Category: Corona Virus

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WHO warns it could take up to 5 years before the coronavirus pandemic is under control – CNBC

May 19, 2020

World Health Organization (WHO) Chief scientist Soumya Swaminathan on January 12, 2020 in Geneva.

FABRICE COFFRINI | AFP via Getty Images

The coronavirus pandemic may continue into the latter half of the decade, a senior global health official has warned, as the death toll of the virus approaches the grim milestone of 300,000.

Dr. Soumya Swaminathan, the World Health Organization's chief scientist, told the Financial Times' Global Boardroom webinar on Wednesday: "I would say in a four to five-year timeframe, we could be looking at controlling this."

Swaminathan said a vaccine appeared to be the "best way out" at present but warned there were lots of "ifs and buts" about its safety, production and equitable distribution.

The development of an effective vaccine and successful confinement measures were both among the factors that would ultimately determine the pandemic's duration, she added, the FT reported.

To date, more than 4.3 million people have contracted the Covid-19 infection, with 297,465 deaths worldwide, according to data compiled by Johns Hopkins University.

A global public health crisis has meant countries have effectively had to shut down, with many world leaders imposing stringent restrictions on the daily lives of billions of people.

The lockdown measures, which vary in their application but broadly include school closures, bans on public gatherings and social distancing, are expected to result in the worst economic downturn since the Great Depression in the 1930s.

In recent weeks, some countries have sought to gradually relax restrictions, allowing some shops and factories to reopen.

People wear a protective mask due to the pandemic of the new coronavirus (Covid-19), this Thursday morning, on Avenida Paulista, in the central region of the city of Sao Paulo.

Fabio Vieira | FotoRua | NurPhoto via Getty Images

However, the emergence of new Covid-19 cases in South Korea and China has exacerbated concerns about the potential for a second wave of infections.

The International Energy Agency on Thursday estimated that the number of people living under some form of confinement measures at the end of May would drop to 2.8 billion people worldwide, down from a recent peak of 4 billion.

At a separate media briefing, Dr. Mike Ryan, executive director of the WHO's emergencies program, said at the organization's Geneva headquarters on Wednesday that the coronavirus "may never go away."

When asked to address Swaminathan's comments earlier in the day, Ryan said no one would be able to accurately predict when the disease might disappear.

He added that trying to control the virus would require a "massive effort," even if a vaccine is found.

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WHO warns it could take up to 5 years before the coronavirus pandemic is under control - CNBC

5 Things To Watch This Week In Politics And Coronavirus – NPR

May 19, 2020

Then-President Obama and then-President-elect Donald Trump shake hands during a transition planning meeting in the Oval Office at the White House in November of 2016. Jim Watson/AFP via Getty Images hide caption

Then-President Obama and then-President-elect Donald Trump shake hands during a transition planning meeting in the Oval Office at the White House in November of 2016.

With Joe Biden on the ballot, so is the legacy of Barack Obama, and it appears we're about to see a throwdown between the last president and the current one and their polar opposite worldviews.

Amid criticism of his handling of the coronavirus pandemic, President Trump has been falsely laying blame on Obama for leaving the "cupboard bare" when it comes to the national stockpile of emergency medical supplies and equipment.

And lately, Trump and conservatives have been running with allegations of potentially criminal activity by Obama administration officials for their handling of surveillance that later led to the investigation and guilty plea of Michael Flynn, Trump's three-week national security adviser. (The Department of Justice now wants to drop its case against Flynn.)

In the past week, Trump has tweeted "Obamagate" (on its own, as a retweet or as a hashtag) 18 times. Three times, he's tweeted simply "Obamagate!" with nothing else.

Neither Trump nor White House officials have been able to identify a specific crime, but it sure helps fire up the base.

Obama, for his part, seemed to reply with one word of his own Thursday: "Vote."

And then, on Saturday, he had more words during two virtual commencement addresses.

"[T]his pandemic has fully, finally torn back the curtain on the idea that so many folks in charge know what they're doing," Obama told graduates of historically black colleges and universities. "A lot of them aren't even pretending to be in charge."

Then, when speaking to graduating high school students, he said: "Do what you think is right. Doing what feels good, what's convenient, what's easy that's how little kids think. Unfortunately, a lot of so-called grownups, including some with fancy titles and important jobs, still think that way which is why things are so screwed up."

Wow.

And a week earlier, when talking to former officials from his administration, leaked audio revealed that Obama called Trump's handling of the coronavirus an "absolute chaotic disaster" and an example of what happens when a "what's in it for me" mindset "is operationalized in our government."

Pressed about Obama's remarks Sunday, Trump said he hadn't heard them, but noted, "Look, he was an incompetent president, that's all I can say, grossly incompetent."

Welcome to the 2020 presidential campaign. Reelections are always a referendum on the sitting president. But with Biden, Obama's vice president, at the top of the Democratic ticket, it's somewhat of a referendum on Obama, too.

And there's reason for Trump to want or even need to try and take Obama down a few pegs. Currently, Obama is among the most popular politicians in the country and one of the highest-polling political figures (besides his wife, Michelle.)

It's a clear and stark choice offered up to voters and one Trump seems to want front and center. He even tweeted at Republican Senate Judiciary Chair Lindsey Graham, who says he wants to hold hearings on the Flynn case, to call Obama to testify.

"Do it @LindseyGrahamSC, just do it," Trump tweeted. "No more Mr. Nice Guy."

Graham responded, telling reporters he thinks that would "be a bad precedent" to compel a former president to testify and would "open up a can of worms."

"I understand President Trump's frustration," Graham said, before warning, "but be careful what you wish for. Just be careful what you wish for."

1. Coronavirus death toll approaches 90,000: About 90,000 people are now confirmed to have died from COVID-19 in the United States, and though new cases are slowing, the country is still on pace for 100,000 deaths from the coronavirus before the end of the month.

That slowing of new cases is good news, but with two-thirds of states significantly relaxing stay-at-home restrictions, experts are concerned about a potential resurgence.

"We're seeing a decline; undoubtedly, that is something good to see," Jeffrey Shaman, an epidemiologist at Columbia University, told The New York Times. "But what we are also seeing is a lot of places right on the edge of controlling the disease."

Another good sign, though: New York Gov. Andrew Cuomo tweeted on Sunday that his state now has "more testing capacity than New Yorkers are using." And he wants not only symptomatic New Yorkers to get tested, but also those who "have been in contact with someone with COVID." That's a first step in what experts say is one of the most important things to do to try and contain the virus test as many people, including those without symptoms, as often as possible.

President Trump and Vice President Pence look on as a video plays of New York Gov. Andrew Cuomo giving a press conference in April. Jim Watson/AFP via Getty Images hide caption

President Trump and Vice President Pence look on as a video plays of New York Gov. Andrew Cuomo giving a press conference in April.

2. Will the Senate make a push for another relief package? Health versus the economy has been the tension since the beginning of the lockdowns. Unemployment has hit almost 15%, the highest since the Great Depression. And as deaths spiked in April, 20 million jobs were lost. Congress has passed four relief packages; the Democratic-led House has passed another, but Senate Republicans and the White House have balked at a fifth major package. "We have not yet felt the urgency of acting immediately," Senate Majority Leader Mitch McConnell, R-Ky., said last week.

On Tuesday, there could be more clarity on the state of the economy and what more the administration is planning to do to support people and the economy in the coming weeks when Treasury Secretary Steven Mnuchin and Federal Reserve Chair Jerome Powell appear before the Senate Banking Committee, as required by the CARES Act.

3. Watching for fallout from inspectors general firings: The firing of the State Department's inspector general, Steve Linick announced on a Friday night, which is where bad news goes to be buried in Washington is raising more questions than answers. Linick is the fourth inspector general the Trump administration has sought to remove in the past six weeks. A Democratic congressional aide told NPR's Michele Kelemen that Linick was looking into Secretary of State Mike Pompeo's conduct.

The move triggered Republican Sens. Mitt Romney, Susan Collins and Chuck Grassley to question Trump's motives. Romney said the move "chills" the IGs' essential independence and called the moves "a threat to accountable democracy." Collins said Trump had not provided "the kind of justification for the removal ... required" by law. Grassley pointed out that "written reasons" are "required" and that "A general lack of confidence simply is not sufficient." But what does the Republican Senate do to maintain the accountability that they say Trump is threatening or not abiding by? So far, during the Trump presidency, it's done little to hold him in check.

4. Senate Republicans move ahead with Hunter Biden probe: On Wednesday, the Senate Homeland Security Committee will vote on a subpoena to Blue Star Strategies. That's a company that worked with the Ukrainian energy company Burisma, which hired Biden's son Hunter to sit on its board. Republican senators are looking into whether Blue Star "sought to leverage Hunter Biden's membership on the board of directors for Burisma." Call it the impeachment backlash.

With Romney signaling he will vote in favor of the subpoena, it is expected to pass, NPR's Philip Ewing and Claudia Grisales report.

5. Supreme Court opinions Monday: The Supreme Court is expected to issue opinions Monday. We are keeping an eye out for an LGBTQ employment discrimination case, as well as whether the court thinks the Trump administration acted lawfully in shutting down the Deferred Action for Childhood Arrivals, or DACA, program. When the DACA case was argued last fall, the court's conservative majority appeared it would go along with the Trump administration. Both of these decisions could be released at any time in the next few weeks.

"After much reflection, I've concluded that circumstances don't lend themselves to my success as a candidate for president this year, and therefore I will not be a candidate."

Rep. Justin Amash of Michigan announcing via Twitter the end of his short-lived Libertarian bid for the presidency. There was much Democratic hand-wringing that Amash could cost Biden votes, especially in Michigan.

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5 Things To Watch This Week In Politics And Coronavirus - NPR

Where New Yorkers Moved to Escape Coronavirus – The New York Times

May 19, 2020

Top 50 metropolitan destinations

outside New York City

Miami-

Fort Lauderdale-

West Palm Beach

Top 50 metropolitan destinations

outside New York City

Miami-Fort Lauderdale-

West Palm Beach

Top 50 metropolitan destinations

outside New York City

Miami-Fort Lauderdale-

West Palm Beach

Top 50 metropolitan destinations

outside New York City

Miami-

Fort Lauderdale-

West Palm Beach

By The New York TimesArrows are sized by the proportion of requests for that destination.

New York City has long been a cheek-to-jowl town with cramped apartments and determined strivers. But starting in March, as the coronavirus outbreak here began, parts of the city emptied out, with many leaving from New York's wealthiest neighborhoods. Mail-forwarding requests show where a number of them went. Some abandoned the Upper West Side for sunny Miami. Others left Gramercy Park for New Jersey. Some left Brooklyn apartments for California.

In March, the United States Post Office received 56,000 mail-forwarding requests from New York City, more than double the monthly average. In April, the number of requests went up to 81,000, twice the number from a year earlier. Sixty percent of those new requests were for destinations outside the city.

By The New York TimesSource: U.S. Postal Service

The empty feeling is the most pronounced in Manhattan. In April, a little more than half of those requests for destinations outside New York City originated in Manhattan, led by neighborhoods on the Upper West and Upper East Sides.

The data from neighborhoods that saw the most requests mirrors cell phone data showing that the city's wealthiest areas saw the most movement.

Right after Covid hit, everyone just blasted out of here, Councilwoman Helen Rosenthal said of the Upper West Side. You could walk just in the middle of Columbus Avenue. And I often did.

Miles of normally cramped streets are empty, and garbage collection is lower in those neighborhoods than in recent years. In Times Square, you can practically hear the hum of electronic signs glowing above empty sidewalks.

Many New Yorkers who fled their homes in the city moved to nearby areas in Long Island, New Jersey and upstate New York.

The Hamptons are a summer

home destination for many

New York City residents.

The Hamptons are a summer

home destination for many

New York City residents.

The Hamptons are a summer

home destination for many

New York City residents.

By The New York TimesSource: U.S. Postal Service

In most locations, the United States Postal Service allows individuals and families who normally get mail at a given location to temporarily forward their mail somewhere new, for up to a year.

Now, mail that used to go to Hells Kitchen in Manhattan is going to Maine and Connecticut. Lower East Side letters are being rerouted to Florida and Pennsylvania. Packages meant for Park Slope, Brooklyn, are going to Texas and Rhode Island.

New York City

region excluding

the city

32% of requests

Miami-

Fort Lauderdale-

West Palm Beach

N.Y.C. region

excluding

the city

32% of

requests

Miami-

Ft. Lauderdale-

W. Palm Beach

N.Y.C. region

outside the city

Miami-Ft. Lauderdale-

West Palm Beach

New York City

region excluding

the city

32% of requests

Miami-

Fort Lauderdale-

West Palm Beach

By The New York TimesSource: U.S. Postal Service

After being laid off from his job as a theater stage hand, Kurt Gardner, his wife and their young daughter left their crowded two-bedroom apartment in the Windsor Terrace section of Brooklyn for the familys three-bedroom summer home in eastern Suffolk County, on Long Island.

Mr. Gardner, 50, said he hears about friends in the city who have to wait outside an hour for Trader Joes. The Gardners now live near a well-stocked supermarket with practically no lines. Theyre surrounded by open space, and their daughter doesnt have to worry about socially distancing at Prospect Park, he said.

As for their mail, it comes maybe once a week, Mr. Gardner said. He and his wife filed mail-forwarding requests in mid-March, but he said much of his mail from March never arrived.

Brooklyn had the second-highest number of mail-forwarding requests, which were concentrated in neighborhoods like Dumbo and Brooklyn Heights.

Mail-forwarding requests

by ZIP code in April

Mail-forwarding

requests by ZIP

code in April

By The New York TimesSource: U.S. Postal Service

Black and Hispanic neighborhoods, including many areas where essential workers live, tended to have far fewer mail-forwarding requests. Roman Suarez works for a union in New York City and travels on weekends doing stand-up comedy. He was in Texas when his boss in New York called to say things were shutting down. I immediately rushed home, said Mr. Suarez, 42, who lives in the Bronx. He picks up medication and groceries for about three dozen family members who live nearby. I just stayed and made myself available for my family, he said.

His neighbors, many of whom work for the city, or in health care, stayed too, he said. His neighborhood, just east of the Bronx Zoo, had fewer than a quarter as many mail-forwarding requests as the Upper East or Upper West Sides.

My father was a cab driver. My mom was a hairdresser, so I understood service to your community, Mr. Suarez said. He recalled living through other challenging times in the city, from Hurricane Gloria in 1985 to the Sept. 11 terror attacks in 2001. Whenever New York goes through stuff, the best thing to do is just be there.

Metropolitan area

Mail-forwarding requests

New York-Newark-Jersey City

16,041

Miami-Fort Lauderdale-West Palm Beach

1,830

Philadelphia

1,456

Bridgeport-Stamford-Norwalk, Conn.

1,456

Washington-Arlington-Alexandria

1,298

Los Angeles-Long Beach-Anaheim

1,131

Boston-Cambridge-Newton

1,092

Kingston, N.Y.

963

Atlanta

710

Torrington, Conn.

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Where New Yorkers Moved to Escape Coronavirus - The New York Times

Doctors raise hopes of blood test for children with coronavirus-linked syndrome – The Guardian

May 19, 2020

Doctors have identified a group of blood compounds that may help to reveal which children are most at risk of developing a rare but life-threatening immune reaction to coronavirus.

The new syndrome emerged last month after hospitals in London admitted a number of children to intensive care units with symptoms that resembled toxic shock mixed with an inflammatory disorder known as Kawasaki disease.

The World Health Organization (WHO) guidance on face masks has remained consistent during the coronavirus pandemic. It has stuck to the line that masks are for healthcare workers not the public.

Wearing a medical mask is one of the prevention measures that can limit the spread of certain respiratory viral diseases, including Covid-19. However, the use of a mask alone is insufficient to provide an adequate level of protection, and other measures should also be adopted, the WHO has stated.

Nevertheless, as some countries have eased lockdown conditions, they have been making it mandatory to wear face coverings outside, as a way of trying to inhibit spread of the virus. This is in the belief that the face covering will prevent people who cough and sneeze ejecting the virus any great distance.

There is no robust scientific evidence in the form of trials that ordinary masks block the virus from infecting people who wear them. There is also concerns the public will not understand how to use a mask properly, and may get infected if they come into contact with the virus when they take it off and then touch their faces.

Also underlying the WHOs concerns is the shortage of high-quality protective masks for frontline healthcare workers.

Nevertheless, masks do have a role when used by people who are already infected. It is accepted that they can block transmission to other people. Given that many people with Covid-19 do not show any symptoms for the first days after they are infected, masks clearly have a potential role to play, especially on crowded public transport as people return to work..

Sarah BoseleyHealth editor

Hospitals around the world have since reported hundreds of similar cases that many doctors believe are caused by the immune system overreacting to the virus sometimes weeks after infection.

About 100 children in Britain have been treated for the disease. Many have been admitted with a persistent fever, skin rashes, abdominal pain and cold hands or feet. At least two children in the UK have died of the disorder, one of whom was an eight-month-old baby at Plymouths Derriford hospital in April.

Researchers at Imperial College London analysed blood from some of the sickest children and found they had high levels of five compounds that can be measured in routine tests. Two of the compounds, ferritin and C-reactive protein or CRP, are common blood markers for inflammation. The others are linked to heart damage and blood clotting, namely troponin, BNP and so-called D-dimers.

We know that these markers are present in the very sick patients and at lower levels in some patients with normal Kawasaki disease, said Michael Levin, a professor of paediatrics and international child health at Imperial.

We think they can help us decide which children are at risk of progressing to cardiac failure. Essentially what were doing is using the blood markers to try and pick out the children that we need to move from district hospitals to specialist centres and then to intensive care units if needed.

It will take more research to work out if the markers are reliable. If they are, doctors could potentially identify children most at risk from the condition with a simple blood test.

To investigate further, the researchers have been granted permission from Englands chief medical officer, Prof Chris Whitty, to recruit children into a European-funded trial called Diamonds that was already underway to study inflammatory disorders. Doctors around the UK and in various hospitals in Europe are now collecting blood samples for the study to learn which markers may help them predict the severity of disease and to understand the genetics of the disorder.

This is a rapidly changing situation and we desperately need to learn how to manage it because we are now seeing quite significant numbers of children being admitted to district hospitals all over the place, Levin said.

What we dont know when were seeing a child for the first time, or hearing about them if theyre at another hospital, is which children are going to get better on their own and which are going to progress to having Kawasaki disease and are therefore at risk of getting coronary artery aneurysms, and who are the small number who will progress to multi-organ failure.

The condition, named paediatric inflammatory multisystem syndrome, resembles a mix of toxic shock and Kawasaki disease, the latter of which overwhelmingly affects children. The disease causes inflammation of the blood vessels and in some cases attacks the heart. The most serious complications are coronary aneurysms which can be fatal when they clot. Doctors typically intervene swiftly with anti-inflammatory drugs or immune-suppressing medicines.

Doctors do not have time to run a formal trial to learn which treatments work best. Instead, plans have been drawn up for an international database they will use to enter anonymous information on children in their care, including blood test results and what treatments are given when. Its not as good as a randomised trial, but its the next best thing in a pandemic. Because the numbers will be so big, it might give us a signal as to which treatments are best, Levin said.

Prof Russell Viner, the president of the Royal College of Paediatrics and Child Health, said it was too early to know how beneficial blood biomarkers might be for stratifying children with the new inflammatory disease.

This peak will tail off as the whole Covid peak tails off and we are already seeing that, Viner said. But if Covid is going to be with us for a while, and theres going to be a rise in Covid cases, we are going to see more of these cases. So we absolutely need ways of identifying early on which children might have this as opposed to a child who just presents with a fever, so biomarkers might be exceptionally helpful in the longer term.

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Doctors raise hopes of blood test for children with coronavirus-linked syndrome - The Guardian

The coronavirus exposed the US’ reliance on India for generic drugs. But that supply chain is ultimately controlled by China – CNN

May 17, 2020

"When the hoarding started, my 30-day supply was in back order," said Thebarge. "The scenario really scared me, what would happen to me if I couldn't get HCQ?"

While the US seems to hold sway with its ally India in obtaining the finished product, there's a bigger issue earlier in the supply chain.

India gets around 68% of its raw materials -- known as active pharmaceutical ingredients (APIs) -- from China. Any disruption in that supply chain can create a major problem, especially during a pandemic.

As scientists and pharmaceutical companies race to find an effective treatment and vaccine for Covid-19, there are fears the current vulnerabilities in the supply chain could expose the US -- and other countries -- to drug shortages, just when they need them most.

The US has pledged to "Buy American" drugs going forward, and Indian plans to ramp up its own API production, but will they be able to replace supplies from China during this pandemic -- or even the next?

Karan Singh, managing director of Indian pharmaceutical company ACG Worldwide, says the government realized its huge population was never going to be able to afford imported patented drugs, and needed to find a solution.

Indian companies excelled in reverse engineering big-name drugs and launched copycat versions -- legally. But it wasn't only India that wanted these products, and in the mid-1980s, regulatory changes opened up the US market more open to cheap copycat drugs, too.

Naturally, the pharmaceutical giants, which had invested millions of dollars in creating new drugs, pushed back, and in 1995 the World Trade Organization (WTO) introduced an agreement giving drug patents 20 years' protection -- and companies were given 10 years to comply.

The WTO conceded that member states could grant licenses to manufacturers to make generic versions of patented medicines needed to protect public health.

Now that company is working to reverse engineer three drugs being tested to fight Covid-19 -- Remdesivir, Favipiravir and Baloxavir. "Twenty years later we are again in the forefront here in India with regards to medicines necessary to combat Covid-19," said Dr Yusuf Hamied, chairman of Cipla.

Still, overcoming challenges from intellectual property rights is only half the story.

"(When) China shut down because of Covid-19, we got desperate," said Vinay Pinto, executive director at Wallace Pharma, one of the country's leading manufacturers of HCQ.

"We are still facing a lot of difficulty in getting imports from China," PC Mishra, director of India's Directorate General of Foreign Trade said in late April. "If we compare March 2020 and 2019, imports from China are down by 40%."

Jayasree Iyer, the executive director of Access to Medicine Foundation, a non-profit that analyzes pharmaceutical industries, says there is also a fear among pharma companies that they "may not have enough stocked-up APIs for their next set of commitments."

India used to have a thriving bulk drug and API industry, but when import restrictions were lifted in the early 1990s, its generic drug manufacturers began getting raw materials from China, where some APIs can cost up to 30% less, according to the CII-KPMG report.

"Large incentives were given by the Chinese government to Chinese pharmaceutical companies to set up large API plants," said Singh of ACG Worldwide. "Because of the sheer size and scale of these facilities they were able to leverage economies of scale to drive cost down."

There are now more than 7,000 API manufacturers in China compared to around 1,500 plants in India, where big players like Sun Pharma and Cipla are a rarity, according to the CII-KPMG report.

This is not the first time India's pharma sector has been affected by a slowdown in China.

After that, the Indian government explored the idea of building Mega Pharma Parks to produce APIs but the project was reportedly shelved due to a lack of financial assistance.

However, the most recent supply shortages have caused a rethink.

On March 21, the Indian government revived plans for Bulk Pharma Parks as part of a $1.3 billion package to boost domestic production of bulk drugs and exports.

It includes establishing three bulk drug parks with common infrastructure facilities and a production-linked incentive scheme to promote domestic production of 53 critical key starting materials, drug intermediates and APIs.

"This is a much-needed step, but we will have to see how it's implemented at state level. In the past we have faced immense challenges for environmental clearances or accessing finance," said Dr Kamal Vashi, Vice President of Mangalam Drugs and Organics, one of India's API manufacturing companies.

The United States, too, has recognized the need to become more self-sufficient.

Speaking about Trump's "Buy American" executive order, he said that after this pandemic, the American government would source essential medicines, medical supplies and equipment only from American companies.

The push to reduce the US's reliance on other countries for drugs has gained bipartisan support.

"India is the source of 24.5% of generic drugs sold in the US," she said. "This appears to suggest that we don't need to worry about generics coming from China. In fact, India is dramatically dependent on China for raw materials and chemical intermediates that are used to make active pharmaceutical ingredients."

In short, the US will only not be reliant on China if it cuts ties with India, too.

Nicole Longo, public affairs director at pharmaceutical lobbying group PhRMA, says US plans to move all pharmaceutical manufacturing onshore vastly "underestimate the significant time, resources and other feasibility challenges and complexities involved."

"They also ignore the strength of a robust and geographically diverse global supply chain," she added.

Indian pharmaceutical companies say it will take time to build up their API production capacity -- and reduce their reliance on China.

"Covid-19 has been an eye opener," said Dinesh Dua, Chairman of Pharmaceuticals Export Promotion Council (Pharmexcil). "The government has done more in the past few weeks than what it has done in the past few years. But even if we start now, it will take us at least 10 years to end our dependency on China."

Philippe Andre, who audits pharmaceutical companies' manufacturing practices in China, endorses a more collaborative approach. "The solution would have to be international, through some sort of system where the producer countries would have to ensure they have sufficient capacity to continue supplying the world during a crisis," he said.

For now, India appears to have little choice but to rely on China for the majority of its APIs -- and the US to rely on India for the majority of its drugs. The true test of that supply chain will will come when -- or perhaps if -- scientists find a treatment or vaccine for Covid-19.

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The coronavirus exposed the US' reliance on India for generic drugs. But that supply chain is ultimately controlled by China - CNN

Live Coronavirus News: Full Analysis and Updates – The New York Times

May 17, 2020

In two graduation speeches, Obama offered advice to students and criticized U.S. leadership.

Former President Barack Obama delivered two virtual commencement addresses this weekend, mixing advice to graduates with criticism of the United States response to the coronavirus pandemic.

More than anything, this pandemic has fully, finally torn back the curtain on the idea that so many of the folks in charge know what theyre doing, he said on Saturday in the first address streamed online. A lot of them arent even pretending to be in charge.

The speeches came as more than two-thirds of states have significantly relaxed restrictions, leaving the nation at a delicate moment.

With states scrambling to pay unemployment claims, a vast attack that flooded unemployment agencies with fraudulent claims appears to have siphoned millions of dollars. Secret Service investigators said they had information implicating a Nigerian fraud ring that filed claims on behalf of people who in many cases had not lost their jobs.

As experts continue to warn that testing needs to be more widely available, the Food and Drug Administration on Saturday granted emergency clearance for a coronavirus testing kit that will enable people to take a nasal sample at home and send it to a laboratory. It was the F.D.A.s second such approval.

Across the United States, low-income communities of color are exposed to significantly higher levels of pollution, studies have found, and also have higher levels of lung disease and other ailments. Now, scientists are racing to understand whether long-term exposure to air pollution plays a role in the pandemic, particularly since minorities in the country are dying disproportionately.

The science is preliminary, because the coronavirus remains poorly understood. But researchers are finding reason to look closely.

Said Dr. Abdul El-Sayed, an epidemiologist and Detroits former health director: The system has allowed, basically, low-income people and people of color to have to breathe the pollution.

Three governors are discussing their states widely watched reopenings on television talk shows on Sunday.

Gov. Gavin Newsom of California, a Democrat leading a state where pandemic conditions vary hugely from county to county, is appearing on State of the Union on CNN. Mr. Newsom will have a national stage from which to explain his efforts, which have drawn some resistance, and provide updates on the pandemic in California.

Mr. Newsom has allowed shops to offer curbside retail and child care services to reopen, along with manufacturers that make retail goods. In much of the state, restaurants and shops remain prohibited from letting customers eat or shop inside their doors. But Mr. Newsom has allowed 22 mostly rural counties, of the states 58, to do so after submitting public safety plans.

Some beaches, trails and parks also reopened in the state this weekend.

Also scheduled to appear on the CNN show is Gov. Mike DeWine of Ohio, a Republican who imposed restrictive measures in the state before many of his Republican colleagues, becoming the first to close schools. The number of new daily cases in the state is down from its peak and has plateaued. Now, as Mr. DeWine looks to reopen the state, he has also chastised those seeking to get ahead of the state orders.

After The Columbus Dispatch published pictures of people crowded together at a restaurant patio, a spokesman for the governor condemned those who were disregarding safety guidelines, even as he noted that, beginning on Friday, restaurants and bars will be able to serve customers at tables outside.

Mr. Polis is not the first leader to do so, but there was pressure to make the process easier in Colorado amid the pandemic, as several big policy options may appear on the ballot in November, including a proposal for paid family leave and several tax measures, according to The Denver Post.

The federal government said this month that it would borrow a record-breaking $3 trillion from April to June to help businesses and workers get through the coronavirus-induced recession.

Running such a large deficit would have been politically untenable a year ago. Since the end of World War II, economists have warned that doing so would risk runaway inflation and possibly unsustainable tax increases on future generations. But now, even some of the United States most ardent deficit hawks have watched the debt pile up and said, More, please.

Economists have pressed for additional aid to small businesses, enhanced unemployment benefits for workers, and more assistance for state and local governments that have seen a steep falloff in tax revenue and have laid off one million workers.

Such spending, they say, would hasten a rebound in economic growth and help save businesses that might otherwise fail, generating a return to the economy that exceeds the relatively low future interest costs incurred by prolific borrowing.

Deficit critics still exist. Republican leaders in the Senate have cited debt concerns as a reason to move slowly on a new package of economic assistance amid the pandemic. But there is little argument among either conservative or liberal economists that the deficit needs to grow, as tax revenues fall and spending needs rise amid a pandemic that has shuttered business activity and thrown at least 20 million people out of work.

Any sensible policy is going to have us racking up the deficit for a long time, if you can, said Kenneth Rogoff, a Harvard economist whose work on government debt and economic growth was frequently cited by lawmakers pushing rapid deficit reduction under President Barack Obama.

If we go up another $10 trillion, he said, I wouldnt even blink at that now.

Medical workers have been celebrated for their commitment to treating coronavirus patients. But even as applause to honor them swells nightly from city windows, and cookies and thank-you notes arrive at hospitals, many doctors, nurses and emergency responders are battling a crushing sense of inadequacy and anxiety.

Every day, they become more susceptible to post-traumatic stress, mental health experts say. And their psychological struggles could impede their ability to continue working with the intensity and focus that their jobs require.

Although the causes for the suicides last month of Dr. Lorna M. Breen, the medical director of the emergency department at NewYork-Presbyterian Allen Hospital, and John Mondello, a New York emergency medical technician, are unknown, the deaths served as a wake-up call about the mental health of medical workers. Even before the pandemic, their professions were pockmarked with burnout and even suicide.

On Wednesday, the World Health Organization issued a report about the pandemics impact on mental health, highlighting health care workers as vulnerable. Recent studies of medical workers in China, Canada and Italy who treated Covid-19 patients found soaring rates of anxiety, depression and insomnia.

Physicians are often very self-reliant and may not easily ask for help said Dr. Chantal Brazeau, a psychiatrist at the Rutgers New Jersey Medical School. In this time of crisis, with high workload and many uncertainties, this trait can add to the load that they carry internally.

The isolation and close quarters of life under lockdown have shifted the balance in relationships between spouses and partners, employees and bosses, children and parents, students and teachers.

Add to this list a classification of people who typically spend years fighting for resources and turf while seeking to coexist in forced proximity.

We are talking about siblings.

The new reality for brothers and sisters is that they must spend much of their time together, in the absence of friends, school peers or teammates.

Parents say that long days at home are peppered with arguments, but it isnt just that. Plenty of families are also noticing a positive development on the new home front: the redefining and even deepening of sibling relationships.

A day after several New York regions were cleared to begin reopening, Gov. Andrew M. Cuomo said this weekend that horse racing tracks in the state, as well as the Watkins Glen International auto racing track, would be allowed to open without fans on June 1.

We can have economic activity without having a crowd thats great, Mr. Cuomo said in his daily briefing on Saturday. We can do that in this state. But no crowds, no fans.

With the coronaviruss grip on the region easing, Mr. Cuomos announcement paved the way for events to begin at tracks, including Belmont Park on Long Island, which hosts the Belmont Stakes. Watkins Glen International is an annual stop for NASCAR, which is set to resume its top series in South Carolina on Sunday.

The steps were announced as major indicators, such as new hospitalizations and virus-related deaths, continued to decline.

Across the Hudson River, Gov. Philip D. Murphy of New Jersey also announced reopening steps in preparation for the states beaches to reopen, with some restrictions, by Memorial Day weekend, along with those in New York, Connecticut and Delaware.

Mr. Murphy said that fishing charters and other boating rental services would be allowed to open Sunday, but that they must ensure social distancing and track customers in logs to help state officials with contract tracing, if necessary.

Mr. Murphy also announced the approval of $1.4 billion in federal funding for the New Jersey Transit system, which has taken an enormous financial hit during the shutdown. I cannot overstate how vital this funding is, Mr. Murphy said.

There were 115 new coronavirus deaths reported on Saturday in the state, bringing the total to 10,249.

As both states looked ahead to plot ways for residents to enjoy the summer without a surge in virus cases, police officers in New York City continued to work to control crowds during a warm weekend, temporarily closing the entrance to the popular Sheep Meadow in Central Park after the area became crowded.

Driving is picking up a little. Refineries in China are buying more oil. Saudi Arabia and Russia ended their price war and slashed production, and U.S. oil companies are decommissioning rigs and shutting wells.

All of those developments helped push up oil prices modestly in recent weeks just enough for some of the best oil wells in the United States to break even, and what may seem like a minor miracle given that the price is more than $60 above where it was about a month ago.

May, it seems, is a month when traders can finally sit back more comfortably for a moment and take a breath, said Bjornar Tonhaugen, the head of oil market research at Rystad Energy, a research and consulting firm. But we warn that the second half of the year will not be met with precrisis oil prices again.

Even after the rally, oil prices are roughly half of what they were at the start of the year. And the average price for regular gasoline in the United States is 99 cents a gallon less than it was a year ago, according to AAA.

Energy experts say that oil prices may dip again if there is another surge in coronavirus cases and deaths. Prices could also fall when tankers filled with more than 50 million barrels of crude oil from Saudi Arabia reach the United States in the next two months.

But there are signs that demand for petroleum products is beginning to rise again, especially the demand for gasoline.

Technical glitches during Advanced Placement online exams are the latest problem that high school students have confronted as they navigate testing, college applications and college visits remotely during the pandemic adding stress to a process that is anxiety-inducing even under the best of circumstances.

The College Board, a nonprofit organization that administers the A.P. exams, said that submission issues had affected under 1 percent of the roughly 2.2 million tests taken last week and that students would be able to retake the tests next month.

We share the deep disappointment of students who were unable to complete their exam whether for technical issues or other reasons, Zach Goldberg, a College Board spokesman, said in a statement. Were working to understand these students unique circumstances in advance of the June makeup exams.

The College Board said in March that it would administer digital versions of the A.P. exams, which can allow high school students to receive credit for introductory-level college courses.

The organization which also oversees the SAT, a standardized test that serves as a gateway to college for millions of applicants each year also said it would develop digital versions for students to take at home in the fall if social distancing continues to be necessary.

In summer resort towns across the United States, livelihoods for the year are built in the 15 weeks between Memorial Day and Labor Day. It is during those weeks that tourists arrive to bask on the beach and gather for festivals and weddings. It is also when associated tour operators, hoteliers, innkeepers, restaurant employees and others earn the bulk of their income.

But this year, with Memorial Day the kickoff for summer approaching next weekend, there will be fewer guests to welcome and likely no sizable weddings or festivals to host. Business owners in resort areas, from Cape Cod, Mass., to Lake Chelan, Wash., say that as the start of summer approaches, they are facing the difficult reality that little money will be made this year.

Between canceled trips and uncertainty about how willing and able people will be to travel once shelter-in-place rules are lifted, business owners say that even if summer travel starts late, it wont make up for losses already incurred.

For this weekend and Memorial Day weekend, everything has been canceled and we have zero income, said Barb Rishel, the owner of the Wellington Inn, a bed-and-breakfast in Traverse City, Mich. Its devastating. Its bleak.

Think smores, stars, the air mattress deflating with a cartoony hiss. Picture childrens faces, fire-lit and, for just another minute, little else. It could happen in farmland, suburbia or the Bronx and it could be lovely. In lieu of summer vacation, there are also ways to take a vacation at home.

Reporting was contributed by Mike Baker, Karen Barrow, Nicholas Bogel-Burroughs, Jan Hoffman, Sheila Kaplan, Clifford Krauss, Michael Levenson, Tariro Mzezewa, Katherine Rosman, Andrea Salcedo, Hiroko Tabuchi and Jim Tankersley.

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Live Coronavirus News: Full Analysis and Updates - The New York Times

When Did the Coronavirus Arrive in the U.S.? Heres a Review of the Evidence. – The New York Times

May 17, 2020

SEATTLE In a county north of Seattle, two people who came down with respiratory illnesses in December now have antibodies for the coronavirus. In Florida, a public health official who got sick in January believes he had Covid-19.

Those cases have contributed to growing questions about when the virus first reached the United States and how long it had been circulating by the time its arrival was publicly confirmed in Washington State at the end of February.

While there was limited testing to uncover specific cases before then, researchers have other tools to trace the path of the coronavirus. That includes genomic sequencing of the virus to help scientists build an ancestral tree of cases, a re-examination of specific deaths and thousands of old flu samples that have been repurposed to look for the coronavirus.

Here is a look at the evidence and what it shows:

It is possible, but it was most likely something else.

The Seattle area emerged as an early epicenter of the coronavirus outbreak at the end of February, but there is compelling evidence that, even there, the virus did not yet have much of a foothold compared with the flu, which had a particularly potent season.

A team that analyzes flu trends in the region has been able to review nearly 7,000 old flu samples collected from around the region in January and February, re-examining them for the coronavirus. All of the samples from January were negative. The earliest sample that tested positive was Feb. 20.

Based on that and later case counts, Trevor Bedford, who studies the evolution of viruses at the Fred Hutchinson Cancer Research Center in Seattle, and who was part of the flu study team, estimated that there were probably a few hundred cases in the area by that point in February.

But even that would still be a small fraction perhaps less than 1 percent of the many thousands of people who had flu symptoms at the time.

The U.S. first identified cases among travelers who had flown in from Wuhan, China, in the middle of January. Officials worked to contain them.

There is some evidence that the virus began getting a bit of traction around the end of January. To seed that late-February emergence in the Seattle area, researchers believe the spread could have begun with a traveler who arrived in the region from Wuhan on Jan. 15, or it may have been another unknown case that arrived in the few weeks that came after.

In San Jose, tissue sampling from a woman who died on Feb. 6 revealed that she was probably the first known person in the U.S. whose death was linked to the coronavirus a strong sign that the virus may have been circulating in that part of Northern California in January.

But was it part of a large, previously unrecognized outbreak?

Dr. George Rutherford, a professor of epidemiology and biostatistics at the University of California, San Francisco, theorized that perhaps the woman, who worked for a company that had an office in Wuhan, was one of only a small number of people who contracted the virus at that time and that transmissions probably petered out for some reason. Otherwise, he said, the region would have seen a much bigger outbreak.

With that kind of early introduction, we should be seeing thousands of more cases, Dr. Rutherford said.

There are other, less concrete signs of earlier infections. In Florida, where the first two official cases were announced on March 1, a state database now lists coronavirus cases in patients who may have had symptoms as far back as January. But the cases are all under investigation, and no one has confirmed that any of those patients had the disease that early.

One of them is Raul Pino, the health officer for the Florida Department of Health in Orange County. He said recently that he suspected he had the virus in the first week of January.

Doctors in France have said that a patients sample from late December has since tested positive for the coronavirus. But so far, there is no comparable evidence of a similar case in the United States.

The strongest possible indicator so far is new evidence that emerged this week of two people in Snohomish County, Wash., who reported coronavirus-like symptoms in December. Both people later tested positive for antibodies, county health officials announced.

But Dr. Chris Spitters, the countys health officer, said that while it was possible that both people had the coronavirus in December even before officials in China had reported a cluster to the World Health Organization at the end of the month he was doubtful.

Its possible and frankly, I think, more likely that they had a non-Covid respiratory viral illness in December and subsequently had an asymptomatic or minimally symptomatic Covid infection subsequent to that, Dr. Spitters said.

Dr. Bedford said he also believed this was the more likely scenario, noting that up to half of people with coronavirus infections have no symptoms.

There could have been a tiny number of isolated coronavirus cases among travelers to the United States in December, Dr. Bedford said. But it is pretty clear that none of them spread.

In part, scientists can tell that by looking at the genomic fingerprints of each case. But another clue is the rapid rate at which the virus spreads, Dr. Rutherford said.

It appears that early in the outbreak, one infection was spreading to about four other people, on average, with an incubation period for new infections of about four days. So a case seeded in December would rapidly quadruple through new generations, most likely growing exponentially to millions of cases from a single unbroken chain of transmission by the end of February. Researchers are not seeing any chains that appear to go that far back.

Modelers looking back at the growth of outbreaks elsewhere have reached similar conclusions. One estimated that New Yorks outbreak could have begun with perhaps 10 infected people who contracted the virus sometime between the end of January to the middle of February, when the first cases of community transmission were identified and hospitals began seeing more cases.

When did the virus begin in China?

The virus first emerged in Wuhan in December after a series of people developed symptoms of a viral pneumonia and an examination found that they had been infected with a new coronavirus.

The information suggests that if the virus did originate from the market, it was most likely circulating by November, early enough to reach that first person. Dr. Bedford said it was conceivable to him that the virus began as early as October, but that November was more likely.

There is no evidence that it started elsewhere. The virus mutates an average of twice a month, something researchers can see in the genomic sequences of individual cases, and all of the cases in Wuhan show close genetic links.

All of the other thousands of cases that have been sequenced around the globe show the Wuhan version as an ancestor.

Dr. Bedford said there was no evidence of genetic engineering in the virus, noting that it appeared to be a genetic outgrowth of a virus circulating among bats. It probably reached humans through an intermediate animal, such as a pangolin, he said.

Theres no hallmarks of it having been manipulated in a lab, Dr. Bedford said. I think thats definitive.

He did not, however, rule out the possibility that some version of the virus being studied by scientists in Wuhan could have somehow escaped and spread from there. But he doubts that is the case. He said that the most prevalent theory about the viruss origins that it spread naturally among animals at a live animal market in Wuhan, then jumped to humans was the most likely explanation.

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When Did the Coronavirus Arrive in the U.S.? Heres a Review of the Evidence. - The New York Times

More than 700 new cases of coronavirus reported in Amarillo region – The Texas Tribune

May 17, 2020

More than 700 new coronavirus cases were reported in the Amarillo region Saturday, as results from targeted testing at meatpacking plants came in.

According to the office of the governor, a surge response team was deployed in Amarillo on May 4 to survey high-risk locations and test workers at meatpacking plants. The Texas Panhandle, where a workforce of Hispanics and immigrants power several meatpacking plants, is home to the highest rates of infection in the state.

"As Texas continues ramping up its testing capabilities, there will be an increase in positive cases as the state targets the most high-risk areas: nursing homes, meatpacking plants and jails," Gov. Greg Abbott said in a statement. "By immediately deploying resources and supplies to these high risk areas, we will identify the positive cases, isolate the individuals and ensure any outbreak is quickly contained."

In a press release Saturday, the governors office indicated plants with widespread outbreaks have temporarily shut down for thorough disinfection.

At a Tyson Foods plant just outside of Amarillo, all 3,587 employees were tested, according to High Plains Public Radio. The plant is undergoing additional sanitation and cleaning during the weekend and plans to operate on Monday, according to the company.

The Amarillo region includes two counties. Potter County reported 618 new cases on Saturday bringing its total to 2,080, while Randall County reported 116 new cases for a total of 593. Moore County, which has the highest rate of cases per 1,000 residents in Texas and is north of Amarillo, added 4 new cases on Saturday. In total, the three counties accounted for 738 of the 1,801 new cases reported on Saturday.

Across the country, the coronavirus has spread easily in meatpacking plants, where workers typically stand shoulder to shoulder on fast-moving butchering lines. More than a dozen have been forced to shut down temporarily after surges in infections and deaths tied to those facilities. The processing plants, including those in Texas, have scrambled to ramp up health and safety precautions, providing masks and eye protection to workers and placing plastic dividers in some areas.

In Moore County, a JBS Beef plant has seen several cases and one death. On Wednesday, the company reversed course and accepted the offer from the state to test employees in their facilities.

Workers at JBS and family members of JBS employees who have been infected previously told The Texas Tribune that plant management was slow to acknowledge when workers began testing positive, and those who come in contact with the sick are not always informed of their exposure.

Alexa Ura contributed to this report.

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More than 700 new cases of coronavirus reported in Amarillo region - The Texas Tribune

F.D.A. Clears Another Coronavirus Testing Kit for Use at Home – The New York Times

May 17, 2020

The Food and Drug Administration on Saturday granted emergency clearance for a coronavirus testing kit that will enable individuals to take a nasal sample at home and send it to a laboratory for diagnostic testing, the second such approval it has made.

Dr. Jeffrey Shuren, director of the agencys Center for Devices and Radiological Health, said in a statement that the new test not only provides increased patient access to tests, but also protects others from potential exposure. Health care workers can risk infection when they administer diagnostic tests.

The kit, made by Everlywell, will contain a swab for individuals to use to take a sample from inside the nostrils, and a tube filled with a saline solution to put it in for sending to one of two private lab companies: Fulgent Therapeutics or Assurance Scientific Laboratories. The company plans to partner with additional laboratories.

Some public health researchers have warned that at-home nasal swab tests can be less accurate than the specimen collection performed by health care providers, which involves inserting a long nasal swab through the nose into the back of the throat.

Christina Song, an Everlywell spokeswoman, said consumers will first take an online screening survey to determine whether they meet federal guidelines for the test. The survey will be reviewed quickly by health care providers affiliated with PWNHealth, the companys telemedicine partner. If a consumer qualifies for the test, one will be shipped out immediately.

From the moment that you hit the order button, to the moment that you get the test results on your phone or device, that process is designed to take three to five days, Ms. Song said.

The test kits will be available later this month, according to Ms. Song, and will cost $135.

In announcing its authorization for the Everlywell testing kit, the F.D.A. said the company had leveraged data from studies supported by the Bill and Melinda Gates Foundation and UnitedHealth Group to show that the specimens would stay stable during shipping.

Everlywell makes a variety of products that individuals can buy online or in stores, among them at-home test kits for diabetes, sexually transmitted diseases and high cholesterol.

Some of the companys products, such as those purporting to test for food sensitivities, have come under criticism. Everlywell was also one of several businesses that drew attention from members of Congress in March for entering the market for coronavirus test kits in March without F.D.A. approval.

Everlywell, which had promoted its at-home kit as a consumer product, said in a statement at the time that it had not sold any of the kits to consumers, but was providing the test materials at cost to hospitals and health care organizations who can commit to providing the test for free to their workers and patients.

The F.D.A.s announcement on Saturday follows other recent emergency use authorizations for coronavirus testing kits that also permit individuals to take samples at home. One, sold by LabCorp, also uses a nasal swab to collect a sample, which is then sent to the lab. The other, developed by a Rutgers University laboratory, called RUCDR Infinite Biologics, in partnership with Spectrum Solutions and Accurate Diagnostic Labs, is for collecting a saliva sample.

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F.D.A. Clears Another Coronavirus Testing Kit for Use at Home - The New York Times

Know the risks: Where you are most likely to get coronavirus – ABC News

May 17, 2020

Recommendations on how to protect ourselves from contracting the virus that causes COVID-19 are everywhere, like washing your hands, wearing a mask, and staying at least 6 feet away from people outside your home. But not all risks are created equal; home, public transportation and the grocery store all have different challenges.

A blog post by University of Massachusetts Dartmouth professor, Dr. Erin Bromage, who studies immunity of infectious diseases in animals, titled "The Risks - Know Them - Avoid Them" garnered major attention for showing that some of the highest risk areas may not be what you'd expect.

A cashier wearing a face shield bags groceries for a customer at the Local Market Foods store in Chicago, April, 8, 2020.

A lot of attention is being spent on opening up the economy, but it seems like the highest risk is more likely your own living room.

The data suggests that most people will get infected in their home, according to Bromage.

Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis.

So where are the highest risk areas in the community for getting infected?

"The general theme of what I can see is, lots of people together in an enclosed environment with poor airflow and usually some sort of talking or singing involved leads to lots of people in that environment getting infected," said Bromage, in an interview with ABC News.

Case studies that traced back COVID-19 outbreaks at the beginning of the pandemic, have found that the main sources of infections in the community lead back to the workplace, public transportation, social gatherings, and restaurants indoor environments, with limited air circulation, and many people spending a prolonged period of time in the same place.

Some of the biggest outbreaks, excluding nursing homes, in fact, that have been reported and traced occurred in prisons, religious ceremonies, choir practices, indoor sporting events, and even birthday parties.

"You've got a lot of people in an enclosed space with lots of huffing, puffing, or yelling, which just led to large outbreak events," Bromage said.

Being exposed to the virus does not automatically mean you will be infected. A successful infection is dependent on the time exposed to the virus and the amount of viral particles you are exposed to. For example, "While joggers may be releasing more virus due to deep breathing, remember the exposure time is also less due to their speed," Bromage writes.

Scientists call the amount of exposure to the virus that leads to infection the "infectious dose." Although scientists are still learning more about how many viral particles lead to infection, they do know that sneezing and coughing release the highest amount of viral material into the air, and you're more likely to become infected if you're in a confined space.

A masked grocery store worker in Brooklyn's Sunset Park neighborhood with one of the city's largest Mexican and Hispanic community, organize shopping carts while people waiting to enter the store, May 5, 2020, in New York City.

A single sneeze, according to Bromage, has been estimated to release about 30,000 droplets that can travel up to 200 miles per hour, which means it could easily cross a room. A cough releases round 3,000 droplets that can travel around 50 miles per hour. These particles may drop to the ground or could hang around in the air for a short period of time.

In fact, a recently published study showed that speaking loudly in an enclosed space creates "substantial" risk of transmitting the virus to others. Prolonged contact and lots of direct talking, breathing, and yelling between individuals increases the direct exposure to viral particles, which increases the likelihood for infection.

The amount of virus a person release changes over the course of the infection and varies by person. This is dependent on the infected persons' viral load, which is the amount of the virus detected in a test sample from a patient and reflects how well the virus is replicating.

Many people are asymptomatic and may easily spread the virus, unknowingly, by directly talking, singing, yelling, or even breathing around other people in close contact. This is why the CDC advises that everyone wear face coverings in public.

Bromage underscores that the exact number of people infected by respiratory droplets versus transmission through touching contaminated objects like door handles and elevator buttons is unknown, which is why it's also important to wash your hands often and avoid touching your face. But the compilation of studies he wrote, "serves to highlight that being in an enclosed space, sharing the same air for a prolonged period increases your chances of exposure and infection."

In very high-risk situations, social distancing guidelines are not as effective because even if you are far away from an infected individual in a small, poorly ventilated enclosed space for a long period of time, a low dose of the virus in the air can reach you and over a sustained period of time may be enough to cause infection.

Bromage said that the activities many typically view as highest risk for infection like grocery shopping might not be as risky if you're spending a brief amount of time at the store, you're avoiding other shoppers, not speaking directly with people, and the store restricts the number of people that can enter at a given time.

Public bathrooms may also pose a risk, but for slightly different reasons, said Bromage. Bathrooms have a lot of high touch surfaces like door handles, faucets, and countertops.

So far, the science seems to suggest that outdoor areas and large ventilated spaces are the lowest risk areas for infection. Outdoor areas are generally safer because wind and infinite air space could dilute the viral particles circulating. If you are actively moving outside that also reduces the exposure time to any viral particles hanging around.

With restrictions lifted in some states, many Americans will face a new challenge: "Just because something is open doesn't mean it is an instruction to go," said Dr. Andrew Noymer, associate professor of population health at UC Irvine.

Before you put yourself in a high-risk situation, Bromage suggests asking yourself, "Are there too many people here and how much time have they spent here? Are there loud talkers? Singing or yelling? What's the amount of people in my area that actually are infected?" If you are in an environment with a lot of people, you should also assess what changes the business owner put in place to lower the risk of virus spreading.

If you choose to meet other people, you should also consider their level of exposure and health status. Ask your friends or family where they have been, how often they go to the store and whether they have been staying home, suggests Dr. Henry Raymond, epidemiologist and associate professor at Rutgers University.

"It's not just about your health but about the health of those people around you," Raymond said.

If you know your friend or relative has underlying health conditions or is at an increased risk of developing severe symptoms due to a weaker immune system you should take extra precautions to avoid exposing them to the virus. If your state permits social gatherings and you decide to meet up, keep it to a small group and make it safe as possible by staying outside, Raymond said. Agree on some ground rules, such as: "We don't shake hands, we bring our own food, we space the chair out at least 6 feet away."

"The best course of action is to be personally cautious and personally responsible. We don't have a vaccine. But we do have social distancing and masks," said Raymond.

Eden David, who's studying neuroscience at Columbia University and is matriculating to medical school later this year, is a contributor to the ABC News Medical Unit.

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Know the risks: Where you are most likely to get coronavirus - ABC News

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