Category: Corona Virus

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It hasnt even been five months since health officials in Wuhan, China, reported unusual pneumonia cases to the World Health Organization.

But those five months have been the most active in the history of epidemiology. Since that report, weve learned so much about the coronavirus. One of the most important lessons? How the disease is spread.

In particular, so-called superspreading events seem to be a major cause of infections. One London School of Hygiene analysis suggested that 80% of the secondary transmissions were caused by just 10% of infected people. In other words, if you want to avoid getting COVID-19, one of your major focuses should be avoiding a superspreading event.

So as Utahns leave their homes and reengage with society, we thought now would be a good time to scour the research to note where these events have been documented and where they havent. We can also learn about the circumstances that led to each superspreading event, and do our best to avoid them.

The result is the following compendium, in alphabetical order, of public places and the lessons we can learn.

Because of South Koreas frankly incredible contact tracing operation, we know a lot about these cases. Researchers say 5,517 people attended the five spots the man visited during the timeline of possible spread. But because these were gay clubs and homosexuality isnt always accepted in Korea many wrote down fake names upon entry. As a result, Korean health officials hadnt been able to contact about 700 of them as of May 13.

We also know a lot about the secondary cases. For example, a 25-year-old teacher got the virus at one of those clubs and later infected 11 people, including five students at the school. As a result, 1,000 members of the church that those students attend have been told to stay home and monitor for symptoms.

In all, over 35,000 people have been tested in relation to this cluster. 35,000! And 8,500 police officers were deployed to stop the outbreak. In reaction, South Korea pushed back opening schools one week. But about a month later, Koreas efforts to quarantine those associated with the cluster seem to have worked.

Dance floors are probably incompatible with social distancing.

High-capacity bars and clubs are going to be potential locations of superspreading events.

Japanese public broadcaster NHK, in consultation with local health experts, got 10 people to dine at a buffet. They put fluorescent paint on the hands of one person to simulate the virus after a sneeze or cough. After 30 minutes, they turned the black light on to see where the virus had gotten.

The answer: everywhere. Peoples hands, faces, plates, napkins, and more were covered with the virus-simulating paint.

Salad bar restaurants like Souplantation and Sweet Tomatoes have decided to permanently close. In Utah, during the moderate and low stages of virus risk, buffets must be served by a restaurant employee; they cant be self-serve.

Self-serve buffets probably create an unmanageable amount of viral spread.

In January, an asymptomatic woman who had recently been to Wuhan took a bus with 66 other passengers to a worship event at a Buddhist temple. She felt sick after returning home.

The ride was 50 minutes each way and passengers stayed in the same seats on both legs of the trip. Of the 66 passengers, 24 were infected. There was no statistically significant correlation between how close the passengers sat to the woman labeled IP below and whether or not they got the disease. Many further than 6 feet away caught it.

The bus air-conditioning was set to recirculation mode. The studys authors note that all passengers who sat next to a window on the left side of the bus where the air-conditioning vents were remained healthy other than the one person who sat next to the sick woman, but they dont know if thats by chance or due to air circulation patterns.

In closed, small environments, virus transmission can occur throughout a room.

Keeping outside ventilation high on buses seems to be a worthwhile goal.

Bus drivers should receive protective gear to prevent infection.

The choir met every Tuesday evening until March 10. At that last meeting, 61 members were present and chairs were arranged close together in six rows of 20 with many empty chairs. They practiced for 40 minutes together, for 50 minutes separated into two smaller groups, and then for 45 minutes sang together again. There was a 15-minute break between the second and third session for oranges and cookies, but many didnt eat.

No one reported physical contact between members and most everyone left immediately after practice. Hand sanitizer was distributed.

But, in the end, 53 of the 61 contracted the coronavirus. Three were hospitalized, two died. Interestingly, the CDC did find someone who had coldlike symptoms in the choir beginning March 7 that person is the most likely Patient Zero in this case, but its not certain that person was responsible for the spread.

This seems to happen repeatedly. The Amsterdam Mixed Choir gave a performance March 8, then 102 out of 130 singers tested positive. Fifty members of the Berlin Cathedral Choir tested positive as well.

Singing appears to significantly raise the likelihood of transmission.

On Tuesday, the CDC released a report about a rural Arkansas church. The pastor and his wife began feeling sick March 10 and 11 after hosting a three-day childrens event a few days earlier.

The event included 1.5 to 2 hours of indoor church services on each day. The children also competed each day to collect offerings from adults. There was some singing, in which most children and some adults took part. On one day, the church hosted a buffet.

After an investigation, another husband and wife said they were symptomatic during the childrens event. On March 11, the church hosted a Bible study, though the pastor said people followed social distancing procedures.

In all, 92 people attended the church between March 6 and 11, and of the 45 tested, 35 became infected, seven were hospitalized, three died.

The Washington Post has a good review of what happened in a church in South Korea on a larger scale. Patient No. 31 in South Korea went to her Shincheonji church while sick, and a month later, the cluster had accounted for 5,080 cases, more than half that nations total. Wow.

Churches can be the site of community-changing superspreading events.

High-risk activities like singing and buffets may make church gatherings more dangerous.

This story is heartbreaking.

In February, a man who had recently traveled out of state attended a close family friends funeral in Chicago. He was experiencing minor symptoms at the time. The night before, he attended a potluck-style meal with the family of the deceased, and reported hugging some of them. Four of those he hugged would contract the virus. One died.

Three days after the funeral, the same condolence-giving, out-of-state-traveling man went to a birthday party for a member of his own family, which nine people attended. The man embraced others and shared food. Seven of the nine became infected; two of them died.

Some of the people this man infected passed the virus on to others, including a fellow churchgoer and health care professionals.

This one poor guy went to a funeral and birthday party and it led to the infection of 16 people and three deaths. We know more about the disease than we did in February. Dont be that guy.

Avoid hugging and sharing food, especially while sick.

One manager concealed a report of coronavirus in his store in the Shandong province of China. Later, 17 people tested positive.

But theres relatively little evidence that says grocery stores are the site of superspreading events, and given that they have stayed open throughout the crisis, youd think wed know by now. There was one study that used a computer model for how airborne particles would spread in a grocery store, but a computer model isnt reality.

Constant movement in spacious buildings probably helps prevent exposure to coronavirus droplets.

In Cheonan, South Korea, a workshop for Zumba fitness instructors Zumba is surprisingly big in Korea was held Feb. 15. Of the 27 instructors in attendance, eight eventually tested positive.

These instructors then went to their communities and taught two 50-minute Zumba classes each week. By March 9, less than a month later, there were 112 cases tied to this Zumba workshop; 57 were students of the positive instructors, the rest secondary infections from those students. In all, those classes had 217 students attend, for an infection rate of about 26%.

Of the eight positive instructors, there were two who led most of the classes where people got sick. One held a class in a gym that had five students but three got infected. Later, another COVID-19 positive instructor taught Pilates and yoga to 25 people in that same room. None got the virus.

Two hypotheses: Either the Pilates instructor wasnt as contagious as the Zumba instructor, or high-intensity dance classes like Zumba mean more heavy breathing and therefore more virus-laden droplets than low-intensity Pilates.

Gyms can quickly spread the coronavirus, especially when instructors become infected.

High-intensity workouts may be more dangerous than low-intensity workouts, though thats unclear.

In Wenzhou, China, 34 people were infected in a shopping mall. The clusters first recorded case involved a person who worked on the malls seventh floor, where it quickly spread to other nearby employees.

A few days later, staff who worked on lower floors started getting the disease, and a few days after that, customers started getting infected.

However, the staff with the virus on the floors below No. 7 and the customers who tested positive all denied knowingly coming into contact with one another. Its possible they all brought the disease to the mall separately, but given that they all developed symptoms at nearly the same time and the high number of cases associated with this mall, its unlikely. Everyone did share restrooms and elevators, which could explain spread from floor to floor or store to store.

In another case in Tianjin, China, 21 people were infected in a mall department store: six staff, and 15 customers over the course of five days. The store was especially crowded for Chinese New Year, so reports were that up to 10,000 people would need to be quarantined because they visited during the outbreak period. The studys authors struggled to figure out the diseases spread through the store staff and customers.

Thanks to high traffic numbers, one mall or large store can infect many people, even though the likelihood of any individual customer being infected is low.

In early March, the South Korean version of the CDC was informed about an outbreak in a call center in a 19-story building. The first 11 floors are commercial offices the call center is on floors 7-9 and 11. Residents in apartments live on the floors above that.

In response, South Korea just started testing everyone. That included 811 people at the call center, 111 people who work in the floors below, 203 people who live in the apartments above, and 20 visitors.

Of those 1,145 people, 97 tested positive and 94 of them worked on the 11th floor in the call center. The other three worked on the 10th or ninth floor. In fact, 89 of the 97 worked on the same side of the same floor of the call center. Positive cases are in blue.

As the study notes, residents and employees in the building had frequent contact in the lobby or elevators, but as you can see, widespread transmission didnt occur there. The vast majority of it happened in the 11th floor on one side of the call center.

The most dangerous method of transmission in an office is spending a long time near an infected person.

Using shared facilities like restrooms with an infected person appears to be less dangerous.

Spending a short amount of time with an infected person, like on an elevator ride, is not especially dangerous.

Jobs with frequent talking, like call centers, do appear to have elevated risk for superspreading.

We dont have any direct studies on COVID-19s transmission on airplanes, but we do have some on a related coronavirus: SARS-CoV-1.

On one plane, a 72-year-old infected man with a cough in seat 14-E of a flight from Hong Kong to Beijing ended up passing SARS to 18 passengers and two flight attendants. The flight was about three hours long. While those seated at the very front and very back of the plane were safe, those infected included those within several rows of the man, including on the other side of the aisle.

Other planes studied, however, did not have that level of transmission. As researchers studied the introduction of SARS to France, a nearly 15-hour flight from Hanoi to Paris infected only two of the 69 people aboard. On two other flights with an infected SARS passenger, only one person out of 561 people was infected. Both of those flights were shorter, though, just 90 minutes long.

A recent opinion piece in The Washington Post from Joseph Allen, a professor of exposure assessment science at Harvard, asserted that You dont get sick on airplanes any more than anywhere else, because the ventilation system requirements for airplanes meet or exceed CDC regulations for COVID-19 rooms in hospitals.

Dont go on a plane with a cough. Everyone should wear a mask.

If there is someone with a cough, those viral particles can likely travel more than 6 feet, but probably not throughout the plane.

The odds of an outbreak on any individual plane trip are low.

In Wisconsin, 400,000 people went to various polling locations to vote in the April 7 primary election. Since then, people have wanted to know whether the in-person voting led to a spike in coronavirus cases.

At the end of April, the Wisconsin Department of Health announced that 52 voters or poll workers had tested positive so far. However, it wasnt clear if that was more than the normal number of cases youd expect.

Three studies have looked at the issue since. One, released April 28 by a team from a Milwaukee hospital, found that coronavirus rates actually declined in the 10 days after the voting when compared to the 10 days before it.

A second study released a day later from researchers at Stanford looked at hospitalization rates as well, and also didnt find any increase after the election.

However, a third study released May 11 found that counties with higher numbers of in-person voting per location did have higher coronavirus rates after the election. Researchers estimated that when the number of voters per location increased by 100, a 3.5% increase in coronavirus rates was found.

Regardless, the election clearly did not cause a huge spike, like some doomsayers predicted. This could be due to the precautions polling places and voters took, or it could be that quick interactions like voting are unlikely drivers of coronavirus transmission.

In-person voting either has a small or neutral impact on coronavirus spread when precautions are taken.

There were 18 coronavirus cases split evenly, nine students and nine staff. But out of 863 close contacts with those people of which 384 were tested only two secondary cases were discovered: one in a high school, and one in a primary school. Thats a tiny transmission rate.

However, the schools werent necessarily operating as normal. Many kids chose to stay home, which may have made social distancing more feasible. Large assemblies were avoided, and more outdoor classes were held.

Still, because schools have been closed nearly everywhere, were not certain that the virus cant effectively spread in classrooms. And theres still a lot of mystery here: Serology studies show that kids are getting the virus somehow, and viral load studies are showing kids have just as much virus in their throats as adults, so why havent we witnessed spread in schools?

Schools are a significant source of spread for other diseases like influenza, but so far, not the coronavirus. We dont know why.

A individual who has contact with an infected child in a school is unlikely to be infected.

Sports venues and stadiums

It was a great day for Atalanta. On Feb. 19, the Italian soccer team from Bergamo defeated Spains Valencia 4-1 in the Champions League, the pinnacle of European soccer. About 40,000 people from Bergamo went to watch the match in the San Siro stadium in Milan.

It also led to a virus explosion in Bergamo a week later.

Its very probable that 40,000 Bergamo citizens in the stands of San Siro, all together, exchanged the virus between them, Bergamo Mayor Giorgio Gori said on Facebook. So many Bergamaschi that night got together in houses, bars to watch the match and did the same.

A journalist who covered the match was Bergamos second positive case. And then 35% of Atalantas staff tested positive. More than a third of Valencias players would eventually test positive. The director of health there called the match a biological bomb.

This can happen on a smaller scale, too. On March 6, 2,800 people showed up for sectional basketball semifinals at a high school in Lawrence, Ind. While testing wasnt widespread, five of the attendees would later die, and at least a dozen others tested positive or had virus symptoms. Decatur County, Indiana had a per-capita death rate that was twice as high as any other Indiana county they blamed their spread on another high school basketball game.

Getting thousands or tens of thousands of people together in one building can result in community-changing biological bombs."

Sports celebrations (singing, hugging, cheering) could potentially mean more spread.

Go here to read the rest:

How the coronavirus spreads in those everyday places we visit - Salt Lake Tribune

A woman wearing a face mask and goggles walks through LAX airport in Los Angeles on Friday. Apu Gomes/AFP via Getty Images hide caption

A woman wearing a face mask and goggles walks through LAX airport in Los Angeles on Friday.

Each week we answer pressing coronavirus questions. We'd like to hear what you're curious about. Email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions."

How big a risk is it to catch the virus through your eyes? Should people be wearing eye protection?

Virologist and epidemiologist Dr. Joseph Fair recently became ill, and he believes he got COVID-19 through his eyes. Fair told NBC's Today from his hospital bed last week that he had been on a crowded flight two weeks earlier, and though he wore a mask and gloves and wiped down his seat, he didn't have any protection over his eyes. "You can still get this virus through your eyes, and epidemiologically, it's the best guess I have of probably how I got it," Fair said. He said his symptoms started three or four days later, though his four tests for the virus were negative.

The notion that you can get the virus through your eyes isn't new, but it has been little discussed compared with the risk of infection through the nose and mouth.

The CDC says that while the nose and mouth are the main avenues by which someone catches the coronavirus, "it may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes."

"Based upon what we know, I would say that the possibility of acquiring it on the surface of your eye is possible. It's certainly plausible," says Dr. Thomas Steinemann, a spokesperson for the American Academy of Ophthalmology and professor of ophthalmology at MetroHealth Medical Center in Cleveland.

"Any sort of open mucosa [mucous membrane] is a chance for a droplet to land there and get into your body," says Dr. Abraar Karan, a physician at Harvard Medical School. But while it's known that the virus can be transmitted through the eyes, "it's hard to quantify exactly what the risk is in terms [of] through the eye specifically."

For most cases, it's impossible to determine with certainty the initial avenue of someone's infection that is, whether a person was infected via their mouth, nose or eyes. And the evidence so far suggests that eyes are not a primary mode of transmission.

If a lot of people were being infected through their eyes, there would be more COVID-19 patients with conjunctivitis inflammation of the eyes, also known as pink eye.

If the virus invades and infiltrates your conjunctiva the clear tissue covering the white part of your eye and the inside of your eyelids likely "there's going to be inflammation or redness in your eyes," Steinemann says. Of course there are many other causes for conjunctivitis, though, so getting pink eye doesn't necessarily mean you have COVID-19.

So far, studies have found that among hospitalized COVID-19 patients, only a small percentage of those who had the fluid in their eyes swabbed for the virus did in fact test positive for the virus in their eyes.

It should be noted, though, that eye swabbing is not standard practice for COVID-19 patients in part because most people don't have much eye fluid, so swabbing it is uncomfortable.

And there's another reason why eyes are not a likely way to be infected with the coronavirus: The pathway from your eyes into your respiratory system is less direct than via your nose and mouth.

If an infectious person coughs or sneezes in your face, and you breathe in through your mouth or nose, not only are you going to receive a sizable viral dose, "you're going to get a fairly direct hit into your airways," Steinemann says.

But to infect you via your eyes, the virus would have to penetrate your eyes' mucous membrane, be washed by tears behind your cheeks into your nasal cavity, and then flow from the nose into your throat. "It's a more circuitous route," says Steinemann.

Our eyes have a number of defense mechanisms that help protect against infection, like eyelids that blink to cover the eye and tears that contain immunoglobulins that fight invaders.

"You blink really easily any time even a puff of air goes near your eye," says Dr. Emily Landon, hospital epidemiologist and infectious diseases specialist at University of Chicago Medicine. "So if somebody coughs or sneezes near you, you're really likely to close off your eyes. That's good. Whereas your mouth and nose don't do that."

A Starbucks employee wears a face shield and mask as she makes a coffee drink at Ronald Reagan Washington National Airport in Arlington, Va., last week. Andrew Caballero-Reynolds/AFP via Getty Images hide caption

A Starbucks employee wears a face shield and mask as she makes a coffee drink at Ronald Reagan Washington National Airport in Arlington, Va., last week.

What precautions should you take to protect your eyes?

The basic precautions against the coronavirus still hold when it comes to your eyes, says Steinemann: Wash your hands, practice social distancing and "don't touch your face" also means don't rub your eyes.

With some airlines now asking flight attendants to wear safety goggles Qatar Airlines is the latest to announce this plan the general public might wonder: Should others do the same?

Karan says that in health care settings, eye coverings are immensely important. "We definitely don't go into [coronavirus patients'] rooms without eye coverings." He says other jobs that require people to work face-to-face, like a barber, might also choose to wear a full-face clear plastic shield.

Steinemann also says whether you need eye protection depends on your job. If you work in an office where you don't have to be in close proximity to people to others, you should be fine without eye protection.

On the other hand, he says, "if you are in close proximity to somebody screaming at you or talking to you or coughing in your face, or if you work in a hospital, suctioning people who are in an intensive care unit those types of situations are extremely high risk, not only to your nose and your mouth, but also to your eyes. In a high-risk situation, I would definitely recommend the use of a full-face shield and goggles."

You don't need to be wearing a face shield on your walk around the neighborhood or your visit to the grocery store, he notes. For those situations, he recommends wearing a mask and practicing good hygiene and social distancing.

And what about the case of the virologist on the packed airplane?

Steinemann says if he was on a crowded airplane and unable to keep distance from other passengers, "Yeah, I think I might wear a face shield and a goggle in that setting."

Landon says that she has face shields at her home but has not yet found an activity where it felt necessary for her family to wear them. "But I am going to ask my mom to wear one when she takes a plane home from Florida if I let her take the plane home from Florida."

Read this article:

Can You Catch Coronavirus Through The Eyes? Will Goggles Reduce The Risk? : Goats and Soda - NPR

Editors note:This is a live account of COVID-19 updates fromSaturday, May 23,as the day unfolded.Click hereto find resources and the latest extended coverage of the pandemic.

phase two of Washingtons reopening only days away, Gov. Jay Inslee said Friday some counties wont be able to open small businesses like barbershops, hair salons and in-store dining by June 1 under his four-part coronavirus plan.The announcement didnt say which counties would see those delays, but Inslees office released numbers ranking counties by the criteria he used earlier this week to make 10 additional counties eligible to start the second phase before June 1. Heres more on what each phase means.

While churches and other house of worship in Washington remain closed under Inslees plan, President Donald Trump on Friday deemed them essential and called ongovernors to allow them to reopen this weekend. If governors dont abide by his request,he will override them, he said though its unclear what authority he has to do so.

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

The following graphic includes the most recent numbers from the Washington State Department of Health, released Friday.

State health officials confirmed 320 new COVID-19 cases in Washington on Saturday night, including five more deaths.

The recent update brings the state's totals to 19,585 cases and 1,055 deaths, according to the state Department of Healths (DOH) data dashboard. The dashboard reports 3,256 total hospitalizations in Washington.

So far, 316,276 tests for the novel coronavirus have been conducted in the state, per DOH. Of those, 6.2% have come back positive.

Paige Cornwell

As of 9 p.m. Saturday, the Washington State Department of Health had not updated its numbers of confirmed COVID-19 cases and deaths since May 22. The Seattle Times' graphic currently reflects numbers as of May 21.

Once the state provides new data, we will update our daily graphic with the latest COVID-19 numbers in Washington state, as usual, at seattletimes.com and in the print edition.

Paige Cornwell

The Northwest Folklife Festival announced in April that the Seattle Center institution is postponed. The postponement marks the first time in 49 years that the festival will not be held over Memorial Day weekend. A makeup date was not given. Instead, Folklife is offering online programming.

View the photo gallery here.

Alan Berner

Twenty-one of Washingtons 39 counties have now been approved to move into the second stage of Gov. Jay Inslees four-phase coronavirus recovery planfollowing the governors expansion of criteriathis week that allowed more counties to apply for reopening.

The second phase of recovery allows several kinds of businesses, including hair salons and restaurants, to welcome back customers two months after Inslees stay-at-home order went into effect, albeit with some with restrictions.

As of this week, counties that have fewer than 10 new COVID-19 cases per 100,000 people over the span of 14 days were allowed to apply for reopening with the Department of Health (DOH). To be approved for Phase 2, counties must also demonstrate that their hospitals are prepared to handle a return of the disease.

Ten smaller counties had been approved to reopen earlier this month. By Saturday, DOH had approved 11 more: Adams, Cowlitz, Grant, Grays Harbor, Island, Jefferson, Lewis, Mason, Pacific, San Juan and Spokane counties.

Read the full story here.

Sydney Brownstone

Kittitas County health officials are directing all residents to wear a face covering if they are indoors, or in a confined public setting with anyone who doesnt live in their household, to slow the spread of COVID-19.

The directive, effective Saturday, applies to spots like grocery and commercial retail stores, restaurants and public transportation. The Kittitas County Public Health Department advises residents to use cloth masks, scarves and bandanna coverings to conserve medical-grade masks for health-care workers.

Residents who violate the directive wont be issued a citation; the directive may and should be used to educate, encourage and persuade individuals to wear face coverings, according to the health department.

There have been 66 positive cases of COVID-19 and zero deaths reported in Kittitas County, according to the Washington State Department of Health. More than half the cases are connected to an outbreak at Twin City Foods in Ellensburg.

Paige Cornwell

Though Washington State Ferries has advised customers to limit travel on ferries, the agency reported a two-hour wait Saturday afternoon for drivers departing from Mukilteo to Whidbey Island and a one-hour wait for drivers in Edmonds for the ferry to Kingston.

Travelers on ferries are encouraged to wear face coverings, and drivers should remain in their vehicles whenever possible. Some ferry sailings may limit the number of walk-on passengers, according to the agency.

About 500,000 people typically ride a ferry over Memorial Day weekend each year. On Friday, ridership was down between 7% and 81% on each route compared to the Friday before the holiday last year, according to Washington State Ferries data.

Paige Cornwell

A coronavirus outbreak has infected 24 employees and shut down the Philadelphia Macaroni Co. plant in Spokane.

The company confirmed Friday that 24 workers out of 72 tested positive for COVID-19 this week, just as state officials Friday declared Spokane County ready to reopen parts of its economy after two months of pandemic lockdown.

In a news release, the company says it has tested all of its employees and disinfected the facility. It said it is evaluating a reopening timeline.

The outbreak led to a jump in Spokane Countys confirmed COVID-19 cases. Spokane had gone the entire month of May with no more than five COVID-19 cases reported every day. But there have been 31 confirmed cases reported in the county in the last two days.

Employees at the Philadelphia Macaroni plant have been working throughout the pandemic with increased safety protocols, such as more sanitation processes and employee training. The company is considered an essential business, and makes the pasta that goes into macaroni and cheese.

Philadelphia Macaroni requires employees to wear masks, and employees are screened before they enter the factory. The company is working with the Spokane Regional Health District to conduct contact tracing as well as to determine further outbreak prevention measures.

Read the whole story here.

The Spokesman-Review

Under normal circumstances in a presidential-election year, Puget Sound voters might encounter numerous local government tax requests on summer or fall ballots.But in 2020, political considerations have been reshaped by the coronavirus crisis.

The King County Library System had planned to ask voters in August for a property tax levy to raise about $75 million a year in additional revenues. But officials have called that off.

With these things, timing is everything. Now is not the right time to ask the voters, said Lisa Rosenblum, executive director of the 50-library system.

The best bet to reach the November ballot in King County is a property tax increase for Harborview Medical Center, which County Executive Dow Constantine sent to the county council last month.

Backed by unions that represent health care and construction workers, the proposal would authorize a 20-year, $1.74 billion bond to build a new hospital tower and carry out other upgrades at the only Level 1 trauma center in Washington. The annual average cost over that time would be $68 for a home of median assessed value.

Seattle also may ask voters to approve a bus service tax. A so-called Amazon tax on large corporations in Seattle could qualify as an initiative, though the virus has complicated signature collecting.

Several other potential measures appear dead in the water. In addition to the county libraries levy, a county transit tax has been ruled out, and the odds are stacked against a county arts tax. Officials in Snohomish and Pierce counties also said they plan no countywide tax ballot measures this year.

Read the whole story here.

Jim Brunner and Daniel Beekman

The coronavirus may still be spreading at epidemic rates in 24 states, particularly in the South and Midwest, according to new research that highlights the risk of a second wave of infections in places that reopen too quickly or without sufficient precautions.

Researchers at Imperial College London created a model that incorporates cellphone data showing that people sharply reduced their movements after stay-at-home orders were broadly imposed in March. With restrictions now easing and mobility increasing with the approach of Memorial Day and the unofficial start of summer, the researchers developed an estimate of viral spread as of May 17.

It is a snapshot of a transitional moment in the pandemic and captures the patchwork nature across the country of COVID-19, the disease caused by the virus. Some states have had little viral spread or crushed the curve to a great degree and have some wiggle room to reopen their economies without generating a new epidemic-level surge in cases. Others are nowhere near containing the virus.

The model, which has not been peer reviewed, shows that in the majority of states, a second wave looms if people abandon efforts to mitigate the viral spread.

Theres evidence that the U.S. is not under control, as an entire country, said Samir Bhatt, a senior lecturer in geostatistics at Imperial College.

Read the whole story here.

The Washington Post

Some Washington religious leaders are rejecting President Trump's call to restart large, in-person worship gatherings.

Trump on Friday labeled churches and other houses of worship "essential" and called on governors to let them reopen this weekend despite coronavirus lockdowns. He also threatened to "override" governors who defy him.

In a statement Friday, the Washington Catholic State Conference said the public celebration of Mass was suspended "not out of fear, but out of our deepest respect for human life and health."

The statement was signed by Seattle Archbishop Paul Etienne, as well as Yakima Bishop Joseph Tyson, Spokane Bishop Thomas Daly, and Auxiliary Seattle Bishops Eusebio Elizondo and Daniel Mueggenborg.

Their statement added:"Our love of God and neighbor is always personal and not partisan. While we share the desire to bring people back to Mass as quickly as possible, we will wait to schedule our public worship when it is safe and we are prepared to do so."

Etienne and the other leaders said they are preparing parishes across the state for eventually re-opening in a manner that "not only is safe, but is liturgically reverent." No date for reopening has been set.

A similar message came from the Council on American-Islamic Relations-Washington (CAIR-WA), which said while religious services are "an essential part of our faith" right now "public gatherings are not an option."

The statement by Masih Fouladi, executive director of CAIR-WA, said at a time when healthcare workers are risking their lives "we must do our part" to protect the workers and the public.

Fouladi added: "And we will not follow the lead of a President who suggests injecting people with disinfectants and who refuses to follow basic CDC guidelines like wearing a mask in public."

He said mosques and Muslim leaders "are doing everything they can to keep people safe and connected to their faith as we approach the end of Ramadan and prepare for Eid" and would continue to follow the guidance of Gov. Jay Inslee and public-health officials.

Jim Brunner

Continue reading here:

Coronavirus daily news updates, May 23: What to know today about COVID-19 in the Seattle area, Washington state and the nation - Seattle Times

Some White House officials suggest deaths are overcounted. Experts disagree.

As the United States continues its advance toward 100,000 coronavirus deaths, a grim milestone the country is expected to reach in the coming days, President Trump and members of his administration have begun questioning the official coronavirus death toll, suggesting the numbers are inflated.

Last Friday, Mr. Trump told reporters that he accepted the current death toll, but that the figures could be lower than the official count, which now totals more than 95,000.

Most statisticians and public health experts say he is wrong; the death toll is probably far higher than what is publicly known. People are dying at their houses and nursing homes without ever being tested, they say, and deaths early this year were likely misidentified as influenza or described only as pneumonia.

Dr. Deborah L. Birx, the White Houses coronavirus response coordinator, has said publicly that the American health care system incorporates a generous definition of a death caused by Covid-19.

There are other countries that if you had a pre-existing condition, and lets say the virus caused you to go to the I.C.U., and then have a heart or kidney problem some countries are recording that as a heart issue or a kidney issue and not a Covid-19 death, she said at a White House news conference last month.

In a brief interview on Thursday, Dr. Birx stressed that there had been no pressure to alter data. But concerns about official statistics are not limited to the death toll, or to administration officials.

Epidemiologists said they were stunned to learn that the C.D.C. is combining tests that detect active infection with those that detect recovery from Covid-19 a system that muddies the picture of the pandemic but raises the percentage of Americans tested as President Trump boasts about testing.

Experts said that data from antibody tests and active virus tests should never be mixed.

It just doesnt make any sense, said Natalie Dean, a biostatistician at the University of Florida. All of us are really baffled.

Epidemiologists, state health officials and a spokeswoman for the C.D.C. said there was no ill intent; they attributed the flawed reporting system to confusion and fatigue in overworked state and local health departments that typically track infections not tests during outbreaks.

Trump demands that governors let houses of worship reopen.

President Trump stepped into the culture wars again on Friday, taking the side of some religious leaders against governors who have moved slowly in reopening places of worship amid the pandemic.

Without any clear authority to do so, Mr. Trump said that he was calling houses of faith, including churches, synagogues, and mosques, essential services and urged governors to reopen them right now.

Today I am identifying houses of worship churches, synagogue and mosques as essential places that provide essential services, Mr. Trump said at a hastily scheduled briefing at the White House on Friday. Some governors have deemed liquor stores and abortion clinics as essential but have left out churches and other houses of worship. Its not right.

After he spoke, the Centers for Disease Control and Prevention issued a number of long-delayed guidelines with suggestions for steps that houses of worship can take to curb the spread of the virus. Among them was a recommendation that religious officials defer to the directive of state and local governments.

Still, the president threatened to override the governors if they did not follow his order, though it was not immediately clear what powers he was claiming. I call upon governors to allow our churches and places of worship to open right now, he said. If theres any question, theyre going to have to call me, but theyre not going to be successful in that call.

When the C.D.C. recently released a set of guidelines for reopening, its report largely mirrored an earlier draft version that the White House had rejected because Trump administration officials worried that the suggestions infringed on religious rights.

On Friday the C.D.C.s new guidelines for religious communities suggested that they consider a number of limitations to keep congregations safe. Among them:

Take steps to limit the size of gatherings in accordance with the guidance and directives of state and local authorities.

Consider suspending or at least decreasing use of a choir/musical ensembles and congregant singing, chanting, or reciting during services or other programming, if appropriate within the faith tradition. The act of singing may contribute to transmission of Covid-19, possibly through emission of aerosols.

Consider temporarily limiting the sharing of frequently touched objects that cannot be easily cleaned between persons, such as worship aids, prayer rugs, prayer books, hymnals, religious texts and other bulletins, books, shared cups, or other items received, passed or shared among congregants.

Mr. Trump said Friday at the White House that the nation needs religion. In America, we need more prayer, not less, he said. He left without taking questions.

David Postman, the chief of staff for Gov. Jay Inslee of Washington, said the state didnt know what the presidents comments meant and noted the state had not seen any formal order. We dont believe the president has the ability to dictate what states can and cannot open, Mr. Postman said.

Were not ready, she said. Honestly, that would be reckless. Its Friday. Theyre not ready.

States differ on their approaches to religious services during the pandemic.

It was not clear what authority President Trump was invoking on Friday when he called for governors to allow our churches and places of worship to open right now, and threatened to override them if they did not. Soon after he spoke, though, the C.D.C. issued guidelines urging faith leaders to take steps to limit the size of gatherings in accordance with the guidance and directives of state and local authorities.

States and localities have been taking a variety of approaches to religious services since the outbreak began.

Houses of worship were already allowed to operate in more than half of the states, though many remain under social distancing instructions and many individual churches, synagogues and mosques have decided to remain closed for safety.

There have been tensions in places that still have restrictions in place. In California, more than 1,200 pastors signed a declaration protesting the states restrictions on in-person services and pledged to reopen their churches by May 31 even if the restrictions are not lifted. Gov. Gavin Newsom, a Democrat, said Friday that the state was working with faith leaders on guidelines to reopen in a safe and responsible manner that would be released by Monday at the latest.

The states guidelines, which will distinguish between megachurches and smaller venues, deal with the configuration of pews and sanitation protocols, the governor said.

In Illinois, Gov. J.B. Pritzker said on Friday that he would continue to operate on the basis of science and data in deciding when it was safe for houses of worship to open.

Im as anxious as anybody to make sure that our churches, our mosques, our synagogues open back to where they were before Covid-19 came along, Mr. Pritzker said. Were gradually moving in that direction. But theres no doubt the most important thing is, we do not want parishioners to get ill because their faith leaders bring them together.

The presidents call to let in-person services resume came just before one of the biggest Muslim holidays of the year, Eid al-Fitr, which starts Saturday night.

Washington State currently allows drive-in services, where congregants remain in their vehicles, and allows houses of worship to bring in personnel to broadcast and stream videos of services. Officials there have been working with an interfaith group to develop guidelines on how religious institutions can safely open up for more in-person activities.

And in some states, houses of worships were never required to close. In Pennsylvania, religious institutions were exempt from a stay-at-home order, though Gov. Tom Wolf has advised religious leaders not to hold in-person services or large gatherings to protect people from the virus.

Gov. Gretchen Whitmer of Michigan, who on Friday extended the states stay-at-home order through June 12, has banned large gatherings but also said that houses of worship would not be subject to penalties, leaving the decision in the hands of religious leaders. Many churches, synagogues and mosques there decided to remain closed anyway, and those that are reopening often remain under strict guidelines, including limiting the number of congregants who could enter.

In hard-hit New York, Gov. Andrew M. Cuomo moved this week to allow religious gatherings of up to 10 people to resume as long as attendees wear masks and maintain social distance. The announcement was particularly significant for Jewish congregations, where a minyan, defined as 10 people over 13, is required for a worship service.

Birx expresses concerns about case levels in Los Angeles, Chicago and Washington.

One testing measure shows that coronavirus cases are persisting at worrisome rates in three major metropolitan areas Los Angeles, Chicago and Washington, D.C. that are still under stay-at-home orders, a top White House official said on Friday.

We have concerns of where cities have remained closed and metros that have remained closed but have still persistent high number of cases, Dr. Deborah L. Birx, the White Houses coronavirus response coordinator, told reporters at a news conference. She said officials from the Centers for Disease Control and Prevention were working with local officials in the three cities to really understand where these new cases coming from, and what do we need to do to prevent them in the future.

Dr. Birxs concern did not suggest that the case rates in the three regions were spiking to alarming new levels, but rather that they were not dropping at the same rate as in many other cities.

Dr. Birx singled out the Washington area which includes the district as well as parts of Maryland and Virginia and said it led the country in the percentage of positive test results, a measure different from total coronavirus cases. Among those who have tested positive is the former N.B.A. all-star Patrick Ewing, now the mens basketball coach at Georgetown University in Washington, who announced on Twitter on Friday that he had the virus.

Unlike New York, the Washington area has seen no dramatic decline in positive test rates or emergency room visits, Dr. Birx said.

Further complicating the picture, Mayor Muriel E. Bowser of Washington said on Thursday that the city could begin a phased reopening as early as May 29, pointing to figures that showed a downward trend in spread of the virus for almost two weeks. Yet on the same day, Washington, D.C., and Virginia announced single-day highs in cases.

The Washington regions high positive-test percentage comes despite reassuring news in most states: 42 have a rate under 10 percent of positive test results as part of a rolling, seven-day average, Dr. Birx said.

The New York area, which includes Jersey City and Newark, is seeing steeper declines by that test result measure, Dr. Birx said. And cities that have been especially hard hit, such as Detroit, Boston and Miami, now have more promising daily case counts.

Ahead of a holiday weekend, beach towns are telling N.Y.C. residents to stay away.

In the Hamptons, the locals have put up barricades to limit parking and deployed enforcement officers to ticket outsiders. Jersey Shore towns have banned short-term leases and Airbnb rentals. And on Long Island, the Suffolk County executives office taunted Mayor Bill de Blasio of New York City: Do your job. Figure out a plan to safely reopen your beaches.

Since the pandemic began, tensions have flared over whether too many New York City residents have decamped to outlying vacation areas, potentially taking the virus with them. But now the region appears on the brink of a full-fledged (and nasty) battle over beaches, touched off by the citys decision to keep its shoreline closed.

In normal times, start of beach season on Memorial Day weekend incites a mass migration from New York to Long Island, the Jersey Shore and, to a lesser extent, Connecticut. But the extension of beach closings in New York City has led to a backlash from local officials in those areas, who say they fear that their shorelines will be overwhelmed by an exodus of sun-starved New Yorkers blocked from their own beaches, which can in normal times attract a million people a day.

To maintain social distancing, beaches across the region are moving to limit access to everyone, and special rules have also been adopted to keep outsiders away.

The Justice Department on Friday backed an Illinois Republicans effort to invalidate the states stay-at-home order, the latest effort by the federal government to undermine governors coronavirus measures.

The U.S. attorney for the Southern District of Illinois argued in a legal brief that Gov. J. B. Pritzker, a Democrat, had exceeded his authority by extending his executive order for more than 30 days.

The brief came in response to a directive from Attorney General William P. Barr that department lawyers review stay-at-home orders around the country to ensure that civil liberties are protected.

Since Mr. Barrs request, the Justice Department has increasingly asserted itself in arguing over the legality of states sweeping orders in response to the coronavirus pandemic.

Under our system, all public officials, including governors, must comply with the law, especially during times of crisis, Eric Dreiband, the head of the departments civil rights division, said in a statement. On Friday, Mr. Dreiband also warned in a letter to Mayor Eric Garcetti of Los Angeles that a long-term lockdown could be illegal.

The move in Illinois came in a lawsuit that was filed by Darren Bailey, a Republican state representative whose fellow lawmakers kicked him out of the building in which they had gathered because he refused to wear a mask. Mr. Bailey had asked an Illinois court to declare the governors order invalid. The governor this week sought to have the case transferred to federal court, a move the Justice Department also said was wrong.

Airlines are permitted to stop flying to dozens of U.S. cities.

The Transportation Department said late Friday that it would tentatively allow 15 airlines to stop flights to about 60 mostly small and midsize cities, though none of the destinations stand to lose service entirely.

American Airlines would be allowed to stop flying to airports in Worcester, Mass., and Aspen, Colo. Delta Air Lines would be able to stop service to Erie, Pa., and Flint, Mich. United Airlines would be able to stop flights to Fairbanks, Alaska; Kalamazoo, Mich.; and Myrtle Beach, S.C., among other locations.

None of the cities would be left without service, the agency said, because it granted exemptions only if other airlines still flew there. Some of the affected regions are also served by other airports.

The decision is rooted in the federal stimulus act passed in late March. Under that law, any airline that received federal assistance is required to maintain a minimum number of flights to locations that it had served before the pandemic. But the law also allowed the Transportation Department to grant exceptions, which it has done regularly for weeks.

The Department of Homeland Security late Friday provided exemptions for certain professional athletes from its travel restrictions that Trump administration officials have said are crucial to preventing the spread of the coronavirus.

The department said in a statement that foreign baseball, basketball, golf, hockey and tennis players, as well as their families and essential staff members, would be allowed to enter the United States. In his push to reopen the economy, President Trump has encouraged sports commissioners to resume play.

Professional sporting events provide much-needed economic benefits, but equally important, they provide community pride and national unity, said Chad F. Wolf, the acting secretary of the Department of Homeland Security. In todays environment, Americans need their sports.

In late January, the administration prohibited foreign travelers who had been in China within the previous 14 days from coming to the United States. The administration later put similar restrictions in place for those from Iran and many European countries, including Britain.

The order on Friday said that allowing the athletes into the United States was within the national interest. But homeland security officials have defended using health authorities granted to the surgeon general to rapidly turn away asylum-seeking migrants at the southwestern border.

As businesses navigate the pandemic, summer internships are sacrificed.

When she found out in mid-March that she had landed an internship with an education nonprofit in Washington, Lydia Burns, a senior at the University of Louisville, called her mother to celebrate.

The euphoria lasted all of a week. As she worked on a paper the next Tuesday, Ms. Burns got an email from the nonprofit: The internship was canceled because of the coronavirus pandemic. She burst into tears.

I feel like I had such a strong plan, she said. I knew what I was going to do I had been working for it all of college. Now I dont know what Im going to do.

For millions of college students, internships can be a steppingstone to full-time work, a vital source of income and even a graduation requirement.

But like so much else, summer internships have been upended by the pandemic, with a wide range of major companies, including tech firms like Yelp and entertainment behemoths like the Walt Disney Company, canceling programs and rescinding offers. Instead, students who had hoped to experience an office setting for the first time are instead looking for work at fast-food restaurants.

The early-stage trial, published in the Lancet, was conducted by researchers at several laboratories and included 108 participants. Subjects who got the vaccine mounted a moderate immune response to the virus, which peaked 28 days after the inoculation, the researchers found.

A vaccine to the new coronavirus is considered to be the best long-term solution to ending the pandemic and helping countries reopen their societies. Nearly 100 teams worldwide are racing to test various candidates.

On Monday, Moderna announced that its RNA vaccine appears to be safe and effective, based on results from eight people in its trial. On Wednesday, researchers in Boston said a prototype vaccine protected monkeys from coronavirus infection.

The vaccine reported today was created with another virus, an adenovirus called Ad5 that easily enters human cells.

But the virus is one that many people already have been exposed to, and some experts have worried that too many already have antibodies to Ad5, limiting its usefulness as a way to deliver a vaccine.

Although the vaccine did elicit some immune response, the results are based on data from just a short period. It is not clear how long-lasting the protection might be.

Apart from pain at the injection site, close to half of the participants also reported fever, fatigue and headaches, and about one in five had muscle pain.

The participants knew whether they were receiving a low, medium or high dose, however, which may have influenced their perceptions of the side effects.

Deadly diseases could surge after disruptions to vaccination programs.

The widespread interruption of routine immunization programs around the world during the coronavirus pandemic is putting 80 million children under 1 year old at risk of contracting deadly, vaccine-preventable diseases, according to a report Friday by the World Health Organization, UNICEF and Gavi, the Vaccine Alliance.

The groups surveyed 129 poor and middle-income countries and found that 68 had some degree of disruption of vaccine services through clinics and through large inoculation campaigns.

Many public health experts say they are worried that deaths from diseases including cholera, rotavirus and diphtheria could far outstrip those from Covid-19 itself.

But officials are now moving toward a cautious risk-benefit analysis.

Employers are preparing to test their workers as they return to offices.

As the country reopens, employers are looking into how to safely bring back their workers. One recurring question: Should they be tested for the new coronavirus?

Some businesses are moving ahead. Amazon plans to spend as much as $1 billion this year to regularly test its work force, while laying the groundwork to build its own lab near the Cincinnati airport.

Las Vegas casinos are testing thousands of employees as they prepare to return to work, collecting nasal samples in convention halls. Gov. Steve Sisolak of Nevada is hoping to reopen the states gambling industry by June 4, he said on Friday.

And Major League Baseball, eager to begin its season, is proposing a detailed regimen that involves testing players and critical staff members multiple times a week.

While public health experts and government officials have emphasized that widespread testing will be critical to reopening, state and federal agencies have given little clear guidance on the role employers should play in detecting and tracking the virus.

Despite rapid advancements in testing, many limitations remain. Diagnostic tests, for example, only detect infections during a certain period. And antibody tests alone should not be used to make decisions about when people can return to work, the Association of Public Health Laboratories and Council of State and Territorial Epidemiologists warned.

Some public health officials also said that broad-based testing might have unintended consequences.

We dont want people to get a false sense of security, said Karen Landers, a district medical officer with the Alabama Department of Public Health, which is not recommending that employers test all workers.

Guidelines from the C.D.C. making the rounds online this week are clarifying what we know about the spread of the virus.

The virus does not spread easily via contaminated surfaces, according to the agency. For those who were worried about wiping down grocery bags or disinfecting mailed packages, the news headlines highlighting this guidance in recent days might have brought some relief.

But this information is not new; the agency has been using similar language for months. If anything, the headlines have pulled into sharper focus what we already know. The virus is thought to spread mainly from one person to another, typically through droplets when an infected person sneezes, coughs or talks at close range even if that person is not showing symptoms.

The C.D.C.s website also says that touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes is a possible way for people to become infected. But those are not thought to be the main way the virus spreads.

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Trump Demands That Governors Reopen Houses of Worship - The New York Times

Cheap and easy antigen tests that detect proteins of the new coronavirus (yellow) in samples from a person are coming, but they arent perfect.

By Robert F. ServiceMay. 22, 2020 , 3:35 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

After a painfully slow rollout of diagnostic testing for active coronavirus infections across the country, some 400,000 people a day in the United States may now receive such a test, estimates suggest. Yet a few public health experts say sending people back to work and school safely and identifying new outbreaks before they spread out of control could require testing much of the U.S. population of 330 million every day. Others suggest checking roughly 900,000 people per day would be enough.

Either way, nearly all the current tests to diagnose infections work by identifying the genetic material of the virus, a technology that will be difficult to scale up much further. There will never be the ability on a nucleic acid test to do 300 million tests a day or to test everybody before they go to work or to school Deborah Birx, White House coronavirus response coordinator, said at a press conference last month.

Birx and others have touted another option: antigen tests, which detect the presence of viral proteins in a biological sample, such as saliva or tissue swabbed from the nasal cavity. Antigen tests are typically cheap, return results in minutes, and, like the genetic tests, reveal an active infection. They already exist for strep throat, influenza, tuberculosis, HIV, and other infectious diseases. But so far, only one antigen test for SARS-CoV-2, the coronavirus that causes COVID-19, has received emergency use authorization from the U.S. Food and Drug Administration (FDA).

Can it or other antigen-based methods solve the testing problem? Some scientists are optimistic, whereasothers remain skeptical, noting that such tests can be far less accurate than nucleic acid tests and may not be as easy to scale up as proponents claim. What everyone wants is for a test to be cheap, accurate, and fast, says Geoffrey Baird, a laboratory medicine specialist at the University of Washington, Seattle. You can only ever have two of those.

Developing an antigen test is not that easy to do, says Werner Kroll, senior vice president for research and development at Quidel, a California-based company that received the greenlight from FDA for its test earlier this month. Rather than performing all the analytical steps inside an expensive dedicated machine at a lab or a doctors office, as is done with tests for the DNA or RNA of virus, antigen tests build most, if not all, those steps into a paperlike strip that returns a simple yes or no answer, much like pregnancy tests.

Its a lab on a swab, says Stephen Tang, president and CEO of Orasure, a diagnostics company developing its own antigen test for SARS-CoV-2. With most setups, a sample of bodily fluid is collected using a nasal swab or related procedure, then mixed with a few milliliters of a liquid, typically a sterile buffer solution. A few drops are spotted on one end of a test strip. Capillary forces pull the liquid over copies of two different antibodies specific for the same viral protein. If both antibodies spot their targeta positive testthe strip generates a signal, often a color change. This signal is generally read out by a person visually, although some setups use small readers to improve the accuracy.

What triggers the signal can differin some tests the antibody bindings set off a chemical reaction or expose a fluorescent marker joined to one antibody. Another test in contention for FDA approval produces an electrical readout after antibodies on an electrochemical sensor bind to their target antigen.

The challenge is finding the right antibodies, says Lee Gehrke, a virologist at the Massachusetts Institute of Technology, who has developed an antigen test for SARS-CoV-2 that E25Bio, a company he co-founded, is now evaluating. Both antibodies must bind to a single viral protein, such as the spike protein SARS-CoV-2 uses to enter cells, but at separate sites. You have to find two antibodies that dont interfere with each other, Gehrke says. Those same antibodies also cant cross react to proteins from other coronavirusesall of which have their own spikes, for exampleor anything else. Antibodies often stick to other things nonspecifically, Baird says.

Another challenge is weak signals. Genetic tests use the polymerase chain reaction (PCR) to amplify tagged DNA or RNA sequences, making it easy to reliably identify just a few copies of a virus. That gives PCR tests for the SARS-CoV-2 virus about a 98% sensitivity and near perfect selectivity, meaning almost every active infection is detected and only in very rare cases does someone uninfected receive a positive test. (Many false negatives, a result indicating an infected person is free of the virus, result not from the tests deficiencies, but from poor samples, which can be difficult to collect with nasal swabs.)

Antigen tests dont amplify their protein signal, so they are inherently less sensitive. To make matters worse, that signal gets diluted when samples are mixed with the liquid needed to enable the material to flow across test strips. As a result, most antigen tests have a sensitivity of anywhere between 50% and 90%in other words, one in two infected people might incorrectly be told they dont have the virus. Last month, Spanish health authorities returned thousands of SARS-CoV-2 antigen tests to the Chinese firm Shengzhen Bioeasy Biotechnology after finding the tests correctly identified infected people only 30% of the time, according to a report by the Spanish newspaperEl Pais.

Quidel executives say the companys initial SARS-CoV-2 test meets FDAs minimum of 80% sensitivity. (That means it could still generate false negative results 20% of the time.)A revised sample preparation protocol that doesnt require dilution of the nasal swab is expected to boost that figure to nearly 90%, but thats still below the 98% sensitivity of state-of-the-art PCR tests.

Antigen tests, however, bring advantages to the table as well. Because they dont require the expensive equipment and chemicals needed to perform PCR, they can be more easily used as point-of-care tests in doctors offices, urgent care centers, hospitals, and even at companies and schools. They also dont require trained specialists, making them cheaper to administeralthough there are a few point-of-care PCR tests, most still involve sending a sample to a lab for manual processing.

And the fast results from an antigen test mean that people who test positive can be isolated quickly, before they risk infecting others. Even if the tests have a 10% false negative rate, people could easily be tested repeatedly, making it likely that anyone missed on the first round would be flagged on the second, says Doug Bryant, Quidels president and CEO.

Another advantage is scalability. Once researchers settle on effective antibodies, the tests are easy to manufacture in bulk, and running them doesnt require additional reagents as PCR tests do. Quidel says it expects to ship 282,000 tests this week and 1 million tests per week by early June. Ultimately, Bryant says the company should be able to produce 84 million tests per year.

Thats still well below the 300 million tests per day that would allow most every person in the United States to have a daily SARS-CoV-2 check, Birxs ambitious hope. (One recent model from the Harvard Global Health Institute said 900,000 diagnostic tests a day in the United States would be enough to have confidence most infections were being caught before an outbreak grew big.) But other companies, including OraSure, which expects to file for FDA emergency use authorization in September, say they expect to rapidly scale up to providing tens of millions of coronavirus antigen tests as well. The demand for such tests, which could cost as little as $1 or less, could be even greater in developing countries without a broad network of centralized labs.

Taken together, the advantages of antigen tests provide real hope that they will be very valuable for stemming this pandemic, says Bettina Fries, chief of infectious diseases at Stony Brook University.

Baird and others are less confident. Not all antigen tests are as simple to read as a pregnancy test. Quidels test requires using a $1200 toaster-size reader to achieve the relatively high sensitivity it has. And even though 43,000 Quidel readers already exist for other antigen tests, most are in the United States, making the test harder to put into use overseas.

Otto Yang, an infectious disease expert at the University of California, Los Angeles, says the tests modest sensitivity is a bigger hurdle. Even a test with the 90% sensitivity and 100% specificity that Quidel is aiming for could misinform more than help. Assuming the virus has a prevalence of about 1% and such a test is given to 1000 people, 10 would correctly be told they are infected whereas100 people will be mistakenly told they dont have the virus. Given how readily SARS-CoV-2 spreads, a misdiagnosis is worse than no diagnosis, Yang says.

Fries doesnt agree. Even if the sensitivity [of antigen tests] is not perfect, if you test over and over you will pick up those cases, she says. We need to let go of the notion that all the tests have to be perfect.

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Coronavirus antigen tests: quick and cheap, but too often wrong? - Science Magazine

As Texas inches away from its economic shutdown and people resume sharing public and sometimes confined spaces, the question of whether to wear a face mask has become a way to pick sides in whats quickly becoming a coronavirus culture war.

The decision has led to everything from protests to the threat of criminal prosecutions and, at times, heated wars of words that have escalated to physical altercations. Mask arguments among Texans are happening everywhere from retail stores to the highest levels of government, frustrating public health experts who say masks help slow the spread of the virus.

The disagreements come as more and more businesses in Texas are allowed to open with state officials trying to strike a balance between further economic devastation and thwarting the virus spread. On Monday, Gov. Greg Abbott announced that the state was entering its second reopening phase, immediately opening child care facilities, while allowing bars to reopen at limited capacity later in the week and promising a return of sporting events sans in-person spectators by the end of the month. Some establishments, like gyms, restaurants and movie theaters, were already allowed to open at limited capacity.

In this phase of reopening, masks remain optional. Some local jurisdictions issued mask mandates last month, but in an executive order April 27, Abbott said municipalities cant impose penalties on residents who violate rules about wearing masks in public.

We strongly recommend that everyone wear a mask, Abbott said. However, its not a mandate. And well make clear that no jurisdiction can impose any type of penalty or fine for anyone not wearing a mask.

But without a statewide directive on personal protective gear, further efforts to flatten the curve have essentially amounted to a statewide experiment in cooperation, hinging on the individual decisions of millions.

Public health experts have advised the use of masks, especially in public spaces. The Centers for Disease Control and Prevention also recommends the use of simple cloth face coverings to slow the spread of the virus.

But pushback has been strong.

In San Antonio, a spectator caught a man without a mask yelling at a 99 Cents Only store employee for asking him to put on a face covering or leave.

I dont care. Just because everyones doing it, doesnt make it legal, the man is heard yelling at the masked employee. The Texas governor said its not legal and I dont have to.

Do you hear that? he goes on, addressing a woman walking past him on the phone whos wearing a thin, blue surgical mask. Texas governor says you dont need shit. Call the cops. You think Im scared?

He later pushes someone recording the confrontation.

Police were dispatched to the store for a report of assault in progress, but no arrests were made, according to the Fort Worth Star-Telegram.

Farther south, in Harris County, an April emergency proclamation mandating face coverings led to so much backlash including a lawsuit against the county judge that officials amended a draft of the order to eliminate jail time as a potential threat for noncompliance. Not wearing a face covering could only lead to a hefty fine, though Abbotts order overruled any penalties associated with the mandate hours after it went into effect.

The lawsuit seeking to block the order was filed by Steve Hotze, one of the most active culture warriors on the ideological right. On the day he filed it, Hotze, a vociferous opponent of same-sex marriage and vocal supporter of the failed 2017 bathroom bill that would have restricted the use of certain public facilities for transgender Texans, held a rally against the order in downtown Houston. Attendees waved signs with messages like Dont Mask My Freedom! and Just Say No to masks.

Public health experts have looked on in dismay at the sight of public places and protests where throngs of people crowd together without protective face gear. Experts have described wearing a face covering as a simple and cheap way to protect others nearby and potentially mitigate the spread among asymptomatic carriers of the contagion.

Summer Johnson McGee, the dean of the School of Health Sciences at the University of New Haven, said people need to think about carrying and using masks the same way they think about umbrellas on a cloudy or rainy day.

If there is a chance of rain, we carry an umbrella, and in the same way, if there is any chance of being exposed to someone with the virus, you should carry a mask and use it, she said.

After social distancing, masks are our most effective tool to prevent the spread of the virus, she added.

But the decision not to wear a face covering, for some, has become a rebellion against what they see as a government foray on their personal liberties. For others, the choice is one of availability or convenience. Some Texans, especially those back in the workplace, said they found the facial coverings uncomfortable, hot or hard to breathe in, a nuisance they were not willing to tolerate long term. Others were skeptical of their feasibility.

I accept that masks are necessary in our current environment, but I find them inconvenient and therefore choose not to venture out, said Josh Ellis, 41, who works in the Dallas legal industry.

We should definitely be wearing masks in any public place, said Paige Brann, a student who lives in Spring Branch. That being said, I havent seen anyone wearing them. People roll their eyes when I wear them.

Aaron Reed, a restaurant worker in Austin, has been wearing a mask for eight to 10 hours a day.

Its incredibly insulting to see some people cant be bothered to do it for the 15 minutes they are in a store, Reed said.

But politicians mask decisions have been as inconsistent as the general publics. At the White House, President Donald Trump said during an April 3 news conference that wearing masks would be a voluntary thing he was choosing not to partake in. In the U.S. House, several Texas Republicans declined to wear masks during the debate on a coronavirus relief package, despite a recommendation to do so by the House attending physician.

At the state level, House Speaker Dennis Bonnen, a Republican, promoted mask wearing earlier this month as a simple, cheap, easy step that can protect those around us and accelerate our states return to economic vitality. Still, at news conferences where he huddles near the governor, lieutenant governor and other statewide health officials, its essentially a mask-free zone.

The result has been resigned anger and unease particularly among Texas Democrats.

A pledge: If @govabbott and co wear masks today, then I will not criticize a single action taken today for at least 24 hours, state Rep. Erin Zwiener, D-Driftwood, tweeted ahead of Mondays press conference.

At the local level, some officials have chosen to don face coverings during public meetings.

Harris County Judge Lina Hidalgo and Houston Mayor Sylvester Turner both regularly wear face coverings during livestreamed press briefings.

Turner said earlier this week that the issue shouldnt become partisan. In response to the question, he turned to Houston City Council member David Martin, a Republican, and said, Im affiliated with one party, the mayor pro tem is affiliated with another party, and were both wearing masks.

The political symbolism associated with wearing face coverings though maybe not as charged as a Make America Great Again hat has led some experts to worry about the damage this could do to the general public, too.

Masks help prevent spreading the virus to other people. Its not 100% effective, but its going to reduce the dose of the virus that youre releasing if youre asymptomatic, said Shelley Payne, the director of the University of Texas at Austins LaMontagne Center for Infectious Disease.

Payne said its important for public officials to talk to health experts and get informed opinions to the public. They can model good behavior by wearing masks themselves, she added.

Matthew Cox, a student at the University of Texas at Austin, says he wears a mask on a daily basis. Still, he acknowledged, its hot out and it sucks. Cox said hes in favor of requiring face masks in public, with the caveat that if they are required, they should be easily available and affordable.To protect the public health and welfare, there is no good objection to not wearing a mask, he said.

All of that said, I am a little concerned that the entitled and short-tempered people will go crazy, he added, noting he witnessed a fight Tuesday at a gas station because some guy didnt want to wear a mask.

Lyle Burk, who works at a meatpacking plant near Amarillo, echoed a similar sentiment. If I and the people I work with ... can wear face masks for eight hours while making the food you go shopping for, you can wear one for your 30-minute trip to the grocery store.

Still, the plight of others hasnt been convincing enough to the people who still choose to go without one. The hardline conservative activist Michael Quinn Sullivan tweeted Wednesday that hed rather drive than wear a required mask on Southwest Airlines flights next week.

Im not wearing a mask on a plane unless its an oxygen mask and I am blasting commies from the sky, he wrote.

Disclosure: The University of Texas at Austin has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.

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How masks in Texas sparked a new partisan fight during coronavirus - The Texas Tribune

Since the emergence of the new coronavirus, called SARS-CoV-2, several researchers have proposed that there is more than one strain, and that mutations have led to changes in how infectious and deadly it is. However, opinions are divided.

Genetic mutations are a natural, everyday phenomenon. They can occur every time genetic material is copied.

When a virus replicates inside the cell it has infected, the myriad of new copies will have small differences. Why is this important?

When mutations lead to changes in how a virus behaves, it can have significant consequences. These do not necessarily have to be detrimental to the host, but in the case of vaccines or drugs that target specified viral proteins, mutations may weaken these interactions.

Since the emergence of SARS-CoV-2, several research studies have highlighted variations in the viruss genetic sequence. This has prompted discussion about whether or not there are several strains, if this has an impact on how easily the virus can infect a host, and whether or not this affects how many more people are likely to die.

Many scientists have called for caution. In this Special Feature, we summarize what researchers currently know about SARS-CoV-2 mutations and hear from experts about their views on what these mean for the pandemic.

SARS-CoV-2 is an enveloped RNA virus, which means that its genetic material is encoded in single-stranded RNA. Inside a host cell, it makes its own replication machinery.

RNA viruses have exceptionally high mutations rates because their replications enzymes are prone to errors when making new virus copies.

Virologist Prof. Jonathan Stoye, a senior group leader at the Francis Crick Institute in London in the United Kingdom, told Medical News Today what makes virus mutations significant.

A mutation is a change in a genetic sequence, he said. The fact of a mutational change is not of primary importance, but the functional consequences are.

If a particular genetic alteration changes the target of a drug or antibody that acts against the virus, those viral particles with the mutation will outgrow the ones that do not have it.

A change in a protein to allow virus entry into a cell that carries very low amounts of receptor protein could also provide a growth advantage for the virus, Prof. Stoye added.

However, it should be stressed that only a fraction [of] all mutations will be advantageous; most will be neutral or harmful to the virus and will not persist.

Mutations in viruses clearly do matter, as evidenced by the need to prepare new vaccines against [the] influenza virus every year for the effective prevention of seasonal flu and the need to treat HIV-1 simultaneously with several drugs to [prevent the] emergence of resistant virus.

Prof. Jonathan Stoye

MNT recently featured a research study by a team from Arizona State University in Tempe. The paper described a mutation that mimics a similar event that occurred during the SARS epidemic in 2003.

The team studied five nasal swab samples that had a positive SARS-CoV-2 test result. They found that one of these had a deletion, which means that a part of the viral genome was missing. To be precise, 81 nucleotides in the viral genetic code were gone.

Previous research indicated that similar mutations lowered the ability of the SARS virus to replicate.

Another study, this time in the Journal of Translational Medicine, proposed that SARS-CoV-2 had picked up specific mutation patterns in distinct geographical regions.

The researchers, from the University of Maryland in Baltimore and Italian biotech company Ulisse Biomed in Trieste, analyzed eight recurrent mutations in 220 COVID-19 patient samples.

They found three of these exclusively in European samples and another three exclusively in samples from North America.

Another study, which has not yet been through the peer review process, suggests that SARS-CoV-2 mutations have made the virus more transmissible in some cases.

In the paper, Bette Korber from the Los Alamos National Laboratory in New Mexico and collaborators describe 13 mutations in the region of the viral genome that encodes the spike protein.

This protein is crucial for infection, as it helps the virus bind to the host cell.

The researchers note that one particular mutation, which changes an amino acid in the spike protein, may have originated either in China or Europe, but [began] to spread rapidly first in Europe, and then in other parts of the world, and which is now the dominant pandemic form in many countries.

Prof. Stoye commented that the results of this study are, in some ways, not surprising.

Viruses are typically finely tuned to their host species. If they jump species, e.g., from bat to human, a degree of retuning is inevitable both to avoid natural host defenses and for optimum interaction with the cells of the new host, he said.

Random mutations will occur, and the most fit viruses will come to predominate, he added. Therefore, it does not seem surprising that SARS-CoV-2 is evolving following its jump to, and spread through, the human population. Clearly, such changes are currently taking place, as evidenced by the apparent spread of the [mutation] observed by Korber [and colleagues].

However, Prof. Stoye does not think that it is clear at this point how mutations will drive the behavior of SARS-CoV-2 in the long term.

Fears about SARS-CoV-2 evolution to resist still-to-be-developed vaccines and drugs are not unreasonable, he explained. Nevertheless, it is also possible that we will see evolution to a less harmful version of the virus, as may well have occurred following initial human colonization by the so-called seasonal coronaviruses.

Earlier this year, researchers from Peking University in Beijing, China, published a paper in National Science Review describing two distinct lineages of SARS-CoV-2, which they termed S and L.

They analyzed 103 virus sequence samples and wrote that around 70% were of the L lineage.

However, a team at the Center for Virus Research at the University of Glasgow in the U.K. disagreed with the findings and published their critique of the data in the journal Virus Evolution.

Given the repercussions of these claims and the intense media coverage of these types of articles, we have examined in detail the data presented [] and show that the major conclusions of that paper cannot be substantiated, the authors write.

Prof. David Robertson, head of Viral Genomics and Bioinformatics at the Centre for Virus Research, was part of the team. MNT asked his views on the possibility of there being more than one strain of SARS-CoV-2.

Until there is some evidence of a change in virus biology, we cannot say that there are new strains of the virus. Its important to appreciate that mutations are a normal byproduct of virus replication and that most mutations we observe wont have any impact on virus biology or function, he said.

Some of the reports of, for example, amino acid changes in the spike protein are interesting, but at the moment, these are at best a hypothesis. Their potential impact is currently being tested in a number of labs.

Prof. Stoye thinks that it is more a case of semantics rather than anything else at the moment.

If we have different sequences, we have different strains. Only when we have a greater understanding of the functional consequences of the evolutionary changes observed does it make sense to reclassify the different isolates, he said.

At that point, we can seek to correlate sequence variation with prognostic or therapeutic implications. This may take a number of years.

So, what kind of evidence are skeptical scientists looking for in the debate around multiple SARS-CoV-2 strains?

MNT asked Prof. Mark Hibberd, from the London School of Hygiene and Tropical Medicine in the U.K., to weigh in on the debate.

For virologists, strain is rather a subjective word that does not always have a clear specific meaning, he commented.

More useful in the SARS-CoV-2 situation would be the idea of serotype, which is used to describe strains that can be distinguished by the human immune response an immune response to one serotype will not usually protect against a different serotype. For SARS-CoV-2, there is no conclusive evidence that this has happened yet.

To show that the virus has genetically changed sufficiently to create a different immune response, we would need to characterize the immune protection and show that it worked for one serotype and not for another, he continued.

Prof. Hibberd explained that scientists are studying neutralizing antibodies to help them define a serotype for SARS-CoV-2. These antibodies can prevent the virus from infecting a host cell, but they may not be effective against a new strain.

Several groups around the world have identified a specific mutation in the SARS-CoV-2 spike protein, and they are concerned that this mutation might alter this type of binding, but we cannot be sure it does that at the moment. More likely, this mutation will likely affect the virus binding to its receptor [], which might affect transmissibility.

Prof. Mark Hibberd

We ideally need experimental evidence, [such as a] demonstration of a mutation leading to a functional change in the virus in the first instance, and secondly a demonstration that this change will have an impact in [people with the infection], Prof. Robertson suggested.

He pointed to lessons that experts learned during the 20142018 Ebola outbreak in West Africa, where several research groups had suggested that a mutation had resulted in the virus becoming more easily passed between people and more deadly.

Cell culture experiments showed that the mutated virus was able to replicate more rapidly. However, when scientists subsequently studied this in animal models, they found that it did not behave any differently than stains without the mutation.

Scientists around the world continue to search for answers to the many outstanding questions around SARS-CoV-2. No doubt, we will see more research emerge in the coming months and years that will assess the impact of SARS-CoV-2 mutations on the COVID-19 pandemic and the future of this new coronavirus.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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COVID-19: How many strains of the new coronavirus are there? - Medical News Today

How likely are you to answer an unknown number popping up on your caller ID? And if you were to pick up, how likely is it that you would disclose personal information about yourself and your family, friends and colleagues to the stranger on the other end of the line?

Ask any census worker, public opinion pollster or cold caller, and they will tell you the answer to both questions is not likely. Indeed, the pickup rate for unfamiliar or unidentified numbers in those circumstances is as low as 6 percent. And the people who do answer are often wary and uncooperative, if not abusive.

That resistance is the crux of the problem with contact tracing, which health experts say is essential to containing the coronavirus.

The idea is to reach out to everyone who has tested positive for the virus, find out whom they might have inadvertently exposed and encourage them all to avoid infecting others. But an army of 180,000 contact tracers provisioned with telephone headsets and scripts does not guarantee that anyone will want to talk to them, much less follow their advice.

A storied group of venereal disease investigators from the last century provides some clues on what it might take for contact tracing to be effective and whether the current patchwork of city and state programs is missing the mark.

The best contact tracers that we have ever had came out of the V.D. investigation program started after World War II, said Dr. William Foege, a former director of the Centers for Disease Control and Prevention who is credited with devising the global strategy that led to the eradication of smallpox in the 1970s.

This was an elite cadre of carefully vetted and trained individuals, who, starting in 1948, were tasked by the Public Health Service to contact trace cases of venereal disease, particularly syphilis. Syphilis was a scourge back then; during wartime, approximately 25,000 positive tests were reported annually in New York City alone.

The shame associated with syphilis made it especially difficult to get infected people to talk. And tracking down contacts was a challenge when often all you had to go on was, the girl who frequents the red-door bar downtown or a guy who said he was a brush salesman from Topeka. Nevertheless, public health advisers, or P.H.A.s, as the investigators were called, were astoundingly effective. By the mid-1950s, syphilis rates were the lowest they had ever been. (Also of note, it was a relentless P.H.A. who blew the whistle on the infamous Tuskegee experiment.)

They had to be psychiatrists, detectives and problem solvers all at once, Dr. Foege said. He worked closely with many public health advisers who ended up at the C.D.C. spearheading efforts to contain other infectious diseases, such as smallpox, measles, H.I.V./AIDS, cholera and Ebola.

The boss of the operation was the poker-playing biostatistician Lida Usilton. Under her direction, all P.H.A.s went through the same selection process. They had to have a college degree, liberal arts preferred, and a variety of work experiences and backgrounds was a plus. One put himself through school working as a dishwasher and a lumberjack. Another was a former farmhand and football player. Some were prisoners of war.

The thinking was that contact tracers had to be able to talk as easily with a Wall Street banker as with a migrant worker. They were interviewed extensively to see whether they had the kind of emotional intelligence that made people want to talk to them and whether they could easily manage conversational curveballs, like when a female contact revealed she was biologically a man.

They didnt have to be rocket scientists but they had to be able to connect with other people to talk in a way that indicated to us they were very approachable and reasonable human beings who could be sensitive and persuasive, said Frederick Stuart Kingma, a 92-year-old retired P.H.A. who trained and recruited other tracers in the 1950s.

Today the process is different. Coronavirus tracers are hired according to various state or local health authorities requirements, for jobs paying from $15 to $30 an hour. In New York City, where 10,000 people have applied for 2,500 coronavirus contact tracing jobs, officials said preference was being given to clients of local food-assistance and social-support organizations. In San Francisco, they are hiring primarily furloughed city employees, such as librarians, city attorneys and tax assessors. And in Massachusetts, where 45,000 people applied for 1,700 positions, rsums were sorted first by algorithm and final decisions were based in large part on videos that applicants submitted explaining why they wanted the job.

Were still learning who the best people are to do this, said Dr. John Welch, who is overseeing recruitment and training of contact tracers for Massachusetts in collaboration with the nonprofit Partners in Health. A furloughed doctor or nurse may not have that empathetic ear thats critical.

Training is similarly all over the map, with some health agencies requiring online courses lasting a few hours and others demanding eight to 20 hours of in-person training, or a combination of both. Much of the training focuses on education about the coronavirus, confidentiality rules and data entry protocols. Relatively little instruction is given on how to build rapport with and earn the trust of people, particularly when they might be reluctant to reveal their contacts, like, say, a married lover or an undocumented employee.

For example, just one hour of the six-hour online training program developed by Johns Hopkins Bloomberg School of Public Health, which New York City and the state of New York are using, is devoted to interviewing techniques. It recommends memorizing catchphrases to use during calls such as I hear you and This is a difficult time. That is, the kinds of canned responses that might send someone into a blind fury when calling tech support.

Dr. Emily Gurley, an infectious-disease epidemiologist who developed the Bloomberg training, said that if people realize that the person on the other end of the line is trying to help them, then I think your interviewing skills dont need to be that great to really get and give the information that you need to.

P.H.A.s, by contrast, were taught that everything depended on their interviewing skills. They were sent away to a kind of interpersonal-skills boot camp where they spent an intense two weeks learning interviewing techniques, shadowing other contact tracers and interviewing people themselves under close supervision. Their success in the field was then closely monitored in terms of numbers of cases reached and contacts generated, as well as how many contacts got tested and treated.

An informal survey of coronavirus contact tracing programs across the country revealed that none had settled on definite metrics of success. We are looking for a set of various measures, said Dr. Umair Shah, the executive director of Harris County Public Health in Texas, which serves Houston and the surrounding area. But ultimately the juice is worth the squeeze if youre only reaching 5 percent of the people, at some point you have to ask why and decide maybe this is not the tool we should use.

This brings us back to getting people to pick up the phone, on which so much depends. Some health authorities are sending text messages first, encouraging people to answer, while others are working on social media campaigns and radio jingles to raise awareness and improve participation. It recalls P.H.A.s in the 1950s driving around the countryside broadcasting songs about syphilis over loudspeakers. They passed out comic books about venereal disease with titles like Little Willie and That Ignorant Cowboy and gave out free samples of Dentyne chewing gum to anyone who got tested.

It was a long time ago, said Mr. Kingma, who, some 70 years after working as a P.H.A., can still make you want to tell him everything moments after getting on the phone with him. But maybe some of the things we learned back then can be of use.

Kate Murphy is a journalist in Houston who contributes frequently to The New York Times and the author of Youre Not Listening: What Youre Missing and Why It Matters.

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 here's our email: letters@nytimes.com.

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Contact Tracing for Coronavirus Is Harder Than It Sounds - The New York Times

Updated 9:36 p.m.: Revised to include information about nursing home testing.

Dallas County Judge Clay Jenkins said Saturday that this weeks COVID-19 hospitalization rate and new daily case average signaled good news for the county, but cautioned that the decisions of residents in the coming days and weeks will determine whether the county sees a steady decline in cases.

The county reported 172 new cases Saturday, closing out the week with a new daily case average of 200, down from 233 last week, Jenkins said. He said the county had 40 deaths this week, up from 27 the previous week, but that hospitalizations, ICU admissions, and emergency room visits for COVID-19 have remained flat compared to last week.

Overall, this week has been good news and we will hopefully begin to see a decline, but that is entirely up to you, Jenkins said in a written statement. We must all make good decisions and focus not on what is legal, but on what is safe Avoid crowds, when you must be in a crowd wear a face covering and maintain 6 foot distancing, and practice good hygiene by washing your hands regularly.

Jenkins added that residents should still stay home whenever possible and continue to follow guidance outlined in the countys color-coded chart, which was created by health experts and details what precautions residents should take as the outbreak continues. On Saturday, the county was still in the red zone.

The new cases bring the countys total to 8,649. The county also reported three additional COVID-19 deaths Saturday, bringing the total number of deaths to 210.

Two of the individuals had underlying health conditions: a man in his 70s who was a resident of a long-term care facility in Richardson and a man in his 80s who was a resident of a long-term care facility in Mesquite. The third death was of a Seagoville woman in her 80s.

The county said more than one-third of all deaths reported to date have been associated with long-term health care facilities. Dallas County does not report coronavirus recoveries.

The county said of patients who were hospitalized and reported employment, more than 80% have been critical infrastructure workers in sectors like health care, transportation, food and agriculture and first responders.

Two-thirds of hospitalizations have been in people under 65, and half of all hospitalized patients didnt have high-risk chronic health conditions. Diabetes has been a high-risk health condition in about a third of hospitalizations.

Tarrant County announced 52 new cases of the novel coronavirus on Saturday, pushing the countys total during the pandemic to 4,951.

Meanwhile, two new deaths were reported, lifting the countys death toll from COVID-19 to 143.

According to county data, 201 COVID-19 patients remain hospitalized, while 1,832 have recovered. Just under 65% of the countys hospital beds are occupied, and 29% of its ventilators are in use.

Men have made up 58 percent of cases in Tarrant County and 61% of deaths, according to the county website.

Denton County reported seven more novel coronavirus cases Saturday, bringing its total to 1,212.

The county said 616 people have recovered, and 566 cases are still active. The county has had 30 deaths related to the virus.

Collin County reported four new cases of the novel coronavirus on Saturday, bringing its total to 1,136 thus far during the pandemic.

No new deaths were reported, leaving the countys total deaths from COVID-19 at 33.

Current cases number 300, including 21 patients in the hospital and 279 people isolating at home. A total of 803 people have recovered, the county reported.

North Texas fire chiefs announced the creation of a task force Friday to help expand testing for COVID-19 at North Texas nursing homes.

The task force, which was created in collaboration with the Texas Division of Emergency Management, is in response to an order earlier this month by Gov. Greg Abbott that requires all Texas nursing home residents and staff to undergo testing.

The task force will help conduct COVID-19 testing at 139 nursing homes in Collin, Dallas, Ellis, Hunt, Kaufman, Navarro and Rockwall counties. Fire departments and agencies from Dallas, Cedar Hill, Plano, Red Oak, Desoto, Ovilla, Lewisville, Corsicana, Ennis, Frisco, Garland, McKinney, Richardson, Sachse and Garland are included in the effort.

In the week following Abbotts order on May 11, local fire departments were able to conduct testing at 50 nursing homes using their own resources, Dallas Fire-Rescue said in a news release.

The regional response involves the use of eight, three-person testing squads, the release said. That effort began a week after the governors order.

Dallas Fire-Rescue said 82 facilities in the region are still in need of testing. Testing has been scheduled at 27 of those facilities.

Ellis, Johnson, Kaufman and Rockwall counties did not provide updates on COVID-19 cases Saturday.

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Dallas County ends week with 'good news' in coronavirus data; North Texas fire departments begin testing area nursing homes - The Dallas Morning News

Alabama added more confirmed coronavirus cases in the week leading up to Memorial Day weekend than in any previous week, but that may not be as bad as it sounds. The state also vastly increased the number of tests it performed, and the percentage of tests performed that came back positive decreased slightly.

Also, fewer Alabamians died this week due to the virus than in any week in the last month.

Signs may be pointing up in some parts of the state, but things are still far from normal. Alabama is continuing the process of reopening its economy, even as some areas are experiencing the worst of the outbreak. Officials in Montgomery County reported hospitals were strained, and many other rural Alabama counties, especially in the Black Belt, are seeing spikes in cases.

In the last week, as of late Friday afternoon, the Alabama Department of Public Health confirmed 2,260 cases of the virus. More than 1,000 of those were in just five counties - the only five counties to add more than 100 cases over that time.

[Cant see the table? Click here.]

Montgomery saw nearly 300 new cases in that time, as the outbreak there continues. Mobile County, which saw a large spike in cases a few weeks ago, continues to see large growth in cases. It added 252 cases last week, and still has the most virus cases and deaths in the state. Jefferson County, home to Birmingham and the most populous county in the state, added 232 cases. It also performed the most tests of any of these five counties, and saw the lowest case-to-test ratio last week of those same counties.

Tuscaloosa County, which has had relatively low numbers to this point, added 133 new cases this week, a 44 percent increase. Franklin County, in northwest Alabama, added 117 cases, for a total of 413. Franklin is home to just 31,000 people, and now has the fourth highest virus rate in the state at 131 cases per 10,000 people.

[Cant see the chart? Click here.]

Overall, the states 2,200 new cases was the highest weekly total since the pandemic started. But other metrics suggest that raw case number isnt as stark as it may first appear. The state performed more than 33,000 tests this week. Thats by far the most of any week so far this year.

The 2,200 positives equate to a 6.7 percent positive rate, which is down from the previous two weeks, meaning the state is finding fewer cases per test, which suggests reduced community spread.

Across Alabama, 52 people died this week because of the virus. Thats the fewest virus-related deaths for any week since April 17.

[Cant see the chart? Click here.]

A few rural areas, especially in the Black Belt, are seeing more serious indications of spread than elsewhere in Alabama.

Franklin County, which saw a large increase in cases relative to its size, also saw a low number of tests performed, especially compared to the other counties with the most new cases. Just 403 tests were done there over the last week, resulting in a case-to-test ratio of 29 new cases per 100 tests. That was third highest in the state last week behind Choctaw county at 41 cases per 100 tests, and Lowndes County with 36 cases per 100 tests.

Lowndes County has the highest per capita rate of infections in Alabama, with 171 cases per 10,000 people. And numbers are not falling there. Lowndes, next door to Montgomery County, added 47 cases this week, for a total of 166.

Lowndes saw a rate of 48.3 new cases per 10,000 people this week, second in the state behind Bullock County, which saw a new case rate of 48.5 per 10,000. They were followed by Sumter, Choctaw and Franklin counties in terms of new cases per capita over the last week.

[Cant see the map? Click here.]

Do you have an idea for a data story about Alabama? Email Ramsey Archibald at rarchibald@al.com, and follow him on Twitter @RamseyArchibald. Read more Alabama data stories here.

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Alabama saw its largest jump in coronavirus cases - and tests - to date: Week in review - AL.com