Category: Covid-19

In January, as a frightening new virus filled hospital wards in Wuhan, China, Stephanie Giordano, a 25-year-old researcher at the drugmaker Regeneron, in a suburb of New York City, began working on a treatment for the disease.

By March, the deadly coronavirus had hit home. Fearing she would get infected on the train that took her to the lab every day, she moved from her apartment in East Harlem to an Airbnb five minutes from the companys headquarters in Tarrytown, in Westchester County.

Then her mother, a nurses assistant who cared for newborn babies at a Long Island hospital, was reassigned to a Covid-19 ward where she tended to older people struggling to breathe. No drug could help these patients or her, if she were to get sick, too.

I had somebody on the line that I really cared about, Ms. Giordano said recently. And I wanted to see her make it through this.

Ms. Giordano, the youngest member of the companys five-person rapid response team for infectious diseases, helped develop what many consider one of the most promising new treatments for Covid-19, which has now infected more than 12 million people around the world, and killed more than 549,000.

She worked in the lab until 10 many nights and through weekends, screening thousands of antibodies the weapons of the immune system that seek out and destroy viruses in search of the most powerful ones. The result was a cocktail of two antibodies that might not only treat the virus, but prevent it by giving the body the same natural defenses that people infected with it produce on their own.

The Trump administration this week gave a major boost to Regenerons treatment, awarding the company $450 million to manufacture and supply as many as 300,000 doses as treatments or 1.3 million doses to prevent infection. Thats in addition to $160 million in federal money the company had already received to run clinical trials and ramp up manufacturing. After the treatment passed an initial safety study, Regenerons broader trials to evaluate the products efficacy got underway.

Dr. Francis S. Collins, the director of the National Institutes of Health, recently singled out the treatment as the most likely to pan out soon. If I had to pick one, I think the monoclonal antibody cocktails have a lot going for them, Dr. Collins said at a Senate hearing last week. Theres all kinds of reasons to think this is the kind of virus it should work for.

If the trials are successful, company executives have said the treatment could be available by the end of the summer. The hope is that it could serve as a stopgap until a vaccine arrives by providing temporary protection to people at high risk of getting infected.

Regeneron is making a significant gamble, ramping up manufacturing of the antibody cocktail before clinical trials have even proved that it works. The most lucrative drugs it makes for other diseases have been relocated to a factory in Ireland.

Regeneron is one of several companies pursuing monoclonal antibody treatments. The drug giant Eli Lilly has also begun clinical trials, and others working on antibody treatments include partnerships of Amgen and Adaptive Biotechnologies and also Vir Biotechnology and GlaxoSmithKline.

Its unclear which of these projects if any will succeed. Drug development is notoriously unpredictable: Just last week, Regeneron announced that an older monoclonal antibody drug, the rheumatoid arthritis treatment Kevzara, had failed to help patients critically ill with Covid-19.

Still, scientists and investors alike are closely watching Regeneron, which developed a treatment for Ebola with this same technology. That treatment was tested during the most recent Ebola outbreak in the Democratic Republic of Congo, which began in 2018 and ended in June. Together with a new Ebola vaccine, the treatment was credited with reducing the deadliness of the outbreak.

Regenerons track record of developing a similar treatment for Ebola doesnt mean they will have a better product, but it does make me relieved that they will not fumble, said Ronny Gal, an analyst for Bernstein, a Wall Street firm.

And Regeneron has taken this all-hands-on-deck approach to Covid-19 in one of the hardest-hit areas of the country. In Westchester County, more than 35,000 people have been infected and more than 1,500 people have died.

Its just a remarkable and unfortunate coincidence, said Dr. Leonard S. Schleifer, Regenerons chief executive.

Ms. Giordano, a research and development associate with a bachelors degree in chemistry from Fordham University, had just transferred to Regenerons viral infectious disease group in January when the researchers noticed a report about a new virus in Wuhan on an international alert system known as ProMED.

Christos Kyratsous, the companys vice president of research for infectious diseases, said his team ordered a synthetic genome of the virus from an outside company, but while they waited for it to arrive, the number of infections simply exploded. While Dr. Kyratsouss team closely watches any new viruses, the way it spread across Wuhan convinced us that this was something worth spending our resources and our time on.

Regeneron has built its business on what Dr. Schleifer, one of the companys founders, calls its magical mice animals that have been genetically engineered to have human immune systems. The mice are infected with harmless viruses that trigger the animals to produce human antibodies. Those antibodies can then be screened for the ones that work best, and then mass-produced in stainless steel vats known as bioreactors.

The technology drove one of the companys biggest blockbusters, the eczema drug Dupixent, as well as the treatment for Ebola.

Dr. Schleifer said he realized the company would need to turn its full attention to developing a treatment in late January, when a news program showed construction vehicles breaking ground on a vast hospital in Wuhan.

They said they were going to build a hospital in five days, he recalled. I said to myself, Holy cow, OK, this doesnt happen just for the fun of it.

In early February, Regeneron expanded a collaboration with the federal government to begin working on the coronavirus treatment. It also started ramping up manufacturing of the antibodies.

Usually, you dont scale it up until youve got something thats proven, Dr. Schleifer said. We knew that the ordinary course of business could not work here. We knew that we needed to get as much capacity as possible.

Dr. Schleifer said the company decided to move its existing products to its plant in Ireland to ensure that the antibody treatment would be made in the United States and available to treat Americans. The pandemic has already led some countries, such as India, to limit exports of drugs that might treat Covid-19, and the United States has snapped up the global supply of another treatment, remdesivir.

There was scary stuff going on in the world about, you know, countries closing borders, he said. We wanted to manufacture as much as we could as close to where the processes were being developed.

The company started its work by collecting as many coronavirus antibodies as possible, both through infecting its magic mice, and from the donated blood of coronavirus survivors.

Those antibodies were handed off to Ms. Giordanos team, which identified the ones that fought off the virus most powerfully.

Ms. Giordanos role was to help develop a phony coronavirus to test against the companys antibody candidates one that, though not harmful, would stand in for the real thing. It was like three years of work in I want to say maybe like a month and a half, she said.

By the end of February, she was clocking 90 hours a week. In March, as the coronavirus arrived in Westchester, she moved to the Airbnb apartment in White Plains the owners gave her a significant discount when she explained what she was working on.

As her mother began caring for Covid-19 patients, the two exchanged photos of each other in their protective gear.

You guys are heros!!!!!!! Ms. Giordano texted in April to her mother, who had sent photos of herself and her co-workers in protective gowns, gloves, face shields and masks. Love ur double glove technique.

Ms. Giordano said that thinking about her mother and her colleagues being at risk of infection kept her going during the grueling days. Because otherwise I think I would have broken down and cried a lot.

As the cases in Westchester County mounted and the state locked down, officials at Regeneron scrambled to keep their labs open without putting employees in danger.

We were truly petrified that we would have this cure that we knew we had to develop, but all of our scientists would get sick and we wouldnt be able to do it, Dr. Schleifer said.

Like many other businesses, the company sent nonessential workers home including Dr. Schleifer, who did conference calls and television appearances from a bedroom in his home. They redirected some cars used by sales representatives to workers who would otherwise rely on public transportation. They staggered researchers shifts so fewer people were in the labs at once.

In late April, the company set up a drive-through testing site in its parking lot, and now requires all employees to get tested at least once every two weeks.

Ms. Giordano and her colleagues, working long hours, took turns grocery shopping at Whole Foods, taking orders for the group. She recalled getting home late one night, eating a bag of defrosted broccoli and carrots for dinner, then collapsing.

In April, the scientists selected their lead candidates for the two-antibody cocktail that would eventually enter clinical trials.

Ms. Giordano turned 25. The group celebrated with a chocolate cake covered in sprinkles. She cut her own bangs. She downloaded the new album by the Strokes, and played it on tiny speakers next to her lab station. (Lana Del Rey was in heavier rotation earlier in the pandemic, she said, because I needed something melodramatic and just kind of soothing in the background.)

Ms. Giordano was listed as an author on two articles in the journal Science describing how Regenerons researchers had selected the antibody cocktail, including their reasoning that, by using two antibodies, they could help prevent resistance to the treatment.

So proud of you!!! her mother wrote in a text.

Now, like everyone else, Ms. Giordano is waiting to see if the antibody treatment will succeed in clinical trials.

While antibody treatments have shown promise in the past, the real question is how well will they work for Covid? said Angela Rasmussen, a virologist at Columbia University. And thats something thats really hard to say, because weve only known about this virus for seven months.

The clinical trials will test how well the antibodies work for three groups: people who are hospitalized, those who are mildly ill and those who have been exposed to someone with the virus. The product will be given as an infusion for people who are sick, and as a lower-dose injection when it is used for prevention. The preliminary results are expected by late summer.

The most intense phase of Ms. Giordanos work on the treatment is now over, and her work schedule has mainly returned to normal. She moved to a new apartment in Greenpoint, Brooklyn, and, as the outbreak ebbed in New York, her mother went back to caring for babies.

She knows the treatment may not ultimately work. Its so scary, she said. But she tries to focus on the science, not her fears.

We did our best, and we tried everything that we could to make something that works, she said. And I think thats enough for now.

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How Scientists Got Coronavirus While Trying to Find a Drug for the Disease - The New York Times

An aerial view of floodwaters flowing from the Tittabawassee River into the lower part of downtown Midland, Mich., on May 20. Thousands of residents were ordered to evacuate after two dams collapsed, causing flooding. Gregory Shamus/Getty Images hide caption

An aerial view of floodwaters flowing from the Tittabawassee River into the lower part of downtown Midland, Mich., on May 20. Thousands of residents were ordered to evacuate after two dams collapsed, causing flooding.

Two crises collided this spring in Michigan. The state was already under a coronavirus lockdown when a catastrophic storm hit and a pair of dams failed, flooding the city of Midland.

The local hospital, MidMichigan Medical Center Midland, hired a disaster recovery company to clean up the mess, including a water-logged basement and morgue. More than 100 workers many of them recent immigrants were brought from as far away as Texas and Florida. Bellaliz Gonzalez was one of them.

"There were cracks in the safety protocols," Gonzalez, an asylum-seeker from Venezuela, said in Spanish through an interpreter. "We would start working without masks and then the supervisors would say, 'We're going to go look for masks,' when we were already working inside!"

"It smelled like something rotten, decomposed," she added. "Like something putrid, pungent. It was horrible."

Bellaliz Gonzalez recorded a video where she said many recovery workers had tested positive for the coronavirus and many were feeling sick as they were packed into vans and transported home from Midland, Mich. Bellaliz Gonzalez hide caption

Bellaliz Gonzalez recorded a video where she said many recovery workers had tested positive for the coronavirus and many were feeling sick as they were packed into vans and transported home from Midland, Mich.

Michigan had strict rules in place for essential workers during the pandemic, but Gonzalez and other workers interviewed by NPR said those rules weren't followed. The workers said they were put up in cramped hotel rooms and weren't given enough protective equipment.

Many of the disaster recovery workers who came to Midland did get sick. A cluster of roughly 20 confirmed cases of the coronavirus drew the attention of local health officials. It also shined a light on a multibillion-dollar industry that's growing fast as climate-driven disasters become more frequent and more expensive.

"These workers are essential, but no one behaves like it," said Saket Soni, the founder and director of a nonprofit group called Resilience Force, which advocates for recovery workers.

Like workers in other industries hit hard by the coronavirus, Soni said recovery workers risk getting and spreading the virus not just to each other and to their families but to the communities where they live and work.

"In a sense, they're like the farmworkers and meat packers ... with one difference," Soni said. "This is a workforce on the go ... that spends most of the year traveling from place to place, fixing up towns, cities, homes and buildings. And that's an additional vulnerability."

Soni said the pandemic has revealed longstanding problems in how the disaster recovery industry treats a workforce that cleans up and rebuilds after hurricanes, wildfires and flooding. Many of the workers are asylum-seekers or undocumented immigrants who don't speak much English and are afraid to complain about working conditions.

Gonzalez, who is 54, worked as an environmental engineer in her native Venezuela before fleeing to the U.S. to seek asylum two years ago. She said she got sick with a high fever in Michigan but tested negative for the coronavirus.

Gonzalez said she was appalled at the working conditions. The first day on the job, she said she asked if there were going to be temperature checks and was told there were no thermometers.

"We were treated worse than animals," Gonzalez said. "They didn't care about our well-being and our lives, they didn't care that we are in the middle of a pandemic."

After the outbreak in Michigan, the finger pointing began.

"We had some people from out of state come in to help, and we are grateful for help, but they brought COVID-19 with them," Gov. Gretchen Whitmer said in an interview with member station WDET in Detroit last month.

No one knows for sure whether the workers brought the coronavirus to Michigan, or caught it there. But we do know what happened next: The workers left town, taking the virus with them.

"We would have preferred if they would have quarantined here in Michigan, but they traveled home," Whitmer said.

Public health workers there say they weren't able to communicate directly with the recovery workers because no one on the contact-tracing team speaks Spanish.

"You really shouldn't cram four and five people into a hotel room that aren't necessarily family members, or put them in a situation where they're thousands of miles from home where they can be exposed to the virus," said Joel Strasz, a public health officer in Bay County, Mich., where the workers were staying.

"All of those conditions are going to really exacerbate the situation, spread the virus," he said.

The MidMichigan Medical Center thought the cleanup company it hired was taking steps to ensure worker safety, according to Julie Newton, an infection prevention nurse at the hospital.

"I was told that they checked for symptoms and temperatures every day," Newton said. "And if someone had symptoms or temperature, they were sent to be tested and were not allowed to work."

Newton said the workers she saw were wearing masks and gloves, and that she didn't talk to the workers directly because she doesn't speak Spanish, either.

"It didn't occur to me to go through and ask a bunch of questions" about whether workers were wearing masks, or how many people were staying in a hotel room, Newton said. "I just expected that they were making sure that those things were happening."

Servpro is a disaster recovery company with franchises around the country, including the one in Michigan hired by the hospital for the cleanup effort. Neither Servpro nor the local franchise responded to requests for comment.(Editor's note: Servpro is an NPR underwriter.)

Servpro's website says its workers always adhere to "cleaning and decontamination standards set by the Centers for Disease Control and Prevention and local authorities."

BTN Services, a Houston-based company that provides cleaning and staffing services, was a subcontractor on the hospital job. CEO Alejandro Fernandez told NPR that there was "a whole bunch of misinformation going around" but declined to elaborate and did not respond to interview requests.

The structure of the industry, with multiple layers of contractors and subcontractors, makes it easier for employers to avoid accountability, said Soni from Resilience Force.

"That's a huge problem," Soni said. "It means no one owns and pays for the standards to be enforced. No one is ultimately accountable."

Recovery worker Armando Negron stands outside a hospital in Michigan. Negron tested positive for the coronavirus while in Michigan and headed home to Florida, where he landed in the hospital for six days. Armando Negron hide caption

Recovery worker Armando Negron stands outside a hospital in Michigan. Negron tested positive for the coronavirus while in Michigan and headed home to Florida, where he landed in the hospital for six days.

The workers on the hospital job say they asked for the work site's COVID-19 preparedness plan, as required by the state under a series of executive orders signed by the governor. But the workers say they never saw one.

Once workers in Michigan began testing positive for the coronavirus, they say they were put on vans that drove them back to Florida and Texas. Several workers said they asked to be quarantined in Michigan but were told they'd have to pay for their own housing if they stayed.

Bellaliz Gonzalez recorded a video on her phone in Michigan just before the workers packed into vans to go home. "We are all sick, some have tested positive, others have not been tested but have symptoms," she said in the video.

One of the workers who got sick was Armando Negron. He said he worked in the hospital morgue without a mask before testing positive for the coronavirus. He headed home to Florida, where he landed in the hospital for six days. Negron, who was born in Puerto Rico, is 56 and has survived two heart attacks.

"I was coughing so hard for 10 to 15 minutes nonstop, I felt that my chest was going to explode," Negron said in Spanish through an interpreter.

"This virus feels like a fire that gets inside your body. You don't feel good sitting down, standing or lying down. It's debilitating and I feel very tired, I don't feel normal," he said.

Meanwhile, the demand for disaster cleanup continues in spite of the coronavirus. Negron said that half a dozen people he worked with in the morgue went directly from Midland to another job site in the Midwest. Two of them, he said, got sick and have been hospitalized.

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'We Were Treated Worse Than Animals': Disaster Recovery Workers Confront COVID-19 - NPR

More patients are in the hospital due to COVID-19 than ever.

This, along with a recent surge in positive cases, has hospital officials on high alert.

Officials at Blessing Hospital said there's currently eight patients in the hospital due to COVID-19.

They said they're ready if that number were to continue to increase.

As hospitalizations at Blessing Hospital rise, so do efforts to keep everything under control.

"We're ready," Blessing Health System CEO and President Maureen Kahn said. "We've got the equipment, we've got the staff who are trained and ready to take care of the patients as they come into the organization."

Kahn said while each case is different, the hospital is equipped to handle it.

"We're managing these patients in the medical surgical units in the hospital in our negative pressure rooms, which give them the added protection of containing and giving them special airflow in those rooms," Kahn said.

She said they have enough beds and PPE for severe cases.

"We have plenty of ventilators, should a patient need to be put on a ventilator," Kahn said. "But now, we have none of our ventilators in use on any of these patients."

Kahn said they also have enough medication for ways to treat symptoms.

"Remember, these medications are not cures, but they help minimize the symptoms these patients may experience," Kahn said.

Health department officials said they want residents to take this more serious in order to help limit cases and hospitalizations.

"Everybody in our community, despite how they feel about masking, despite what they think about gathering together in this environment, need to be conscientious about your individual behaviors right now for a lot of reasons," Adams County Public Health Administrator Jerrod Welch said.

Should they have the need, Kahn said they are prepared to admit more patients.

"Eight is a large number, but we have plenty of capacity," Kahn said. "We probably have like 30 available beds right now."

Kahn said two of the patients are not from Adams County, but from surrounding counties.

She said they are still allowing visitors here at the hospital and still have a number of guidelines in place for them.

Kahn said if you have any symptoms or think you may have been exposed, you should get tested.

To do so, you can call the COVID-19 Community Hotline.

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COVID-19 hospitalizations on the rise at Blessing Hospital - WGEM

Will I get COVID-19 doing this? Here's how risky normal activities are  KOMO News

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Will I get COVID-19 doing this? Here's how risky normal activities are - KOMO News

People who know Maria Van Kerkhove describe her as someone who has worked her whole life to be in this place, at this moment.

This place is at the core of the World Health Organizations coronavirus team, this moment is when the WHO is trying to steer the globes response to the Covid-19 pandemic. No one would expect such a job to be anything less than highly stressful, but lately, the ride has been a rocky one.

Van Kerkhove, who for months has joined Director-General Tedros Adhanom Ghebreyesus during regular press briefings, found herself in a firestorm last month after saying that people with Covid-19 who are asymptomatic very rarely transmit the infection.

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The agencys pandemic response team, which Van Kerkhove helps lead as the head of the WHOs emerging diseases unit, came under fire again this week when more than 200 scientists accused the WHO in an open letter of resisting evidence that virus-laced aerosols emitted by people infected with Covid-19 are fueling spread of the disease.

While the latter critique was aimed broadly at the WHO, Van Kerkhove was personally in the hot seat in the case of the earlier controversy. At the time, she was speaking about people who never develop symptoms. But asymptomatic is also a term sometimes used to describe people who are infected and who havent yet developed symptoms. Its been established those people can and do transmit the infection.

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Covid-19 Twitter erupted after Van Kerkhoves remarks. The following day, she and Mike Ryan, the head of the WHOs health emergencies program, turned to Facebook Live to clarify the comments.

She should have recognized thats how it would get interpreted, Ashish Jha, director of Harvards Global Health Institute, said a couple of days later. Even the next days walk-back I just dont think they clarified it well enough.

Van Kerkhove, who strives for precision in her Covid-19 messaging, is still bruised by the episode.

I was talking with my husband [recently] and I was saying Im struggling at the moment with the pushback and the second-guessing and the challenging, she told STAT in an interview. Im trying to get information out to help people. Im trying to get the information out to clarify WHOs position, which is to help people, which is to suppress transmission and to save lives.

Theres no other motivation. So, the idea that, you know, were doing things that could potentially be harming people and hurting people, its very difficult for me to rectify, Van Kerkhove said.

To that end, Van Kerkhove and others at the WHO have written hundreds of guidance documents on Covid-19 on breastfeeding while infected (encouraged when possible), on preparing hospitals for surges in patients, on controlling spread of the virus at border crossings, to name but a few.

Ryan described the incident as a storm in a teacup. When Van Kerkhove wanted to clarify her statement the following day, he joined her online. Through that whole thing she showed just immense courage and character, he said.

Ryan, of course, is hardly unbiased. Certain professionals, you almost feel like theyve spent a lifetime preparing for a role a role they didnt know they were going to have, he said in a recent interview. She feels like someone like that to me. Someone whos been subconsciously preparing for the big one.

Indeed, Van Kerkhoves awe of science germinated early on. Her twin sister, Alisa DeJoseph, with whom she grew up in upstate New York, recalls being the right brain, excelling in the arts, while Maria was the left brain, excelling in math and science.

Peter Goodfriend, who taught Van Kerkhove advanced placement biology her senior year of high school, said he once videotaped and brought into class a TV segment about The Hot Zone, Richard Prestons just-released bestseller on Ebola. He also bought and read the book, then lent it to Van Kerkhove one of those students who just stand out, as he put it.

It made an impression. Van Kerkhove, now 43, said she remembers trying to figure out the careers of the characters Preston wrote about. Some were virologists, she knew. But there was another set of professionals, doing a job she hadnt previously heard of: epidemiologists.

I thought the idea of understanding why certain people get sick, why others dont, what were those differences? That was quite fascinating. Almost detective-like, she said.

Pursuit of this newfound career path took Van Kerkhove to some of the best universities around. They were also places where degrees dont come cheap Cornell, Stanford, and the London School of Hygiene and Tropical Medicine, where she got a bachelor of biological sciences, a masters in epidemiology, and a Ph.D. in infectious disease epidemiology, respectively. I had a lot of student loans, she said.

During summer breaks at Cornell, she did field work on projects run by her professors traveling to Mexico, Venezuela, and Costa Rica. Sometimes the research involved studying the plants indigenous peoples used for medicinal purposes; one summer she was studying leaves and fruits capuchin monkeys rub on their fur. Decades later she recalls how dark the nights were, the constant chorus of frogs, the tang of freshly squeezed juice in the mornings.

After Cornell, Van Kerkhove was accepted to Stanford to do a masters degree in epidemiology, a one- or two-year program that she completed in one. She then pressed pause on her studies, moving to New York City to take a job as an epidemiologist for Exponent Health Services Practice, a consulting firm. Much of her time was spent on the issue of power line expansions and the fears of communities that electromagnetic fields emitted by them could cause cancers.

In what people who know her well would probably describe as classic Van Kerkhove behavior, she dug in, trying to learn everything she could about the subject. The experience taught her how to weigh evidence, she said, and the critical importance of risk communications one of the skills shes leaning heavily into in the Covid-19 pandemic.

What I tried to do was link the science to the concern and tried to explain, you know, what I could and alleviate some fears, she said.

With some of her student loans paid off, Van Kerkhove was ready to pursue a Ph.D. She wanted to study at an institution that focused on global health. Enter the London School of Hygiene and Tropical Medicine.

This was the mid-2000s, when bird flu the H5N1 virus was racing through Asia and beyond, decimating poultry flocks. It rarely infected people, but when it did, the outcome was more often than not fatal. About 60% of people known to have been infected with that virus died.

Van Kerkhove spent the better part of two years shuttling between London and Cambodia, where she worked with scientists at the Pasteur Institute in Phnom Penh, trying to chart the movement of poultry in a country where commercial-scale poultry production didnt exist.

The study Van Kerkhove and her Cambodian colleagues produced showed that infected poultry entering the country from China made its way through Vietnam to Cambodia through a series of middlemen. It became the subject of Van Kerkhoves Ph.D. thesis. That was a great piece of work, said Malik Peiris, a world-renowned virologist at Hong Kong University who was one of the thesis reviewers and was later a colleague on Van Kerkhoves work on MERS, a camel coronavirus.

A number of the Cambodian scientists Van Kerkhove collaborated with remain at the Pasteur Institute. Sowath Ly, who is now deputy head of the institute, said they marvel to see the scientist with whom they quizzed Cambodian villagers about bird flu sitting beside the director general of the WHO informing the world about Covid-19.

We are very proud of her, said Ly, who described Van Kerkhove as a good mentor.

Others are more reserved about the WHOs handling of the pandemic response. Jha, the Harvard expert, described the agencys communications efforts as good but not great. (Still, he credited the agency for communicating at all, noting that the Centers for Disease Control and Prevention barely briefs at all these days.)

Multiple people who have worked with Van Kerkhove talk about her laser focus and her prodigious capacity for work.

While doing postdoctoral work at Londons Imperial College under prominent mathematical modeler Neil Ferguson, she became a liaison between Fergusons group and the WHOs influenza team. Effectively, Ferguson lent Van Kerkhove to WHO; for a number of years she traveled weekly from London to Geneva to lend a badly needed hand.

She worked under Tony Mounts, a CDC infectious diseases epidemiologist who was at the time seconded to the WHO. Van Kerkhoves productivity intimidated some of his other staff, Mounts recalled, because she was so efficient that she tended to run circles around people at times.

When the 2009 influenza pandemic began, his unit tapped into that capacity, producing with her help important papers assessing the risk factors for severe H1N1 infection that is the flu strain that triggered the pandemic and estimating global mortality.

Its really stuff we couldnt have gotten done without her. We just didnt have the time or the people or the expertise on our team without her to do that, says Mounts, who is now on assignment to USAID. She just kind of buckles down and gets work done.

In 2015 she was hired by the Institut Pasteur in Paris to create a network of rapid outbreak response teams throughout the famed organizations 33 branches worldwide. Van Kerkhove speaks well of the experience, but friends say she didnt get the support she needed to make the goal a reality. Two years later the WHO was looking for someone to head its coronavirus work. It was a job she wanted, and back to Geneva she went.

Around Christmastime last year, Van Kerkhove was in North Carolina with her husband, Neil, and their two children. They were visiting family when she got a phone call that changed the tenor of the vacation. A mysterious virus spreading in China, she was told. A couple of days later, she was en route to Geneva again.

The work has been nonstop since.

Van Kerkhove was part of the WHOs nine-day mission to China in February to study the new disease and Chinas response to it. After her return to Geneva, some staff at WHO headquarters contracted Covid-19. Fearful shed bring the virus home to her family, Van Kerkhove decided to quarantine herself when she was at home.

For at least two months, she didnt touch her children: Cole, now 9 , and Miro, who is 18 months old.

She often left for work before they were up, arriving home after they were in bed. When she was home, she sequestered herself in a room a technique many frontline health workers have used in this pandemic. She would talk to her children through windows. It was awful. Awful! she shuddered.

Cole, who had initially been excited his mother was trying to help the world respond to a crisis, became convinced shed die from the new disease when she went to China. Miro thought his mother was playing a game of hide and seek, and would run after her whenever he saw her.

I would laugh in front of him and then come into the bedroom and cry because it was just a horrible, horrible thing, she said. Eventually the rate of new infections in Geneva started dropping, schools reopened, and there were no recent cases among WHO staff.

There was one day that I came home and I was on front lawn, and the baby just ran up to me and I just grabbed him. I just couldnt do it anymore, Van Kerkhove said.

She credits her husband for being incredibly supportive, but acknowledges 2020 has been a slog.

Its difficult for all of us. I havent been home a lot in six months, she said.

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A disease detective on the frontlines of WHO's Covid-19 response - STAT

UPCOMING FREE COMMUNITY TESTING: MARSHALL, MERCER, MONONGALIA, PRESTON, UPSHUR, AND WAYNE COUNTIES Additionally during his briefing, Gov. Justice offered a reminder that the next round offree community COVID-19 testingwill be provided later this week Friday, July 10 and Saturday, July 11 in Marshall, Mercer, Monongalia, Preston, Upshur, and Wayne counties.

The effort is part of a plan to provide free optional testing to all residents in several counties that are experiencing higher rates of COVID-19 transmission. It targets residents who have struggled to be seen by a physician or do not have insurance to pay for testing. However, other residents, including those who are asymptomatic are welcome to be tested.

Testing is scheduled as follows:

Marshall County Friday, July 10 9 a.m. 4 p.m. McMechen City Hall: 325 Logan Street, McMechen, WV 26040 Saturday, July 11 9 a.m. 4 p.m. Marshall County Health Department: 513 6th Street, Moundsville, WV 26041

Mercer County Saturday, July 11 9:30 a.m. 4 p.m. Mercer County Health Department: 978 Blue Prince Road, Bluefield, WV 24701

Monongalia County Friday, July 10 9 a.m. 4 p.m. Morgantown Farmers Market (Downtown): 400 Spruce Street, Morgantown, WV 26505 Saturday, July 11 9 a.m. 4 p.m. Mountainview Elementary School: 661 Green Bag Road, Morgantown, WV 26508

Preston County Friday, July 10 & Saturday, July 11 9 a.m. 4 p.m. Kingwood Elementary School: 207 South Price Street, Kingwood, WV 26537

Upshur County Friday, July 10 & Saturday, July 11 10 a.m. 7 p.m. Buckhannon-Upshur High School: 270 B-U Drive, Buckhannon, WV 26201 Friday, July 10 & Saturday, July 11 10 a.m. 4 p.m. 78 Queens Alley, Rock Cave, WV 26234

Wayne County Friday, July 10 10 a.m. 4 p.m. Dunlow Community Center: 1475 Left Fork Dunlow Bypass Road, Dunlow, WV 25511 Saturday, July 11 10 a.m. 4 p.m. Wayne Elementary School: 80 McGinnis Drive, Wayne, WV 25570

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COVID-19 UPDATE: Gov. Justice announces reopening date for West Virginia schools - West Virginia Department of Health and Human Resources

In early March, most doctors in the United States had never seen a person sick with COVID-19. Four months later, nearly every emergency room and intensive care physician in the country is intimately familiar with the disease. In that time, theyve learned a lot about how best to treat patients. But in some cases, theyre still taking the same approach they did in the spring.

Theres so much thats different, and so much thats the same, says Megan Ranney, an emergency physician and associate professor at the Brown University Department of Emergency Medicine.

For the first few months of the pandemic, recommendations for every incremental decision made in a hospital were changing faster than they ever have before. You almost couldnt keep up from one day to the next, your practice would change and your protocols would change. It was really disorienting for doctors and nurses, Ranney says.

Information spread between colleagues, through medical education blogs and podcasts, and on social media. Doctors talked about new research on Twitter and shared new strategies in Facebook groups and on WhatsApp. If a suggestion that floated by a doctor in a Facebook group was low-risk and seemed like it might be helpful, it could be put into practice immediately. If its a small change, they could start using it the next day, she says.

Thats how the now-common practice of asking patients with COVID-19 to flip onto their stomachs spread: through word-of-mouth and on social media. When someone is on their back, their organs squish their lungs and make it harder for their airways to fully expand. When someone is on their stomach, their lungs have more room to fill up with air. The advice started circulating through the medical community before there was a formal, published study on the practice.

Testing it out wouldnt have many downsides (it wasnt dangerous to patients), and it was easy to do. Theres this possibility that it could be positive, and there were a lot of stories about it having a positive effect, Ranney says. So, it spread in a much more organic and quick way, because it was something that we could do, but we werent worried it would hurt patients.

Doctors like Seth Trueger, an assistant professor of emergency medicine at Northwestern University, saw the position help patients get enough oxygen to avoid needing a ventilator. I started jokingly call it tummy time, he says. Studies are starting to validate those observations, finding that patients who spent time on their stomachs were, in fact, better off.

Since March, physicians have also figured out other ways to help severely ill patients avoid ventilation. We appreciate that its probably not a great thing for these patients, and weve developed other ways to get people high levels of oxygen, says James Hudspeth, the COVID response inpatient floor lead at Boston Medical Center. For example, doctors are turning to nasal cannulas, which are noninvasive prongs that blow oxygen into the nose, before a ventilator.

They have better medications for hospitalized patients now, too. Since March, doctors have cycled through a few different options like hydroxychloroquine, which turned out not to be effective. Now, theyre primarily using remdesivir, and antiviral drug that appears to help COVID-19 patients recover more quickly, and the steroid dexamethasone, which helps improve the survival rate for patients on ventilators. Many intensive care units and many hospitals have created their own standard order sets, or standard therapies, for people with COVID-19, Ranney says. Those shift as new evidence comes out around different medications.

Thats not unusual, Ranney says. Hospitals regularly change the drugs they use for conditions like flu and pneumonia as new data comes out. Whats unusual is to change practice so quickly, she says. Thats just the reality of a global pandemic, with a disease weve never seen before.

Most of the changes in doctors strategies over the past few months have been in patients who are severely ill. If someone is sick enough to be hospitalized with COVID-19 but doesnt need to be in intensive care, there still isnt much doctors can do for them. Theyll get fluids to make sure they stay hydrated and are given oxygen if they need it. Doctors will try to keep their fever down and monitor them to see if they get sicker, but thats about it.

Its just those basic things, Ranney says. Doctors now are more vigilant to the threat from blood clots, which have appeared in many COVID-19 patients over the past months. Because testing is more available in hospitals than it was earlier this year, theyll also confirm that a moderately ill patient actually does have COVID-19 and avoid giving them unnecessary treatments. But active interventions for patients with less severe symptoms are still around the same as they were back in March. Were still kind of in this watchful waiting, she says.

One lingering question, Hudspeth says, is figuring out how to keep those moderately ill patients from becoming severely ill. Steroids may be helpful earlier on, he says, as could artificial antibody treatments that block the virus, though those strategies are still under investigation. Part the challenge we face at the present moment is that the moderate patients are often where we would want to intervene, he says.

Changes to treatment strategies for patients who are not severely sick have been harder to come by in part because its riskier to try something new in that group. If someone isnt dangerously sick, there isnt as much to gain from using an experimental treatment that may have a chance of causing harm, so doctors are less likely to take risks. Were more likely to try stuff with sicker patients, Ranney says. And their families are more likely to consent to a clinical trial.

Despite the open issues around COVID-19 treatments, the rate of new information is slowing down. Doctors arent shifting their practices as quickly as they were back in March and April, and Trueger says he thinks the next few months may be relatively stable. Doctors might get new information about which medications are more or less helpful, but other common best practices might be more entrenched. I dont think things are going to change as rapidly as the changes we had up front, when we were really flying half blind, he says.

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Doctors are better at treating COVID-19 patients now than they were in March - The Verge

The US is struggling with a resurgence of the coronavirus in the South and West. But the severity of Arizonas Covid-19 outbreak is in a league of its own.

Over the week of June 30, Arizona reported 55 new coronavirus cases per 100,000 people per day. Thats 34 percent more than the second-worst state, Florida. Its more than double Texas, another hard-hit state. Its more than triple the US average.

Arizona also maintained the highest rate of positive tests of any state at more than 25 percent over the week of June 30 meaning more than a quarter of people who were tested for the coronavirus ultimately had it. Thats more than five times the recommended maximum of 5 percent. Such a high positive rate indicates Arizona doesnt have enough testing to match its big Covid-19 outbreak.

To put it another way: As bad as Arizonas coronavirus outbreak seems right now, the state is very likely still undercounting a lot of cases since it doesnt have enough testing to pick up all the new infections.

The state also leads the country in coronavirus-related hospitalizations. According to the Centers for Disease Control and Prevention, more than one in five inpatient beds in Arizona are occupied by Covid-19 patients about 42 percent more than Texas and 65 percent more than Florida, the states with the next-highest share of Covid-19 patient-occupied beds. With hospitalizations rapidly climbing, Arizona became the first in the country to trigger crisis care standards to help doctors and nurses decide who gets treatment as the system deals with a surge of patients. Around 90 percent of the states intensive care unit beds are occupied, based on Arizona Department of Health Services data.

While reported deaths typically lag new coronavirus cases, the state has also seen its Covid-19 death toll increase over the past several weeks.

This is the result, experts say, of Arizonas missteps at three crucial points in the pandemic. The state reacted too slowly to the coronavirus pandemic in March. As cases began to level off nationwide, officials moved too quickly to reopen in early and mid-May. As cases rose in the state in late May and then June, its leaders once again moved too slowly.

What youre seeing is not only a premature opening, but one done so rapidly there was no way to ensure the health care and public health systems didnt get stressed in this process, Saskia Popescu, an infectious disease epidemiologist based in Arizona, told me.

At the same time, recommended precautions against the coronavirus werent always taken seriously by the general public with experts saying that, anecdotally, mask use in the state can be spotty. That could be partly a result of Republican Gov. Doug Ducey downplaying the threat of the virus: While he eventually told people to wear masks in mid-June, as of late May he claimed that its safe out there, adding, I want to encourage people to get out and about, to take a loved one to dinner, to go retail shopping.

Duceys actions and comments gave the impression we were past Covid-19 and it was no longer an issue, Popescu said, which I believe encouraged people to become lax in their masking [and] social distancing.

After weeks of increases in coronavirus cases and hospitalizations, Ducey pulled back Arizonas reopening on June 29, closing downs bars, theaters, and gyms.

Experts say the move is a positive step forward, but also one that came too late: With coronavirus symptoms taking up to two weeks to develop, there are already infections out there that arent yet showing up in the data. The state can expect cases, hospitalizations, and, probably, deaths to continue to climb over the next few weeks.

Ducey acknowledged the sad reality: It will take several weeks for the mitigations that we have put in place and are putting in place to take effect, he said. But they will take effect.

Duceys office argued it took the action as was necessary at the time, based on the data it collected and its experts recommendations. Our steps are in line with our facts on the ground that weve been tracking closely, Patrick Ptak, a spokesperson for the governors office, told me.

Arizona now offers a warning to the rest of the world. The states caseload was for months far below the totals in New York, Michigan, and Louisiana, among the states that suffered the brunt of the virus in the US in the early months. But by letting its guard down, Arizona became a global hot spot for Covid-19 a testament to the need for continued vigilance against the coronavirus until a vaccine or similarly effective treatment is developed.

Arizona was initially slow to close down. While neighboring California instituted a stay-at-home order on March 19, Ducey didnt issue a similar order for Arizona until March 31 12 days later.

That might not seem like too much time, but experts say it really is: When the number of Covid-19 cases statewide can double within just 24 to 72 hours, days and weeks matter.

Arizona was also quick to reopen its economy. After states started to close down, experts and the White House recommended that states see a decline in coronavirus cases for two weeks before they reopen. Arizona never saw such a decline. In fact, it arguably never even saw a real plateau. The number of daily new cases rose slowly and steadily through April and into May, and then the exponential spike took off.

So its not quite right to say that Arizona is experiencing a second wave of the coronavirus. It arguably never controlled the first wave, and the current rise of cases is a result of continued inaction as the initial wave of the virus continued spreading across the state. (The Navajo Nation, which is partly in Arizona, was an initial coronavirus hot spot. But its case count has declined since May, in part because it took strong measures against the virus.)

Arizona and other states experiencing a surge in Covid-19 now never got to flat, Pia MacDonald, an epidemiologist at the research institute RTI International, told me. That means the states didnt get to very good compliance with the public health interventions that we all need to take to make sure the outbreak doesnt continue to grow.

Despite no sustained decline in Covid-19 cases, Arizona moved forward with reopening anyway. Ptak, the governors spokesperson, acknowledged that the state didnt meet the two-week decline in cases, but he said the state had met another federal gating criteria for reopening by seeing a decline in the test positivity rate week after week throughout May.

Once the state started to reopen, it moved quickly. Within weeks, Arizona not only let hospitals do elective surgeries but started to allow dining-in at restaurants and bars, and gyms and salons, among other high-risk indoor spaces, to reopen. The short time frame prevented the state from seeing the full impact of each step of its reopening, even as it moved forward with additional steps.

Will Humble, executive director of the Arizona Public Health Association, argued it was this rate of reopening that really caused problems for the state. It was a free-for-all by May 15, Humble told me. Referencing federal guidelines for reopening in phases, he added, Arizona effectively went from phase 0 to phase 3.

Its not just that Ducey aggressively reopened the state, but that he also prevented local governments from imposing their own stricter measures. That included requirements for masks, which Ducey didnt allow municipalities to impose until mid-June weeks after Covid-19 cases started to rapidly rise. (Ptak claimed the governor acted once he received requests from mayors along the southern border to do so.)

Some of that is likely political. As recommendations and requirements for masks have expanded, some conservatives have suggested wearing a mask is emblematic of an overreaction to the coronavirus pandemic that has eroded civil liberties. President Donald Trump has by and large refused to wear a mask in public, even saying that people wear masks to spite him and suggesting, contrary to the evidence, that masks do more harm than good. While some Republicans are breaking from Trump on this issue, his comments and actions have helped politicize mask-wearing and other measures.

For example, there was an anti-mask rally in Scottsdale, Arizona, on June 24. There, a local council member, Republican Guy Phillips, shouted George Floyds dying words I cant breathe! before ripping his own mask off, according to the Washington Post. (Phillips later apologized to anyone who became offended.)

Evidence supports the use of masks: Several recent studies found masks reduce transmission. Some experts hypothesize and early research suggests that masks played a significant role in containing outbreaks in several Asian countries where their use is widespread, like South Korea and Japan.

But for a Republican governor like Ducey, the politicization of the issue means a large chunk of his political base is resistant to the kind of measures needed to get the coronavirus under control. And those same constituents are likelier to reject taking precautions against the coronavirus, even if theyre recommended by government officials or experts.

Ducey himself seemed to play into the politics: One day before Trump visited a plant in the state, and as the president urged states to reopen, Ducey announced an acceleration of the states reopening plans.

Other factors, beyond policy, likely played a role as well in the rise in cases. While summer in other parts of the country lets people go outside more often where the coronavirus is less likely to spread triple-digit temperatures in Arizona can actually push people inside, where poor ventilation and close contact is more likely to lead to transmission.

Some officials have argued Black Lives Matter protests played a role in the new outbreak. But the research and data so far suggest the demonstrations didnt lead to a significant increase in Covid-19 cases, thanks to protests mostly taking place outside and participants embracing steps, such as wearing masks, that mitigate the risk of transmission. In Arizona, the surge in coronavirus cases also began before the protests took off in the state.

Arizona saw its coronavirus cases start to increase by Memorial Day on May 25. The increase came hard with the test positivity rate rising too, indicating early on that the increase was not merely the result of more testing in Arizona. Hospitalizations and deaths soon followed.

Yet Ducey didnt begin to scale back the states reopening until more than a month later on June 29. This left weeks for the coronavirus to spread throughout the community.

The sad reality is Arizona will suffer the consequences of the governors slow action for weeks. Because people can spread the virus without showing symptoms, can take up to weeks to show symptoms or get seriously ill, and theres a delay in when new cases and deaths are reported, Arizona is bound to see weeks of new infections and deaths even after Duceys renewed restrictions.

Even if I put in 100 percent face mask use and everybody complied with it in Arizona right now, there would still be weeks of pain, Cyrus Shahpar, a director at the global health advocacy group Resolve to Save Lives, told me. There are people out there spreading disease, and it takes time [to pick them up as cases], from exposure to symptom onset to testing to getting the testing results.

Experts argue the state still needs to go even further. Humble advocated for more hospital staffing, a statewide mask requirement, more rigorous rules and better enforcement of the rules for reopening businesses, and improved testing capacity and contact tracing. He also pointed to the lack of timely testing in prisons as one area that hasnt gotten enough attention and could lead to a blind spot for future Covid-19 outbreaks.

One potentially mitigating factor is the states infected have trended younger than they did in initial bouts of the USs coronavirus outbreak, with people aged 20 to 44 making up roughly half of cases. That could keep the death toll down a bit though Covid-19 deaths in Arizona have already risen, and experts warn of the risks of long-term complications from the coronavirus, including severe lung scarring, among young people as well.

Above all, experts say that the rise in cases was preventable and predictable.

The research suggests the lockdowns worked. One study in Health Affairs concluded:

Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 15 days, 6.8 after 610 days, 8.2 after 1115 days, and 9.1 after 1620 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million).

The flipside, then, is likely true: Easing lockdowns likely led to more virus transmission.

This is what researchers saw in previous disease outbreaks.

Several studies of the 1918 flu pandemic found that quicker and more aggressive steps to enforce social distancing saved lives in those areas. But this research also shows the consequences of pulling back restrictions too early: A 2007 study in JAMA found that when St. Louis widely praised for its response to the 1918 pandemic eased its school closures, bans on public gatherings, and other restrictions, it saw a rise in deaths.

Heres how that looks in chart form, with the dotted line representing excess flu deaths and the black and gray bars showing when social distancing measures were in place. The peak came after those measures were lifted, and the death rate fell only after they were reinstated.

This did not happen only in St. Louis. Analyzing data from 43 cities, the JAMA study found this pattern repeatedly across the country. Howard Markel, a co-author of the study and the director of the University of Michigans Center for the History of Medicine, described the results as a bunch of double-humped epi curves officials instituted social distancing measures, saw flu cases fall, then pulled back the measures and saw flu cases rise again.

Arizona is now seeing that in real time: Social distancing worked at first. But as the state relaxed social distancing, it saw cases quickly rise.

This is why experts consistently cautioned not just Arizona but other states against reopening too quickly. Its why they asked for some time two weeks of falling cases before states could start to reopen. Its why they asked for states to take the reopening process slowly, ensuring that each relaxation didnt lead to a surge in new Covid-19 cases.

Because Arizona and its leaders didnt heed such warnings, its now suffering a predictable, preventable crisis making it the state with the worst coronavirus epidemic in the country thats suffered the most widespread coronavirus outbreak in the world.

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Why Arizonas Covid-19 epidemic became the worst in the US - Vox.com

Now, as nurses are hailed as health care heroes during the pandemic, we're faced with what to do about these psychological injuries, not only for the 4 million nurses in the US the largest health care workforce in America but for the rest of us who depend on them.For the past five years, I've examined the types of psychological trauma that nurses experience. Along with Dr. John Thompson, my co-author, I've described them in our 2019 book, prophetic as it was published six months before Covid-19 first appeared in China.

Prior to the pandemic, nurses faced ethical and personal safety dilemmas during disasters and other emergencies. They saw patients suffer, not only from illness itself, but because of health care interventions, otherwise known as medically induced trauma (think of a patient on a ventilator).

Demands for resources largely ignored for decades

More recently, there has been a shortage of PPE (personal protective equipment) throughout US hospitals. But I know nurses who were told by employers to take care of Covid-19 patients regardless of whether or not adequate PPE was available. Clearly this was a danger to both nurses and patients; surely this qualifies as a traumatizing experience.

Other nurses some new, some working previously in non-acute care have been deployed to critical care units. Understanding the technology of these complex environments requires a steep learning curve. The knowledge, then, to competently care for these patients may be considered an insufficient resource.

The toll on patients and nurses

Nurses, more than anything, strive to deliver high-quality care and connect with patients during their most vulnerable times. But often there isn't the time. The inability to achieve that goal causes stress. Imagine being forced to choose between giving morning meds and sitting down with a patient newly diagnosed with cancer or spending time with the family of a patient with Covid-19. Choices like that leave nurses focused on tasks and morally injured.

Some traumas may be unavoidable. That happens when the nurse fully engages with the patient and co-experiences suffering. This is called secondary or vicarious trauma. That's why we need to offer trauma-informed care to both nurse and patient. Meaningful connections with others is critical, but so is psychological safety.

Compassion helps to heal

While I haven't been at the bedside for a number of years, I still remember how it felt to report to the acute care center at the hospital, hoping no one had called in sick. When that happened, I was assigned an extra patient or two. I knew I couldn't give the care I wanted to the paraplegic young man. I knew I couldn't spend more time communicating with the older adult who had a sudden right-sided stroke. I couldn't give them the things so important to healing -- the physical care, the nursing presence and the compassion they needed and deserved.

Those experiences stay with you. It's a heck of a feeling.

Nursing care is both an art and a science; it is a distinct profession that wields enormous influence on those who need the most help. They do not merely follow instructions from other providers. It's a beautiful profession, unlike any other, founded on intellect, judgment and a caring spirit. It pushes a person to examine values such as social justice and the ethics of life, and it becomes a part of who a nurse is.

Until all of us see nursing this way and until organizations provide sufficient resources to prevent avoidable trauma, which will allow nurses to provide safe, quality care nurses will continue to suffer. More will choose to leave the profession. Particularly now, that's a loss society can't afford.

Karen J. Foli is an associate professor at the School of Nursing, Purdue University. Disclosure: Foli received funding for her research from the National Council of State Boards of Nursing: Center for Regulatory Excellence. She receives royalties from her book, "The Influence of Psychological Trauma in Nursing."

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Nurses are struggling with trauma. But they were suffering long before Covid-19 hit - CNN

The news: A group of 239 scientists from 32 countries have written an open letter to the World Health Organization arguing that covid-19 can be transmitted through the air. You might think we know that already, but most current guidance is based on the idea that covid-19 is transmitted via droplets expelled from an infected persons nose or mouth. The thought is that these larger respiratory droplets quickly fall to the floor. That's the position the WHO has taken from early on in the pandemic, and thats why we have been keeping at a distance from one other. However, the signatories of the open letter say the organization is underestimating the role of airborne transmission, where much smaller droplets (called aerosols) stay suspended in the air. These aerosols can travel farther than droplets and linger in an area even when an infected person has left.

Whats the evidence? The letter says multiple studies have demonstrated beyond any reasonable doubt that viruses are released during exhalation, talking, and coughing in microdroplets small enough to remain aloft in air. It says these microdroplets pose a risk of exposure at distances beyond 1 to 2 m from an infected individual. An early laboratory study carried out by the US National Institutes of Healthfound that the coronavirus can linger in the air for up to four hours in aerosol form. The coronavirus was also detected in aerosols collected at two hospitals in Wuhan, China, according to a study published in Nature in April. And superspreading events add to the weight of evidence: for example, after a choir practice in the US nearly 50 people were infected even though they kept a safe distance apart.

The implications: If airborne transmission is a route for the spread of the virus, it could lead to changes in the current advice. It would suggest that social distancing may be insufficient, especially indoors. This may place yet more importance on mask-wearing around people who are not part of your household if you meet them indoors, even if you are distancing, and increasing ventilation in enclosed areas. It could make air-filtering systems more important to try to cut down on the recirculation of air. And it might mean health-care workers caring for coronavirus patients need the highest grade of maskN95to filter out the smallest droplets.

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A group of 239 scientists says theres growing evidence covid-19 is airborne - MIT Technology Review