Category Archives: Social Distancing

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.”

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!