Category: Covid-19

State health officials warned again Thursday about the potential for exponential growth of COVID-19 infections in York County, urging residents to follow health precautions as the virus becomes prevalent in the wider community.

The 18 additional COVID-19 cases reported in York County on Thursday accounted for more than 40 percent of the 43 new confirmed or probable new cases reported. The now weeks-long spike in cases in York County has, in turn, driven up Maines statewide rolling average from 28 new infections daily for the week ending Sept. 17 to an average of 38 new daily infections on Thursday.

There were no additional deaths reported among individuals who have contracted the coronavirus.

The Maine Center for Disease Control and Prevention continues to monitor outbreaks in York County, including a new potential cluster at Brink Chiropractic Practice in Sanford. But Maine CDC director Dr. Nirav Shah said the rate of virus has achieved a certain level that its everywhere in wide circulation across the county.

Shah said Maine CDCs contract tracers are finding fewer cases emanating from specific outbreaks, but instead are seeing the virus spread from person to person in more casual settings because of its prevalence in the community. Shah gave the generic example of an infected person having lunch with one or two other people, who then go on to infect others in the personal circle.

That is concerning because those are the preconditions for exponential growth, Shah said during a Thursday briefing. So weve got an ever-shrinking window in which to get a lid on what is happening in York County. And if we are not successful in doing so, that pattern of transmission could quickly lead to exponential growth.

Statewide, Maine continues to have lower COVID-19 infection rates than most other states.

Maine averaged 2.3 new cases for every 100,000 residents during the previous seven-day period, which is the second-lowest in the country after Vermont, according to the Harvard Global Health Institute. North Dakota and South Dakota had the highest rates at 45.8 and 35.5 new cases for every 100,000 people.

Maine and Vermont also had the two lowest per capita infection rates to date of 388 and 276 cases, respectively, for every 100,000 residents, according to tracking by The New York Times.

The positivity rate for the more than 8,000 test results received by the Maine CDC from the previous day stood at 0.45 percent while the seven-day average positive rate was 0.6 percent, compared to a national average of 5 percent.

To date, the Maine CDC has tracked 5,215 confirmed or probable cases of COVID-19 since the coronavirus was first detected in the state in mid-March. At least 140 people have died after contracting the virus but 4,478 individuals have recovered.

But new outbreaks have been reported this week in York County at Sanford High School and Sanford Regional Technical Center, the Sanford Wolves Club, Hussey Seating Company in North Berwick and the Ogunquit Beach Lobster House.

Shah said Thursday that the number of cases at Sanford High School had held steady at 12 but he urged all students, teachers and staff to get tested so epidemiologists could better determine the extent of the virus within the school.

The high school switched to all-online classes this week following the outbreaks at the school and in the community.

Some of the outbreaks in York County, including a large one at the county jail, have been linked to an Aug. 7 wedding and reception in Millinocket, located roughly 200 miles to the north. The number of total cases linked to that wedding held steady at 178 on Thursday.

York County has emerged as the coronavirus hotspot in Maine. Neighboring Cumberland County had been the virus epicenter in Maine all spring and for much of the summer but has only had a handful of days during the past month in which new cases climbed out of the single digits.

Thursday was one of those days as Maine CDC reported 11 additional cases in Cumberland County. Asked whether Maine CDC epidemiologists are seeing the virus spread from York County into Cumberland County, Shah said that is certainly a concern although it is too early to tell.

We dont know that with scientific precision yet but that is, again, our leading hypothesis as we start to see an increase in cases initially in Cumberland County but then also now, more recently, in Androscoggin County as well, Shah said.

Political events held in Maine on Wednesday and Thursday are also drawing attention and scrutiny.

President Trumps son, Donald Trump Jr., held a rally in Holden on Wednesday night and swung through Auburn on Thursday to stump for his father and other Republicans, including former state lawmaker Dale Crafts in his bid for the 2nd Congressional District seat.

Media reports and social media posts show several hundred people attending the outdoor event in Holden, with the vast majority not wearing masks or physically distancing from each other. Executive orders issued by the administration of Gov. Janet Mills state that outdoor events should be limited to 100 people or less.

And in Auburn, Trumps eldest son greeted about 80 people outside of Rollys Diner. According to the Lewiston Sun Journal, Trump shook hands with many people after the event and even posed for up-close-and-personal selfies while not wearing a mask.

The Trump campaign hopes to at least repeat its 2016 performance in Maine when the Republican picked up one of Maines four Electoral College votes by winning majority support in the 2nd Congressional District.

Asked about the rallies, Shah steered well clear of the politics of the event and said other agencies are responsible for enforcing Maines size limits on gatherings and other health requirements. But Shah urged everyone, regardless of the event, to take precautions such as wearing masks or keeping distance from others.

It doesnt matter for what purpose the gathering was organized or who is there, Shah said. What weve seen is whether its a wedding, whether its a funeral, whether its any type of place where people are together for a longer period of time in high density, COVID-19 can pass from person to person to person, potentially even generating outbreaks.

The administration of Gov. Janet Mills announced Wednesday that residents of Massachusetts would no longer be required to receive a negative COVID-19 test or quarantine for 14 days in order to visit Maine because of falling infection rates there.

Other states with similar exemptions are New Hampshire, Vermont, New York, New Jersey and Connecticut.

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Maine CDC warns of community spread of COVID-19 in York County - Press Herald

Theres still no clear path back to any sense of business-as-usual as the COVID-19 pandemic continues, but United Airlines is embarking on a new pilot project to see if easy access to COVID-19 testing immediately prior to a flight can help ease freedom of mobility. The airline will offer COVID-19 tests (either rapid tests at the airport, or mail-in at home tests prior to travel) to passengers flying from SFO in San Francisco to Hawaiian airports, beginning on October 15.

United worked directly with the Hawaiian government and health regulators to meet the states requirements when it comes to quarantine measures, so that travelers who return a negative result with this pre-trip test wont have to observe the mandatory quarantine period in place upon their arrival. Thats obviously a major barrier to travel to a popular tourist destination like Hawaii, as a two-week quarantine eats up all or more of the typical period of stay for anyone coming from the mainland.

The airline has partnered with two companies to provide the tests: Color for the at-home kit, which is ordered by a physician and provides results within 1-2 days of receiving the sample, and GoHealth Urgent Care, which will be providing the on-site tests at the airport using the Abbot ID NOW rapid COVID-19 test that returns results in just 15 minutes.

If passengers choose the Color option, theyre advised to request the test kit at least 10 days before they fly, and then to provide their sample for testing within 72 hours before they fly, in order to ensure first that they receive the sample kit in time, and second that the results are recent enough that its extremely unlikely theyve contracted COVID-19 in the ensuing time prior to their flight. Passengers choosing this method can even return the sample via a drop box at SFO, with the results arriving after their landing, but still curtailing their mandatory quarantine period once received.

The on-site option will require scheduling a visit to the testing facility in SFOs international terminal in advance, with tests available between 9 AM to 6 PM PT every day at the airport.

This is just a pilot program, and thats a very good thing, because it will be crucially important to see what happens as a result of this kind of deployment, and its ability to skip the quarantine period. The two-week quarantine after traveling, which is fairly widely adopted globally at this stage in the pandemic, is intentionally meant to apply in most locations regardless of test results, no matter the source or recency.

Thats because at this stage in testing, the results arent anywhere near foolproof testing has potentially less efficacy at detecting COVID-19 in asymptomatic individuals, for instance, and when viral loads arent yet high enough to provide reliable measurement. Those situations can result in false negatives, which isnt an issue when the 14-day quarantine periods are mandatory and universal.

Tourism, especially domestic U.S. tourism, is vital to the economic well-being of states like Hawaii and widespread testing could be a lever to open up more of this kind of economic activity both elsewhere in the U.S. and internationally. But itll require close and careful study, scrutinized by health professionals, as well as improvements in the accuracy and consistency of diagnostics before these measures should expand beyond the pilot stage.

The rest is here:

United Airlines is making COVID-19 tests available to passengers, powered in part by Color - TechCrunch

Chicago Mayor Lori Lightfoot and labor leaders whose members could bear the brunt of layoffs or furloughs as the city tries to close a yawning 2021 budget deficit called on Illinois' Congressional delegation this week to work toward passage of a federal aid package that could forestall the deepest cuts.

Its not likely the letter they sent to legislators from Illinois will have much impact on the partisan Washington D.C. impasse over aid to cities and other units of government hard-hit by the COVID-19 pandemic.

Meanwhile, the death toll from the coronavirus in Illinois has passed 8,500, according to state public health officials who say more than 1,600 people are currently hospitalized with the disease, more than 350 of them in intensive care units.

Public health officials said there have been more than 283,000 positive cases of COVID-19 out of more than 5.3 million tests administered in the state. On Friday, 69,793 tests had been done over the past 24 hours, putting the states seven-day positivity rate at 3.6%.

However, Gov. J.B. Pritzker has warned that Region 1 in northern Illinois, which includes the Rockford and Dixon areas, has seen positivity rates rise to 7.5%, near the 8% threshold that would bring additional restrictions on public gatherings.

Heres whats happening Friday with COVID-19 in the Chicago area and Illinois:

1:37 p.m.: Mayor Lori Lightfoot, labor leaders call for congressional help on Chicagos coronavirus revenue hole

Chicago Mayor Lori Lightfoot and labor leaders whose members could bear the brunt of layoffs or furloughs as the city tries to close a yawning 2021 budget deficit called on Illinois' Congressional delegation this week to work toward passage of a federal aid package that could forestall the deepest cuts.

Its not likely the letter they sent to legislators from Illinois will have much impact on the partisan Washington D.C. impasse over aid to cities and other units of government hard-hit by the COVID-19 pandemic.

But it illustrates how Lightfoot and union heads are trying to show theyre working together before the mayor introduces a budget proposal next month that she has warned could include significant payroll cuts in many front line city departments to help close a shortfall for next year she estimates at $1.2 billion.

Whilelaying out that financial holelast month, Lightfoot said a federal revenue deal is the best way to avoid cuts that would impact city services.

1:35 p.m.: Buffalo Grove to allow Halloween trick-or-treating with safety suggestions

Buffalo Grove trustees agreed to accept staff recommendations to not ban trick-or-treating in the village on Halloween, but instead offer alternatives and suggestions to improve safety during the annual candy gathering in the time of coronavirus.

The board agreed with that approach, Assistant Village Manager Jennifer Maltas told Pioneer Press in an interview following Mondays combination virtual and in-person meeting.

Regarding trick-or-treating, Maltas said the U.S. Centers for Disease Control and Prevention has categorized the traditional door-to-door candy collection as a high-risk activity in light of the ongoing novel coronavirus pandemic and she said the Illinois Department of Public Health is expected to finalize its guidelines in the coming days.

Village officials may tweak their recommendations after reviewing that information, she said.

12:12 p.m.: 2,514 newly confirmed cases of COVID-19 and 25 additional deaths reported

Illinois public health officials reported Friday they had logged 2,514 newly diagnosed cases and 25 additional confirmed deaths of people with COVID-19, raising the statewide tally to 283,885 known cases and 8,563 deaths.

11:42 a.m.: 20 Valparaiso, Indiana, football players quarantined after positive COVID-19 case; games against Crown Point, Merrillville canceled

Valparaiso High School has announced that both junior varsity and varsity football teams will suspend practice and competition until Oct. 5, effectively canceling games against Crown Point and Merrillville.

In a statement sent to football parents, Head Coach Bill Marshall and Athletic Director Stacy Adams said school officials received word of a positive COVID-19 case at the high school.

In collaboration with the Porter County Health Department, those in direct contact with the individual who tested positive were identified, notified and instructed to quarantine for 14 days.

10:59 a.m.: Coronavirus cases are on the rise in the US heartland, where anti-mask sentiment runs high

It began with devastation in the New York City area, followed by a summertime crisis in the Sun Belt. Now the coronavirus is striking cities with much smaller populations in the heartland, often in conservative corners of America where anti-mask sentiment runs high.

The spread has created new problems at hospitals, schools and colleges in the Midwest and West.

Wisconsin is averaging more than 2,000 new cases a day over the last week, compared with 675 three weeks earlier. Hospitalizations in the state are at the highest level since the outbreak took hold in the U.S. in March.

Utah has seen its average daily case count more than double from three weeks earlier. Oklahoma and Missouri are regularly recording 1,000 new cases a day, and Missouri Gov. Mike Parson, a staunch opponent of mask rules, tested positive for the virus this week. And South Dakota, Idaho and Iowa are seeing sky-high rates of tests coming back positive.

The U.S. is averaging more than 40,000 new confirmed cases a day. While that number is dramatically lower than the peak of nearly 70,000 over the summer, the numbers are worrisome nonetheless. The nations death toll eclipsed 200,000 this week, the highest in the world.

9:09 a.m.: Neiman Marcus is notifying employees of a new round of staff cuts

Neiman Marcus is exiting its bankruptcy with a smaller workforce.

Significant staff cuts at both its Neiman Marcus and Bergdorf Goodman stores have started this week. The company didnt say how many people are permanently losing jobs.

We plan to separate from selling and non-selling associates, the Dallas-based luxury retailer said in emailed statement. These are difficult decisions we must make at this time and we are so grateful for our dedicated stores associates.

7:11 a.m.: What will it take to make diners feel safe indoors? Nearly 60% feel uneasy eating inside, so restaurants try sterilizing UV wands, tabletop air purifiers as winter looms.

The host greeting diners at Formentos, an Italian restaurant in the West Town neighborhood, now offers guests something new alongside the menu and wine list: a portable air purifier for their table.

The tabletop devices are among a series of air quality upgrades the restaurant introduced this month to assure customers they can breathe easy dining inside.

Diners can also expect to see bussers using ultraviolet wands to sterilize glassware and utensils, and little air-sucking robots in various corners of the restaurant that use heat to kill microorganisms. Unseen are new air filters installed in the HVAC system meant to trap virus particles.

The changes were costly for a restaurant that continues to lose money due to COVID-19.

5 a.m.: With the pandemic, parents and educators embrace outdoor preschools. Many hope the move will be permanent.

On a hazy September afternoon near a willow tree, a boy with a bright red backpack spotted something slimy on the ground.

Hello, all the mushrooms, he said, gently tapping the fungus, trying not to crush any as his small feet moved through the grass.

A teacher asked why they might be growing in that spot. The boy thought for a moment. Because its shady and wet!

That was just one lesson for the group of kids at the Chicago Botanic Garden Nature Preschool, a program thats part of the growing field of nature-based early childhood education.

Nature preschools were increasing before the pandemic, more than doubling in the last three years, according to a report from the Natural Start Alliance, a project of the North American Association for Environmental Education. The report estimates 585 schools across the country have nature-based education at their core, meaning a significant amount of time is spent outside. Illinois is among the states with the most programs topping 20. California and Washington, with about 50 programs each, lead the list.

Stay up to date with the latest information on coronavirus with our breaking news alerts.

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COVID-19 in Illinois updates: Heres whats happening Friday - Chicago Tribune

Sing Sing Correctional Facility in Ossining, N.Y. Mary Altaffer/AP hide caption

Sing Sing Correctional Facility in Ossining, N.Y.

Back in early April as the COVID-19 pandemic ravaged New York, John J. Lennon was sure he would contract the coronavirus.

As a prisoner at Sing Sing Correctional Facility in Ossining, N.Y., social distancing was impossible, he says. Making calls on prison phones, Lennon says, meant being "chest to shoulders" with nearly two dozen inmates. "It was a death-trap situation to use the phone," he says.

Not long after he made his prediction, Lennon started to feel feverish. He lost his sense of taste. The true number of infected inmates will likely never be known; he says incarcerated people at Sing Sing who didn't need medical intervention weren't being tested.

"I would sort of have conversations with my neighbors, sort of swapping symptoms," he told NPR's Morning Edition in early September. "Some guys were being ambulanced out to the surrounding hospitals. And by May, we had five deaths, including one officer."

His symptoms were mild, Lennon says, but he remembers having trouble breathing in part because of anxiety. He remembers he had to talk himself "off the ledge" of a panic attack.

"You got CNN on in your cell TV in the background talking about hundreds of people dying. It's like a torture chamber," he said.

In July, Lennon was transferred to Sullivan Correctional Facility in Fallsburg, N.Y. He's not sure why he was moved there from Sing Sing, but when he arrived, he found a community that hadn't been hit as hard by the virus as the one he came from. He believes that's due to a prison population at Sullivan that is older and with existing health problems, so prison leaders took different precautions. For example, the superintendent keeps a careful eye on incarcerated people at the facility for early signs of the virus.

Lennon has written about what it's like catching the virus and living during the pandemic in prison for New York Magazine.

The interview highlights contain some extra content that did not air in the broadcast version.

On the changing attitude incarcerated people have had to masks

The New York State Department of Corrections and Community Supervision has issued masks statewide, but they started issuing them in early May. Sing Sing was hit hard in April. By early May, five people were already dead. So that time that we were hit hard, there were no masks. I remember the moment we got masks, it was the first week of May and they started giving the masks out and the whole cell block erupted and they just started cursing and saying 'It's too late now.'

On how the inmates who died of COVID-19 are remembered at Sing Sing

My sort of "money" as an incarcerated journalist is reporting on what's happening inside. I don't know what happened to the men that died.

Calvin Grohoske, he was having a hard time breathing. He was taken out in mid-April and I talked to his neighbor, Paul Davidson, and I asked him what happened. He said, 'I just saw his cell being packed up and guys going in Tyvek suits and putting it in bags. And I never saw him again, and I used to watch the SYFY channel with him. That was my boy.' They were tight. He doesn't know what happened to his body.

There's a lot of unknowns. That seems to be the theme of 2020, the unknown.

On Leonard Carter, a formerly incarcerated person at Sing Sing who served 25 years who died of COVID-19 shortly after he was released

He had made parole, I believe, in February. And he went down to a pre-release facility in Queensborough, and he died there.

It was hard for me when I heard it because, when you know somebody personally I worked with him on the mental health unit when I first arrived at Sing Sing, and he was like a veteran, sort of giving me the ropes. He's like "These guys are having a hard time, they take a lot of antipsychotic medication." Like, he knew the ins and outs of this. So when I learned it was Leonard Carter, everyone called him Mr. Carter, I felt bad because I was like, wow, this guy was probably going to go home and do good work. He was a decent guy.

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For Inmates With COVID-19, Anxiety and Isolation Make Prison 'Like A Torture Chamber' - NPR

Google Maps will soon include information on COVID-19 spread in states, counties, and some cities. Toggling on the COVID layer in the app will show the seven-day average number of confirmed cases in each area per 100,000 people. Areas of the map will be color-coded based on case rate, and a label shows if cases are going up or down. The feature will roll out on Android and iOS this week.

The layer is designed to help people make more informed decisions about where to go and what to do, wrote Sujoy Banerjee, a Google Maps project manager, in a blog post. Public health experts and the Centers for Disease Control and Prevention (CDC) recommend that people keep track of the amount of COVID-19 spread in their area to figure out the risk of certain activities. Transmission rates in local communities is important for parents to consider when deciding if they should send their kids to school and for families to monitor in advance of any holiday plans.

The COVID overlay pulls its data from Johns Hopkins COVID-19 dashboard, The New York Times, and Wikipedia.

This is one of many pandemic-related features introduced in Google Maps over the past few months the app also includes alerts about face-covering mandates on public transportation, information about takeout options at restaurants, and warnings to call ahead to a doctors office if you think you have COVID-19.

The rollout of the new feature comes as rates of COVID-19 in the United States are starting to climb again, driven in part by growing outbreaks in the Midwest. Experts are worried that a fall spike is on its way.

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Google Maps adds an overlay of COVID-19 case trends - The Verge

An illegal roadside graveyard in northeastern Namibia. People in the townships surrounding Rundu, a town on the border to Angola, are too poor to afford a funeral plot at the municipal graveyard and resorted to burying their dead next to a dusty gravel road just outside of the town. Brigitte Weidlich/AFP via Getty Images hide caption

An illegal roadside graveyard in northeastern Namibia. People in the townships surrounding Rundu, a town on the border to Angola, are too poor to afford a funeral plot at the municipal graveyard and resorted to burying their dead next to a dusty gravel road just outside of the town.

It's hard to keep track of the dead.

And even the records we do have are not accurate.

As the world approaches the 1 million mark for COVID-19 fatalities, public health experts believe the actual toll the recorded deaths plus the unrecorded deaths is much higher.

But that's not just an issue with the novel coronavirus.

According to World Health Organization data, each year, two-thirds of global deaths are not registered with local authorities. That's a total of 38 million annual deaths that aren't part of any permanent record. Not only are the numbers not part of any global death tally, but the cause of death is also not recorded leaving policymakers without critical information about population trends and health.

Now, that vast undercount of deaths might be changing thanks to the virus. It's pushed the science of death-counting into the international spotlight, highlighting the importance of strong and developed death registries.

"The pandemic has been a game-changer," says Romesh Silva, a demographer working for the United Nations Population Fund. "It's prompted the realization [among national governments] that comprehensive death registration is the most preferable way of understanding mortality."

Public health experts agree: From the perspective of national planning, having good death data is imperative. You need good numbers to assess and understand risk factors that cause death. And to assess the success of health programs.

That's why counting the dead and describing causes represent "the GPS" to better global health, says Dr. Prabhat Jha, an epidemiologist and the founding director of the Centre for Global Health Research. Without the numbers, he says, you're flying blind.

"If you don't know how many people are dying of malaria in Mozambique, or how many people are dying of HIV/AIDS in Kenya, then you can't adjust your program to say, well, we're going to have treatment or prevention programs that meet the need," says Jha. "In the absence of that information, you don't really have a roadmap to improving health."

Counting deaths: 'much easier said than done'

Jha spearheads the seminal Million Death Study (MDS), an ongoing human mortality project rolled out in collaboration with the Registrar General of India the country's official unit for coordinating and unifying birth and death records. It began in 1998 to better understand and document causes of death in India, where the vast majority of deaths occur outside the official medical system. He says the paucity of reliable mortality data has posed a long-standing challenge to the development and implementation of timely and life-saving public health interventions.

But why the undercount?

Intuitively, it seems important that we understand something so fundamental as why people die. Turns out it's much easier said than done.

For one, deaths in the developing world are simply hard to count by virtue of where they happen. In lower-income countries, deaths often occur in rural areas far from hospitals. Individuals largely die at home, explains Jha, and deaths are largely unreported -- so they're never officially registered with local authorities, nor are the causes of death established and documented.

Researchers hypothesize that the undercount could also be due to cultural factors. Jha says in poor countries, incentives to record a death are often weak. In the West, those incentives often revolve around financial matters proof of death is needed to open an estate and claim an inheritance. But many countries in the Global South follow informal ways of transferring assets, so families don't have a huge reason to record a death. In many religions, getting a quick burial or cremation is considered tantamount by the time proceedings are over, many miss the small window of opportunity to be able to report the information surrounding a family member's death.

Just as individuals in lower-income countries may not be as rigorous about recording deaths, neither are governments. It's hard to muster enthusiasm for what seems like the bureaucratic science of death registration and vital stats which is why, on an international level, it's been difficult to generate traction on death registration, Silva says. Especially for countries grappling with an array of health and poverty matters, shoring up support and funding for death registration has been a pretty hard sell, he adds. As Silva puts it: "vital statistics aren't particularly sexy."

The consequence has been a stagnation in the quality of death estimates and data collection, Silva says. In recent decades, commitment to civil registration and death registration systems has faltered for various reasons, resulting in limited progress in terms of mortality statistics.

This isn't to note that some countries haven't seen success, as quite the contrary is true. A handful have.

"Sri Lanka, for example, has been able to get pretty much all of the deaths, even those that occur at home, recorded," Jha says. "[For decades,] they've used community doctors to try and get a diagnosis of the cause of death [in different areas]."

Furthermore, public health experts and population demographers have been on a quest to improve death estimates for years piloting new systems and testing novel methods to get a better count of those who pass away. They've rolled out fleets of trained medical interviewers to conduct verbal autopsies in India and Sierra Leone, inquiring about deaths and relaying the information to a central body, and propelled similar efforts across Asia and Africa.

Even still, the World Health Organization says progress has been limited. As it stands, more than 100 developing countries still lack functioning systems that "can support efficient registration of births and other life events like marriages and death." And globally, nearly 230 million children under the age of five are not registered, according to the same report.

Raising the stakes, death registration infrastructure is often weakest where need is most severe, Jha says. The largest gaps are in South Asia India, Bangladesh and Pakistan and in sub-Saharan Africa, precisely the places where premature mortality is the highest. In other words, though these nations face a disproportionate number of preventable deaths, they have much weaker systems to be able to report the causes of death.

'Back-solving' for a pandemic's impact

Mortality figures hold humongous weight on their own for priority and policy setting. But they take on pronounced importance during a pandemic, says Srdjan Mrki, chief of the United Nations Statistical Commission's (UNSD) demographic statistics section especially for statisticians and public health experts. Liana Rosenkrantz Woskie of the Harvard Global Health Institute explains why: these figures offer a unique way to "back-solve" for the impact of the pandemic.

Unlike virus death totals, disease mortality rates or COVID-19 caseloads, national death statistics don't rely on testing, which can vary significantly from country to country. By looking at excess mortality, or the number of deaths above and beyond what we would have expected to see under "normal" conditions in a particular time period, public health authorities and statisticians can make inferences about the scope and severity of the virus.

These inferences are key to rolling out an appropriate public health response the number of health workers that should be deployed, or ventilators needed, or hospital strain to be expected.

The caveat is that for countries to use excess mortality as an effective measure, they need years of benchmark data to compare the new numbers to. And that's a big if for most countries, mostly low-income, which have historically lacked the resources to mount strong civil registries and death reporting infrastructure.

Collecting death data amid COVID-19

Mrki has been working alongside UNICEF and other members of the UNSD to follow up with a number of national governments to understand how their registries and death reporting strategies have been impacted by the virus.

The results were clear across the board: According to Mrki, the COVID-19 pandemic has resulted in widespread disruptions to vital statistics collection due in part to the sheer volume of new deaths and also international pressure for governments to produce timely mortality counts. But it's also been a wellspring of innovation, as some nations have worked to scale up death reporting and take steps to modernize existing infrastructure.

At the start of the pandemic, Mrki says the UNSD drew up a questionnaire that was dispatched to U.N. member states worldwide. The survey asked how countries were prepared to capture new deaths, record births and provide timely health data amid lockdowns.

The United Nations observed two clusters of national results: First, largely developed countries, for which the pandemic did not have an adverse effect on the functioning of civil registry; and also a cluster of low-resource countries, where the pandemic's effects on counting deaths had been severe and negative.

In this second cluster of nations, Mrki explains that families, fearing the virus, were often hesitant to bring a critically ill relative to the hospital, where deaths are legally required to be registered.

What's more, in at least 15% of the countries, like Malawi for example, civil registry isn't classified as an essential pandemic service so some population bureaus and their services were scaled back altogether, with reduced working hours and staff. According to a presentation from the United Nations Legal Identity Agenda Task Force, an effort dedicated to tackling issues of legal identity from birth to death, these cutbacks had a "considerable impact" on production of timely and reliable death statistics.

"What I am afraid of is that in the wake of the pandemic you will have an unaccounted number of deaths that will never be included in vital statistics," Mrki says. "It might be impossible to get the actual numbers in many countries."

Researchers stress it's important not to be discouraged. Mrki points out that there are some hopeful stories.

Some countries, like Costa Rica and Uganda, have dispatched workers to typically disconnected areas to get better counts, while others have deployed civil health units to different regions facing higher death burdens due to the pandemic.

Other nations, especially in Latin America, have expanded electronic registration systems for registering deaths, which has improved efficiency and equal access, says Mrki.

Helena Cruz Castanheira, a population affairs officer for the United Nations Economic Commission for Latin America and the Caribbean, says though results were mixed, many countries, like Colombia and Brazil, have removed barriers to facilitating online death registry via technology.

"South Africa and Ecuador are real standouts they've moved from annual to weekly reporting of mortality statistics," Silva says. "This pandemic has brought to bear the importance of innovation prioritizing data and dispensing it quickly."

"We have a long way to go," Silva says. But he is hopeful given the groundswell of support for better ways to count pandemic deaths.

For a path forward, it will be critical, he says.

"As we like to say, 'In order to look after the living, you need to count the dead.'"

Pranav Baskar is a freelance journalist.

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Why It's So Hard To Count The World's COVID-19 Deaths : Goats and Soda - NPR

PROVIDENCE, R.I. (WPRI) Rhode Islanders gathered outside the Department of Health Thursday evening to honor the hundreds of local nursing home residents who have died from COVID-19.

Among the attendees was Vicki Moss, whose mother Dorothy died of COVID-19.

After she passed, we found out that she was now testing positive and that was the cause of death on the death certificate, Moss recalled.

Raise The Bar, the coalition that organized the event, said there have been roughly 800 resident deaths in nursing homes since March.

Eighty percent of the deaths in Rhode Island are in nursing homes and I wanted to make sure that there was a face attached to the tragedy, Bob Raphael, Dorothys son-in-law said.

The family also felt it was important to acknowledge the caregivers who ended up contracting COVID-19 while caring for sick residents.

Adelina Ramos, a caregiver at a nursing home in Greenville, said she ended up testing positive. She said nine residents at her nursing home have died since March.

We are afraid to bring it home to our family, but we still have to go to work every day and take care of these residents because they need us at the end of the day, Ramos said.

Raise The Bar has made it its mission to help the caregivers putting their lives on the line every day.

Coordinator Adanjesus Marin said the coalition is pushing for the Nursing Home Staffing and Quality Care Act to pass in Rhode Island.

It was passed unanimously in the Senate, the House opted instead of taking action to create a study commission which has no power to affect any change, Marin said.

The legislation would make it so each facility has to legally provide a minimum of 4.1 hours to direct nursing care to each resident daily.

Marin said nursing homes will continue to have the most COVID-19 deaths in the state if the legislation isnt passed.

Dorothys family said this is the first time theyve been able to publicly mourn their loss and hopes it spurs action at the State House.

It was important for us to be here today to at least do that a little bit and get that taken care of in some way, Raphael said.

Marin said theres no public record to show how many nursing home caregivers in Rhode Island have died of COVID-19.

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Rhode Islanders mourn loss of local nursing home residents to COVID-19 - WPRI.com

Deep learning-based triage and analysis of lesion burden for COVID-19: a retrospective study with external validation  The Lancet

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Deep learning-based triage and analysis of lesion burden for COVID-19: a retrospective study with external validation - The Lancet

Seasonal workers who packed asparagus at a west Michigan farm initially chalked up their exhaustion, dizziness and headaches to the demands of working 13 hour-shifts seven days a week.

But then some workers lost their sense of taste and smell and had a hard time breathing. Bymid-June, it was clear that Todd Greiner Farmsin Hart was dealing with a major COVID-19 outbreak among its workforce.

At least 94 people tied to the farm tested positive, the largest farm outbreak in Oceana County, according to county health department emailsobtained by the Documenting COVID-19 project at the Brown Institute for Media Innovation at Columbia University and provided to the Free Press.

Health department spreadsheets tracked the diagnosis of 55 cases from Todd Greiner Farms from under two weeks in June, in which nearly all of the employees identified as Hispanic or Latino. According to emails, the virus spread to farmworkers' families, with 15% of infections being household or secondary cases by mid-June.

It is crazy but I am sure underneath everyones story there is a connection to a migrant worker, Doreen Byrne wrote on June 28. Byrne is thecommunicable disease coordinator for District Health Department 10, which covers 10 counties in northwest Michigan.

Among those at Todd Greiner Farms who fell ill was a supervisor who died, two workers said. The man's death certificate lists his cause of death asCOVID 19 Pneumonia Complications."

Its not known how many of the states estimated 45,000 migrant and seasonal farmworkers, many of whom are Latino,have tested positive for COVID-19 since the pandemic hit in March. There have been at least 46outbreaks at agriculture, food processing and migrant camp settings as of Sept. 17, according to the Michigan Department of Health and Human Services.

MDHHSmandated COVID-19 testing by agriculture employers and migrant labor camp operators in August, a move that some farmers pushed back on with alegal fight.

Emails obtained under Freedom of Information Act requests show that health department officials in several counties had concerns around outbreaks and testing at farms well before the state mandate. Among the findings:

During a shift at Todd Greiner Farms in mid-June, a 25-year-old woman who was among several workers who asked not to be identified in this article out of concern for losing their jobs or not finding work in the futuresaid she started coughing so hard thatshe couldn't catch her breath. She described a chaotic day of ambulances rushing away one worker who turned alarmingly pale in the break room and another who had a hard time breathing. The woman said she left work that day and tested positive.

"That day, 30 people, including me, we all left," she said.

Todd Greiner Farms did not return emails seeking comment. A woman who answered the phone declined to comment, saying: "Nobody here would be interested" in talking about coronavirus cases.

Michigan farmers and their representatives defend their practices, saying the health and safety of their workers is one of their top concerns. They say this year has been a struggle for them, with many uncertain about their future.

"Our farms and our agricultural businesses have gone through extreme measures to protect the health and safety of their workers," said Ernie Birchmeier, a manager at the Michigan Farm Bureau. "It is critically important that we do that because we rely on a workforce to get the crops harvested, to get them packaged, to get them delivered. So our farms have taken this situation very seriously and continue to do so."

Migrant workers lay down a reflective material to help apples with ripening Monday, Aug. 31, 2020 at a farm near Grand Rapids.Mandi Wright, Detroit Free Press

Farmworkers serve a vital role in Michigans agriculture industry, which contributes $104.7 billion annually to the states economy, according to theMichigan Department ofAgriculture and Rural Development. Michigan, with more than 300 different commodities, is the second most agriculturally diverse state after California.

Some workers arrive as early as February to begin the planting season and stay as late as mid-November, moving from farm to farm. The fruit and vegetable season starts with asparagus in the spring and wraps up with apples in the fall.

Coronavirus outbreaks concern farmworker advocates and health experts. They say migrant laborers are at risk for exploitation and can be vulnerable to COVID-19, in part because they often work and live in crowded environments.

More: Lawsuit over coronavirus testing for Michigan farmworkers is dismissed

More: Michigan farm workers call for coronavirus safety

Historically, migrant workers have encountered a lack of labor protections, said Alexis Handal and LisbethIglesias-Rios, researchers at the University of Michigan School of Public Health who interviewed farmworkers in 2019 for a study called the Michigan Farmworker Project.Workers might not speak up about their health and safety because they're afraid of losing their jobs.

Theres some really important power dynamics at play here, and workers are not empowered to really have control of their working and living conditions, said Handal, an associate professor of epidemiology.

And the fear of deportation is huge for those who are undocumented, said Iglesias-Rios, a postdoctoral research fellow. That can mean staying quiet about problemssuch as a lack of masks and other personal protective equipment.

Having a silent workforce is dangerous during the pandemic, Iglesias-Rios said.

Adrian Vazquez-Alatorre, executive director of El Concilio, an immigrant advocacy group in Kalamazoo, said that Latino immigrant workers have struggled to get protection during the pandemic, especially earlier this year.

"They weren't giving them masks before,"Vazquez-Alatorre said of some greenhouses, farms and food processing centers. He said employers brushed aside workers' requests for masks and other protections.

Some workers who believe they contracted COVID-19 on the job told the Free Press that their employers showed little regard for their health and safety and didnt pay them for their time off after they tested positive. Yet, other farmworkers said their employers tested them before it was mandated and compensated them for sick time.

The worker at Todd Greiner Farms who got sick with COVID-19said she and her colleagues stood about 2 feet apart on the production line and would bump into each other as they grabbed bundles of asparagus off a belt.

I still feel like the people that were working there was just too many, said the woman, who lives in Hart. I was like, I dont see why you dont do a second shift ... and have more space between us.

Another worker,a 25-year-old Texas woman, said Todd Greiner Farms had protocol for hand-washing, wearing gloves and social distancing in break rooms.

"But working in the line, in the production line, we were all very close together. They didnt follow the 6-feet distancing," the woman said.

Both womensaid Todd Greiner Farms provided reusable cloth masks that were collected at the end of each shift for washing and redistributed to different workers.

How can you keep the virus away from people when youre doing that? How sure are you that the virus is going to be out or the germs are going to be out from those face masks? the Hart resident said.

She said workers were allowed to use their own masks, but she thinks the farm should have provided disposable masks.

She said frustrated workers walked out.

Her account of employees leaving is supported by emails among staff at District Health Department 10. Byrne, the communicable disease coordinator, wrote in a June 28email to another official that "the farm is closed for the season. The employees all walked out last week."

Agricultureoutbreaks spiked quickly over a few days in the beginning of June, saidRobin Walicki, clinical supervisor for District Health Department 10. In the department's 10-county coverage area, Oceana County saw the biggest jump, with additional cases at farms andfood processing plants inNewaygo and Mason counties.

"It ramped up so quicklythere in a couple days that I think it mightve taken us a little bit by surprise," Walicki told the Free Press. "There wasthe dip after everybody stayed home. We had a couple days with zero cases. I think we were lulled into a little bit of a sense of security. ...It just very quickly became very hard to follow up on all the contacts."

The health department brought in more translators and reassigned about 20 people from different divisions to help with contact tracing. Nurses worked daily for close to six weeks, Walicki said.

Walicki didn't have exact numbers Monday but said cases have increased only sporadically since MDHHS mandated farmworker testing in August as apple orchards prepared for the season.

"I think because of the fact that we might have newer peoplein the area with the different harvest season, were starting to see a few different peopleget tested," she said."Everybody else had been tested, isolated, quarantined."

In late August, after an outbreak in late June among four workers,Arbre Farms in the Oceana County village of Walkerville had its first what if they already tested positive scenario with a migrant worker,according to emails between the farm and health officials. The employee had tested positive less than two months earlier and was refused testing at multiple health clinics due to the fact that he already tested positive not long before.

Emails show some suspicion about how quickly farmworkers were returning to work and the issue of being retested.

It is my understanding that if someone has tested positive for COVID 19 previously, that no one in the area will retest them, wrote Arbre Farms HR Administrator Jennifer Juliano, as she asked whether she could employ workers who couldnt get tested. Confusion surrounding protocol meant they were directed from the county health department to the state.

Michael Fusilier of Manchester, who runs a small family-owned vegetable farm and greenhouse in Washtenaw County, said they've been protecting their workers.

"We do make sure everybody's wearing masks," Fusilier told the Free Press. "I have one of my ladies who was working for me, she's in charge of making sure our crews are doing the right things and trying to abide by the rules of the executive orders. And so we were trying very hard."

Adding to the uncertainty, Fusilier Family Farms had to shut down because of a state executive order that prevented greenhouses from selling any products. The Michigan Nursery and Landscape Association filed a lawsuit challenging the order. The state lifted the restrictions in April.

"That was a very stressful time, not knowing what was going on," Fusilier said. "We did lose some sales right off the bat because we weren't able to open as early as we normally do."

The state mandated that baseline testing had to be done by Aug. 24 and applied to agricultureemployers with more than 20 workers on-site at a time and migrant housing providers.Going forward, they must test new workers,as well as those who have been exposed to COVID-19 or have symptoms.

Employers and housing operators foot the bill for testing, but they can get help covering some or all of the costs.

A number of immigrant advocates supported thestate order, while some farms and farmworkers alleged it unfairly targeted farms and Latinos. Opponents filed a federal lawsuit challenging the order.

"We are very disappointed in the public health order that came out specifically targeting migrant and seasonal workers in the agricultural community," said Birchmeier, of the Michigan Farm Bureau, which backed the suit. "The workers themselves were very concerned about that."

The Farm Bureau said the order led to some Michigan farmworkers leaving fields and orchards.

But the 6th Circuit Court of Appeals sided with the state, and the two farms and four workers who brought the legal action withdrew their suitthis month.

Before the statemandated testing, Gov. Gretchen Whitmer in June ordered COVID-19 protections at the state's 782 licensed migrant labor housing camps.

The state Department of Agriculture and Rural Development says it has inspected all licensed migrant housing camps, most of which are in west Michigan, for compliance with theexecutive order. Among other things, the requirements include:

Aspokesman for the department of agriculture said Sept. 11 that all licensed camps were in compliance with the order, and no civil or criminal penalties hadbeen filed against any housing provider.

Migrant Legal Aid Executive Director Teresa Hendricks, left, and law clerk Molly Spaak hand out bags of face masks, hand sanitizer and gloves at a migrant camp in Kent County on Monday, Aug. 31, 2020.Mandi Wright, Detroit Free Press

But Teresa Hendricks, executive director of Migrant Legal Aid in Grand Rapids, said she and her staff have documented a number of issues while doing outreach at housing sites. The nonprofit law firm visited camps in west Michigan three days a week and handed out 4,600 reusable masks this summer.

Last year, Migrant Legal Aid referred 67 complaints about housing conditions and other issues to the department of agriculture. Theyve made 102referrals so far this year, Hendricks said.

She said the most common complaintsare housing camps not posting their COVID-19 preparedness plans, a lack of disinfectant products and no clear isolation areas for people who test positive.

Most farmworker housing is set up for workers to share rooms, which Hendricks said ranges from four-person bedrooms in trailers to barracks-style housing of 50 or more beds in one room. Whitmer's order requires camps to separate beds by 6 feet when possible and encourage residents to sleep head-to-toe.

I see the workers trying to make their own barriers between other workers, hanging sheets around their bed so that they dont combine airspace, Hendricks said. We see people trying to reuse surgical face masks, wash and then hang them on a line.

On a warm afternoon in late August, Hendricks and law clerk Molly Spaak packed a van with more than 100 bags of cloth masks, hand sanitizer, plastic gloves and information about how workers could reach them with complaints. They headed northof Grand Rapids to Kent Countys Fruit Ridge, where the apple harvest was just beginning.

A disposable face mask hangs on a clothesline at a migrant camp in Ottawa County.Migrant Legal Aid

At a camp south of Sparta, they met workers who'd recently arrived from Mexico on temporary agricultural visas, known as an H-2A, and planned to stay until late October. About a dozen men in a trailer-like building chatted in Spanish with Hendricks and Spaak.They said they were getting tested for COVID-19 the next day.

At another housing site tucked between rows of Honeycrisp and Gala apple trees, Spaak walked through the tidy camp to see whether anyone was home.

She approached the white, multi-person cabins, calling out, Hello. Hola. Alguien? Anyone?

They found 32-year-old Brenda Martinez home with her two young children while her husband and the rest of the farmworkers were out.Her husband has been a seasonal employee with Chase Orchards for four years. He likes it there, she said. Most of the other workers come through the H-2A program.

Her husband got sick in July and tested positive for COVID-19, Martinez said. Chase Orchards checked on her family while he was ill and off work, and neither Martinez nor her kids caught the virus.

Martinez's mother worked on a blueberry farm in Ottawa County this summer. Workers who tested positive there left because they didnt want to isolate, she said.

Brenda Martinez, 32, the wife of a farmworker, is reflected in the sunglasses of Migrant Legal Aid Executive Director Teresa Hendricks on Monday, Aug. 31, 2020 as Hendricks speaks to Martinez about COVID-19.Mandi Wright, Detroit Free Press

They wanted to work, so they just left, she said.

Hendricks said farmworker testing is well-intended, but the fact that people cant work while they have the virus is a hardship for those who arent paid sick time. She mentioneda woman who went a month without income while she had COVID-19. Because shes undocumented,she didn't feel she could demand tobe paid for the time she lost, Hendricks said.

A 43-year-old farmworker in Newaygo County, who asked to not be identified, saidhes concerned about the virus because he has four kids. But hes also afraid of losing his job if he tests positive. He said he doesnt understand why testing isnt required of workers in many other industries.

It should have applied to everybody, not just farmworkers, the man said through a translator. We dont know why its so focused on us.

Other agriculture workers said they were glad to be tested. Raquel Ramirez Hernandez, 59, is employed year-round at Peterson Farms in the Oceana County village of Shelby, where she packages peaches, apples, cherries and blueberries.

She said the company tested its workforce in late spring as temporary workers were arriving.

There was a very large influx of people, and we were all happy to get tested, Ramirez Hernandez, of Hart, said through a translator.

She tested negative at first. Thirty-seven peopleassociated with Peterson Farms tested positive as of mid-June, according to health department emails. Ramirez Hernandez contracted the virus in early July and was given paid sick time for two weeks off.

America Reyes, 52, a Texas resident living in Hart for the growing season, believes that she and other family members who contracted COVID-19 got itfrom two siblings who worked at Peterson Farms. Reyes said her siblings contracted with Peterson and werent paid for the hours they missed while sick.

A spokesman for Peterson Farms declined an interview request.

Other workers said they have faced similar problems.

Juana, 39, who asked that her last name not be used, has worked on farms in Michigan for 15 years and currently packs eggs.

She said she tested positive for the coronavirus in April and had to miss work for a month and a half, making it hard to pay her bills.

"COVID-19 has affected me in a lot of ways, mentally, financially, economically," Juana said through a translator during a news conference last month organized by immigrant advocates. "I was infected with COVID-19 because at work they did not provide us with security protections, did not give us masks. We had to buy masks with our own money. And many of us at work got sick due to the lack of protective equipment at our workplaces."

The Texas woman who worked at Todd Greiner Farms said before she got sick with COVID-19 in June, she and others on the production lineswere pushed to work quickly as the end of asparagus season neared.

She said people were so tired that they forgot to take care of themselves.

"They forgot to notice the fatigue that this virus costs you. They thought they were just tired because of work. I think it was because we were already infected," she said.

Contact Angie Jackson: ajackson@freepress.com; 313-222-1850. Follow her on Twitter: @AngieJackson23

Contact Niraj Warikoo: nwarikoo@freepress.com or 313-223-4792. Twitter @nwarikoo

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In one Michigan county, almost half the COVID-19 cases are tied to farm outbreaks - Detroit Free Press

John Balentines tortured logic and excuse-making for the Trump administration is breathtaking, never more than in his Pandemic Peeves, part III (Sept. 11). His vilification of Dr. Anthony Fauci is undeserved and almost laughable.

Dr. Fauci is one of the worlds most respected infectious disease experts, having served the last six presidents in distinguished fashion and possessing six honorary doctorates. In denigrating Faucis work and nitpicking he had his mask off for a minute at a baseball game; President Trump never wears one Balentine is being small-minded. Fauci has had the courage to say when he was wrong on issues surrounding COVID-19. Trump never admits a mistake.

Balentine excoriates Faucis performance, yet has no problem with the president peddling bogus cures (Remember bleach and hydroxycholoroquine?) and not informing the public about the seriousness of the virus for months. He tells Bob Woodward one thing and the public another. Its all on tape. And, somehow, according to Trump, its Woodwards fault the public wasnt informed. Or as reporter Phil Rucker put it,But youre the president.

Balentine also has no problem with Trump ignoring the recommendations of his own CDC, having no plan to open schools safely, making fun of Joe Biden for wearing a mask and holding packed rallies with no social distancing and few masks. At his Nevada rally, most of the people within camera range were told to wear masks. Off camera, contrary to state regulations, there were no masks. Cute PR trick. Its on tape.

The presidents failures on COVID-19 have been monumental, yet Balentine sticks his head in the sand. He spends his time denigrating Dr. Fauci, the adult in the room.

Balentine says its amazing Trump still allows Fauci to be on the virus task force. In reality, it is amazing he has stayed. They call that taking one for the team.

Tom Lizotte

Biddeford

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Letter: President's failures on COVID-19 have been monumental - Press Herald