Category: Corona Virus

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In addition to the selected guidance included below, all of WHOs technical guidance on COVID-19 can be found online here.

All events listed below are in the Geneva, Switzerland time zone (CET/CEST). Note that the dates listed for documents are based on when they were finalised and timestamped.

WHOs Country Office in the Peoples Republic of China picked up a media statement by the Wuhan Municipal Health Commission from their website on cases of viral pneumonia in Wuhan, Peoples Republic of China.

The Country Office notified the International Health Regulations (IHR) focal point in the WHO Western Pacific Regional Office about the Wuhan Municipal Health Commission media statement of the cases and provided a translation of it.

WHOs Epidemic Intelligence from Open Sources (EIOS) platform also picked up a media report on ProMED (a programme of the International Society for Infectious Diseases) about the same cluster of cases of pneumonia of unknown cause, in Wuhan.

Several health authorities from around the world contacted WHO seeking additional information.

WHO requested information on the reported cluster of atypical pneumonia cases in Wuhan from the Chinese authorities.

WHO activated its Incident Management Support Team (IMST), as part of its emergency response framework, which ensures coordination of activities and response acrossnthe three levels of WHO (Headquarters, Regional, Country) for public health emergencies.

The WHO Representative in China wrote to the National Health Commission, offering WHO support and repeating the request for further information on the cluster of cases.

WHO informed Global Outbreak Alert and Response Network (GOARN) partners about the cluster of pneumonia cases in the Peoples Republic of China. GOARN partners include majornpublic health agencies, laboratories, sister UN agencies, international organizations and NGOs.

Chinese officials provided information to WHO on the cluster of cases of viral pneumonia of unknown cause identified in Wuhan.

WHO tweeted that there was a cluster of pneumonia cases with no deaths in Wuhan, Hubei province, Peoples Republic of China, and that investigations to identify the cause were underway.

WHO shared detailed information about a cluster of cases of pneumonia of unknown cause through the IHR (2005) Event Information System, which is accessible to all Member States. The event notice provided information on the cases and advised Member States to take precautions to reduce the risk of acute respiratory infections.

WHO also issued its first Disease Outbreak News report. This is a public, web-based platform for the publication of technical information addressed to the scientific and public health communities, as well as global media. The report contained information about the number of cases and their clinical status; details about the Wuhan national authoritys response measures; and WHOs risk assessment and advice on public health measures. It advised that WHOs recommendations on public health measures and surveillance of influenza and severe acute respiratory infections still apply.

WHO reported that Chinese authorities have determined that the outbreak is caused by a novel coronavirus.

WHO convened the first of many teleconferences with global expert networks, beginning with the Clinical Network.

The Global Coordination Mechanism for Research and Development to prevent and respond to epidemics held its first teleconference on the novel coronavirus, as did the Scientific Advisory Group of the research and development (R&D) Blueprint, a global strategy and preparedness plan that allows the rapid activation of research and development activities during epidemics.

The Director-General spoke with the Head of the National Health Commission of the Peoples Republic of China. He also had a call to share information with the Director of the Chinese Center for Disease Control and Prevention.

WHO published a comprehensive package of guidance documents for countries, covering topics related to the management of an outbreak of a new disease:

Chinese media reported the first death from the novel coronavirus.

WHO convened the first teleconference with the diagnostics and laboratories global expert network.

The Ministry of Public Health in Thailand reported an imported case of lab-confirmed novel coronavirus from Wuhan, the first recorded case outside of the Peoples Republic of China.

WHO publishes first protocol for a RT-PCR assay by a WHO partner laboratory to diagnose the novel coronavirus.

14 January 2020

WHO held a press briefing during which it stated that, based on experience with respiratory pathogens, the potential for human-to-human transmission in the 41 confirmed cases in the Peoples Republic of China existed: it is certainly possible that there is limited human-to-human transmission.

WHO tweeted that preliminary investigations by the Chinese authorities had found no clear evidence of human-to-human transmission. In its risk assessment, WHO said additional investigation was needed to ascertain the presence of human-to-human transmission, modes of transmission, common source of exposure and the presence of asymptomatic or mildly symptomatic cases that are undetected.

The Japanese Ministry of Health, Labour and Welfare informed WHO of a confirmed case of a novel coronavirus in a person who travelled to Wuhan. This was the second confirmed case detected outside of the Peoples Republic of China. WHO stated that considering global travel patterns, additional cases in other countries were likely.

The Pan American Health Organization/WHO Regional office for the Americas (PAHO/AMRO) issued its first epidemiological alert on the novel coronavirus. The alert included recommendations covering international travellers, infection prevention and control measures and laboratory testing.

WHO convened the first meeting of the analysis and modelling working group for the novel coronavirus.

The WHO Western Pacific Regional Office (WHO/WPRO) tweeted that, according to the latest information received and WHO analysis, there was evidence of limited human-to-human transmission.

WHO published guidance on home care for patients with suspected infection.

WHO conducted the first mission to Wuhan and met with public health officials to learn about the response to the cluster of cases of novel coronavirus.

WHO/WPRO tweeted that it was now very clear from the latest information that there was at least some human-to-human transmission, and that infections among health care workers strengthened the evidence for this.

The United States of America (USA) reported its first confirmed case of the novel coronavirus. This was the first case in the WHO Region of the Americas.

WHO convened the first meeting of the global expert network on infection prevention and control.

The WHO mission to Wuhan issued a statement saying that evidence suggested human-to-human transmission in Wuhan but that more investigation was needed to understand the full extent of transmission.

The WHO Director-Generalconvenedan IHR Emergency Committee (EC) regarding the outbreak of novel coronavirus. The EC was comprised of 15 independent experts from around the world and was charged with advising the Director-General as to whether the outbreak constituted a public health emergency of international concern (PHEIC).

The Committee was not able to reach a conclusion on 22 January based on the limited information available. As the Committee was not able to make a recommendation, the Director-General asked the Committee to continue its deliberations the next day. The Director-General held a media briefing on the novel coronavirus, to provide an update on the Committees deliberations.

The EC met again on 23 January and members were equally divided as to whether the event constituted a PHEIC, as several members considered that there was still not enough information for it, given its restrictive and binary nature (only PHEIC or no PHEIC can be determined; there is no intermediate level of warning). As there was a divergence of views, the EC did not advise the Director-General that the event constituted a PHEIC but said it was ready to be reconvened within 10 days. The EC formulated advice for WHO, the Peoples Republic of China, other countries and the global community.

The Director-General accepted the advice of the Committee and held a second media briefing, giving a statement on the advice of the EC and what WHO was doing in response to the outbreak.

France informed WHO of three cases of novel coronavirus, all of whom had travelled from Wuhan. These were the first confirmed cases in the WHO European region (EURO).

WHO held an informal consultation on the prioritization of candidate therapeutic agents for use in novel coronavirus infection.

The Director of the Pan American Health Organization (PAHO) urged countries in the Americas to be prepared to detect early, isolate and care for patients infected with the new coronavirus, in case of receiving travelers from countries where there was ongoing transmission of novel coronavirus cases. The Director spoke at a PAHO briefing for ambassadors of the Americas to the Organization of American States (OAS) in Washington.

The WHO Regional Director for Europe issued a public statement outlining the importance of being ready at the local and national levels for detecting cases, testing samples and clinical management.

WHO released its first free online course on the novel coronavirus on its OpenWHO learning platform.

The WHO Regional Director for South-East Asia issued a press release that urged countries in the Region to focus on their readiness for the rapid detection of imported cases and prevention of further spread.

A senior WHO delegation led by the Director-General arrived in Beijing to meet Chinese leaders, learn more about the response in the Peoples Republic of China, and to offer technical assistance. The Director-General met with President Xi Jinping on 28 January, and discussed continued collaboration on containment measures in Wuhan, public health measures in other cities and provinces, conducting further studies on the severity and transmissibility of the virus, continuing to share data, and a request for China to share biological material with WHO. They agreed that an international team of leading scientists should travel to China to better understand the context, the overall response, and exchange information and experience.

On his return to Switzerland from China, the Director-General presented an update to Member States on the response to the outbreak of novel coronavirus infection in China, at the 30th Meeting of the Programme, Budget and Administration Committee (PBAC) of the Executive Board. He informed the PBAC that he had reconvened the Emergency Committee on the novel coronavirus under the IHR (2005), which would meet the following day to advise on whether the outbreak constituted a PHEIC.

The Director-General also held a press briefing on his visit to China and announced the reconvening of the EC the next day. The Director-General based the decision to reconvene on the deeply concerning continued increase in cases and evidence of human-to-human transmission outside China, in addition to the numbers outside China holding the potential for a much larger outbreak, even though they were still relatively small. The Director-General also spoke of his agreement with President Xi Jinping that WHO would lead a team of international experts to visit China as soon as possible to work with the government on increasing the understanding of the outbreak, to guide global response efforts.

WHO held the first of its weekly informal discussions with a group of public health leaders from around the world, in line with its commitment to conducting listening exercises and outreach beyond formal mechanisms.

The United Arab Emirates reported the first cases in the WHO Eastern Mediterranean Region. The Regional Director affirmed that the Regional Office continued to monitor disease trends and work with Member States to ensure the ability to detect and respond to potential cases.

The Pandemic Supply Chain Network (PSCN) created by WHO, in collaboration with the World Economic Forum, held its first meeting. The mission of PSCN is to create and manage a market network allowing for WHO and private sector partners to access any supply chain functionality and asset from end-to-end anywhere in the world at any scale.

WHO published advice on the use of masks in the community, during home care and in health care settings.

WHO held a Member State briefing to provide more information about the outbreak.

The WHO Director-General reconvened the IHR Emergency Committee (EC).

The EC advised the Director-General that the outbreak now met the criteria for a PHEIC. The Director-General accepted the ECs advice and declared the novel coronavirus outbreak a PHEIC. At that time there were 98 cases and no deaths in 18 countries outside China. Four countries had evidence (8 cases) of human-to-human transmission outside China (Germany, Japan, the United States of America, and Viet Nam).

The EC formulated advice for the Peoples Republic of China, all countries and the global community, which the Director-General accepted and issued as Temporary Recommendations under the IHR. The Director-General gave a statement, providing an overview of the situation in China and globally; the statement also explained the reasoning behind the decision to declare a PHEIC and outlined the EC's recommendations.

WHOs Regional Director for Africa sent out a guidance note to all countries in the Region emphasising the importance of readiness and early detection of cases.

First dispatch of RT-PCR lab diagnostic kits shipped to WHO Regional Offices.

WHO finalised its Strategic Preparedness and Response Plan (SPRP), centred on improving capacity to detect, prepare and respond to the outbreak. The SPRP translated what had been learned about the virus at that stage into strategic action to guide the development of national and regional operational plans. Its content is structured around how to rapidly establish international coordination, scale up country preparedness and response operations, and accelerate research and innovation.

The WHO Director-General asked the UN Secretary-General to activate the UN crisis management policy, which held its first meeting on 11 February.

During the 146th Executive Board, WHO held a technical briefing on the novel coronavirus. In his opening remarks, the Director-General urged Member States to prepare themselves by taking action now, saying We have a window of opportunity. While 99% of cases are in China, in the rest of the world we only have 176 cases.

Responding to a question at the Executive Board, the Secretariat said, it is possible that there may be individuals who are asymptomatic that shed virus, but we need more detailed studies around this to determine how often that is happening and if this is leading to secondary transmission.

WHO's headquarters began holding daily media briefings on the novel coronavirus, the first time that WHO has held daily briefings by the Director-General or Executive Director of the WHO Health Emergencies Programme.

WHO deployed an advance team for the WHO-China Joint Mission, having received final sign-off from the Peoples Republic of China that day. The mission had been agreed between the Director-General and President Xi Jinping during the WHO delegations visit to China at the end of January. The advance team completed five days of intensive preparation for the Mission, working with Chinas National Health Commission, the Chinese Center for Disease Control and Prevention, local partners and related entities and the WHO China Country Office.

WHO announced that the disease caused by the novel coronavirus would be named COVID-19. Following best practices, the name of the disease was chosen to avoid inaccuracy and stigma and therefore did not refer to a geographical location, an animal, an individual or group of people.

WHO convened a GlobalResearch and Innovation Forum on the novel coronavirus, attended in person by more than 300 experts and funders from 48 countries, with a further 150 joining online.Participants came together to assess the level of knowledge, identify gaps and work together to accelerate and fund priority research, with equitable access as a fundamental principle underpinning this work.

Topics covered by the Forum included: the origin of the virus, natural history, transmission, diagnosis; epidemiological studies; clinical characterization and management; infection prevention and control; R&D for candidate therapeutics and vaccines; ethical considerations for research; and the integration of the social sciences into the outbreak response.

The Forum was convened in line with the WHO R&D Blueprint, which was activated to accelerate diagnostics, vaccines and therapeutics for this novel coronavirus.

Supplementing the SPRP with further detail, WHO published Operational Planning Guidelines to Support Country Preparedness and Response, structured around the eight pillars of country-level coordination, planning, and monitoring; risk communication and community engagement; surveillance, rapid response teams, and case investigation; points of entry; national laboratories; infection prevention and control; case management; and operational support and logistics. These guidelines operationalised technical guidance, such as that published on 10-12 January.

WHOs Digital Solutions Unit convened a roundtable of 30 companies in Silicon Valley to help build support for WHO to keep people safe and informed about COVID-19.

Based on lessons learned from the H1N1 and Ebola outbreaks, WHO finalised guidelines for organizers of mass gatherings, in light of COVID-19.

The Director-General spoke at the Munich Security Conference, a global forum dedicated to issues of international security, including health security, where he also held several bilateral meetings

In his speech, the Director-General made three requests of the international community: use the window of opportunity to intensify preparedness, adopt a whole-of-government approach and be guided by solidarity, not stigma. He also expressed concern at the global lack of urgency in funding the response.

The WHO-China Joint Mission began its work. As part of the mission to assess the seriousness of this new disease; its transmission dynamics; and the nature and impact of Chinas control measures, teams made field visits to Beijing, Guangdong, Sichuan and Wuhan.

The Mission consisted of 25 national and international experts from the Peoples Republic of China, Germany, Japan, the Republic of Korea, Nigeria, the Russian Federation, Singapore, the United States of America and WHO, all selected after broad consultation to secure the best talent from a diversity of geographies and specialties. It was led by a Senior Advisor to the WHO Director-General, with the Head of Expert Panel of COVID-19 Response at the China National Health Commission (NHC) as co-lead.

Throughout the global outbreak, WHO has regularly sent missions to countries to learn from and support responses, at the request of the affected Member State. Particularly in the early stages of the worldwide COVID-19 response, missions went to countries facing relatively high levels of community transmission, such as the Islamic Republic of Iran, Italy, and Spain.

Weekly WHO Member State Briefings on COVID-19 began, to share the latest knowledge and insights on COVID-19.

The WHO Director-General appointed six special envoys on COVID-19, to provide strategic advice and high-level political advocacy and engagement in different parts of the world:

The Team Leaders of the WHO-China Joint Mission on COVID-19 held a press conference to report on the main findings of the mission.

The Mission warned that "much of the global community is not yet ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China.

The Mission stressed that to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures, such as case detection and isolation, contact tracing and monitoring/quarantining and community engagement.

Major recommendations were developed for the Peoples Republic of China, countries with imported cases and/or outbreaks of COVID-19, uninfected countries, the public and the international community. For example, in addition to the above, countries with imported cases and/or outbreaks were recommended to "immediately activate the highest level of national Response Management protocols to ensure the all-of-government and all-of-society approach needed to contain COVID-19".

Success was presented as dependent on fast decision-making by top leaders, operational thoroughness by public health systems and societal engagement.

In addition to the Mission press conference, WHO published operational considerations for managing COVID-19 cases and outbreaks on board ships, following the outbreak of COVID-19 during an international voyage.

Confirmation of the first case in WHO's African Region, in Algeria. This followed the earlier reporting of a case in Egypt, the first on the African continent. The Regional Director for Africa called for countries to step up their readiness.

WHO published guidance on the rational use of personal protective equipment, in view of global shortages. This provided recommendations on the type of personal protective equipment to use depending on the setting, personnel and type of activity.

The Report of the WHO-China Joint Mission was issued, as a reference point for countries on measures needed to contain COVID-19.

WHO published considerations for the quarantine of individuals in the context of containment for COVID-19. This described who should be quarantined and the minimum conditions for quarantine to avoid the risk of further transmission.

WHO issued a call for industry and governments to increase manufacturing by 40 per cent to meet rising global demand in response to the shortage of personal protective equipment endangering health workers worldwide.

This call fits within a broader scope of ongoing engagement with industry, through WHOs EPI-WIN network and via partners, such as the International Chamber of Commerce and World Economic Forum, the latter of which has supported COVID-19 media briefings at the regional level.

WHO published the Global Research Roadmap for the novel coronavirus developed by the working groups of the Research Forum.

The Roadmap outlines key research priorities in nine key areas. These include the natural history of the virus, epidemiology, diagnostics, clinical management, ethical considerations and social sciences, as well as longer-term goals for therapeutics and vaccines.

To mark the number of confirmed COVID-19 cases surpassing 100 000 globally, WHO issued a statement calling for action to stop, contain, control, delay and reduce the impact of the virus at every opportunity.

WHO issued a consolidated package of existing guidance covering the preparedness, readiness and response actions for four different transmission scenarios: no cases, sporadic cases, clusters of cases and community transmission.

The Global Preparedness Monitoring Board, an independent high-level body established by WHO and the World Bank, responsible for monitoring global preparedness for health emergencies, called for an immediate injection of $8 billion for the COVID-19 response to: support WHO to coordinate and prioritize support efforts to the most vulnerable countries; develop new diagnostics, therapeutics, and vaccines; strengthen unmet needs for regional surveillance and coordination; and to ensure sufficient supplies of protective equipment for health workers.

WHO, UNICEF and the International Federation of Red Cross and Red Crescent Societies (IFRC) issued guidance outlining critical considerations and practical checklists to keep schools safe, with tips for parents and caregivers, as well as children and students themselves.

Deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction, WHO made the assessment that COVID-19 could be characterized as a pandemic.

Read more:

Timeline of WHO's response to COVID-19 - World Health Organization

As protests against racism and police violence swept across the country, drawing massive crowds into the streets amid a pandemic, public health officials worried about what the overall impact would be.

The latest from the coronavirus outbreak in Colorado:

>> FULL COVERAGE

Would these protests which many health leaders said they support also turn out to be virus super-spreading events?

But a new study by a nationwide research team that includes a University of Colorado Denver professor has found something surprising: The protests may have slowed the overall spread of the coronavirus in cities with large demonstrations, including Denver.

We think that whats going on is its the people who are not going to protest are staying away, said Andrew Friedson, the CU-Denver professor who is one of the papers co-authors. The overall effect for the entire city is more social distancing because people are avoiding the protests.

Friedsons specialty is economics specifically the economics of health care. The field of COVID-19 research now contains a multitude of subspecialties, and it has often been economists leading the way in understanding how people are changing their behaviors in response to the pandemic.

MORE: Coloradans are moving around at nearly pre-pandemic levels. Will a second coronavirus wave follow?

As the protests built, Friedson said he and his colleagues took note of the rising concerns about virus spread. He said they also realized they had the ability to answer that question using official coronavirus case counts and the anonymous, aggregated cell phone data that has become the gold standard for tracking societal shifts in movement.

The team worked quickly and published their findings earlier this month as a National Bureau of Economic Research working paper meaning it has not yet been peer-reviewed.

Im someone who likes to get the answers out, Friedson said. There are a lot of people who say, Well I think it should happen or I think this should happen, and its nice to have some numbers to inform these decision-making processes.

The paper comes as officials in Colorado and other states are concerned about rising infections, especially among young people.

New infections among young people have contributed significantly to Colorados uptick in cases in recent days a rise that reversed a weeks-long trend of falling case numbers and has put Colorado back onto the list of potential coronavirus problem spots. Meanwhile, the number of new infections among older Coloradans has dropped.

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With the July 4 holiday approaching, Gov. Jared Polis and county health officials have pleaded with people to be responsible and avoid large gatherings.

We dont have the direct causation of this uptick, Polis told reporters last week, noting that there is evidence that some young people who are part of an outbreak in Boulder had attended protests while other outbreaks are tied to social gatherings. And we hope this is a trend that is reversed in our state.

On Monday, a spokesman for the Colorado Department of Public Health and Environment said that, while the state has now seen rising numbers of new cases for two consecutive weeks, we have not seen any clear association between the protests and an increase in cases.

The spokesman, Ian Dickson, said the uptick in infections may be partly due to some Coloradans changing their behavior especially socializing in larger groups, sometimes without proper distancing or mask wearing.

Friedson said his paper doesnt try to figure out whether the protests spread the virus among the people at the protest. Instead, he said the research took the bigger-picture view: What did the protests mean for overall transmission of the virus within the entire community?

The study looked at 315 American cities with populations of more than 100,000 and found that 281 of those cities saw protests. The remaining 34 cities that did not see protests which, at the time, included Aurora were used as a control group against which to measure the impact of the protests.

The researchers found that protests correlated with a net increase in overall stay-at-home behavior in cities where they occurred and the increase was larger in cities that saw more sustained protests or reports of violence.

Friedson said he and his colleagues were a bit surprised at first. The protests in many cities, including Denver, were massive, drawing tens of thousands of people out to march. But they occurred in cities with hundreds of thousands to millions of residents.

We started thinking about it a little more and we thought, Oh my gosh were capturing everybody else, he said.

The paper also found that, with greater social distancing, COVID case growth slowed in cities with protests from what would be expected but not by a statistically significant amount. There may be other explanations for the trends, the studys authors note. Overall, though, they say the data show that any resurgence in coronavirus cases cant be pinned entirely on the protests.

Public speech and public health did not trade off against each other in this case, the authors wrote in the paper.

But Friedson said there is one last important thing to keep in mind about this study: Its not a green light for governments to fully reopen bars, concert venues and other places where people gather in large numbers. The key to the researchers conclusions is that the protests, while receiving lots of support, were ultimately things most people decided to avoid. Thats not true of many other large gatherings.

An outdoor wedding doesnt generate avoidance behavior; were measuring avoidance behavior, Friedson said. People dont say, Oh man, theres an outdoor wedding next door, we should stay home.

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The rest is here:

Black Lives Matter protests may have slowed overall spread of coronavirus in Denver and other cities, new study finds - The Colorado Sun

Here are some of the top stories we're following for Tuesday, June 30, 2020. Wochit

Gov. John Carney announced Tuesday afternoon that bars in Delaware beach towns will be ordered toclose Friday ahead of the holiday weekend, as the state has seen a spike in COVID-19 cases in the area.

Customers will nolonger be able to sit or stand at a bar, according to the new guidance. Instead, beachgoers will have to sit at a table and be served by a server.

This will affect taprooms and bar service in the following towns: Lewes, Rehoboth Beach, Dewey Beach, Long Neck, Bethany Beach, South Bethany, Fenwick Island, West Fenwick Island, Ocean View and Millville, according to the order.

This begins at8 a.m. on July 3 and lasts indefinitely, Carney said during his weekly press briefing.Restaurants will need to close their bar serviceand continue to follow the current phase two guidelines.

The city of Rehoboth Beach announced Tuesday that it will require people over the age of 12 to wear a face covering in all public places. Face coverings are not required when in the ocean. This order goes into effect 5 p.m. on July 1.

In recent weeks, tourists have poured into the beach towns of Rehoboth and Dewey, and even more crowds were expected for theFourth of July weekend. State health officials said they have identified at least 100 cases related to the beaches and warned about thepotential forwidespread infection in the state's coastal communities.

On Monday, the Rehoboth Beach Police Department announced that threelifeguards have tested positive for the coronavirus.

LEARN YOUR RISK: Delaware beach towns balance risks, economics during COVID-19

Some Delaware beach restaurants have closed their businesses due to the uptick in cases. The state has also significantly increased its testing capacity in these resort areas.

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State health officials attribute the recent increase in cases to a lack of social distancing and wearing of face coverings of those who go to the beach. Officials also noted that some restaurant servers have not been wearing face masks.

There's also a culture issue: Many of these workers are young people who live and socialize together, which can increase the likelihood of the infection spreading.

"Clearly we've had an outbreak among bars, restaurants, social activity in Delaware beaches," Carney said. "We've also witnessed throughout our statebut in particularly in beach communitiescomplacency with respect to mask wearing and social distancing."

As the country continues to see a rise in COVID-19 infections, many states have paused or reversed their reopening efforts. Carney announced last week that Delaware will delay the third phase of its reopening.

Gov. Phil Murphy of New Jersey announced Monday that indoor restaurant dining will be postponed indefinitely.In Florida, some counties have closed their beaches ahead of the holiday weekend.

Carney said during his Tuesday press briefing that the state does not plan to close the beaches orhalt indoor dining.But he said the state will become will be more aggressive in enforcing these guidelines.

This means some bars could face significant fines or even closure.

Carrie Leishman, president and CEO of the Delaware Restaurant Association, said she understands why Carney is imposing new restrictions, due to the spike in coronavirus cases among visitors and employees at businesses in the beach towns.

It's a setback for the bar and restaurant industry in that area, said Leishman, adding she is glad the new restrictions arent statewide. Ninety-nine percent of our industry are doing [things] the right way.

Steve"Monty"Montgomery, co-owner of the Starboard in Dewey Beach, said he found the announcement "disappointing" but not"totally shocking."

Early into the second phase, the Starboard staff "learned quickly that it was difficult to enforce folks to keep their masks on after 11 p.m." This led to the business to close before that time.

Montgomery said he wishes bars could have remained opened yet ordered to close at an earlier time. At Starboard, a lot of customers eat at the bars, he said.

"To lose that much seating is a real heartbreak, but we will continue on with table service for everyone and make the best of this situation,"Montgomery said.

"The amount of stress and pressure on everyone in the hospitality industry these days is totally over the top," he continued, "most every restaurant and bar that I know is working so hard to do the right thing, but there is still so much uncertainty."

As of June 30, Delaware has confirmed11,474 COVID-19 cases and 509related deaths.Since June 21, Delaware has seen a significantincrease in cases in the Rehoboth-Dewey Beach ZIP code. Many of these cases are in young people and beach residents.

Of about 1,081tests conducted at Rehoboth Beach site on June 25, about 9.5% of people were positive COVID-19, Karyl Rattay, director of the Delaware Division of Public Health, said. The average age was about 29 years old.

At a Dewey Beach testing site for restaurant employees, almost 15% of people tested positive for the virus, according to state data. Of the 93 tests conducted, 12 came back positive.

Of those who tested positive, many of the people had mild symptoms or were asymptomatic, Rattay said.

Carney said Delaware is in a much better position to fight the virus than it was in mid-March. The state is also in "much better shape" compared withplaces like Texas and California.

"If we get complacent, if we listen to the naysayers, then we're going to end up like some of those other states," Carney said."I don't want to be in that place, and I know Delawareans across our state don't want to be in that place."

Reporters Ryan Cormier and Patricia Talorico contributed to this article.

Contact Meredith Newman at (302) 324-2386 or at mnewman@delawareonline.com. Follow her on Twitter at @merenewman.

Read or Share this story: https://www.delawareonline.com/story/news/health/2020/06/30/bars-delaware-beaches-covid/5348619002/

Continued here:

Carney: Bars at Delaware beaches to close ahead of July Fourth weekend due to coronavirus spike - The News Journal

The F.B.I. has issued a warning about scammers who advertise fraudulent Covid-19 antibody tests as a way to obtain personal information that can be used for identity theft or medical insurance fraud.

The warning, issued Friday, is the latest in a series of alerts from the federal government about fraudulent exploitation of the coronavirus pandemic.

Scammers are advertising the fake or unapproved tests which could provide false results online, through social media or email, or in person or over the phone, the F.B.I. said. They could claim that the tests were approved by the Food and Drug Administration, as well as advertise free Covid-19 antibody tests or provide incentives for testing.

The Federal Bureau of Investigation recommends that those looking to take an antibody test which is used to determine whether a person has had the coronavirus consult a list of tests and testing companies that the Food and Drug Administration has approved. These tests have been evaluated in a study performed at the National Institutes of Healths cancer institute or by another F.D.A. designated government agency.

People should also consult with their primary care physician before taking any Covid-19 antibody test at home, the F.B.I. says. It also warned against sharing personal or health information with anyone who is not a known and trusted medical professional, as well as checking medical bills for suspicious claims and reporting those claims to health insurance providers.

Among the methods fraudulent marketers use to obtain crucial personal information is calling people and telling them that theyre working with the government or that government officials are requiring them to take a Covid-19 antibody test. They sometimes also offer to perform the test for cash.

The goal is to seek personal data, like a persons name, date of birth, Social Security number, Medicare and health insurance information. This can later be used for identity theft or medical insurance fraud.

The fraudulent tests, the authorities say, are just another way for scammers to capitalize on peoples fear and uncertainty from the coronavirus pandemic.

Last Wednesday, the Federal Trade Commission warned of scammers pretending to be contact tracers. In early June, the Internal Revenue Service alerted people about fraud surrounding government stimulus coronavirus payments.

Back in April, the F.B.I. issued a similar warning related to Covid-19 testing and scammers looking to sell false coronavirus cures, treatments and vaccines. Federal officials also warned last week about fake cards that were being sold that claimed to exempt people from wearing face masks.

Originally posted here:

Fraudulent Covid Antibody Tests? FBI Warns of Scammers, Identity Theft - The New York Times

The antiviral drug remdesivir has been approved for emergency use among hospitalized COVID-19 patients, and in recent studies, has shown promise as a treatment for the pandemic disease.

How exactly does remdesivir counter SARS-CoV-2 -- the coronavirus strain responsible for COVID-19?

With hat tips to virologist Jan Carette, PhD, geneticist Judith Frydman, PhD, and infectious-disease expert Bob Shafer, MD, let's follow the coronavirus downstream as it courses through its agenda within the infected cell.

Toward the end, we'll zero in on one of the virus's several Achilles heels, and we'll see how remdesivir could help -- and alas, why it may not be able to save the day on its own.

Previously, I tracked the novel coronavirus's invasion of a susceptible cell. When we left off, SARS-CoV-2 had come riding into the cell like a Lilliputian aquanaut, stealthily stowed inside a little membrane-bound bubble called an endosome.

Within that endosome, the virus remains clad in its own membrane coat, or envelope, which (when things go right for the virus) fuses with the membrane of the surrounding endosome. The viral envelope's contents spill into the (relatively) vast surrounding cellular ocean, or cytosol, that occupies the space between the cell's nucleus and its outer membrane.

Chief among those contents is the virus's genome, which wriggles out of its self-imposed prison to pursue its destiny: It aspires to generate thousands of identical progeny that will eventually burst out through the cell's enclosing membrane and fan out to infect more cells.

That lonely single strand of RNA that is the virus's genome has a big job to do -- two, in fact, Frydman and Carette told me --- in order to bootstrap itself into parenting a pack of progeny. For one thing, it must replicate itself in entirety and in bulk, with each copy the potential seed of a new viral particle. For another, it must generate multiple partial copies of itself -- sawed-off snippets that serve as instruction guides telling the cell's protein-making machines, called ribosomes, how to manufacture the virus's more than two dozen proteins.

To do both of those things, the virus needs its own special kind of polymerase: a protein that acts as a copy machine for genetic material. Every living cell uses polymerases to copy its DNA-based genome, as well as to transcribe the resident genes along that genome into RNA-based instructions that ribosomes can read.

The SARS-CoV2 genome, unlike ours, is made of RNA, so it's already ribosome-friendly; but replicating itself means making RNA copies of RNA. Our cells never need to do this, and they lack polymerases that can.

SARS-CoV2's genome, though, does carry a gene coding for an RNA-to-RNA polymerase. If that lone RNA strand can find and latch onto a ribosome, the latter can translate the viral polymerase's genetic blueprint into a working polymerase. Fortunately for the virus, there can be as many as 10 million ribosomes in a single cell.

Once made, the viral polymerase whirls into action, cranking out not only multiple copies of the full-length viral genome -- replication -- but also smaller sections, representing individual viral genes or groups of them. These smaller sections can clamber aboard ribosomes and command that they produce all of the proteins needed to assemble numerous new viral offspring.

This repertoire of newly created proteins includes, notably, more polymerase molecules. Each copy of the SARS-CoV-2 genome can be fed repeatedly through prolific polymerase molecules, generating myriad faithful reproductions of the initial RNA strand.

Well, mostly faithful. We all make mistakes, and the viral polymerase is no exception; actually it's pretty sloppy as polymerases go -- much more so than our own cells' polymerases, Carette and Frydman told me. So the copies of the initial viral genome -- and their copies -- are at risk of being riddled with copying errors, aka mutations.

However, coronavirus polymerases, including SARS-CoV-2's, come uniquely equipped with a sidekick "proofreader protein" that catches most of those errors. It chops out the wrongly inserted chemical component and gives the polymerase another, generally successful, stab at inserting the proper chemical unit into the growing RNA sequence.

Here's where remdesivir could become important. It belongs to a class of antiviral drugs that work by posing as legitimate chemical building blocks of a DNA or RNA sequence. These poseurs get themselves stitched into the nascent strand and gum things up so badly that the polymerase stalls out or produces a defective product. Remdesivir has the virtue of not messing up our cells' own polymerases, said Shafer, who maintains a continuously updated database of results from trials of drugs targeting SARS-CoV-2.

"Now the virus is making a lot of rotten genomes that poison the viral replication process," Frydman told me. If its progeny are defective and unable to bust out and invade other cells throughout the body, the virus's mission is defeated -- and the patient gets better.

But while remdesivir is pretty good -- better than many other antivirals, anyway -- at faking out the viral polymerase's companion proofreader protein, it's far from perfect, Shafer said. Some intact viral-genome copies may still manage to get made, escape from the cell, and infect other cells -- mission accomplished.

Using remdesivir in combination with some still-sought, as-yet-undiscovered drug that could block the proofreader could turn out to be a more surefire strategy than remdesivir alone.

Barring that, it may well be that the most lethal aspect of SARS-CoV-2 is our own immune response to it.

Stay tuned.

Image of SARS-CoV-2 emerging from the surface of cells cultured in the lab, courtesy of National Institute of Allergy and Infectious Diseases-Rocky Mountain Laboratories, NIH

Link:

How remdesivir works, and why it's not the ultimate coronavirus killer - Scope

The Sardar Patel COVID Care Centre, the largest facility of its kind in India, became partly operational on Sunday, with 2,000 of its 10,000 beds available, according to the Delhi government.

India's Home Minister Amit Shah and Delhi's Chief Minister Arvind Kejriwal visited the care center on Saturday ahead of its launch.

In a message posted on Twitter that day, Kejriwal described the center as being "among the largest hospitals in the world."

Meanwhile, the Home Minister tweeted that the 10,000-bed facility "would provide huge relief to the people of Delhi."

The administration and operations of the facility will be run by the Indo-Tiberan Border Police (ITBP), Shah confirmed.

"I applaud our courageous ITBP personnel, who would be operating this COVID Care facility during these trying times. Their commitment to serve the nation and people of Delhi is unparalleled," he added in a tweet.

The opening of the hospital coincided with the release of India health ministry data on Sunday which showed the largest rise in the daily number of new Covid-19 cases.

The country reported 19,906 new infections and 410 new deaths from the virus, bringing the total to 528,859 positive cases and 16,095 fatalities.

Delhi became the country's worst-hit city on Wednesday, surpassing Mumbai's coronavirus tally. Only the west India state of Maharashtra with 159,133 cases has had more infections than the capital.

Excerpt from:

India opens one of the world's largest hospitals to fight coronavirus - CNN

New York malls will need high quality air systems that can filter out the coronavirus before they will be allowed to reopen, Gov. Andrew Cuomo said on Monday.

"Any malls that will open in New York, large malls, we will make it mandatory that they have air filtration systems that can filter out the Covid virus," Cuomo said at a press briefing.

High efficiency particle air filters, or HEPA filters, have been shown to help reduce the presence of Covid-19 in the air, according to a presentation from Cuomo.

The U.S. Centers for Disease Control and Prevention says the coronavirus is thought to spread primarily through person-to-person contact, when an infected person produces respiratory droplets by coughing, sneezing or talking in close contact with other people. It's possible someone can become infected by touching a surface and then touching their mouth, nose or eyes, but that's not considered to be the main way the virus is transmitted, the CDC says.

Some epidemiologists say the virus also appears to spread through exhaled air when people talk or breathe, known as aerosols, according to Nature.

The coronavirus' particle has a diameter of about 0.125 micron, he said, pointing torecent studies. HEPA filters are designed to filter particles that are 0.01 micron and above, Cuomo said, a figure he based on a previousNASA studyon HEPA filtration.

The Lufthansa logo is visible through a HEPA filter (High Efficiency Particulate Air filter). During a press tour, the airport operator Fraport and the airline Lufthansa explain their hygiene concept under current corona conditions.

Andreas Arnold | picture alliance | Getty Images

. New York has not allowed malls to reopen in the state yet, Cuomo said. He said the state recommends all businesses and offices "explore the potential for their air conditioning air filtration system."

New Jersey allowed malls to reopen on Monday while following the same health precautions required of other stores but without advanced filtration systems, according to the state's guidelines.

Cuomo has allowed other businesses to reopen without installing high-end filtration systems. So far, indoor retail, except for malls, indoor and outdoor dining and some office spaces have reopened in different regions of the state with reduced capacity.

New York City is expected to begin on July 6 its next phase of reopening, which will allow for indoor dining and personal care services such as nail salons, spas, massage parlors, and tattoo and piercing facilities with limited occupancy.

Cuomo said on Monday, however, that he's concerned about the city's enforcement of previous reopenings and that it has experienced a lack of compliance when it comes to social distancing and mask wearing, he said.

"You can see it in pictures, you can see it if you walk down the street, you can see the crowds in front of bars, you can see the crowds on street corners. It is undeniable," Cuomo said.

Indoor dining has proven problematic in other states where cases are rising, Cuomo said. Meanwhile, outdoor dining has so far worked well across the state, including in New York City, he added.

Cuomo said the state is reviewing the data and talking with local business owners but could decide to postpone indoor dining at restaurants. The state will provide a final decision by Wednesday, he said.

"This is a real issue. Our reopenings have worked very well. We're not going backwards; we're going forwards," Cuomo said. "A lot of other states have actually had to go backwards."

Gov. Andrew Cuomo during a daily coronavirus briefing on June 29th, 2020.

Source: New York State

To illustrate the state's progress suppressing the coronavirus outbreak, Cuomo appeared in front of a sculpture of a mountain that represented the curve of the outbreak, saying it was "the mountain that New Yorkers climbed," reaching the peak in the first 42 days. On Sunday, the state reported 853 people currently hospitalized with Covid-19, down from a peak of more than 18,800.

"Do you know what this is? This is the mountain," Cuomo said while standing in front of the green sculpture.

He has previously called the state's outbreak a mountain, referring to the shape of newly reported Covid-19 cases on a chart. Earlier in June, Cuomo said he was going to declare the "Covid mountain" the highest mountain in the state of New York.

CLARIFICATION: This story has been updated to show that HEPA filters are designed to filter particles that are 0.01 micron and above, according to New York Gov. Andrew Cuomo. He based the figure on a previousNASA studyon HEPA filtration.

Read more:

NY malls can't open without air conditioning systems that filter the coronavirus, Gov. Cuomo says - CNBC

Gwen Darien is a three-time cancer survivor. When she was thirty-five, she was diagnosed with lymphoma; in her fifties, she was treated for breast cancer; two years ago, she learned that she had endometrial cancer. With curly black hair and an indomitable personality, she embodies vibrancy, courage, and resilience. Even so, last month, when she received a call from her doctors office about an upcoming visit, she decided to postpone it indefinitely. I was very unnerved, she told me. I thought about all the risks. First, Id have to get transportationUber or train or subway. Then Id have to walk into the doctors office, near a hospital with COVID-19 patients. Then Id have to be in the office with other people, even if they are socially distanced. Id much rather just wait.

During the pandemic, many patients and physicians have felt this kind of hesitation. Some people with chronic illnesses, fearful of entering a medical setting or even venturing outside, have stopped seeing doctors altogether. Others have tried to make appointments but found clinics closed and routine care suspended. At many hospitals, non-urgent or elective care has been postponed for months. Its difficult to say for sure what the effects of such postponements have been and will be. But statistics show that, across the United States, so-called excess deathsdeaths beyond those that are historically typicalhave surged. Although many of these deaths can be attributed to COVID-19, delayed or cancelled care is probably a contributing factor, too. An analysis of death certificates shows that a fifth of the twenty-four thousand excess deaths that occurred in New York City between March 11th and May 2nd were caused by factors other than COVID-19; according to a study currently in pre-publication review, hospitals saw a thirty-eight-per-cent drop in serious heart-attack cases in March alone, suggesting that even people with acute, life-threatening illnesses have been avoiding medical visits. (The American College of Cardiology has gone so far as to issue a statement urging people to seek medical attention if theyre having cardiac symptoms.) A nationwide survey conducted in April found that a quarter of cancer patients receiving active treatment had seen their care delayed. Ultimately, its not just people with COVID-19 who are suffering; those with other illnesses are affected by the pandemic, too.

The coronavirus crisis itself continues to deepen. Although the first peak has passed in a few major cities, cases have held steady in many parts of the country and are rising in twenty-six states. North Carolina saw its highest single-day increase in coronavirus cases on June 12th; Florida, Arizona, and Texas saw record spikes this week. Some of this growth reflects increased testing, but, in many places, deaths caused by the virus are also risinga sign that the spike is real and not a statistical artefact. The U.S. still records more than thirty thousand new cases each day; according to projections from the Centers for Disease Control and Prevention, the national death toll could reach a hundred and forty thousand by the Fourth of July; the countrys public-health response remains scattershot, with grossly inadequate testing and contact tracing; and mass protests and planned reopenings, which are continuing despite the risks, have given the virus new breathing room. America as a whole seems to have entered a long viral plateau. The pandemic is now a rolling collection of mini-epidemics that surge and subside as the virus bobs and weaves its way across the country. It will be a long time before life returns to normal.

The persistence of the pandemic is creating serious challenges, many of them unforeseen, for the health-care system. Even before the pandemic, many hospitals were in precarious financial condition: in 2018, the average hospital had a two-per-cent operating margin and less than two months of cash on hand; the situation was worse for rural hospitals, a fifth of which were already at risk of closing due to financial problems. Having lost billions of dollars in revenue, hospitals must now figure out how to reintroduce routine care while keeping patients safe and preparing for possible surges of COVID-19. (As my colleague Atul Gawande has written, it is possible for hospitals to reopen without becoming vectors for the virus; doing so, however, requires time, resources, and personnel.) Hospitals in Massachusetts are losing $1.4 billion in revenue per month, and project total losses of five billion dollars by the end of July. The Mayo Clinic alone, which runs twenty-three hospitals nationwide, is set to lose three billion dollars this year. The American Hospital Association estimates that, altogether, U.S. hospitals are bleeding fifty billion dollars a month during the pandemic. The hundreds of thousands of doctors in independent practice have more limited capital reserves, and many may be forced to shutter their operations or merge them with others.

In the context of the economy as a whole, these losses are substantial. According to the Department of Commerce, the American economy shrank by nearly five per cent in the first quarter of 2020. Nearly half of this changethe biggest single-quarter drop since the Great Recessionhad to do with reductions in health care. In a few months time, the coronavirus has accomplished what lawmakers have been trying to do for decades: by flattening the curve of infection, we have bent the curve of health-care spending. But its been bent haphazardly, by the hurried cancellation or postponement of colonoscopies and mammograms, hip replacements and cataract surgeries, stress tests and root canalsand those unsustainable choices will have real consequences for the health of patients. As the virus continues to spread, the clinical damage will almost certainly compound.

Its vitally important, thereforeboth for the health of individuals and of the system as a wholefor doctors to resume seeing patients who dont have COVID-19. In April, medical organizations, including the American Hospital Association, began releasing road maps for the resumption of regular care; since then, governors have announced various protocols in their own states. The details vary, but the basic principles are the same: wait for a sustained reduction in COVID-19 cases; insure an adequate supply of personal protective equipment (P.P.E.); test constantly; and plan to throttle back on the expansion of services if the virus surges again. The more fine-grained question, of exactly which procedures should be prioritized and which delayed, is usually left unanswered.

Vivek Prachand, a surgeon at the University of Chicago, has been thinking about this problem since early March, when hospitals first started grappling with how to rank procedures in terms of their clinical urgency. Often, he told me, the decisions were being made by individual physicians or small committees within hospitals. It was really just surgeons saying, O.K., go ahead, or, No, we need to hold off, he said. You can imagine the emotional and ethical challenges of being in that position. He and his colleagues have developed a rubric to help guide such decisions during the pandemic, which they call the Medically Necessary, Time-Sensitive System, or MENTS.

Prachand dislikes referring to care as elective, because the term suggests that procedures are optional or unnecessary; really, elective care is just care that can be scheduled. (Setting a broken arm is urgent care; brain surgery, most of the time, isnt.) To help set the schedule, the MENTS protocol asks three kinds of questions. First, it assesses procedural factors, such as how long the surgery will take, how many clinicians will be exposed, how much P.P.E. will be used, and how likely the patient is to be intubated or require a prolonged stay in the hospital. Second, it grades the dangers presented by the problems the surgery hopes to solve, asking how bad the condition will get if doctors wait, and whether there are any effective non-surgical remedies. Finally, it sizes up how much viral risk the operation poses to the patient. Is she immunosuppressed? Does she have an underlying lung disease? What are the chances that shes already been exposed to the virus? The answers to all of these questions are combined into a formula that yields a recommendation about when the team should proceed.

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The Coronavirus Pandemics Wider Health-Care Crisis - The New Yorker

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U.S. sets new high point in daily cases, two months after the previous record.

More than two months after the United States recorded its worst day of new infections since the start of the coronavirus pandemic, the nation reached another grim milestone on Wednesday as it reported 36,880 new cases.

The number of infections indicated that the country was not only failing to contain the coronavirus, but also that the caseload was worsening a path at odds with many other nations that have seen steady declines after an earlier peak. Cases in the United States had been on a downward trajectory after the previous high of 36,739 cases on April 24, but they have roared back in recent weeks.

The resurgence is concentrated largely in the South and West. Florida, Texas, Oklahoma and South Carolina reported their highest single-day totals on Wednesday, but case numbers have been rising in more than 20 states.

The tally of new cases, based on a New York Times database, showed that the outbreak was stronger than ever even as the United States continued to reopen its economy. The elevated numbers are a result of worsening conditions across much of the country, as well as increased testing but testing alone does not explain the surge. The percentage of people in Florida found to be positive for the virus has risen sharply. Increases in hospitalizations also signal the viruss spread.

Some states, including New York, which at one point had the most daily virus cases, have brought their numbers under control. Hoping to keep it that way, New York along with New Jersey and Connecticut said it would institute a quarantine for some out-of-state travelers.

The stock market slid 2.6 percent as investors fretted about what the latest troubling news meant for the economic recovery. That could lead some states to slow the reopening of businesses, further hobbling the economy and delaying its recovery.

As of Wednesday, 2.3 million Americans have been infected with the coronavirus, and 121,925 have died.

On Wednesday it was as if the country had found itself back in March at the start of the pandemic, in the early days of the lockdown, when masks were in short supply and when the death toll was skyrocketing.

Gov. Gavin Newsom of California said that the state had recorded more than 7,000 new cases over the previous day.

In Washington State, where case numbers have again been trending upward, the governor said residents would have to start wearing masks in public.

This is about saving lives, said the states governor, Jay Inslee, a Democrat. Its about reopening our businesses. And its about showing respect and care for one another.

In Florida on Wednesday, Gov. Ron DeSantis gave no indication that the state would roll back its economic opening, but he urged residents to avoid closed spaces with poor ventilation, crowds and close contact with others.

Mr. DeSantis, a Republican, continued to attribute the rising infections, especially in cities, to younger people who have started to socialize in bars and homes, in spite of rules in many municipalities prohibiting group gatherings. He pressed older people to keep staying home as much as possible, and pleaded with young people to be responsible.

You need to do your part and make sure that youre not spreading it to people who are going to be more at risk for this, he said.

Arizona on Tuesday reported its highest number of virus hospitalizations, as did North Carolina, prompting its governor, Roy Cooper, to announce on Wednesday that the state would pause reopening for three weeks and require face masks. In Texas, more than 4,300 people with the virus are hospitalized, more than double the number at the beginning of June.

But in Missouri, where new case reports have reached their highest levels in recent days, coronavirus hospitalizations have declined slightly over the last month.

We are NOT overwhelmed, Gov. Mike Parson, a Republican, said on Twitter, linking the uptick to more testing. We are NOT currently experiencing a second wave. We have NO intentions of closing Missouri back down at this point in time.

The World Health Organization warned on Wednesday that if governments and communities in the Americas are not able to stop the spread of the virus through surveillance, isolation of cases and quarantine of contacts, there may be a need to impose or reimpose general lockdowns.

It is very difficult to take the sting out of this pandemic unless we are able to successfully isolate cases and quarantine contacts, said Dr. Michael Ryan, the executive director of the W.H.O. health emergencies program. In the absence of a capacity to do that, then the specter of further lockdowns cannot be excluded.

He said that the growing number of coronavirus cases in the Americas has not peaked and that the region is likely to see sustained numbers of cases and deaths in the coming weeks.

With cases surging in the Houston area, the citys intensive-care units are now filled to 97 percent of capacity, Mayor Sylvester Turner told the City Council on Wednesday, with Covid-19 patients accounting for more than one-quarter of all patients in intensive care.

The city, known for its large concentration of medical schools and research hospitals, could run out of I.C.U. beds within two weeks if nothing is done to slow the upward trajectory of the virus, said Dr. Peter Jay Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine. He called on the state to reimpose more aggressive social distancing restrictions.

Dr. Hotez said that hospitalizations were rising along with the case counts, so the data is not just the result of increased testing. That means we have to act this week, Dr. Hotez said.

On Wednesday, Gov. Greg Abbott said in a television interview that more than 5,000 people had tested positive in the past day and that more than 4,000 were hospitalized. There is a massive outbreak of Covid-19 across the state of Texas today, he said.

Apple said it closed seven of its stores in the Houston area because of rising coronavirus cases in the region. The move on Wednesday followed its closing of 11 stores in Arizona, Florida, South Carolina and North Carolina because of the virus. Apple had closed nearly all of its roughly 500 stores worldwide months ago, but had opened most in the United States in recent weeks after cases declined. Just over 200 of Apples 271 American stores are now open, with some still closed because of damage from protests, an Apple spokesman said.

In other news around the United States:

In Florida, which had a record number of new coronavirus cases on Wednesday, Gov. Ron DeSantis urged people to avoid closed spaces with poor ventilation, crowds and close contact with others. Total virus cases in Florida exceeded 100,000 on Monday, with more than 3,100 deaths. About one-quarter of the cases have been in Miami-Dade County, where the per capita rate is twice the number statewide. Still, Trump National Doral, which is in the county and is the most important source of revenue for the presidents strained family business, reopened last weekend.

Gov. Roy Cooper of North Carolina, which reached a record 915 virus hospitalizations on Tuesday, announced on Wednesday that the state would pause its reopening for three weeks and require face masks in public. The state has more than 56,000 cases and nearly 1,300 deaths. Mr. Cooper said that hospitals had not reached capacity, but could quickly become overwhelmed. Also, a judge in the state ruled against the reopening of Ace Speedway, which state health officials had ordered to shut down, saying the racetrack had defied restrictions on the size of public gatherings.

State officials in Virginia are proposing workplace virus safety rules that, unlike those in some other states, would be mandatory and backed by enforcement. Labor activists and state officials said Virginia was acting because the federal Occupational Safety and Health Administration had not issued enforceable standards or acted on thousands of complaints. The Virginia rules would impose physical distancing and sanitation requirements, and among other measures, companies would have to notify workers of possible exposure. Violators could be fined or shut down.

Joseph R. Biden Jr. has taken a commanding lead over President Trump in the 2020 presidential race, building a wide advantage among women and nonwhite voters, according to a new national poll of registered voters by The New York Times and Siena College. Mr. Biden has made deep inroads into some traditionally Republican-leaning groups that have shifted away from Mr. Trump after his ineffective response to the coronavirus pandemic. He currently leads Mr. Trump by 14 percentage points, garnering 50 percent of the vote. Nearly three-fifths of voters disapprove of Mr. Trumps handling of the pandemic.

A judge in Texas who signed an order requiring everyone in the San Antonio area to wear masks was assaulted at a Lowes home improvement store on Wednesday after he confronted another customer who was not wearing a mask, the authorities said. When Judge Nelson Wolff tried to hand a card to the man, the other customer slapped away his hand, surveillance video released by the Bexar County Sheriffs Office showed. It was not clear what the card said. The man, who also berated the judge, could face a felony charge of assault of a public servant, the sheriff, Javier Salazar, said during a news conference at the store.

As California recorded its highest number of infections, Disneyland indefinitely postponed its plans to reopen in Anaheim on July 17. The Walt Disney Co. said that it was awaiting the states guidelines for reopening theme parks, which were not expected to be issued until after July 4. Thousands of workers at Disneyland and at Walt Disney World in Florida, which is scheduled to begin a phased reopening on July 11, have signed petitions calling on Disney executives to pause plans.

N.Y. ROUNDUP

Gov. Andrew M. Cuomo of New York announced on Wednesday that the state will begin requiring out-of-state travelers coming from hard-hit states to quarantine for two weeks upon arrival, a move that punctuated a stark shift in the course of the nations outbreak.

The restrictions will be based on specific health metrics related to the virus, he said at a news conference. The quarantine would apply to travelers arriving from a state, as well as New Yorkers returning from a state, where there was either a positive test rate higher than 10 per 100,000 residents, or a state with a 10 percent or higher rate over a seven-day rolling average.

A lot of people come into this region and they could literally bring the infection with them, he said. It wouldnt be malicious or malevolent, but it would still be real.

Eight states would be included, Mr. Cuomo said, when the restrictions took effect at midnight: Alabama, Arizona, Arkansas, Florida, North Carolina, South Carolina, Texas and Utah. Washington State had originally been included, but was dropped from the list after a further review of the data.

Travelers returning to New Jersey and Connecticut from those states would also be told to quarantine; their governors appeared with Mr. Cuomo to announce a tristate joint travel advisory. Mr. Cuomo said that enforcement would be up to each of the three states. Officials from New Jersey and Connecticut said there was no enforcement mechanism at the moment in their states.

In New York, those violating the quarantine order could be subject to a judicial order and mandatory quarantine, he said, and fines of up to $10,000. Mr. Cuomo also said that officials would not be stopping people at state borders to forbid them to enter, but that travelers were being asked to comply once they arrived.

A spokesman for Mr. Cuomo said that if a New Yorker believes that a recent arrival or a returning neighbor has not been abiding by the quarantine, then that person should start by reporting the possible violation to the local health department. Elsewhere in the U.S. where there are similar quarantines for travelers, there has not been widespread enforcement.

The goal, the governor said, was to maintain the hard-fought gains made in the region at great economic and human cost. For months, the state New York City particularly had been a global center of the pandemic. Hospitals filled to near capacity. Hundreds died each day, reaching a peak in mid-April. But on Wednesday, Mr. Cuomo said there were only an additional 17 deaths statewide.

New Yorks quarantine will not apply to Yankees and Mets players returning to the area to complete spring training, which can begin on July 1, Mr. Cuomo said, adding that the state had been working on separate health protocols with them since last week.

Elsewhere in New York:

The New York City Marathon has been canceled this year. City officials and organizers decided holding the race, the worlds largest marathon, would be too risky.

The mayor said that the city will close 23 more miles of streets to car traffic to provide more outdoor space while social distancing rules remain in place. The citys beaches will also be open for swimming and recreation on July 1 but with required social distancing.

Five upstate regions are set to enter Phase 4, the final phase of the states reopening plan, on Friday, Mr. Cuomo said. Indoor gatherings of up to 50 people will be allowed, and some arts and entertainment venues can open. Malls, movie theaters and gyms must remain closed.

New Jersey officials said on Wednesday that bowling alleys, museums, arcades, aquariums, batting cages, shooting ranges and libraries may reopen at 25 percent capacity on July 2. Gyms stay closed, though individual appointments with trainers can be scheduled, said the governor, who reported 48 more deaths on Wednesday.

The global economy will shrink 4.9 percent this year, the I.M.F. predicts in a dismal forecast.

The forecast underscores the scale of the task that policymakers are facing as they try to dig out from what the I.M.F. has described as the most severe economic contraction since the Great Depression. Even as countries begin reopening their economies, it is increasingly evident that the recovery will be uneven and protracted, particularly until the virus dissipates or a vaccine becomes available.

In an update to its World Economic Outlook, the I.M.F. said it expected the global economy to shrink 4.9 percent this year a sharper contraction than the 3 percent it predicted in April. The fund noted that, even as businesses began to reopen, voluntary social distancing and enhanced workplace safety standards were weighing on economic activity. Moreover, the scarring of the labor force from mass job cuts and business closures means that the world economy will recover much more slowly, with the I.M.F. projecting 5.4 percent global growth in 2021, far below its pre-pandemic projections.

The I.M.F. now projects that the U.S. economy will shrink 8 percent this year before expanding 4.5 percent next year. Economies in the eurozone are projected to shrink 10.2 percent this year and expand 6 percent next year. The economy of China, where the virus originated and which imposed draconian containment measures, is expected to expand 1 percent this year and 8.2 percent in 2021.

In the markets on Wednesday, the S&P 500 fell more than 2 percent by midafternoon, erasing gains from earlier in the week, as investors confronted new signs of the pandemics persistence. Shares of retailers, airlines and cruise companies which are proxies for sentiment about the prospects of a recovery are faring poorly. Nervousness about the economic outlook was evident in oil prices, and shares of energy companies also declined.

In Yemen, the toll of the pandemic is rising. So is the cost of a burial.

The top U.N. relief official warned Wednesday of a drastic worsening in the outbreak in war-ravaged Yemen, the Arab worlds poorest country, where he said 25 percent of those infected die about five times the global average.

As Covid-19 sweeps the country, many deaths are most likely going unreported, said Mark Lowcock, the under secretary general for humanitarian affairs. But there is one unmistakable measure of the viruss toll: Burial prices in some areas have increased by seven times compared to a few months ago, he said.

The United Nations has been chronically hampered in providing aid to Yemen, where a Saudi-led coalition has been waging war on the rebel Houthi group for more than five years.

Even before the pandemic, the devastation caused by the war had left a vast majority of Yemens population hungry, destitute and afflicted with preventable diseases, including cholera and diphtheria. Millions of Yemeni children are malnourished, and some have died of starvation.

Mr. Lowcock spoke Wednesday at a United Nations Security Council briefing on the conflict, held three weeks after a major donor conference to raise money for the humanitarian emergency in Yemen secured $1.35 billion in pledges.

That was about half what was pledged a year earlier and many of the pledges, Mr. Lowcock said, have not yet been paid.

If donors fail to make good on their pledges, he said, at a minimum, we can expect many more people to starve to death and to succumb to Covid-19, and to die of cholera, and to watch their children die because they are not immunized for killer diseases.

The pandemic could erase 20 years of progress against tuberculosis, H.I.V. and malaria, an NGO warns.

In low-income nations, the pandemic may erase 20 years of hard-fought progress against tuberculosis, H.I.V. and malaria, diseases that together claim more than 2.4 million lives each year.

A report released on Wednesday estimates that countries hit hard by these diseases will need at least $28.5 billion over the next year to shore up health campaigns and to respond to the pandemic itself. The figure does not include costs associated with a vaccine, assuming one is found.

Updated June 24, 2020

A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise comes with issues of potential breathing restriction and discomfort and requires balancing benefits versus possible adverse events. Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. In my personal experience, he says, heart rates are higher at the same relative intensity when you wear a mask. Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

The toll is most severe in nations already strapped for resources. The pandemic has overwhelmed fragile health care systems in those countries, disrupting programs for preventing and treating tuberculosis, H.I.V. and malaria. Restricted air and sea transport also threatens the availability of crucial medicines.

Several models produced by the World Health Organization and others project that deaths from these diseases could double as a result. Treatment interruptions also raise the threat of drug resistance, already a formidable problem in many countries.

The stakes are extraordinarily high, Peter Sands, who heads The Global Fund, a public-private partnership that published the estimates, said in a statement. The knock-on effects of Covid-19 on the fight against H.I.V., T.B. and malaria and other infectious diseases could be catastrophic.

Since March, The Global Fund, which works mostly in sub-Saharan Africa and Southeast Asia, has provided $1 billion to help countries maintain their campaigns against these diseases. In the new report, the organization said that amount served only as a stopgap measure.

The Global Fund estimated that countries would need more than $13 billion to protect front-line health care workers and shore up their health systems, about $9 billion to develop and deploy treatments, and nearly $5 billion for diagnostics.

A state-run veterans home in Massachusetts was total pandemonium and a nightmare in late March, when a series of blunders contributed to the rapid spread of the virus at the home and the deaths of 76 patients, employees told investigators.

A blistering 174-page independent report on the outbreak at the Holyoke Soldiers Home, released on Wednesday, paints a picture of a facility in chaos, as traumatized nurses carried out orders to combine wards of infected and uninfected men, knowing that the move would prove deadly to many of their patients.

One social worker told investigators that she felt it was like moving the concentration camp we [were] moving these unknowing veterans off to die, the report said.

More than 60 percent of fatalities from the coronavirus in Massachusetts have been at nursing homes.

In addition to combining crowded wards, the report said, the home rotated staff members between the wards; discouraged them from using protective gear in an effort to conserve limited supplies; and often failed to isolate infected veterans or to test those who had symptoms.

In short, this was the opposite of infection control, the report said.

Thousands of employees with the federal agency that administers the countrys immigration system are expected to begin receiving furlough notices as applications for green cards, citizenship and other programs drop, Zolan Kanno-Youngs reports.

At one office, where well over half the employees were warned to expect furlough notices, staffers were told that the agency was focused on retaining jobs that keep the lights on, according to an email obtained by The New York Times.

LaDonna Davis, a spokeswoman for the agency, said that more than 13,000 employees should expect to receive the notices in early July.

This dramatic drop in revenue has made it impossible for our agency to operate at full capacity, she said. Without additional funding from Congress before Aug. 3, U.S.C.I.S. has no choice but to administratively furlough a substantial portion of our work force.

The agency has asked lawmakers for $1.2 billion, citing economic damage from the pandemic.

But critics say the problem lies not with the recession but with the Trump administrations restrictionist immigration policies, which have led to backlogs and skyrocketing denials. The agency relies on application fees to fund most of its operations.

Evan Hollander, spokesman for the Democratic-controlled House Appropriations Committee, said the Office of Management and Budget had provided a letter to the committee with virtually no information on the shortfall or their proposed remedies. He said Democratic lawmakers were prepared to discuss the financial situation with Republicans.

Citizenship and Immigration Services officials have told Congress they would repay the funds to the Treasury Department by adding a 10-percent surcharge to applications.

In the email obtained by The Times, Jennifer Higgins, associate director of the office that deals with asylum and refugee applications, said the agency would send furlough notices to 1,500 of its 2,200 employees. It will to retain people whose duties include border screenings, refugee case completions and parole requests, she said.

Global roundup

President Vladimir V. Putin of Russia on Wednesday celebrated his countrys victory 75 years ago against Nazi Germany, presiding over an enormous military parade through Red Square in Moscow that featured thousands of soldiers marching shoulder-to-shoulder without face masks.

The parade, the largest of several celebrations taking place nationwide, was originally scheduled for May 9, an annual holiday known as Victory Day, but was delayed for six weeks by the pandemic. The outbreak continues to grow in Russia the worlds third-worst-affected country, with more than 600,000 cases but at a slightly slower pace than before.

Aging veterans in their 80s and 90s joined Mr. Putin on the reviewing stand, nearly all of them without masks, to watch 14,000 troops march by.

Kremlin critics have accused Mr. Putin of gambling with public health to put himself at the center of a gigantic display of Russias military might and to rally support ahead of a nationwide vote on his future. Voting on constitutional amendments that would allow Mr. Putin to stay in power until 2036 starts on Thursday.

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U.S. Sets Record for Daily New Cases as Virus Surges in South and West - The New York Times