Category: Covid-19

Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial  The Lancet

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Inhaled budesonide in the treatment of early COVID-19 (STOIC): a phase 2, open-label, randomised controlled trial - The Lancet

Other variants are circulating in the U.S., and more could emerge. But there are ways to protect yourself from these concerning strains, and that's by following the same public health guidance that experts have been promoting all along: Wear a mask in public, keep a safe distance from others, wash your hands often and avoid crowded and poorly ventilated spaces. Health leaders are also encouraging people to get vaccinated when it's their turn.

"This is a good reminder to follow those infection prevention efforts as we work to vaccinate people, says Saskia Popescu, an infectious disease epidemiologist and assistant professor at George Mason University's Schar School of Policy and Government.

Another factor that could determine whether current trends continue to climb is pandemic fatigue. The combination of a year of restrictions and the growing availability of vaccines is leading some to let their guards down and socialize more and do more things, Cash-Goldwasser says.

But doing so could result in devastating consequences, and health experts are pleading for Americans to stay the course. In an April 7 press briefing, Andy Slavitt, White House senior adviser for COVID-19 response, said better days are on the horizon, and even predicted that a more normal Fourth of July holiday is within reach. But he warned that all of the progress that has been made can be reversed if the public lets down its guard.

"We need to keep being careful, and we need to get shots into arms. And if people get vaccinated as soon as they possibly can and continue to practice these measures, hopefully we will be able to keep things under better control and not see a surge, Cash-Goldwasser says.

Rachel Nania joined AARP as a health and medicine writer in 2019 after spending several years as a radio reporter and editor in Washington, D.C. She is the recipient of a 2018 Gracie Award and a 2019 regional Edward R. Murrow Award, and participated in a 2019 dementia fellowship with the National Press Foundation.

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COVID-19's Fourth Wave: What You Need to Know Now - AARP

Providing incentives for employees to get the COVID-19 vaccine continues to be on the minds of organizations as vaccinations pick up speed. However, concerns about privacy and the shifting positions on wellness program regulation has left many employers wary about implementing more robust incentives. According toBloomberg, two GOP members of Congress are urging the Equal Employment Opportunity Commission (EEOC) to provide some clarity.

Employer-sponsored wellness programs come in many forms, such as:

An education campaign to inform employees about healthier eating habits.

A gym membership subsidy.

A health risk questionnaire to help employees be more informed about their health risks.

A walking program designed to decrease sedentary lifestyles.

Making health coaches available for engagement on general wellness and/or chronic health issues.

Satisfaction of key health-related measures heart rate, cholesterol level, body mass index (BMI).

Such programs are often tied to group health plans and the incentives for satisfying program requirements come in the form of cash payments, reduced contributions toward premiums, points that can later be redeemed, and other creative arrangements. A key compliance challenge for many of these programs is the size of the incentive the underlying issue being whether the size of the incentive causes a loss of voluntariness. Programs that are part of group health plans generally are subject to regulations issued under the Affordable Care Act (ACA) and the Health Insurance Portability and Accountability Act (HIPAA), although other rules including those referred to below may apply. The ACA/HIPAA regulations are relatively clear on incentive limits and are not what GOP members of Congress and business leaders have expressed concerns about.

Under the Americans with Disabilities Act, disability-related inquiries of employees generally must be job-related and consistent with business necessity, unless made in connection with a voluntary wellness program. It is that exception, specifically whether the program is voluntary, that is causing much of the concern about vaccination incentive programs.We outlined a brief history of the EEOCs position on voluntariness here.

Depending on the design of a COVID-19 vaccination incentive program, disability-related inquiries may be involved, raising the question about voluntariness. Is a $50 gift card too much, what about $500, will that render the program involuntary? How about 2 days off with pay? It is worth noting that,according to the EEOC,

[s]imply requesting proof of receipt of a COVID-19 vaccination is not likely to elicit information about a disability and, therefore, is not a disability-related inquiry.

On January 7, 2021, theEEOC proposeda new approach that might wind up providing employers some certainty, but those regulations have been withdrawn following a regulatory freeze issued by the White House on January 20, 2021. Under those proposed rules, however, incentives are permitted under such programsprovided they are de minimis.

Sen. Richard Burr (R-N.C.) and Rep. Virginia Foxx (R-N.C.) observed to the EEOC in a letter obtained by Bloomberg, looking for a response by April 20, 2021:

Employers actively working to protect their employees by increasing the number of workers receiving vaccinations through incentive programs are seeking assurance this action is allowable and does not violate important labor laws such as the Americans with Disabilities Act (ADA) and other statutes within the jurisdiction of the EEOC

Additionally, the data privacy, confidentiality, security, and record retention of the information needed to administer such programs also raises compliance issues under federal and state law. This includes the confidentiality rule under the ADA, the HIPAA privacy and security regulations for programs that are part of group health plans, OSHA record retention requirements, and state reasonable safeguard and breach notification requirements.

Many organizations have moved forward offering a variety of incentive programs to spur employees to get a COVID-19 vaccine. The level of legal risk, if any, for those programs is a function of several factors does the program include a disability-related inquiry, how large is the incentive, is the program part of a group health plan, how is the program administered and enforced, and how is the privacy and security of the data maintained.

It remains to be seen whether the EEOC will provide greater clarity on the voluntariness of incentives for COVID-19 vaccination programs. In the meantime, employers will need to think carefully about the design and implementation of their programs.

Jackson Lewis P.C. 2021National Law Review, Volume XI, Number 99

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EEOC Clarity on Incentives for COVID-19 Vaccinations - The National Law Review

TAMPA, Fla. (WFLA) Multiple COVID-19 vaccination sites across Tampa Bay have closed early Saturday afternoon due to a bout of storms heading toward the area.

According to the Florida Division of Emergency Management, the following locations have closed early to the public:

The sites will remain closed until noon on Sunday.

For the latest updates on the forecast, check out Max Defender 8s radar.

Originally posted here:

Several COVID-19 vaccination sites close early ahead of storms coming toward Tampa Bay - WFLA

The big day is finally here: Its time for your second vaccine dose. Youve got your ID, youve confirmed your appointment time, and wait hang on a second where did that card go?

Youre not the first person to misplace that piece of paper. Google searches for lost vaccine card have ticked up through 2021 as more and more people have gotten vaccinated (currently standing at roughly 1 in 3 Californians).

Its not the only question people have had about what to do with their vaccine card. Heres a list of dos and donts for the most exciting piece of paper youll get this year.

Return for your second appointment as planned with your ID. Your vaccination record regardless of where you received the shot will be registered in the California Immunization Registry (CAIR). The provider should have you in the system from last time, and they will be able to issue you a new card.

Most healthcare providers are connected to CAIR. People can ask their healthcare provider if they are able to access this record and provide a printed copy, a representative for L.A. County Public Health wrote in an email.

If you lost your card after your second dose, reach out to wherever you got your shots and ask them for a replacement. Again, your information should be in the system, so it shouldnt be a problem to get you another one. You can also request your vaccination record directly from CAIR.

If you booked your appointment at a city-led mass vaccination site through Carbon Health, youll get a secure digital vaccine record called Health Pass as well as the paper card, said CEO and co-founder Eren Bali.

Staples and Office Depot are offering free lamination for vaccine cards, but dont take them up on it. The heat from the laminating machine can damage the ink. Also, you may need to get a COVID vaccine booster in the future, the county public health department noted, so its probably best to leave it unlaminated. A better way to protect it: a clear plastic sleeve, like a badge ID holder. You might have an old one on a lanyard from a conference kicking around somewhere.

Make sure your name and date of birth are correct. Ideally, youll do this before you leave your first appointment, but if thats already in the past, its still good to check. Ask the provider for a replacement with corrected information if something is wrong.

Discussions of so-called vaccine passports are mostly theoretical at this point. Theres no reason to carry your card in your wallet at all times right now. Keep it somewhere secure in your house like you would any other important document.

UPDATED April 9, 2021 | 5:36 PM

Only in public or around unvaccinated people, according to the CDC. If youre around other fully vaccinated people in a private setting, go ahead and take your masks off.

Yes, you can visit one other household with unvaccinated people, indoors and without masks even, as long as they and anyone they live with are at low risk of developing a severe case of COVID-19. Avoid mixing with more than one household at a time.

Be sure to check and follow the rules in place for wherever youre headed, but in general, yes. And you dont have to quarantine when you return home.

The CDC recommends that you do not. In California, stadiums and other large venues that are opening are doing so with limited capacity and physical distancing and other measures in place.

Suggested reading for the vaccinated:

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As a back-up for the physical card, you can take photos of the front and back of it and email those to yourself.

Some people have shared vaccine selfies with their birth dates covered up, ostensibly for identity theft protection. Thats good its never smart to share personal information like that online. But you really dont want to be widely sharing the other information on the card either, Bali said, particularly as stories crop up about people trying to create fake ones: You dont want to make it even easier to do that by conveniently providing a recent lot number.

Every person who shares a photo of themselves beaming with a fresh shoulder Band-Aid helps the cause, Bali said. Vaccine hesitancy has decreased as the rollout has progressed, but your photo could be the difference for someone you know to go from thinking, nah, Ill wait a while longer and see how it goes to if this person feels OK about it, so do I.

A smiling person is definitely more effective than a photo of a vaccination record, Bali said.

You heard it here: Post your selfies. Its good for your (and the publics) health.

Excerpt from:

Lost COVID-19 vaccine card: What to do (and other advice) - Los Angeles Times

DEAR DR. ROACH: Could you please provide your recommendations on how we should conduct ourselves after we get the COVID vaccine? Please include an explanation of how immune we actually will be. -- T.S.

ANSWER: Three vaccines are approved under an emergency authorization at the time of this writing: Two mRNA vaccines, made by Moderna and Pfizer, and the Johnson & Johnson vaccine, which uses a different virus and DNA to teach our cells how to respond to COVID-19.

The available mRNA vaccines are both nearly 95% effective at preventing disease after two doses; the single-dose Johnson & Johnson vaccine was 66% effective in preventing moderate to severe COVID-19 but 100% effective at preventing COVID-19-related hospitalization and death. This is very good protection, but given how prevalent the infection is throughout North America, exposure to the virus is very likely unless you take proper precautions. This includes mask-wearing and hand-washing, but also avoiding high-risk exposures, such as eating indoors or being in a large group of unmasked people. Even those who had the vaccine can still get COVID: 66% and 95% are good, but not perfect. Also, that high protection takes time -- two to three weeks after the full series.

A second issue is that we just arent sure whether the vaccine keeps people from being contagious. It may be that even people protected from COVID-19 illness may still be infectious for a time after they get exposed. Recent data suggest the vaccines are very effective at doing so but the data is not yet conclusive.

For these two reasons -- protecting yourself from COVID-19 (imperfect vaccines) and protecting others (unknown protection against possible asymptomatic spread) -- experts recommend continuing to take precautions. As more and more people get the vaccine, the pandemic will subside. As the prevalence decreases, life will return to normal, and masks and social distancing can be stopped. How soon that will be depends on how fast the population can be vaccinated, and how careful people are about masks and social distancing until then.

* * *

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

(c) 2021 North America Syndicate Inc.

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Dear Doctor: Just how immune are we after a COVID-19 vaccination? - OregonLive

Syracuse, N.Y. As Syracuse University tries to contain a surge of Covid-19 cases, some infected students are refusing to identify fellow students they may have exposed to the virus.

Some students are choosing not to participate in SUs contact tracing process which seeks to quickly identify, trace and quarantine individuals who may have been infected, according to Mike Haynie, SUs vice chancellor.

To knowingly withhold information that could prevent another member of our community or their family members from becoming infected and possibly very ill is categorically wrong and indefensible, Haynie said in a message posted today on SUs website. We expect every member of our campus community to participate fully and honestly in the contact tracing process.

SU requires students to participate in contact tracing as part of the schools stay safe pledge. Students who refuse to do so can face disciplinary sanctions.

Cases have been increasing at SU since mid-March. There have been 325 new cases in the past 14 days. SU reported 17 new positive cases today. There are currently 346 students in quarantine because they may have been exposed to the virus.

Haynie called the increase troubling.

As we head into another weekend, I urge all our students to recommit themselves to responsible public health behaviors to keep you and those around you safe, healthy and on campus, Haynie said.

James T. Mulder covers health and higher education. Have a news tip? Contact him at (315) 470-2245 or jmulder@syracuse.com

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Some Syracuse University students with Covid-19 refusing to identify who they exposed - syracuse.com

As San Diego County this week enters yet another phase in the reopening of its pandemic-era economy, the public will have to navigate a mind-numbing set of new rules and capacity limits, whether its dining indoors at a restaurant, catching a new release at the multiplex, or heading to Petco Park to watch the Padres.

While Californias color-coded roadmap for safely easing back into something resembling a pre-COVID-19 life is set to vanish by June 15, San Diegans still have two more months to live with a system that rewards both consumers and businesses when infection, hospitalization and vaccination rates continue to improve.

Under the countys more relaxed orange tier the second least restrictive in Californias reopening plan some business categories, like restaurants and movie theaters, are seeing their indoor occupancy limits double overnight, offering some hope for a return to profitability following a year of decimated revenues. In other instances, such as attending an outdoor sporting event, capacity levels will increase significantly as long as all attendees show proof of a negative coronavirus test or full vaccination against COVID-19.

And still more new rules will go into effect April 15, when indoor live events like concerts and theatrical performances will be allowed to resume, again with prescribed capacity limits.

As tantalizing as it all sounds, significant challenges remain. Restaurants and theme parks are having a tough time hiring enough workers as they all expand their business operations at once. Also a puzzler for business owners is how to implement a verification process for COVID-19 vaccinations and tests among their patrons.

And then theres the ever-nagging fear of returning to the more restrictive red tier should COVID-19 hospitalization and transmission rates rise locally the way they have in other parts of the U.S.

Weve been here before, and were still not completely out of the clear, said longtime restaurant owner Brian Malarkey, whose three restaurants are now open indoors. A fourth, the more casual Herb & Eatery, ceased operating last year due to the pandemic. I cant help but look over my shoulder and see rising numbers in the East Coast. Weve been put on a yo-yo, and its exhausting for our employees and the customers. I just hope were doing the right thing and am excited to get back to as much as normal as we can.

In the interest of simplifying life under the orange tier, the Union-Tribune has assembled a guide showing what has and has not changed.

The county moved from red to orange because its case rate has been under six cases per every 100,000 residents for the last two weeks since moving to the red tier March 17. That move became a little easier once the state raised the qualifying case rate threshold after meeting a goal to vaccinate more than 4 million Californians living in areas deemed to have the worst access to health care and other resources necessary for healthy living.

Indoor seating at restaurants and bars that serve food has expanded from 25 percent capacity to 50 percent, or 200 people maximum, whichever is fewer. And the 10 p.m. to 5 a.m. curfew has been lifted. There are no changes for outdoor seating, which many restaurants have expanded by moving onto sidewalks and parking areas of streets.

The Field Irish Pub in the Gaslamp Quarter

(K.C. Alfred/The San Diego Union-Tribune)

Bars that offer no food service can now open up outdoors, with modifications. Wineries, breweries and distilleries are permitted to operate indoors after being restricted to outdoor-only in the red tier. The capacity limit is 25 percent or 100 people maximum.

Led by Junior Leoso, Pacific Beach Training offers both group classes and private lessons at its indoor facility.

(Courtesy of Pacific Beach Training)

Gyms and fitness centers are also getting an increase in capacity from just 10 percent to 25 percent and indoor pools can now open. Indoor hot tubs, saunas and steam rooms are still off-limits.

Movie theaters can seat 50 percent of their usual capacity or 200 people, whichever is fewer. Many theaters will continue to use online reservations to control capacity and make it easier for moviegoers to socially distance themselves while they munch on popcorn and watch the latest flick on the big screen.

Jason Mahrdt watches a movie with his Kids Ryan,4, Phoebe,8, and Olivia 4 at Angelika Film Center & Cafe at Carmel Mountain Plaza on March 20, 2021.

(Sandy Huffaker/SDUT)

While its not required, some movie theaters are limiting concession sales in the theater lobby and instead offering online ordering with treats delivered to where people are sitting.

Retail spaces, including supermarkets, and shopping centers can reopen to full, pre-pandemic indoor capacity if they stick with public health modifications such as masking, regularly cleaning surfaces and Plexiglass barriers at checkout stations. In the red tier, capacity was set at 50 percent. For malls, the capacity limitations for restaurants remain in place for food courts.

Eric Whitman works on a tattoo on Alexa DeFrazie on at Pacific Beach Tattoo in this June 2020 photo.

(Sandy Huffaker/For The San Diego Union-Tribune)

Barbershops and personal care services, which include tattoo parlors, nail salons and other places you go for grooming and pampering, have been open indoors without capacity limits since the purple tier and will stay open. Thats because theres no evidence these settings play a major role in the spread of the coronavirus.

Case in point: In a report published by the Centers for Disease Control and Prevention last July, two hair stylists with COVID-19 who kept their masks on while working with 139 clients didnt get any of their customers sick.

The San Diego Automotive Museum recently reopened since closing back in November. During the closure the museum underwent a total remodel, including flooring, painting, and new wall graphics.

(Nelvin C. Cepeda/The San Diego Union-Tribune)

These venues can now operate at 50 percent of their indoor capacity. Theyve been able to operate outdoors since the purple tier but were previously limited to 25 percent indoor capacity in the red tier. The orange tier probably wont change much for visitors to the San Diego Zoo and Safari Park, as both parks are largely outdoors.

Theme parks were only allowed to reopen a little more than a week ago, and with San Diego now in the orange tier, the overall capacity limit is going from 15 percent to 25 percent. That same restriction applies to any part of the park that is indoors.

Martin Lopez, left, and Katie Byle check seat restraints on the Electric Eel roller coaster for a test run at SeaWorld in advance of reopening its rides on Monday.

(K.C. Alfred/The San Diego Union-Tribune)

Belmont Park in Mission Beach opened up its rides April 1, and Legoland, which had been closed for more than a year, also reopened that same day, with a wider reopening planned for April 15. On Monday, SeaWorld, which has been allowing guests under rules for accredited zoos since early February, will now reopen many of its rides. Additional conditions, including required reservations and a prohibition of out-of-state visitors remain the same, regardless of the tier level.

For the first time under the tier system, such venues think bowling alleys, escape rooms and trampoline parks can open indoors. The capacity limit is 25 percent, although that goes up to 50 percent if all customers are tested for COVID-19 or show proof of full vaccination. Masking is required except for food and beverage service at such locations.

The San Diego Padres take on the Arizona Diamondbacks at Petco Park in their home opener on Thursday, April 1, 2021. Following California COVID-19 restrictions and guidelines for sporting events, Petco Park opened with reduced capacity.

(Nelvin C. Cepeda / The San Diego Union-Tribune)

The biggest change is more generous limits on overall capacity, which has gone from 25 percent to 33 percent in the orange tier. That limit, however, rises dramatically to 67 percent if attendees can show evidence of a negative test for COVID-19 or proof that theyve been fully vaccinated. In advance of the Padres next homestand, the team has sent out a survey to its season ticket holders querying them about their seating preferences, noting that it may be possible to allow 67 percent capacity in certain sections of Petco Park for those who have provided proof of COVID tests or vaccinations.

Team spokesman Craig Hughner said the Padres are still awaiting clarification on guidelines to see if they will allow for larger capacities in designated seating sections.

The Manchester Grand Hyatt is the biggest hotel, by capacity, in Southern California.

(Myung J. Chun/Los Angeles Times)

Hotels have been open since the purple tier, but the move to orange means that on-site fitness centers can use 25 percent of their capacity. And if sweating on a treadmill isnt your style, you can take a dip in the indoor hotel pool, which was closed in the red tier.

These are incremental changes. Whats arguably more significant is that, starting April 15, hotels can host private meetings, such as conferences and wedding receptions. In the orange tier, these events can hold 100 people outdoors. If all guests can show that theyve been vaccinated or recently tested negative against the coronavirus, then hotels can host 300 people outdoors or 150 people indoors.

Some hoteliers have welcomed the news, while others have said the capacity limits are too strict for them to make a profit a common refrain among business owners frustrated with the states tiered reopening system. No decision has been made yet by the state on large conventions, a sector that has been moribund since the start of the pandemic.

Like the upcoming changes for hotel meetings, there will be expanded opportunities for indoor performances starting April 15. For venues with a capacity of up to 1,500 people, the cap will be 15 percent or 200 people, and will increase to 35 percent if all guests are tested or fully vaccinated. For larger capacity venues able to accommodate more than 1,500 people, the cap for the orange tier is 10 percent or 2,000 people, whichever is fewer, though it could increase to 50 percent if all those attending are tested or fully vaccinated.

The move to the orange tier now allows offices to be open indoors, although working remotely is encouraged.

Similar to many indoor business activities, places of worship get a bump up in their indoor capacity from 25 percent to 50 percent. These settings include churches, mosques and synagogues, as well as locations where weddings and funerals take place.

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A guide to reopening in the COVID-19 orange tier: what San Diegans need to know - The San Diego Union-Tribune

More than a year after a "mysterious pneumonia" sickened workers at a seafood market in China, scientists are still gathering clues about where SARS-CoV-2 -- the virus that causes COVID-19 -- emerged from.

"It's critical to understand where this virus came from, so that we can understand how to stop future outbreaks going forward," said Anne Rimoin, an infectious disease epidemiologist at UCLA.

The investigation into the virus' origins is crucial for public health and science reasons, but it has also sparked tension among world powers, especially between the United States and China, whose leaders have accused one another of lack of transparency and xenophobia during the pandemic.

"It's not about finger-pointing -- it's just about understanding it, so we know how to do better in the future," Rimoin said.

Peter Ben Embarek, a member of the World Health Organization (WHO) team tasked with investigating the origins of the coronavirus disease (COVID-19), attends the WHO-China joint study news conference at a hotel in Wuhan, China, Feb. 9, 2021.

To that end, on Jan. 14, 2021, the World Health Organization deployed a group of 17 international experts to Wuhan to work with Chinese scientists on an in-depth investigation into the virus' origins.

Scientists have long said that SARS-CoV-2 has zoonotic origins, meaning that it likely jumped from animals to people when humans came in contact with an animal infected with the virus. That contact could include handling the infected animal, eating it or preparing the animal for market, according to Rimoin.

A member of a World Health Organization team is seen wearing protective gear during a field visit to the Hubei Animal Disease Control and Prevention Center for another day of field visit in Wuhan, China, Feb. 2, 2021.

However, experts didn't know exactly how the virus had gotten into people and reaching a definitive conclusion about SARS-CoV-2's origins might take years. They also don't know where or when the virus first made its way into humans and several studies suggest that it may have been present elsewhere in the world -- perhaps circulating at low levels -- before the major outbreak in Wuhan, China.

"You're trying to reconstruct events from a year and a half ago with incomplete sampling and data," Dr. W. Ian Lipkin, director of Columbia Universitys Center for Infection and Immunity, told ABC News. "We may never know exactly what happened."

If previous infectious disease investigations are any clue, the virus' origins could remain shrouded in mystery. The best comparison is the 2003 SARS outbreak, which was caused by a close cousin of the virus that causes COVID-19 and eventually traced back to a single population of horseshoe crab bats.

But that search took more than five years. "I think they were quite lucky," Vincent Racaniello, a microbiology and immunology professor at Columbia University's College of Physicians and Surgeons, said of the SARS investigation. "We've still not found the source of Ebola virus outbreaks after many years of looking," he added. "It's not easy."

A mink looks out from its cage at a farm, Nov. 6, 2020.

The joint WHO-China report is considered a first step in what will likely be a years-long investigation released its findings last week. But the report itself has been mired in controversy. Following its release, the United States and 13 other countries raised concerns about the report in a joint statement, arguing that the international investigation was "significantly delayed and lacked access to complete, original data and samples."

But many experts say the report, though imperfect, is an important first step.

The investigators explored four major theories of how the virus spilled over into humans, ranking those ranked those theories in order of likelihood, from "very likely" to "extremely unlikely."

The WHO-China report investigated possible pathways through which SARS-CoV-2 could have emerged.

The intermediary host theory: This theory proposes that the virus was transmitted from an original animal host to an intermediate host, such as a minks, pangolins, rabbits, raccoon dogs, domesticated cats, civets or ferret badgers, and then directly infected humans through live contact with the second animal.

WHO-China investigation conclusion: "likely to very likely"

The WHO-China report investigated possible pathways through which SARS-CoV-2 could have emerged.

The zoonotic spillover theory: The zoonotic spillover theory suggests that SARS-CoV-2 was passed directly from an animal, most likely a bat, to humans. This transmission could have happened through farming, hunting or other close contact between humans and animals.

WHO-China investigation conclusion: "possible to likely"

The WHO-China report investigated possible pathways through which SARS-CoV-2 could have emerged.

The frozen food chain theory: The "cold-chain" theory suggests that transmission of SARS-CoV-2 from animals to humans might have happened through contaminated frozen food. A frozen food product contaminated with animal waste that contained SARS-CoV-2 could have transferred the virus to humans without any direct live contact between humans and animals.

WHO-China investigation conclusion: "possible"

Peter Daszak, Thea Fischer, and other members of the World Health Organization (WHO) team investigating the origins of the COVID-19 coronavirus arrive at the Wuhan Institute of Virology in Wuhan, China, Feb. 3, 2021.

As part of the investigation, scientists returned to the Huanan seafood market associated with the first known cluster of cases in Wuhan. They also visited the Hubei Provincial Hospital of Integrated Chinese and Western Medicine, where some of the first COVID-19 cases were treated, and looked at viral sequencing data. That viral sequencing showed that different minor variants of SARS-CoV-2 were spreading in Wuhan in December 2020.

"That again suggests that maybe the virus had been circulating a little bit longer than people had realized," said Dominic Dwyer, an epidemiologist and member of the WHO investigative team.

Viral sequencing also showed that the Huanan market likely wasn't the primary source of the outbreak. While many early cases were connected to the market, a similar number of cases were associated with other markets, or no markets at all, the WHO-China report found.

"The market was certainly an amplifier, but probably not the actual source of the whole outbreak," Dwyer said.

One of the last places the investigators visited was the Wuhan Institute of Virology, the target of a politically charged theory that the virus had accidentally leaked from a lab. The report cited high biosafety levels at labs in Wuhan, no evidence of respiratory illness in workers and no storage or lab activities on coronaviruses or bat viruses.

Prior genomic sequencing showed that the virus had natural origins and the WHO-China team ranked the lab leak theory as "extremely unlikely."

But Dr. Tedros Adhanom Ghebreyesus, the WHO's director-general, said that he didn't think the team's assessment of the theory was extensive enough.

Further data and studies will be needed to reach more robust conclusions, Tedros said at a press conference about the report's findings, noting that he was ready to deploy additional missions with specialist experts to do so.

"Science can't rule things out like that," Peter Daszak, a zoologist and member of the WHO investigative team, said of the lab leak theory. "You can only really show positive findings, you can't prove a negative. But what we did find is that the lab escape was extremely unlikely."

Barriers are setup at the closed Huanan Seafood Market where the COVID-19 coronavirus is believed to have emerged in Wuhan, China, April 15, 2020.

The most likely pathway, the report found, was the first theory, that the virus passed from a bat to an intermediary animal and then to humans. According to Daszak, next steps for investigation could include tracing back the first cases of the virus; investigating market suppliers for unusual spikes in antibodies; and examining locations with concentrations of animals we know are susceptible to SARS-CoV-2.

Rimoin hopes the pandemic has shown that disease surveillance is key to preventing future outbreaks, not just reacting to them. As population growth and climate change push humans further into animal habitats, "we will see more viruses jumping from animals to humans and we're going to see more disease emergence events," Rimoin said.

"An infection anywhere is potentially an infection everywhere," she said.

ABC News' Sasha Pezenik, Sony Salzman and Eric Silberman contributed to this report.

Eric Silberman, MD, a resident physician in internal medicine at Northwestern Memorial Hospital, is a contributor to the ABC News Medical Unit.

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COVID-19 origins: What to know about the search for the start of the virus - ABC News

But the Bulldogs were granted a second chance this season. They navigated a complicated set of pandemic protocols, earned an at-large bid to their sixth consecutive NCAA tournament and prevailed in five overtimes last month against top-ranked North Dakota in the state of North Dakota to reach an fourth-consecutive Frozen Four at PPG Paints Arena in Pittsburgh.

Unfortunately for UMD, its story will not end with another national championship, or even an appearance in the national championship game. While the Bulldogs were able to stave off the coronavirus, they could not hold back Massachusetts, which scored 14:30 into overtime Thursday to beat the Bulldogs 3-2 in the semifinals of the NCAA Frozen Four at PPG Paints Arena.

To get back here, it's not an easy thing to do, Bulldogs coach Scott Sandelin said. And to be able to do it four years in a row, it still leaves a bitter taste losing the game, but certainly proud of our group.

UMD led 2-1 after two periods thanks to goals by junior wings Tanner Laderoute and Cole Koepke, and a healthy 26-11 shots on goal advantage.

UMass junior forward Anthony Del Gazio, with just his second goal of the season, tied the game 8:25 into the third period to force overtime, and from there the Minutemen overwhelmed the Bulldogs by a 13-2 margin in shots on goal.

It was the 13th puck UMass put on net, one that was quickly slid across the crease by Bobby Trivigno and onto the stick of fellow junior forward Garrett Wait a former Minnesota Golden Gopher of all people that found its way through.

Duluth is the best team we've played this year. They play a really heavy style that we're not used to playing against, said coach Greg Carvel, whose UMass team will play St. Cloud State for the national championship on Saturday. For two periods we struggled with it. I don't know if frustration is the right word, but what we usually do just wasn't working. So after the second period, I really urged the players to realize that it's going to take more, and I thought the kids did a great job in the third period.

It wasnt just the Bulldogs' shot at a three-peat that came to an end Thursday, but a number of historic runs by the program that will be remembered for years and years to come.

Already one of just five teams to have made three consecutive NCAA title games along with Boston College (2006-08), Minnesota (1974-76) and Michigan, twice (1951-53 and 55-57), the Bulldogs were trying to be the first school to appear in four straight national championship games.

UMD had a nine-game NCAA tournament winning streak that stretched back to 2018 snapped. Thursday's loss was only the program's second in 14 NCAA tournament games dating back to 2017.

Minnesota Duluth players celebrate a second period goal against Massachusetts during the NCAA Frozen Four semifinal game at PPG Paints Arena Thursday, April 8, 2021 in Pittsburgh, Pennsylvania. (Clint Austin / caustin@duluthnews.com)

The Bulldogs had won nine consecutive NCAA tournament overtime games prior to Thursday. The last time UMD lost in OT in the NCAA tournament was 6-5 to RPI in the 1985 Frozen Four semifinals.

It's been awesome, said UMD senior wing Nick Swaney, who has been to three Frozen Fours in four seasons, winning two NCAA titles. It's hard to describe everything that we've gone through these four years. Getting back here every single year, that's just something you don't see a lot, and a testament to the culture we have here at Duluth. I'm fortunate to be part of so many great teams and so many great groups of guys.

Some streaks still stand.

UMD will be seeking a seventh-consecutive NCAA tournament berth in 2021-22. Their current run of six tournaments is the longest active streak in NCAA men's hockey.

The Bulldogs will also get a chance to keep their Frozen Four streak alive. One of 11 teams to ever reach four straight Frozen Fours, they can join Colorado College (1948-1952) and Boston University (1974-1978) as the only schools to make five straight Frozen Fours.

Tanner Laderoute (13) of Minnesota Duluth greets players on the bench after scoring a goal against Massachusetts in the first period during the NCAA Frozen Four semifinal game at PPG Paints Arena Thursday, April 8, 2021 in Pittsburgh, Pennsylvania. (Clint Austin / caustin@duluthnews.com)

It's all about the culture we created, said Laderoute, who has been to two Frozen Fours and won one national championship in three seasons at UMD. We're good hockey players, but even more than that, we have good people. We have good character. That's what we create. That's why we keep coming back.

We faced so much adversity, every team has, but it's supposed to be this once-in-a-lifetime opportunity. And it seems that we keep coming. So it's a pleasure to be here. I couldn't be more lucky to do it with all these guys.

The longest consecutive Frozen Four streak belongs to Michigan, who made 10 in a row in college hockeys early days from 1948-1957. Thats also the only time any school has ever three-peated as national champions, with Michigan winning in 1951, 1952 and 1953.

Sandelin, who hasnt spoken to his team following a season-ending postseason defeat since the loss to Denver in the 2017 NCAA championship game in Chicago, said there wasnt much he could say to the team Thursday night, just that hes really proud of the team for the opportunity they gave themselves during a tough year.

I'm not sure going into the year a lot of people gave us a chance to get back, to have a chance to win another championship, Sandelin said. This group fought some of those odds and grew together during the year.

"A lot of those guys, they don't know this feeling. Sometimes the highs are unbelievable and the lows are really low, but you can learn from everything. So hopefully we learn from this and use it as motivation to get back here next year.

Massachusetts head coach Greg Carvel (right) talks to head coach Scott Sandelin of Minnesota Duluth after Massachusetts defeated Minnesota Duluth 3-2 in overtime during the NCAA Frozen Four semifinal game at PPG Paints Arena Thursday, April 8, 2021 in Pittsburgh, Pennsylvania. (Clint Austin / caustin@duluthnews.com)

So how did the Minutemen, who were dominated by the Bulldogs two years ago in the national championship game in Buffalo and again during the opening two periods of Thursday's national semifinal, finally get the best of UMD?

Carvel had the answer to that.

When it got to overtime and as we found more confidence in our game and more aggression, being more aggressive in our play, we were getting them stuck in their D zone, Carvel said. That really wears you out when you have to play in your own zone for a long time. The overtime was pretty lopsided.

The one thing about this team is they know what makes them good and when they smell blood in the water, I just thought they took it up a notch and they all played great down the stretch in overtime.

Massachusetts forward George Mika (29) delivers an open ice check to Tanner Laderoute (13) of Minnesota Duluth in the overtime period during the NCAA Frozen Four semifinal game at PPG Paints Arena Thursday, April 8, 2021 in Pittsburgh, Pennsylvania. (Clint Austin / caustin@duluthnews.com)

Carvel said he saw an opportunity when the Bulldogs began rolling only three lines in the third period. He had been matching UMD through the first two periods, but decided not to follow Sandelin and continue to roll all four of his lines.

By the time the game went into overtime, Carvel said he thought UMD ran out of gas.

We were trying to match, but if they're only playing three lines, I've got to play that fourth line against somebody, Carvel said. Eventually I didn't care who they put on the ice. We were just rolling four lines for the most part.

It's such an asset to be able to do that, to play all your players. And it was great because we're in overtime, I'm looking at the bench, the next line up is completely rested and ready to go and to continue the momentum that we had built.

Minnesota Duluth players react after losing 3-2 in overtime to Massachusetts during the NCAA Frozen Four semifinal game at PPG Paints Arena Thursday, April 8, 2021 in Pittsburgh, Pennsylvania. (Clint Austin / caustin@duluthnews.com)

Sandelin said rolling only three lines was not the reason his team was winded in the overtime Thursday. Instead it was because of their decision-making in the defensive zone, and because of the relentless pressure UMass put on them each and every shift.

The Bulldogs were forced to expel so much energy defending, they had no energy to go the other way and create any offense, Sandelin said.

The difference was we couldn't get out of our zone. When you play defense, you run out of gas quick, Sandelin said. They did a good job. We knew what they liked to do and how they play as far as pressure and keeping pucks alive.

We couldn't get pucks out. Some of it was just decisions. We needed to make better decisions, harder plays.

Koby Bender (11) of Minnesota Duluth shoots the puck on goal against Massachusetts goaltender Matt Murray (31) during the NCAA Frozen Four semifinal game at PPG Paints Arena Thursday, April 8, 2021 in Pittsburgh, Pennsylvania. (Clint Austin / caustin@duluthnews.com)

3. UMD junior wing Tanner Laderoute UMass took an initial 1-0 lead with a power play goal, but Laderoute was able to tie the game 2 minutes and 17 seconds later. He also had a look at a breakaway in overtime, only to be taken down. UMass scored the game-winner shortly after.

And while UMD fans were screaming for a call to be made in OT on the takedown, Laderoute wasnt after the game.

I mean, that's hockey, he said. I think I had a step on him. He maybe tangled me up a bit, but it's overtime at the Frozen Four. You can't be asking for calls at that time. They're a good team. They have fast skaters too. You've got to battle through.

2. UMass junior forward Bobby Trivigno The architect of the game-winning goal, Trivigno took advantage of another UMD turnover in its own zone and nabbing the puck along the boards. He then worked it down low, got himself to the front of the UMD net and slid the puck across the crease for Wait to tap in. Game over.

1. UMass senior goaltender Matt Murray With starter Filip Lindberg one of four Minutemen out due to COVID-19 protocols, Murray made his first start since Jan. 18. He made 38 saves to keep his team in the game and get them to overtime.

It's quite a story to be able to overcome that situation of losing that many players, said Carvel, who was also missing his leading goal scorer. Everything tonight was a testament to the culture of this team. I'm very proud of them.

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Thumbs up, thumbs down, three stars: UMass does what COVID-19 could not by denying the Bulldogs a three-peat - Duluth News Tribune