothing in his new order appears to forbid gatherings.

The Arizona Department of Health Services recommended on Monday “that mass gatherings (such as graduations, concerts) are not held at this time.” 

Even still, the agency outlined steps for attendees and organizers to take if they planned to forge ahead with a ceremony: 

  • Anyone sick should stay home. 
  • Attendees should stay six feet away from each other.
  • Anyone in a high-risk group should not attend, including older adults and anyone with a serious underlying medical condition. 
  • Attendees should not touch their eyes, nose or mouth and should use hand sanitizer after leaving the event. They should also wash their hands with soap and water for at least 20 seconds upon returning home. 
  • Attendees should cover their faces at the event.
  • They should not borrow or rent graduation regalia.

Major Arizona school districts have either postponed ceremonies or have decided to hold virtual ceremonies.

Chandler Unified, the second-largest school district in the state, wrote to families on May 5 that the district is working on a plan to hold graduation ceremonies at each high school “while still adhering to the recommended CDC guidelines.”

At the ceremonies, students would be seated six feet apart and the audience would likely be limited. The ceremonies would be livestreamed for families to watch.

One superintendent in suburban Milwaukee, Wisconsin, initially resisted the idea of a virtual graduation because it made the emotional event seem so impersonal.

Back in early April, Wauwatosa School District Superintendent Phil Ertl said he hoped to just keep pushing back the date of an in-person ceremony for as long as it took to do it safely. But by early May, his district had gone the route of many others, with a planned video celebration set for June 7.

“We are also still hanging on to July 26 in hopes that we can do something in person,” Ertl said this week. “So much is changing. To cancel that date right now doesn’t make sense to me.”  

Pleas for the show to go on 

People in at least nine school districts across Arizona have started Change.org petitions to hold in-person graduation ceremonies. 

After Arizona Gov. DougDucey announced that businesses could start to reopen, a group of Arizona seniors made a video pleading for an in-person ceremony.

“There are ways we can make this happen,” one of the students in the video said. “We deserve a graduation.” 

The video was posted on Twitter and received nearly 100 retweets. But some who responded to the tweet scoffed at the idea.

“You’re asking to put your friends’ parents at risk of dying so you can feel accomplished for a completely normal and baseline accomplishment,” one Twitter user responded.

Others have tried to come up with alternatives to graduation. 

Beth Obermeyer, who works with high school students at New Foundation church in Goodyear, held driveway graduations for seniors. Using a megaphone, church staff surprised students by showing up on their driveway and holding impromptu celebrations, six feet apart. 

“We were trying to think of a way to make our high school seniors feel better because they’ve had such a rough spring,” Obermeyer said.

No prom, either: So, these families toasted a high school couple in their own backyard prom

In Great Falls, Montana, district officials said they did not want the coronavirus to end the tradition of graduating seniors’ ringing a school bell. Officials are leaving the bell in the school’s parking lot for students to ring. 

If students choose to ring the bell, they are asked to maintain social distancing, wear the supplied disposable gloves and sanitize hands before and after ringing the bell. The school is setting up a hand-sanitizing station.

‘We’re not taking this lightly’: Small Montana school to be among first in US to reopen

Some have said schools are being too cautious.

A group of Mountain View High parents in Mesa, Arizona, are throwing a senior salute parade for grads. Seniors on May 16 will line up six feet apart on the sidewalk of a Mesa street for cars to drive by in celebration.

Destinee Mack, a parent and one of the event’s organizers, initially asked the district if parents could drop their student off in the high school’s parking lot so the students could safely line up.

Mesa Public Schools denied that request, Mack said. Mesa did not respond to a request for comment. 

“I do think there’s a risk, but I do also think that if we follow the social distancing protocols . I think we can still do this in a socially responsible way,” Mack said. 

Harvard epidemiologist: Beware COVID-19’s second wave this fall

Len Strazewski writer for the AMA questioned whether sunshine and warm weather bring an end to face masks, physical distancing and other pandemic mitigation tactics? Several states may be easing stay-at-home orders, but the joy of the release of COVID-19 restrictions may be short-lived. And that is what we saw last weekend here in Ocean City, Maryland. The crowds were amazing!

People believe the talk of the second wave, which I became more aware when one of my cosmetic surgery patients, scheduled for her surgery rescheduled for September just cancelled her surgery due to her belief that there would be a second wave of the COVID-19 disease.

Featured updates: COVID-19

Track the evolving situation with the AMA’s library of the most up-to-date resources from JAMA, CDC and WHO.

Summer may slow the spread of the coronavirus a bit, but it will back by fall with a second wave that looks a lot like the first wave, said a leading epidemiology researcher. And the immunity that will bring a real end to the pandemic may be a long time coming.

Marc Lipsitch, DPhil, is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of the Center for Communicable Disease Dynamics. He discussed the prospects for mitigating a second wave of the COVID-19 pandemic and the potential approaches to faster development of a vaccine, with JAMA Editor-in-Chief Howard Bauchner, MD, on Dr. Bauchner’s podcast, “Conversations with Dr. Bauchner.”

“Almost every government is talking about lifting control measures. Not every government, but many, because of the economic burdens. Given the fairly high caseloads that we have in the United States, that’s a really risky thing to do right now,” Lipsitch said.

“I hope that the summer weather will help,” he added, but his research indicates that the warmer weather will only reduce transmission rates by about 20%. “That’s only enough to slow it down, but not enough to stop it.”

Jurisdictions may learn more about which tactics work best in mitigating transmission during this period and may learn whether some mitigation tactics such as school closings are valuable.

“But the downside,” Lipsitch warned, “is that many jurisdictions will have a plan to open up but not a plan to reclose, leading to more situations like New York, New Orleans and Detroit where there’s extreme strains on the heath care.”

Learn more with the AMA about the four signposts to safely reopen America. Also consult the AMA’s new physician practice guide to reopening.

Stay up to speed on the fast-moving pandemic with the AMA’s COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization. Also check out the JAMA Network COVID-19 resource center.

Serological studies

Testing will be important, Lipsitch said, and medical researchers need to learn more about infection rates. Preliminary research indicates that rates may vary widely around the country and a real understanding may have to wait until comprehensive serological testing, he explained.

Local leaders will need to understand more about who gets infected before they can make good decisions about openings and staying open. Sociological factors such as poverty and transportation maybe important determinants in understanding infection and serological surveys may help in understanding who gets infected and which intervention and mitigation tactics are most valuable.

Fall will be difficult

Lipsitch said that despite hopes that summer will bring continued relief from the spread of the virus, “fall will be very much like the spring,” and the usual pattern of coronaviruses is likely continue with new transmission peaking in November and cases peaking in December.

“We will have a harder time controlling coronavirus in the fall … and we will all be very tired of social distancing and other tactics. The hard thing will be to keep enough of it to protect our ICUs and keep the number of cases from flaring up,” he said.

Controlling the virus may call for a return to the tactics that have worked in spring and a continued focus on maintaining resources such as personal protective equipment and increasing viral testing.

Illinois mandated ‘Stay-at-home’ orders, nearby Iowa didn’t: here’s what happened

Healthday reporter, Dennis Thompson noted that Statewide stay-at-home orders appear to help slow the spread of COVID-19 above and beyond other steps like banning large gatherings and closing non-essential businesses.

That’s the suggestion from a new cross-border study.

Certain counties in Iowa—one of five states that didn’t issue a stay-at-home order for its citizens—experienced a 30% greater increase in COVID-19 cases compared to counties right across the border in Illinois, which did issue such an order, the researchers reported.

“It does line up with a lot of other evidence that’s coming up from other national studies,” said senior researcher George Wehby, a professor of health management and policy with the University of Iowa College of Public Health. “Overall, there’s evidence the more restrictive measures were associated with greater declines in COVID case growth.”

For this study, Wehby and a colleague compared COVID-19 rates for counties on either side of the Iowa/Illinois border. “Border counties serve as nice controls because they tend to be somewhat similar,” Wehby said.

As the pandemic unfolded, Iowa issued a series of social distancing orders. The state banned gatherings and closed bars and restaurants, then closed non-essential businesses, and then closed all primary and secondary schools.

But Iowa did not issue a broad shelter-in-place order directing residents to stay home unless absolutely necessary, a step taken by Illinois on March 21.

The researchers found that the addition of a stay-at-home order was associated with a slower growth of cases in seven Illinois counties compared with eight neighboring counties in Iowa.

Within a month of the Illinois stay-at-home order, that state had nearly five fewer COVID-19 cases per 10,000 residents in border counties, compared with their neighbors across the line in Iowa, according to the report published online May 15 in JAMA Network Open.

Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security, said, “It is not surprising that when a stay-at-home order is issued that you see a decrement in cases. The virus requires social interaction to transmit and a stay-at-home order delimits social interaction.” Adalja was not involved with the new study.

“However,” he continued, “the key metric is not necessarily the number of cases but the hospital stress load induced by the cases. Stay-at-home orders ideally should be issued with the primary aim of preserving hospital capacity.”

It’s important to know which social distancing measures work best as the world refines its response to COVID-19, Wehby said.

“Understanding what might be working more or less is a key question,” Wehby said. “This study only adds a little more information into the bucket of evidence that needs to be accumulated.”

For some unknown reason, stay-at-home orders appear to be associated with less transmission of the coronavirus, according to these results.

“These shelter-in-place or stay-at-home orders, there is something about them that seems to add above and beyond just closing restaurants,” Wehby said.

“Do people behave differently even when they go out under a stay-at-home order?” Wehby pondered. “Are you more cautious? Do you keep a larger distance? Are you more likely to wear a mask or avoid being close to people? People with more health risks, are they more likely to stay home following these orders?”

A COVID-19 survivor’s warning: Don’t rush back to normal. It doesn’t exist

The problem with recovery from COVID is that it may never be normal. Cortlynn Stark of the Kansas City Star reported that Stacy Jackson given birth five times. She’s not being dramatic. She could barely breathe.

“My body felt like someone had beat me and drugged me and then hung me up and beat and drugged me again,” Jackson said.

She had COVID-19.

Two of her uncles also later tested positive and were hospitalized. One of them, Marvin Jackson, died.

After nearly being placed on a ventilator, her kidneys beginning to fail, and spending five days unconscious, Jackson survived. Now she has a warning for Kansas City: Don’t rush to go back to normal. It doesn’t exist.

A positive test

Stacy Jackson started to feel sick on March 23. By the 26th, she tried to see her primary care physician. Staff asked Jackson, who also has Type 2 diabetes, over the phone if she was running a temperature. Jackson didn’t know, so staff came out with a thermometer to take her temperature. It was 104 degrees. Her doctor couldn’t see her.

From there, she went to the emergency room at Truman Medical Center. She was given a cocktail of drugs to help, what she called the “COVID super pack,” and a test for the coronavirus. Her test results would be ready in two days.

March 27 was her 21st wedding anniversary. Jackson and her husband had already taken the day off. She spent the day in bed, sick. She lost her senses of taste and smell. Her appetite was gone. Jackson spent the next day in bed as well.

Two days after her anniversary, she received her positive test result. Her condition continued to deteriorate and she went back to the hospital for a couple hours.

“I was scared to death,” Jackson said.

It was still in the early days of the virus in Kansas City. Fewer than 300 people had tested positive in the metro and no one in the city had died of it, according to statistics tracked by The Star.

By March 31, Jackson was struggling to breathe. Nearly 500 people across the metro had tested positive. “I just told myself, ‘you’re not gonna die,'” Jackson said. She told her husband he had to take her back to the hospital. He dropped her off outside. He couldn’t go in, of course. Health care facilities had already begun limiting visitors.

Jackson said she thinks the lack of oxygen took a toll on her brain as the disease took its toll on her mentally and physically. She was placed in the ICU and was in and out of consciousness from March 31 to April 4. Sometime during those five days, she became aware of two doctors in her room talking to each other: She may have to be put on a ventilator.

“I remember shaking my head no,” Jackson said. In a phone call a month later, she said she worried that if she was put on a ventilator, she wouldn’t survive. A study of patients in a New York placed on ventilators found that just 3% left the hospital alive. A quarter of them died. About 72% were still in the hospital.

On April 5, her fever broke and she started becoming more responsive. But every time she got up, “it was like running around Kansas City seven times,” Jackson said. By this time, more than 700 people tested positive in the metro.

For the first time since March 31st, she was able to call her husband. But talking was still painful. “He said ‘babe don’t talk, I’m just so glad I’m able to hear you,'” Jackson said. She left the hospital three days later.

A solitary battle

Jackson is used to being surrounded by family. But she hadn’t seen her mother since before Kansas City’s stay-at-home order went into effect on March 24. The month before, her mother, who lives at an assisted living facility in Overland Park, was in the hospital battling the flu and pneumonia. Jackson was by her side.

“We are a face to face family,” Jackson said. “When people are stricken with disease in our family, we pray together.” But no one could be by her side. Or the sides of her two sick uncles.

COVID-19 is isolating. Instead of family members by her hospital bed, she was surrounded by nurses and doctors—genuine and caring, she said—covered in personal protective equipment. One nurse, Jackson said, told her that if she left the hospital, she would be one of the first to leave the COVID-19 dedicated floor alive.

Her uncle Marvin Jackson died on April 23—one of three to die that day and one of 106 people to die across the metro since the outbreak began.

Never the same

When Jackson left the hospital on April 8, staff played the “Rocky” theme song for her. At home, four of her six children and her husband were waiting for her.

Her oldest two children have their own apartments in Kansas City. The middle two were home from college. Her youngest, twin boys, are seniors in high school. She was on oxygen support for two weeks. But she’s worried about reopening.

Beginning May 15, Kansas City businesses can reopen under a “10/10/10” rule. In Kansas, Gov. Laura Kelly’s phased reopening plan last week includes rules that businesses opening must maintain 6 feet of separation between customers and limit gatherings to less than 10. On the Missouri side, Gov. Mike Parson ordered businesses to maintain social distancing, but did not limit social gatherings.

“We’re risking millions of lives for comfortability,” Jackson said. “We need to stop the madness. I would rather have a light bill that I can’t pay than lose my life.”

She wants people to take the virus seriously and respect the severity. With most of her immediate and large family in the Kansas City area, they often have large gatherings of up to 45 people at her home.

Not anymore.

Jackson said her family would often rent out four tables at a Japanese steakhouse on the County Club Plaza.

Not anymore.

And even though she has cable, and a number of streaming services, she would still go to movie theaters.

Not anymore.

“We can’t go back to the way it was,” Jackson said. “I don’t know when I’ll be able to go back to a restaurant and feel safe.”

She couldn’t throw the usual Mother’s Day brunch for her aunts, cousins and sister-in-law either. By May 9, the day before Mother’s Day, 2,900 people tested positive and 146 people in the metro died of COVID-19. More than 1.3 million people across the country tested positive and more than 78,000 people have died.

“I value life a little bit more and how precious life is,” Jackson said. “We could be gone in the blink of an eye. We need to do everything in our power not to make it worse.”

Jackson is thankful to be alive.

74% of people are worried social distancing will not be followed as lockdown is eased

A University College London reported on a study that nearly eight in 10 people are worried about COVID-19 infections rising and people not adhering to social distancing as lockdown is eased, according to UCL’s COVID-19 study.

The study, launched in the week before the lockdown, is the UK’s largest on adult wellbeing and mental health during the coronavirus epidemic and has over 90,000 participants who report their feelings about the lockdown, government advice, along with wellbeing and mental health.

It is funded by the Nuffield Foundation with additional support from Wellcome and UK Research and Innovation (UKRI). Findings are broken down by age, gender, income, those living with children, those who are keyworkers and those living in rural areas and whether people live alone or not.

This week’s findings, which focus on how people have been feeling between 4-10 May, find that economic concerns about recession and unemployment levels rising also rank highly. Additionally, around one in three people express concern about pollution increasing, social cohesion decreasing, and crime levels rising.

Lead author, Dr. Daisy Fancourt (UCL Epidemiology & Health Care) said: “Our findings show that concern about increasing cases of COVID-19 are consistent across all ages, but concern about hospitals becoming overwhelmed is higher in younger adults, while concern about people not adhering to social distancing is higher in older adults.

“Concerns about unemployment and recession are consistent across ages, but concern about crime rising is higher in older adults, while concern about pollution increasing and social cohesion decreasing is slightly higher in adults under the age of 30.”

This week’s report also finds that half of people do not feel in control of their future plans with 23% of people and 39% of people feeling the same about their mental health and employment respectively.

Dr. Fancourt (UCL Epidemiology & Health Care) added: “This week we also found 50 % of our participants do not currently feel in control of their future plans, and many feel unable to manage their mental health and are worried about their future employment.

“However, in terms of physical health, eight out of ten people feel in control and the same can be said for their marriage or relationship. When we compare ‘sense of control’ across age groups, younger adults report feeling less in control across all domains. “The study team has also received support from Wellcome to launch an international network of longitudinal studies called the COVID-MINDS Network. Through the network, dozens of scientists and clinicians are coming together internationally to collate results from mental health studies running in countries around the world and compare findings. The initiative will support the launching of new mental health studies in other countries and show whether actions taken in specific countries are helping to protect mental health.

Unfortunately, I have to agree with this study, that is, as the lockdowns are eased, people will not take responsibility for their actions and ignore social distancing. As I mentioned from the beginning, people are stupid and are only concerned about what they want rather what is best for the general public and this disease. I do understand that many want to get back to work so that they can save their businesses and support themselves, their family and their employees.

And lastly, Happy Memorial Day Weekend and remember why we celebrate this day and those who gave their lives to protect us, our country and our freedoms!

Coronavirus: Top scientist who battled COVID-19 says we will never live normally without vaccine! Nursing Homes, Packed Coffee Houses, and When will it Be Over?

As anyone else noticed the advertisements on television? They are mainly auto dealerships who will delivery your new car to your home and more attorney companies who will sue whomever you want and will not get charged unless they will your case. One of my former professors during my MBA program is a federal judge who warned me that judges are expecting to see many cases of malpractice cases coming to the courts secondary to the COVID-19 cases. Unbelievable!

 Ross McGuinness reported that a top scientist who fell ill with COVID-19 has said the world will never return to normal unless there is a coronavirus vaccine.

Peter Piot, director of the London School of Hygiene & Tropical Medicine, spent a week in hospital after contracting the virus in March. The Belgian virologist, who led the Joint United Nations Program on HIV/AIDS between 1995 and 2008, said climbing a flight of stairs still leaves him breathless.

Last week, a World Health Organization (WHO) official warned there may never be a coronavirus vaccine.

Prof Piot, one of the discoverers of the Ebola virus, is currently a coronavirus adviser to European Commission president Ursula von der Leyen. In an interview with Belgian magazine Knack, later translated by Science Magazine, he warned that a vaccine is needed for people to live normally again.

“The Commission is strongly committed to supporting the development of a vaccine,” he said. “Let’s be clear: Without a coronavirus vaccine, we will never be able to live normally again. “The only real exit strategy from this crisis is a vaccine that can be rolled out worldwide.

“That means producing billions of doses of it, which, in itself, is a huge challenge in terms of manufacturing logistics. And despite the efforts, it is still not even certain that developing a COVID-19 vaccine is possible.”

Prof Piot criticized anti-vaxxers, saying: “Today there’s also the paradox that some people who owe their lives to vaccines no longer want their children to be vaccinated. “That could become a problem if we want to roll out a vaccine against the coronavirus, because if too many people refuse to join, we will never get the pandemic under control.”

He said he hoped the coronavirus pandemic can help ease political tensions, citing how polio vaccination campaigns have led to truces between countries. He said he hoped the WHO could be “reformed to make it less bureaucratic”, saying it too often resembles a “political battleground”.

According to Johns Hopkins University, the US is the worst-hit country by coronavirus, with more than 79,500 deaths, followed by the UK with more than 31,900 and Italy with more than 30,500.

On Sunday, British prime minister Boris Johnson announced a range of new measures to ease the UK out of its COVID-19 lockdown. However, his announcement of the government’s measures was criticized by scientists, opposition politicians and workers’ unions, who called it confusing.

The government was left scrambling on Monday to bring some kind of clarity to the new measures. A 50-page document outlining the easing of restrictions was published on Monday. From Wednesday, people will be able to meet one person from another household in a park as long as they stay two meters apart.

Covid-19: nursing homes account for ‘staggering’ share of US deaths, data show

Reporter Jessica Glenza noted that residents of nursing homes have accounted for a staggering proportion of Covid-19 deaths in the US, according to incomplete data gathered by healthcare researchers.

Privately compiled data shows such deaths now account for more than half of all fatalities in 14 states, according to the Kaiser Family Foundation. Only 33 states report nursing home-related deaths.

“I was on a phone call last week, where four or five patients came into our hospital just in one day from nursing homes,” said infectious disease specialist Dr Sunil Parikh, of Yale School of Public Health in Connecticut. “It’s just a staggering number day to day.”

Despite early warnings that nursing homes were vulnerable to Covid-19, because of group living settings and the age of residents, the federal government is only beginning to gather national data.

In Connecticut, 194 of 216 nursing homes have had at least one Covid-19 case. Nearly half the Covid-19 deaths in the state – more than 1,200 people – have been of nursing home residents. The proportion is higher elsewhere. In New Hampshire, 72% of deaths have been nursing home residents.

Parikh said limited testing and a lack of personal protective equipment such as masks hampered efforts to curb the spread of Covid-19 in care homes. Due to limited testing capacity, most state nursing homes are still only able to test residents with symptoms, even though the disease is known to spread asymptomatically.

“What I would like to see is the ability to test the entire nursing homes,” Parikh said. “This symptomatic approach is just not cutting it. Many states, including Connecticut, are starting to move in that direction … but I hope it becomes a national effort.”

Nursing homes have been closed to the public for weeks but a bleak picture has nonetheless emerged. In New Jersey, Governor Phil Murphy called in 120 members of the state national guard to help long-term care facilities, after 17 bodies piled up in one nursing home.

In Maine, a 72-year-old woman who went into a home to recover from surgery died just a few months later, in the state’s largest outbreak.

“I feel like I failed my mom because I put her in the wrong nursing home,” the woman’s daughter, Andrea Donovan, told the Bangor Daily News. “This facility is responsible for so much sadness for this family for not protecting their residents.”

Fifteen states have moved to shield nursing homes from lawsuits, according to Modern Healthcare.

Nursing home residents were among the first known cases of Covid-19 in the US. In mid-February in suburban Kirkland, Washington, 80 of 130 residents in one facility were sickened by an unknown respiratory illness, later identified as Covid-19.

Statistics from Kirkland now appear to tell the national story. Of 129 staff members, visitors and residents who got sick, all but one of the 22 who died were older residents, according to the US Centers for Disease Control and Prevention (CDC).

By early March, most Covid-19 deaths in the US could still be traced to Kirkland.

“One thing stands out as the virus spreads throughout the United States: nursing homes and other long-term care facilities are ground zero,” wrote Dr Tom Frieden, the former head of the CDC, for CNN on 8 March.

That day, Frieden called on federal authorities to ban visitors from nursing homes. US authorities announced new measures to protect residents several days later.

The CDC investigation into Kirkland was released on 18 March. It contained another warning: “Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to Covid-19.”

It was not until 19 April that the head of the Centers for Medicare and Medicaid Services promised to track all deaths in nursing homes. That requirement went into effect this Friday, but there is still a two-week grace period for compliance. During the period from 19 April to 8 May, 13,000 people died, according to an NBC News analysis.

“This is really decimating state after state,” said Parikh. “We have to have a very rapid shift [of focus] to the nursing homes, the veteran homes … Covid will be with us for many months.”

Texas begins to reopen after Covid-19 quarantine – but political controversy and health risks await

Three reporters contributed to this article, Erum Salam, Nina Lakhani and Oliver Laughland, where they noted that Tim Handren, the chief executive of Santikos Entertainment, a small cinema chain in San Antonio, admits his business is not essential. But while the giants of the industry keep their screens closed, he has taken a different approach.

Since last weekend, three of nine Santikos cinemas have reopened to the public, among the first in America to do so during the coronavirus pandemic.

“Take your mask off and relax,” Handren said in a recorded message to customers. “Breathe in some great buttery popcorn smells, watch a great movie, and just enjoy some time with your family.”

The reopening is among the starker examples in Texas, where one of the quickest and most expansive efforts to reignite the economy has drawn significant controversy.

On the one hand, some civil liberty advocates have argued that their right to drink at bars, have their hair cut and dine at restaurants has been curtailed. On the other, many public health experts warn thousands will become infected as the state reopens.

Handren, who is also the mayor of the small town of Boerne, said that although his cinemas would keep patrons 6ft apart and offer a reduced menu there remained debate in the community about whether the shutdown had been necessary at all.

“Unfortunately, I still interact with people that believe Covid-19 is a hoax concocted by the media after all this time. That’s the extreme on that side of the equation … ‘We should have never shut down’. Even the lieutenant governor said that. And then there are others who want to hunker down and hibernate for the next six months. I’ve had to, as a mayor, balance health and economics.”

Abbott, a Republican, last week ended a stay-at-home order and allowed businesses including barber shops and retail outlets to open. The move followed decisions in other southern states including Florida and Georgia, and earned praise from Donald Trump.

The president told reporters: “Texas is opening up and a lot of places are opening up. And we want to do it, and I’m not sure that we even have a choice. I think we have to do it. You know, this country can’t stay closed and locked down for years.”

In private, Abbott has acknowledged that his decision to reopen is likely to cause an increase in coronavirus cases. Leaked audio obtained by the Daily Beast captured comments during a private call with state lawmakers.

Abbott, who has sought to downplay the increased risk to the public, said: “The more that you have people out there, the greater the possibility is for transmission. The goal never has been to get transmission down to zero.”

Infectious disease experts predict the average daily Covid-19 positive test rate in Texas could rise from 1,053 at the beginning of May to up to 1,800 by June.

As of this weekend, Texas had an estimated 16,670 active cases and 1,049 deaths. With the occasional dip, the number of cases continues to rise even while testing lags behind other states.

Harris county, which includes Houston, has 157 coronavirus cases per 100,000 people – 31% higher than the state average. Last month, officials said African Americans accounted for two-thirds of Covid-19 deaths in the city despite making up only 22.5% of the population.

Harris county judge Lina Hidalgo, a Democrat, has attempted to enforce a mandatory mask order. Abbott has publicly criticized her.

Dr Andrew Miller, a pediatric ophthalmologist in Harris county, reopened his clinic last week with social distancing in place. He told the Guardian that even after his decision to reopen, because of the pressing needs of patients, he was experiencing significant anger from those who refuse to wear masks.

He said: “We’ve had some pushback from families because we won’t let them in without a mask. They’ve been ugly to the staff. While I respect their civil liberties, I am entitled to not see them.”

Last week, Abbott took power away from officials who arrest Texans for certain Covid-19 violations. The move was prompted by a conservative backlash against the arrest of a salon owner in Dallas – another hotspot – who opened up against local rules. In an act that exacerbated the divisions on the case, Texas senator Ted Cruz appeared at the salon to receive a haircut from the recently released owner.

Houston lies in a sprawling industrial region with more than 500 petrochemical facilities, a busy shipping channel, large highways and commercial railroads, and one of the highest densities of polluting industries in the country, if not the world.

Air quality, specifically particulate matter, which increases the risk of multiple lung and heart conditions also associated with Covid-19 complications, has been worse in some parts of the city despite the lockdown, leading environmentalists to criticize the decision to reopen so quickly.

“It’s a blind, uninformed decision based on optimism that everything will be better, even though the evidence points to the contrary,” said Elena Craft, senior director at the Environmental Defense Fund (EDF), which coordinates a local project tracking air quality.

The meatpacking industry is also linked to several emerging hotspots in the Texas panhandle, a semi-rural region of 26 northern counties where Trump won 79.9% of the vote in 2016 and the Republican party dominates every level of government.

Moore county has the highest infection rate in Texas. Its death rate is 28 per 100,000 people, almost 10 times higher than Harris county and the state average.

Moore, where around 55% of residents identify as Latino or Hispanic, is home to the massive Brazilian-owned JSB meatpacking plant, which employs mostly Hispanic and migrant workers, many bussed in on company shuttles from towns including Amarillo. Nationwide, industrial meat plants have emerged as incubators for coronavirus spread.

Amarillo, the region’s largest city, situated across Potter and Randall counties, had 1,304 cases as of last Wednesday, including at least 18 deaths. The infection rate is rapidly rising. Potter county has the second worst rate in Texas, with infections doubling every seven or eight days.

Just to the south, in the city of Odessa, a group of armed militia men were arrested last week as they protested alongside bar owner Gabrielle Ellison, who attempted to reopen in violation of an executive order which mandates bars should remain closed.

The six men were members of a militia named Open Texas, which according to reports has operated across the state, offering armed support to business owners.

Ellison, who was also arrested, told local news from jail: “I think some rights were taken away from us, which one of them was like a right to survive. We have to survive and I think those rights were stripped from us.”

But looked what happened in Colorado!

Customers in Packed Colorado Coffee Shop Ignore Mask and Distancing Advice

 We have many stupid people as this next story proves. Customers in a Colorado coffee outlet on Sunday, May 10, resisted official calls for people to wear face masks and gloves – and to distance from one another – when in public.

This video shows the crowded scene inside a C&C Coffee and Kitchen store in Castle Rock on Mother’s Day morning. Few customers appear to be wearing face masks or distancing from one another to the extent suggested by federal and state officials.

Colorado Gov Jared Polis’s ‘Safer at Home’ order, which encourages six feet of distance between people, remains in effect until May 27.

As of May 10, Colorado had reported 19,703 confirmed cases of the coronavirus and 971 deaths.

Opinion: The coronavirus is accelerating America’s decline

Arvind Subramanian reported that the federal government’s response to the pandemic exposes incompetence and decay. The consequences will play out over years to come.

The COVID-19 crisis augurs three watersheds: the end of Europe’s integration project, the end of a united, functional America, and the end of the implicit social compact between the Chinese state and its citizens.                                                                                                                    As a result, all three powers will emerge from the pandemic internally weakened, undermining their ability to provide global leadership.                                                           Europe                                                                                                                                                Start with Europe. As with the 2010-12 eurozone crisis, the bloc’s fault line today runs through Italy. Drained over decades of dynamism and fiscally fragile, it is too big for Europe to save and too big to let fail. During the pandemic, Italians have felt abandoned by their European partners at a moment of existential crisis, creating fertile ground for populist politicians to exploit. The images of Bergamo’s COVID-19 victims being carried in body bags by military convoy to their anonymous, unaccompanied burials, will long remain etched in the Italian collective psyche.                                                                                    Meanwhile, when addressing how to help pandemic-stricken member states, the European Union’s technocratic, ostrich-like elites lapse into the institutional alphabet soup — ECB, ESM, OMT, MFF and PEPP — that has become their default language. The continent’s leaders have faltered and dithered, from European Central Bank President Christine Lagarde’s apparent gaffe in March — when she said that the ECB was “not here to close spreads” between member states’ borrowing costs — to the bickering over debt mutualization and COVID-19 rescue funds and the reluctant, grudging incrementalism of the latest agreement.                                                                                                                          Suppose, as seems likely, that the successful economies of the EU core recover from the crisis while those on the bloc’s periphery falter. No political integration project can survive a narrative featuring a permanent underclass of countries that do not share their neighbors’ prosperity in good times and are left to their own devices when calamity strikes.                             U.S.                                                                                                                                                      The United States’ decline, meanwhile, is over-predicted and under-believed. Even before the COVID-19 crisis, key U.S. institutions signaled decay: the incontinent presidency of Donald Trump, a gerrymandered Congress, a politicized Supreme Court, fractured federalism and captured regulatory institutions (with the U.S. Federal Reserve being an outstanding exception).                                                                                                                          Deep down, however, many of those Americans who see the decay reject the thesis of decline. They remain convinced that the country’s thick web of non-state institutions and underlying strengths — including its universities, media, entrepreneurial spirit, and technological prowess, as well as the global supremacy of the dollar — provide the resilience America needs to maintain its pre-eminence.

But so far, the world’s richest country has been by far the worst at coping with the pandemic. Although the US has less than 5% of the world’s population, it currently accounts for about 24% of total confirmed COVID-19 deaths and 32% of all cases.

In rapid succession, therefore, America’s credibility and global leadership have been buffeted by imperial overreach (the Iraq war), a rigged economic system (the global financial crisis), political dysfunction (the Trump presidency), and now staggering incompetence in tackling COVID-19. The cumulative blow is devastating, even if it is not yet fatal.                                                                                                                                                              Many of these pathologies in turn stem from the deep and poisonous polarization in US society. Indeed, Trump is now goading his supporters into insurrection. Come November, even the basic democratic criterion of holding free and fair elections could end up being flouted.                                                                                                                                         This is a critical moment. Prepare for the trading day with MarketWatch’s Need to Know newsletter. Our flagship email guides investors to the most important, insightful items required to chart the trading a day ahead.                                                      Of course, it would be alarmist and premature to see America’s far-reaching failures in the face of the COVID-19 crisis as threatening U.S. democracy or nationhood. But clinging adamantly to American exceptionalism at such a time seems like dangerous denialism.    China                                                                                                                                         Finally, there is China. Since the time of Deng Xiaoping, the country has thrived on a simple, implicit agreement: citizens remain politically quiescent, accepting curbs on freedom and liberties, and the state — firmly under the control of the Communist Party of China — guarantees order and rising prosperity. But the COVID-19 crisis threatens that grand bargain in two ways.                                                                                         First, the Chinese authorities’ terrible initial handling of the pandemic, and in particular their catastrophic suppression of the truth about the COVID-19 outbreak in Wuhan, has called the regime’s legitimacy and competence into question. After all, the social contract looks less attractive if the state cannot guarantee citizens’ basic well-being, including life itself. China’s true COVID-19 death toll, which is almost certainly higher than the authorities are admitting, will eventually come to light. So, too, will the stark contrast with the exemplary response to the pandemic by the freer societies of Taiwan and Hong Kong.  Second, the pandemic could lead to an external squeeze on trade, investment, and finance. If the world deglobalizes as a result of COVID-19, other countries will almost certainly look to reduce their reliance on China, thus shrinking the country’s trading opportunities. Similarly, more Chinese companies will be blocked from investing abroad, and not just on security grounds — as India has recently signaled, for example. And China’s Belt and Road Initiative — its laudable effort to boost its soft power by building trade and communications infrastructure from Asia to Europe — is at risk of unraveling as its pandemic-ravaged poorer participants start defaulting on onerous loans.                              The COVID-19 crisis will therefore probably hurt China’s long-term economic prospects. Widespread internal rumblings have begun, even if they are less evident externally. Domestic disorder is unlikely, because President Xi Jinping could ratchet up repression even more ruthlessly and effectively than he already has. But the current social contract will seem increasingly Faustian to the average Chinese citizen.

Command of resources is a prerequisite for power. But, as international-relations theory reminds us, projecting power beyond one’s borders requires a modicum of cohesion and solidarity within them. Weak, fractured societies, no matter how rich, cannot wield strategic influence or provide international leadership — nor can societies that cease to remain models worthy of emulation.                                                                                                     We have been living for some time in a G-minus-2 world of poor leadership by the U.S. and China. Both have been providing global public “bads” such as trade wars and erosion of international institutions, instead of public goods such as stability, open markets, and finance. By further weakening the internal cohesion of the world’s leading powers, the COVID-19 crisis threatens to leave the world even more rudderless, unstable, and conflict-prone. The sense of three endings in Europe, America, and China is pregnant with such grim geopolitical possibilities.                                                                                                            And Now Wuhan reported its first new coronavirus case in more than a month                                                                                                                      Aly Song from Reuters reported that Wuhan reported their first new COVID case.

  • The central Chinese city of Wuhan has reported its first new coronavirus case in more than a month.
  • The Wuhan Municipal Health Commission said Sunday that an 89-year-old man was confirmed to have the virus on Saturday. His wife, along with several members of the community, were recorded as asymptomatic cases, which are not included in official case tallies.
  • On Sunday, the National Health Commission revealed that 14 new symptomatic cases were reported on Saturday, marking the largest increase since April 28.

The central Chinese city of Wuhan, where the coronavirus first appeared last year, reported its first new case in more than a month on Sunday. The Wuhan Municipal Health Commission announced Sunday an 89-year-old male with a history of various health problems, tested positive for the virus on Saturday after showing symptoms.

His wife, who tested positive without symptoms, has been recorded as an asymptomatic case. Several other members of the community were also recorded as asymptomatic cases. The health commission said the elderly man, who resides in the Dongxihu district, lived in an area where 20 other people previously tested positive for the virus. The risk level for his district was raised to medium on Sunday. The new case is, according to multiple outlets, the first case reported in Wuhan since April 3.

Wuhan, the Chinese city hardest hit by the virus, has reported a total of 50,334 coronavirus cases and at least 3,869 deaths. In mid-April, the city revised its death toll, increasing it by 50%. The numbers coming out of China have repeatedly been called into question, especially by US officials, including the president.

China has argued that numbers are low because it took decisive action. The strict quarantine of Wuhan, a sprawling city of 11 million people, began on Jan. 23 and ended on April 8. Similar action was taken in cities across China.

On Sunday, China’s National Health Commission announced that there were 14 new coronavirus cases reported nationwide on Saturday, marking the largest single-day increase since April 28, according to Reuters. The majority of the new cases were reported in Shulan, a city in China’s northeastern Jilin province. Local officials raised the risk level to high in response.

China also reported 20 new asymptomatic cases, which are not included in the total tally. The country has reported 82,901 cases and 4,633 deaths.

How a COVID-19 Testing Model No One Is Talking About Could Save Thousands of Lives

Andrea Galeotti noted that with solid data in short supply relating to the characteristics and spread of COVID-19, many governments and health officials are struggling to formulate suitable health and economic policies. As a consequence, some although not all, countries are effectively waging a war against the coronavirus based on the dynamics of a game of chance. This in turn is producing considerable anxiety about when lockdowns might end and the first steps towards economic activity might begin to occur.

This absence of data and resultant lack of concrete purpose is perhaps best illustrated in the U.S. where the federal government has left individual states to decide when to reopen in phases, without clarity on how widespread COVID-19 actually is. What state governments should be doing is formulating a reopening procedure that is based on selecting and testing a representative sample of the population.

There is now abundant evidence that asymptomatic individuals are the key diffusers of COVID-19 and as such firmly locating those individuals is the only way to stop further waves of contagion. Testing has always been of paramount importance, but this should not be seen as a mandate to test on a massive scale. That option is clearly not practicable and should urgently be substituted for well-designed testing strategies that determine the rate of infection in the local communities of individuals being tested, as well offering a firmer bearing on the general prevalence and diffusion of the virus within the greater population. Based on this information, contact tracing and smart containment strategies can be designed in order to ensure that contagion curve is kept flat and the health system can operate within its capacity.

COVID-19 has shown it can infect people regardless of age, race, gender, and geography, and therefore has proved unpredictable and difficult to contain. This unpredictability has been mirrored by the divergent testing strategies of different governments around the world. Countries such as Italy, U.K., and the U.S. have principally been testing patients with severe symptoms and have largely withheld testing asymptomatic individuals. By contrast, in countries such as Germany, Iceland and South Korea, the testing regimen has quickly expanded to mildly symptomatic cases, and to asymptomatic individuals who work in jobs where, should the become infected, have a high chance of spreading the virus to many others. That includes, for example, medical staff and workers in transportation hubs.

These different approaches may have been dictated by different logistical constraints, yet it is clear those countries that have employed intelligent testing and contact tracing strategies have in turn been more successful in containing COVID-19. For example, Iceland, South Korea, Australia, and Singapore all have strong testing and contact tracing initiatives and their infection and mortality numbers are a fraction of the U.S.’s.

A key piece of the exit strategy for countries like the U.S., Italy, and the U.K., then, seems simple: develop a serological testing program on a representative sample of the population, while also gathering information on demographic characteristics such as age, gender, number of children, type of working sector, skills, social and working associations.

Serological tests detect the presence of antibodies for COVID-19 and make sense for this purpose for a few reasons. PCR tests, which detect RNA evidence of a virus, can only reveal a current or recent infection. Antibody tests, on the other hand, can, in theory, identify someone who was exposed to the virus months ago. By testing with this method, governments will be able to capture a clear picture to what extent the virus has already spread and identify trends across geographical regions as well as across individual characteristics such as age, gender, working sectors and skills.

Gathering this representative sample would be relatively easy and cost-effective to implement. It is also easy because countries can use representative samples of the population that are regularly used for socio-economic surveys. For example, the U.S. Bureau of Labor Statistics’ “Labor Force Statistics from the Current Population Survey” could be adapted to run such tests. Secondly, the data collected can be analyzed though standard statistical methods, which will help to infer a body of valuable analysis related to the spread across the wider population.

There are aspects of the design of such test programs that will need to be very carefully managed. For example, they could be vulnerable to outcomes that wrongly indicate the presence of COVID-19 in a given region, or, conversely, identify regions that notionally suggest low infection rates. In both examples, test validation is critical.

Through the collection and statistical analysis of such data, governments will be in a position to make an informed choice and evaluate the advantages and the disadvantages that are inherent in any policy that will relax social distancing before a vaccine is available. Formulating an exit strategy without this information amounts to flipping a coin—the proverbial game of chance and is the new cases of COVID-19 a signal of what we could see in this country as we ease self-quarantine and the “severe” lock-down in states and cities?

We need a comprehensive collection of data using contact as well as post infection patient tracing to get a handle on this pandemic and the possible recurrent waves!

Telehealth use, Coverage by Insurers Soaring in Response to COVID-19; COVID Testing, Contact Tracing and How to Reopen the US and Pandemic Resilience?

Dr. Sarah-Anne Schumann, UnitedHealthcare’s chief medical officer for employer and individual health care plans in North Texas and Oklahoma, says telehealth visits are soaring.

The growth of telemedicine is apparent at UnitedHealthcare’s sister company, Optum, which went from 1,000 telemedicine-trained care providers to 5,000 in a matter of weeks. That number is expected to grow to 10,000 providers by the end of April.

In the interview that follows, Schumann, who is a family doctor in addition to her role with UnitedHealthcare, gives us a look at the growth of telemedicine during the coronavirus from the viewpoint of both the insurer and the physician.

How has the acceptance and reliance on telehealth grown given the COVID-19 pandemic?

Telehealth has been around for a long time, and basically what telehealth does is it allows people to see a doctor anywhere and anytime on a mobile device or computer. It’s available 24 hours a day, seven days a week. People can get their medical conditions diagnosed and treated that way. With the coronavirus, now that there’s a lot of risk with going into a doctor’s office — a risk of you exposing other people or you being exposed to coronavirus — more and more doctors’ practices have very quickly scaled up their technology to allow their doctors to provide telehealth.

Can you quantify the growth?

I have some statistics. Seventy-six percent of hospitals can connect patients and care providers using digital and other technology. On the employer side, nearly nine out of 10 employers offer telemedicine to their employees.

When did UnitedHealthcare start allowing for telehealth visits?

We did allow for telehealth before COVID, but our policies have changed. We have much broader coverage since COVID. Our policy now is we are covering telehealth with no cost-sharing at all. That started on March 31. As of now through June 18, we are waiving all cost-sharing for in-network health visits for our Medicaid, Medicare Advantage and our fully insured individual and group health plans. For self-funded employers, they can opt in to telehealth with no cost-sharing.

That’s not just for COVID-related visits, but for absolutely any telehealth visits. It’s not just primary care and urgent care, but also for outpatient behavioral health and physical therapy, occupational therapy and speech therapy.

Did UnitedHealthcare broaden the coverage because of the COVID-19 pandemic?

Yes. Some primary care offices are closed right now both for safety and because there’s decreased volume for a lot of the businesses. This is a very safe way to get people assessed when they’re feeling sick but not sick enough to go to an emergency room.

It’s my understanding that insurance won’t pay the same for a telehealth visit vs. an in-person doctor visit. Is that true with UnitedHealthcare?

They are covered at a different rate, but there are many ongoing conversations. Right now, with COVID, for the doctors’ practices that have moved over to provide telehealth, they are being reimbursed at the same rate as an in-person visit. Another change, because the doctor’s offices had to pivot so quickly to start offering this, right now, there can even be phone-only visits that are covered.

Typically, do you Facetime or how do the providers get the visuals from the patient?

If you have a smartphone, which most people have, or a tablet or computer, that’s usually how it works. But right now, you can do phone-only visits.

How does a patient find out if their existing doctor is signed up and licensed to practice telemedicine?

Call the practice or go on their website. It’s best to try your own doctor first, but if that doesn’t work, try your (insurance company’s) website and it will connect you with a national provider.

What should employers know about telehealth?

Telehealth, of course, is not for everything. But for simple, urgent medical issues like allergy symptoms or pink-eye or rashes or fever, telehealth is a great way for their employees to access care. It reduces the burden on the health care system and it reduces cost and improves accessibility to care. Another thing for employers to think about is, right now while people are at home, there’s a lot of increased stress and anxiety, and virtual visits can be a way to connect with a therapist or psychologist or psychiatrist.

Do you think the COVID-19 pandemic will cause permanent changes in how people access health care?

A lot of the changes that we are experiencing in society because of the pandemic are going to be permanent changes. Things like people working from home. Some people are more productive when they’re working from home. It’s the same thing with telemedicine. Now that people are introduced to this, I think in the cases where telemedicine is a good substitute, waiting to see the doctor for urgent-care type visits where you don’t need to have a blood test done or get IV medication or things like that, people are going to see that telemedicine is a great substitute.

How to reopen the US, according to Johns Hopkins and Harvard: Test 20 million people a day, hire an army of contact tracers, and expand healthcare coverage

Hilary Bruek reported that experts from Harvard and Johns Hopkins, as well as the former FDA commissioner, have each released their plans for how to reopen the country safely.

The plans suggest the US will need to massively ramp-up its disease testing and tracing capabilities to allow people to return to work and school. 

Collectively, the reports suggest the US will need: around 5 million tests a day by July, 100,000 public health workers to contact trace, and a “national infectious disease forecasting center.” 

Most Americans are still stuck at home, but a trio of reports, out from Harvard, Johns Hopkins, and former US Food and Drug Administration Commissioner Scott Gottlieb, are starting to lay a foundation for what reopening the country might look like, if done safely.

Though staying inside is certainly keeping more infections at bay right now, it’s not without its costs.

Aside from the strain stay-at-home orders are putting on families, friends and communities, the newfound national quiet means the US is “hemorrhaging $100 billion to $350 billion a month,” according to the new Harvard analysis, which was released on Monday.

A hasty, careless reopening would be a deadly disaster, though.

If everyone rushed back into the streets, hugging, kissing, shaking hands, and entirely abandoning social distancing measures, more than 300,000 people nationwide could die, according to federal documents from the Department of Health and Human Services, first released in a report from the Center for Public Integrity on Tuesday.

That’s why any thoughtful plan to reopen the country must involve massive additional investments in public health, especially the testing and tracing of US coronavirus cases.

Here are the key topline suggestions from the experts for not only emerging from the coronavirus crisis successfully and safely, but also, as the Harvard report put it, becoming a “pandemic resilient” nation.

Harvard’s Roadmap to Pandemic Resilience says more testing is fundamental to recovery 

Broadly, the Harvard report suggests the task ahead of us is “bigger than most people realize.”

“We need to massively scale-up testing, contact tracing, isolation, and quarantine—together with providing the resources to make these possible for all individuals,” the authors write. 

Here’s how:

In the coming months, the US should rapidly ramp up its capacity to test for the coronavirus, eventually testing upwards of 2 to 6% of the population on any given day. (Currently, the US tests around 150,000 people per day, or about 0.04% of the population.) The plan starts with: 5 million tests per day by early June, and continues trending upward towards 20 million tests a day nationwide, by late July. That kind of widespread testing would be on a scale larger than Germany (testing 0.06% of the country per day, with more than 50,000 coronavirus tests), and would even surpass South Korea, which so far has tested more than 1.1% of the country, overall, for COVID-19.

But “even this number may not be high enough to protect public health,” the report authors warn.

“Given that 40% of the economy is already open,” the report says, “our first priority for a massively scaled up pandemic testing program should be to stabilize the essential workforce.” Policy makers should listen to worker voices, the report also said, “because workers have expert knowledge about how to make their jobs safe and when safety-related rules are not being followed.” 

Tests will eventually also be needed for others, including:

  1. Everyone with coronavirus symptoms, and their close contacts.
  2. People with presumed exposure (healthcare workers, essential workers, etc.)
  3. Nursing home residents and staff.
  4. Incarcerated people.
  5. Companies and schools.
  6. Those who have tested negative within a very recent window and those who show immunity in reliable antibody tests (assuming these prove feasible) should be free to return to work,” the report said.
  7. The authors were cautious about the idea of immunity cards or passports, though. “Certificates of immunity should be used only in contexts where people have equal access to testing and where a recent negative test result provides the same access to mobility as immunity,” the report says. “Any other use of immunity certificates would be likely to violate constitutional equal protection requirements.” 
  8. In order to be able to follow 14-day quarantine orders successfully, people will need to be supported with more job protection and healthcare, the report added.
  9. The cost of testing and tracing at this scale is an estimated $50 – 300 billion over two years, which, the authors write is still far cheaper than “the economic cost of continued collective quarantine,” at $100 to 350 billion a month. 
  10. Pandemic Testing Board should also be established by the federal government, the report suggests, with a National Director of Testing Supply appointed to help ramp up testing efforts. “In virtually every successful historical example of such rapid coordination, a central authority has set goals and ensured that each part of the chain meets the interlocking goals required for the chain to succeed,” the report authors add.  

There’s just one problem, though: the Harvard approach relies on all coronavirus tests being accurate, but some are not

Claudio Furlan/LaPresse noted that the swab-the-nose-and-throat coronavirus testing delivers about 30% false negatives, which means that roughly 3 in 10 people who have the virus could wrongly assume they don’t after they’re tested, and then could go on to infect others at work or at school.

Coronavirus blood tests, which are meant to determine whether a person has been infected in the past with the coronavirus and developed disease-fighting antibodies, have so far performed much worse than the swab tests, with some operating at just 30% accuracy, the New York Times recently reported.

Johns Hopkins’ ‘National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US’ adds an army of contact tracers to the Harvard testing plan

The goal of deploying thousands of contact tracers across the US, the report authors write, is to “find every COVID-19 case in the midst of a national epidemic … and then work quickly to contain spread through intensive case and contact tracing interventions,” by warning others who might’ve been exposed to those sick people to stay home.

“This entire operation has never been done before,” New York Governor Andrew Cuomo said Wednesday, as he announced during a news conference that his state would be partnering with Johns Hopkins to roll out a new army of contact tracers in the tri-state area, to the tune of $10 million.

“You’ve never heard the words testing, tracing, isolate before,” Cuomo said. “No one has. We’ve just never done this.”

Here’s how the plan could work, nationwide:

  • Hire “an extra 100,000 contact tracers across the United States,” the report says. “While this figure may be stunning, it is still the equivalent of less than half the number [of contact tracers] employed in Wuhan,” the authors point out. 
  • Contact tracers will need to be trained by existing state and territorial public health departments on: disease transmission, principles of case isolation and quarantine, ethics of public health data collection and use, risk communication, cultural sensitivity, and more. 
  • The plan could provide jobs for: former government employees, retired public health and public safety workers & medical personnel, medical and public health students, Medical Reserve Corps or Peace Corps members, community health workers, and others “seeking employment—especially those who have lost their jobs due to COVID-19.” People with good communication and interviewing skills would be especially well-qualified for the task.
  • The new workforce will cost the US an estimated $3.6 billion, and the report authors urge Congress to fund this idea in its fourth stimulus package.
  • The cost of not tracing is also high: “It is estimated that each infected person can, on average, infect two to three others,” the authors write. “This means that if one person spreads the virus to three others, that first positive case can turn into more than 59,000 cases in 10 rounds of infections.” 

Apple and Google have also released their own plans to make contact tracing and surveillance happen more automatically on our phones

Apple and Google are both working on new apps and other press-of-a-button opt-in functionalities for phones that would harness Bluetooth technology to track where we’ve been, and then warn others who’ve been near us, in the event we get sick with the coronavirus, in a new brand of push notification-friendly contact tracing.

The companies promise that “user privacy and security” will be paramount in any forthcoming app design.

Other countries have already tried out similar Bluetooth-reliant tracing techniques, but they’re not always very successful, as you need a large percentage of the population to use them in order to have any major impact on transmission. 

Scott Gottlieb’s ‘Road Map to Reopening’ from the American Enterprise Institute adds in the element of a weather forecasting service for pandemics 

James Gathany reviewed that Scott Gottlieb reviewed the “Road Map to Reopening” from the American Institute and reported that Gottlieb calls it a “National Infectious Disease Forecasting Center,” and says “this permanent federal institution would function similarly to the National Weather Service, providing a centralized capability for both producing models and undertaking investigations to improve methods used to advance basic science, data science, and visualization capabilities.” 

Gottlieb also cautioned that we should not rush to return the US to business-as-usual, even as some restrictions are lifted. As schools and businesses reopen, “teleworking should continue where convenient” he said, and “social gatherings should continue to be limited to fewer than 50 people wherever possible.”

‘It’s going to be brutal,’ billionaire Mark Cuban says of economy’s recovery from coronavirus, and ‘there’s no way to sugarcoat it’

‘It’s going to be brutal. There’s no way to sugarcoat it at all.’

That is outspoken billionaire and Dallas Mavericks owner Mark Cuban, who has been increasingly visible as the National Basketball Association has been temporarily suspended due to the deadly COVID-19 pandemic.

Reporter DeCambre reviewed an interview with Mark Cuban with Maria Bartiromo. Cuban, speaking with Fox Business anchor Maria Bartiromo, explained why he thought the recovery from the economic fallout wrought by the illness caused by a novel coronavirus strain could be a long and ugly one for the average American and small businesses in particular.

“It’s going to be brutal. There’s no way to sugarcoat it at all. And when we get to the other side, companies are going to be operating differently,” Cuban said on the business network.

The entrepreneur, who boasts a net worth of $4.3 billion, according to Forbes, says that challenges for businesses are manifold and include additional costs that will be incurred to sanitize and retrofit spaces as nearly shutdown economies attempt to reboot after a virus-imposed hibernation.

“Companies are going to have to be agile … Companies are going to have to build from the bottom up,” Cuban said.

The “Shark Tank” star said he remains confident that some normalcy will return in two to three years but predicts that investors and business owners will need to endure some pain to get to the other side.

His comments came as Robert Redfield, director of the Centers for Disease Control and Prevention, was quoted in the Washington Post as saying in an interview published on Tuesday that “there’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through.”

The deadly contagion that was first identified late last year in Wuhan, China, has, infected more than 2.6 million people globally and killed about 179,000, according to data aggregated by Johns Hopkins University, as of Wednesday morning.

On Thursday, investors and others will be watching for a House vote on a nearly $500 billion aid package for small businesses amid the coronavirus pandemic, after the Senate passed the measure on Tuesday.

The passage of the bill and the possibility of restarting stalled economies may be conferring some optimism on markets, with the Dow Jones Industrial Average DJIA, +1.10%, the S&P 500 SPX, +1.39% and the Nasdaq Composite Index COMP, +1.64% all closing sharply higher Wednesday.

That said, Cuban believes that small businesses may require at least a third installment of funds to operate through the crisis, and he is looking to invest in companies that sit outside the criteria for obtaining government-backed loans.

“We haven’t talked about those companies that are 501 and up. They are suffering the most,” he said, referring to language that stipulates that businesses need to have 500 or fewer employees to qualify for the small-business recovery funding. 

So, when do we really reopen the economy and back to the “new” normal and do we use scientific data? I think as we can see we need data based on more testing, but the testing has to be accurate and more sensitive and then we need comprehensive contact tracing and case follow-up tracing. Also, what technology will we use for contact tracing and could it be the use of APPS on our phones or other home health and fitness wearables or other real time monitors?

This technology needs to integrate multiple longitudinal electronic medical records across all sources including healthcare providers and healthcare facilities, labs, clinics, pharmacies, long-term care facilities, etc. with nationwide coverage and interoperability and more important it needs to be HIPPA compliant to respect personal information.

Big wishes and needs, which will lead the way to solutions and attaining our goals of defeating COVID-19 and also prepare the US for whatever the next possible pandemic may raise its ugly head!

When This War Is Over, Many of Us Will Leave Medicine and the Stresses of Healthcare Workers on All Fronts

One ER physician recounts the stress of constant intubations and PPE shortages

Michele Harper reviews the stress of our frontline healthcare workers and here is a case.

I couldn’t see. My face shield was blurred by a streaky haze. I tilted my neck back and forth in an effort to peer beyond it, beneath it, through it, whatever might work. Was it condensation? I started to raise my hands to my face to wipe it away before I remembered and yanked them back down: I cannot touch my face, can’t ever touch my face — neither inside this room nor outside it.

As I stood at the head of the patient’s bed in ER Room 3, her nurse, Kate, secured a mask over the patient’s face to deliver additional oxygen. I checked to ensure the oxygen was cranked up to the maximum flow rate while we waited for the respiratory therapist. Even with that increased oxygen, the patient was saturating 85% at best, and her blood pressure was dropping.

Ninety minutes earlier, the patient — a woman of 68 years with significant impairment from a stroke — had been fine. The nurse at her nursing home called to inform us they were sending the patient to the ER for evaluation of “altered mental status” because she was less “perky” than usual. Her oxygen level on arrival was normal with no shortness of breath. Her blood pressure was a little low, but her blood glucose read high. Nothing a little IV fluid couldn’t fix, and initially, it did.

I had requested a rectal temperature; it read 103 degrees. The combination of her being a nursing home resident and running a fever was a red flag during these coronavirus times. I placed her on respiratory isolation and asked Kate to be extra vigilant for any decline. I ordered broad-spectrum antibiotics to kill any likely source of infection while I awaited her chest X-ray, urine, and blood tests. Her portable chest X-ray was done first and revealed what I had already anticipated: diffuse atypical infiltrates, a presumed telltale sign of Covid-19. Although our understanding of this viral infection is ever-evolving, it seems the only observation we can reliably conclude is that we have not yet identified anything pathognomonic about it.

Seventy-five minutes later, another nurse, Charlene, called, “They need you in Room 3.”

“Okay,” I replied as I entered orders on the next chest pain patient with shortness of breath.

“Dr. Harper, they need you in Room 3 now,” Charlene called again.

“Room 3? The nursing home patient? I’ll be right there. What happened?”

“Her oxygen is at 67%.”

I asked the clerk to call respiratory therapy for intubation. I then turned back to Charlene to ask her to help Kate prepare for the procedure.

Then the personal protective equipment (PPE) sequence. I grabbed gloves to remove my N95 mask from its paper bag and placed it over my face, checking it was snug over my nose and lower jaw. After removing those gloves, I donned my face shield, then walked to the cart for a new gown. Lastly, a fresh set of gloves before entering the patient’s room.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily.

Now I waited for the respiratory therapist. It was good that she needed extra time to get the ventilator and then don her PPE because I had to figure out why I couldn’t see without manually manipulating my face shield. My thoughts were pierced by the sound of panting. I checked the patient who was taking the oxygen quietly, rapidly, ineffectively at regular intervals that didn’t register a sound. Her eyes remained closed—no flip of an eyelash, no wince of her forehead, no twitch in a limb. Despite her instability, the patient was in no visible distress. No heaving breath there. The nurse to my left was concentrating on the patient’s oxygen. I heard only the crinkle of her gown as she adjusted her stance. The panting wasn’t hers. The nurse to my right prepared to administer the intubation medications. He read out my orders — the name and dose of the medication in each syringe and the order in which they were to be pushed. His voice was steady. It wasn’t him hyperventilating. The nurse just outside of the room kept documentation of the procedure on scrap paper she used to carefully transcribe each detail onto her laptop. She was too far away to be heard unless she yelled, so that audible breathing certainly wasn’t hers.

The panting was my own.

A hailstorm of thoughts ensued. Was my breath the fog on my face shield? If so, my N95 mask had a leak. Unsuspecting, had I already inhaled the virus? Would I be intubated next?

The respiratory therapist had arrived with the ventilator and put on her face shield. She was almost ready, so there was little time to pull myself together.

Breathe in, I commanded myself: One, two, three. Breathe out. I obeyed: One, two, three, four.

Was I already short of breath? Had I not noticed my symptoms when I drove to work this morning? Yesterday? Last night?

Breathe in. One two, three. Breathe out. One, two, three, four.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily. We’re a type of special forces who step in when everything else has failed. Typically, we do our job anonymously then leave when the mission is complete. Any injury to ourselves incurred in the line of duty is dealt with after we’re off the clock.

Once in a while, however, there are circumstances when the capacity to compartmentalize is overwhelmed, when the chronic stress breaks through so that the fear works on you. Now, as I stood at the patient’s bed with the video laryngoscope blade in one hand and the endotracheal tube in the other, panic pushed its way through me in involuntary. forceful. rapid. shallow. breaths.

Breathe in on one, two, three. Breathe out on one, two, three, four.

The respiratory therapist slapped on her gloves and in moments was at my side. It was time for intubation.

Breathe in on three and out on four.

At last, my breathing was smooth, measured, sound.

I looked through my mask again. It wasn’t condensation. It was streaks from the sanitizing wipes because we had to reuse our equipment.

I adjusted my eyes to the clear spaces. Finally, I could see. My N95 mask fit. I could breathe.

The room was relatively quiet, what I like to call “ER calm.” All was still, save for the bagging of respiratory therapy, save for the swoosh of oxygen jetting from its port aerosolizing everything.

I requested that the intubation medications be administered then checked for a response. After visualizing the vocal cords easily with the video laryngoscope, I slid in the endotracheal tube, and respiratory connected it to the vent. The patient’s oxygen increased to 100% on the monitor.

Those of us who survive will return each day to battle. But when this war is over, this is why many of us will leave.

Doffing my gown and gloves, I put on new gloves to remove and sanitize my face shield. I couldn’t imagine there was a way to effectively clean the foam band across the forehead. I hoped to remove the streaks. I also hoped the impossible: to remove the virus, because it was the same shield I had to use repeatedly during my shift. I took off the N95. We’re now told that we can reuse it, too, numerous times before getting a new one due to the PPE shortages, so I put the contaminated mask back in the bag until I would need to do it again for the next patient.

This is how we get infected. This is how we die.

Those of us who survive will return each day to battle because we do not walk away from war until it’s done. But when this war is over, this is why many of us will leave.

I walked to the back of the ER to use the restroom in the seven minutes before the patient was ready for CT and saw my ER director standing in the lounge. I waved hello.

“How did it go?” she asked, her eyes gentle, her smile sympathetic.

“It went,” I replied.

“How did you feel in the PPE? Did you feel protected?”

I paused to regulate my answer. Her intentions were good. She was an ER doctor who did her best to walk the fine line between the docs on the front lines and the administrators who notified me that “doctors don’t get paid sick leave” and “thank you for your service,” which were graciously sent out in two separate emails. Just another reminder that we health care providers are regarded as more disposable than our PPE. But this wasn’t her fault, so I felt responsible, in that moment, for her feelings too.

I pulled in my tone. “No. That equipment doesn’t protect us. There’s no way that we’re not all covered in Covid, but we’re following the ‘guidelines.’”

She nodded and frowned.

“Honestly,” I continued, “and I hate to say this, but my feeling is that the majority of people will have contracted this virus. Most people will get through it, and others won’t. Many will die. I don’t want any of us to die, but many health care providers will. The thing is, it’s impossible to know which camp we’re in until it happens.”

She nodded again.

We smiled at each other, and I continued to the bathroom. I washed my hands, turning them over each other, lathering the soap along each finger, under each nail. As I dried my hands, I looked up at the mirror, noting that my breath was now imperceptible when my phone rang.

A FaceTime request from my nine-year-old nephew, Eli.

My policy used to be to not answer the phone at work unless it was critical. But this is a different era. Eli is sheltering-in-place at a military base in California while his mother, my sister, is away for deployment.

I swiped the phone to answer. “Hi, Eli!”

“Hello, Aunt,” he announced more softly than usual. His eyelids hovered low, and his eyes weren’t their typical bright.

“How are you, Eli?” I inquired, masking my concern.

“I’m good.” He smiled with sleepy eyes. “I just woke up.” He yawned; his bushy eyebrows raised high. Years ago, he said his eyebrows were the indisputable evidence that Frida Kahlo was his great, great grandmother so he had to meet her forthwith. Upon being told that she had already passed away, he cried for the woman he had decided was his long-lost ancestor. Now, as he yawned again, his thick eyelashes shut tight. His head drifted back and his mouth reeled open expelling the strongest exhale of the bravest lion cub.

Smiling to myself, I sighed easily.

He breathed.

I breathed.

Today we are OK.

Anxiety on the Frontlines of COVID-19 

It’s not just healthcare workers’ physical health but also their mental health that’s suffering

Richard van Zyl-Smit, M.D./PhD described to a friend this week the current feeling of being in the hospital with COVID-19, as like sitting under a 1,000V high-tension electricity cable: there is a constant humming above your head, which is unnerving and just does not go away.

Two years ago, he published a book called They Don’t Award Nobel Prizes to Dead People about my experience as an academic clinician with a stress-induced anxiety disorder. The context is very different now, but the lessons I learned in that time might be of help to those of you feeling this intangible “humming” — a sense of anxiety that is neither defined nor visible even with no COVID patient contact — and for those of you who are caring daily for COVID-19 patients.

The first and most important aspect of this time is to recognize that anxiety is real. This is not something you might have experienced before. For those of us who have previously or currently suffer from anxiety, it is easily recognizable for what it is, but you may never have experienced it quite like this. You are not losing your mind or losing control, you are experiencing a loss of control of your environment. In many ways, the daily changing updates, the ever-changing schedules and call rosters are unsettling at best and can be completely unnerving as we can’t be certain from one day to the next. There is not a lot you can do about it, except to acknowledge it and talk about it.

The second aspect relates directly to that gnawing “hum.”

I learned previously the benefit of and strongly believe in “downtime.” Getting away from the humming, which is not so easy anymore as we don’t have rugby or soccer scores to get excited or depressed about, we don’t have news about politics or current affairs — except COVID, COVID, COVID. I used to play Candy Crush to get my mind off work and to get away from the “hum,” but recognized that did not accomplish much — it just kept my mind going, and the anxiety was still there. I now try to be creative, to garden, draw, write, crochet (see below), paint, anything that I can do that takes the focus off my work.

Exercise is great too — but now restricted to indoors! I don’t look at the hundreds of WhatsApp group messages unless I am at work; the latest medical publication of how I should treat my ventilated COVID-19 patient on my next week on call is not important when I am at home.

I am convinced that switching off the social media, medical media, and media media when you are not working is vital for your mental health. For some, it might mean no social media, for others less, but getting out from under the electricity cable when you can, is an important way to ensure your own sustainability over the next few months.

The last aspect relates to relationships: physical distance is key — but find, and seek out the people who can support you; keep talking to each other, be kind to each other and to yourself, and talk about the anxiety, fears, worries, or stress. Professional services are available to those feeling very out of control, but simply talking with someone is a fantastic way to get the humming out of your head.

As much as we need to care for our COVID-19 patients and protect ourselves with PPE, we also need to look after ourselves and protect our mental health. It is not a sign of weakness but requires courage and bravery to ask for help.

“Asking for help is not giving up, it is refusing to give up.” — Charlie Mackesy

We are all in this together — we need to be kind to each other and to ourselves.

India coronavirus doctors: Notes on hope, fear and longing Reporter Vikas Pandey shows us how the Corona virus is affecting doctors in India. Dr Milind Baldi was on duty in a Covid-19 ward when a 46-year-old man was wheeled in  with severe breathing difficulty.

The man was scared for his life and kept repeating one question: “Will I survive?”

The question was followed by a plea: “Please save me, I don’t want to die.” Dr Baldi assured the man that he was going to do “everything possible to save him”.

These were the last words spoken between the two men. The patient was put on a ventilator, and died two days later. The doctor, who works in a hospital in the central Indian city of Indore, vividly remembers the 30 “terrifying minutes” after the patient was brought to his hospital.

“He kept holding my hands. His eyes were full of fear and pain. I will never forget his face.”

His death deeply affected Dr Baldi. “It ate away my soul from inside and left a lacuna in my heart.” Seeing patients die in critical care wards is not uncommon for doctors like him. But, he says, nothing can compare to the psychological stress of working in a Covid-19 ward.

Most coronavirus patients are kept in isolation, which means, if they become critically ill, doctors and nurses are the only people they see in their final hours.

“No doctor ever wants to be in this scenario,” says Dr A Fathahudeen, who heads the critical care department at Ernakulam Medical College in southern India.

Doctors say they usually share the emotional burden of treating someone with that person’s family. But Covid-19 doesn’t allow that. Dr Fathahudeen says he will never forget “the blankness in the eyes” of a Covid-19 patient who died in his hospital.

“He wasn’t able to talk. But his eyes reflected the pain and the fear he was experiencing.” Dr Fathahudeen felt helpless because the patient was going to die alone. But there was a tiny sliver of hope: the man’s wife was being treated for coronavirus in the same hospital.

So, Dr Fathahudeen brought her to the ward. She stood still and kept looking at him and said her goodbye. She never thought her 40-year marriage would end so abruptly.

The experienced doctor says the incident left him “emotionally consumed”. But, he adds, there was “some satisfaction that he didn’t die without seeing his wife”. “But that won’t always happen. The harsh truth is that some patients will die without saying goodbye to their loved ones.”

The emotional toll is made much worse as many doctors are themselves in a form of isolation – most are staying away from their families to protect them. As a result, Dr Mir Shahnawaz, who works at the Government Chest Hospital in Srinagar, says it’s “not just the disease we are fighting with”.

“Imagine not knowing when you will see your family next, add that to the constant fear that you may get infected and you will begin to understand what we are going through.”

Adding to the stress, is the fact that they also have to constantly deal with the emotional outbursts of patients. “They are very scared and we have to keep them calm – be their friend and doctor at the same time.”

And doctors also have to make phone calls to the families of patients, and deal with their fears too. The whole process, Dr Shahnawaz says, is emotionally draining.

“It hits you when you go back to your room in the night. Then there is the fear of the unknown – we don’t know how bad the situation will get.”

Doctors are used to saving lives, he adds, and “we will continue to do that no matter what”. “But the truth is that we are also human beings and we are also scared.” He says that the first coronavirus death in his hospital made his colleagues break down: it was when they realized that Covid-19 doesn’t afford the family a final glimpse of their loved one.

“Family members want to remember the final moments of a patient – a faint smile, a few last words, anything really to hold on to. But they can’t even give a proper burial to the dead.”

Dr Fathahudeen says such psychological pressure needs to be addressed and each hospital needs to have a psychiatrist – both for doctors and patients. “This is something I have done in my hospital. It’s important because otherwise the emotional scars will be too deep to heal. We are staring at cases of PTSD among frontline workers.”

Doorstep doctors

It is not just those working in Covid-19 wards who are on the front line, but also the doctors, community health workers and officials who are involved in contact tracing and screening suspected patients by going door-to-door in virus hotspots.

Dr Varsha Saxena, who works in the badly affected northern city of Jaipur, says she walks into grave danger knowingly every day. Her job is to screen people for possible symptoms. “There is no other option. It’s the fight of our lifetime, but one can’t ignore the risks,” she says. “But it poses great risk because we don’t know who among the ones, we are screening is actually positive,” she adds.

She says doctors like her don’t always get proper medical-grade personal protective equipment. “The fear of getting infected is always there and we have to live with it. It does play on our mind and we have to fight hard to keep such negative thoughts away.”

But her biggest fear, she says, is getting infected and not showing any symptoms. “Then the risk is that we may end up infecting others. That is why field doctors also need PPE,” she adds. And the stress, sometimes, also comes home.

“It’s so draining. My husband is also a doctor, most nights we don’t even have energy to cook and our dinner involves just bread.”

Aqueel Khan, a bureaucrat and a colleague of Dr Saxena, acknowledges that psychological stress is a reality for all frontline workers, including officers like him who are embedded with medical teams. The fear really comes home for these workers when somebody close to them dies.

“I lost my uncle and a friend recently. It shook me, I can’t stop thinking about them. You can’t stop thinking that it can easily happen to you,” he says.

Mr. Khan is also staying away from his family: this year is the first time he will miss his daughter’s birthday. “My heart says to go home and see her from far, but the mind tells me otherwise. This constant struggle is very stressful.

“But we can’t turn our backs on the job. We just have to just keep at it, hoping that we come out alive on the other side of this fight.” ‘The risk is always there’

There is no respite for doctors and nurses even when they are not directly involved in the fight against coronavirus. People with other ailments are continuing to come to hospitals. And there has also been a surge in the number of people who are turning up at hospitals with coronavirus-like symptoms.

Dr Mohsin Bin Mushtaq, who works at the GMC Hospital in Indian-administered Kashmir, says coronavirus has “fundamentally changed our lives”. “We are seeing patients every day for other ailments. But the risk is always there that some of them could be infected,” he said.

And it worries him even more when he reads about doctors getting infected despite wearing PPE and dying. A number of doctors have died in India and dozens have tested positive. There is nothing we can do about it, he says, adding that “we just have to be mentally strong and do our jobs”.

Dr Mehnaz Bhat and Dr Sartaz Bhat also work in the same hospital, and they say that the “fear among patients is too much”. Dr Sartaz says people with a slight cold end up thinking they have coronavirus, and rush to the hospital. “So apart from treating them, we also have to deal with their fear,” Dr Sartaz adds.

He recently diagnosed Covid-19 symptoms in a patient and advised him to go for testing. But his family refused and took him away. The patient was brought back to the hospital after Dr Sartaz called the police. He says he had never imagined doing something like this in his medical career. “This is the new normal.”

The way patients are examined has also changed for some doctors. “We really have to try and limit close interactions with patients,” Dr Mehnaz Bhat says. “But it’s not what we have been trained for. So much has changed so quickly, it’s stressful,” she says.

And several attacks on doctors and nurses across the country have made them even more worried. She says it’s difficult to understand why anybody would attack doctors. “We are saving lives, risking our lives every day. We need love, not fear.” she adds.

And even worse:

E.R. doc on COVID-19 ‘front lines’ died by suicide                             To show how serious the stress is seen in this report by Cory Siemaszko reported that a New York City emergency room doctor who was on the “front lines” of the fight against the coronavirus has died by suicide, police said Monday. Dr. Lorna Breen, 49, who worked at New York-Presbyterian Allen Hospital, was in Virginia when she died on Sunday, said Tyler Hawn, a spokesman for the Charlottesville Police Department.

“The victim was taken to U.V.A. Hospital for treatment, but later succumbed to self-inflicted injuries,” Hawn said.

It was her father, Dr. Phillip Breen, who revealed the first details about his daughter’s tragic death. “She tried to do her job, and it killed her,” he told The New York Times. “She was truly in the trenches of the front line.”

He said his daughter seemed very detached of late and that she had described some of the horrors she had witnessed at the hospital while battling the virus. “Make sure she’s praised as a hero, because she was,” Phillip Breen said. “She’s a casualty just as much as anybody else who has died.”

The hospital confirmed Lorna Breen’s death in a statement released by chief spokesperson Lucky Tran, but gave few other details. “Words cannot convey the sense of loss we feel today,” the statement said. “Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department. Our focus today is to provide support to her family, friends, and colleagues as they cope with this news during what is already an extraordinarily difficult time.”

NewYork-Presbyterian Allen Hospital has 200 beds, is in northern Manhattan and is one of the seven hospitals that make up NewYork-Presbyterian Hospital.

Infectious Disease Expert Makes Chilling Prediction for States Reopening Amid Pandemic                                                                 Reporter Lee Moran noted that infectious disease expert Michael Osterholm warned that the states starting to reopen amid the coronavirus pandemic “will pay a big price later on.”

Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN’s Jake Tapper on Thursday that states like Georgia, Colorado and others that are easing social distancing restrictions were “putting gasoline on fire.”

“I think right now, this is one of the things we’ve learned, if we’re going to learn to live with this, then you just don’t walk in the face of it and spit in its eye, because it will hit you,” said Osterholm. “And I think that that’s a really important issue right now,” he continued. “When we have transmission increasing, when our hospitals are not able to take care of it and we don’t have enough testing to even know what’s going on, then that’s not the time to loosen up.”

Osterholm suggested it was “the worst example of how to start this discussion” about the “loosening” of society. “I wouldn’t do it,” he added. “I fear that these states will have to pay a big price later on because of what they’re doing.”

COVID-19: National Psychiatrist-Run Hotline Offers Docs Emotional PPE                                                                                              Emily Sohn reported that Mona Masood, DO, a Philadelphia-area psychiatrist and moderator of a Facebook forum called the COVID-19 Physicians Group, reviewed post after post about her colleagues’ fears, anxieties, and the crushing pressure to act like a hero, inspiration struck. Would it be possible, she wondered, to create a resource through which psychiatrists would be available to provide frontline physicians with some emotional personal protective equipment (PPE)?

She floated the idea in the Facebook forum, which has more than 30,000 members. The response was immediate. “All these psychiatrists just started contacting me, saying, ‘Please let me be a part of this. I want to volunteer,’ ” she told Medscape Medical News.

On March 30, Masood launched the Physician Support Line, a free mental health hotline exclusively for doctors. Within the first 3 weeks, the hotline logged more than 3000 minutes of call time. Some physicians have called repeatedly, and early feedback suggests the resource is meeting a vast need.

“Most of the cases have a lot of emotion from both sides. There are a lot of tears, a lot of relief,” said Masood.

“If Not Me, Then Who?”

Physicians have been facing mental health challenges long before the pandemic, and doctors have long struggled with stigma in seeking psychological help, says Katherine Gold, MD, a family medicine physician at the University of Michigan, Ann Arbor, who studies physician well-being, suicide, and mental health.

As a whole, physicians tend to be perfectionists and have high expectations of themselves. That combination can set them up for mental distress, Gold notes. Studies that have focused mainly on medical students and residents show that nearly 30% have experienced depression. Physicians are also at significant risk of dying by suicide.

Compounding the issue is the fact that physicians are also often reluctant to seek help, and institutional stigma is one persistent reason, Gold says. Many states require annual license renewal applications in which physicians are asked questions about mental health. Doctors fear they’ll lose their licenses if they seek psychological help, so they don’t pursue it.

A study conducted by Gold and colleagues that analyzed data from 2003 to 2008 showed that compared to the general public, physicians who died by suicide were less likely to have consulted mental health experts, less likely to have been diagnosed with mental health problems, and less likely to have antidepressants in their system at the time of death.

The COVID-19 pandemic may exacerbate these trends, suggests a recent study from China in which investigators surveyed 1257 healthcare workers in January and February.

Results revealed that a significant proportion of respondents had symptoms of depression, anxiety, insomnia, and distress. This was especially true among women, nurses, those in Wuhan, and frontline healthcare workers who were directly engaged in diagnosing, treating, or caring for patients with suspected or confirmed cases of COVID-19.

As Masood watched similar concerns accumulate on the COVID-19 Physicians Group Facebook forum, she decided to take action. She says her mentality was, “If not me, then who?”

Assisted by a team of experts, she created the hotline without any funding but with pro bono contributions of legal and ethical work, and she received a heavy discount from a company called Telzio, which developed the hotline app.

The hotline is open daily from 8:00 AM to midnight Eastern Time, and calls are free. Services are available only to physicians, in part because as a group, doctors tend to harbor guilt about asking for help that someone else might need more, Masood says.

When other types of healthcare workers call in, volunteers redirect them to hotlines set up for first responders and other healthcare providers.

So far, more than 600 psychiatrists have volunteered. They sign up for hour-long shifts, which they fit in between their own patients. Two or three psychiatrists are available each hour. Calls come directly through the app to their phones. There is no time limit on calls. If calls run long, psychiatrists either stay on past their shifts or pass the call to another volunteer.

Since its launch, the number of calls has steadily increased, Masood says. Callers include ICU doctors, anesthesiologists, surgeons, emergency department doctors, and some physicians in private practice who, Masood says, often express guilt for not being on the front lines.

Some physicians call in every week at a certain time as part of their self-care routine. Others call late at night after their families are in bed. If indicated, psychiatrists refer callers for follow-up care to a website that has compiled a list of psychiatrists across the United States who offer telehealth services.

There are no rules about what physicians can discuss when they call the hotline, and popular topics have evolved over time, says Masood. In the first week after the hotline’s launch, many callers were anxious about what the future held, and they saw other hospitals becoming overwhelmed. They worried about how they could prepare themselves and protect their families.

By the second week, when more doctors were in the thick of the pandemic and were working long hours, sometimes alone or covering shifts for infected colleagues, there were concerns about coworkers. Some were grieving the loss of patients and family members. The lack of personal protective equipment (PPE), says Masood, has been a common topic of conversation from the beginning.

Given the many unknowns about the virus, physicians have also grappled with the uncertainty around safety protocols for patients and for themselves.

On a deeper level, physicians have expressed a desire to run away, to stop going to work, or to quit medicine altogether. These escape fantasies are a normal part of the fight-or-flight response to stress, Masood says.

Doctors often feel they can’t share their fears, even with family members, in part because of societal pressures to act like heroes on the front lines of what has been framed as a war, she adds.

Heroes aren’t supposed to complain or show vulnerability, Masood says, and this can make it hard for physicians to get the support they need. Through the hotline, psychiatrists give doctors permission to feel what they are feeling, and that can help motivate them to go back to work.

“They don’t want to look like cowards, because that’s the opposite of a hero,” she said. “Saying it to another doctor feels much better because we get it, and we normalize that for them. It’s normal to feel that way.”

Each week, Masood conducts debriefing sessions with volunteers, who talk about conversations filled with raw emotion. When conversations wind down, most physicians express gratitude.

They tell volunteers that just knowing the hotline is there provides them with an emotional safety net. Masood says many physicians tell volunteers, “I know that if anything’s going wrong, I can just call and somebody will be there.” Volunteers, too, say they are benefiting from being involved.

“We are all really having this desperate need to be there for one another right now. We truly feel like no one gets it as much as we get one another,” said Masood.

Long-term Fallout

The need for psychiatric care is unlikely to end after the pandemic retreats, and Masood’s plan is to keep the hotline running as long as it’s needed. Like the rest of the world, physicians are in survival mode, but she expects a wave of grief to hit when the immediate danger ends. Some might blame themselves for patient deaths or question what they could have done differently. The long-term impact of trauma is definitely a concern, Gold says. Physicians in the ER and ICU are seeing many patients who decline quickly and die alone, and they witness young, previously healthy people succumb to the virus.

They’re seeing these kinds of cases over and over, and they’re often doing it in an environment where they don’t feel safe or supported while people in many places stage protests against the measures they feel are helping protect them.

Like veterans returning from war, they will need to reflect on what they’ve experienced after the adrenaline is gone and there is time to think.

“Even when things calm down, it will be great to have resources like this still functioning that can help folks think back through what they’ve been through and how to process that,” Gold said. “Things are going to remind them of experiences they had during COVID, and they can’t predict that right now. There will be a need for the support to go on.”

Masood is optimistic that the pandemic will bring the issue of physicians’ mental health out of the shadows.

“We have a really deep feeling of hope that that there’s going to be a lot more empathy for one another after this,” she said. “There’s going to be a willingness to not take mental health for granted. Doctors are people, too.”

We understand about those on the frontline of this pandemic. But do you all realize that many physicians and nurses are being furloughed during this pandemic due to elimination of elective surgery, many of which are necessary such as transplants and cancer treatments and surgery as well as limitation of their practice during this pandemic.

How do physicians pay their malpractice insurance and pay their staff and overhead and their huge education loans?

I fear that we may see a mass quitting/retirement of many nurses and physicians in our country and maybe world wide or many suffering from PTSD (Post Traumatic Stress Syndrome).

What then happens to our healthcare system? Will this pandemic force Congress to finally get serious regarding improving our healthcare system for All?

What It’s Like to Watch Your Business Fail? The New Labor Movement and Comicon!

I discussed previously regarding the stress and anxiety of self-isolation, state-wide lockdowns and quarantine, but what about the effect on business owners? Chris Thompson noted that his wife’s job has always been to keep people relaxed. The stress of keeping that dream alive is agonizing. Chris Thompson noted that the widespread crumbling of American small businesses in the year 2020 will ultimately be a second- or third-order concern, at best, as millions of people are infected by the novel coronavirus and some horrifying percentage succumb to Covid-19. It’s worth observing, though, that just as the ultimate tally of lives lost will be bloated by a slapdash governmental response that left many folks to balance for themselves the danger of multiple existential threats, so too will the eventual failure of hundreds of thousands of small businesses reflect the confusion, incompetence, and indifference of the people whose job it is to manage this crisis.

My wife has owned and operated a boutique day spa in the Virginia suburbs of Washington D.C. for going on 15 years now. A dozen practitioners tend to rosters of dedicated clients; a small handful of support and administrative staffers keep things organized. Because it’s a very small operation, my wife is both the main administrator and also a practitioner who sees clients. It’s a demanding job, and it eats up much more of her time than a full-time job in someone else’s spa would, but she’s very good at it and is fulfilled by the opportunity to execute her own vision of how a spa should operate.

Turns out when a novel virus leaps oceans and uses close human contact to navigate its way to the most vulnerable, businesses that make their money via direct physical contact between workers and customers are put in a uniquely difficult situation. The spa industry is loaded down with standards designed to limit the transmission of diseases between parties, but zero transmission is not possible, and this isn’t the common cold. Somewhere around 200 people come into the spa each week, and all 200 are in direct physical contact with a staff person; half or more are there to have another person’s hands and fingers directly applied to their face for an hour or longer, in services where steam is applied and hangs in the air. There is no such thing as social distancing inside a spa. Even with every safety measure applied as fastidiously as possible, two perfectly healthy seeming clients sharing a waiting room can trade illnesses in the time it takes to fill out a single-page intake form.

The spa industry is loaded down with standards designed to limit the transmission of diseases between parties, but zero transmission is not possible, and this isn’t the common cold.

The right thing to do, then, is to suspend operations at least until widespread testing has begun, if not until the spread of the virus is fully understood and the brunt of the pandemic has been absorbed. While no one knows who the hell has the virus and while hospitals are having their asses kicked by the surge of infections, operating a serene little coronavirus distribution center in a densely populated area would be a very shitty thing to do for the public good.

But closing the business, even for just a few weeks, presents some immediate challenges. Practitioners depend upon commissions from services in order to pay their bills. A cut of service income is set aside to pay administrative staff. Shuttering the business for a couple of months means coming up with tens of thousands of dollars to help keep these people afloat, or setting them adrift to fend for themselves. And there are other expenses applying considerable pressure to that primary concern: Lease payments are due on expensive machinery; professional insurance cannot be allowed to lapse; the landlord is expecting another rent payment, and another, and then another.

The Trump administration directed the Small Business Administration on March 12 to offer a special reduced interest rate on get-me-over “recovery” loans to businesses affected by the pandemic, money that at least in theory could provide a source of cash with which to pay staffers to stay home. But there’s a rub—or several. For absolutely no good reason, the disaster rate is contingent on a given state’s emergency posture. So, for example, if your business is in, say, Kansas, where prominent politicians have said coronavirus is not a threat because there is not a large Chinese population, you would not qualify for the disaster rate without a statewide disaster declaration. If you want to do the right thing for your staff and community and temporarily suspend the operations of your small business ahead of this declaration, any loans you seek to increase your cash on hand will not be protected from predatory rates.

As it happens, Virginia declared a state of emergency on March 12, which meant the “recovery loans” should’ve been available within hours of the executive directive to the SBA. But here we encounter the second and third rubs. First, it turns out no one at the SBA had been given much direction about what exact governmental declaration qualified businesses in a given state for the special rate, and so no one at the SBA and none of the SBA-linked banks could say for sure whether a Virginia small business qualified. Second, and most horrifying of all, the recovery loans were not available for businesses “with credit available elsewhere.” If the SBA determined that a business had opportunities to borrow money without its protections, it was happy to dropkick that business out into the wilderness.

It’s worth noting how backward and screwy it is that a once-in-a-lifetime pandemic would force otherwise perfectly successful small businesses to take on crippling debt and pay interest to lenders, in order to provide disaster pay to workers who, like their employers, did absolutely nothing wrong. If there’s going to be a thing called a Small Business Administration — hell, if there’s going to be a thing called a federal government — it ought to have better tools at its disposal than a Rolodex of carrion-circling lenders and a negotiated interest rate. In fact, it does! It’s just that the real help is being shifted to billion-dollar companies with tycoon CEOs, while small businesses are being fed to the sharks.

The next-best option for my wife’s efforts at keeping her staff on their feet involved emptying savings accounts used for reserving money for taxes and liabilities (think gift certificates, which accrue impressively but which are not payment for services rendered, cannot expire, and are refundable). A day spa, even a reasonably successful one, is a low-margin business: A savings account reserved for liabilities holds roughly $10,000; another savings account reserving estimated tax money holds another $4,500; one single payroll for half a month’s regular work runs $23,000 to $32,000. Emptying those accounts would mean dealing a grievous self-wound for very fleeting, dubious benefits. It would cover somewhere around half of a paycheck per staff person but would make it far more likely that the business would fold before the end of the current crisis, depriving these people of a job to which they would otherwise happily return.

So, this is all pointing at layoffs — a strategic termination so that her people could collect unemployment and the company could still be around to gather them back up again in a few months. But first, my wife had to see if she could lower her non-payroll expenses to as close to zero as possible if she was to have any chance of avoiding the devastating defeat of cutting loose a good and loyal and dedicated staff of excellent people, many of whom have families to support. This meant seeking forbearance from lenders, banks, and the landlord.

The only thing that seems to matter to anyone with any power is whether money continues to flow upward. It only ever flows upward; the only thing that trickles down is pressure.

The first two calls were to lenders, and they were not encouraging. The first lender said my wife could go through the usual payment deferral process, but that her interest rate would increase and penalties would accrue, and there would be an eventual balloon payment at the end of her loan period. The second lender had disconnected their telephone and was unreachable for four days. Both lenders ultimately settled on limited forbearance through April — payments could be missed, but hundreds of dollars in penalties would accrue per payment missed, and the sum of missed payments, plus penalties, would be added to payments beginning in May. Her interest rate would jump, per the original agreement, to reflect missed payments.

The word from the landlord was even more troubling. My wife pays $4,500 in monthly rent to a developer that manages an impressive spread of commercial real estate. Their representative announced in a bemused tone that they had not even considered whether they would need to offer any sort of relief or forbearance to their tenants. After having the situation explained to them, their best offer was one month of forbearance in exchange for extending the lease period by a full year, and they indicated they’d be offering this deal to their tenants on a case-by-case basis. Two days later, they sent a form email to their tenants announcing that the deal would, in fact, be two months of forbearance in exchange for two years added to existing leases.

What has been lacking in all this is firm direction from the federal government. It has been in their power all along to suspend collection of rent, mortgage, and debt payments, and to mandate two or three months of social distancing and a halt on all nonessential business. Hilariously, they’ve managed to suspend rent payments for airlines at airport terminals, once again directing relief at massively profitable, publicly-traded, billion-dollar businesses and ignoring everyone else. They’ve left it up to governors and mayors to determine how much traffic and business to permit; they’ve left it up to banks and landlords to determine how much relief is appropriate; they’ve left it up to business owners to figure out how to balance the threat to the public of staying open versus the threat to the business of shutting down; they’ve left it up to individuals to hammer out arrangements for keeping a roof overhead and food on the table. There are no right answers. The only thing that seems to matter to anyone with any power is whether money continues to flow upward. It only ever flows upward; the only thing that trickles down is pressure.

What is likely to finally kill my wife’s business, in a blast of dark cosmic humor, will be the administration’s favoring of the market over public health. While society was settled on indefinite self-isolation and a hiatus for all nonessential work — something the federal government never quite got around to championing but which was nonetheless taken for granted by all nonsociopaths — it was possible to make limited headway negotiating forbearance from banks and lenders and landlords, using phrases like “act of God” and “force majeure.” If and when the president arbitrarily declares the battle won after a few short weeks of half-assed social distancing — long before a framework for widespread testing has been established, to say nothing of any formal measures to quickly increase the stockpile of masks and ventilators — small businesses will be forced to ignore the urgent pleas of the scientific and medical communities and reopen for business or face down creditors and landlords without the backing of an official mandate. Small businesses will have to choose between operating as coronavirus distribution centers or sinking immediately under the weight of debt.

Here is where things stand for my wife and her business: Her rent has been deferred for one month, at the cost of another full year on her lease; her two loans have been deferred for two months each, but not without penalty. Insurance for her company and its practitioners has not been deferred. Bills will begin piling up in earnest, thousands and tens of thousands of dollars at a time, beginning [checks watch] uhh yesterday. An end to social distancing is months and possibly a year away; Virginia’s current stay-at-home order runs into June. There is no telling how soon it will be anything other than catastrophically reckless to reopen her doors and accept business, but the people upstream have drawn their line. The clock is ticking.

Most painfully, the staffers who could not survive without immediate income have agreed to have their employment terminated, so that they can collect unemployment and seek Medicaid. My wife, who is a good practitioner and a good business owner and has not done anything wrong to put her business at risk, is in an impossible, untenable position. Because she will have to start paying rent again in one month, and because she will have to start making loan payments by summertime, and because she has several very talented and qualified and hardworking staff people in the wind, there will be enormous pressure on her to turn the lights back on before the end of April. If she does, she and all the other small businesses forced into the same position will be active vectors for coronavirus, despite every possible effort. If she doesn’t, it is very likely she never will again.

America Is About to Witness the Biggest Labor Movement It’s Seen in Decades

It took 40 years and a pandemic to stir up a worker revolution that’s about to hit corporate America!

Steve LeVine remembered that in September 1945, a little-remembered frenzy erupted in the United States. Japan had surrendered, ending World War II, but American meat packers, steelworkers, telephone installers, telegraph operators, and auto assemblers had something different from partying in mind. In rolling actions, they went on strike. After years of patriotic silence on the home front, these workers, along with unhappy roughnecks, lumberjacks, railroad engineers, and elevator operators — some 6 million workers in all — shut down their industries and some entire cities. Mainly they were seeking higher pay — and they got it, averaging 18% increases.

The era of raucous labor is long past, and worker chutzpah along with it. That is, it was — until now. Desperately needed to staff the basic economy while the rest of us remain secluded from Covid-19, ordinarily little-noticed workers are wielding unusual leverage. Across the country, cashiers, truckers, nurses, burger flippers, stock replenishers, meat plant workers, and warehouse hands are suddenly seen as heroic, and they are successfully protesting. For the previous generation of labor, the goal post was the 40-hour week. New labor’s immediate aims are much more prosaic: a sensible face mask, a bottle of sanitizer, and some sick days.

The question is what happens next. Are we watching a startling but fleeting moment for newly muscular labor? Or, once the coronavirus is beaten, do companies face a future of vocal workers aiming to rebuild lost decades of wage increases and regained influence in boardrooms and the halls of power?

For now at least, some of the country’s most powerful CEOs are clearly nervous. Late last month, Apple, faced with reporters asking about a company decision to furlough hundreds of contract workers without pay, did a quick about-face. Those employees, Apple now said, would receive their hourly wages. A few weeks earlier, after Amazon warehouse workers demanded better benefits during the virus pandemic, that company also reversed course, offering paid sick days and unlimited unpaid time off.

The backdrop is a country at a standstill and uncertain over which businesses will survive the current economic shakeout, and in what form. With some notable exceptions, very few companies seem prepared to risk riling their employees, especially given broad popular support for workers at their grocery stores, nurses at their hospitals, and drivers who are keeping supply arteries open.

The past four decades have been perhaps labor’s weakest since the Industrial Age.

But if companies are responding to those who are protesting, they might also think ahead and preempt festering trouble down the road. “I like to believe people will say, ‘We treat these people as disposable, but they are pretty indispensable. Maybe we should do what we can to recognize their contribution,’” says David Autor, a labor economist at MIT and co-director of the school’s Work of the Future Task Force.

Until the 1980s, layoffs were barely a thing, writes Louis Uchitelle in The Disposable American: Layoffs and Their Consequences. Companies tended to avoid large-scale dismissals, because they violated a red line of publicly accepted practice and also could finger the company for blame. The United States was still in the age of company as community and societal patron, and even when workers went on strike, they were generally not replaced, because the optics would be bad.

But in 1981, President Ronald Reagan changed all that. Some 12,000 air traffic controllers went on strike, demanding higher pay and a shorter workweek. In a breathtaking decision, Reagan fired all but a few hundred of them. The Federal Labor Relations Authority decertified the controllers’ union entirely. The era of strong labor was over.

In the subsequent age of the no-excuses layoff, the number of major strikes has plunged. Starting in 1947, when the government began keeping such data, there were almost always anywhere from 200 to more than 400 big strikes every year. But in 1982, the year after the air traffic controllers debacle, the number for the first time fell below 100. In 2017, there were just seven. “There was damage to self-esteem every time there was a layoff. It took the militancy out of organized labor, and I don’t think it ever recovered,” Uchitelle says.

The past four decades have been perhaps labor’s weakest since the Industrial Age. For a half century, those working for hourly wages have won almost no real gains. The real average hourly wage in 2018 dollars adjusted for inflation was $22.65 in 2018, compared with $20.27 in 1964 — just an 11.7% gain, according to Pew Research. Real median hourly wages rose by only another 0.6% last year despite the sharp tightening of the job market and an increase in the minimum wage across the country, according to the Bureau of Labor Statistics.

The current revival of worker activism precedes Covid-19 in the unlikeliest of places. In 2018, West Virginia teachers, among the lowest paid in the nation and four years without a raise, went on strike for nine days in a demand for higher pay. That they won a 5% increase was one astonishing thing. But the walkout itself was stunning, specifically because of the state where it occurred — a former bedrock of ultramilitant coal miners who had repeatedly gone to actual war for better pay and safety but more recently were a bastion of worker passivity.

If teachers are an indicator of what is coming, Amazon, fast food restaurants, hospitals, and gig companies have a long, hot few years ahead.

Last year, the West Virginia teachers were on the picket lines again. This time, they stopped the state legislature from funding private schools in what they saw as an attempt to weaken their newly revived strength. Officials buckled after just a day. The strikes meanwhile spread to a dozen red and blue cities and states. Often wearing red shirts as the symbol of the strikes, the teachers were demanding more money — from 2000 to 2017, teachers’ real salaries actually shrunk by 1.6% nationally, according to the National Center for Health Statistics — as well as more supplies and help in the classroom. In Arizona, teachers won a 20% raise, and Los Angeles teachers won a 6% raise. That triggered more strikes through much of 2019, with Chicago teachers, for one, winning a 16% pay raise. Strikes seemed likely this year, too, in Detroit and Philadelphia, for starters.

If teachers are an indicator of what is coming, Amazon, fast food restaurants, hospitals, and gig companies have a long, hot few years ahead. On April 6 alone, the employees of a Los Angeles McDonald’s walked out when a co-worker was diagnosed positive for the coronavirus. For the second time in a month, workers at a Staten Island Amazon warehouse went on strike after 26 co-workers came down with the virus. And outside Chicago, employees of two plants walked out because management failed to immediately announce that co-workers had been diagnosed with Covid-19.

Across the country, workers are on the march over safety, pay, and sick days. The picture is jarring at a time when 16 million people are newly out of work. Companies and CEOs need to prepare for a new post-Covid-19 reality where workers will recognize their power — and use it.

 “Business models based on ridiculous labor rates plus arbitrage where you foist all your costs onto the employee are coming to an end.”

When the virus struck Hilton Hotels starting in January, its global occupancy plummeted to somewhere between 10% and 15%, and most of its 6,100 managed and franchised properties closed. Executives were convinced that the travel industry would eventually rebound, but from there they faced a conundrum: They did not want to lose a trained workforce, but they also knew they and their franchisees could not afford to keep their approximately 260,000 employees on the payroll. So, on March 24, the decision was announced to, in effect, loan them out.

Staff in Hilton’s human relations unit contacted counterparts at Amazon, Albertson’s, CVS, and Walgreens, says Nigel Glennie, vice president of corporate communications at Hilton. These retailers were experiencing Covid-19 boomlets and, combined, were in the market for hundreds of thousands of workers. Were they interested in some already trained workers, Hilton asked, who are expert specifically in catering to exceedingly particular customers? So an expedited hiring portal was set up, ultimately connecting Hilton’s workforce with 28 retailers that were suddenly responsible for almost the entire working economy.

The outcome was ideal for Hilton: It would not lay off but instead furlough its workers, thus allowing them to collect unemployment checks or work elsewhere. Once the crisis ended, they could return to Hilton. “We have a commercial interest in this decision. We know we have well-trained people who we want back,” Glennie says. “We wanted to make sure they were looked after. We want to do the right thing by our people.”

Jeff Lackey, vice president of talent acquisition for CVS Health, says his company was seeking 50,000 new employees at the time. Albertson’s says it was hiring 30,000. Neither know exactly how many of Hilton’s workforce are now working for their respective companies, but Lackey says the hiring process was being completed in as little as a single day. “I understand what it’s like to live paycheck to paycheck,” he says.

Less flattering attention has gone to companies that have violated an unwritten set of rules that have emerged for corporate behavior. Hospital management has been upbraided for suspending nurses who try to protect themselves by buying their own equipment and disciplining those who speak out. Former employees of Bird, the scooter company, described drawn-out hours of uninformed dread prior to an announced Zoom meeting, followed by a short announcement by someone they did not know. And Dig Inn, the fast-casual chain, sprung the news by text.

Sephora, too, has been faulted publicly by recently laid-off employees. At first, the retail beauty chain closed but promised to keep paying everyone for as long as the stores remained shuttered. Then, on March 31, it laid off part-time staff anyway. The decision caught a lot of Sephora employees by surprise. In tweets and online videos, some workers said they had been on calls with their managers that very day discussing the opposite — how they would go ahead in the new environment. Suddenly, though, employees received texts saying that in 15 minutes, they were to participate in a mandatory audio call.

When Lydia Cymone, a Sephora makeup artist in Alpharetta, Georgia, heard the call, she was right in the middle of videotaping a makeup tutorial and posted the tearful video. Brittney Coorpender, who did facial treatments at a Sephora store in San Jose, California, told me in an email exchange that she felt misled. “Women/men who forgot to mute themselves could be heard sobbing right before I ended the call,” Coorpender wrote. “They promised and promised us we were fine and gave zero indication we weren’t, until that call.”

In response to a request for comment, Sephora sent the March 31 statement it posted to its website. Dan Davenport, president of recruiter Randstad RiseSmart, says, “If you’re making a statement that you’re not going to be laying anyone off, you better be right about that.”

If corporate America does face a post-Covid-19 reckoning from workers, the gig economy seems like one of the top probable targets. Jim Chanos, president of Kynikos Associates, a hedge fund that shorts stocks, was made famous in the early 1990s for blowing the whistle on Enron. Today, Chanos is shorting Uber and Grubhub, among other gig companies. In an interview, he said he had already been shorting the two companies but has added to these bets since the virus struck.

What makes them weak, in Chanos’ view, is the optics of their business model, which is based on paying an arguably miserly cut of revenue to their workers and a refusal to make them actual employees. While allowing these companies to avoid a lot of the conventional costs of doing business, the strategy has also always left the gig companies at risk of their workers and the public turning against them. Chanos predicts that’s exactly what’s going to happen in the post-coronavirus era. The public is “going to look askance” at companies that have relied on taxpayers to fully cover their workers’ jobless benefits, since they do not pay into unemployment insurance funds. “Business models based on ridiculous labor rates plus arbitrage where you foist all your costs onto the employee are coming to an end,” he says.

Until the virus, the notion of unionized tech workers was just that — a notion that seemed to violate the very spirit of Silicon Valley. It’s still hard to imagine unionized software engineers. But it’s equally difficult to say where the boundaries of the possible lie.

White-collar tech activism goes back two years, when Google workers around the world walked off the job in a protest against sexual harassment. More workers are griping now. Last month, some Instacart workers walked off the job in a bid for a higher share of the revenue and better safety; in some cities, they are starting to join unions like the United Food and Commercial Workers local in Chicago. In San Francisco, Uber and Lyft drivers protested last month in front of Uber headquarters.

The tremors, though, will be felt not just in the gig economy but also tech at large: In February, employees at Kickstarter, the crowdfunding platform, voted to unionize, becoming the first white-collar tech company staff to do so, according to a database at Cal Berkeley. The Teamsters are making an open run at organizing other Silicon Valley workers. If you put Covid-19 out of your mind, the move is mind-blowing. Until the virus, the notion of unionized tech workers was just that — a notion that seemed to violate the very spirit of Silicon Valley. It’s still hard to imagine unionized software engineers. But it’s equally difficult to say where the boundaries of the possible lie.

The biggest fish of all in terms of tech unionization is Amazon. The e-commerce giant is beset with worker complaints just as it has begun to transcend its barbarian image, repositioning itself as a public good at the very center of the U.S. economy. An issue that has drawn particular heat is its decision on March 30 to fire Chris Smalls, a worker at an Amazon warehouse on Staten Island who loudly complained about health safety. On April 8, a group of Democratic U.S. senators wrote a letter to Amazon CEO Jeff Bezos raising skeptical questions about Smalls’ dismissal and Covid-19 safety generally at company warehouses. Amazon has seemed generally conflicted: On one hand, it has responded with added pay and off-days for sick employees. But Amazon has also repeatedly fired workers it has deemed disloyal — three employees just over the past week who had criticized health conditions. Whole Foods, too, owned by Amazon and run by John Mackey, the devotee of “conscious capitalism,” faced a sick-out in March and look, now a number of Amazon facilities are seeing sick outs. In a statement, an Amazon spokesperson said the points raised in the senators’ letter were unfounded and that Smalls was dismissed for violations of social distancing guidelines. “Nothing is more important than the safety of our teams,” the spokesperson said.

Robert Shiller, the Nobel Prize–winning economist at Yale, compares labor’s newfound position to its stature in the Great Depression, when workers also suddenly were conferred with vast public sympathy.

While complaints and denunciation of Amazon abound, no one has gone so far as to try an old-style shutdown of any of the company’s operations — the kind of display of strength that typified unions in their heyday. For that matter, no rabble-rousing worker is known to have recently banged on the desk of a major company executive — or a leading politician — and demanded the production of a plant be kept open and workers on the job. Even if one did, would the public go along? Would large numbers of people stop shopping at Amazon? If they did, Amazon would have to concede quickly, just as railroad workers shut down transportation across the country in labor’s peak. “If you could really shut down a warehouse, that would really shock Amazon and get them to address the worker concerns,” says Steven Greenhouse, author of Beaten Down, Worked Up, a history of American labor.

Robert Shiller, the Nobel Prize–winning economist at Yale, compares labor’s newfound position to its stature in the Great Depression, when workers also suddenly were conferred with vast public sympathy. “The narrative was that it wasn’t their fault. There was something in the system,” Shiller told me. “This is another case where obviously it’s not their fault. And there is heroism in how they are delivering to us through this.”

In a way, labor’s resurgence is not all that surprising. The age of Trump and Brexit is, at its crux, an uprising against globalization, the movement that, after Reagan and his contemporaneous British counterpart, Margaret Thatcher, diminished labor and championed worldly capitalism at whatever the local cost. If we are spurning globalization, it stands to reason that the local comes back into focus. And what is more local than the grocery bagger, the postman, the nurse?

Where workers have advantage today has been in keeping their demands modest, drawing the public to their side, and making it very difficult for management to refuse. Worker efforts could be blunted by high unemployment, at least until jobs return. But their pluck, beaten out of them by the years of layoffs, has returned with Covid-19.

A class war? A global power shift? A world isolated? How experts see the future after coronavirus.

Joel Shannon noted that what will “normal” be like after coronavirus? Experts imagine a different world.

The coming weeks hold plenty of uncertainty as the world reels from the coronavirus pandemic, but some experts are already thinking about how the current crisis will impact society for years to come.

A report from Deloitte and Salesforce released this month presents four scenarios for the next three to five years — and they all tell a story of a world radically changed by the virus with the intent of helping leaders prepare for a variety of possible futures. “Even their best-case scenario looks pretty bad,” trends expert and keynote speaker Daniel Levine told USA TODAY.

Rather than making specific predictions, the scenarios in “The world remade by COVID-19” report focus on what we don’t know at this time, Andrew Blau — managing director of Deloitte Consulting and a leader on the project — told USA TODAY.

When will life return to normal? Expert says US testing is too far behind to know, expects second wave of cases. The end result: An intentionally fuzzy picture of several possible futures, varying based on how several unknowns — such as the duration of the pandemic — unfold. Those possible futures highlight trends that may soon define our times.

On one end of the spectrum: A short-lived pandemic that will batter small and medium-sized businesses. It leaves consumers — grateful to once again gather with friends, loved ones and coworkers in person — reevaluating some of their pre-pandemic habits. On the other end: A prolonged, nearly impossible to contain virus that leaves the world isolated, distrustful and suffering.

Levine, who was not involved with the project, said the report approached the difficult task of looking years into the future the right way. While none of the scenarios described in the report are likely to pan out as authors imagine them today, Levine said the future will likely hold a mix of them. 

Here’s the authors’ four scenarios:

The passing storm

In this possible future, our fight against the virus goes better than expected — but still at great economic cost, especially to the middle class and small businesses.

The pandemic “leaves its mark on society, but doesn’t change everything,” Blau said. 

Governments’ plans to contain the virus generally work and citizens comply with the measures. The success leads to a greater trust in our institutions, but class tensions simmer as the lower and middle classes bear the brunt of the economic damage. 

What might life be like in this future? In many ways, daily life would remain relatively stable, Blau said. Life under lockdown will remind many people about the value of community and companionship. Weeks of increased teleworking and online retail will lead many people to alter some of their behaviors. 

Sunrise in the east

Authors note the possibility that China and other East Asian counties will be able to manage the virus more effectively, through what western nations may see as heavy-handed tactics. Aggressively enforced lockdowns and surveillance technology have shown promise in multiple East Asian countries’ fight against the virus. If western countries’ uneven response proves less effective, global power could shift to China and its neighbors, authors speculated.

What might life be like in this future? The political impacts of this are hard to pin down for Blau, although he suspects eastern Asian countries would be looked to as a positive example in how western governments are run. Clearer to him: Our relationship with technology could change. For years, many people have held deep privacy concerns and a suspicion of artificial intelligence. If technology proves invaluable in our fight against the virus, those perceptions could evolve.

Good company

This scenario imagines a world where many factors — such as the severity of the disease and the economic impacts — are not as bad as they could be, but only because corporations stepped up when governments were ineffective.

It’s an expansion of a trend seen to some extent in the today — public-private partnerships where big corporations step in when governments can’t handle the crisis alone. There are threads of this in the daily news of today: Tech companies fixing broken ventilators for the government; Apple and Google developing apps to help fight the pandemic.

What might life be like in this future? Corporations would play an even bigger role in our lives than they currently do — and Blau suspects we would come to embrace that, since those companies helped us through the crisis. The report says this future could lead to an era of greater corporate responsibility and trust.

Lone wolves

This is the future “no one wants to happen,” Blau said. This scenario could happen if the virus proves impossible to contain and spreads in long-lasting waves around the globe. “Mounting deaths, social unrest, and economic freefall become prominent,” the report says. 

As a result, nations turn inward and limit contact with the outside world in the interest of national security. It’s a future where even allies feel like they cannot trust each other.

What might life be like in this future? Different nations will feel the impacts in different ways, but Blau imagines we’d live in a less connected, less trusting, less prosperous world, focused on survival. It’s a “dark scenario” where technology is used for surveillance and control, nations limit trade with each other and paranoia is common among citizens.

Will any of these scenarios actually happen?

The good news: The future isn’t written yet, and we have a say in how it plays out.

Report authors listed how citizens of nations responded to the crisis as one of their top unknowns. Nations that work together and “think big and act fast” will fare better, they predicted.

The scenarios in the report are meant to confront you with a possible reality that might surprise or unsettle you — and that’s part of the point, Blau said. The goal is to get readers thinking and mentally preparing for a wide variety of possible futures, even ones that don’t seem intuitive.

Instead of believing specific predictions for the future, he suggested embracing the uncertainty we are all living at this moment.

“We’re all imagining the future,” Blau said. “None of us actually know.” 

Coronavirus Forces Organizers to Cancel San Diego Comic-Con

Brakkton Booker reported that the continued spread of the coronavirus claimed yet another big event on the 2020 entertainment calendar this Friday, when the San Diego Comic-Con announced the annual entertainment and comic book convention would be postponed until 2021.

In a statement on its website, organizers said it is “with deep regret that there will be no Comic-Con in 2020,” marking the first time in the event’s 50-year history it would not be held.

“Extraordinary times require extraordinary measures and while we are saddened to take this action, we know it is the right decision,” said Comic-Con spokesperson David Glanzer. “We eagerly look forward to the time when we can all meet again and share in the community we all love and enjoy.”

The event, which was expected to draw more than 100,000 people, was scheduled to be held July 23-26. It will now take place almost a year to the day later, kicking off July 22-25, 2021.

Comic-Con — which launched as a small comic-book themed event — is now a powerhouse summer festival that attracts major figures from movies and television. It’s one of the biggest fan events of the year; last year more than 135,000 people attended, and not just for comics, but for interactive experiences, signings and big announcements about the latest Marvel movies.

SDCC officials said fans who bought passes for Comic-Con 2020 can either request a refund or transfer their badges to next year. The same offer is being made to the event’s exhibitors.

Organizers also announced that a previously postponed event, Anaheim WonderCon — originally set for April 10-12 — will also be pushed to 2021. It will be held at California’s Anaheim Convention Center from March 26-28.

The spread of the coronavirus has decimated the festival and sporting calendar, with many states implementing broad social distancing guidelines and stay at home orders that have shuttered all but essential businesses from operating.

In March, California governor Gavin Newsom issued a stay at home order, and banned gatherings of more than 250 people.

What will happen next as more and more states consider “getting back to “normal” and as more and more groups push back with non-social gathering demonstrations. Don’t be idiots and follow science and our public healthcare teams!

The questions are when will this end, which prediction model do we believe and what will the new normal be?