Category: Covid-19

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COVID-19 Daily Update 7-31-2020 – 5 PM – West Virginia Department of Health and Human Resources

August 3, 2020

The West Virginia Department of Health andHuman Resources (DHHR)reports as of 5:00 p.m., on July 31, 2020, there have been 283,848 totalconfirmatory laboratory results receivedfor COVID-19, with 6,642 total cases and 116 deaths.

Inalignment with updated definitions from the Centers for Disease Control andPrevention, the dashboard includes probable cases which are individuals that havesymptoms and either serologic (antibody) or epidemiologic (e.g., a link to aconfirmed case) evidence of disease, but no confirmatory test.

CASESPER COUNTY (Case confirmed by lab test/Probable case):Barbour (29/0), Berkeley (623/22), Boone (76/0), Braxton (8/0), Brooke(59/1), Cabell (306/9), Calhoun (6/0), Clay (17/0), Doddridge (4/0), Fayette(126/0), Gilmer (16/0), Grant (67/1), Greenbrier (85/0), Hampshire (73/0),Hancock (93/4), Hardy (53/1), Harrison (182/1), Jackson (157/0), Jefferson(283/5), Kanawha (785/13), Lewis (25/1), Lincoln (61/0), Logan (133/0), Marion(166/4), Marshall (122/2), Mason (45/0), McDowell (25/1), Mercer (138/0),Mineral (107/2), Mingo (119/2), Monongalia (880/16), Monroe (18/1), Morgan(25/1), Nicholas (30/1), Ohio (248/0), Pendleton (36/1), Pleasants (7/1),Pocahontas (40/1), Preston (99/23), Putnam (158/1), Raleigh (166/6), Randolph(204/3), Ritchie (3/0), Roane (14/0), Summers (6/0), Taylor (51/1), Tucker(9/0), Tyler (12/0), Upshur (36/2), Wayne (180/2), Webster (3/0), Wetzel(40/0), Wirt (6/0), Wood (222/11), Wyoming (20/0).

Ascase surveillance continues at the local health department level, it may revealthat those tested in a certain county may not be a resident of that county, oreven the state as an individual in question may have crossed the state borderto be tested. Suchis the case of Nicholas,Preston, Summers, and Wyoming counties in this report.

Please note that delays may be experiencedwith the reporting of information from the local health department to DHHR.

Please visit the dashboard at http://www.coronavirus.wv.gov for more detailed information.

Additionalreport:

Toincrease COVID-19 testing opportunities, the Governor's Office, the HerbertHenderson Office of Minority Affairs, WV Department of Health and HumanResources, WV National Guard, local health departments, and community partnerstoday provided free COVID-19 testing for residents in counties with highminority populations and evidence of COVID-19 transmission.

The testing resulted in 195 individuals tested in Gilmer County (first day oftwo-day testing event). Please note these are considered preliminary numbers.

Testing will be held tomorrow in Gilmer andMarion counties in these locations.

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COVID-19 Daily Update 7-31-2020 - 5 PM - West Virginia Department of Health and Human Resources

Indiana student tests positive for Covid-19 on first day of school – CNN

August 3, 2020

The Hancock County Health Department notified Greenfield-Central Junior High School Thursday afternoon that one of their students, who had attended part of the school day, tested positive for Covid-19, Superintendent Harold Olin said in a letter.

Olin said the school enacted its "Positive COVID-19 Test Protocol" once school officials became aware of the positive result.

School officials immediately isolated the student within the school's clinic, and they examined the student's schedule, including transportation and extracurricular activities, to determine who had come in close contact.

As part of the district's return to in-person learning, "all areas of all schools" are already being disinfected professionally each evening, according to Olin's letter. But the superintendent noted that special attention would be given to areas and classrooms that the infected student had visited.

"We understand that this information will cause concern for some of you. It was very evident today that nearly all of our families and students were prepared to properly follow the safety protocols we have established," Olin said. "Adhering to these protocols is essential for maintaining a safe environment for all students and staff."

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Indiana student tests positive for Covid-19 on first day of school - CNN

From The Brain Poke To The Mouth Swab: Which Test For COVID-19 Is The Most Accurate? – WBEZ

August 3, 2020

Sara Navin has gotten tested for COVID-19 three times now. And, each time, the process has been a surprisingly pleasant experience.

I just sign up on the citys free website where you dont need insurance or any symptoms to make an appointment, she said. Its really easy.

Part of that ease, Navin said, was the painless sample collection process. She simply sat in her car, coughed three times, swabbed her mouth for 20 seconds and then sealed the swab in a vial.

This was a relief since shed heard horror stories from friends about invasive sample collections called nasopharyngeal swabs that involved getting long plastic sticks jammed up their nose.

Most of the other people Ive talked to have gotten that [deep] nasal swab, she said, And so I was wondering why city of Chicago sites were doing the mouth swab and if there was any difference in the accuracy of those tests.

Weve heard similar questions from other Chicagoans who wonder why they were subjected to the uncomfortable nasopharyngeal swab (NPS) affectionately referred to as the brain poke while their friends got to administer their own mouth or nasal swabs. Many assumed the less invasive collection methods must not be as good, and they wanted to know why there was such a wide variety of methods instead of one standard.

We took these questions to doctors, researchers and health officials and learned that pandemic shortages have forced healthcare providers to use several collection methods in recent months.

But we also discovered some good news for people like Sara: Emerging research suggests that self-collected mouth and shallow nose swabs can be nearly as good, or better, than nasopharyngeal samples at detecting COVID-19. In fact, in late April, federal health authorities officially removed their preference for the use of NPS in COVID testing. And, beyond accuracy, the non-NPS methods offer some important advantages when it comes to ramping up testing to fight the virus.

Still, most microbiologists and pathologists we talked to maintain their preference for nasopharyngeal samples as a first choice.

The gold standard is the nasopharyngeal swab, said Karen Kaulk, chair of the pathology and laboratory medicine at NorthShore University Health System. The COVID virus, like other viruses including the flu, likes to live in the nasopharynx and so that is the best place to go.

This is why you still primarily see NPS collection at big hospitals such as Northwestern Medicine, Loyola University Medical Center and NorthShore University HealthSystem. But Kaulk said theyre all looking into alternatives because NPS has some major drawbacks right now.

In order to collect [using NPS] you need an appropriate supply chain of swabs which is one of the problems weve been dealing with, she said. And it also requires a bit more training than other collection methods.

An even bigger problem may be the danger to healthcare workers who have to wear PPE and change it often, because when you put a stick up peoples nose, they sneeze and cough, [creating] a risk of exposure there, Kaulk said.

On top of that, some patients swing their arms, swat away the swab or even accidentally hit healthcare workers as they involuntarily react to the brain poke.

So, in recent months, medical professionals have turned to alternate collection methods including throat swabs, shallower nasal swabs and mouth swabs.

At University of Chicago, we started collecting [samples] from the front of the nose rather than the back of the nose [using NPS], said Dr. Kathleen Beavis, the medical director of Microbiology and Immunology Laboratories at UChicago Medicine. We wanted to do that for a few reasons and one of them was comfort to the patient so now most specimens are collected that way at University of Chicago.

Beavis said front-of-the-nose samples (also called anterior nasal sampling) are proving just as accurate for them and they will soon move to allow patients to collect their own anterior samples that way.

The quality of those samples was also tested by researchers in a small study at Stanford led by Dr. Yvonne Maldonado. Researchers found that self administered nasal swabbing produced good and sometimes better results than NPS samples gathered by health workers.

But what about the mouth swab tests that Sara and hundreds of thousands of other Chicagoans have been taking at free city sites for more than two months?

Ann Wyllie, associate research scientist at the Yale School of Public Health, looked at results from 142 patients and discovered something surprising: Among her subjects, mouth swabbing performed as well and in two cases better than nasopharyngeal swabbing.

Two of her subjects had been asymptomatic healthcare workers infected with COVID-19. The mouth swab test detected the virus but the NPS test did not.

So that is when I thought, O.K. we might have something here, Wyllie said of the unexpected result.

Wyllies study is still in the pre-publication stages, but she said shes received encouraging feedback from peer reviewers and is gathering more data.

Weve updated the data set twice now and doubled the sample size and the findings are holding true, she said.

A microbiologist by training, Wyllie said she was drawn to the topic because her PhD research examined the accuracy of saliva sampling in detecting a strain of streptococcus infection. Knowing that this might make some think she has a pro-saliva bias, Wyllie enlisted the collaboration of 49 other Yale scientists on the study.

Currently, Wyllie is also working on a way to accelerate the process by skipping a step called RNA extraction where you pull out specific genetic material from the sample and go straight to testing the whole saliva sample. She and her colleagues recently submitted a protocol for that faster process to the US Food and Drug Administration for approval. And they have an unlikely collaborator on the project: professional basketball.

We are currently validating that method in partnership with the NBA to see how this also works for detecting [COVID-19] in asymptomatic individuals, she said.

This is good news for Fred Turner, the 25-year-old founder of Curative Inc., whose team developed the oral fluid mouth swab tests that are used by all of Chicagos city-run community sites, as well as municipal testing centers around the country. His company had been working on sepsis diagnostics when it turned its focus to COVID in March as the scope of the pandemic became clear. So, why focus on mouth fluids?

When we were evaluating different sampling methods back in March one of the key criteria was that the country would need to screen millions of people every day so it had to be scalable, the British native said. And when you look at nasopharyngeal swabs, they are hard to scale. So we looked for a self-collection method that was easy to self administer whilst still being accurate.

And that method was Curatives particular protocol for mouth swabbing, which Turner is quick to point out is unlike other mouth swab or saliva samples being tested across the nation.

Our method is an oral fluid swab test which means the individual first coughs three times, he said. The idea there is that the coughing releases virus in the lungs that gets caught in the saliva so that when you are swabbing the inside of your mouth and around your gums you are getting viral samples both from the lungs and upper respiratory tract as well as virus that would be in the saliva. So you are getting this two site sampling with a single swab.

This protocol impressed officials at the Chicago Department of Public Health for many reasons especially the self-collection aspect.

It limits the potential exposure to the person helping collect the specimen and it cuts down on the amount of PPE needed for the people staffing the sites, said Jennifer Layden, Chicagos chief medical officer. The other element is that it was essentially a self-contained kit which has the swab and the little vial all in one bag.

And, to supply the kit, Curative Inc. sources equipment outside of the strained supply chains used by other testing protocols.

This way we didnt have to compete with or tap into resources that our clinical partners are using, Layden said.

Curatives test received emergency use authorization from the FDA in mid-April, and by mid-May, Chicagos Department of Public Health had launched four sites using the protocol. Today, it also uses them in 50 mobile sites that travel around the city where needed, Layden said.

By mid-July, Layden said, the sites, staffed by workers from CORE (a community action nonprofit founded by the actor Sean Penn), had collected more than 46,000 tests. She said they will continue running the sites for the foreseeable future based on community need, which is reassessed regularly.

In some cities the Curative tests are billed to insurance, but in Chicago all tests are free to the patient. Layden said the city uses federal funds from the CARES act and the CDC to pay for the test but does not have exact figures on how much an average test costs.

Turner said his companys clinical trials have found their oral fluid collection method to be 90% accurate in detecting COVID-19. By contrast, he said, the same trials showed NPS to be accurate 79% of the time. His methodology is explained in Curatives emergency use authorization summary on the FDA site.

Microbiologists we talked to say they are impressed with the improving alternate technologies but that they still believe nasopharyngeal collection is the gold standard, even if it presents challenges at this time.

Just five months into the U.S pandemic, researchers are still working with relatively small data sets and say that different protocols and samples from patients at different levels of infectiousness are understandably showing slightly different outcomes.

But one of the largest studies, conducted by researchers at the University of Washington and United HealthGroup in Minnesota, found that three collection methods (front of nose, mid nose and tongue) all performed well against NPS, even when patients took the samples themselves. All three alternative methods detected the virus when NPS didnt in a small number of cases.

I think weve got lots of little pieces of the puzzle, and we are trying to make a clear picture out of something that is still pretty pixelated, said Amanda Harrington, director of the microbiology lab at Loyola University Medical Center. Its not like we have one standarized approach to compare against, and everyone is using a different tool so I dont know if I could compare my approach to my neighbors.

In the end, though, she thinks Sara doesnt have much to worry about.

If youre asking if we can use alternate collection devices and are they adequate to detect COVID, then by and large the answer is yes, Harrington said. The most important thing is for people to get tested.

(Note: Illinois free testing sites also use self-collected samples that patients collect from their nose. IDPH officials did respond to questions about how many tests they have done, who is currently staffing the sites or what their average turnaround time is for results.)

Sara Navin grew up in Evanston and now lives in Chicago. She recently earned her masters degree in public health and epidemiology and will start a research job at the University of Chicago this fall.

When she heard the answer to her questions about the citys mouth swab testing, she was encouraged.

Even though we dont have a ton of data, its good to know that there are at least some encouraging smaller studies, she said. I would feel secure going and getting tested there again.

She also thinks it makes sense that the citys testing program would turn to methods that use fewer resources and leave people with a better experience that they might recommend to friends.

Every time Ive gone, it has been really easy and a good experience, she said. One time it was even in a park where there was a taco truck and music and voter registration. I have definitely been talking it up to people.

When shes not working or studying, Sara said she likes to ride her bike and swim in the lake.

I cant wait for Chicago beaches to reopen again, she said. I feel like its way safer than indoor dining.

Until then, she will be enjoying bike rides around town sometimes even to COVID testing centers.

Monica Eng is the reporter for WBEZs Curious City. You can write to her at meng@wbez.org.

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From The Brain Poke To The Mouth Swab: Which Test For COVID-19 Is The Most Accurate? - WBEZ

Trump heads to his own golf club as Covid-19 surges and jobless benefits expire – The Guardian

August 3, 2020

Donald Trump prompted a familiar barrage of criticism on Saturday by visiting one of his own golf clubs as the country remains caught in numerous intensifying crises, from the raging coronavirus epidemic to anti-racism protests to the failure to extend benefits to tens of millions of jobless Americans.

Trump arrived at his Virginia golf club in the morning, according to a report from the White House pool, after leaving Washington via motorcade and dressed in his usual golfing attire of a baseball cap and a polo shirt.

CNN, which tallies Trump trips to his golf clubs, reported that the visit was Trumps 283th trip to a golf course while in office and his 376th day at a Trump property.

In the 2016 campaign, and before, Trump often lambasted then president Barack Obama for his visits to the golf course and claimed that he would be too busy to play the sport if he was president. Since taking office, Trumps visits to golf courses have far outpaced those of Obama.

Trumps latest visit comes as the death toll in the US from the coronavirus tops 153,000 with more than 4.5 million positive cases by far the largest totals in the world. It also happens as Washington fails to agree on an extension to a vital $600 weekly payment to jobless Americans who will now lose that benefit.

The visit triggered much online criticism, including from some anti-Trump Republicans.

Im glad hes playing golf. Id pay him to play golf for the rest of his Presidency. The country would be much safer and much better off if all he did was golf for the next 5-6 months, tweeted Joe Walsh, a former Republican congressman who ran a brief and unsuccessful bid to oust Trump as the partys nominee in the 2020 election.

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Trump heads to his own golf club as Covid-19 surges and jobless benefits expire - The Guardian

2020 Riverfest Re-Invents Due to COVID-19 – 9 & 10 News – 9&10 News

August 3, 2020

For the third year, the Grass River Natural Area is holding their Riverfest, but this year it will be held virtually.

Due to the coronavirus, they decided to keep it online to promote social distancing. It will be held on August 13.

Since March 13, the Grass River Natural Area has not been able to put on any of their programs, which increased the importance of still being able put on the festival.

They will be doing everything online, including an auction and a HappyHour.

There are many items up for auction that will run through September 3, at 11 pm.

You can enjoy the HappyHour for free or pay $60, where GRNA will deliver a package with food from Shanty Creek and drinks from Shorts.

For more information or to register, you can visit their website.

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2020 Riverfest Re-Invents Due to COVID-19 - 9 & 10 News - 9&10 News

Marlins forced to make roster moves during COVID-19 outbreak; here are the pitchers Miami has added – CBS Sports

August 3, 2020

The Miami Marlins have not played a game since last Sunday due to a team-wide COVID-19 outbreak that resulted in 18 players testing positive throughout the week. The Marlins have not had any positive tests over the last two days, however, and Major League Baseball set their return to the field for Tuesday vs. the Orioles. Marlins players who contracted COVID-19 will need two negative tests at least 24 hours apart before returning to action, so Miami's lineup and roster will look different on Tuesday in Baltimore than they did July 26 in Philadelphia.

While the exact parameters of Miami's outbreak are unknown, it seems that the Marlins' front office is in the process of rebuilding at least a segment of its roster -- in part because it has no choice. They made a trade early Saturday, acquiring left-handed reliever Richard Bleier from the Baltimore Orioles in exchange for a player to be named later.

Bleier is the fourth pitcher the Marlins have acquired through trade or waivers this week, joining Justin Shafer, Josh D. Smith, and Mike Morin. (Keep in mind, these pitchers have had little say in joining the team that, at least so far, has been hit the hardest by the pandemic.)

So what should the Marlins and their fans expect from the new additions? Here's a quick scouting report on some of the new Miami arms.

Richard Bleier, 33, has had the most success of anyone in the quartet. From 2016-18, he made 111 appearances and notched a 1.97 ERA. He's been limited to 55 appearances since the onset of the 2019 season, and hasn't been nearly as successful. Bleier doesn't throw hard and relies on generating soft groundball contact. He's coerced at least 55 percent grounders in each of his big-league seasons, according to Statcast.

Mike Morin, 29, has a career 87 ERA+ but continues to find work thanks to solid underlying numbers, including a 3.25 strikeout-to-walk ratio. Last season, that ratio had more to do with a lack of walks (1.8 per nine) instead of a ton of strikeouts (4.6 per nine). Morin pairs a low-90s fastball with a slow changeup that often arrives in the low-70s. Opponents hit .138 versus the parachute piece with an 84.4 mph exit velocity-against in 2019. Managing contact by keeping batters off-balance is the key to him remaining employable.

Josh D. Smith, 30, is in his second stint with the Marlins, having finished last season with the club following a waiver claim from Cleveland. (The Cincinnati Reds then claimed him off waivers in October.) Smith's fastball only averages 90 mph, but might be sneaky effective thanks to a spin rate that placed in the 99th percentile in 2019. He has a crossfire delivery and a low three-quarters/sidearm release point, suggesting he should be tough against left-handed hitters.

Justin Shafer, 28 come mid-September, has a 3.75 ERA (121 ERA+) in 40 career appearances. Pretty good, so why was he available on waivers? Because of his wild tendencies. Shafer has walked 32 batters in 48 innings, a rate that equals six per nine innings. To his credit, he's shown he can evade bats with a high-spin mid-90s fastball and a mid-80s slider.

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Marlins forced to make roster moves during COVID-19 outbreak; here are the pitchers Miami has added - CBS Sports

Phillies test negative again for COVID-19; Jake Arrieta slated to start Monday night in New York – The Philadelphia Inquirer

August 3, 2020

Those days were tough not being able to come to the field, Arrieta said. To be shut down again like that was tough for all of us. Its human nature to think, Why us? Or [to say], Poor Phillies, why did this happen? But once you have that initial thought and you get it out of your head, then its time to think about, OK, what do we need to do to stay as ready as we possibly can even though its difficult?

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Phillies test negative again for COVID-19; Jake Arrieta slated to start Monday night in New York - The Philadelphia Inquirer

Overcrowded Housing Invites Covid-19, Even in Silicon Valley – The New York Times

August 3, 2020

It was not surprising when three-quarters of the house tested positive. There were 12 people in three bedrooms, with a bathroom whose door frequently required a knock and a kitchen where dinnertime shifts extended from 5 p.m. well into the evening.

Karla Lorenzo, a Guatemalan immigrant who cleaned houses in San Francisco and Silicon Valley, lived in the big room along the driveway. Big is a relative term when a room has five people in it. She and her partner, Abel, slept in a queen-size bed along the wall. There was a crib for the baby at the foot, with the older childrens bunk bed next to that. The other housemates had similar layouts.

Living among many people, as Ms. Lorenzo put it in Spanish, you cannot really avoid your housemates. The sounds, the smells, the moods everyone is pressed against all of it, and they understood that if one of them got the coronavirus, the rest probably would.

That happened in April, and now the house is returning to health. Abel, referred to by his first name because his immigration status is uncertain, is home after three weeks in the hospital, where Ms. Lorenzo feared he would die alone gasping for air. And she is no longer squirreled in the closet where she spent days to avoid giving the virus to the children.

Now comes a second struggle: figuring out how to pay rent. Abel is back at work at a home supply store, but Ms. Lorenzos housecleaning jobs dried up and one of the other families moved out increasing the monthly bill by $850. We dont know how we are going to do it, she said.

From the early outbreaks to the economic destruction that has come after, the coronavirus pandemic has mapped itself onto Americas longstanding affordable housing problem and the gaping inequality that underlies it. To offset rising rents in a nation where one in four tenant households spend more than half of their pretax income on shelter, a multitude of low-wage service workers have piled into ever more crowded homes.

Living in overstuffed units subdivided by hinged partitions and tacked-up sheets, these households many of them retail and service workers who are unable to do their jobs from home were acutely susceptible to the viruss spread. With double-digit unemployment projected to persist through next year, the same families face losing the crowded homes that make it so easy to get sick in the first place.

To combat the virus, Americans of every income are being encouraged to wear masks and keep their distance. But for low-income families who crowd together to stretch their budgets, home has its own risks.

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For these families, a good amount of the response has included triaging a decades-old shortage of affordable housing. Cities and states are renting hotel rooms for people who normally sleep on the streets. There are trailers to quarantine those whose apartments are too crowded for isolation. Fearing a wave of homelessness, governments have followed up with rental aid and moratoriums on evictions.

Combined with federal stimulus funds, and $600 a week in supplemental unemployment benefits that have just lapsed, these measures have prevented the dire predictions of mass displacement. Congress is working on another emergency package, and property owners and affordable-housing advocates have pressed for direct rental assistance.

But evictions are already ramping back up, and the longer the economic malaise continues, the more housing insecurity there will be. Some of the evicted will become homeless, but if the past is a guide, most are likely to find somewhere else to go, and that somewhere is likely to be overcrowded compounding the conditions that make it so easy to spread the virus.

We have clients struggling to choose between living in an overcrowded home or facing eviction for not being able to make rent, said Nazanin Salehi, a lawyer with the nonprofit group Community Legal Services in East Palo Alto. No matter what they decide, the risk is more exposure to this virus.

Visitors to Silicon Valley may take a wrong turn or freeway exit on the way to this or that office park and find themselves in an area like the North Central neighborhood of San Mateo, Calif. That is where Ms. Lorenzo lives on a block of faded homes on small lots, with packed driveways and cars parked liberally on the sidewalk. The scene is one side of the tech economy.

For much of the peninsula stretching south from San Francisco, there is a rough economic split. Cities and neighborhoods to the east, places like East Palo Alto, North Fair Oaks and the Belle Haven section of Menlo Park, are more overcrowded and have a larger share of low-income and Black and Latino residents, many of whom have been disproportionately affected by the virus. Towns and neighborhoods to the west, places like Hillsborough and Palo Alto, are whiter and rich.

This geography is as fundamental to how the place operates as the invention of the microchip. Every day, throngs of clerks, landscapers and elder-care workers wake up on the eastern parts and travel to homes on the western parts or to the corporate campuses of tech companies to do subcontracting work. And every night, they return to overcrowded homes.

Ms. Lorenzo was one of them. She immigrated to the United States six years ago from Guatemala with her two children, fleeing a broken relationship and looking for a new start. Now she is a green-card holder with a new partner and a 2-year-old. Until the pandemic hit, she made about $16 an hour mopping floors and vacuuming carpets in homes on the other side of the peninsula.

For a while, her wages and Abels were enough for their own small place a $1,600-a-month studio that had a bed for them and a shared mattress for the children. Then the rent jumped to $2,100. And then to $2,650.

The couple went looking for cheaper housing and roommates, a quest that has become a Bay Area ritual. Since the Great Recession, a growing share of Bay Area movers, from all but the most well-off households, have gone to homes with four or more adults from ones with one or two adults, according to a study by researchers at Stanford University and the Federal Reserve Bank of San Francisco.

The high-end version is dressed up with a description like co-living or explained as a culturally in-tune couple sacrificing an extra bedroom in the suburbs for a life of less driving closer to the city. The low-end version is poverty. Whatever it is called, the economic calculus is the same.

Wages are higher in coastal California than in inland areas, where housing is cheaper, so all but the very rich have to make a trade-off between a commute and space. It is just that the choices for poorer workers are more extreme, like a three-hour commute from cities like Stockton or huddling together in homes where nearly every space is the site of someones bed.

Researchers define extreme overcrowding as any home that is occupied by more than one person for every room without a toilet. By this measurement, overcrowding has increased nationwide since the mid-2000s, and the problem is particularly acute in California. About 13.4 percent of rental units more than double the national average were considered overcrowded in 2018, according to the Census Bureau. San Mateo and Santa Clara Counties, which roughly outline Silicon Valley, have one of the worlds densest concentrations of billionaires as well as some of the countrys most overcrowded homes.

After the studio, Ms. Lorenzo found a $1,250-a-month room in her current home, a blue stucco house at the back of a two-unit lot, with chalk drawings on the driveway and a dirt yard in the back. There were 11 occupants after Ms. Lorenzo moved in, 12 after her younger child was born.

Dividing the rent had benefits, like allowing Ms. Lorenzo to save money and buy her first television. The childrens shared mattress from the studio was replaced with a new bunk bed. More clothes, more shoes for the children, she said, because we were limited in many things.

The catch was living with personalities, rules and understandings. Cooking privileges were on a first-come basis, which meant that the last family to use the kitchen might not eat until 9:30 p.m. There was no official time limit on the bathroom, but people knew to be fast. If anyone got a cold, everyone was exposed.

Crowded homes have been a concern practically as long as public health has been a field. Living with a pile of roommates has long been associated with faster-spreading infections, inescapable stress, irregular sleep and the effects that follow, including higher blood pressure and weakened immune systems.

But those take years to develop. The coronavirus spreads in days. By moving so fast and furiously, the virus has exposed in weeks something doctors have been worried about for generations, said Dr. Margot Kushel, an internist and director of the Benioff Homelessness and Housing Initiative at the University of California, San Francisco. Covid has really become a story of essential workers living in crowded housing, she said.

The sickness began, as it does, with worry.

In mid-April, after schools shut down and the children were sent home with worksheets, Abel returned from his job with a report that two of his co-workers had been out sick. He showered with the garden hose and slept in the car that night. But it was too late.

His symptoms were initially mild, before escalating to a 104-degree fever and a shortness of breath that prompted Ms. Lorenzo to take him to the hospital. The county health department, worried that a crowded home would accelerate the spread of what was confirmed to be the coronavirus, dispatched a case worker to test everyone in the house, Ms. Lorenzo said. Eight all except her children were also positive.

Ms. Lorenzo never got more than a headache and a sore throat, which in normal times would not have even prevented her from going to work. Suddenly she had to isolate herself in a house where everything was shared.

She settled on the closet, running a phone charger under the door and sitting there for six to eight hours a day, playing word games on her phone, calling relatives in Guatemala, sometimes just napping. Her 10-year-old son took over cooking meals and changing diapers. All the while, Abel was in the hospital. Improving or worsening, alive or dead, Ms. Lorenzo had no idea.

There was no communication with him, so my head was spinning, she said.

Ms. Lorenzo sprayed down the bathroom whenever she or the children used it. She avoided the kitchen and had her sister, who lives more than a half-hour away in Oakland, deliver food through the bedroom window. One time, the sister brought a thermos of hot coffee that Ms. Lorenzo said might as well have been hot water; the virus had so ruined her sense of taste that she could not tell the difference.

Still, the house got tense. One of the housemates accused Abel of infecting them. She told Ms. Lorenzo that if anyone in her family died, she would figure out a way to sue her. After that came the silent treatment no hablaba and as house relations plummeted, Ms. Lorenzo feared she would be evicted with nowhere to go.

After two weeks, a county health worker returned to test the house again. Ms. Lorenzos children were still negative, which seemed so unlikely, given the crowding, that the county retested them several times. All negative, she said. Worried that this luck would soon run out, the county moved her and the children to an emergency trailer.

They lived there for nine days, leaving only to collect stale salad and sandwiches left on an outdoor table. When they finally went home, Abel was back from the hospital.

Days of deep cleaning ensued. Ms. Lorenzo, back to health, is wondering when the world will return to some semblance of normality. Yet she feels lucky that things are not worse, because she thought her partner was going to die. We are trying to cope with it, she said. Trying to leave everything in the past.

Early in the outbreak, Gov. Andrew M. Cuomo of New York and some commentators blamed dense housing and public transit for the spread of the virus. The proof seemed as intuitive as New Yorks status as an early epicenter. The recent surge of cases in the more sprawling metropolitan areas of the South and the West has undercut that thesis, and a number of new studies suggest that density, the number of housing units per acre, is less important than crowding, the number of people per bedroom.

One widely cited report was from New York Universitys Furman Center, which found that infections were much more intense in Queens neighborhoods with high rates of overcrowding than in Manhattan neighborhoods with higher density but fewer people per unit. The link between crowding and transmission has since shown up in suburbs, rural America and Native American reservations. There is even some evidence that dense metropolitan counties, while suffering higher raw numbers of infections, have a lower death rate because it is easier to get to a hospital.

San Mateo County has been a bright spot, with a rate of about 700 coronavirus cases per 100,000, about half the rate of the state. Still, the countys cases have been concentrated in low-income households, with most coming lately from front-line workers who live in crowded multigenerational conditions, according to the county health officer.

In Chelsea, Mass., which had one of the nations worst outbreaks, there is a compelling suggestion that less-crowded quarters can help control the spread. Sleeved into the same blocks where buildings were overrun with infection are 375 subsidized apartments owned by The Neighborhood Developers, a housing nonprofit. The 968 tenants are mostly nonwhite, have the same mix of low-paid service jobs as their neighbors, and live in multistory buildings. But their units are subsidized and less crowded and so far, healthier.

The Neighborhood Developers has had eight reported cases of the coronavirus in Chelsea, or 826 per 100,000 people, about a tenth the rate of the surrounding community. Its not how many people you run into on the street but how many people you see when you come home, said Rafael Mares, executive director of The Neighborhood Developers.

The story is tempered by its rarity. The United States has a deficit of seven million apartments available to the lowest-income households, or an average of 36 available affordable units for every 100 extremely low-income families in search of one, according to the National Low Income Housing Coalition.

In April of last year, The Neighborhood Developers opened a five-story building with 34 apartments for homeless and low-income families. It received 3,598 applications.

Stacked against a wall in Ms. Lorenzos living room are three red-and-white coolers that her sister used to fill with ice cream to sell on the street. They are furloughed because of the lack of demand and have become just another obstacle that her cooped-up children have to dodge while zipping around the house.

Abel still gets headaches and a tremor in his left arm, but the virus is gone and he is well enough to work. Ms. Lorenzo has not cleaned a house since March but recently got a new job cleaning offices. The family has also been relying on nonprofit organizations and Christian charities for staples.

Once a week Ms. Lorenzo joins the procession of cars that roll through a parking-lot food bank set up by Samaritan House, a San Mateo-based organization that has seen demand for food double and is spending $200,000 a week on rental assistance. Since April 1, 4,000 families have applied for some $8 million in assistance on rent and utilities and it hasnt even really hit yet, said Bart Charlow, Samaritan Houses chief executive.

Ms. Lorenzos name could soon be on the list. In June, the departure of the angry housemates opened up an extra bedroom, and her family spread out, with the older children moving across the hall the sort of arrangement that the San Mateo County Health Department has been recommending for years, except that it is financially unsustainable.

After taking the extra bedroom, Ms. Lorenzos familys share of the rent jumped to $2,100 from $1,250. Their savings got them through July. Now that money is gone, and August is here.

Liliana Michelena and Ben Casselman contributed reporting.

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Overcrowded Housing Invites Covid-19, Even in Silicon Valley - The New York Times

What We Know: COVID-19 Clusters at South Bay Costco Locations – NBC Bay Area

July 31, 2020

Santa Clara County on Thursday confirmed COVID-19 clusters among employees at four Costco locations across the county.

Below is a breakdown of the clusters, as provided by the county.

The county said Costco has been "very cooperative" with its investigation and both are working closely to ensure the safety of customers and employees.

Preliminary investigation results indicate that "many of the cases" have been a result of community transmission and "most likely" not due to internal transmission among the workers, the county said. The investigation, to this point, also indicates that Costco is complying with social distancing guidelines and other protocols.

"Because of the investigation so far, we have not closed any of those stores," Santa Clara County COVID-19 Testing Officer Dr. Marty Fenstersheib said. "We feel like they are following guidelines. We feel that the public is totally safe in continuing to shop at Costco."

An employee, who asked not to be identified said workers want more protection.

"They dont understand that you have pregnant employees. You have employees with young kids. Employees that go home to grandparents, elderly parents, and everybody is at risk," they said.

All Costco customers and the general public are reminded to continue to wear face coverings and practice social distancing.

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What We Know: COVID-19 Clusters at South Bay Costco Locations - NBC Bay Area

State reports death of Anchorage resident with COVID-19 and nearly 2500 active cases – Anchorage Daily News

July 31, 2020

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A resident of Anchorage is the 23rd Alaskan with COVID-19 to die since the pandemic began, the state reported Tuesday as virus cases continue to surge around the state.

The person who died was a man in his 60s with a history of underlying medical issues, according to Elizabeth Manning, a communications manager with the state health department.

Alaska on Tuesday reported 84 new cases among Alaskans and 36 cases among nonresidents, leading to an overall total of 2,489 active cases statewide as of Thursday.

Current hospitalizations of people with COVID-19 increased by three from the previous day to 37, new numbers on the states COVID-19 dashboard showed, and another eight hospital patients are under investigation for COVID-19. Three people with either confirmed or cases under investigation were on ventilators statewide.

In a call with reporters on Thursday, state health officials urged people who show symptoms and are waiting for a test result to isolate at home. And those who test positive for the illness should isolate until theyre better and have been cleared by public health workers.

If a person spends 15 minutes or more with someone else who ends up testing positive including the two days before someone shows symptoms or tests positive they must quarantine for two weeks, and a testing strategy cant shorten that, Dr. Anne Zink, the states chief medical officer, said during the call.

We really need people to minimize the risk of transmission during that time, Zink said.

New cases reported by the state Thursday include 42 residents of Anchorage, which also tallied one new nonresident case, and one Eagle River resident. In the Matanuska-Susitna Borough, Wasilla saw seven resident cases and one nonresident case, and four Palmer residents and two Big Lake residents also tested positive.

Six Fairbanks residents and two nonresidents tested positive, as did a resident of a smaller community within the Fairbanks North Star Borough.

In the Kenai Peninsula Borough, Seward saw 23 nonresident cases while Soldotna had four new cases among residents plus one involving a nonresident, and one Kenai resident tested positive.

In the Northwest Arctic Borough, two people from Kotzebue and seven people from smaller communities tested positive, state data showed.

In Juneau, two residents and four nonresidents tested positive. The state also reported one case each among residents of Kodiak, Craig, Utqiagvik, Unalaska and smaller communities in the Bethel Census Area and the combined Yakutat and Hoonah-Angoon region.

There were also four cases among nonresidents in unknown areas, state data showed.

[Because of a high volume of comments requiring moderation, we are temporarily disabling comments on many of our articles so editors can focus on the coronavirus crisis and other coverage. We invite you to write a letter to the editor or reach out directly if youd like to communicate with us about a particular article. Thanks.]

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State reports death of Anchorage resident with COVID-19 and nearly 2500 active cases - Anchorage Daily News

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