Category: Covid-19

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Lockdown is back. Or, at least, a version of one. Effective Wednesday, Oregon and Washington are enacting their strongest COVID-19 restrictions since April. This time, more businesses and parks are open, and while non-essential, in-state travel is being discouraged, its not being restricted. But theres also a lot more of the coronavirus going around and a spike in COVID-19 cases.

OHSU nurse practitioner Shelby Freed tests a patient for COVID-19 at a drive-up testing station in Portland, Ore., in this file photo. Bradley W. Parks

Bradley W. Parks / OPB

Its pretty bad. Yes, plenty of states have higher daily case counts than Oregon, and higher per-capita case counts. Its more important to look at how fast the number of new cases is rising. Just two weeks ago, on average, 400 new people in Oregon were diagnosed with COVID-19 each day. Last week, Oregons daily average topped 1,000 new cases.

Thats exponential growth thats everyones biggest fear. If it keeps doubling at that speed, by the end of next week Oregon could be seeing 2,000 cases per day.

Of course, that might not happen. But it depends on us. The coronavirus that causes COVID-19 is more prevalent and widespread in Oregon than it has been at any point during this pandemic. If people dont follow new COVID-19 restrictions and even if they do cases could continue to rise. And it will take a few weeks to figure out how well new restrictions work, once they go into effect.

Its hard to compare case numbers to those during the spring: we had so little testing. So instead of comparing the number of sick people, we should look at the number of people hospitalized.

Morning rush hour emptied of cars in downtown Portland, Oregon during coronavirus pandemic, March 20, 2020.

Stephani Gordon/OPB

In April, COVID-19 hospitalization peaked at just over 300. At that point, the number of cases in Oregon was already declining. Right now, there are over 400 people hospitalized with COVID-19 in Oregon. But the number of cases is still rising. So its going to get worse.

Thats very hard to say. The situation in hospitals is going to get worse no matter what because a lot of people newly diagnosed with COVID-19 have yet to get sick. Theyre baked into our total count.

Were also going to be in it for the long haul. As far as we can tell, this virus is acting the way new respiratory viruses usually do: its less prevalent in the summer, and then returns with a vengeance in fall, winter, and spring. We were lucky when COVID-19 first hit, temperatures were getting warmer and people were moving outside. But now its getting colder, and well be spending more time indoors. There will be more opportunities for the virus to spread.

To get an idea of how bad things could be, we can look to the Southern Hemisphere. After an initial lockdown, cases skyrocketed as winter began. Victoria, one of the coldest and hardest-hit Australian states, enacted very strict lockdowns: people could only leave their houses once a day and werent supposed to drive more than a few miles away from their homes. Cases there peaked at about 700 in late July.

Related: Freeze, Oregon: Gov. Kate Brown restricts businesses again as COVID-19 cases surge

The lockdown was hard, but it worked. Since mid-September, Victoria has seen less than 30 cases a day, and on Tuesday it recorded its 18th consecutive day with no COVID-19 diagnoses or deaths. There are only three active cases in the entire state.

Its hard to say. In a press conference Friday, State Epidemiologist Dr. Dean Sidelinger said that the exponential growth of the virus snuck up on them, and that two weeks ago, it didnt look likely. Sidelinger also said that potential economic impacts were weighed when deciding whether or not to impose more restrictions.

Initially, Oregon planned to close down individual counties if cases got dangerously high. It was commonly thought that COVID-19 would spike in some places, but not in others, and statewide restrictions wouldnt be necessary. But it quickly became clear that cases were rising across Oregon, and that every free hospital bed in the state could be needed to take care of people with COVID-19.

We have a lot more freedom during this lockdown. Weve learned a lot since the pandemic started. We know that being outdoors is fairly safe. Weve also learned a lot about how important social interaction can be to staying psychologically healthy during this pandemic.

In this lockdown, you can still see friends. But in Oregon, gatherings need to be limited to two households, and less than six people. You can still go to some businesses, like salons and physical therapy.

Hair stylist Ceanna Jennifer Lee works with a client on the first day of her salon's reopening following COVID-19 closure on June 6, 2020, Beaverton, Oregon.

Arya Surowidjojo/OPB

Washington is in a four-week pause. Some restrictions went into place on Monday. The new restrictions on restaurants will take effect on Wednesday, and theyre a lot like Oregons restrictions. Outdoor dining at restaurants is allowed, but only in groups of less than five people. Outdoor gatherings of five people or less are allowed. Indoor gatherings are allowed if people quarantine for two weeks first. Businesses can stay open, as long as they operate at 25% capacity or less. Churches, too 25% capacity, and no more than 200 people, can attend faith-based gatherings.

Oregon Gov. Kate Brown said during a press conference last Friday that violating the new COVID-19 restrictions is a misdemeanor, punishable by citations and even arrest. As of Monday, Brown had yet to outline exactly how those citations would be issued or what they would be for but said she is working with law enforcement officials on the logistics.

Thats a really tough one. The official freeze is for two weeks. But Brown has said that counties could need to extend their shutdown by a further two weeks. Multnomah County already has.

How long these new restrictions will be in place depends entirely on how well they work and how well people follow them. If everyone stayed home for two weeks, Oregon could theoretically identify every symptomatic case of COVID-19 and re-open. But that isnt possible. Under these rules, people are still going to church, still going to grocery stores, still getting haircuts and massages. And, of course, not everyone follows the rules.

But each individuals decisions can make a big difference in COVID-19 spread.

Yes! Theres a lot you can do. Unfortunately, it all comes down to the same thing: avoid close contact indoors with other people as much as possible. So even though its not required, try to limit your trips to the grocery store like you did in the spring.

Limit your interactions with other friends, and before you hang out with them, have an honest conversation about your potential COVID-19 exposure. And consider quarantining after any potential exposure.

Remember: every time you have contact with someone, you are also essentially in contact with everyone they have met or will meet. Your germs, or theirs, can spread far beyond that one interaction. Also keep in mind that cases are climbing rapidly, and already-overworked contact tracers have a lot on their plates. Before and after I meet with anyone, I ask myself: if I got sick, how many people would contact tracers need to call? Keep that number as low as possible.

Julie Epling, RN, works a shift at OHSU's Mission Control, in May, 2018. (Photo courtesy OHSU)

Kristyna Wentz-Graff / (Photo courtesy OHSU)

You just ask. Or, personally, I like to set the stage by offering my own exposure. For example, in October I helped a coworker move. When I offered to help, I told her that I had met with two friends on separate days outdoors, and one had a recent negative COVID-19 test. I had gone grocery shopping once in the last two weeks. Unprompted, she told me shed been essentially isolated for two weeks, but had met with her new property managers.

I could have been infected. There was no guarantee I wasnt. So could my friend. But that gave both of us the information we needed to make an informed choice before meeting face-to-face.

They might not be. Data shows that while some Oregonians go above and beyond complying with COVID-19 restrictions, others dont.

But peer pressure is a hell of a drug. The more people wear their masks, the more people avoid social gatherings, the more likely other people are to comply. Lead by example: you want it to be normal for friends to show up with masks to spare and a list of past contacts. The fact that you take things seriously could be enough to convince some friends who might be on the edge.

No. Or, at least, you cant do them like you used to.

Oregons current rules forbid gatherings of more than six, or gatherings of more than two households. So a three-person household could meet with a two-person household for Thanskgiving, and still comply with Oregons rules. In Washington, groups of five or fewer can meet together outside or meet together inside if all members have quarantined for two weeks. And thats a true quarantine no trips to the grocery store, no coffee runs. But that doesnt mean its safe. Just because you can have a few members of your friends or family over for Thanksgiving doesnt mean you should. Every close interaction is a risk. Remember: assume everyone you have met with is infected.

Me too, my friends. Me too.

So Ill say it here: If, and thats a big if, youre following guidelines, it can be OK to have a Thanksgiving dinner or meet up with friends. Thats not an endorsement of gatherings (theyre never completely safe!) but some of us need to take a little bit of risk in order to stay sane.

The important thing is to take as little risk as possible and to prioritize where you take that risk. You want to have a Thanksgiving dinner? Okay. But its a tradeoff. In exchange, maybe you cancel other plans with friends or decide to stay home for Christmas. Avoid having close contact with anyone leading up to the holiday. Your safest bet is to quarantine yourself for two weeks before Thanksgiving and ask guests to do the same.

Thanksgiving is a risk. To do it responsibly, you need to at the very least, cut down risks you take in other areas.

If the weather is nice enough to gather outside (lets be honest, were in Oregon, its unlikely) you should gather outside. You should ask everyone attending about their potential COVID-19 exposure, and let them know that if they arent meeting your own safety standards, they will be uninvited. I quarantined for two weeks so I could visit my mother for her birthday in June. I wont be seeing my parents for Thanksgiving, but if I were, I would quarantine for two weeks first.

Eating indoors is always risky, but there are steps you can take to make it safer. Do anything you can to increase the flow of clean air. Open windows. If you have central air, check and change your air filter and keep the air running on high. If you have air purifiers with true HEPA filters, run them in the rooms where people are gathering.

Everyone should be masked at all times unless they are eating or drinking. This can be a good opportunity to get clever: maybe you socialize indoors and scarf down your dinner outside or in a different room.

The Umbrella Man statue wears a mask in Pioneer Courthouse Square in Portland, Ore., Saturday, April 18, 2020. Public health officials have encouraged people to wear masks to slow the spread of COVID-19.

Bradley W. Parks / OPB

Invest in some reusable straws. They can help you drink without taking off your mask.

Assume everyone that you have had contact with is infected with COVID-19, and after Thanksgiving, assume you are infected. You want to avoid getting sick in the first place, but if you do get sick, you want to make sure that you are a virus-transmitting dead-end. Consider quarantining after Thanksgiving, not just before.

Conceptually, yes: as long as you also wear masks and practice social distancing. Scientifically, the jury is still out: there havent been any experiments yet. Its best to think of them like masks: it wont protect you totally, but its one more thing that can reduce your risk of exposure. And when used in conjunction with other social distancing measures, like masks, the amount of protection you have increases.

Sheila Mulrooney Eldred wrote about air filters for NPR. She interviewed medical experts and virologists, and they all said the same thing: theres no reason air purifiers shouldnt reduce the number of virus particles circulating in a room if they are the right type and used properly.

A true HEPA filter will catch at least 99.7% of particles that are .3 micrometers. It will also catch larger particles and smaller particles, but thats the baseline it needs to meet to qualify as true HEPA.

SARS-CoV-2, the virus that causes COVID-19, is smaller than .3 micrometers. But it doesnt float around in the air on its own, its carried in tiny droplets of water and mucus called aerosols. Those droplets are large enough to be caught by filters.

Eldred writes that any HEPA filter youre purchasing to catch viruses should meet certain specifications. Look on the air cleaners box to see if it has a CADR of 300 CFM or more. Ugh, jargon, but thats how they get labeled. A CADR is the clean-air delivery rate of a filter. CFM is a measure: cubic feet per minute. So: an air filter with a CADR of 300 CFM can circulate all the air in a normal-sized bathroom once a minute, and a 130 square foot living room roughly four times a minute.

And keep in mind: they are not a 100% guarantee. Its when you couple an air purifier with social distancing, masks, increased airflow, and handwashing that youll have the best results.

The vast majority of evidence gathered from states and countries around the world suggests that school is safe, particularly for students age 10 and younger, if good social distancing measures are practiced. You can read more about some of the research here.

Related: Oregon governor renews talk of reopening schools as COVID cases dip

There are a lot of reasons to keep schools open. Many students learn best by in-person education, and distance learning has opened up a new world of problems for parents who are trying to work from home and educate their students. Schools also provide a ton of benefits to students outside of an education. Closing schools is, therefore, being treated as a last resort.

We are seeing more cases in kids under 18. But heres the weird thing: were seeing more cases in kids who are distance-learning, too. So kids are getting sick, but so far it doesnt seem like theyre catching the virus at school.

Teacher Austyn McNew's second-grade class at Fort Vannoy Elementary School in Grants Pass.

Austyn McNew

There are a lot of reasons to get excited about the progress different countries and companies have made in developing a COVID-19 vaccine. Most of these are DNA vaccines, a type of vaccine that had never before been tested but was first envisioned to battle cancer. DNA vaccines take much less time to produce than traditional vaccines, which use all or part of sick or dead viruses to trigger an immune response.

Several vaccines are currently in phase 3 trials. Phases 1 and 2 check for safety in small groups. Phase 3 trials involve vaccinating a large number of people, and looking to see if it works. This is also when the less-common side effects of a vaccine will be found.

Some of those trials were paused while illnesses were investigated. That is completely normal and means the system is working. Most drug trials have a pause like this: when you test a new drug on thousands of people, some will inevitably get sick for entirely unrelated reasons. Manufacturers need to be sure that the illness is unrelated, so they pause the trial. In some cases, the illnesses were found to not be related to the vaccine, and the trial resumed. Others were ended permanently: that is also a good thing that means the system is working.

Dr. Anthony Fauci, the nations top COVID-19 expert, said that vaccines could begin to roll out early next year, or even in late December. But it could be much longer before theyre available to the general public. Theres going to be a lot of demand and limited supply. Were in this for the long haul.

In September, public health watchdogs were very concerned that a new COVID-19 vaccine would not be properly vetted by the U.S. Food and Drug Administration. President Donald Trump was pushing for weaker regulations. Ultimately, the FDA chose to continue with their usual, strict vaccine-vetting plan.

Still, SARS-CoV-2 vaccines have become politicized. A recent poll found that only 6 out of 10 Americans said they will get a COVID-19 vaccine, and only if it cuts their chances of getting infected by 50% or more.

Thankfully, the data coming out of the current vaccine trials is promising: both Moderna and Pfizer say their vaccines are over 90% effective. For what its worth, Fauci says he trusts the system currently in place to vet the vaccines and will take a COVID-19 vaccine when they become available.

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Everything you need to know about COVID-19 now that cases are soaring and the 'freeze' is here - OPB News

Oregon and Washington both have new COVID-19 restrictions. Heres how they compare - OPB

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Washington Gov. Jay Inslee and his wife, Trudi, wear masks in the governor's office before making a statewide televised address on COVID-19, which health officials have warned is accelerating rapidly throughout the state, Thursday, Nov. 12, 2020, at the Capitol in Olympia, Wash.

Ted S. Warren / AP

Much like the rest of the country, Pacific Northwest states are experiencing a dramatic rise in new cases of COVID-19. Oregon and Washington have both repeatedly broken their own records in recent weeks for posting the highest daily counts of new confirmed and presumptive coronavirus cases statewide since the beginning of the pandemic. As the holiday season, in normal years, is a time for family gatherings and travel. But in 2020, amid a raging pandemic, governors in both states have enacted new rules to help mitigate the already rapid spread of the virus.

The restrictions are slightly different in each state. Northwest News Network Olympia correspondent Austin Jenkins joined OPBs All Things Considered this week to compare and contrast them. You can listen to the entire conversation using the audio player at the top of this story. Here are some highlights:

On what Washingtons newly enacted COVID-19 restrictions look like:

So its quite a long list, but here are the basics: Indoor social gatherings are prohibited unless people quarantine for 14 days beforehand, or, quarantine for seven days beforehand and get a negative COVID test no more than 48 hours before the gathering. Outdoor social gatherings are limited to five people from outside your household. Restaurants and bars are closed for dine-in service. Gyms, bowling alleys, theaters, museums are all having to close down again. Wedding and funeral receptions are not being allowed. No open houses for real estate, and theres also a limit on capacity in retail settings.

On some key differences between Oregons and Washingtons new rules:

"In Washington, restaurants can still serve people outside: outside dining, with up to five people at the table. In Oregon, both indoor and outdoor dining is paused. Another key difference is that Oregon is allowing grocery and retail stores to operate with up to 75% capacity, while Washington is at this 25% capacity percentage. I asked health officials here in Washington to justify this. Secretary of Health John Wiesman responded by saying that masks are not 100% effective.

"'Paying attention to what the science tells us, it says that we limit our time somewhere, limit the number of people who are there at the same time, keep your distance, cover your face. All of those things together can help us be successful, Wiesman said.

"I did not get an answer as to why 25% is the magic number in Washington. But I do want to note that before this latest guidance, Washington retailers were actually limited to 30% of capacity. I dont think most people knew that. But what we did hear is that most grocers said that they actually did not need to regulate the front door at that level, because shoppers tend to spread themselves out anyway throughout the day.

On a collective action taken by Oregon, Washington and California to limit travel:

[The West Coast travel advisory] encourages non-essential travel to not happen. It also says, if you leave the state and come back, they want you to self-quarantine. And anybody coming into one of our West Coast states from elsewhere is asked to self-quarantine. It doesnt look like theyre planning to enforce this, but they are asking for people to comply with it, and it sort of sets a tone and an expectation.

On what the Western States Pact' to fight COVID-19 really means in practice:

When this pact was formed in April and by the way, Colorado and Nevada also later joined [with Oregon, Washington and California] it was billed by the governors as a shared vision for reopening their economies and controlling COVID-19. But, they also said at the time that each state would build its own state-specific plan, and that this was more a pact on principles. A spokesperson for Gov. Inslee told me that this Western States Pact was not about making decisions in lockstep. It was about sharing information and supporting one another when theres need. So, there may have been kind of an expectation, when you hear the term pact, that wed be doing things in unison. But what Im hearing from the governors office here at least, is that that wasnt the expectation going into it, and its certainly not going to be the reality day-to-day, week-to-week or month-to-month.

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Oregon was largely spared by the global pandemic, but no longer. Cases mount as Oregon and Washington enact the strictest social-distancing measures since April. With holidays rapidly approaching, we have answers to all of your questions: just how bad is it? How is this lockdown different from the last? Can I have Thanksgiving?

With new restrictions starting on Wednesday and doctors blaming social gatherings for the COVID-19 spike, the basic rule state leaders seem to want the public to adopt is common sense.

New restrictions for restaurants, gatherings, grocery stores and more take effect starting Tuesday, Nov. 17 and last through Dec. 14.

Tags:COVID-19, Health, Oregon, Washington

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Oregon and Washington both have new COVID-19 restrictions. Here's how they compare - OPB News

In a sign of the continued political polarization surrounding COVID-19, officials in Orange County are expressing frustration following Gov. Gavin Newsoms decision to move the region into the most restrictive reopening tier amid a dangerous new surge in coronavirus infections statewide.

Conservative county leaders have long been at odds with the Democratic governor over the restrictions imposed on businesses, public spaces and activities, but it now appears that clash will stretch into the holiday season as California enters what could be its most challenging chapter of the pandemic.

The state has rolled back reopenings in much of California as cases have climbed. Some areas are considering even more local restrictions including hard-hit Los Angeles County, where officials imposed new restrictions Tuesday and warned of a curfew and new stay-at-home order if conditions continue to deteriorate while others, including Bay Area counties like San Francisco, have voluntarily added restrictions that go beyond the state requirements as a protective measure.

But Orange County leaders on Tuesday argued the state has gone too far.

A server wears a protective mask at Watsons Original Soda Fountain in downtown Orange. Orange County has dropped back into the COVID-19 Purple Tier - the states most restrictive.

(Luis Sinco/Los Angeles Times)

Though they reiterated the importance of residents taking steps to protect themselves and their loved ones from the virus, some county supervisors took Newsom and his administration to task for the reclassification.

Board Chairwoman Michelle Steel, a Republican who was recently elected to Congress, called the decision a unilateral move that she thinks is troubling and harmful to Orange County families who need to put food on the table, to small businesses struggling to stay open and to the mental health of our community.

Instead of combatting COVID-19 in a thoughtful manner, this one-size fits-all approach threatens the livelihoods of our residents, she said in a statement.

Mondays dramatic announcement saw Orange County, along with 27 other counties in the state, regress to the purple tier the most stringent of the four color-coded categories in the states coronavirus reopening system.

As a result, many businesses and other public facilities will have to suspend or severely limit indoor operations.

The widespread reassignment, which Newsom likened to pulling an emergency brake, comes as California grapples with its most significant coronavirus surge to date.

Weekly infections across the state are now almost 150% worse than a month ago, rising from about 22,600 to 56,000 for the seven-day period that ended Sunday, according to a Times analysis. California reported 13,412 new coronavirus cases Monday, a single-day record. Health experts have largely backed the states approach, saying restrictions are needed to help slow the skyrocketing infection rate.

Given the explosion in the number of cases, this weeks tier reassignments were accelerated. The system is based on new coronavirus cases and testing positivity rates, and previously, a countys metrics had to fall within the threshold of a more restrictive tier for two consecutive weeks before it fell back. The state now says only one weeks worth of data is needed.

Orange County had for weeks been in the second-most severe or red category. However, its latest adjusted daily case rate per 100,000 residents was 10.8, high enough to land in the purple range, indicating widespread transmission of the disease.

Even with the backsliding, that adjusted rate is the third-lowest in Southern California, trailing only Santa Barbara County and, narrowly, San Diego County, according to state data.

To some in Orange County, though, the abrupt shift aside from causing undue confusion and consternation for residents and businesses is the latest example of a state pandemic response that too often has been top-down, uneven and overbroad.

Were hearing a bit of hopelessness that is out there in the community as we move back into purple, and that hopelessness, I think, is not there just because, Oh, gosh, were doing more clampdowns, but because were seeing no end in sight, Supervisor Don Wagner said during Tuesdays board meeting.

And by that I mean every time this governor has come up with some sort of a plan for dealing with coronavirus, it ends up changing changing for the worse.

Others took issue with the tiered system itself, saying that the state should take other metrics such as hospitalization numbers into consideration.

Our healthcare system is very prepared, Supervisor Lisa Bartlett said. So while we want to balance that with health and safety, I think reopening our economy to the greatest extent possible, and weve proven that we can safely do that, is really the proper way to go.

Orange County has tussled with the governor over coronavirus-related restrictions before, including when the state briefly closed local beaches. Some cities have also drawn headlines for their residents reluctance to wear masks in public settings, even though local leaders have urged them to do so.

However, officials pointed out that the countys case rates and hospitalization numbers remain in better shape than some of its Southern California neighbors.

What weve been doing and what this board has been doing and what Dr. [Clayton] Chau and, more importantly, the people of Orange County have been doing to direct the resources where they need to go and to protect themselves is working, Wagner said. Thats the model not the hopelessness, the despair, the shut everything down and hope for the best that the governor is foisting on us. We tried that before. This is proof it doesnt work.

The county isnt alone in expressing concerns about, or antipathy toward, state restrictions. More than 100 elected officials, business owners and residents rallied near San Diegos waterfront Monday, demanding the county also in the purple tier let restaurants, churches and other small businesses reopen.

This is not a choice between opening up businesses or saving lives, San Diego County Supervisor Jim Desmond said. We can do both.

Overall, Orange County has reported roughly 66,000 cumulative coronavirus cases, and more than 1,500 residents have died of COVID-19.

County officials still stressed that its up to residents and businesses to do their part to help stem the spread of the virus.

Thats especially true when just around the corner are the holidays a time when residents might be tempted to gather with family and friends without taking precautions.

California has generally banned large gatherings, though brief, small ones of no more than three households may be held, provided they take place outdoors and attendees physically distance and wear face coverings.

Chau, director of the OC Health Care Agency and the countys health officer, said he hopes residents take the guidance to heart.

I know this is hard. Were all in this together, he said. And I would strongly recommend [to] our residents that we can get through this very quickly if we follow those.

Link:

Orange County frustrated with move to purple COVID-19 tier - Los Angeles Times

The details are these: On November 6, Newsom and his wife, Jennifer, attended a 50th birthday party for political consultant and lobbyist Jason Kinney, at the uber-exclusive French Laundry restaurant in the heart of the state's Napa Valley. They were two of a dozen people at the event, which was held at an outdoor table in the courtyard of the restaurant. Photos obtained by Fox 11 in Los Angeles show Newsom sitting closely packed with other guests -- and none wearing a mask. (There is also some debate as to whether they were fully outside, as the woman who took the photos at the restaurant told Fox 11 that the group was loud and sliding doors were closed to keep the room quieter.)

"I made a bad mistake," Newsom said by way of apology on Monday. "I should have stood up and ... drove back to my house. The spirit of what I'm preaching all the time was contradicted. I need to preach and practice, not just preach."

Yes. To all of that.

Newsom was the first governor in the country to issue a stay-at-home order (on March 19) and was generally quite proactive in his response to the evolving virus. But this episode has so many things wrong with it: Skirting his own rules to dine at a restaurant that costs more for dinner than many Californians make in a week to fete a lobbyist. Bad, very bad and really, really bad.

"The governor, who has been among the state's most vocal advocates of playing by the pandemic rules that he himself has created, blew it. He did not, in his own tired phrase, meet the moment. I mean, they do say the food at the French Laundry is to die for. But is it?

"Newsom understood right away how bad that dinner looked. He had just foolishly handed his opponents ammunition on a silver platter."

Now, to his credit, Newsom's apology was fulsome -- and without the sort of "sorry if anyone was offended" caveats that politicians love to lean on. And California is one of the most Democratic states in the country, so it's unlikely that this error in judgment will seriously jeopardize Newsom's chances at a second term in 2022 or his future national political aspirations. (And trust me, he has future national political aspirations.)

But for someone who had been leading the charge on what effective government response to this pandemic looked like, Newsom's knuckle-headed decision to defy his own best practices is a bad look. A very bad look.

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This Democratic governor thinks his own Covid-19 rules don't apply to him - CNN

If more of us could see what frontline workers witness in the war against COVID-19 people gasping for air and lungs shutting down maybe more people would understand the seriousness of the disease.

Thomas Steele has been there. The 50-year-old was healthy with no preexisting conditions, and he was working in sales at a New Braunfels, Texas, construction company when he contracted COVID-19. He didnt worry about it too much, but then it got bad.

He was hospitalized in San Antonio and placed on an ECMO machine, a last-ditch treatment that does the job of a patients heart or lungs by moving blood and oxygen. He was tethered to the machine for two months, but still his condition worsened.

His lungs deteriorated so severely that he was transferred to Houston Methodist Hospital, where surgeon Dr. Thomas MacGillivray performed a double lung transplant that saved his life.

In all of this terrible pandemic, which has been a scourge to the whole world, Mr. Steele's story is one that we can all be joyful about, MacGillivray says. It's a real victory over this terrible disease.

Steele had the surgery about a month ago and is now recovering at a rehab facility in Texas. Despite his ordeal, he considers himself one of the lucky ones because he lived to tell his story.

Up until he received his diagnosis, Steele says he and his wife were following safety precautions such as wearing masks, washing their hands and not visiting the restaurants and vineyards they love as often as they used to. But he was still skeptical and didnt think the disease was that serious. Now he wants everyone to know what its truly like.

Take it from somebody who's been in the hospital for over three months, you know, it's nothing you want to do, nothing you want to go through, he says. I can remember fighting for every breath of air for a couple of weeks period there where you're just gasping for every breath. It's not a joke. It's nothing to play with. It's real and it's serious.

Steele was exposed to the coronavirus when there was an outbreak at his office. After testing positive, his daughter, whos studying to be a doctor, suggested he buy a pulse oximeter to measure his blood-oxygen level. Hes now recommending everyone get one.

It tells you a lot really quick, he says. I was getting shortness of breath, almost like somebody was sitting on my chest. And so then I was checking this thing, and I went like from 88s to 84s to 85 and I kept getting worse. So I immediately called back to the ER and asked them and they said, 'Well, if it's that low, you need to come in right now.

By the time he was transferred to Houston Methodist, Dr. MacGillivray says Steeles lungs were totally destroyed.

Viruses are nasty little things, MacGillivray says. The body unleashes the full effect of our immune system in an attempt to neutralize and kill the virus. But what happens in some people is that the immune system, in an effort of trying to destroy the virus, destroys our own lungs or other organs.

Thats exactly what had happened to Steeles lungs. He says the experience was terrifying.

You pretty much are gasping for every breath, and you're thinking about every breath, Steele says. And every breath you take, you feel like a little click in the back of your throat because you're just taking so much oxygen in and stuff and it's just you're always just like gasping. You're sucking for air.

MacGillivray says most people whose lungs are in that condition dont survive. But from the moment he laid eyes on him, he says he knew Steele was a special guy.

Through part miracle, part of just incredible physical and mental and spiritual strength on Mr. Steele's part, he was able to survive it and prevail through it, he says. And then we were fortunate to get a set of lungs offered for him at the right time and got his transplant done very well.

Especially with the holidays coming up, both MacGillivray and Steele are urging people to take the coronavirus seriously and follow safety guidelines to prevent infection.

As a community and as a society, we're all interconnected and things like wearing a mask protects ourselves and helps us protect each other, and it's really a small sacrifice to make to keep everybody as safe as we possibly can, MacGillivray says. It's something that we can do that's positive to help.

Karyn Miller-Medzon produced and edited this interview for broadcast with Tinku Ray and Todd Mundt. Samantha Raphelson adapted it for the web.

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Double Lung Transplant Patient With COVID-19 Describes Gasping For Air - Here And Now

Thousands attend the Red for Ed rally at the Indiana State House Indianapolis Star

A year ago Thursday, Indiana saw one of the largest Statehouse rallies in recent memory.

That morning, the buses arrived early and often, depositing throngs of red-clad educators and supportersto the lawn of the states capitol building. By 9 a.m., the block around the building had turned into a crimson sea.

Teachers had shown up and shown out for the closest thing to a walkout Indiana had seen since the Red for Ed movement picked up steam elsewhere around the country in the preceding years. Half of the states roughly one million schoolchildren were out of class for the day as more than 130 school districts closed some in solidarity and some because they didnt have enough teachers left to cover classrooms.

Thousands of teachers gathered outside the Indiana Statehouse for Red for Ed Action Day on Tuesday, Nov. 19, 2019.(Photo: Jenna Watson/IndyStar)

It attracted national figures and national attention.

And it was largely successful.

Two of the three biggest requests teachers had that day were granted later in the legislative session. The third an investment in teacher pay has been a taller order and, at the time, lawmakers said it would have to wait until the state crafted its next biennial budget during the 2021 legislative session.

Three months later, the world changed when the coronavirus pandemic swept across the globe. And now the ongoing public health crisis has largely erased the sense of momentum built during last years historic march and any gains earned then may not be enough to keep teachers in the classroom now.

There was buzz around the event for days leading up to it as schools began to close as more teachers requested the day off. By 9 a.m. that morning, nearly the entire south lawn of the Statehouse was packed and a sea of red started wrapping around the building. Human tunnels greeted lawmakers at every entrance. A marching band took up residence on the south steps and whipped the crowd into a frenzy.

Randi Weingarten, the president of the American Federation of Teachers, received a rock star's welcome as teachers lined up to take selfies with her. When she took the stage later in the day, the crowd erupted in chants of "Randi, Randi, Randi."

Taylor Malayer, a Crawfordsville High School teacher dressed as "Clifford the Big Red Dog," rallies amongst thousands on the south lawn of the Indiana Statehouse on Red for Ed Action Day in Indianapolis on Tuesday, Nov. 19, 2019.(Photo: Jenna Watson/IndyStar)

More than 15,000 people registered to attend the event, although no official crowd estimate was available. The Indiana State Police said 5,000 people made it into the capitol building for the days events, but there were thousands more outside all decked out in red coats, hats and, in at least one case, a "Clifford the Big Red Dog" costume.

Inside that costume was Taylor Malayer, an English teacher at Crawfordsville High School.

It was this huge build up, Malayer said. Locally, we did pass some major changes for teacher salaries. But then COVID changed the communitys view on teachers again.

Malayer said she felt a lot of support in the wake of the Red for Ed Action Day last November. Her school district raised salaries for most teachers, though she didnt have enough years with the district to be one of them.

Shell get the salary bump in two more years. But thats if she stays, and thats looking a lot less certain than it used to.

Do I look for jobs more often jobs than I should?" she said."Probably."

Malayer said it would take a serious salary increase to keep her in the profession. When she started teaching seven years ago, she made $40,000 a year. Now, the 30-year-old says she makes just $42,000 and the 30-year-old said she needs a boost to help pay off her student loans.

And the challenges of teaching during the pandemic are compounding all of the issues that existed before, she said. Teaching both online and in-person is exhausting, she said, as is trying to find some way to bring joy to a school year dominated by face masks, plexiglass and assigned seats at lunch.

Especially after COVID, I can see plenty of teachers retiring,"she said, "or young teachers wanting to leave."

The Indiana State Teachers Association put out a dire warning this week that the states existing teacher shortage could get much worse before it gets better if the state doesnt do something to address teacher pay and the increasing demands the pandemic has placed on educators.

A recent survey found current workloads and working conditions are leading to burnout.

Nearly all responding teachers 95% of 2,290 responses said theyve seen an increase in workloads due to COVID-19 and 71% said theyve considered retiring early or leaving the profession due to workload increases. Nearly 40,000 educators are members of ISTA.

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We simply dont have the personnel going into the field and weve got to turn that around, Gambill said. The number one way that is going to happen will be through pay.

Its the one thing that ISTA asked for last year and received little movement on from the General Assembly. Lawmakerssaid it would have to wait until the next budget writing year, which is 2021.

Gov. Eric Holcomb put together a commission to study the issue and recommendations are due to the legislature next month. But the pandemic has wreaked havoc on state finances and its unclear how much, if any, extra the state will have to give teachers.

House Speaker Todd Huston, R-Fishers, said Tuesday that an upcomingrevenue forecast would give budget writers a better idea of the state's financial position heading into the upcoming session.

Lawmakers say they have increased the states investment in education in the two years and they did. But in most cases, those increases barely kept up with inflation and they were distributed unevenly across districts. The state has also done little to ensure any extra dollars actually make it into teachers pockets.

Most districts did give teachers a raise last year, but again they were awarded unevenly and still didnt get the state close to competitive with neighboring states like Michigan, Illinois and Ohio, which has long been the goal.

ISTA has argued it will take a bigger down payment on teacher pay to boost salaries to where they need to be starting pay of $40,000 and an average salary of $60,000.

We knew that a year ago, Gambill said, before we were in this time. It is the leading indicator as to why folks are leaving the profession.

Its one reason why Jack Graves is leaving the profession.

He grabbed attention during the Red for Ed rally last year with a sign that said, I make more at YATS. During his decade in education working as an autism therapist, he also held down a second job at YATS, a popular local restaurant.

Jack Graves has been a teacher for 10 years and also works at Yats restaurant for seven of those years. Yats is what pays his car payment and gives him spending money, he said.(Photo: MJ Slaby/IndyStar)

This is his last week with Indianapolis Public Schools. Graves said he was promised a raise but never saw one at least not from the district. Graves said YATS gave him one after the school district didnt.

Hes leaving school-based work to continue his work for an in-home service provider. His girlfriend, also a teacher, is leaving the profession at the end of the semester.

I fear theres going to be a mass exodus soon, he said. I know of a lot of people walking out of the classroom.

Graves said teachers need to be shown more respect if theyre going to stick around. During last years Red for Ed event, he said it seemed like a chance to gain a little bit of that back. For him, though, it didnt come to fruition.

I dont feel like anything came of it, he said. I had a great piece of pizza that day. That was about it.

There was no mass gathering at this years Organization Day, held earlier in the week. But ISTA is still outlining a series of legislative priorities for lawmakers to tackle when they begin the session in January.

Top of the list again this year: teacher pay.

Education reporter MJ Slaby contributed to this report.

Call IndyStar education reporter Arika Herron at 317-201-5620 or email her at Arika.Herron@indystar.com. Follow her on Twitter: @ArikaHerron.

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Indianas Red for Ed: A year later, COVID-19 has largely erased the sense of momentum - IndyStar

Abstract

Tremendous progress has been made in understanding the role of T cell immunity in acute and convalescent COVID-19 infection. Here we shed light on the known unknowns of pre-existing and acquired T cell responses in relation to acute and convalescent SARS-CoV-2 infection.

The broad clinical spectrum of COVID-19 indicates widespread intraindividual differences in the host immune defense against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The underlying cause of disease heterogeneity is probably multifactorial. However, a rapid early host response is likely critical to generate control of SARS-CoV-2 viremia before spread to the lower respiratory tract and onset of damaging hyperinflammation. In this regard, the literature is full of examples where functional T cell responses can provide early control of acute viral infections, including SARS-CoV and MERS-CoV (1, 2). Although multiple studies have indicated that T cells play a role in the early immune response to SARS-CoV-2 and can generate a functional memory pool, there are still multiple unanswered questions in the field (Box 1). Here, we summarize and speculate on a specific set of questions related to T cell immunity against respiratory viral infections, with a focus on COVID-19 severity, immunity, long-term consequences, and vaccination (Fig. 1).

What do acute SARS-CoV-2-specific T cell responses in the blood tell us about contemporaneous T cell responses in the lung?

Which host and viral factors regulate the strength and efficacy of the early antiviral T cell response?

Do CD4+ T cell responses to the virus predominate over CD8+ responses in the lung as well as the blood?

Do poor CD4+ TFH responses to the virus correlate with reduced longevity of antibody responses?

Is severe COVID 19 linked to an impaired development of SARS-CoV-2-specific memory T cells?

(A) Clinical and virological factors likely to be related to the development and function of antigen-specific T cell responses against SARS-CoV-2. The impact of factors including sex, age, chronic conditions affecting immune health, viral load dynamics, degree of lymphopenia, and risk of exposure to SARS-CoV-2, on the strength and efficacy of the early antiviral T cell response remains elusive. Furthermore, some individuals experience delayed viral clearance or other symptoms for an extended period (long COVID) despite viral clearance. (B) The broad clinical spectrum of acute COVID-19 includes asymptomatic, mild, severe, and fatal outcomes. Whether convalescent individuals will be protected against SARS-CoV-2 (re)infection and the longevity of this protection remain to be determined. (C) Immunological and virological factors influence generation of SARS-CoV-2-specific T cells and may influence the clinical manifestations and quality of the induced T cell response in acute and convalescent COVID-19 patients. Here, the ability of the host to generate efficient T cell responses following SARS-CoV-2 infection are likely to be dependent on the epitopes targeted, antigen abundance, involvement of resident memory T cells (TRM) at the site of infection, presence or absence of preexisting cross-reactive T cells, and host genetic factors such as HLA type and TCR repertoire. Furthermore, the level of inflammation and amount of proinflammatory cytokines are likely to be associated with T cell activation and exhaustion and subsequent T cell memory formation. (D) The potential link between vaccination outcome in relation to T cell immunity remains to be determined.

T cells are critical to generate early control and clearance of many viral infections of the respiratory system (3). Recent studies in transgenic mouse models provided evidence that T cells are also important for viral clearance and disease resolution after SARS-CoV-2 infection (4). As such, it is not surprising that T cell activation has emerged as a hallmark of acute COVID-19; probably as a consequence of an early SARS-CoV-2-specific cellular immune response (59). Although early T cell responses may play a critical role in dampening disease severity, there are also reports describing a dysregulated and unchecked T cell activation pattern in severe cases (1012). Increased T cell activation in severe cases likely reflects increased antigen levels in the respiratory system, but whether the early T cell response reaches a state of exhaustion in subjects with severe hyperinflammation remains to be determined. Furthermore, given that COVID-19 is a disease of the respiratory tract it will be important to define if early detection of T cell activation in blood correlates with tissue-specific events. For instance, will delayed detection of SARS-CoV-2-specific T cells in blood reflect the later onset of cellular immunity in the respiratory tract or are these two compartments independent of each other in relation to disease severity?

If elicitation of an early T cell response would be beneficial to dampen COVID-19 severity, what might be the underlying causes and correlates of an early versus late onset of SARS-CoV-2-specific T cell activity? Old age and male sex are both associated with increased risk of COVID-19 complications. Interestingly, females seem to mount a somewhat stronger T cell activation following SARS-CoV-2 infection (13) and disruption of T and B cell coordination has been implicated in elderly patients with severe COVID-19 (14). On the other end of the age spectrum, decreased frequencies of IFN-+CD4+ and CD25+CD4+ T cells have been described in hospitalized pediatric patients, who have shorter lengths of stay compared with their adult counterparts (15). In conjunction with age and sex, host and viral factors probably also play a role in the early immune defense and coordination of the early SARS-CoV-2-specific T cell response. For instance, SARS-CoV-2 has mechanisms to antagonize proinflammatory signals, particularly type I IFN (IFN-I) signaling (16, 17). IFN-I proteins are key inflammatory mediators to initiate antiviral defense, from which viral evasion might lead to a delayed clearance of SARS-CoV-2 (4). This is supported by the observation that inborn errors of immunity and autoantibodies that diminish IFN-I activity are more commonly detected in patients with severe COVID-19 (18, 19). Concordantly, the early expansion and differentiation of antiviral T cells are dependent on the direct action of IFN-I. Given that activated T cells from older individuals exhibit reduced responses to IFN-I, it is tempting to speculate that higher risk elderly persons experience delayed activation of SARS-CoV-2-specific T cells that may lead to reduced clearance of the virus and exacerbated COVID-19 severity. Collectively, more data are needed from mechanistic studies in animal models as well as large cohort studies on males and females in different age groups to identify beneficial and detrimental viral and host factors that have an impact on the early T cell response against SARS-CoV-2.

Generation of memory T cells can provide lifelong protection against pathogens (20). Previous studies have demonstrated that SARS-CoV- and MERS-CoV-specific T cells can be detected many years after infection (2123). Likewise, SARS-CoV-2-specific CD4+ and CD8+ T cells are distinguished in a vast majority of convalescent donors (7, 9, 21, 2427). Studies using peripheral blood have reported stronger SARS-CoV-2-specific CD4+ than CD8+ T cell responses in most subjects. However, it is well established that CD4+ T cells experience a higher propensity to recirculate between tissues and blood than CD8+ T cells. As such, whether SARS-CoV-2-specific CD4+ T cell responses also predominate in tissues, and particularly at barrier sites close to the epithelium, needs to be confirmed through studies on the upper and lower respiratory tract.

Similar to the CD4+ T cell polarized response to many other viral infections, SARS-CoV-2-specific CD4+ T cells mainly possess a Th1 or circulating T follicular helper (TFH) cell phenotype (79, 14, 28). Circulating TFH differentiation seems to be impaired in certain patients with severe COVID-19 (11, 29) and recent analysis of postmortem lymph nodes and spleen samples showed an absence of germinal centers along with a defect in Bcl6+ TFH differentiation in deceased COVID-19 patients (30). Whether these consequences are due to sampling from postmortem patients remains unknown, but further studies are needed to clarify whether TFH cell formation is impaired by SARS-CoV-2 and could have an impact on declining antibody responses in specific convalescent donors. Furthermore, more mechanistic studies are needed to understand if memory T cells can generate protective immunity to lethal challenge with SARS-CoV-2, as previously demonstrated in SARS-CoV and MERS-CoV models (1, 2), in the presence or absence of high titers of neutralizing antibodies. Likewise, longitudinal human studies will also inform us of whether functional memory T cell responses are present many years after SARS-CoV-2 infection and correlate with protection from reinfection.

Several studies have demonstrated the presence of CD4+ and to a lesser extent CD8+ T cells recognizing SARS-CoV-2 peptides in a significant proportion of unexposed individuals (7, 21, 24, 26, 31). Mapping of SARS-CoV-2 epitopes in unexposed blood donors revealed pre-existing T cell immunity, potentially induced by seasonal human coronaviruses (HCoVs) causing common colds (27, 32). This is supported by a relatively high amino acid similarity between recognized SARS-CoV-2 epitopes and seasonal HCoVs such as HCoV-OC43, -HKU1, -229E and -NL63. The presence of cross-reactive cellular immune responses in the population generates an obstacle to the use of T cell-based assays to track SARS-CoV-2 infection rates in blood donors. Given that antibodies do not result in the same degree of cross-reactivity as T cells and are consequently easier to use in clinical diagnostic settings, serology will likely be a better readout for tracing the infection rate in the society. Nevertheless, more thorough studies are needed to better understand the full spectrum of cross-reactive versus newly-induced SARS-CoV-2-specific CD4+ and CD8+ T cell responses.

A key question in the field is whether pre-existing T cell responses influence the severity of COVID-19. Pre-existing SARS-CoV-2-specific T cells are unlikely to provide sterilizing or herd immunity but may allow the host to bypass immune evasion mechanisms, for instance evasion from IFN-I, and generate early pressure on the virus. This concept is supported by studies in mice showing that airway memory CD4+ T cells recognizing a conserved SARS-CoV epitope provided protection from related CoVs (1). Similar scenarios in which pre-existing T cells may provide earlier viral clearance and thus less severe symptoms have been proposed elsewhere (33). Here, the level of conservation between antigens may have a substantial impact on whether pre-existing T cells are beneficial or detrimental for the host. On the other hand, the concept of original antigenic sin, in which earlier induced antibody or T cell responses influence the response against future viral infections, needs further evaluation (34). If pre-existing T cells are less effective in clearing viral infection upon activation but contribute to systemic and permanent increase in inflammatory signals, it might lead to increased hyperinflammation and COVID-19 severity. In a first analysis, comparing T cell responses against SARS-CoV-2 and HCoV sequences did not find any evidence of original antigenic sin (32). Again, the level of conservation of targeted epitopes is likely to impact the outcome, and further evaluation of this concept is needed. Collectively, further animal studies and human studies done before and after SARS-CoV-2 infection are needed to define the biological relevance of pre-existing T cell responses and their role as friends or foes in host defense against SARS-CoV-2.

Resident memory T cells (TRM) are a distinct memory T cell lineage. These cells reside within tissues, do not recirculate to peripheral blood, and have been defined as local sentinels mediating rapid protection from reinfection (35). In fact, a vast majority of T cells in nonlymphoid tissues, such as the respiratory tract, are considered to be TRM (36). In terms of respiratory infections, there is a growing body of literature demonstrating that TRM can provide protection against severe pulmonary disease (37, 38). Likewise, airway CD4+ T cells can generate cross-reactive immunity between human and bat coronaviruses (1), emphasizing that cross-reactive T cells in the respiratory tract can provide protection from lethal challenge with pathogenic coronaviruses. Whether cross-reactive TRM, induced by seasonal coronaviruses, can block transmission of SARS-CoV-2 from the upper respiratory tract to the lung and thereby attenuate severe COVID-19 remains unanswered. This scenario, where TRM block the spread of viral disease from upper to lower respiratory tract, has been demonstrated in influenza A infection (37) and might account for partial immunity of secondary infection with heterologous strains (39, 40). Furthermore, whether SARS-CoV-2-specific TRM are induced after COVID-19 and whether these cells will provide protection in the long term also remains unknown (41). Although certain studies in mice have suggested that TRM in the lung are short-lived (42), there is evidence that their counterparts in the upper respiratory tract persist with minimal decay (37) and for more than a year in human lung (43). Altogether, there is currently no evidence supporting the provision of sterilizing immunity by TRM, but data presented above suggest that TRM could facilitate rapid control of upper respiratory tract SARS-CoV-2 infection, replication, and spread. In this regard, further work in animal models may provide evidence for whether local immunity mediated by TRM can achieve this type of immunity.

A substantial number of COVID-19 patients experience heterogeneous symptoms that persist over a month and onward (4446). This heterogeneous phenomenon is being referred to as long COVID and affects around 10% of all COVID-19 patients (44, 45). Many symptoms can be attributed to persistent tissue damage in severe COVID-19. Nevertheless, the fact that many individuals with milder COVID-19 symptoms also experience chronic lingering symptoms, involving the cardiovascular, nervous, and respiratory systems, indicates that persistent immune activation and/or inflammation may play a role in long COVID. Multiple mechanisms are probably involved in this condition and whether T cells play any role in long COVID is unknown. The higher incidence of long COVID in females than males, similar to autoimmune diseases (47), raises the question of whether T cells orchestrate long COVID through similar mechanisms as in autoimmune or inflammatory conditions (48, 49). One hypothetical underlying mechanism behind autoimmune-related conditions after COVID-19 could be molecular mimicry, given that HCoV-specific T cells can cross-react to myelin in multiple sclerosis patients (50). Whether SARS-CoV-2-specific T cells have the ability to react against self-antigens remains to be determined. In line with a possible effect of HLA type on COVID-19 susceptibility/severity (51, 52), we believe that larger genetic studies are needed to clarify if HLA or other immune-related genes are associated with an increased risk of developing long COVID.

Based on the uncertainty of whether cross-reactive T cells or antibodies will provide protective or long-lasting immunity to COVID-19, it will become absolutely critical to administrate a safe and effective vaccine to the population to reach broad immunity and break the negative spiral of new infections. Ongoing vaccine efforts mainly target B cells to promote the induction of neutralizing antibodies (nAbs) against SARS-CoV-2 (53, 54). Although the induction of anti-spike nAbs is the key component for an effective SARS-CoV-2 vaccine, it is well-known that T cells, and in particular TFH cells, are critical to generate antibody-producing plasma cells and long-lived memory B cells. In COVID-19 patients, high nAb titers correlated with strong CD4+ T cell responses, and the lack of functional TFH cells reacting against SARS-CoV-2 was shown to be detrimental (11, 29, 30). Preliminary results from the two major mRNA vaccine trials in humans have demonstrated potent Th1 responses (55, 56). However, previous studies have reported strong TFH responses against certain mRNA vaccines (57), and future trials should therefore include other activation induced markers, such as CD40L and/or CD200, in addition to IFN- ELISPOT assays to understand if potent B-helper mechanisms are induced by the current vaccine regimens. Other outstanding questions are whether vaccine-induced TFH responses will be equally induced in all age groups and how long these responses will persist in blood and vaccination site-draining lymph nodes. A final issue to consider is whether high quantities of vaccine-induced CD8+ T cells at local sites need to be elicited by future vaccine candidates. If the initial group of vaccines in clinical trials that are primarily focused on generating an effective nAb response provide recipients with long-standing protection, it may not be necessary to invest in such efforts. However, if problems emerge in the vaccinated population with breakthrough infections, waning antibody levels after vaccination, and/or the emergence of new viral strains, it would be wise to reconsider vaccine approaches specifically designed to induce functional CD8+ TRM responses in the upper respiratory tract.

Collective efforts have greatly enhanced our scientific understanding of T cell responses against SARS-CoV-2 but many unknowns remain to be resolved. Although it is clear that T cells play a central role in generating early control and clearance of many viral infections, their role in SARS-CoV-2 infection is only starting to be revealed. Specific T cells may even have a detrimental impact on the clinical outcome and contribute to long COVID symptoms. Currently, there is a need for deeper analysis using both animal models and longitudinal follow-up studies of large patient cohorts to define the beneficial versus detrimental aspects of SARS-CoV-2-specific T cells in acute, convalescent and vaccine settings of COVID-19.

Acknowledgments: Funding. A.C.K. was supported by the Swedish Research Council, the Karolinska Institutet, and The Center for Innovative Medicine. M.B. was supported by the Swedish Research Council, the Karolinska Institutet, the Jeansson Stiftelse, the ke Wibergs Stiftelse, the Swedish Society of Medicine, the Swedish Cancer Society, the Magnus Bergvalls Stiftelse, the Lars Hiertas Stiftelse, the Swedish Physician against AIDS Foundation, the Jonas Sderquist Stiftelse, and the Clas Groschinskys Minnesfond. Author contributions: A.C.K., M.H. and M.B. contributed to writing and drafting the illustration. A.C.K. and M.B. edited the manuscript. Competing Interests. The authors declare that they have no competing interests.

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The known unknowns of T cell immunity to COVID-19 - Science

LAWRENCE, KS Back in September, LMH Health announced the funding received through the Coronavirus Aid, Relief and Economic Security (CARES) Act. One major area of focus for LMH Healths funding request was testing in three specific areas: mass community testing, back-to-school baseline testing and healthcare and first responder surveillance testing.

Over the past few months, we have been working in partnership with Lawrence-Douglas County Public Health (LDCPH) and our clinicians to identify highest and best use for testing in these three areas. This funding has allowed us to create a plan and deliver testing for asymptomatic persons who live and work in Douglas County, testing for staff and residents of the Lawrence shelter, medical providers and more. We have been allotted a full total of 55,000 tests which we will be delegating to different areas and organizations within the Lawrence community based on guidance from LDCPH.

We have collaborated to create a structured plan for allocating testing and to the delegated sites, said Russ Johnson, LMH Health President and CEO. The CARES Act provided the funding that has made surveillance testing possible and we appreciate the community support as we carry out all testing plans. We are thankful for the clear and strong leadership from LDCPH and for their guidance.

Beginning next week, we will be rolling out our surveillance testing plan. Testing for public schools will begin on Nov. 30 and testing for private schools has already started. Although many people who are infected with COVID-19 become symptomatic, others do not show symptoms but can still spread the illness to others. With general population surveillance testing we strive to identify and mitigate asymptomatic cases in the community. One of our primary goals is to ensure that populations who are vulnerable or at higher risk have access to testing. LMH Health and LDCPH aim to ensure that individuals over 65 years of age, those with certain medical conditions, vulnerable populations and non-Lawrence residents are able to access a proportionate share of the tests available, the distribution of which has been determined by Public Health.

Per LDCPH, tests will be allocated based on number of constituents and the nature and frequency of each outreach event. The tests are saliva PCR tests and individuals will be required to spit into a tube in order to provide the sample. Staff will be available to answer any questions while the sample is being collected. Our goal is to provide easy access to testing back to the community to increase safety and decrease exposures from both those who may be symptomatic or not. More information about the specific testing plans will be available from each sector in the coming weeks.

We have collaborated to create a structured plan that is both fair and accurate in allocating testing and amounts of testing to the delegated sites, said Dan Partridge, director of LDCPH. We are beyond grateful for the collaboration with LMH Health to carry out a plan that strives to better the health and safety of our community.

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LMH Health, formerly Lawrence Memorial Hospital, was founded in 1921, and includes a 174-bed hospital located in Lawrence, Kansas, as well as a number of primary and specialty care clinics throughout Lawrence, Douglas County, Jefferson County and Leavenworth County. LMH Health is a community, not-for-profit hospital that serves the health care needs of the community regardless of an individual's ability to pay. LMH Health receives no tax support from the city of Lawrence or Douglas County. Dedicated to serving as a partner for lifelong health, LMH invests all excess revenues in services, equipment and facilities that further that mission.

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Community COVID-19 Surveillance Testing - LMH Health

The state health officer says Washington is experiencing the fastest growth of coronavirus since March, and Thanksgiving is creating more concern.

SEATTLE Washington state health officials are continuing to warn people against hosting Thanksgiving gatherings as coronavirus cases keep rising.

During a Wednesday briefing, State Health Officer Dr. Kathy Lofy said Washington is experiencing the fastest growth of COVID-19 cases since March. If we continue on the transmission rate that we are on, Dr. Lofy said the estimate is the state will see almost 150 people admitted to hospitals everyday.

Dr. Elizabeth Wako, chief operating officer at Swedish First Hill, said her hospital is already reducing elective surgeries to make room for more COVID-19 patients.

"Just this morning, we admitted 10 patients in five hours, so that is exponential for us," said Dr. Wako.

A new national survey by the Ohio State University Wexner Medical Center found nearly two in five people report they will likely attend a gathering with more than 10 people for Thanksgiving.

"If you gather with 15 people for Thanksgiving dinner, there will be an 18% chance that one of the individuals will be infected with COVID," said Dr. Lofy.

Deputy Secretary of Health Lacy Fehrenbach added, "There's risk for further transmission. Those guests who become infected may go on to do other things the following week. They may go to a religious service. Another might work in a nursing home. A child who attended could go to school leading to outbreaks in these locations."

Dr. Mike Famulare, the principal research scientist at the Institute for Disease Modeling, found the number of COVID-19 cases rising quickly with Washington state is on track to hit 1% prevalence by Thanksgiving.

In a series of tweets, Dr. Famulare explained that could mean, 76,000 people with COVID on Thanksgiving, and between 25,000 to 40,000 people who won't yet know they are sick and bringing "#COVID19 to dinner."

"Around 450 of those people, if that comes to pass, will not make it to New Years," said Famulare. "This is growing rapidly in a way we haven't seen since the beginning of the pandemic, and what we can do about that is in our control."

Dr. Famulare said we can reverse the trend by wearing masks, practicing social distancing, and staying home as much as possible. He added that he knows it is hard to not get together for Thanksgiving, but he recommended avoiding gatherings.

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Dont bring COVID-19 to dinner: Washington health officials warn against holiday gatherings - KING5.com

PHOENIX - As the nation gets closer to Thanksgiving amid the ongoing COVID-19 pandemic, many people are planning to travel or hold get-togethers with family and friends, and that isone of the big reasons why there's a rush on COVID-19 tests in the Valley.

According to doctors, besides the holiday season, there is another reasonwhy so many people are now getting testing, and that is because the state is seeing a surge in the number of new COVID-19 cases, people are getting concerned and they want to be on the safe side.

"Getting a lot more calls from people with kids in schools who had a scare and now needing to have their child tested,"said RayYoung with Terros Health.

Young says even though they are seeing a large increase in testing, there isnt a backlog, and testing wait times at his facilities are now down to about two to three days.Thats in comparison to the two week wait times from back in the spring months.

"The labs are better equipped to handle them,"said Young."I hear they are doing about 15,000 tests a day."

Young says one of the reasons why so many people are now deciding to get tested, some of them asymptomatic, is because of the holidays.

"Were hearing people are trying to decide whether to get together to go on these holiday trips," said Young.

Dr. Jeffrey Weber, Medical Director for InfusAble Care says he is seeing a similar trend at his office in Scottsdale, where they just started offering rapid 15-minute tests.

"The ability to make a more informed decision about what you are doing for the holidays. You can feel more safe and make a more informed decision about whats right for you," said Dr. Weber.

Whatever peopledecide to do this holiday season, Young says its important to practice kindness, as well as hygiene.

"Just be kind to one another," said Young. "Take care of one another. Were all experiencing this together and lets help one another out."

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People rush to take COVID-19 tests amid holidays and surge in new cases - FOX 10 News Phoenix