Category: Covid-19

As the coronavirus pandemic continues to surge in parts of the US, some companies have moved forward with plans to let their employees re-enter the office after months of working from home.

In the absence of federal guidelines around best practices, office managers will likely need to rely on an abundance of caution. This may turn offices into ghost towns of their former selves, with gatherings by the water cooler, big meetings, and buzzing shared spaces disappearing for the foreseeable future.

If your office decides to move forward with reopening, you may start to hear the phrase de-densifying in conversations about how to do so safely. The term, which many schools have used when laying out plans for reopening in the fall, refers to restricting the number of people who have access to a given space at any one time, in order to ensure social distancing.

For offices, that could mean phased re-openings. It is important to note that not all employees will return to a location at the same time, said JPMorgan Chase in a May memo to employees, obtained by the Guardian. It will happen in waves over a period of time, with business leaders prioritizing who returns when.

It could also mean major changes to the physical layout of your office. The 100-person tech firm Submittable reports experimenting with different seating arrangements to avoid clustered workspaces. It is also planning staggered workdays, with teams rotating between designated days in the office.

With health officials predicting another wave of the virus in the fall, this staggered standard will likely continue over the next six to twelve months.

While big office meetings may not officially be a thing of the past yet, theyre most certainly arent a thing of the immediate future, said Asta So, Head of People at Submittable. We may have smaller groups in large meeting rooms, while everyones wearing a face mask. The virtual meetings and social gatherings that have developed over the last two months will likely remain the norm.

Stations for personal protective equipment, like hand sanitizer, masks and gloves, will be new permanent fixtures in offices, placed at entrances, exits and other strategic locations. Forward-thinking businesses may have stations for you to recycle your masks and gloves as well. Branded, individual back-to-work safety kits will now be as common as zip drives and pens: companies like iPromo, a Chicago-based bulk supplier, have been selling personal kits to offices by the thousands. Some of these include sanitizer, masks, gloves, tissues, soap, a stylus pen for use on high-touch surfaces like printers and elevator buttons, and brass antimicrobial hook-style keys that can open door handles.

Even though we now believe the virus is not as easily transmitted via contact with contaminated surfaces, workers will likely need to get into the habit of wiping down their desk and other office supplies. Most janitorial services cant keep up with the now-constant disinfectant requirements of things like elevator buttons and faucet buttons.

We might add wiping high-touch surfaces to office task lists, So said. And well be asking employees to make choices that avoid touching potentially contaminated surfaces, like taking the stairs instead of the elevator.

No-touch infrared thermometers have already been spotted in certain businesses, including airports and restaurants. Even though experts have said these tools have limitations for curbing the spread of Covid-19, including reporting false positives and user error, workers can still expect these to make more frequent appearances in the office.

The state of Connecticut, for example, announced in May that it would distribute 50,000 infrared thermometers to small businesses and non-profits. Some businesses may even spring for a body thermal scanner at office entrances, like Amazon has done at its warehouses. High-tech fever detectors are coming, said Friedman.

A recent survey of employers conducted by Willis Towers Watson found that almost half of companies surveyed (47%) are enhancing health care benefits for employees in the face of Covid-19. Forty-five percent of respondents reported expanding wellbeing coverage, and 33% reported planning changes to paid time off policies. While coverage of Covid-19 treatment for employees isnt federally mandated, new legislation, effective 18 March, required group health plans to cover testing and related services without cost sharing.

At the same time, experts predict that health insurance premiums for employers will rise in 2021 anywhere from 4% to 40%, based on recent filings from health insurance companies with the District of Columbias Department of Insurance, Securities and Banking. A report from Covered California predicted employers no longer being able to offer affordable coverage, or dramatically shifting costs to employees.

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The future of workplaces: how Covid-19 will transform office life - The Guardian

New York City had its first 24-hour period since March without a death from the coronavirus on Saturday. Here, people dine outdoors on July Fourth in Manhattan's Little Italy. Byron Smith/Getty Images hide caption

New York City had its first 24-hour period since March without a death from the coronavirus on Saturday. Here, people dine outdoors on July Fourth in Manhattan's Little Italy.

For the first time in months, there was a 24-hour period in which no one in New York City died of the coronavirus.

The New York City Department of Health and Mental Hygiene reported zero deaths on Saturday, but that number could change as death data can lag and new deaths could be confirmed retroactively at any point. The city's first confirmed coronavirus death was March 11.

Mayor Bill de Blasio called the milestone a statement about "how this city fights back and people do not ever give in."

"It's something that should make us hopeful, but it's very hard to take a victory lap because we know we have so much more ahead. This disease is far from beaten," de Blasio said during a news conference Monday. "And we look around the country and we look at what so many other Americans are going through and so many other states and cities hurting so bad right now. So no one can celebrate, but we can at least take a moment to appreciate that every one of you did so much to get us to this point."

New York City has had 18,708 confirmed deaths due to COVID-19 as well as 4,615 probable deaths.

"Twenty-four hours where no one died," the mayor said. "Let's have many more days like that."

De Blasio also called upon President Trump to invoke the Defense Production Act to speed up the processing of coronavirus tests:

"Mr. President, all you have to do is say, 'I am now invoking the Defense Production Act to expand lab capacity in the United States of America, to make sure we have everything we need to get tests to people quickly.' You can do that with the stroke of a pen. We need it not only here in New York; we need it all over this country."

Trump previously invoked the act in March to boost production of masks and ventilators.

"The federal government has to step up now, because now it's becoming a national crisis," the mayor said. "We used to have almost no testing. Now we have more testing, but if you can't get the results in real time, it doesn't help you enough."

Amid the huge reduction of coronavirus cases in the city, there is one worrying trend: a rising infection rate among young adults, particularly 20- to 29-year-olds.

"I understand for so many younger adults it has been a really difficult time cooped up, disconnected, away from loved ones," de Blasio said. "I understand that people are just yearning to break out of that, but we've got to keep telling everyone, particularly our younger adults, how important it is to stick to what has worked: the social distancing, the face coverings, getting tested."

The city plans to expand its outreach to young people through social media influencers, mask giveaways and mobile testing vans. There will also be 10 new free, walk-up testing sites in the Bronx, Brooklyn and Queens.

As more people return to work indoors and go back to using the subways, de Blasio urged New Yorkers to wear face coverings whenever they are indoors outside their homes, even if other people aren't in close proximity.

On Monday, the city reported a 2% positivity rating for coronavirus testing. Fifty-six patients were admitted to the hospital, and 279 patients were in intensive care units.

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NYC Has Its First Day In Months With No COVID-19 Deaths - NPR

Theres no point in sugar-coating this. The U.S. response to the Covid-19 pandemic is a raging dumpster fire.

Where a number of countries in Asia and Europe have managed to dampen spread of the SARS-CoV-2 virus to the point where they can consider returning to a semblance of normalcy friends from Paris just emailed me pictures from their Sicilian vacation many international borders remain closed to Americans.

On Sunday, Florida reported more than 15,000 cases in a single day. South Korea hasnt registered 15,000 cases in the entire pandemic to date. One day last week the U.S. recorded more than 68,000 cases.

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The website Covidexitstrategy.org has updated its previously tri-colored U.S. map, which showed states as either green, signifying they are trending better; yellow, making progress; or red, trending poorly. A fourth designation, called bruised red, signals states with uncontrolled spread; criteria for this category includes hospitals nearing capacity both in terms of overall beds and ICU space. Already 17 states are wearing bruised red.

The virus suppression gains earned through the painful societal shutdowns of March, April, and May the flattened epidemiological curves have been squandered in many parts of the country, dejected public health experts agree. A vaccine for the masses is still months away. What can be done?

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One thing is clear, according to public health experts: Widespread returns to lockdown must be a last resort and may not be doable.

It would be really a morale breaker, Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told STAT. The stress and strain that people were under during prolonged lockdown is the genesis of why, when they were given the opportunity to try and open up, they rebounded so abruptly. Because what I think happened is, they overshot.

But this is not a binary choice between societal lockdowns and the party like its 2019 approach that put the country in the bind its in now. With that in mind, STAT asked a number of public health experts for a single suggestion of how we get ourselves out of this mess. We got lots.

None is a magic bullet. This is going to be a painful and slow process. But there are things individuals, public health departments, state and local governments, and the Trump administration can do.

The fire brigade needs us all.

Pent-up people embraced newfound freedoms over-exuberantly, Fauci said. He suggests going back to Phase 1 of the reopening process and then working forward with more caution. Do it the way they should have done it in the beginning, he said.

If we do that, particularly closing the bars, avoiding anything that has a congregation of a large number of people, wearing masks outside essentially all the time, keep distancing I would almost guarantee that we would see a turnaround of the resurgence that were seeing now.

Ashish Jha, director of Harvards Global Health Institute, favors banning all indoor public activities that bring together groups of people, for now including church services.

My best read of the data is that a large chunk of the transmission is happening when people gather indoors. So, cut out the indoors. No restaurants, no bars, no nightclubs, obviously no schools right now, Jha said.

Hed close stores, except pharmacies and grocery stores, and require those to limit the number of people they admit at any one time. Staff and customers would have to wear face coverings.

Saskia Popescu, an infection prevention epidemiologist at the University of Arizona, thinks advice like this needs to be pragmatic and take into account that conditions vary across the country. Like where she lives, in sweltering Phoenix.

Everyone likes to say eat outside! she notes. You cant do that in 115 F heat, so lets give people the tools to apply infection prevention strategies for these environments.

Social responsibility is huge, but if we dont do effective risk communication and education, youre failing people, Popescu said.

Marm Kilpatrick listens to a lot of NPR. On NPR, he hears a lot of public service announcements from the Centers for Disease Control and Prevention urging people to cover their coughs, wash their hands, practice social distancing. Kilpatrick, an infectious diseases dynamics researcher at the University of California, Santa Cruz, thinks most of that advice is, by now, not useful.

People should be wearing masks, so by definition coughs are covered. (Plus, people who are coughing should be staying home.) Fomites viruses coughed onto surfaces are no longer thought to be major mode of transmission. And people dont really get how to social distance except avoid strangers, he said.

They need better, more useful messages telling them how to do the things they want to do, but safely. Kilpatrick gives it a go: Wear a mask. Meet outside. Give space.

One thing I notice is that when people ask me a question, they say yet. Can I do this yet? said Amesh Adalja, an expert on emerging infectious disease and pandemic preparedness at Johns Hopkins. And I say, There is no yet.

He suggests borrowing a page from the harm reduction work that has been done to address sexually transmitted diseases and the opioid epidemic helping people figure out the risks they face and how to navigate them.

We have to get better at individual risk calculus, Adalja said. Its not something that people are very good at. And I think thats why when bars opened in certain places it was like the whole town turned 21.

We need to learn to live with SARS-CoV-2, said Michael Osterholm, director of the University of Minnesotas Center for Infectious Diseases Research and Policy.

Pretending the virus is not a threat or trying to will it away is a recipe for disaster. You have less chance of winning a policy debate against this virus than you do of winning a debate against 2,000 angry 2-year-olds, Osterholm said.

People have to understand that. Its like trying to defy gravity. Just because you want to doesnt mean you can.

Public health is amassing lots of information about who is getting sick and where theyre getting infected. That data should be put to better use, said Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security.

We can use that information to better direct resources and interventions, for example by closing high-risk activities rather than broad shutdowns, Rivers said. These kinds of analyses will need to be ongoing, because conditions will change, and should be made public to help people assess their personal risks and guide their decision-making.

Data mining could be used to develop local forecasting services, said William Hanage, an epidemiologist at Harvards T.H. Chan School of Public Health.

He envisages something like: Covid activity in your area is currently low. While the risk is not zero, all you need to do is wear a mask while indoors in a public space, or Covid activity is expected to be very high and you are advised to shelter in place. Please avoid contact with at-risk persons.

Enough with the but the flu and its getting better and its going to go away on its own talk. There needs to be consistent communications from all levels of government about the risk the virus poses, said Alessandro Vespignani, director of the Network Science Institute at Northeastern University.

I know it sounds trivial, Vespignani said, but I have the feeling that is impossible to win the fight if a large fraction of the population is not believing there is something to fight.

With more than six months worth of experience with Covid-19, the world has good evidence about what works to suppress spread of the virus. All levels of government should be urging people to take those steps, said Tom Inglesby, director of the Center for Health Security at Johns Hopkins.

If leaders from this point forwardspoke with the same messages, consistently, clearly, without division,they likelyhave the power to changetheviews of many who have been less convinced of the right things to do because of conflicting, confusing messages they have been hearing, he said.

Leaders should also practice what they preach masks in public, avoiding large gatherings and be guided by science, Inglesby said.

Black, Latinx, and Native American communities have been disproportionately hard hit by this pandemic, said Richard Besser, president and CEO of the Robert Wood Johnson Foundation. And too little has been done to ensure that essential workers, many in low-paying jobs, have the tools to protect their health and the health of their families and communities.

Fixing this means providing income support so people who are sick or exposed can stay home, and ensuring they have sick leave and family medical leave. It also means funding unemployment insurance for the millions of people who have lost their jobs in the pandemic, and extending rent forgiveness and moratoriums on evictions and foreclosures, Besser said, as well as providing safe places for people who need to isolate or quarantine but dont have the space to do it at home.

Natalie Dean said more geographically focused testing would turn up cases that are being missed. And bringing the tests to where the people are would result in a lot more people being tested. Dean, an assistant professor of biostatistics at the University of Florida, said more mobile testing vans could help identify where transmission is happening. Thats a different approach than the efforts to find and quarantine people who have been contacts of confirmed cases.

So, it is less about using tracing to reconstruct a chain, and more about identifying a hot spot and trying to flood the area with tests, she said.

Low-cost $1 a day or less home testing for Covid-19 is doable, said Michael Mina, a Harvard epidemiologist and associate medical director of clinical microbiology at Bostons Brigham and Womens Hospital.

The tests exist. The technology exists. They could be manufactured tomorrow and they would detect people on the days that they are most likely to be transmitting, Mina said.

These tests arent as sensitive as laboratory tests they miss some cases but they have the advantage of giving an instant answer. The turnaround for lab testing can be a week. If everyone in a high transmission zone could test themselves daily and stay home while they test positive, it would dramatically lower transmission, he said, arguing the government should pay for these tests.

Too few states have the capacity to do effective contact tracing, says Crystal Watson, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

We need this capacity now and we will need it in the fall, said Watson, alluding to the fact that Covid-19 and influenza will be co-circulating as we get into the autumn and winter. The White House should embrace a national initiative for contact tracing, and Congress should provide additional funding for state and local public health authorities to expand contact tracing capacity.

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How to fix the Covid-19 dumpster fire in the US - STAT - STAT

PHILADELPHIA (CBS) The Pennsylvania Department of Health says the spike in COVID-19 cases is mainly related to younger people traveling and socializing. The spike prompted the department to send out an emergency warning.

COVID-19 infections are going up in Pennsylvania because of a significant increase in cases among younger people.

The concerning new trend prompted the Department of Health to send out alerts over the weekend.

The alert, titled Changing Epidemiology of COVID-19 Case Demographics, was sent to health care providers over the weekend.

The new trend is a significant increase in cases among younger people, mainly between the ages of 19 to 24.

Driven by scenes like this from Allegheny County, which includes Pittsburgh, where people are crowded together and not following safety precautions.

(credit: CBS3)

Statewide, we have been seeing increases in the number of new cases of COVID-19 in Pennsylvania, Pennsylvania Health Secretary Dr. Rachel Levine said.

Nearly half of the positive cases in the state are in people under 50 years old which could trigger more infections and deaths among the elderly again.

At the start of the pandemic we saw a higher number of cases, right at the beginning, in people ages 19 to 49 before it spread to seniors age 65 and older, said Dr. Levine.

The state health alert said the increased cases among young adults is associated with social gatherings at parties, restaurants and bars, plus travel to other affected parts of the country.

Were concerned of course about that rapid increases that we have seen in those other states, were concerned about traveling and were concerned that one state will lead to next continuous state and head north and head east, Dr. Levine said. So those are all things that we watch really carefully.

New research also shows one-third of young people may be at risk of getting seriously sick, even dying from COVID-19, if they smoke or vape. Smoking, which has recently increased among young adults, was the most common risk factor for severe complications.

There are now more than 95,000 cases of coronavirus in Pennsylvania. The state has expanded its travel advisory list to include people traveling from Delaware who are being advised to self-quarantine for two weeks.

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Pennsylvania Department Of Health Issues Emergency Warning After Spike In COVID-19 Cases Related To Young People Traveling, Socializing - CBS Philly

Thanks to the COVID-19 pandemic, the House of Representatives has been, since mid-March, trying to adapt to new ways of doing businessincluding the efforts by committees to oversee actions by the Trump administration. Weve been tracking oversight activity during this periodboth related to the pandemic itself and beyondusing the Brookings House Oversight Tracker, and heres what weve learned.

1. Many committees are involved in COVID-19-related oversight.

COVID-19 has greatly increased both the supply of and demand for oversight activity within the House Democratic caucus.

Unlike the impeachment inquiry, where six committees were given specific investigatory powers and the lions share of the work was done by two (Intelligence and Judiciary), COVID-19 investigations have been less coordinated. The Select Subcommittee on the Coronavirus Crisis, a creation of the CARES Act that was meant to play a central role in the House oversight efforts, was slow to start investigations.[1] While the subcommittees investigative work has since increased, the Democratic members also hold the gavels of separate committees or subcommittees, and many are continuing to pursue COVID-19-related investigations within their own jurisdictions.[2]

Demand for oversight activity is also high with members seeking opportunities to demonstrate to their constituents that they have taken deliberate action to combat the damaging effects of the virus. As of July 2, 34 committees and subcommittees had held an oversight hearing or sent an investigative letter on a topic related to COVID-19. The impressive number of committees participating in oversight activity can also be attributed to the wide scope of issues encompassed by the crisis.

2. Committees are continuing preexisting oversight investigations but using COVID-19 to frame requests.

House committees are also exploring the implications of COVID-19 for policy areas in which they were engaging in oversight before the pandemic. The Judiciary Committee, for example, has increased its scrutiny of the administrations family separation policy, arguing that the administration is exploiting the crisis to pursue unlawful and inhumane immigration policies. In a separate letter, the Committee also scrutinized the preparedness of detention sites for coronavirus outbreaks and their general sanitation. Similarly, the Committees on Homeland Security, Natural Resources, and Oversight and Reform have all sought answers from the Federal Emergency Management Agency on its preparation for a threatening hurricane season. In their letters, the committees use COVID-19 as a reason to follow up on previous investigations into disaster preparedness.

3. Fewer hearings may be pushing rank-and-file House members, and Democratic Senators, to sign more letters.

Since March 13, the House has held 26 oversight hearings, a 76% reduction from the comparable period last year. As opportunities to participate in hearings have declined, rank-and-file members appear to be increasing their engagement with oversight letters in response. Although these additional signatures are not legally significant, they provide members with a way to signal their positions on issues. Prior to March 13, 2020, when representatives largely vacated the Hill over coronavirus concerns, 19% of oversight letters included signatures from members other than the relevant committee or subcommittee chair. Since that date, however, 29% of oversight letters have been signed by at least one rank-and-file member, and the average number of additional signatures per letter more than doubled from 1.29 to 2.63.

With Senate oversight at its weakest point in the last twelve years by one measure, senators have increased engagement with the House oversight letter process. The average number of Senators signatures on House oversight letters has jumped by 50% to 0.21 from 0.14 during the same time period last year. A May 27 letter from the Committee on Natural Resources to the FEMA Administrator regarding the preparedness of U.S. territories for both the hurricane season and coronavirus infections, for example, garnered 41 non-chair signatories, including 14 senators.

4. Letters are making fewer oversight requests.

Since vacating Capitol Hill in mid-March, committees have been more likely to send letters urging a change in administration policy, such as expanding authorities under the Defense Production Act for medical supplies, as opposed to making an oversight request.

Since March 13, only 51% of all letters sent by House committees involved oversight requests compared to 64% of letters prior to that date. Of letters addressed to executive branch officials specifically, that share only dropped slightly from 73% to 71%. While there are several potential explanations for this change, one involves legislators shifting their strategy for influencing the executive branch in a time of fewer hearings and less legislating.

With the House likely to continue a significant amount of remote operations in the coming months and emerging pressure to investigate issues like structural racism in police departments on the agenda, members will have to continue to adaptas they have so farto the realities of the COVID-19 pandemic.

[1] The Select Subcommittee had only launched two formal oversight investigations as of June 19th into COVID-19 deaths in Nursing Homes and the Disbursement of PPP funds.

[2] Chairwoman Maxine Waters (Committee on Financial Services), Chairwoman Carolyn (Committee on Oversight and Reform), Chairwoman Nydia Velazquez (Committee on Small Business) and Chairman Jamie Raskin (Committee on Oversight and Reform, Subcommittee on Civil Rights and Civil Liberties) have all overseen COVID-19 related oversight actions within their own committees.

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How is COVID-19 affecting House oversight efforts? - Brookings Institution

The COVID-19 coronavirus crisis has wrought economic disruption on a monumental scale, contributing to a dangerous and volatile global upheaval politically, socially and geopolitically while raising deep concerns about the environment and the extending reach of technology into our lives.

World Economic Forum Founder and Executive Chairman Klaus Schwab and Thierry Malleret, Co-Founder of Monthly Barometer, explore these themes in their new book, COVID-19: The Great Reset.

The books main objective is to help us understand whats coming: it has three main chapters, offering a panoramic overview of the future landscape. The first assesses what the impact of the pandemic will be on five key macro categories: the economic, societal, geopolitical, environmental and technological factors. The second considers the effects in micro terms, on specific industries and companies. The third hypothesizes about the nature of the possible consequences at the individual level.

Last month, the World Economic Forum launched the Great Reset initiative: a commitment to jointly and urgently build the foundations of our economic and social system for a fairer, sustainable and more resilient post-COVID future. Find out more here.

Tune in at 14:00 CET later today to join in a virtual briefing about COVID-19: The Great Reset.

Professor Klaus Schwab, Founder and Executive Chairman, World Economic Forum

Dr. Thierry Malleret, Co-Founder, Monthly Barometer

Saadia Zahidi, Managing Director, World Economic Forum

Adrian Monck, Managing Director, World Economic Forum

The book can be ordered here, and you can leave a review here.

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COVID-19: The Great Reset - World Economic Forum

Oregon Gov. Kate Brown announced a statewide ban on indoor dining at bars and restaurants at a press conference in Portland on March 16. Nearly four months later, with COVID-19 cases on the rise after a phased-in economic reopening, she announced new restrictions including a 10-person limit on social gatherings. Gillian Flaccus/AP hide caption

Oregon Gov. Kate Brown announced a statewide ban on indoor dining at bars and restaurants at a press conference in Portland on March 16. Nearly four months later, with COVID-19 cases on the rise after a phased-in economic reopening, she announced new restrictions including a 10-person limit on social gatherings.

As coronavirus cases continue to climb in the U.S., two governors on opposite sides of the country took a similar step on Monday: reducing the number of people allowed at social gatherings, among other restrictions.

Oregon Gov. Kate Brown announced that indoor social get-togethers of more than 10 people will be prohibited starting Wednesday.

Gatherings of up to 25 people were allowed in Phase One of the state's reopening plan, and indoor limits increased to 50 for counties that reached Phase Two.

Brown also extended the statewide face covering requirement, which took effect earlier this month, to outdoor public spaces where six feet of distance cannot be maintained.

Oregon recorded 332 new cases on Sunday, bringing its cumulative total to 12,170. Brown said on Monday the state reported more cases in the past week than the entire month of May.

"Today we are sounding the alarm because we are at risk of letting the virus spiral out of control," she said. "The question now is whether Oregon will be the next New York or the next Texas."

In West Virginia, Gov. Jim Justice imposed several new statewide restrictions, including reducing the social gathering limit from 100 to 25 people, effective Tuesday. The same executive order also closes all fairs, festivals and similar events, and prohibits both indoor and outdoor concerts.

Justice also ordered all bars closed for ten days in Monongalia County, which has seen a significant uptick in infections and had 340 active cases as of Monday.

"We want everyone to know this is not playtime stuff," Justice told viewers at a daily briefing. "We now, in West Virginia, have 1,338 active cases. We have grown 206 active cases since I saw you the last time on Friday."

Governors in both states stressed that the new limits apply only to social gatherings.

Justice said the new order does not cover any activity, business or entity designated as essential, such as religious services or group conferences. Attendees of such events must practice social distancing based on Centers for Disease Control and Prevention recommendations, he said.

And Brown said Oregon's new rule would not change the operation of businesses or churches "at this time." She added failure to comply will lead to more outbreaks, as well as more restrictive closures.

"We need to do absolutely everything we can to reduce transmission in ways that do not require us to close down businesses again," Brown said. "The proof here will be in the numbers. Either people will adhere to this requirement and be a positive force for stopping COVID-19, or I will be forced to take more restrictive measures."

Governors across the country are reimposing certain restrictions to combat the spread of the virus, though few have officially rolled back limits on social gatherings.

Many of the latest measures have been aimed at bars and other indoor establishments.

On Monday, California Gov. Gavin Newsom announced the statewide closure of all bars and indoor operations of several types of businesses. Texas Gov. Greg Abbott closed bars and tightened business restrictions in June, and Florida Gov. Ron DeSantis also previously ordered bars to close. South Carolina Gov. Henry McMaster imposed an 11 p.m. curfew on bars and restaurants last week.

Excerpt from:

Oregon And West Virginia Will Shrink Social Gatherings To Combat COVID-19 - NPR

Eight hundred fifty. Thats the number of major procedures general surgery residents need to perform before graduating from residency.

As Covid-19 continues to spread across the United States, this requirement and those of other residencies become more difficult to achieve.

In mid-March, as the pandemic loomed in the U.S., the Accredited Council for Graduate Medical Education the organization responsible for setting minimum case requirements for residencies announced it would allow hospitals to redeploy residents to other specialties and suspend educational requirements for residency training programs.

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As a yearlong patchwork pandemic becomes reality, with hot spots popping up across the country, more residents will leave the curricula of their chosen specialty education to become Covid-19 physicians. For residents in disciplines like general surgery, that could mean not meeting minimum case requirements. And that could mean not being able to competently perform some common procedures. In other words, inadequately trained doctors.

From March 2 to April 12, at the peak of the pandemic in New York state, 75% of residency programs in the New York metropolitan area deployed residents to Covid-19 units. Residents in specialties like dermatology, plastic surgery, and psychiatry were plucked from their curricula and placed in emergency departments and intensive care units to function as medical interns, stopping work in their specialties. For example, chief orthopedic surgery residents stopped operating, their educational lectures were cancelled, and they received pulmonary critical care training instead of orthopedic training.

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Even residents who werent redeployed to other specialties, like my colleagues and I in radiology, saw dramatic shifts in their education. Imaging of the heart and chest is playing a bigger role in our education during the pandemic, for example, with a corresponding decrease in other types, like mammography, which is an essential component of residents training.

Many hospital departments have been operating on skeleton crews of a few residents assigned to hospital duties, such as covering urgent services and doing direct patient care, while nonessential residents have been quarantined at home, missing out on learning opportunities in the hospital.

For residents in areas that have (so far) been relatively spared by Covid-19, state lockdowns prevented many hospital departments from seeing patients. Some ENT surgery departments, for example, are resuming procedures this month. As a result, many residents are now struggling to demonstrate competence in some procedures they will likely have to perform after they graduate. Some general surgery residents lack the number of procedures needed to determine competence in some areas. Many of these procedures are the same ones with the lowest levels of reported operative confidence among chief residents, typically chosen as the programs most talented trainees.

It is unlikely that specialties that are primarily outpatient, such as dermatology, will rebound to their pre-pandemic volume for some time. Once the scheduling of nonemergency procedures ramps back up, cases will need to be more widely spaced out in time to allow hospitals to perform new decontamination protocols. Social distancing guidelines may also limit the number of trainees permitted in operating or procedure rooms. For academic urban programs with a large number of residents, this means fewer cases per resident.

The response to this may be to cut training spots.

The Hospital for Special Surgery in Manhattan has already notified applicants to one of its fellowship training programs that it had to decrease the number of spots for the 2021-2022 application cycle. Residency spots could also be cut in certain regions, as they are funded by Medicare, which has the right to reduce the number of full-time residents at hospitals.

A recent analysis of rural hospitals spanning 40 states showed that almost 354 could close as a result of the lockdown, and with them their training opportunities for residents. The disruption a hospital closure has on resident education was evident when bankrupt Hanhnemann University Hospital in Philadelphia closed and its more than 550 residency spots were auctioned off to other hospital systems. Some of the residents went to smaller rural hospitals, which may now close, turning graduate medical education into a turbulent game of musical chairs that may worsen a parallel epidemic: the doctor shortage.

According to the Association of American Medical Colleges (AAMC), more than 3,000 medical school graduates did not match into residency positions this year. The increase in the number of medical school graduates has far outpaced the increase in residency training programs. The AAMC projects a shortage of as many as 43,000 doctors this year and 121,000 by 2030.

While the pandemic will most certainly worsen the doctor shortage, it may also prevent medical boards from testing doctors-in-training altogether.

As the pandemic forces standardized tests like the SAT to migrate to the web, board certification exams for residents are almost all still to be conducted in person. Many medical boards have had difficulty pivoting to online formats, delaying their exams until 2021. This could potentially put board eligibility for candidates in jeopardy and may unnecessarily prolong residency training for some new physicians.

As the pandemic continues to unfold, more residents will join the all-hands-on-deck response. The long-term effect of this on the training of young doctors who will soon be out of residency and independently performing knee replacements on 65-year-old grandmothers or reading pediatric brain MRIs is yet to be seen.

Corbin Pomeranz is a physician and chief radiology resident at Thomas Jefferson University Hospital in Philadelphia.

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As residents pivot to treat Covid-19, they may falter in their own specialties - STAT

Washington reports over 1,000 new COVID-19 cases for third time in last week  KOMO News

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Washington reports over 1,000 new COVID-19 cases for third time in last week - KOMO News

COVID-19 cases in US federal and state prisons were 5.5 times higherand death rates three times higherthan in the general population from Mar 31 to Jun 6, according to a research letter published yesterday in JAMA.

Researchers from Johns Hopkins University and the University of California Los Angeles' COVID-19 Behind Bars Data Project examined prison data from all states, the District of Columbia, and the Federal Bureau of Prisons from publicly available data sources such as medical examiner reports, corrections department websites, media reports, and news releases.

A total of 42,107 of 1,295,285 prisoners had been infected with the novel coronavirus, for a case rate of 3.25%, versus 0.59% in the general US population. In the US population, there had been 1,920,904 coronavirus cases and 95,608 deaths.

Of prisoners infected, 510 died, for a death rate of 0.039%, versus 0.029% outside of prisons. But the proportion of prisoners aged 65 and older in the prison population was smaller than that of the general population (3% vs 16%, respectively). That age-group accounted for 81% of US coronavirus deaths.

After adjusting for age and sex differences between the two populations, the death rate was three times higher for inmates than for non-inmates.

The COVID-19 case rate in prisons had been lower than that of the general population until mid-April. Mean daily case rate was 8.3% in prisons and 3.4% per day in the rest of the United States. Some prisons had outbreaks involving 65% of inmates.

The authors noted that the true prevalence of coronavirus in prisons is likely higher than that measured in the study because some prisons aren't reporting cases, and others are not testing prisoners at all. More than 2 million people are incarcerated in US prisons.

Prisoners are particularly susceptible to highly infectious diseases such as COVID-19 because of close confinement, limited access to personal protective equipment, and high rates of underlying respiratory and heart conditions, they said.

Some prisons have tried to suppress transmission of infectious diseases through early release of inmates unlikely to reoffend, institution of strict infection-control practices, and implementation of widespread testing.

"Although some facilities did engage in efforts to control outbreaks, the findings suggest that overall, COVID-19 in US prisons is unlikely to be contained without implementation of more effective infection control," the authors wrote.

In a Johns Hopkins press release, lead author Brendan Saloner, PhD, said that although prisoners have a right to protection of their health, "the reality of these findings shows that we aren't coming anywhere close to meeting their basic needs. Ultimately, it creates a dangerous situation for the inmates, prison staff, the communities that prisons are located in, and in our overall effort to contain the crisis."

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US prison inmates among those hit hard with COVID-19 - CIDRAP