Category: Covid-19

ByBloomberg School of Public Health staff report

Infants and toddlers who experienced community infection with SARS-CoV-2, the coronavirus that causes COVID-19, had significantly higher levels of antibodies against the virus compared to adults, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health in collaboration with the Centers for Disease Control and Prevention.

The new study suggests that children tend to have strong antibody responses after SARS-CoV-2 infection. Understanding antibody responses to SARS-CoV-2 at different ages can inform COVID-19 vaccine strategies and policies.

The findings are published online in the journal JCI Insight.

This analysis is based on samples taken at enrollment from 682 children and adults in 175 Maryland households who participated in a household surveillance study of SARS-CoV-2 infection and had not yet received a COVID-19 vaccine. Participants ranged in age from 0 to 62 years, and enrollment samples were collected between November 2020 and March 2021.

Ruth Karron

Director, Johns Hopkins Vaccine Initiative

The researchers found evidence of SARS-CoV-2 antibodies, indicating prior infection with the virus, in 56 people at the time of enrollment. Of these 56 people with antibody evidence of previous SARS-CoV-2 infection, 15 were children ages 0 to 4 years, with the youngest three months old; 13 were children ages 5-17 years; and 28 were adults ages 18 years or older. Antibodies to a key site on the virus's outer spike proteinthe "receptor-binding domain," or RBDwere present at much higher levels in children compared to adults: more than 13 times higher in children age 0-4, and nearly 9 times higher in children age 5-17. And levels of SARS-CoV-2 neutralizing antibodies, which may help to predict protection against severe COVID-19 infection, were nearly twice as high in children ages 0-4 compared to adults.

In most households where both children and adults had antibody evidence of SARS-CoV-2 infection, children ages 0-4 years had the highest levels of SARS-CoV-2 RBD and neutralizing antibodies of all infected household members.

"This study demonstrates that even children in the first few years of life have the capacity to develop strong antibody responses to SARS-CoV-2 infection, which in some cases exceed adult responses," says Ruth Karron, lead investigator and a professor in the Department of International Health and director of the Johns Hopkins Vaccine Initiative at the Bloomberg School.

Karron and colleagues set up their prospective household surveillance study, known as SARS-CoV-2 Epidemiology And Response in Children, or SEARCh, to learn more about SARS-CoV-2 infection in children less than 5 years of age, a relatively understudied population. To be included in the study, each household had to have at least one child four years old or younger, and agree to approximately 8 months of follow-up for evidence of SARS-CoV-2 infection.

The analysis of these samples also found that only about half of those with RBD antibodies had been previously told by a health care provider that they may have SARS-CoV-2 infection, indicating that many milder or asymptomatic SARS-CoV-2 infections in the community may not be recognized and counted as infection cases. None of the individuals in the study with previously suspected SARS-CoV-2 infection were hospitalized because of their infections.

"Very young children in our study developed high titers of antibody to the SARS-CoV-2 spike protein, which is the target antigen for COVID vaccines," Karron says. "These findings should provide some reassurance that with the appropriate vaccine doses we can effectively immunize very young children against SARS-CoV-2."

Few studies have looked at antibody responses to SARS-CoV-2 in both children and adults. A study of hospitalized patients found that adults mounted higher neutralizing antibody responses than children. In contrast, several community-based studies found that children mounted robust responses. Findings from this study expand on those from previous community-based studies.

Children ages 5-17 years are currently eligible for the Pfizer-BioNTech mRNA COVID-19 vaccine, and studies of the vaccine in younger children are ongoing.

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Study: Children's antibody responses to COVID-19 are stronger than adults' - The Hub at Johns Hopkins

The New York State Commissioner of Healths designation of COVID-19 under the Health & Essential Rights Act (HERO Act) as an airborne infectious disease that presents a serious risk of harm to the public health ended on March 17, 2022. What this means: effective immediately, private-sector employers are no longer required to implement and follow their HERO Act-based infectious disease prevention plans.

Employers should keep in mind that HERO Act requires that employers adopt a prevention plan and keep the plans in reserve. Employers only need implement their plan, however, when the New York State Commissioner of Health designates a particular disease as an airborne infectious disease.

The New York State Commissioner of Health first designated COVID-19 as an airborne infectious disease on September 6, 2021, requiring covered employers to activate their prevention plans. The Commissioner of Health extended the designation on multiple occasions.

Although the designation of COVID-19 being a disease that presents a serious harm to the public has ended for the time being, covered employers must be mindful of other obligations under the HERO Act that continue on even though no designation is in effect. Not only must covered employers at least create a prevention plan, but they are also required to:

Continued here:

Update on the NYS HERO Act: COVID-19 Designation Ends - JD Supra

GREENWICH The number of new cases of COVID-19 in the Greenwich Public Schools dropped back into the teens in the latest report issued Tuesday on the districts online tracker.

And of those COVID-19 cases, 16 cases were considered active, down from the 40 active cases last Friday, according to the tracker.

Seven schools were impacted, with four active cases reported at Riverside; three active cases each at Eastern Middle and Old Greenwich; two active cases each at New Lebanon and North Street; and one active case each at Greenwich High and Western Middle, according to the tracker.

The 16 active cases of COVID-19 were affecting 12 students and four teachers, according to the tracker.

Many local families in the district have been heavily affected by COVID-19, with 380 families reporting 825 cases during the school year, according to the tracker.

The district continues to offer COVID-19 test kits to families if needed, said Jonathan Supranowitz, director of communications and board of education liaison at the Greenwich Public Schools.

The district had small clusters of positive cases, typically with mild symptoms, in a limited number of classes in the past week, Supranowitz said last week.

Coronavirus in Connecticut

Those outbreaks have become common over the past two weeks in our region of Fairfield County, he said.

At the start of March, the district switched to a mask-optional policy in all of its buildings and on school buses. Previously, masks had been required for all students, teachers and other staff since the COVID-19 pandemic began.

Since that change in policy, the school district had experienced a small jump in COVID-19 cases.

The 29 new cases of COVID-19 reported March 18 and the 30 reported March 15 were each double the 15 new cases that were reported on the tracker on March 11. On March 7, the local schools reported 10 new cases, which was down from the 11 cases reported each on March 4 and March 1 in the districts twice-a-week updates.

So far in March, the district has reported 124 cases of COVID-19, and 161 cases since students returned from Winter Recess on Feb. 22.

Since classes began Sept. 1, the school district so far has reported 2,227 cases of COVID-19, which is more than triple the 700 total cases reported in the 2020-21 school year.

The number of COVID-19 cases reported in the Greenwich Public Schools increased in late December and then spiked in early January, after starting with single- and double-digit numbers mostly reported in the updates during the first three months of the school year.

In September, the district reported 58 cases of COVID-19, according to the tracker, with 29 cases in October and 65 cases in November. The number of cases began to increase, with 392 cases of COVID-19 reported in December and a spike of 1,422 cases in January before the numbers declined to 137 in February, according to the tracker.

The school district updates the tracker on Tuesdays and Fridays to keep the community informed about the COVID-19 pandemic.

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New cases of COVID-19 in Greenwich schools drops into the teens in latest report - Greenwich Time

Last week Allegheny Countys health department reported fewer than 100 new cases of COVID-19 a day. But the growing use of at-home testing coupled with an overall drop in people getting tested for COVID-19 makes it hard to know if this is truly a milestone.

A 100-foot deep well of raw sewage might hold the answers.

Skimming data

The sewage well is where wastewater for Pittsburgh and 82 other municipalities enter the Allegheny County Sanitary Authority, located on the banks of the Ohio River.

Theres been no screening, filtering, no disinfectant, explained Doug Jackson, ALCOSANs director of operations and maintenance. This is as raw as the wastewater gets, coming into the treatment plant.

COVID-19 is excreted in feces, and since this fall, the Allegheny County Health Department says its been analyzing ALCOSAN sewage for the virus.

Sample collection occurs in an adjacent building to the well. Wastewater flows into a container roughly the size of an extra-large cereal box. Every 10- to 15-minutes, a small amount of water is transferred to a 2.5-liter plastic bottle. Then the remaining liquid is emptied, and the process repeats so that the bottle slowly fills over 12 hours.

A commercial lab currently performs the actual analysis in Florida. The county health departments Dr. Robert Wadowsky said it takes at least a week to get results on how much COVID-19 is in the water supply, then roughly another week to determine which variants are present.

Waiting this long diminishes the informations value to act as an early warning system of potential surges. For example, the county only learned omicron was present in its wastewater a day or two before the first people tested positive for the variant, which is now dominant in the county.

Additionally, current methods cannot differentiate between subvariants and therefore cant give data on omicrons sister strain, which is driving up cases in other parts of the world. While individual Allegheny County residents have tested positive for the subvariant, both wastewater data and raw case numbers show that local transmission continues to decline.

Still, wastewater monitoring is a powerful tool, which is why the health department wants to start doing this analysis in-house.

We have the technique ready to go, just about but it is so difficult for us to hire staff to work in the laboratory, said Wadowsky, who is the director of the departments public health laboratory.

The county is collaborating with researchers at Carnegie Mellon University to perform that analysis and create an online dashboard for the public to view the data, which Wadowsky predicts will launch later this spring.

Whats reflected in the wastewater?

According to data from the county health department, in early March, when the county was reporting about 100 cases a day, the presence of COVID-19 in the wastewater was slightly below where it was around Halloween. At the time, the daily case counts exceeded 300.

While testing numbers and wastewater data dont perfectly align, the analysis follows the same general pattern of hospitalizations in the county with a significant spike that peaked in early January, followed by a steep and rapid decline. This is significant because while only a fraction of people who catch the coronavirus will become seriously ill, the percentage of those who develop severe COVID-19 is relatively stable.

Sampling sewage for public health surveillance isnt new it's been done for opioids, HIV, and antibiotics, to name a few. But it became more common during the pandemic, and last month the Centers for Disease Control and Prevention launched a dashboard tracking COVID-19 in wastewater at more than 400 sites. There are so many applications because it captures populations other methods miss.

People that dont have access to care, that dont have insurance and therefore dont go to the doctor, and therefore cant be counted through traditional hospital-based or clinic-based surveillance, they still flush the toilet, said epidemiologist Matt Ferrari, director of Penn States Center for Infectious Disease Dynamics.

All those bathroom breaks create lots of data, which means greater sensitivity to subtle changes in transmission. For example, in areas where polio has been nearly eliminated, wastewater analysis can tell public health workers if there are cases they dont know about.

And that then alerts them to, OK, weve seen it in wastewater, said Ferrari. Now weve got to go look harder in people.

Beyond COVID-19

Wadowsky admits that he was initially skeptical that the wastewater analysis would be effective. That changed when he saw the consistency of the data.

I thought for sure that there was going to be so much fluctuation, he said. So, really, I was quite amazed.

For that reason, he sees other eventual applications, such as monitoring for an enterovirus that causes acute flaccid myelitis a rare but serious polio-like illness most commonly seen in young children. The CDC reports there have only been 679 confirmed cases since August 2014. Just between 20-30% of patients make full recoveries.

In the meantime, the county will continue watching for signs of COVID-19 surges in the sewage. For the moment, the wastewater looks calm.

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Wastewater offers clues to COVID-19's next move in Allegheny County - 90.5 WESA

Background

The coronavirus disease 2019 (COVID-19) vaccinations have brought new hope to the world and have a significant psychosocial impact on communities as well as healthcare systems around the globe. This study aimed to assess the antibody titer level among healthcare workers after at least six weeks of the second dose of the COVID-19 vaccine.

Participants of the study were healthcare workers of a tertiary care cardiac center including doctors, nursing staff, paramedics, and office staff. All participants were fully vaccinated with recommended double dose of available vaccine at least six weeks before the study. A blood sample of five milliliters was collected from all the participants by a trained phlebotomist at a local laboratory, and COVID-19 antibodies titer level was assessed using Food and Drug Administration (FDA) approved kit with a standard range of 1.0. This qualitative assay detects IgG and IgM as total antibodies targeted against nucleocapsid antigen performed on a fully automated cobas 6000 analyzer (F. Hoffmann-La Roche Ltd, Basel, Switzerland) using electrochemiluminescence technology. COVID-19 antibodies titer levels were categorized as 100, 101-250, and >250.

A total of 151 healthcare workers were included, of which 70.2% (106) were male. The history of COVID-19 infection before vaccination was found in 41.1% (62). The mean duration since the last dose of the vaccine was 89.640.07 days. In total71.5% (108)had antibodies titer level of >250, which were mostly found in participants of younger age and who had previous COVID-19 infection. However, antibodies titer level of >250 were observed in 84% (21/25) at 61 to 90 days of vaccination, which declined to 80% (20/25) after 91 to 120 days and to 57.1% (32/56) after >120 days of vaccination.

Good antibodies titer levels were observed in vaccinated healthcare workers, especially in those who were younger and had previous COVID-19 infection.

According to the World Health Organization (WHO), coronavirus disease 2019 (COVID-19) infected more than 464.5 million individuals globally as of March 17, 2022, and has claimed around 6 million lives since the very first case reported in December 2019 [1]. COVID-19 caused an unprecedented scenario with significant health, security, and financial implications, especially in developing countries [2,3]. The frontline healthcare workers remain the most vulnerable and affected segment throughout this pandemic. Hence, the arrival of long-awaited efficacious vaccines was well welcomed. Healthcare workers were the first to get vaccinated in most healthcare systems across the globe [4].

According to the WHO COVID-19 dashboard, as of March 17, 2022, a total of 10,925 million doses of vaccine have been administered [1]. The vaccination strategy for most of the currently approved vaccines is a two-stage "prime and boost" strategy with the first dose followed by the second at least three weeks later [5,6]. Clinical data from the initial experience of vaccination reported good effectiveness in preventing symptoms [7].

The COVID-19 vaccinations have brought new hope to the world and have a significant psychosocial impact on communities and healthcare systems around the globe. However, data regarding the clinical effectiveness of the COVID-19 vaccine for improving immunity levels in our population is very limited. Therefore, this study was designed to assess the antibody titer level among frontline healthcare workers after at least six weeks of the second dose of the COVID-19 vaccine.

This cross-sectional study was conducted at a tertiary care cardiac center of Karachi, Pakistan, between July 1, 2021, and August 15, 2021. The study was approved by the ethical board of the National Institute of Cardiovascular Diseases, Karachi, Pakistan (ERC-65/2021). Participants of the study were healthcare workers working in a public section tertiary care cardiac center of Karachi, Pakistan, in various designations, including doctors, nursing staff, paramedics, and office staff. Study inclusion criteria were healthcare workers of either gender above 18 years of age, fully vaccinated with recommended double dose of available vaccine at least six weeks before the study. Healthcare workers who did not give consent to assess COVID-19 antibody titers or participate in the study were excluded. Study participants were assessed using the non-probability convenient sampling technique.

The purpose and process of the study were explained to all the participants and demographic data such as gender and age were obtained. Data regarding pre-existing co-morbidities were also obtained, which include the history of chronic obstructive pulmonary disease (COPD)/asthma, diabetes, hypertension, obesity, and smoking status. Vaccination information was obtained and verified from government-approved vaccination certificates. Vaccination-related data included type of vaccine (Sinopharm, China National Pharmaceutical Group Corporation, Beijing, China; Sinovac, Sinovac Biotech Ltd, Beijing, China; CanSino-Bio Convidecia; CanSino Biologics Inc., Tianjin, China), duration since final dose (in days), pre-and post-vaccination COVID-19 infection status, and severity. Pre- and post-vaccination COVID-19 infection status was verified through a polymerase chain reaction (PCR) test record.

A blood sample of five milliliterswas collected from all the participants by a trained phlebotomist at a local laboratory, and COVID-19 antibodies titer level was assessed using Food and Drug Administration (FDA) approved kit with a standard range of 1.0. This qualitative assay detects IgG and IgM as total antibodies targeted against nucleocapsid antigen performed on a fully automated cobas 6000 analyzer (F. Hoffmann-La Roche Ltd, Basel, Switzerland) using electrochemiluminescence technology.

Antibodies titer levels were categorized into three groups, less than or equal to 100, between 101 and 250, and more than 250. Collected information was recorded using a predefined proforma designed using Google Forms (Google LLC, Menlo Park, California, United States (US)).

IBM SPSS Statistics for Windows, Version 21.0 (Released 2012; IBM Corp., Armonk, New York, US) was used to analyze data. Mean SD was computed for the continuous variables such as the age of the participant and duration since final dose of vaccination (days), other categorical variables were expressed as frequency and column percentage (Col. %) or row percentage (Row %). The strength of association between COVID-19 antibodies titer level and baseline characteristics was assessed by conducting an appropriate Chi-square test/analysis of variance (ANOVA). Statistical significance was taken as p-value 0.05.

A total of 151 fully vaccinated healthcare workers participated in this study, 70.2% (106) of whom were male, and a majority, 65.6% (99), were under 35 years of age. The history of COVID-19 infection before vaccination was found in 41.1% (62). The mean duration since the last dose of the vaccine was 89.6 40.07 days, and most of the participants, 79.5% (120), were vaccinated with Sinopharm. Vaccine-related complications were reported by eight (5.3%) participants, which included pain at the site of vaccination (four), fever (four), flu (two), and myalgia (five). A majority of the participants, 71.5% (108), had antibodies titer levels of >250, and 11.9% (18) participants were observed to have antibodies titer levels of 100. Good distribution of antibodies titer level was associated with younger age and previous COVID-19 infection. However, antibodies titer level of >250was observed in 84% (21/25) at 61 to 90 days of vaccination, which declined to 80% (20/25) after 91 to 120 days and 57.1% (32/56) after >120 days of vaccination (Table 1).

The most common co-morbid condition was obesity observed in 12.6% (19). Eight (5.3%) participants were smokers, eight (5.3%) had COPD/asthma, five (3.3%) were hypertensive, and two (1.3%) were diabetic. No apparent statistically significant association was observed between the distribution of antibodies titer level and co-morbid conditions (Table 2).

The development of vaccination has brought new hope for humanity against the extremely infectious COVID-19, and mass vaccination is considered the primary strategy to curtailthis pandemic [8]. Several vaccines have been given approval for emergency use by the regulatory authorities. The results from the mass vaccination campaigns are promising with high protection against disease with the recommended two doses of the vaccine. In the current research, we aimed to assess the antibody titer level in healthcare workers who have completed the recommended two doses of vaccine at least six weeks before the study. Vaccine-related complications were reported by 5.3% of the participants. A majority of the vaccinated healthcare workers had suitable antibodies titer levels, and higher antibodies titer levels were associated with younger age and previous COVID-19 infection. Moreover, a decline in antibodies titer level was observed with an increase in duration since the last dosage with a maximum of 84% of the participants with >250 antibodies titer levels at 61 to 90 days and 57.1% after more than 120 days of vaccination. Even though most of the patients developed suitable antibodies, around 7.3% (11) of the participants did develop COVID-19 infection post-vaccination.

Nearly 80% of the participants in our study were vaccinated with Sinopharm. The Sinopharm vaccine has been shown to have neutralizing antibody response for COVID-19 with a low adverse event rate. However, extensive data regarding the safety and efficacy of other available types of the vaccine have been reported, but only a few studies have been conducted for the Sinopharm vaccine [9-11]. Fear of unknown side effects was a significant driver for vaccine hesitancy in a survey conducted in United Arab Emirates (UAE). Similar to ours, the study further reported injection site pain (42.2%), fatigue (12.2%), and headache (9.6%) as common complicationsafter vaccination[12]. Shapiro et al. [13] conducted a study to estimate the efficacy of various vaccines being rolled out globally; these included Sinopharm, Sinovac, Pfizer-BioNTech (Pfizer Inc., New York, US; BioNTech SE, Mainz, Germany), Sputnik (Gamaleya Research Institute, Moscow, Russia), AstraZeneca (AstraZeneca plc, Cambridge, United Kingdom), Moderna (Moderna, Inc., Cambridge, Massachusetts, US), Johnson & Johnson (Johnson & Johnson, New Jersey, US), and Novavax (Novavax, Inc., Maryland, US). It determined an average efficacy of 85% against disease with confirmed infection, 84% against infection, and 54% for transmission to others. Another review reported 100% efficacy of Sinopharm, Sputnik V, and AstraZeneca in prevention against severe COVID-19 [14].

Now that the mass vaccination strategy is implemented; the ultimate goal is to achieve herd immunity; based on Ro value for the infection, nearly 75-90% vaccination coverage is necessary to attain herd immunity against COVID-19 [15]. However, vaccine hesitancy with refusal to get vaccinated due to various myths, rumors, and untrue speculations are deterrents to mass COVID-19 vaccination strategies [16,17]. Along with logistic requirements to ensure mass vaccination, appropriate strategies are also needed to address the misconceptions regarding the development of the vaccine to curtail the transmission of COVID-19.

A very recent study from England on 212,102 vaccinated individuals by Ward et al. reported a peak positive antibody rate at four to five weeks of the first dose [18]. Similar to our observations, antibody positivity was higher in female patients and patients with a history of COVID-19 infection, while antibody positivity decreased with age. Lower antibody positivity was observed in smokers, obese individuals, and recipients of transplants [18]. The study further reported detectable antibodies in a significant number of individuals up until ten weeks after the second dose of vaccine. However, implications of antibody positivity are not fully understood [19]; antibody-positive test does not guarantee protection, just as the absence of antibodies does not, technically, means vulnerability to COVID-19 infection as 11 fully vaccinated subjects with suitable antibodies in our study got infected even after vaccination. However, Earle et al. [20] summarized the evidence for post-immunization antibody titers as a correlate of protection against COVID-19 infection with a correlation coefficient of 0.93 between efficacy and binding antibody titer and 0.79 between efficacy and neutralizing titer.

Good antibodies titer levels were observed in healthcare workers vaccinated with a recommended dose of vaccine. High antibody titers were associated with younger age and previous COVID-19 infection. A decline in antibodies titer level was observed with an increase in duration since the last dosage with maximum positivity at 61 to 90 days. Hence, further studies are required to assess the need for a booster dose to maintain the immunity level.

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COVID-19 Antibodies in Vaccinated Healthcare Workers: The Security Currency - Cureus

Venture-capital firm Omega Funds has created and provided initial funding to Aerium Therapeutics, a biotech startup seeking to develop a broadly effective drug for Covid-19.

Aerium, based in Boston and Lausanne, Switzerland, said it is developing a two-antibody combination treatment. In preclinical studies, the antibodies have been potent neutralizers of SARS-CoV-2 and its variants. That group includes Omicron and its sub-variants, among them the BA.2 strain that has been detected in at least 40 countries. The Centers for...

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Startup Aerium Therapeutics Developing Antibody Treatment for Covid-19 - The Wall Street Journal

Tuesday, the Minnesota Department of Health (MDH) reported*:

*Data reported on Tuesday represents data as of the remainder of Friday, Saturday, Sunday and as of 4 a.m. on Monday. Of the deaths reported Tuesday, MDH says 11 are from March and one is from January.

MDH also reported the following data regarding hospital capacity**:

**For this data set, MDH defines COVID beds in use as being the number of patients who are currently positive with COVID-19 occupying a staffed inpatient bed in Minnesota. This does not include patients that were once positive but are now negative.

Additionally, MDH said:

View the complete updatevia the interactive infographicbelow or here.

Meanwhile, the Centers for Disease Control and Prevention reported, as of Tuesday, six counties in Minnesota remained at a high level of COVID-19 community transmission. Another 36 counties are considered at a substantial spread.

View the complete update via the interactive map below or here.

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MDH: 12 newly reported COVID-19 deaths, 250 current hospitalizations - KSTP

Dr. Fauci talks to News-leader about vaccines, COVID cases in Missouri

Dr. Anthony Fauci spoke with News-Leader reporter Galen Bacharier on July 15, 2021 about vaccinations and the spread of COVID-19 in Missouri.

Galen Bacharier, Springfield News-Leader

Missouri recorded its first positive case of what was then known as "the novel coronavirus" on March 7, 2020. Two years later, the virus persists throughout the Show-Me State, the U.S. and the world.

In those 24 months, COVID-19 has infected more than a million Missourians and taken the lives of thousands. More than a health crisis, the pandemic brought with it a tumultuous saga of government action and inaction, political conflict and crucialdecision-making bystate and local institutions.

The most recent surge in cases, which forced school closures in late January as the omicron variant spread, has largely subsided. Government restrictions have nearly all been lifted and case rates at local hospitals have fallen significantly.

"We are in a nice trough, possibly between waves," CoxHealth CEO Steve Edwards wrote Monday on Twitter. Although he and other experts continue to monitor increasing case counts elsewhere, "This is a moment to enjoy safely with currently low Covid disease rates."

In this period of calm, the News-Leader has taken the opportunity to review key moments from two years of reporting: The compiled entries (which link to additional coverage on News-Leader.com), cover major legislative, executive and local policy decisions; notable quotes from elected officials and health leaders; and seasonal death and vaccination counts.

With the benefit of hindsight, the resulting timeline paints a more complete picture of how government in Missouri responded to the pandemic.

To navigate to specific time periods, click on the links below:

Cumulative COVID-19 deathtotals in Missouri are based on data from the Center for Systems Science and Engineering at Johns Hopkins University. Vaccination rates are according to data from the Centers of Disease Control & Prevention.

March 7: Missouri records its first presumptive positive case of COVID-19, a woman in her 20s in St. Louis County.

March 12:Leaders in the Missouri House offer dueling responses on the state's preparation for the virus. Democratic Minority Leader Crystal Quade says Missouri is "wildly behind."Republican House Speaker Elijah Haahr says the chamber is focused on passing its annual budget, arguing it is too early to make "dramatic policy changes."

Gov. Mike Parson declinesto declare a state of emergency and focuseshis messaging on individual responsibility. "I am confident that Missouri is well-equipped to deal with the coronavirus," he says.

March 13: Parson declares a state of emergency, freeing state money to ratchet up testing capabilities.

March 16:Parson recommends a pause on public gatherings of more than 50 people.A number of school districts, including Springfield Public Schools the state's largest shut down for two weeks in an extended spring break.

March 18:The state records its first death from COVID-19 in mid-Missouri's Boone County.

March 19: Parson says all Missouri public schools have temporarily closed, sending home over 900,000 students.

March 21: Parson orders a statewide pause on gatherings of more than 10 people.

March 26: Unemployment claims in Missouri jump tenfold from the week prior as the virus prompts layoffs and business shutdowns.

April 1: Parson freezes $176 million in the state budget, with the biggest cuts hitting state colleges and universities.

April 3: Parson issues a statewide stay-at-home order with few changes from his previous small gatherings order. "Now more than ever, we must all make sacrifices," he says.

April 9: State lawmakers approve spending more than $6 billion to aid in the state's COVID-19 response, much of which would come from the federal government. Parson orders all public schools to close their buildings for the remainder of the school year.

April 15: Missourians begin to receive $1,200 stimulus checks from the federal CARES Act. Parson says he would not allow everyone to vote absentee in June's elections, despiterequests fromlocal elections officials.

April 16: Parson extends the state's social distancing order until May 3.

April 21: Attorney General Eric Schmitt sues the Chinese government over COVID-19, claiming the nation's top officials are to blame for the virus.

Springfield and Greene County extend their stay-at-home order until May 4. "The worst thing we could do right now is to totally open up," Springfield Mayor Ken McClure says.

April 28: Parson says the state's gathering limits will soon end and allows all businesses to reopen, expressing confidence that the timing to do so is right.

April 30: Springfield and Greene County allow gatherings up to 15 people and for most businesses to reopen. "We're better prepared, we have better tools and we're no longer flying blind," health director Clay Goddard says.

May 15, 2020: Missouri lawmakers adjourn their annual legislative session after taking almost a month off due to virus concerns. In addition to emergency pandemic legislation, Republican priorities also make it to the governor's desk.

As May ends, 581 Missourians have died from COVID-19.

June 1: Parson freezes another $209 million in state spending, with the majority of the cuts again coming from public schools, colleges and universities.

June 4: Springfield's Mayor McClure praiseslocal leaders for their pandemic response in a livestreamed"State of the City" address, but says "inequities laid bare" in recent months "make it painfully clear how far we are from a truly inclusive democracy."

June 13: Parson lifts statewide virus restrictions, calling it "time to begin repairing our economy and getting Missouri citizens back on their feet and back to work," ostensibly leaving enforcement to local governments.

June 24: Parson says a new spike in cases does not indicate a rising threat to the state. "We are not overwhelmed, we are not currently experiencing a second wave, and we have no intentions of closing Missouri back down at this point in time," he says.

June 30: Parson cuts another $459 million from the state budget, totaling around $844 million in cuts since the beginning of the pandemic. The cuts again center on K-12 and higher education.

July 5: Local officials in Missouri hot spots say there's little need to intervene, even as cases and hospitalizations surge. One Newton County commissioner said "things are getting back to normal," another in McDonald County said "everything as far as I'm concerned is doing just fine," and a third, in Jasper County, said he thinks the virus is "just going to have to run its course."

July 11: State health director Randall Williams urges young people to take more precautions, including social distancing and wearing masks.

July 18: Parson attends a campaign event without a mask on. He tells supporters "you don't need government to tell you to wear a dang mask. If you want to wear a dang mask, wear a mask."

July 28: Springfield City Council votes to take $2.7 million out of the health department's emergency fund to help fund contact tracing and data analysis efforts.

Aug. 11: Williams briefs state lawmakers on the state's plan to open schools for the fall, saying there is the capacity to adequately administer COVID-19 tests. Springfield Public Schools, the state's largest district, starts the year with the majority of students learning virtually.

Aug. 13: McClure, in Springfield, asks Parson to mandate masks statewide. "A united, statewide approach would be the best approach to stem the surge of COVID-19 and return Missouri to normal," he writes in a letter.

Aug. 16: The White House COVID-19 task force recommends Missouri adopt a statewide mask mandate. Parson, whose office receives weekly reports from the task force, disregards the recommendation.

Aug. 25: Missouri begins to increase weekly unemployment payouts by $300 under federal executive order.

Aug. 28: State and local officials say they won't follow Trump administration guidance to test non-symptomatic people less. Williams says "that's not the path that I would set out on."

At the end of August, 1,547 Missourians have died from COVID-19.

Sept. 23: Gov. Parson and First Lady Teresa Parson test positive for COVID-19. The governor says in a recorded video he feels fine and has "no symptoms of any kind."

Oct. 16: Missouri submits its vaccine rollout plan to the Centers for Disease Control & Prevention. Its first phase prioritizes health care workers, before expanding to at-risk populations and then the remainder of the state.

Nov. 3: Parson wins re-election, defeating State Auditor Nicole Galloway for his first full term as governor. Republicans sweep statewide office races and maintain supermajorities in both statehouse chambers.

Nov. 12: Parson relaxes quarantine guidelines for teachers and students who are exposed to COVID-19 but do not test positive. Commissioner of Education Margie Vandeven says the quarantines could have "unintended consequences" for families, schools and the economy. "We know that COVID-19 is not going away soon," Parson says.

Nov. 16: An outbreak among members and staff of the Missouri Senate delays plans for the chamber to approve and send to Parson's desk an emergency spending plan to allocate federal relief money. The week prior, Senate Republicans had gathered for a retreat at Big Cedar Lodge in Branson.

Dec. 2: The Missouri Senate approves a plan to allocate $1.3 billion in federal dollars, around $750 million of which will go toward pandemicrelief efforts. Parson signs off on the plan.

Dec. 3: Missouri and the state hospital associationannouncea contract with the Texas staffing firm Vizient to bring in additional nurses and medical staff.

Dec. 7: A report commissioned by the state finds that the Missouri Veterans Commission failed to recognize and respond to COVID-19 outbreaks, resulting in an "inadequate" virus response within veterans homes in the state.

Dec. 8: Springfield and Greene County stop publishing daily death totals, moving to weekly totals due to surging fatalities from the virus.

Dec. 14: Missourians begin getting vaccinated against COVID-19 as boxes of doses arrive at hospitals around the state. "It's really exciting," says Mercy Springfield nurse Wanda Brown. "We're making history."

Dec. 19: Rural hospitals in Missouri struggle to find beds for patients. Executives tell the News-Leader they sometimes spend hours on the phone trying to find care for those who need it. "It doesn't just impact COVID patients, it impacts any patient coming to any facility with a need for an ICU bed," one said.

Dec. 24: Greene County distributes the last of CARES Act federal money to businesses and organizations. The Springfield Area Chamber of Commerce receives the largest payment, at $536,600.

As 2020 ends, 5,694 Missourians have died from COVID-19.

Jan. 6: State lawmakers return to Jefferson City, with Democrats and some Republicans masked. One priority for some lawmakers is passing legislation to protect businesses from COVID-related lawsuits.

Jan. 14: Missouri begins vaccinating first responders and at-risk individuals, including those over 65.

Jan. 27: Parson delivers his State of the State address, touting the state's virus response and acknowledging the death toll and those hospitalized. "The bottom line is that we have been working day in and day out to fight COVID-19," he said.

Feb. 1: Large-scale vaccine clinics will be held around the state in the coming weeks, Parson says.

Feb. 18: CoxHealth's specialized COVID-19 ICU is emptied for the first time in seven months. The unit had seen about a third of the hospital's roughly 3,000 patients from the virus and had been the site of between 80 and 90 percent of deaths.

Parson says he received the first dose of a COVID-19 vaccine.

As February ends, 7,997 Missourians have died from COVID-19.

4.26 percent of those eligible are fully vaccinated.

March 1: Parson reverses the last of the cuts he earlier made to the 2020-21 budget, citing an improved economy.

March 18: Vaccines will be open to all Missourians by April 9, Parson announces, starting "Phase 2" of the state's rollout plan."With progress we're currently seeing and vaccine supply expected to increase significantly in the coming weeks, we are well ahead of schedule," he says.

April 6: Springfield Mayor McClure is re-elected, fending off a challenge from candidate Marcus Aton, who made the city's response to the pandemic central to his campaign.

April 19: Missouri's state-run vaccine tracker program receives an update, streamlining the process to schedule an appointment that previously required signing up separately through some local health department systems.

April 20: State health director Dr. Randall Williams resigns after four years in Jefferson City and 15 months leading Missouri's COVID-19 response. No reason is given for his departure, and Parson's office does not release further details. Robert Knodell, Parson's deputy chief of staff, is named acting director.

April 25: Eighty percent of Missouri teachers feel more stressed than ever and a portion have felt "personally attacked" by decision-making during the pandemic, according to a statewide survey.

May 4: Springfield City Council unanimously ends most outdoor masking rules inside city limits.

May 11: Parson says Missouri will cut off federal unemployment benefits in June, arguing the extra money has "incentivized people to stay out of the workforce." Quade, the leader of House Democrats, callsthat sentiment "an offensive right-wing myth."

May 17: Springfield City Council unanimously ends the city's mask mandate, effectiveMay 27, the city's school district's final day.

At the end of May, 9,271 Missourians have died from COVID-19.

32.87 percent of those eligible are fully vaccinated.

June 15: Parson signs a bill restricting local health departments' power to issue and extend public health orders, as well as banning any requirement to show proof of vaccination on public transportation. He says "there was overreach on the local levels" in response to the pandemic, and "there's going to be consequences to that."

June 21: A new variant of COVID-19, the more contagious delta variant, begins to surge in Springfield, accounting for an estimated 90 percent of new cases and bringing national news coverage to southwest Missouri.

July 7: Parson signs a bill protecting businesses against lawsuits related to COVID-19,requiring those suing to prove the businesses "engaged in recklessness or willful misconduct" that led to virus exposure.

July 8: Federal health officials arrive in southwest Missouri to aid local authorities in curbing the delta variant surge. Parson characterizes the action as "sending government employees or agents door-to-door to compel vaccination," which "would NOT be an effective OR a welcome strategy in Missouri!"

White House Press Secretary Jen Psaki callssuch language "a disservice to the country" and to those urging for vaccination.

July 21: Parson appoints longtime Illinois health director Donald Kauerauf as Missouri's new health director. Kauerauf says he believes Missouri "has (followed) the CDC playbook" and that his job is to "increase ... the ability for Missouri to respond to COVID."

Parson announces a new vaccine lottery program, with 180 total winners claiming $10,000 over the next two months.

July 22: Emergency ambulance teams and equipment will be sent to Greene County, Parson says, to aid in transporting COVID-19 patients.

July 23: Acting director Katie Towns is named permanent health director of the Springfield-Greene County Health Department.

July 27: Parson praises the state's COVID-19 response in remarks to Springfield-area business leaders. "There was no playbook that you could turn around and say, 'this is what you do in a crisis like this,'" he says.

July 29: Springfield and Greene County withdraw a previous request for the state to set up a field hospital to treat additional COVID-19 patients. One hospital says the withdrawal was not "because the need is not great. It is because we needed to serve patients quickly."

Aug. 6: Missouri sends FEMA ambulance teams around the state to transport COVID-19 patients to less full hospitals after a request from the state.

Aug. 24: Attorney General Schmitt files a class-action lawsuit against Missouri school districts with mask mandates. The move is criticized by districts, one of which says it will "waste taxpayer dollars and resources."

Members of Springfield City Council condemn comparisons made by local citizens comparing COVID-19 vaccinations to the Holocaust.

By the end of July, 10,827 Missourians have died from COVID-19.

44.64 percent of those eligible are fully vaccinated.

Sept. 5: Internal emails and documents obtained by the News-Leader through public records requests illustrate frustration and desperation among southwest Missouri officials as they sought help from the state during the delta variant surge. "I get the distinct impression ... that DHSS is at best dragging its feet at worst throwing roadblocks," a Greene County official wrote to a hospital executive. "I have been told they want nothing to do with the word COVID," the executive wrote back.

Sept. 10: Missouri Republicans blast new federal vaccine requirements, with lawmakers asking Parson to call a special session to legislate on the matter. Parson says the orders are "seeking to dictate personal freedom and private business decisions."

Sept. 14: Kauerauf, the new health director, tells lawmakers he wants to fight misinformation on COVID-19 and vaccines. "We failed, as a nation, public health because we got to this point," he says.

Oct. 2: Emergency ambulance teams transported southwest Missouri patients across state lines and throughout the entire state, according to a News-Leader analysis. The teams made over 200 trips within their first 13 days on the ground.

Oct. 6: Greene County reports its first child to die of COVID-19, a teenage boy.

Oct. 28: Parson and Schmitt push back against vaccine requirements for federal contractors, with the governor issuing a largely symbolic executive order and the attorney general filing a lawsuit. "In the state of Missouri, public health decisions are left to the people to either make their own personal decisions or speak through their elected representatives in the General Assembly," Parson says.

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Two years of COVID-19: How Missouri government responded to the pandemic - News-Leader

1. U.S. Covid-19 Infections Likely to Rise Again, Fauci Says  Bloomberg
2. U.S. COVID-19 infections are likely to rise again, Fauci says. Here's why  Fortune
3. Fears of COVID-19 resurgence in the US grow as officials warn of potential upticks  ABC News
4. Fauci Says U.S. COVID-19 Infections Likely to Rise Again  TIME
5. Fauci warns COVID-19 infection rates likely to increase  WHNT News 19
6. View Full Coverage on Google News

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U.S. Covid-19 Infections Likely to Rise Again, Fauci Says - Bloomberg

COLONIE Counties have been on the frontlines during the pandemic, implementing mask mandates, coordinating testing and vaccinations and tracing the virus virulent path through their populations.

Now an annual gathering of county officials appears to have lit the fuse on a fresh round of infections rocketing through their ranks.

At least three elected officials have tested positive for COVID-19 following the New York State Association of Counties annual conference at the The Desmond Hotel in Colonie last week including Albany County Executive Dan McCoy, who announced his diagnosis on Saturday.

Two other officials Essex County Board of Supervisors Chairman Shaun Gillilland and Moriah Town Supervisor Tom Scozzafava told the Times Union they tested positive following the event which wrapped last Wednesday.

Gillilland confirmed he learned of two additional infections on Sunday, bringing the total of known cases up to five.

A who's who of the state's top-ranking politicians addressed attendees during the three-day event, including Gov. Kathy Hochul, state Attorney General Letitia James and state Comptroller Thomas DiNapoli.

McCoy informed NYSAC following his diagnosis, according to a spokeswoman, Mary Rozak. Hes not aware of other attendees who contracted the virus, Rozak said.

Previous tests revealed the county executive had antibodies against the virus, an indiction that he had already contracted COVID-19. Rozak said that exposure and infection were likely the result of McCoy's packed travel schedule prior to the pandemic's U.S. onset in early-2020.

NYSAC Executive Director Stephen J. Acquario wished McCoy a speedy recovery on behalf of the advocacy group and said the organization has notified attendees to encourage them to monitor their health symptoms and take appropriate precautions.

NYSAC has not been contacted by any other county official or conference attendee who has tested positive for the virus, said Acquario, who urged those who do test positive to follow the guidelines for tracing, isolation and quarantining measures.

We are now in the 25th month of COVID and our county leaders have been at the forefront of protecting the health and well-being of the public, Acquario said. Lets use this as an opportunity and reminder as concerts, sporting events and conventions return, that we may be done with COVID but COVID isnt done with us. New Yorkers should get vaccinated, boosted, and to take all other recommended health precautions.

"We are not aware of any staff testing positive prior to or since the NYSAC event," a spokeswoman for The Desmond said Sunday evening.

The potential outbreak comes as the virus is waning across the U.S. and local, state and federal regulations have largely been scrapped.

Statewide, the number of hospitalizations are at their lowest levels since Aug. 3, according to the governors office. The state logged 12 deaths on Saturday. Statewide, the seven-day average for positive infections is 1.87 percent slightly lower than the Capital Regions 2.52 percent.

But two months after the omicron variant propelled caseloads to record-breaking levels, scientists and public health experts are warily eyeing the emergence of a more contagious subvariant of omicron, known as BA.2, from Western Europe.

"Case numbers are still dropping nationally, but BA.2 accounts for a growing proportion of those infections, rising to almost one-quarter of new cases last week," the New York Times reported on Saturday. "The subvariant is estimated to be 30 to 50 percent more contagious than the previous version of Omicron, BA.1."

Fewer than half of Americans who have received primary vaccine doses have received booster shots, according to the New York Times, placing the nation more at risk in the event of another surge.

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5 officials - perhaps more - infected with COVID-19 following counties conference - Times Union