New estimates of the number of asymptomatic people with the coronavirus suggest that "silent" COVID-19 is much more prevalent than once thought, according to two studies published Wednesday.
The first study, published in JAMA Network Open, found that 42 percent of cases from a group of people in Wuhan, China, were asymptomatic. The second study, published in Thorax, found much higher rates of asymptomatic individuals: 81 percent of cases on a cruise to Antarctica.
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The study from Wuhan looked at 78 patients who tested positive for COVID-19, and found that 33 of the individuals had no symptoms of the illness. These patients were more likely to be women, and more likely to be younger, in their 20s, 30s and early 40s.
Meanwhile, the second study, from Australian researchers, looked at 217 people on a cruise bound for Antarctica. The ship set sail in mid-March, just after the World Health Organization declared the coronavirus a pandemic.
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The first fever on board was reported eight days into the voyage. Over the following two weeks, eight people had to be evacuated from the ship because they fell ill.
All of the 217 people who remained on board were tested for COVID-19. More than half (59 percent) tested positive, but just 19 percent of those patients had symptoms. The other 81 percent were symptom-free.
"Many people still haven't grasped the notion that asymptomatic people can be so common, and they wonder why it is they have to wear the mask when they're feeling well, or why they have to keep doing this social distancing stuff," Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, said.
"Simply exhaling can send out viral particles," said Schaffner, who wasn't involved with either study.
That's why the CDC encourages everyone to wear face coverings or masks in public to help prevent the spread of the virus. The agency's estimate of the prevalence of asymptomatic cases, based on mathematical modeling, is lower, at 35 percent.
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There was one positive finding, however, from the study in China: Asymptomatic individuals may not spread the virus for as long as symptomatic patients do. The patients without symptoms shed the virus for about eight days, compared with 19 days among those who did have symptoms, the researchers, from Zhongnan Hospital of Wuhan University, found.
Still, asymptomatic COVID-19 cases remain a concern.
"This is very important because, theoretically, you can spread the infection when you're shedding the virus because it's so highly contagious," Dr. Aditya Shah, an infectious disease fellow at Mayo Clinic in Rochester, Minnesota, said.
Though COVID-19 has proven it has the ability to sicken anyone at any age, people over age 65 and those with underlying chronic health conditions, such as type 2 diabetes, appear to be most vulnerable.
"I don't know of a single person, no matter how independently-minded they are, who has any desire to give this virus to anyone else," Schaffner said. "But they have to recognize that they could."
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Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."
Getting infected with Covid-19 is a frightening, isolating experience. But as more people endure it, the community of survivors is growing and with them comes better guidance.
My husband and I got sick from the coronavirus in late March. We had so-called mild cases, meaning only that we werent hospitalized: In fact, we were sicker than we had ever been. Because we could breathe fine, we knew we werent supposed to go to the hospital. But what were we supposed to do?
The standard advice rest, fluids and fever reducers was and is essential, but at times it felt inadequate to the severity of the illness.
As we recovered, I spoke with many friends, colleagues and internet strangers going through similar ordeals. Here is some collective wisdom on how to manage noncritical cases of Covid-19.
First, of course, you need to be confident that your illness can be managed at home. Most cases of Covid-19 can be. But if you develop any symptoms on this list, including trouble breathing, persistent pain or pressure in the chest, new confusion, an inability to wake or stay awake and/or bluish lips or face, seek emergency care.
Some people will have relatively mild symptoms at first and then become more seriously ill. These patients are likely to develop shortness of breath four to eight days after their first symptoms, and thats really where people should start paying attention, said Dr. Pieter Cohen, an associate professor at Harvard Medical School and an internist at the Cambridge Health Alliance who was co-author of an article about the progression of Covid-19 symptoms.
If the shortness of breath worsens from day to day, Dr. Cohen said, thats a sign to call your doctor. Less commonly, patients with low oxygen levels may experience dizziness or lightheadedness instead of shortness of breath, so keep an eye out for that too.
Otherwise, read on.
If youre reading this while healthy, buy basic supplies now, including a thermometer, acetaminophen or ibuprofen, and rehydration drinks like Pedialyte.
A pulse oximeter can sometimes be helpful, both in flagging severe illness and in reassuring you of the opposite, my colleague Dana Goldstein says: If you feel short of breath but your oxygen level is normal, you may be able to avoid the hospital. (You should still contact your doctor.)
If youre sick and dont have supplies, see if a friend can pick them up for you, or if a grocery store or bodega will deliver. (Tip well!) Either way, avoid contact: Whether its a friend or a delivery person, have the bag left outside your door, and dont open the door until the delivery person is gone.
Over-the-counter drugs may not be enough. In particular, the coughing and nausea caused by Covid-19 can be severe enough to warrant prescription medication.
For my husband and me, benzonatate (for the cough) and promethazine (for the nausea) were lifesavers. Some colleagues were prescribed codeine-based cough medicine or Zofran. If you feel you might need them, ask your doctor about medications sooner rather than later. Dont wait until youre doubled over coughing or cant keep anything down.
If you dont have a primary care doctor, some urgent care clinics offer virtual appointments, and some pharmacies offer prescription delivery.
Dry air can exacerbate some symptoms such as coughing and chest tightness. If you have a humidifier, use it. If not, a hot shower works.
Several readers reported that they felt better when they lay on their stomach. A woman in Britain whose partner was sick for several weeks told me that a particular breathing exercise helped him:
You take a deep breath, hold it for 5 seconds and release. Do that 5 times, then on the 6th time on the release, cough hard. Do that cycle twice, then lie on your front and take slightly deeper breaths for 10 minutes. Try to do it a couple of times a day.
In some cases, your doctor may also prescribe an albuterol inhaler to reduce your cough and ease your breathing.
As soon as you get sick, start a detailed log. Every time you take your temperature do it several times a day, at consistent times log it. Every time you take a pill, log it. Every time you eat or drink, log it. If one symptom resolves or a new one develops, log it.
As my colleague Eliza Shapiro noted in a Twitter thread worth reading in full, this creates a detailed record to take along if you end up needing medical attention. It also helps you stay on top of your care.
Can I take more cough medicine yet? How long have I had this fever? Is it a little lower than it was yesterday? You wont be able to keep these things straight while shivering in bed, but a spreadsheet can.
Having Covid-19 is intensely stressful. Its not unusual to feel depressed or anxious, or to have panic attacks. Dont be embarrassed to talk to your doctor about your mental health its just as important as your physical health.
Derek Norman, a news assistant at The Times, says that in the worst moments of his illness, when he felt short of breath and panicky, he would sit upright, focus on breathing steadily and picture a vivid memory.
Id close my eyes and picture the exact details of a scene I had once experienced, and Id completely immerse myself in that memory. Something like sitting at an outdoor cafe in Morocco. Id try to recall the sounds of street life and the dry desert air on my skin, or the smell of the spices, hookah and exhaust swirling in the air. Very, very specific details that I look back fondly on. Id continue to slowly breathe through it.
Tim Herrera, our Smarter Living editor, emphasized fresh air. That can be hard to come by safely when youre contagious, but even if you live in a crowded area with no private outdoor space, it can help to open a window.
Its also OK to not be OK. You dont have to handle this well, whatever that means. You just have to get through each day. So go ahead and cry, binge Netflix, do a jigsaw puzzle, reread the entire Animorphs series whatever gets you through the day.
Some people have mild symptoms for the first few days and then suddenly get sicker. Some have fevers that go up and down repeatedly. Some are sick for two weeks straight, then have a few symptom-free days, then relapse. Some have lingering symptoms for months.
This is both maddening and very common. Give yourself as much time to rest as your job and financial situation will allow. For me and for several colleagues, that meant nearly three weeks of sick time.
Since tweeting about my experience last month, Ive received many emails from people in the this will never end phase. I share the same screenshot with all of them: a text I sent to a friend on April 5.
Why do I even bother giving good news when its only going to last a few hours? I wrote. Im just so tired of this. I dont know how to keep dealing with it.
Every day, more people will hit that wall and every day, more people will find their way past it. They will feel alone, but they wont be.
Sarah Maslin Nir contributed reporting.
With physician offices not seeing patients with COVID-19 symptoms in April, Timothy Regan said he had little choice when Denver Health directed him first to its urgent care facility and then to its emergency room. "I felt bad, but I had been dealing with it for a while," he says. Ethan Welty for KHN hide caption
With physician offices not seeing patients with COVID-19 symptoms in April, Timothy Regan said he had little choice when Denver Health directed him first to its urgent care facility and then to its emergency room. "I felt bad, but I had been dealing with it for a while," he says.
From late March into April, Timothy Regan had severe coughing fits several times a day that often left him out of breath. He had a periodic low-grade fever too.
Wondering if he had COVID-19, Regan called a nurse hotline run by Denver Health, a large public health system in his city. A nurse listened to him describe his symptoms and told him to immediately go to the hospital system's urgent care facility.
When he arrived at Denver Health where the emergency room and urgent care facility sit side by side at its main location downtown a nurse directed him to the ER after he noted chest pain as one of his symptoms.
Regan was seen quickly and given a chest X-ray and electrocardiogram, known as an EKG, to check his lungs and heart. Both were normal.
A doctor prescribed an inhaler to help his breathing and told him he might have bronchitis. The doctor advised that he had to presume he had COVID-19 and must quarantine at home for two weeks.
At the time, on April 3, Denver Health reserved COVID-19 tests for sicker patients. Two hours after arriving at the hospital, Regan was back home. His longest wait was for his inhaler prescription to be filled.
Regan wasn't concerned about just his own health. His wife, Elissa, who is expecting their second child in August, and their 1-year-old son, Finn, also felt sick with symptoms like those of COVID-19 in April. "Nothing terrible but enough to make me worry," he said.
Regan, who is an estimator for a construction firm, worked from home throughout his sickness including while quarantined. (Construction in Colorado and many states has been considered an essential business and has continued to operate.) Regan said he was worried about taking a day off and losing his job.
"I was thinking I had to make all the money I could in case we all had to be hospitalized," he said. "All I could do was keep working in hopes that everything would be OK."
Within a couple of weeks, the whole family indeed was OK. "We got lucky," Elissa said.
Then the bill came.
The patient: Timothy Regan, 40, an estimator for a construction company. The family has health insurance through Elissa's job at a nonprofit in Denver.
Total bill: Denver Health billed Regan $3,278 for the ER visit. His insurer paid $1,042, leaving him with $2,236 to pay based on his $3,500 in-network deductible. The biggest part of the bill was the $2,921 general ER fee.
Service provider: Denver Health, a large public health system
Medical service: Regan was evaluated in the emergency room for COVID-19-like symptoms, including a severe cough, fever and chest pain. He was given several tests to check his heart and lungs, prescribed an inhaler and sent home.
What gives: When patients use hospital emergency rooms even for short visits with few tests it's not unusual for them to get billed thousands of dollars no matter how minor the treatment received. Hospitals say the high fees come from having to staff the ER with specialists 24 hours a day and keep lifesaving equipment up to date.
Denver Health coded Timothy's ER visit as a Level 4 the second highest and second most expensive on a 5-point scale. The other items on his bill were $225 for the EKG, $126 for the chest X-ray and $6 for his albuterol inhaler, a medication that provides quick relief for breathing problems.
The Regans knew they had a high deductible, and they try to avoid unnecessarily using the ER. But with physician offices not seeing patients with COVID-19 symptoms in April, Timothy said he had little choice when Denver Health directed him first to its urgent care and then to its ER. "I felt bad, but I had been dealing with it for a while," he said.
Elissa said they were trying hard to do everything by the book, including using a health provider in their plan's network.
"We did not anticipate being hit with such a huge bill for the visit," Elissa said. "We had intentionally called the nurse's line trying to be responsible, but that did not work."
In an effort to remove barriers to people getting tested and evaluated for COVID-19, UnitedHealthcare is one of many insurers that announced it will waive cost sharing for COVID-19 testing-related visits and treatment. But it is not clear how many people who had COVID-19 symptoms but who did not get tested when tests were in short supply have been billed as the Regans were.
Resolution: A Denver Health spokesperson said Regan was not tested for COVID-19 because he was not admitted and did not have risk factors such as diabetes, heart disease or asthma. He was not billed as a COVID-19 patient because he was not tested for the virus. The medical center has since expanded its testing capacity, the spokesperson said.
UnitedHealthcare officials reviewed Regan's case at the request of Kaiser Health News. Based on Regan's symptoms and the tests performed, Denver Health should have billed them using a COVID-19 billing code, an insurer spokesperson said. "We reprocessed Mr. Regan's original claims after reviewing the services that he received," a UnitedHealthcare spokesperson said. "All cost share for that visit has been waived."
Timothy and Elissa Regan say they try to avoid needlessly visiting the ER because of their high-deductible insurance plan. Denver Health billed $3,278 for Timothy's ER visit. Ethan Welty for KHN hide caption
Timothy and Elissa Regan say they try to avoid needlessly visiting the ER because of their high-deductible insurance plan. Denver Health billed $3,278 for Timothy's ER visit.
The Regans said they were thrilled with UHC's decision.
"That is wonderful news," Elissa said upon hearing from a KHN reporter that UHC would waive their costs. "We are very thankful. It is a huge relief."
The takeaway: The Regans said they initially found no satisfaction in calling the hospital or the insurer to resolve their dispute but it was the right thing to do.
"He's definitely not alone," said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. "The takeaway here is both the provider as well as insurance company are still on a learning curve with respect to this virus and how to bill and pay for it."
Corlette said Timothy should not have second-guessed his decision to use the Denver Health ER when directed there by a nurse. That, too, was the right call.
Insurers' move to waive costs associated with COVID-19 testing and related treatment is vital to stem the outbreak but it works only if patients can trust they won't get stuck with a large bill, she said. "It's a critical piece of the public health strategy to beat this disease," Corlette said.
To help with billing, she said, patients could ask their provider to note on their medical chart when they seek care for a possible case of COVID-19. But it's not patients' responsibility to make sure providers use the right billing code, she said. Patients need to know they have rights to appeal costs to their insurer. They can also seek assistance from their employer's benefits department and state insurance department.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
Gov. Tim Walzs restrictions on businesses during the COVID-19 pandemic have had a profound economic impact in Minnesota, causing more than 710,000 people to apply for unemployment benefits since March 16. The Twin Cities metro area alone was down more than 270,000 jobs in April compared to April of 2019.
But the fallout from COVID-19 hasnt just affected employment. There has also been an increase in need for help paying for food, housing and other daily costs in Minnesota. One way to measure this increase is through calls to a statewide 211 helpline run by the Greater Twin Cities United Way. That organization has seen an explosion in the number of people needing assistance.
Hennepin County, on the other hand, has had only a modest influx in applications for cash aid like the Supplemental Nutrition Assistance Program (SNAP), which helps people buy groceries. While the county is bracing for greater need down the road, its even reporting something peculiar: a decrease in April applications for short-term, emergency assistance programs.
The United Way runs a free 211 helpline for people to call in seeking aid to meet their basic needs. When a person calls, texts, or chats online with 211 operators, they can get a referral for what service could best help them, including government aid programs.
Between March 16 and May 16, There was a 395 percent increase in referrals for food help over the same period in 2019. (Demand has also spiked at food shelves.) Utility referrals were up 153 percent and healthcare referrals jumped 85 percent.
There was also a 109 percent increase in referrals for clothing and household goods, which Julie Ogunleye, who leads the United Ways 211 information and referral program, said includes cleaning supplies and hygiene needs like toilet paper.
Julie Ogunleye
Ogunleye said theyre watching for an even larger increase once Walzs statewide eviction moratorium is lifted. The United Way didnt have data to compare the need for services and help to the Great Recession, but Ogunleye said that economic downturn was more of a slow moving disaster.
The state Department of Human Services had limited early data on how the pandemic is driving the need for Minnesotas most common forms of assistance. But average daily applications to SNAP rose from 394 in late February to 543 in late March.
Between March and April, 64,000 people were added to SNAP, a larger jump in participation compared to the first two months of the year, according to DHS. In 2019, the state averaged 400,000 total monthly recipients.
Daily applications to the Minnesota Family Investment Program (MFIP), a cash assistance program for low-income families with children, rose from 60 in late February to 116 during mid-to-late March. And daily applications were already rising to SNAP and MFIP, both of which are administered by county and tribal governments, before the pandemic.
In Hennepin County, applications to SNAP were up 12 percent in April compared to the same month in 2019, while applications for cash assistance like MFIP were up 10 percent in March and April compared to 2019.
MFIP helps low-income families with children get cash and food benefits. The cash help is dependent on the size of a family, though state lawmakers boosted the monthly payment by $100 in 2019, the first time it had been raised in 33 years.
Caseload for health care programs like Medicaid were up from 92,500 to 100,200 since March. In April 2019, the health care caseload was 92,390.
Applications for emergency assistance which includes programs that give short-term cash aid to people in financial crises, typically for housing needs like rent, mortgage and utility payments, home repairs, emergency temporary shelter and foreclosure prevention were up 10 percent in March compared to 2019. But in April, applications actually declined by 5 percent compared to the same period last year.
Jason Hedin, the countys human services program manager, said the 10 percent spike across programs in March and April has also come back down to at or below year over year trends.
The modest increase in applications has been surprising, Hedin said. But he added the state and federal aid such as the extra $600 a week in unemployment benefits and $1,200 cash payment for most Americans might be the reason there hasnt been a bigger spike in applications for these cash help programs. The moratorium on evictions and promises from utility companies to avoid shutting off services during the pandemic could also be preventing greater need, Hedin said.
The jump during March and April was still notable and higher than any typical seasonal fluctuation, Hedin said. And caseloads in the programs had been fairly even in the previous six months. But the dip in emergency assistance applications was still unexpected, Hedin said.
We know theres been an influx of other funding sources, Hedin said. In other sorts of economic downturns there maybe wasnt as many.
In Ramsey County, spokesman Chris Burns said applications to SNAP and MFIP have been fluctuating, and said its hard to get a full picture of trends caused by COVID-19. Preliminary data shows fewer approved SNAP applications in March of 2020 than March of 2019, though the information may be incomplete based on lag in how its recorded.
Still, Burns and Hedin said the early numbers may give way to a jump in need once federal payments and moratoriums on bills start to end. Given the current situation with job losses, we anticipate that the eventual trend will be more need for assistance, Burns said.
If the extra unemployment payments expire, will that then cause another increase or a spike in applications for the programs that were administering here? Hedin said.
WHITE COOUNTY, Ind. (WLFI) Six employees at the White County courthouse are battling COVID-19 and others are showing symptoms.
This is according to the White County Commissioners' local disaster emergency declaration.
It was published Tuesday.
It said people have tested positive for COVID-19 and some are awaiting results after showing symptoms.
The White County Government said it has reached out directly to the employees who have been in close contact with the infected people.
Those employees were told to self-quarantine at home.
The statement provided on the White County government website laid out some additions details
It said the courthouse building was deep cleaned on May 21st, 2020.
It also said White County government officials realize the concerns and assuring everyone they are doing everything they can to mitigate the spread.
HURON, S.D. (KELO) Huron was an early hotspot for COVID-19. Two people died, including state lawmaker Bob Glanzer. Then, the northeastern South Dakota town went nearly six weeks without a reported case.
But now Beadle County is reporting 163 cases of coronavirus.
Because Huron is home to the state fair, the school year doesnt start until after Labor Day and ends tomorrow. But with the rash of new cases in Huron, precautions are in place for students turning in their iPads and supplies. Due to construction out front, Huron High School has setup a tent at a side door to accept students materials.
Its all going to be carried in by people in face masks, put along the walls of the hallwaysthe hallway is secured and then nothing will be touched for 48 hours and then theyll start processing the materials, Nebelsick said.
School District Superintendent Terry Nebelsick says theyre taking every precaution after at least three students and some of their parents tested positive for COVID-19.
There was a kindergartener, that had identified positive, along with a parent and there was a kid who graduated in our virtual graduation this past Sunday that identified and then I knew from last Fridays information from health officials that we had an eighth grader who had identified positive along with his father, Nebelsick said.
Nebelsick does not know their conditions.
Its not panic up here, its more like, here we go again. Lets be as diligent as we can and get through this, Nebelsick said.
Over at the Dakota Provisions meat processing plant, cases have also spiked, now at 16. Dakota Provisions Mark (Smokey) Heuston told the Huron COVID-19 Task Force that the plants early sanitizing measures and other precautions worked to keep cases out of the plant until recently.
One couple chose to ignore these guidelines and travel to Aberdeen on Mothers Day weekend and visit relatives. One of these relatives worked at the beef plant in Aberdeen. When this couple returned to Huron, they learned one of the people they visited had now tested positive for coronavirus. That mistake took us to where we are today, Heuston said during task force meeting.
Sick employees are being paid to stay home while the plant takes steps to prevent further spread.
Several of our employees wear a paper mask, a cloth mask and a face shield all at the same time. Last month we built a pavilion at the plant on the east side so employees can practice better social distancing during break periods, Heuston said.
Meanwhile, Hurons School Board is considering plans for how to start classes up again in the fall in the face of future spikes.
When the conditions are right, well get to school, well get as much as we canbut when there is a surge in any one of the communities in South Dakota, like we are now, then were going to have to take it outside-what I see as 14 dayshit a restart and go again. Nothing is finalized yet, but thats our vision of what we need to do, because its not going to go away until there is a vaccine, Nebelsick said.
The task force has set up of a drive through testing site, but according to the state website theyre doing fewer than 40 tests in Beadle County per day. About half of them are coming back positive, which could indicate there isnt enough testing.
HENDRY COUNTY
More people are testing positive for the coronavirus in Hendry County and the health department said its working around the clock to find out whats behind the increase.
The Department of Health in Hendry County said they found a spike in people testing positive, mostly from one cluster people in one spot, in close contact with each other and spreading the virus. Theyre tracking down those who have been in contact with known positive cases.
They said being a smaller county actually helps.
Our team has been working seven days a week, 12, 14 hours a day to try to keep the community safe, said Brenda Barnes with the Florida Department of Health in Hendry County/Glades County.
Ten people are working to keep around 42,000 people healthy and alive in Hendry County.
We have some known clusters in the community. What that means is with contract tracing in our community, an individual that tested positive or other individuals in the same family or who work very closely together on the job, Barnes said.
The contact tracing team calls people who might have been exposed. Those people can self-isolate, monitor for symptoms or get tested if they need to.
The team also helps to educate a business where there could be exposure.
Now thats definitely a plus, being a small community in that we know the business owners, a lot of them. we know the people in our community. Its easier to have those conversations, Barnes said.
The latest numbers from the Florida Department of Health show that there are 339 known positive cases in Hendry County, with 12 deaths attributed to COVID-19.
The health department said there are six testing sites in Hendry County, with drive-thru testing in LaBelle at 1140 Pratt Blvd., and in Clewiston at 1100 S. Olympia.
Those tests are available to anyone, but they do ask that you make an appointment. Call 863-983-1408 in Clewiston or 863-674-4041 in Clewiston.
How dangerous is it to live in New York City during this pandemic? How much safer is it in other places? Is the risk of dying from Covid-19 comparable to driving to work every day, skydiving or being a soldier in a war?
We are awash in statistics about Covid-19: number of deaths, fatality rates, contagion rates. But what does this all mean in terms of personal risk?
In 2011, another invisible danger, radiation, sowed fear and confusion in Japan, where I served as the U.S. Ambassadors science adviser after the nuclear meltdown at Fukushima Daiichi. Then, as now, the news was full of scary numbers. And then, as now, there wasnt nearly enough context for people to make sense of them, much less act upon them.
Fortunately, there are tools for assessing risk that can help us put the daily torrent of numbers in perspective. I found the best way to communicate the level of risk was to put it in terms that allowed easier comparison to other, more familiar, risks. One could then talk, for instance, about how dangerous living in a contaminated city was compared to smoking a pack of cigarettes a day.
A useful way to understand risks is by comparing them with what is called a micromort, which measures a one-in-a-million chance of dying. Note that we are considering only fatality risks here, not the risk of growing sick from coronavirus, or morbidity. The micromort allows one to easily compare the risk of dying from skydiving, for example (7 micromorts per jump), or going under general anesthesia in the United States (5 micromorts), to that of giving birth in the United States (210 micromorts).
The average American endures about one micromort of risk per day, or one in a million chance of dying, from nonnatural causes, such as being electrocuted, dying in a car wreck or being struck by an asteroid (the list is long).
Lets apply this concept to Covid-19.
Using data from the Centers for Disease Control and Prevention, New York City experienced approximately 24,000 excess deaths from March 15 to May 9, when the pandemic was peaking. Thats 24,000 more deaths than would have normally occurred during the same time period in previous years, without this pandemic. This statistic is considered a more accurate estimate of the overall mortality risk related to Covid-19 than using the reported number of deaths resulting from confirmed cases, since it captures indirect deaths associated with Covid-19 (because of an overwhelmed health care system, for example) as well as the deaths caused by the virus itself.
Converting this to micromort language, an individual living in New York City has experienced roughly 50 additional micromorts of risk per day because of Covid-19. That means you were roughly twice as likely to die as you would have been if you were serving in the U.S. armed forces in Afghanistan throughout 2010, a particularly deadly year.
The quality of data varies from state and state, and continues to be updated. But for comparison, using the C.D.C. data, Michigan had approximately 6,200 excess deaths during this same time period. That is roughly the same risk of dying as driving a motorcycle 44 miles every day (11 micromorts per day). Living in Maryland during this time would be roughly as risky as doing one skydiving jump a day for that duration (7 micromorts per jump).
Now, if youre infected with the virus, your odds of dying jump dramatically. Estimates of the fatality rate vary as doctors continue to learn more about this virus and how to care for people sickened by it, but lets assume it is 1 percent for sake of this discussion. That translates into 10,000 micromorts. That risk is comparable to your chances of dying on a climb in the Himalayas if you go above 26,000 feet, where the tallest peaks, such as Everest and K2, stand (using climbing data taken between 1990 and 2006).
But that risk estimate is for the entire population, with an average age of 38. If you happen to be older, the fatality rate can be as much as 10 times higher, which is just slightly less than flying four Royal Air Force bombing missions over Germany during World War II.
The acceptability of risk depends, of course, on ones own attitudes and proclivity to take risks, and whether one has a choice in the matter. Unlike skydiving or hang-gliding, in which the risk is limited to the person making the leap, with Covid-19 the actions of the individual change the risk levels of everyone in the community.
So while there are many thrill seekers who happily jump out of planes, they might think twice about forcing their frail grandmothers, or their neighbors, to jump with them.
David Roberts (@DRobertsNYC), a former academic physicist, served as the U.S. Ambassadors science adviser in Tokyo during the post-Fukushima recovery. Micromort examples came from The Norm Chronicles by Michael Blastland and David Spiegelhalter (2014).
Two months into the stay-at-home order, nearly every sector of life along the Midpeninsula is moving ahead at a new pace: Real estate activity and consumer spending have plummeted, but so have pollution, traffic and overall crime. Schools and cities are preparing for massive budget cuts while hospitals are seeing an unprecedented outpouring of donations. Meanwhile, unemployment has surged along with local volunteer efforts.
The pandemic is changing how we live and has revealed the community at its best and worst along the way. To show how the COVID-19 pandemic has impacted daily life, the Palo Alto Weekly has woven together local, regional and national numbers into a series of interactive infographics, which can be found here.
Small businesses have been among the hardest hit. Only 58% of business owners surveyed in Palo Alto said they are likely to reopen. The community has already seen iconic eateries, such as Mountain View's 75-year-old Clarke's Charcoal Broiler, shutter. It has also seen patrons near and far pitch in to raise $130,000 to save Menlo Park's Cafe Borrone.
Overall, Silicon Valley consumers have decreased their spending at restaurants by 25%, and their retail spending has dropped 59% compared to the same time last year, leaving at least 8,560 service employees at risk of losing their jobs in coming months, according to an April consumer spending report from the Joint Venture Silicon Valleys Institute for Regional Studies.
In April alone, 20.5 million Americans lost their jobs, pushing the national unemployment rate to 14.3%, according to the U.S. Department of Labor. Local unemployment rates in cities along the Midpeninsula now range between 5.5% and 12.4%.
Staff work at a drive-through coronavirus testing site outside the American Airlines center in North Dallas in late March. Dan Tian/Xinhua News Agency/Getty Images hide caption
Staff work at a drive-through coronavirus testing site outside the American Airlines center in North Dallas in late March.
As COVID-19 continues to spread across the country, state and local health officials rush to try to detect and contain outbreaks before they get out of control. A key to that is testing, and despite a slow start, testing has increased around the country.
But it's still not always easy to get a test. While many things can affect access to testing, location is an important starting point.
NPR investigated the location of public testing sites in Texas, one of the first states to reopen, to see how they were distributed between predominantly white and predominantly minority areas. The investigation found that in four out of six of the largest cities in Texas, testing sites are disproportionately located in whiter neighborhoods.
With evidence growing that black and Latino communities are harder hit by this deadly disease, community leaders say that testing disparities are problematic. Many experts warn that if communities don't test the most vulnerable, they could miss pockets of infection and have new large outbreaks.
"If you're casting a very small net, and you're shining a flashlight on a small portion of infections that are out there, you might think you're doing OK," says Dr. Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins COVID Testing Insights Initiative. "Whereas there's this whole pool of infections that you haven't seen."
Nationally, it's hard to determine where there may be testing disparities because data is scarce. Most states and cities across the country either do not track or do not report the racial breakdown of tests that are conducted. But there are media reports of racial disparities that suggest that the patterns identified in Texas are happening in other parts of the country.
"I was acutely concerned from the very beginning," says Dr. Wayne Frederick, president of Howard University, a historically black college in Washington, D.C., who is leading efforts by the university to bring more testing to black neighborhoods. The lack of attention paid to minority health care, he says, "is not a good strategy for our health care system and for the vulnerable part of our community."
Texas: Whiter neighborhoods have more testing sites
In Dallas, a stark divide exists between the north and south ends of town. Interstate 30 bisects the city and largely serves as a borderline between the city's predominantly white neighborhoods to the north and the predominantly black or Hispanic neighborhoods in the south.
In North Dallas there are 20 testing sites. Southern Dallas has nine, with a third of those sitting within a mile of the interstate.
Dallas County, home to the city of Dallas, has the second-highest COVID-19 case count in the state.
In three other cities, the trend was the same: More testing sites were in whiter neighborhoods. In each city, NPR ranked neighborhoods based on their density of white residents. The analysis then focused on the half with the lowest density of white residents to see how many testing sites that are open to the public are located in those areas:
To determine where permanent testing sites were located, NPR contacted health care providers in those six largest cities in Texas representing a total population of 7.9 million by most recent Census estimates and reviewed government, health care and news websites.
The testing site locations include facilities where residents can go to get diagnostic testing for active infection, such as urgent care clinics, hospitals and drive-through testing sites. They don't include sites such as doctor's offices and some hospitals that may provide tests for admitted patients but are not available to the public. Mobile sites, where locations regularly change, are also not included. Reporters analyzed the racial breakdown in areas where testing sites are located using census tract data.
NPR offered city and county health officials the opportunity to review the findings and point to additional testing sites.
These disparities could point to a larger problem in Texas, says Nuzzo. Without good testing access in places where minorities live, the state could be missing cases. She notes that Texas has a low rate of positive cases a measure that can indicate a community is conducting sufficient testing but it also has one of the lowest rates of testing among states.
"It's either that there's just not that much infection in Texas, or that there is infection, but they're testing the wrong people," says Nuzzo. "And it's been hard for me to believe that there's not that much infection in Texas."
The Texas Division of Emergency Management and the Department of State Health Services did not make anyone available for an interview on the state's testing plan.
The national picture
Testing disparities have also been reported in New York City and Chicago.
Some communities across the country are starting to identify and tackle the issue, but only four states currently publish racial breakdowns of who is being tested: Nevada, Delaware, Kansas and Illinois. In New York City, authorities have identified hotspots in low-income and minority neighborhoods and have set up testing sites at over 70 faith-based organizations to target those communities. And in Wisconsin, where some of the first reports of stark racial disparities emerged, free testing is now available to all black, Hispanic, and Native American residents.
At the federal level, the House of Representatives passed a wide-ranging coronavirus relief bill this month that would, in part, fund testing centers in minority communities. Continuing negotiations on the bill, however, make it unlikely that it will pass the Republican-controlled Senate in its current form. Democratic Rep. Bobby Rush of Illinois has introduced a separate bill that would fund testing sites, prioritizing those around coronavirus hot spots and in underserved communities.
"We don't know the numbers, we don't know the number of people who have not been diagnosed," says Rush, who represents a mostly black district in Chicago, recalling his early response to Chicago's outbreak. "We were operating blindly regarding the individual community response to COVID-19, and the white community was better informed."
The House Energy and Commerce committee also announced Tuesday it would hold a hearing on states' testing plans, including access to testing for minority communities.
But local communities might have trouble piecing together what testing access looks like. Local public health departments have dealt with years of underfunding, and the federal government isn't keeping track of and publishing its own list of testing sites. States may not have complete data either. Texas has its own state map, but some sites located by NPR were missing or out of date.
"For the most part across the U.S., it's really, really hard to rely on those government websites for the information," says Tarryn Marcus, who leads a volunteer effort called Get Tested COVID-19, which is attempting to compile a national database of testing locations. "There's a lot of inconsistency, a lot of outdated information stuff that was true maybe a month ago or a few weeks ago but it's no longer true."
Marcus' organization is attempting to fill in the gaps with their database, which was compiled over two months by more than 80 volunteers. Though it's still not complete, their data reinforce what NPR found in Texas cities. Marcus' team analyzed the sites they do have to look at where there were large numbers of people without a nearby testing site. Across the country, most of the areas with gaps, she says, were in blue collar communities with low income.
Cities in Texas vary in their approach
Not all cities in Texas have a disparity in testing site locations. In San Antonio, the state's second largest city, testing sites are equally distributed by race. Houston, the state's largest city, has more testing sites in minority neighborhoods than white neighborhoods. The city says it took into account risk factors for disease, as well as CDC testing data, to determine where to target its testing.
But in Dallas, recent research by the UT Health School of Public Health identified parts of South Dallas as vulnerable to COVID-19 hospitalization because of higher concentration of some chronic conditions like asthma, diabetes and obesity. These were the same areas predominantly minority neighborhoods that NPR's analysis show to lack testing sites. The state does not provide detailed data on the races of coronavirus patients, and Dallas County's is incomplete.
"If we're looking to protect our most vulnerable in the population, then we need to concentrate some testing resources in the areas where they're more likely to live," says Dr. Stephen Linder, one of the UT Health researchers.
Dr. Philip Huang, director of Dallas County Health and Human Services, said many of the testing sites in north Dallas are at private sector providers. That's where most of Dallas' hospitals are as well.
Huang said the county has tried to focus public sector testing efforts towards underserved communities as much as possible.
"We have been trying to definitely target those resources that we have control over into those areas," he said, including two federally-funded drive-thru sites, one in South Dallas and the other downtown. Combined, they can test 1,000 people a day. "A lot of the disparity ... is reflecting some of that private sector availability of tests in the northern part of Dallas compared to southern Dallas."
In an attempt to fill the gaps, in mid-May the city started sending health care workers to residents' homes if they don't have transportation to get to a testing site. That effort has averaged 20 tests per day, according to figures provided by the city. Other cities have set up temporary sites that are open for days at a time before moving on to the next location.
Even the public health systems, which exist to fill these gaps, present obstacles for someone trying to get a test. Parkland, the public hospital system in Dallas, does have clinics in South Dallas that can test, but you have to be a patient already or be seen through the ER. You can also be referred to Parkland through one of the area's federally qualified health centers, but those centers don't do testing themselves.
For cities that have testing disparities like these, the solution involves not just opening an equal number of testing sites in minority neighborhoods, but actually focusing on those that are most at risk, says Dr. William Owen, a medical school administrator whose work has focused on health care access for racial minorities.
In other words, Owen says, communities should make sure it's easy to get tested in places carrying the heaviest burden of the disease.
"That's where I'm going to plot my testing sites," he says. "Direct your resources specifically while they're limited which is what they are right now to where you think you'll get the most hits."
Other barriers to testing
Location, of course, isn't the only factor that determines whether at-risk people will get tested for the disease. Other barriers can keep someone from being tested, including whether a doctor needs to refer you to a testing center or whether you can just walk in; how much the tests cost if you're uninsured; and how much time you have to wait at a testing site. Cost could be an issue in a place like Texas, which has not expanded Medicaid and has the highest uninsured rate in the country. Lack of transportation and concerns about being able to work after testing positive can also keep people away from testing sites.
These challenges can be especially difficult for people of color to navigate: They're more likely to be uninsured and, in some places, more likely to work in essential services, making it difficult or impossible to spend hours traveling or waiting at a testing site.
"This disease has absolutely highlighted many disparities that we have in our country when it comes to public health," says Angela Clendenin, an instructional assistant professor of epidemiology at the Texas A&M School of Public Health. "And it boils down to access."
One way to deal with these challenges is to work with community leaders and groups that people are already familiar with to encourage them to get tested, says Owen, the medical school administrator. Leaning on faith-based leaders to stress the importance of testing, along with setting up makeshift testing sites at community centers like churches, could bring large-scale public health efforts to the doors of people who might otherwise be excluded.
A South Dallas church, for example, hosted a two-day mobile testing event last week, sponsored by the state and National Guard.
"How do you do voter registration? You do it at the local high school. You maybe have someone in front of the grocery store in the neighborhood. You have somebody at the church," Owen says. "If I were the mayor, I'd say, 'Great, let's have the arena. But by the way, we're going to have a small testing center at the big churches.'"
NPR gathered addresses of permanent testing sites from county, city and state websites, health care providers and news reports. NPR verified these sites by contacting health care providers and city officials by phone or email. City and county officials were offered the opportunity to review the findings and point to additional testing sites. Mobile and temporary testing sites are not included in this dataset. Sites that only perform antibody testing are not included.
NPR geocoded testing site locations on an online geocoding platform to determine what census tract they were within. A reporter verified each location with a geocoding "accuracy score" of below 0.9. For each city, the analysis included only census tracts within the city's official boundaries, which do not include suburbs. The Census Bureau provided median household income and demographic data, which were used along with data from the Social Vulnerability Index (SVI). The main demographic measure referenced in this story was the percent of the population who identify as 'white alone.' For income, percent white and SVI, NPR calculated the number of sites and distance from a site for tracts above and below the city's overall median for that measure. Medians referenced are medians of census tracts, not population medians, and may therefore differ slightly from population medians.
The dataset used in this analysis is available on Google Sheets.
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