Category: Corona Virus

Pooled Testing Could Expand Testing Capacity Across States

Potential change in testing capacity

Potential change in testing capacity

Potential change in testing capacity

Americans are waiting longer to get their coronavirus test results, with major labs reporting turnaround times as long as two weeks. Testing capacity has failed to keep pace with increased demand, but public health researchers think they have a way to quickly and sharply increase capacity in many states.

Instead of running a test for each person, laboratories could pool together tests from small groups of people and analyze them all at once. Because 98.9 percent of people now taking tests in New York State dont have coronavirus, most of those pooled tests would come back negative. For the ones that come back positive, tests could be rerun one at a time with unused portions of the original samples, achieving the same results using fewer resources.

This can work, and it does work, said Chris Bilder, a statistician at the University of Nebraska who has written extensively on pooled testing. It has been used in many different ways and, as long as disease prevalence is low, you will receive some good benefits.

Mr. Bilder and his colleagues estimate that three states Connecticut, Maine and Vermont could quadruple their testing capacity with pooling. A fourth, New York, could get nearly to that level, adding 294 percent capacity. An additional seven states, mostly in the Northeast but also Hawaii and Michigan, could more than triple their capacity.

Government statisticians came up with this idea in the 1940s, when they needed a more efficient way to screen World War II draftees for syphilis. It has suddenly become especially relevant.

In a 1943 paper titled The Detection of Defective Members of Large Populations, the economist Robert Dorfman wrote that it could yield significant savings in effort and expense when a complete elimination of defective units is required.

Until now, pooled testing was typically reserved for public health laboratories that needed a cheap way to screen thousands of samples for sexually transmitted diseases, tests that require expensive chemicals to run. In recent weeks the Food and Drug Administration has allowed a major medical laboratory to pool coronavirus tests. Overseas, the technique is more popular. Because labs usually collect more sample than they need, they have enough material to do a second analysis if necessary without requiring the person to come back in.

Were really working to increase pooling, Deborah Birx, the White House coronavirus response coordinator, told Fox News last week. She is one of several top health officials who are encouraging the approach. We know that can dramatically increase our throughput.

Quest Diagnostics has never pooled tests for any other diseases, but began doing so this month for coronavirus at its laboratories in Marlborough, Mass., and Chantilly, Va. The medical laboratory processes 130,000 tests each day, about one-sixth of all those taken in the United States. Its average wait times have risen from a few days in early June to a week by late July.

The lab now tests four results at once for specimens that come in from the Northeast, where coronavirus prevalence is low and where there is the greatest potential to increase capacity. If you put four specimens in one well, and they are all negative, youve just gotten four times the capacity, said James Davis, executive vice president at Quest Diagnostics.

Mr. Davis expects to free up more testing for harder-hit areas in the South and speed up the reporting of results in both regions.

Demand in the Southeast Florida, Georgia, South Carolina is very high and we cannot handle it locally, he said.

Poolings Benefit Depends on the States Positive Test Rate

Potential Increase

in Testing Capacity

States with low positive test rates have the ability to greatly expand their testing capacity. The increase is much smaller among states with higher test rates.

Poolings Benefit Depends on the States Positive Test Rate

Potential Increase

in Testing Capacity

States with low positive test rates have the ability to greatly expand their testing capacity. The increase is much smaller among states with higher test rates.

Potential Increase

in Testing Capacity

Poolings Benefit Depends on the States Positive Test Rate

States with low positive test rates have the ability to greatly expand their testing capacity. The increase is much smaller among states with higher test rates.

Quest has not explored pooling larger groups, which could create even larger capacity gains. Researchers worry that, as the size of a pool grows, the test may lose sensitivity and miss certain cases where patients have very low viral loads, typically very early or late in their infections. Researchers in Germany have pooled as many as 30 samples but note that borderline positive single samples might escape detection in large pools.

In the United States, the first approval for a pooled coronavirus test came in Nebraska. Researchers at the state public health lab were able to show the F.D.A. that it could run five tests at once without any diminution in accuracy. Nebraska used that pooled test for public health surveillance when cases were low there, but it had to switch back to individual testing when the virus became more widespread in groups it was testing, like meatpacking workers.

Dr. Steven Hinrichs, the chair of the department of pathology and microbiology at the University of Nebraska Medical Center, said his team started missing some weak positive results when it went higher than a five-test pool using a test developed by the Centers for Disease Control and Prevention. We didnt want to miss anybody, Dr. Hinrichs said. By setting it at five, we didnt miss anybody. His team is now investigating whether pooled versions of other testing protocols could get larger and stay accurate.

A quarter of Arizonas coronavirus tests have recently come back positive. It would get only about a 10 percent increase in capacity with pooling, probably not enough to justify setting up a new system. Vermont has the lowest coronavirus positivity rate in the nation, and could increase its testing capacity by 326 percent using pooling, according to Mr. Bilders estimates.

In practice, those gains could help speed up testing in other places: Around a third of coronavirus tests are currently performed by two national lab companies, which often ship samples around the country to speed up processing time.

Pooled testing may be particularly useful for testing groups at lower risk of disease. Employers, college campuses or professional sports teams eager to identify infected individuals before an outbreak starts could use pooled testing to screen large numbers of people regularly, without using up testing supplies needed for people with symptoms or known exposure to the virus. Colby College in Maine, for example, has announced plans to test students on campus twice a week this fall.

The University of Nebraska Medical Center is hoping to use pooled testing to screen patients seeking elective surgeries at the hospital. A health clinic in Germany has already used the technique to screen its workers.

In most situations where pooled testing has been used over the years in screening blood for rare diseases, or soldiers for sexually transmitted diseases the goal has been to lower costs. That may not happen with pooled coronavirus tests: Quest, at least, plans to charge insurance companies the same price for its new pooled test as it would if each test were run individually. But because of shortages of testing materials and machines, pooling could achieve a different kind of savings, by allowing more people to get results from the same amount of testing supplies.

Read the original here:

How to Test More People for Coronavirus Without Actually Needing More Tests - The New York Times

Mistakes were made: the area around Bergamo was not declared a no-go area; family doctors were left on their own; patients were brought into hospitals where doctors and nurses were infected; tests for the general population were unavailable for too long.

But Italy coped.

Northern Italians showed resilience; Central and Southern Italians stayed at home, even though the epidemic was less visible there. Here and there, young crowds gathered dangerously, with the cover of night life, beach life, politics, football, even an air show in Turin. But on the whole, Italy stuck to the rules.

From early March to early May, the country found itself with its back to the wall; and thats a position where we Italians give our best. We can be disciplined, but somehow we dont like to admit it, as if it might damage our reputation.

Of course some things didnt work. We were the first in Europe to shut down the schools, and well be the last to reopen them (on Sept. 14, hopefully). For millions of Italians with young children and small apartments, working from home turned out to be a nightmare. And political squabbles, after a lull, restarted. The political parties sniff an early election, and are jockeying for position.

This slows down all decisions. Despite endless consultations, Mr. Conte has not made up his mind about the European Stability Mechanism, whose funds are earmarked for health expenditure. And, more important, he hasnt decided how to allocate Italys share of the E.U. Recovery Fund. This has complicated negotiations at the recent European Council in Brussels, and has given suspicious northern countries led by the Netherlands an excuse to stall. But in the end, predictably, an agreement was found.

Last Tuesday, after 90 hours of negotiation led by the European Commission, the 27 leaders of the European Union agreed to look forward. The 2021-2027 budget will be 1.8 trillion euros: of these, 750 billion will go to the post-Covid recovery fund, called Next Generation E.U. (390 billion will be in aid, 360 billion in loans). Italy one of two countries in Europe hardest hit by the pandemic, alongside Spain will be the main beneficiary. Each Italian citizen, on average, will receive 500 euros; each German and each Dutchman will shell out 840 and 930 euros respectively.

Europe may be hyper-regulated; but in an emergency, rules and regulations help to keep the situation under control. Slowly and painfully, the European Union is getting out of it. Some countries suffered more than others; but none was refused help, nor did any refuse it. As of July 20, 135,000 deaths had been reported among the 445,000,00 people living in the Union. The day before, for the first time since February, Lombardy where I live, and where it all started for Italy registered no coronavirus deaths. We are still worried, but we can finally breathe.

Beppe Severgnini, an editorial writer and editor at Corriere della Sera, writes regularly about Italian and European politics, society and culture.

The Times is committed to publishing a diversity of letters to the editor. Wed like to hear what you think about this or any of our articles. Here are some tips. And heres our email: letters@nytimes.com.

Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram.

Originally posted here:

Slowly, Italy Is Waking From the Coronavirus Nightmare - The New York Times

KALAMAZOO, MI -- A forensic lab in Kalamazoo can produce 2,000 coronavirus antibody tests in four hours, but they are waiting for interest from the community to get rolling.

Meanwhile, Kalamazoo County health officials do not see the immediate value in widespread antibody testing.

Antibody testing can identify if a person was exposed to a virus like COVID-19, but it is not considered a diagnostic test. This is because antibody testing is not yet advanced enough to determine the length or strength of immunity granted from antibodies, Kalamazoo County epidemiologist Mary Franks said.

Related: Latest on coronavirus antibodies and immunity: What we know and what we dont at this point

For that reason, Franks said she sees antibody testing for individuals as something to do out of curiosity rather than making behavioral decisions in relation to immunity from the virus.

At the local public health department, it doesnt inform our practice, she said. That data wont help inform our practice and make for evidence based decisions, so I see it as having kind of a low utility.

Forensic Fluids lab director Bridget Lorenz Lemberg believes that widespread antibody testing will give a fuller picture of who has been exposed to the coronavirus.

Forensic Fluids, a drug testing facility in Kalamazoo, can use its equipment and expertise to identify two antibodies that indicate when someone would be contagious and if they could be immune to the virus.

The lab reached out to local hospitals and first responders for volunteers to be tested but did not find any participants in the Kalamazoo area, Lorenz Lemberg said.

The lab was able to test a fire department in the Lansing area. One paramedics test results in particular piqued their interest, Lorenz Lemberg said.

The departments sole paramedic has likely been transporting coronavirus patients since January, Lorenz Lemberg said. Although the paramedic never showed symptoms of the virus and never had a positive result from a nasal swab, his antibodies showed that he had been exposed.

If the demand for antibody testing increased, Lorenz Lemberg said the lab could add a second shift and double the number of tests they could do in a day. Forensic Fluids boasts a turnaround time of 24 hours, she said.

We can give the state capacity to test people, she said. At four to six thousand [tests], if we had more than one shift, we could make a dent in the population of Kalamazoo County.

Both Franks and Kalamazoo County Medical Director William Nettleton agree that antibody testing will be informative for future studies on a larger population scale. But, they stress antibody testing cannot replace the diagnostic testing that happens through a nasal swab.

Decisions about going back to work, for example, should not hinge on an antibody test, Nettleton said.

Western Michigan University Homer Stryker M.D. School of Medicine is developing antibody testing in collaboration with Kalamazoo-based company, IONTOX, according to a news release.

The medical schools associate dean for research, Greg Vanden Heuvel, said it appears around 5% of the population has been infected with the virus, including people who are asymptomatic, according to a WMed press release.

Researchers believe antibody testing could answer the question of whether there is a difference in the rate of transmission in a populous area like New York or Detroit and a more rural area like Southwest Michigan.

Theres a lot of talk about how different the response to being infected with the virus is, Vanden Heuvel said in a statement. Some people get really sick and wind up on a ventilator and other people never get sick at all. The question remains, how many people have been infected with this virus? That is up in the air.

The medical school worked with Bronson Methodist Hospital to obtain serum from patients who had been hospitalized with COVID-19. That serum was used to develop the antibody test.

As of Monday, July 27, Bronson Methodist Hospital was currently treating nine COVID-19 patients. In total, the downtown hospital reports 139 recovered patients.

The hospital currently has capacity to run several hundred tests per day, Bronson Healthcare communication specialist Carolyn Wyllie said. However, the demand has been much lower at an average of 20 tests per day being ordered.

From May to July, approximately 800 antibody test were administered at Bronson Methodist Hospital. Bronsons new downtown laboratory will perform antibody testing as well, according to a press release.

The state data hub has also started recording both diagnostic and serology test results. Serology tests include antibody tests and enzyme tests.

As of Sunday, July 26, Michigan recorded only 10.92% of the 1,901,252 tests recorded were serology tests.

More on MLive:

Masks can be powerful tool in keeping coronavirus low in Kalamazoo County, medical director says

Whitmer, Fauci among Michigans most-trusted sources on coronavirus, survey shows

Why youre seeing different numbers for Michigans daily coronavirus cases, and other tips for mining data

Original post:

Coronavirus antibody testing expands in Kalamazoo but health officials say it has low utility' - mlive.com

Maryland Gov. Larry Hogan arrives for a coronavirus briefing in front of the Maryland State House on April 17. Hogan's book Still Standing is out Tuesday. Chip Somodevilla/Getty Images hide caption

Maryland Gov. Larry Hogan arrives for a coronavirus briefing in front of the Maryland State House on April 17. Hogan's book Still Standing is out Tuesday.

Larry Hogan defeated non-Hodgkin's lymphoma five years ago, a fight that he says has colored many of his decisions as the Republican governor of Maryland, from criticizing President Trump to navigating the coronavirus pandemic.

"It changed me as a person and the way I look at life and what's important. And maybe that's one of the reasons I'm not afraid to stand up and say what I think," Hogan told NPR's All Things Considered. "Cancer is pretty scary. Nothing else really is going to scare me away from anything."

Maryland is currently experiencing an uptick in COVID-19 cases and has seen more than 83,000 cases and 3,300 deaths since the beginning of the pandemic, according to the state's database. And cases are increasing. On Saturday, the state had 1,288 new cases, the largest single-day increase since May 19, according to The Baltimore Sun.

"I do have a lot of empathy for people going through those kinds of things," Hogan said, adding that while his experience governing during the pandemic has differed greatly from his personal experience fighting cancer, there are parallels between the two. "It perhaps made me more intensely focused on trying to protect the health of everybody. It probably didn't just impact my decisions on the coronavirus, but probably everything I do as a governor."

Hogan recently had his five-year checkup and he remains cancer-free. "When the pandemic's over, I can go back and hug some people," he said.

But he still has to deal with a climbing health crisis in his state. Despite the increase in cases, Hogan said Tuesday that he will not change the state's reopening plan now, but added that he would consider doing so in the future if rates of deaths, new infections and hospitalizations continue to rise, The Washington Post reported.

"But as soon as we start to see numbers that don't look good, it's going to cause us to take whatever actions that are necessary," he said on C-SPAN on Tuesday. "My goal is to try to keep the economy safely open, because the economic crisis is nearly as bad as or just as bad as the health crisis."

Hogan dives into the pandemic, his cancer diagnosis, the protests for racial justice that flooded his state following the death of Freddie Gray in police custody and working in politics in 2020 in his book Still Standing: Surviving Cancer, Riots, a Global Pandemic, and the Toxic Politics that Divide America out Tuesday.

Gemma Watters and Tinbete Ermyas edited and produced the audio version of this story.

Originally posted here:

Larry Hogan On The Parallels Of Fighting Cancer And Maryland's Coronavirus Outbreak - NPR

The Newport Beach Fire Department is feeling the effect of the coronavirus among its own ranks.

Ten firefighters and 11 lifeguards had tested positive for the virus, Fire Chief Jeff Boyles confirmed Friday.

Boyles said the virus apparently broke through to his crews through community spread and not while directly treating coronavirus patients. He said all fire stations and trucks remain staffed, and cleaning protocols have been tweaked. Newport Beach Fire is not sending crews to out-of-county wildland fires.

We have been very vigilant when we go on calls with what we know to be sick people, but people have lives outside of work, Boyles told the City Council at its last meeting on July 14.

An additional 30 firefighters and 21 lifeguards have quarantined at some point in July, Boyles said Friday. Going into this weekend, 11 lifeguards four positive and seven in quarantine were off duty. Four firefighters all recovering after testing positive, none left in quarantine were away from work.

Fortunately, not all of them were off at the same time so we were able to maintain our staffing levels in the fire stations, lifeguard towers and junior lifeguard program, Boyles said. It was a balancing act for a small window of time in order to accomplish that.

Overall, Orange County reported more than 33,900 coronavirus cases and 560 related deaths as of Saturday, with 685 COVID-19 patients in county hospitals.

Coronavirus among the countys lifeguard ranks was a key part of Newports decision to make the unprecedented decision to close beaches on the Fourth of July, historically the summer peak for visitors. Leading up to the holiday, two lifeguards had tested positive and more than 20 were being quarantined.

Fire and lifeguard officials said they had enough staff for the big weekend, but a cautious City Council voted for the hard closure to keep the remaining guards from having to do more with less.

Boyles said the U.S. Centers for Disease Control and Prevention and county health officials say first responders can work until they are symptomatic if they have been exposed, but Newport has been aggressive with its contact tracing and quarantining.

The majority of those who tested positive were already identified as exposed and were in quarantine when their test results came back positive, Boyles said. That tells us that we theoretically prevented them from working and causing an even greater outbreak.

The infected individuals come from a corps of about 120 firefighters, 50 lifeguard reservists, 55 junior guards and 95 in lifeguard operations.

Read more from the original source:

Coronavirus cases seep into the ranks of Newport Beach first responders - Los Angeles Times

The pandemic alone is a call to our elected officials for the type of leadership and vision we expect at a moment of crisis, says the report, which grew out of interviews conducted by Leonard Steinhorn, a professor of communication at American University, and Mark Sobol, an author and expert on organizational development and executive leadership. But we are also facing another reckoning, one over our nations original sin and the racial inequities that have beset our country since its founding.

The study ticks through familiar themes when it comes to assessing the sorry state of Congress: the lack of any real across-the-aisle relationships, a schedule that limits opportunities for interaction, too much power concentrated in leadership, constant fund-raising demands, discouragement of bipartisanship, the negative influence of round-the-clock media, the fact that the most important election for lawmakers is often their primary, and the shutting out of minority-party voices.

It also warns that the shifts toward a more virtual Congress as a result of the pandemic, such as a new system of proxy voting in the House that allows lawmakers to cast their votes without traveling to Washington, could exacerbate the existing problems. If the idea of a remote Congress takes hold, the report suggests, it would be a serious setback to efforts to enhance bipartisan interaction.

Because of the pandemic, Congress was forced to conduct much of its business virtually, and we certainly understand why, the report said. But as much as that may have been a necessity, it should not be interpreted as a virtue.

The document says Congress needs more and not less in-person interaction among members of Congress. They need to learn more about each others districts, hold civil conversations aimed at finding common ground, build relationships of trust that can lead understanding and solutions.

In a week when Representative Alexandria Ocasio-Cortez, Democrat of New York, was verbally assaulted without provocation by Representative Ted Yoho, Republican of Florida, and fellow Republicans ganged up on Representative Liz Cheney, Republican of Wyoming, in a hostile confrontation, the call for civility rang especially true.

More:

Congress Was Already Broken. The Coronavirus Could Make It Worse. - The New York Times

People walk the boardwalk in early July in Wildwood, N.J., after some coronavirus restrictions were lifted. There's concern that case counts could push back up in Mid-Atlantic and Northeastern states. Mark Makela/Getty Images hide caption

People walk the boardwalk in early July in Wildwood, N.J., after some coronavirus restrictions were lifted. There's concern that case counts could push back up in Mid-Atlantic and Northeastern states.

For weeks the U.S. coronavirus pandemic has largely been driven by spiraling outbreaks in the South and West. But some forecasters say Mid-Atlantic and Northeast states could soon be in deep trouble again, too.

The warning comes from researchers at the PolicyLab at Children's Hospital of Philadelphia, which has built a model to provide four-week forecasts for every U.S. county. NPR spoke to David Rubin, PolicyLab's director, an epidemiologist and professor at the University of Pennsylvania. Here are five takeaways:

The virus is marching up the East Coast

Rubin says in recent weeks there's been a noticeable trend of rising cases moving northward from Florida "up travel corridors like I-95."

"We have watched this epidemic marching right up the East Coast," Rubin says. "It's not just Florida. It's not just South Carolina. It's not just North Carolina. But the beach areas of Virginia and Rehoboth Beach in Delaware."

Over the last two weeks, he notes, "the highest infection rate of case growths we've seen in a major city in this country have been in Baltimore."

And, he adds, "we are now seeing a clear resurgence in the Philadelphia area and [surrounding] counties. We're starting to see upticks in the shore regions of New Jersey. And we're actually seeing some elevated [transmission rates] every week in the New York City boroughs."

New England is also at risk: "[Transmission rates in] New Haven [in Connecticut] are clearly increasing. The state of Rhode Island broadly has increasing transmission. And in the Boston area, we're seeing the same patterns we saw a couple of weeks ago in Philadelphia. We even now have an outbreak on Cape Cod. And we're seeing [more of the virus] in New Hampshire."

The Eastern Seaboard isn't Rubin's only concern. He's "extremely worried" about a number of Northern and Midwestern cities such as Indianapolis, Detroit and Milwaukee that "no one is talking about now but [for which] our models very clearly are detecting elevated risk for the next few weeks, not just in the cities but in their suburban counties."

The current low case numbers are obscuring the looming problem

Rubin says in many instances, these incipient outbreaks haven't attracted much attention yet because while the rate of growth in cases is rising, the number of daily new cases is still relatively low especially compared with the current outbreaks in the South as well as to some of the outbreaks in these same Mid-Atlantic and especially Northern states in the spring.

"When your case counts have been degraded for a while, a doubling [of the numbers] doesn't look as impressive," Rubin says. "But those doublings are there."

"What worries me most about areas like New York and Philadelphia and Boston," he adds, "is they're at much higher levels of population density. Even though it may have taken three or four weeks for some of these other areas down South to see exponential growth, our models don't know exactly how well an area like the Bronx or Queens is going to be able to contain transmission if it becomes widespread there."

The South appears to have reseeded the virus in the North

The prospect of a blowup in New York seems all the more poignant given how devastating the spring outbreak was there and how successfully the subsequent shelter-in-place strategy proved in bringing the caseload down.

"I give all the credit to the leaders throughout the Northeast region who really handled this crisis the way it needed to be handled," Rubin says. Not only did they institute strict social distancing, he notes, they kept it in place long enough to bring daily new infections to manageable levels and eased up on social distancing slowly.

"I saw areas in the Northeast wait an extra week or two to great frustration of residents because they weren't satisfied they had degraded their counts enough," Rubin says. "So it was reopening later but also [doing so] more cautiously and slowly that helped these areas."

Unfortunately, he says, much of the South followed the opposite pattern. He says that these areas failed to keep social distancing in place long enough, and then "they pushed very quickly through the gates and they ignored clear warning signs. As their resurgence was really starting to grow, they continued to go through the reopening plans."

This absence of a unified national approach is what is now threatening the Mid-Atlantic and Northeast. "This virus doesn't know state lines," Rubin says. "People are traveling that's what we do as Americans. We travel. We go on family vacations. And I've privately heard officials [in Northern counties] express some level of resignation that, 'We could even go back into sheltering in place. But if families are traveling outside the area and coming back, as soon as we lift those restrictions, the transmission will return.' "

Summer travel is making things worse

The surge of cases in the South has also coincided with the summer travel season. At first the impact of this was most noticeable in Southern localities, Rubin says.

"What you saw was major traffic going to some of these vacation destinations like Galveston, Texas. And you could very clearly see within a couple of weeks, the conferred risk not just to Galveston but back up to Houston as people came and went between these major metro areas to their vacation destinations."

Then, "in the Carolinas, you saw similar things," Rubin says. "When you look at Hilton Head and Myrtle Beach, they really took off in a similar fashion." (Rubin adds that the sheer number of meat and poultry processing plants in the Carolinas also played a role in fueling local outbreaks.)

In recent weeks the trend "has just continued to evolve to Virginia Beach, the eastern and western shores of Maryland, the entire Lake Michigan coastline." Many of those vacation destinations are starting to have some of the highest rates of transmission nationwide, Rubin says. "So very clearly travel is playing a significant role here. People have been penned up in their houses for a long time and are blowing off steam and getting out there."

Interestingly, efforts by Northern vacationers to avoid destinations in the South have only created new problems. "People made logical decisions to try to seek areas where they thought there was less transmission," Rubin says. "We saw the greatest amount of traffic on the July Fourth weekend in New Jersey shore locations as I think people looked at the South and said, 'We're going to go North.' " But Rubin says, "This is now conferring new risks to regions that weren't as impacted before."

Rubin says he's seen it firsthand. "I spent a lot of time in upstate New York, and the campsites throughout the Adirondack region are packed right now because there's nothing to do in the cities. So there's a lot of spreading out going on this summer, and that is just increasing the amount of mixing that people are doing."

It's even creating a noticeable spike in infections in certain rural areas that lie between major population centers and vacation spots. Normally such rural areas are more insulated. But "people are traveling through, and when they go to the convenience store or the gas station, that's where these infections are occurring," Rubin says. "And so we're seeing even rural areas really blow up." These include ones, he adds, "without the health care resources that are necessary to respond to this challenge."

It's not too late

As grim as all this sounds, there is still hope.

For one thing, it's worth keeping in mind that the forecast from Rubin's team is one of many models. According to Nicholas Reich, a biostatistician at the University of Massachusetts Amherst who has created a system to compare many of the most prominent forecasts, there's fairly broad agreement among those that forecast the county level that coronavirus infections will increase in Virginia Beach, Baltimore, Detroit, Milwaukee and Indianapolis. But for some other areas such as Philadelphia, Rehoboth Beach in Delaware and New York City, Rubin's model is noticeably more pessimistic.

Even if Rubin's predictions are correct, he notes that the Mid-Atlantic and Northern counties that are at risk have an advantage: Because their case numbers are low, if they act now they can bend the curve of infections before large numbers of people contract the virus.

"That's why we do these forecasts," he says. "We're making assumptions [about what could happen two to three weeks in advance] so that people could hopefully calibrate their routines."

A return to a full shelter-in-place strategy is not necessary, but people will need to ramp back up their social distancing and step up mask wearing ideally as part of a nationwide strategy to get case numbers under control across the country by Labor Day.

"We need to be a little bit more proactive in terms of our response and talk about a sacrifice right now," Rubin says, "for the good of having those school reopenings and getting us back to work in the fall so that we don't squander all that we have achieved."

Originally posted here:

Coronavirus Hot Spots: Could The Mid-Atlantic And Northeast See A COVID-19 Rebound? - NPR

Editors note:This is a live account of COVID-19 updates from Saturday, July 25 as the day unfolded. It is no longer being updated. Clickhereto see all the most recent news about the pandemic, andclick hereto find additional resources.

The coronavirus pandemic continues to cripple Americans whose families have experienced layoffs in the past several months, and a new poll shows nearly half of those families believe those jobs are lost forever. But negotiations over a new COVID-19 rescue bill were still in flux Friday after the White House floated cutting an unemployment benefits boost to as little as $100.

In King County, the top health official warned residents Friday that the current seven-day average of new coronavirus cases has reached the highest its been since the beginning of April, and urged community members to start making long-term fundamental changes.

Throughout Saturday, on this page, well be posting updates on the pandemic and its effects on the Seattle area, the Pacific Northwest and the world. Updates from Friday can be foundhere, and all our coronavirus coverage can be foundhere.

After facing intense scrutiny for planning to air a baseless conspiracy theory that infectious-disease expert Anthony Fauci helped to create the coronavirus, conservative TV broadcaster Sinclair Broadcast Group announced Saturday that it will delay the segment to edit the context of the claims.

Sinclair, which has 191 stations across the country, received backlash this week after America This Week host Eric Bolling interviewed Judy Mikovits, a former medical researcher featured in the debunked Plandemic conspiracy online film.

In the Sinclair interview, Mikovits claimed that Fauci manufactured the coronavirus and shipped it to Wuhan, China, where the outbreak originated. A chyron during the segment reads, DID DR. FAUCI CREATE COVID-19?

Mikovits and her lawyer Larry Klayman dropped other unfounded allegations during the show, including President Donald Trump soft-pedaling relations with China because he has evidence of the countrys involvement with the inception of the virus.

The show was released online earlier this week before it was to be aired on local news channels. The segment was first reported by Media Matters, a left-leaning media watchdog. As of Saturday afternoon, the show was pulled from Sinclair websites.

Read the full story here.

The Washington Post

If your town is partly closed or youre wary of travel during the COVID-19 pandemic, it might feel as if your phones map app is just sitting there gathering digital dust. But even if youre not tappingApples MapsorGoogle Mapsto explore an exotic vacation spot or to belt out turn-by-turn directions on a long road trip this summer, your interactive travel aid can be useful. Here are a few things you can do.

Find whats open or closed

Major U.S. cities have been in varying stages of closure for months, and it may be hard to remember which businesses are open. While a local governments website should have general guidelines posted, both the iOS Maps app from Apple and Google Maps (forAndroidandiOS) have been updating their map labels and listings pages for specific businesses to note adjusted hours, any curbside pickup service and temporary closures.

But what if you find outdated details? In Apples Maps app, tap the name of the business on the map and, when its information page opens, scroll down and tap Report an Issue; you canreport other cartographic issues by tapping the encircled i in the top-right corner of the map itself. In Google Maps, select a business and scroll down on its information page to the Suggest an edit option.

Find restaurants

Many dining establishments have struggled during the pandemic, as some have stayed open with reduced service while others have been forced to close. Apples Maps app often notes temporary or permanent closures and operating hours on its Yelp-assisted restaurant listings pages. As part of itsCOVID-19 updates, Google now adds a line on a restaurants info page that lists the status of dine-in, takeout and delivery service.

Like Google Maps, Apples Maps includes the restaurants phone number and website for details straight from the source. Use this contact information to confirm current delivery and takeout services along with any outdoor-dining options.

Find a COVID-19 testing site

State and local health departments manage testing, but if you have coronavirussymptomsor your medical provider advises you toget tested, find a facility. Apple and Google now include the locations of COVID-19 testing sites in their maps apps using data gleaned from government agencies, public-health departments and health care institutions.

Read the full story here.

The New York Times

After a Mexican orchard worker died earlier this month from COVID 19 complications, the state Department of Labor & Industries is demanding changes in the farm labor camps of a major eastern Washington fruit grower that employed the man in Okanogan County.

The order and notice of restraint results from several site visits in an investigation of a Gebbers Farms labor camp where the worker, who died July 8, was lodged. The notice requires Gebbers to either remove bunk beds in this and other company labor camps, or comply with a state rule that requires camp workers to be in groups that live, travel and labor together.

We take this very seriously. The choice is pretty simple. Stop using bunk beds or follow all the requirements, said Tim Church, a Labor & Industries spokesman who added that the unusual action reflects the risks of the disease spreading to other workers.

Failure to comply with the order carries the risk of criminal penalties.

In a statement, the family-own companys chief executive officer, Cass Gebbers, disputed the Labor departments description of their COVID-19 protocols, which he said were reviewed by a consultant who also serves as a program officer of the Bill & Melinda Gates Foundation.

The accusations are simply false, Gebbers said in the statement that declared workers already are properly separated into distinct groups that live and work together, although the company cannot dictate what happens during off-duty hours.

Read the full story here.

Hal Bernton

A Puyallup skilled nursing and rehabilitation center has confirmed 61 cases of COVID-19, and one death.

The outbreak occurred at the Life Care Center of South Hill as of July 21, company spokesperson Timothy Killian told the Tacoma News Tribune. The death occurred three weeks ago.

Twenty-eight patients and 33 staff members have tested positive at the center as of July 24.

The test results were received in the past week.

Of 31 patients, only three have not been infected with the coronavirus.

Killian said Life Care staff at the South Hill facility have worked at only the one building since early March.

Read the full story here.

Tacoma News Tribune

State health officials reported 1,025 new COVID-19 cases in Washington as of Friday night, but the number of deaths dropped by one, from 1,495 to 1,494, when the state removed one death from its official tally.

State Department of Health spokesman Frank Ameduri was checking with state epidemiologists about the reason for the lower number, but said that over time, some causes of death are found to be unrelated to COVID-19.

The update brings the states totals to 51,849 cases and 1,494 deaths, meaning that 2.9% of people diagnosed in Washington have died, according to the state Department of Health (DOH). The data is as of 11:59 p.m. Friday.

So far, 903.674 tests for the novel coronavirus have been conducted in the state, per DOH. Of those, 5.7% have come back positive.

In King County, the state most populous, state health officials have confirmed 14,249 diagnoses and 644 deaths in King County, accounting for a little less than half of the states COVID-19 death toll.

Nicole Brodeur

Washington'sstatewide face covering order expands Saturday to require face coverings in any indoor setting outside of people's residence and not just in public buildings.

The order expands the outdoor requirement to nonpublic settings when people can't maintain at least 6 feet of distance from nonhousehold members, including common areas in apartment buildings, condos, Greek houses and assisted living facilities.

"The current orders about face coverings are intended to increase the use of face coverings and emphasize their critical importance to our overall strategy to slow the spread of COVID-19," the state Department of Health (DOH) said in a statement released Saturday.

As many as 30 to 50% of infections occur before people have symptoms, according to DOH.

"You could be infected and not know it, but a cloth face covering greatly reduces the distance respiratory droplets travel, and that protects everyone."

The department asked people to keep staying home even if it's hard and said hanging out and socializing in close proximity to others "is one of the worst things we can do right now."

Christine Clarridge

The tallies for people hospitalized in New York with the coronavirus are continuing to drop to the lowest levels since the pandemic began, Gov. Andrew Cuomo said Saturday.

There were at least 646 people hospitalized in the state on Friday, a new low since March 18 and down slightly from the previous day, the Democratic governor said in a statement. The number of reported deaths in the state rose by one, to 10.

Daily statewide statistics show New York with more than 750 newly confirmed cases, representing only about 1% of all tests performed. The true number of cases is likely higher because many people have not been tested, and studies suggest people can be infected and not feel sick.

New York, once a pandemic hot spot, has so far avoided a surge in new cases like those plaguing other states in the South and West. But Cuomo has repeatedly warned New Yorkers could be at risk if they abandon social distancing, face coverings and other practices adopted to stop the spread of the virus.

The Associated Press

The governor of Lombardy, Italys hardest-hit region in the pandemic, acknowledged Saturday that he is being investigated by Milan prosecutors over a lucrative contract to obtain protective medical gowns from his brother-in-laws company.

The contract for 75,000 gowns reportedly was awarded without public bidding in April, when the coronavirus outbreak was devastating Italy, Italian news reports said.

Gov. Attilio Fontana said in a Facebook post about the probe that he represents the region responsibly and was confident about the correctness of Lombardys actions.

The governor insisted that the region never paid for the gowns, which were reportedly eventually donated to Lombardy.

Fontanas wife has a minor stake in the company, according to Italian media.

Read the story here.

The Associated Press

Frances coronavirus infection rate crept higher Saturday and Spain cracked down on nightlife but German authorities were confident enough to send a cruise ship out to sea with 1,200 passengers for a weekend test of how the cruise industry can begin to resume.

French health authorities said the closely watched R gauge is now up to 1.3, suggesting that infected people are contaminating 1.3 other people on average. That means the virus still has enough victims to keep on going instead of petering out.

Frances daily new infections are also rising up to 1,130 on Friday.

We have thus erased much of the progress that wed achieved in the first weeks of lockdown-easing, health authorities said, adding that the French appear to be letting down their guard during their summer vacations and those testing positive are making less of an effort to self-isolate.

In Spain, Catalonia became the latest region to crack down on nightlife, trying to tamp down on new infection clusters.

India, which has the worlds third-highest infections behind the United States and Brazil, reported its death toll rose by 740 to 30,601. It saw a surge of more than 49,000 new cases, raising its total to over 1.2 million.

South Africa, Africas hardest-hit country, reported more than 13,000 new cases, raising its total to over 408,000.

Read the story here.

The Associated Press

What if these are the good old days?

Depressing as that might seem after the coronavirus pandemic has claimed well over 630,000 lives worldwide, cost tens of millions their jobs and inflicted untold misery across the planet, its entirely possible increasingly likely, some say that things will get worse before they get better.

Americans in particular have been optimists by nature for the better part of four centuries. But even here, a bleak dystopian vision is emerging in some corners. Its not pretty.

It imagines a not-too-distant future where well all look back with nostalgia at 2020 as a time when most of us had plenty of food and wine, could get many of the goods and services we needed, and could work from home at jobs that still paid us.

This could be as good as it gets, so lets take pleasure in what we have now, Katherine Tallman, the CEO of the Coolidge Corner Theatre, an indie cinema in Brookline, Massachusetts, told a recent Zoom roundtable.

The pandemic continues to buffet the planet economically, dashing hopes that the worst of the joblessness might be behind us.

For 18 consecutive weeks now, more than a million Americans have sought unemployment benefits. New infections have been surging in states like Florida and California that power the economy, threatening peoples health and livelihoods for the foreseeable future.

Thats bad. But in online forums and on social media, futurists see the potential for worse. Much worse. Their musings arent for the faint of heart.

Read the story here.

William J. Kole, The Associated Press

A skilled nursing and rehabilitation center in Puyallup is in the middle of a COVID-19 outbreak,with 61 confirmed cases. All 61 cases are still positive, company spokesperson Timothy Killian said.

Life Care Center of South Hill has reported the death of at least one client from COVID-19 as of July 21, The News Tribune of Tacoma reported.The death occurred three weeks ago.

Killian said 28 patients and 33 staff members have tested positive as of Friday at the center on 7th Street Southeast. The test results were received in the past week.

Of 31 patients, only three have not been infected with the coronavirus.

Killian said Life Care staff at the South Hill facility have worked at only the one building since early March.

Josephine Peterson, The News Tribune

By his estimation, Stephen Santa took Pennsylvanias coronavirus lockdown seriously: He pretty much went only to grocery stores and picked up takeout once a week to help Pittsburghs restaurants.

Whatever Santa and everyone else in Pittsburgh did, it seemed to work: The city racked up a fraction of the coronavirus cases during the spring shutdown, while the other side of Pennsylvania flared up into a hot spot.

With a state-mandated masking order in place, Pittsburghs gyms, salons, bars and restaurants got permission to reopen in early June, ahead of many parts of Pennsylvania, as part of the so-called green phase in Gov. Tom Wolfs three-step stoplight-colored reopening plan.

Santa promptly went to a nearby Italian restaurant for a meal in its outdoor courtyard with a couple relatives.

When they got there, around 5 p.m. on a Tuesday, it was practically empty. When they left, it was packed inside: every table full, no masks and nobody keeping 3 feet (1 meter) apart, never mind 6 feet (2 meters) apart.

I think partly a lot of people saw the word green and it meant go and were going back how things were,' Santa said.

Barely three weeks later, officials in Allegheny County home to Pittsburgh and 1.2 million residents raised the alarm over a spike in COVID-19 cases.

The culprit? Primarily, people in their 20s, 30s and 40s who told contact tracers that they had been visiting bars and restaurants or working in them, county officials said.

Read the story here.

The Associated Press

If Black, Hispanic and Native Americans are hospitalized and killed by the coronavirus at far higher rates than others, shouldnt the government count them as high risk for serious illness?

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Coronavirus daily news updates, July 25: What to know today about COVID-19 in the Seattle area, Washington state and the world - Seattle Times

The two students tested positive for the virus Sunday, just one day after taking the ACT at Edmond North High School on July 18, according to an ACT spokesperson.

"Upon learning of these positive tests, the school immediately contacted local public health officials, notified ACT, and we have informed all students and test monitors in attendance that day," Tarah DeSousa, the spokesperson, told CNN.

"As part of ACT's test center social distancing guidelines, students and monitors were asked to complete a series of COVID-19 symptom and travel screening questions, instructed to practice social distancing guidelines while on campus, and it was recommended that masks be worn by all."

Students, parents, and test administrators who were in the same testing center as the two students received emails from ACT officials alerting them that they were likely "within the area of one or both of these students for up to 15 minutes."

However, those who took the exam in the same room as the students received a different email warning them that they were probably around the students for hours.

"According to seat assignments, it's likely that you or your child were on the same floor or room as one or both of these students for up to four hours," said an ACT email obtained by CNN.

Fears over testing practices

But for one parent, a cancellation would have been a blessing in disguise.

Greta Rasmussen DeCoster's son, high-schooler Frederick DeCoster, was one of many students taking the ACT on Saturday in Wood County, Wisconsin.

While no coronavirus cases have been reported from his testing center, Frederick DeCoster is now one week into a 14-day quarantine after fearing he may have been exposed to the virus by a student who he said appeared ill. He is worried that if he was exposed, he could pass it on to family members who may be more at risk.

The 18-year-old senior was placed in a room with about 16 other students, only one who was wearing a mask, with a desk in between each of them, he said.

"The proctor waited to ask us if anyone tested positive for Covid or came in contact with someone who tested positive after we were already sitting grouped together," Frederick DeCoster told CNN.

"Almost no one was wearing a mask, even the proctor was constantly taking it off. I didn't feel safe. Then there was a kid sitting behind me sneezing, coughing hard, breathing really heavily. If you were to describe someone with coronavirus showing all the symptoms, it would be this guy. I was really worried."

Although ACT guidelines require test centers to position desks six feet apart, only test center staff are required to wear masks. Students are recommended to wear masks during testing, but not required unless there is a local mask mandate.

The DeCosters said they filed a complaint with ACT officials to bring awareness to what goes on inside testing centers, but were told the investigation would likely take five weeks -- which Greta Rasmussen DeCoster said is more than enough time "for many other students to get the virus from an ACT testing center."

"He was already angry when they started the test, but as soon as it started he realized the boy seated directly behind him was wheezing, breathing extremely loud and fast, sniffling, and repeatedly clearing his throat," she told CNN.

"As a mother I immediately thought of all the other families who attended that test center and hundreds of others around the country that day, who may not be aware that CDC guidelines were not followed at every test center, and who may be at risk or have someone in their family at risk if their child was exposed."

With states across the country bringing children back to school, Greta Rasmussen DeCoster hopes education officials learn from the ACT's issues and incorporate them in their models for how schools and universities can reopen successfully and safely,

A plea to cancel the ACT/SAT requirement

Before the coronavirus pandemic, students spent years stressing about scoring high enough on their standardized tests to get into their dream schools. Now they're still stressing, not just over scores, but also about possibly contracting a dangerous virus.

For Frederick DeCoster, who said he "blew the exam" because he could not concentrate on anything but his fear of contracting Covid and exposing his immunocompromised mother to the virus, the issue is about more than just the ACT.

"Many students don't have the chance to take off work or travel to take the ACT," he said. "I'm lucky to be able to study and then travel to retake the test, but in doing so, me and my family's health has been put at risk because they ignored all screening and mask guidelines."

Many other parents and students worry that standardized tests, including the ACT and SAT, are giving privileged students an undue advantage, especially amid the pandemic. Not everyone can afford paying for exam tutoring, taking off work to travel hours back and forth or renting a hotel for the night.

While some US colleges and universities have already suspended ACT and SAT tests as an admission requirement until 2024, many parents and students fear that not taking the test -- even if it isn't a requirement -- could hurt their chances of getting accepted into a good school.

"This has nothing to do with academics anymore," Greta Rasmussen DeCoster said. "This is a life or death situation and that's why I'm mad. They put my child's life at risk and there's really no other way to put it."

See more here:

Two students tested positive for coronavirus after taking the ACT at an Oklahoma high school - CNN

Because of that, we spent time this spring -- toward the start of the crisis in the US -- speaking to mayors about the vast challenges at the local level they were navigating. Their medical workers didn't have personal protective equipment, they didn't have tests and they were worried about hospital capacity.

These local leaders were also concerned about the physical, mental and economic health of the constituents who are also their friends and neighbors.

Now, almost five months in, we checked back with several of those mayors to see how the pandemic fight is going now. From the South, to the Midwest to the Northeast, there are still deep and common concerns. PPE is available but testing is still inadequate. Schools they never imagined would not resume in the fall are all struggling with how to do so safely in communities where case numbers are still high.

And, for some their biggest fear came true: Reopening parts of their cities too soon proved to be a mistake.

Tampa, Florida: 'Opening of the bars, that was a mistake'

Now she says a flaw in the statewide reopening plan fueled a resurgence in Covid-19 cases: opening Florida's bars.

"No one followed the rules from go," she said, noting people crowded bars, which she called "the veritable Petri dish for Covid-19."

Castor says they are scrambling to correct what she calls a "huge mistake" by sending law enforcement to crack down on "bad actors."

"We sent out a letter from our city attorney to over 100 bars and restaurants just reminding them of what the orders are now in the state of Florida and then any violations could result in a loss of a liquor license. So, that usually gets the bars' attention," Castor said.

Castor said she does not generally think the state, or her city, reopened too soon, despite the city enduring about 400 new coronavirus cases a day.

"We took the steps I think that we were thoughtful, and we were slow and deliberate," she said.

Still, things were so bad earlier this month, she put a mask mandate in place, which she said is starting to show positive results.

Last week the new case numbers had spiked to 900 a day in Tampa, which has a population of nearly 393,000 people. She says her mask ordinance combined with a "continued drumbeat" for people to socially distance, helped cut that number more than in half this week.

"I'm not making any excuses or trying to tie a bow around any of that. We're still in a very precarious spot. But one of the things proportionally that the number of deaths that we have is very, very low for the number of cases," Castor says.

But testing remains a problem in Tampa just as it does around the country. It is more available than before but results often take up to 10 days to process.

When we spoke in early April, Castor, who was Tampa's police chief for three decades, told us that in all of her years of law enforcement and emergency management, she had never seen this kind of unpreparedness from the federal government.

"That statement still holds true," Castor told us this week. "There's just a complete lack of leadership or direction on the federal level in this particular incident."

One of the big ripple effects on Tampa, as it is nationwide, is uncertainty about reopening schools. DeSantis wants them to open, but she says Tampa's superintendent is giving parents a choice.

"Kids can stay home and go through the e-learning that they've been using all summer. They can respond to the classroom. My instinct tells me that the schools aren't going to open on time, that there'd be an actual delay," she said.

Waterloo, Iowa: 'We're not out of the woods yet'

Tysons had indefinitely suspended production at the plant where more than 1,000 workers became infected. Now, the plant is open with increased safety measures including on-site testing and social distancing.

Hart, a Democrat, said it's "doing pretty well."

"We're happy and we're pleased about that. And that's also reflected in our numbers too. ... We were seeing hundreds of people per day, well into 50, 60 people per day. Now it may be seven, it may be six, it may be less," he said.

But Hart is not convinced his city is out of the woods yet, as state and county numbers continue to rise.

"We are very cautious because we don't want to move too fast and refer to where we're like some of the other states that are now open too fast, did things too soon but now have to scale back things," Hart says.

He is strongly encouraging his citizens to wear masks, but he is not considering implementing a mandatory mask mandate like the one just put in place in Iowa City.

Iowa Gov. Kim Reynolds, a Republican, has said cities do not have the authority to do so.

"I think it's incredible where mayors are able to make the best decisions for their individual communities. The way we deal with it is not a cookie cutter situation in how we enforce things," he said.

"Mayors need to have the discretion to be able to have nonpolitical, non-biased opportunities to lead their communities, and not have that disrupted by governors and federal officials. We need to be able to have home rule," he added.

Not listening to local leaders, Hart believes, is where the state and federal governments went wrong during the peak of Waterloo's outbreak in April.

"I feel that if they would have listened to us locally, sooner, than us having to go on television and write a myriad of different letters ... then we wouldn't have had near the amount of cases we had," the mayor said.

All things considered, Hart says he is proud of the way his city locally managed the outbreak, and he attributes some of their success to being proactive on the public health side.

"Pro-business means pro-worker means pro-public health. That's the way we approach this. We don't have it all solved, but we're talking a lot more and communicating upfront," the mayor said.

As the debate about reopening schools continues nationwide, Reynolds issued a proclamation saying 50% of schooling needs to be in person, which Hart calls a "huge concern."

"You may have districts that have teachers and administrators that are susceptible and vulnerable populations. And so, you're basically forcing these people to go back into a situation where they may lose their life from if they contracted Covid. So, that's a challenge," Hart said.

Hart is no stranger to the concerns of educators and students returning to school. His wife is a vice principal at a local elementary school, and he has young children at home. Waterloo's school system will begin with a phased opening.

"There is going to be the option of parents to be able to do some online learning. But as we know, there may be a lot of parents out there that can't stay home and work from home while they do education," he explained.

He thinks it will be hard for schools to follow US Centers for Disease Control and Prevention guidelines of staying six feet apart, but says the schools are trying to erect dividers between desks, provide masks and put a contact tracing system in place.

Hart, the first black mayor of his city, says the list of what keeps him up at night keeps growing.

"It was Tyson, then it was Covid, but then it was also with the Black Lives Matter movement," he said.

"I would probably say trying to figure out what we can do better keeps me up, and that is still Covid, that is still police-community relations, that is still trying to get economic development to areas that need it," he added.

He said the past six months have completely changed his life and created a new normal within his community and he is trying to adapt.

"Still show good, humble leadership in these times," he said.

Topeka, Kansas: 'Our community is starting to see how serious it is'

"We actually recently had a few public figures in our community having the virus, and just yesterday, one of our council members, our deputy mayor, was talking about the challenges that he has. And I'm hopeful that these are the conversations that are helping us understand that the virus is serious," De La Isla, a Democrat, told CNN in a phone interview.

Topeka's cases are climbing, but because she believes her residents are finally practicing social distancing and wearing masks, she is hoping the trend will reverse. There are signs that could happen -- the city saw its first drop in the number of cases on Wednesday.

Topeka has not seen case numbers anywhere near as high as hotspots nationwide. They average between 15 and 20 new cases each day, according to De La Isla. She thinks the executive order that Kansas Gov. Laura Kelly, a fellow Democrat, put in place in early July requiring masks statewide has made all the difference.

"Overall, we are very fortunate that the governor was wise enough to request the use of masks by everybody in the state because the numbers in the state started to go up, and I can tell you that I think it's starting to work. It's been a week, and we are finally seeing our first drop in our chart," she explained.

De La Isla also praised the governor's push for more testing statewide, which has allowed her to have more free testing for individuals in her community. Her state still falls on the lower end of testing per capita, and De La Isla is concerned test results are taking too long.

"I think that we are starting to overwhelm the system, and sometimes the testing is coming back four to five days after testing," she said.

Her city is now in Phase 3 of reopening, and she worries her constituents are exhausted by all of the precautions to protect themselves against Covid-19.

"Our joke here has been that we are in phase 3.4 of people feeling that we're OK. ... There is absolutely fatigue," she said.

The mental health of her constituents has been a top priority for De La Isla since the pandemic began. When we spoke in April, she had found creative ways to connect with her residents and provide emotional support, like starting a "warm line" (instead of hot line) for people in distress, and reading to children on Facebook every Sunday, which she still does.

As a single mom, De La Isla is having to make the same tough decision that parents across the nation are facing whether her two teen daughters will return to school in the fall.

"Does it worry me? Of course. I don't want my daughters to get sick. I don't want to get sick, but I'm hopeful that the school districts will come up with a plan that will include social distancing entry and exit strategies, as well as mass protection, and the proper protocol so that if somebody ends up sick, that we all understand how to do this," she said.

Kelly issued an executive order that would delay the start of the school year for a few weeks until September 8, but the Kansas State Board of Education rejected the order this week.

But some school districts, like Topeka, already plan to open in September with a phased approach beginning with all virtual learning.

De La Isla says her daughters want to go back to school.

"I can tell you that for my oldest daughter, she likes the online classes. She did very well in them. My youngest daughter had a really hard time with online learning. She's a social creature. She enjoys the camaraderie of her teachers and her classmates, and she was very demoralized. Both of them are dying for school to start back up," De La Isla said.

When we asked De La Isla back in April what keeps her up at night, she said it was whether doctors will have enough equipment if the virus hits her city hard, and whether the city's hospitals will have enough beds.

For now, her city is managing on both fronts, but her worries have shifted

"I firmly believe that we are at the intersection of 1918, with the pandemic, and 1968, with the civil arrest demonstrations that we had across the nation," she said.

De La Isla wants to make sure everyone in her community feels safe, "regardless of the color of their skin or who they worship and who they love." And as mayor, she needs to balance that with the demands of Covid and maintaining their city's ability to "test everybody that needs testing, so that we can continue moving our economy forward."

The emotions of her job are sometimes too much for her to contain.

"A few weeks ago, after the George Floyd incidents, I was pretty transparent. I was crying in the TV when I was telling everybody that I was not OK. That the weight of what's happening nationally combined with Covid, it's a lot for anybody to handle," the mayor said.

"It's just a very challenging time to be a mayor and know that you are responsible for the wellbeing of a whole community, and understanding and working every single day, face-to-face with these challenges. Just check on your mayors. Seriously, just check in on your mayors because we're carrying a lot of burden," she added.

Philadelphia: "We want federal help, but not that kind of federal help"

Nearly half of all Philadelphia coronavirus cases are African Americans. No other group even comes close.

"That represents the disparity in all of our society. Medical care, medical access, access to medical care has been poor for people of color. Systemic racism has put them in situations where, not only are they more likely to get Covid or die from Covid, but also diabetes and heart disease," Kenney, a Democrat, told us in a phone conversation this week.

When pressed, Kenney conceded -- as he did when we spoke three months ago - that they must do better.

"We have a poor population. Our poverty rate is higher than we certainly want it to be," he admitted.

That adds to the challenge every local leader is dealing with about what school will look like in the fall. Philadelphia is planning for two days a week in school and virtual learning for the other three days. The continuing issue is how to serve students who live in poverty.

"Having Internet access is really critical for them. And we're working hard with some of our companies like Comcast and others to get those key kids plugged in so that if they can't go back to school, they're at least up to speed with Internet connection," he said.

But the fundamental issue is the health care crisis in the Black community.

"The access to primary care physicians, to having your primary care physician be in an emergency room, it's been an ongoing problem, both for the residents and citizens and for the hospital emergency system itself," he said.

Kenney, a supporter of universal health care, ripped the Trump administration for making matters worse by dismantling Obamacare, never mind shirking its responsibility to, in his view, develop a national strategy to administer and pay for widespread testing.

"This is a perfect example of what federal government that's competent can do to protect the citizens of this country by having a national mask rule, by having a national testing program, by having national PPE distribution, by having all the things that we floundered on and tripped up on in March and April and May would have been resolved by a military style effort to keep all of our citizens safe," he said.

But when it comes to another flashpoint issue big city mayors like Kenney are grappling with now -- the potential for federal intervention for alleged violence -- he draws the line.

"We want federal help, but not that kind of federal help. When the administration had the opportunity to help us months ago, they refused to do so. Now he's floundering in the polls, he's playing to his base, he's playing to what he perceived to be the suburban fear of cities. And he's dividing people again, and he's making a dangerous situation, even worse, and we're prepared to fight in court in every way possible to keep that from happening in Philadelphia," Kenney said.

Excerpt from:

Four mayors reflect on their evolving response to the coronavirus pandemic - CNN