Category: Covid-19

As thepandemic slammed Michigan, workers inside some of the state's hardest-hit nursing homes rationed protective gear, went without COVID-19 tests and struggled to care for seniors who carried a deadly virus.

At one Lapeer County facility, an occupational therapist and a nursing assistant said they had been ordered in late March not to wear masks by a supervisor, according to an inspection report.

On March 29 19 days after Michigan confirmed its first COVID-19 cases a nurse at a Macomb County facility told a government inspectorthat a resident there was "actively dying right now" and there were no tests for the virus available.

Out of the 45 nursing homes in Michigan that have reported the most deaths linked to COVID-19, nearly half 22 have been cited by state inspectors in the last four months for failing to follow infection control, isolation or staffing policies, according to a Detroit News review of hundreds of pages of state records.

The News' review of the documents provides the most comprehensive examinationyet ofconditions inside Michigan's nursing homes as the coronavirus began infecting vulnerable seniors in March and as hospitals were struggling to provide care for COVID-19 patients.They could also play into an ongoing policy debate over Gov. Gretchen Whitmer's decision to have facilities set up isolated areas for caring for residents with the virus.

As of Sunday, the Michigan Department of Health and Human Services had tracked 1,988 COVID-19 deaths linked to the facilities, accounting for 33% of the statewide death toll.

Nursing homes were caught off guard by the virus initially and haven't been able to catch up, said Tamara Blue, who worked for a facility in Detroit as a certified nursing assistant and is a representative for the Service Employees International Union. Blue was making $13 an hour at her job where she cared for residents with COVID-19 before she stepped away because she contracted it, she said.

"Its overwhelming," Blue said of working in nursing homes during the pandemic. Its heartbreaking because you are literally watching someone take their last breath over and over and over again. And theres nothing you can do about it."

But the situation varies from facility to facility, said Melissa Samuel, president and CEO of the Health Care Association of Michigan, which represents nursing homes. Likewise, she said, the severity of citations from inspectors varies.

"At the beginning of this battle, there were more unknowns than knowns," Samuel added. "New protocols and procedures were being written and implemented on a daily basis. The state and federal government changed our operations overnight.

"Facilities were working to comply and make those changes as quickly as possible. The primary reasons for the COVID-19 outbreaks in nursing facilities is the prevalence in the community and the lack of prioritizing these settings for testing and PPE (personal protective equipment)."

The 45 facilities reviewed by The Detroit News represent about 10% of the nursing homes statewide.

Of the 45, five didn't have COVID-19 inspection or survey reports available online through a website of the state Department of Licensing and Regulatory Affairs. For 18 others, government inspectors listed them in "substantial compliance" with safety policies after COVID-19-related surveys or didn't list any violations in documents available Wednesday.

The Bureau of Community and Health Systems within the Department of Licensing and Regulatory Affairs serves as an agent of the federal Centers for Medicare and Medicaid Services and provides regulatory oversight of the states nursing homes.

According to the available reports, 22 facilities failed to meet at least one standard directly related to stemming the spread of a virus that hasdevastated the elderly. Nearly 69% of Michigan's COVID-19 deaths have been individuals who were at least 70 years old, according to state data.

For every citation, a facility must write a plan of correction, and the state must then confirm that those corrections have been implemented, Samuel noted.

AARP Michigan, which advocates on behalf of the elderly, is "greatly concerned about differences in quality from one nursing home to another across the state," said Mark Hornbeck, the organization's spokesman.

"We know some long-term care facilities are doing a great job and others are struggling," Hornbeck added. "We are hearing firsthand accounts every day that reflect these differences."

Some Michigan nursing homes' violations have been relatively minor, such as masks found lying on the ground or a mystery oxygen tank left leaning on a chair in a common area inside the COVID-19 unit.

For others, state inspectors found a laundry list of missteps and specifically said in their reports the facilities' actions increased the potential for spread of COVID-19, hospitalizations and death.

An inspector required The Villages of Lapeer Nursing & Rehabilitation to seek "immediate" action to correct problems in April after workers revealed that the facility's then-director of nursing had ordered them not to wear masks inside the facility.

This is a section of an April 2020 state survey report examining the practices of The Villages of Lapeer Nursing & Rehabilitation.(Photo: Screenshot)

On March 24 14 days after Michigan confirmed its first cases of the virus the director of nursing, who isnot identified by name, entered the facility's therapy room and told an occupational therapist to remove "her own personal protective face mask," according to an inspector's report.

The occupational therapist "was not going to wear the mask in 'her building,'" the director of nursing said, according to the report.

"This was during a worldwide pandemic of the COVID-19 virus," the inspector wrote.

A nursing assistant at the facility told an inspector that the same director of nursing ordered her to take her mask off or "go home."

The director of nursing later resigned, and her successor said all personal protective equipment was welcomed at the facility. According to an inspector's report, the former director of nursing was concerned masks would cause "a panic." By April 7, an inspector found staff to be wearing proper protective equipment.

The Villages of Lapeer has reported 47 COVID-19 cases among residents, 16 cases among staff and 19 deaths linked to the virus among residents, according to state data. An official didn't respond to a request for comment for this story.

Medilodge of Southfield located at 26715 Greenfield Road(Photo: Max Ortiz, The Detroit News)

Many of the 22 facilities cited for failing to meet safety standards faced shortages in personal protective equipment, staffing or COVID-19 tests, according to the inspection reports.

At Medilodge of Southfield, a handful of employees told an inspector that they had to use the same isolation gown "all day for residents with COVID-19 and those without it," according to a state report on that facility.

A nursing assistant told an inspector that the assistant was not provided a face shield to use when caring for residents with the coronavirus before April 28, 49 days after Michigan confirmed its first cases of the virus.

"CNA I (the abbreviation used to keep the employee's name secret) indicated that residents would cough all over them and the staff were getting sick," an inspector wrote.

Medilodge of Southfield has reported 51 cases among residents, 16 cases among staff and 20 deaths linked to the virus among residents, according to the state's tracking.

Medilodge didn't respond to a request for comment. But according to the inspection report, staff members were re-educated on the use of personal protective equipment and walking rounds were made by management staff each shift to conduct observations of staff and the use of the equipment.

Advantage Living Center in Roseville.(Photo: Max Ortiz, The Detroit News)

Multiple facilities faced staffing shortages as employees called off work or contracted the virus and had to take time off, according to inspectors' findings.

At Advantage Living Center Roseville, a nursing assistant told a state inspector on March 29 that the nursing assistant wasthe only oneworking on the facility's isolation unit, which had 23 residents. Of those 23 residents, 98% required assistance or were incontinent, the nursing assistant said, according to the inspection report.

Asked how the nursing assistant providedregular care for each of the residents, the nursing assistant responded, "I can't."

On the same day in the same facility, an inspector reported questioning whether a nurse was aware their mask was not positioned properly.

'"No," the nurse replied before adding, ''I have one (resident) who is actively dying right now,'" according to the survey report.

This is a section of a state COVID-19 survey report on Advantage Living Center Roseville from March 2020.(Photo: Screenshot)

The nurse told the inspector she didn't have time to take a break, the facility wasn't able to obtain COVID-19 tests to determine whohad the virus and there were "no tests" available on March 29.

As of Tuesday, Advantage Living Center Roseville reported 66 COVID-19 cases among residents and eight among staff, according to state tracking data. The facility reported 20 COVID-19 deaths among residents and one death among staff.

Advantage Living Centers didn't respond to a request for comment. However, it instituted a plan to resolve issues identified in the state's inspection, according to the report. The plan included re-educating staff on personal protective equipment procedures.

Testing was also an issue at Medilodge of Kalamazoo, according to an inspection report.

This is a section of a state COVID-19 survey of Medilodge of Kalamzoo from April 2020.(Photo: Screenshot)

There, an unnamed nursing home administrator told an inspector on April 23 that four staff members had tested positive for COVID-19 and the administrator said "they would not test anymore of their staff members for COVID-19," according to a report.

A spokesman for Medilodge didn't respond to a request for comment. On June 15, Gov. Gretchen Whitmer's administration unveiled new testing policies, requiring nursing homes to test all residents and staff initially and to test residents and staff with symptoms of the virus.

Michigan's nursing home policies have been in the spotlight for months now as Republican lawmakers and some Democratic legislators have disagreed with the Democratic governor's decision to have elderly individuals with the virus cared for in isolated areas of existing facilities.

Republicans have argued individuals with COVID-19 should be cared for in other facilities like hospitals or separate quarantine centers to prevent the spread of the virus to other vulnerable nursing home residents. But Whitmer's administration has been worried about overwhelming hospital capacity during the pandemic and has voiced concerns about the ability to properly care for nursing home residents in a makeshift field hospital.

The debate has largely focused on buildings and not the safety of nursing home employees, said Sen. Jeff Irwin, D-Ann Arbor, who serves on the Senate Oversight Committee, which has been investigating nursing home policies.

"They cant afford to miss work if theyre sick," Irwin said of nursing home workers Wednesday. "They cant afford to contract a cold, much less COVID-19."

Samuel, who leads the Health Care Association of Michigan, said state and federal government need to prioritize nursing facilities for personal protective equipment, testing and support for staff.

"The collective goal of local, state, federal agencies as well as other stakeholders should be to build up nursing facilities to enable them to meet and overcome the challenges inherent with the presence of COVID-19," Samuel said. "Nursing facilities are taking extraordinary measures to meet the new expectations of how care is provided based on regulatory and operational changes required by the state and federal governments."

Whitmer established the Michigan Nursing Homes COVID-19 Preparedness Task Force in June to help the state ready facilities for a potential second wave of the virus. On Tuesday, the governor announced the task force's 20 members.

The panel includes four state lawmakers, two members of Whitmer's administration, the leaders of a handful of health care interest groups and TreceAndrews ofDetroit, who isa caregiver at the nursing home Regencyat St. Clair Shores.

"Im excited and proud to be a voice who can speak with first-hand experience on conditions in nursing homes," Andrews said in a press release. A lot of attention has been paid to resident safety, but not enough to worker safety."

On Monday, Michigan's Bureau of Community and Health Systems saidit had completed 100% of federally required infection control surveys of nursing homes. All of the state's 442 federally certified nursing homeswent through an infection control survey from March 26 through June 19, according to the press release.

cmauger@detroitnews.com

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Michigan nursing home workers faced 'heartbreaking' reality as COVID-19 hit, inspection records reveal - The Detroit News

Over 500 new COVID-19 cases reported as Washington nears 38,000 total cases  KOMO News

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Over 500 new COVID-19 cases reported as Washington nears 38,000 total cases - KOMO News

More on Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China  nejm.org

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More on Clinical Characteristics of Pregnant Women with Covid-19 in Wuhan, China - nejm.org

TOKYO (AP) The spokesman for the Tokyo Olympics expects the postponed games to go ahead in 2021 despite a recent poll in Japan in which 77% of respondents said they did not believe the games could be held next year.

The poll by the Japan News Network said only 17% thought it could be held next year in the face of the coronavirus pandemic.

Masa Takaya, the spokesman, was speaking Thursday on remote hookup on a day of contentious news for the Tokyo Olympics.

Tokyos city government reported a single-day record of 224 new coronavirus infections on Thursday, surpassing a high of 204 in April. Though low by many standards, it marks a steady increase over the last week in the Japanese capital.

Japan has recorded about 1,000 deaths attributed to COVID-19.

Takaya said the way the polls are constructed may result in very different messages. He said Tokyos only plan was to open the games on July 23, 2021.

Also, Takaya did not flatly deny a leaked report in almost all Japanese media that said organizers were on track to secure all venues for next years Olympics.

Tokyo 2020 is aware of these media reports, Takaya said. I need to be very clear that this is not something that the Tokyo Metropolitan Government or the organizing committee has made a formal announcement on.

Details of any progress are sure to be presented next week at scheduled meetings of the Swiss-based International Olympic Committee.

Organizers had previously said that 80% of the venues had been secured. Few expect local venue owners to defy the Japanese government, or the IOC, particularly if there are incentives in the new contracts.

Estimates in Japan put the cost of delay at $2 billion to $6 billion. The IOC and local organizers have not given any estimate.

A poll published last month by Japanese news agency Kyodo and a Tokyo television outlet found that 51.7% did not think the games should be held next year. But 46% wanted to see the rescheduled Olympics go forward.

Among those opposed, 27.7% said they should be canceled altogether, and 24% said they should be postponed again because of COVID-19.

The IOC and local organizers have ruled out another postponement and say they will be canceled if they dont happen in 2021.

Takaya also dismissed a recent comment attributed in Japanese media to Yoshiro Mori, the president of the Tokyo Olympic organizing committee. Mori reportedly said April was the deadline for deciding to go ahead with the Olympics.

We dont know in what kind of environment he might have made such a comment, Takaya said. In that respect, we dont even know if he made such a comment.

Takaya added: We do not have any such deadline.

___

More AP sports: https://apnews.com/apf-sports and https://twitter.com/AP_Sports

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Tokyo Games face skeptics, 1-day COVID-19 infection record - The Associated Press

By Laura French

DENMARK Falck has released the results of a COVID-19 study, which it says shows a correlation between frequent patient contact and positive antibody tests.

The Denmark-based emergency services company conducted the study in cooperation with Professors Henrik Ullum and Kasper Karmark Iversen from the Capital Region of Denmark, and received approval for the research from The Danish National Committee on Health Research Ethics, according to a Falck news release. The project was sponsored by the Lundbeck Foundation.

The company surveyed more than 3,000 of its employees in Sweden and Denmark, including EMS providers, firefighters, roadside assistance staff, office staff and other health care staff, and also tested the voluntary participants for COVID-19 antibodies.

Participants were asked about their number of daily patient or client contacts, ranging from zero to 20 or more. Researchers found that frequent patient contact correlated with the likelihood of a positive antibody test,according to the press release.

Falck reported that 3.4% of participants tested positive for antibodies. The company plans to conduct further research to gain knowledge of how the virus spreads in order to assess protection measures for employees and the public.

"With its design, the high number of participants geographically distributed and the regular testing, the study is an opportunity for us to gain knowledge of how the virus spreads over time and the risk of infection for employees with a high, daily number of patient contacts," said Falck CEO Jakob Riis, in a statement. "We will publish interim results during the project in order to use the new knowledge as quickly as possible."

Participants will continue to be tested for antibodies every other week until the end of 2020.

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Falck COVID-19 study finds correlation between patient contact and antibodies - EMS1.com

A scientist at work at the Serum Institute of India, which is working on COVID-19 vaccines. Two Indian companies have received the green light to start human trials of their candidate vaccines.

By Sanjay KumarJul. 6, 2020 , 4:55 PM

Science's COVID-19 reporting is supported by the Pulitzer Center.

NEW DELHIThe apparent speed at which an Indian government agency aims to test and approve a homegrown COVID-19 vaccine has created an uproar among scientists both in India, which is increasingly overwhelmed by the new coronavirus, and abroad. A letter leaked on Twitter on Friday suggests the first vaccines could be rolled out by 15 August, which would leave far too little time for proper testing, critics say. The Indian Academy of Sciences calls the timeline unreasonable and without precedent.

Six Indian companies are developing vaccines against COVID-19. Last week, the Indian government gave two of them, Bharat Biotech and Zydus Cadila, permission to start phase I and II human clinical trials of their most advanced vaccines, named covaxin and ZyCov-D respectively.

For covaxin, Bharat Biotech has joined with the National Institute of Virology, which is part of the Indian Council of Medical Research (ICMR). (The company is separately developing COVID-19 vaccine candidates in collaboration with Thomas Jefferson University in Philadelphia and the University of Wisconsin, Madison.)

ICMR Director-General Balram Bhargava revealed the extremely tight deadline in a letter to hospitals designated to be involved in the Covaxin studies. It is envisaged to launch the vaccine for public health use latest by 15 August 2020 after completion of all clinical trials, Bhargava wrote. He asked the hospitals to fast-track all approvals for the vaccine and be ready to enroll participants no later than 7 July 2020, adding that noncompliance will be viewed very seriously.

But its absurd to think studies could show a vaccine to be safe and effective in less than 2 months, many scientists say. In my knowledge, such an accelerated development pathway has never ever been done for any kind of vaccine, says Anant Bhan, an independent ethics and policy researcher and past president of the International Association of Bioethics. This seems really, really rushed. The timeline carries potential risks and provides inadequate attention to required safety procedures, Bhan adds.

Clinical trials cannot be rushed, concurs Indian virologist and veteran vaccine researcher Thekkekara Jacob John, formerly of the Christian Medical College in Vellore. Even when expedited, phase I and phase II trials will take a minimum of 5 months, he says. The duration of a phase III trial would depend on several factors, including the number of subjects enrolled and decisions by a data safety monitoring board, but would probably add at least another 6 months, Jacob John says. ICMRs intentions may be good but the processes have been vitiated and the risk is it can derail the vaccine, he says.

Critics believe the target date is political: 15 August is Indias Independence Day, when Prime Minister Narendra Modi traditionally climbs the ramparts of the Red Fort in Delhi to give a long speech touting his governments achievements and make major announcements.

In a statement on Saturday, ICMR said Bhargava's letter was meant to cut unnecessary red tape, without bypassing any necessary process, and speed up recruitment of participants.

Faced with the unprecedented nature of the COVID-19 pandemic, and the consequent dislocation of the normal life, all other vaccine candidates across the globe have been similarly fast-tracked, the agency claimed. In reality, no other country has announced plans to roll out a vaccine this fast, and ICMR did not explain how it thinks it can accelerate the process. Bharat Biotech declined Sciences request for comment.

India is eagerly awaiting a COVID-19 vaccine. It just surpassed Russia as the country with the third-highest number of cases, after the United States and Brazil. There were 24,000 confirmed new cases on Sunday; the national tally stands at 697,413 cases and 19,693 deaths.

But India should keep in mind that most vaccine candidates fail, says Seth Berkley, CEO of Gavi, the Vaccine Alliance. Normally, the probability of success for a vaccine in the preclinical phase is around 7%, rising to 15% to 20% for vaccines that reach clinical tests, such as Covaxin and ZyCov-D, Berkley says.

ICMRs actions lower the credibility of Indian science, says T. Sundararaman, global coordinator of the Peoples Health Movement, a network of grassroots health activists, civil society organizations, and academic institutions. Its not about getting there first but to be able to do it well and it is good that India has been able to come up with candidate vaccines, which is not a small achievement.

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Scientists scoff at Indian agency's plan to have COVID-19 vaccine ready for use next month - Science Magazine

TheWest Virginia Department of Health and Human Resources (DHHR)reports as of 10:00 a.m., on July 7, 2020, there have been 189,740 totalconfirmatory laboratory results receivedfor COVID-19, with 3,461 total cases and 95 deaths.

In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.

CASES PER COUNTY (Caseconfirmed by lab test/Probable case): Barbour(17/0), Berkeley (475/18), Boone (29/0), Braxton (3/0), Brooke (14/1), Cabell(162/6), Calhoun (2/0), Clay (11/0), Fayette (72/0), Gilmer (13/0), Grant (15/1),Greenbrier (66/0), Hampshire (42/0), Hancock (29/3), Hardy (44/1), Harrison(79/0), Jackson (145/0), Jefferson (240/5), Kanawha (345/10), Lewis (19/1),Lincoln (9/0), Logan (27/0), Marion (86/3), Marshall (43/1), Mason (21/0),McDowell (6/0), Mercer (57/0), Mineral (56/2), Mingo (20/3), Monongalia(287/14), Monroe (15/1), Morgan (19/1), Nicholas (14/1), Ohio (109/1),Pendleton (13/1), Pleasants (4/1), Pocahontas (34/1), Preston (73/16), Putnam(69/1), Raleigh (62/1), Randolph (169/2), Ritchie (2/0), Roane (11/0), Summers(2/0), Taylor (16/1), Tucker (6/0), Tyler (5/0), Upshur (20/1), Wayne (119/1),Webster (1/0), Wetzel (18/0), Wirt (5/0), Wood (127/8), Wyoming (7/0).

As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county, or even the state as an individualin question may have crossed the state border to be tested.

Please visit thedashboard at http://www.coronavirus.wv.gov for more information.

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COVID-19 Daily Update 7--7-2020 - 10 AM - West Virginia Department of Health and Human Resources

Seventy-three countries have warned that they are at risk of stock-outs of antiretroviral (ARV) medicines as a result of the COVID-19 pandemic, according to a new WHO survey conducted ahead of the International AIDS Societys biannual conference. Twenty-four countries reported having either a critically low stock of ARVs or disruptions in the supply of these life-saving medicines.

The survey follows a modelling exercise convened by WHO and UNAIDS in May which forecasted that a six-month disruption in access to ARVs could lead to a doubling in AIDS-related deaths in sub-Saharan Africa in 2020 alone.

In 2019, an estimated 8.3 million people were benefiting from ARVs in the 24 countries now experiencing supply shortages. This represents about one third (33%) of all people taking HIV treatment globally. While there is no cure for HIV, ARVs can control the virus and prevent onward sexual transmission to other people.

A failure of suppliers to deliver ARVs on time and a shut-down of land and air transport services, coupled with limited access to health services within countries as a result of the pandemic, were among the causes cited for the disruptions in the survey.

The findings of this survey are deeply concerning, said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. Countries and their development partners must do all they can to ensure that people who need HIV treatment continue to access it. We cannot let the COVID-19 pandemic undo the hard-won gains in the global response to this disease.

According to data released today from UNAIDS and WHO, new HIV infections fell by 39% between 2000 and 2019. HIV-related deaths fell by 51% over the same time period, and some 15 million lives were saved through the use of antiretroviral therapy.

However, progresstowards global targets is stalling. Over the last two years, the annual number of new HIV infections has plateaued at 1.7 million and there was only a modest reduction in HIV-related death, from 730 000 in 2018 to 690 000 in 2019. Despite steady advances in scaling up treatment coverage with more than 25 million people in need of ARVs receiving them in 2019 key 2020 global targets will be missed.

HIV prevention and testing services are not reaching the groups that need them most. Improved targeting of proven prevention and testing services will be critical to reinvigorate theglobal response to HIV.

COVID-19 risks exacerbating the situation. WHO recently developed guidance for countries on how to safely maintain access to essential health services during the pandemic, including forall people living with or affected by HIV. The guidance encourages countries to limit disruptions in access to HIV treatment through multi-month dispensing, a policy whereby medicines are prescribed for longer periods of time up to six months. To date, 129 countries have adopted this policy.

Countries are also mitigating the impact of the disruptions by working to maintain flights and supply chains, engaging communities in the delivery of HIV medicines, and working with manufacturers to overcome logistics challenges.

At the IAS conference, WHO will highlight how global progress in reducing HIV-related deaths can be accelerated by stepping up support and services for populations disproportionately impacted by the epidemic, including young children. In 2019, there were an estimated 95 000 HIV-related deaths and 150 000 new infections among children. Only about half (53%) of children in need of antiretroviral therapy were receiving it. A lack of optimal medicines with suitable pediatric formulations has been a longstanding barrier to improving health outcomes for children living with HIV.

Last month, WHO welcomed a decision by the U.S. Food and Drug Administration to approve a new 5mg formulation of dolutegravir (DTG) for infants and children older than 4 weeks and weighing more than 3 kg. This decision will ensure that all children have rapid access to an optimal drug that, to date, has only been available for adults, adolescents and older children. WHO is committed to fast-tracking the prequalification of DTG as a generic drug so that it can be used as soon as possible by countries to save lives.

Through a collaboration of multiple partners, we are likely to see generic versions of dolutegravir for children by early 2021, allowing for a rapid reduction in the cost of this medicine, said Dr Meg Doherty, Director of the Department of Global HIV, Hepatitis and STI Programmes at WHO. This will give us another new tool to reach children living with HIV and keep them alive and healthy.

Many HIV-related deaths result from infections that take advantage of an individuals weakened immune system. These include bacterial infections, such as tuberculosis, viral infections likehepatitis and COVID-19, parasitic infections such as toxoplasmosis and fungal infections, including histoplasmosis.

Today, WHO is releasing new guidelines for the diagnosis and management of histoplasmosis, among people living with HIV. Histoplasmosis is highly prevalent in the WHO Region of theAmericas, where as many as 15 600 new cases and 4500 deaths are reported each year among people living with HIV. Many of these deaths could be prevented through timely diagnosis and treatment of the disease.

In recent years, the development of highly sensitive diagnostic tests has allowed for a rapid and accurate confirmation of histoplasmosis and earlier initiation of treatment. However, innovative diagnostics and optimal treatments for this disease are not yet widely available in resource-limited settings.

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WHO: access to HIV medicines severely impacted by COVID-19 as AIDS response stalls - World Health Organization

Weve identified four key strategies for making free, fair, safe November elections possible in the face of COVID-19:

Face-to-face voter registration procedures are unsafe during the pandemic, so states need to provide other ways for eligible voters to update their registration status. Only 18 states have automatic voter registration, which is both eligible and secure. Other options like online registration are more widespread, but often include requirements that limit access. All states should offer accessible online registration along with same-day registration.

The safest way for people to vote this November is for every eligible voter to receive a ballot in the mail that can be returned in a self-adhesive, postage-paid envelope or dropped off at a secure ballot box. Unfortunately, too many states are behind the curve on vote-by-mail. Scaling up capacity is crucial. It will require removing legal barriers, expanding states capacity to handle mail ballots, investing in the US Postal Service, and implementing technology to allow voters to track their ballots.

Millions of Americans, due to disabilities or other factors, have no option but to vote in person. To meet their needs, states should establish strategically located voting centers and keep them open for at least two weeks before Election Day to prevent long lines and crowded polling places. By following Centers for Disease Control and Prevention guidelines for precinct hygiene and sanitation, states can make in-person voting a safe option for those who need it, ensuring that all voters have an equal opportunity to exercise their right to vote.

Expansion of mail-in voting will require transparent and rigorous processes to verify ballotsincluding training for verification judgesand to ensure that voters have an adequate opportunity to correct ballot errors. Election officials also need time to process and validate election results accurately, which means that election results in many places wont be available on election night. To maintain public confidence in the election process, states will need to work with local media and political organizations to ensure that the public is receiving accurate information. It will take months to put these procedures in place.

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Voting and COVID-19 - Union of Concerned Scientists

TheWest Virginia Department of Health and Human Resources (DHHR)reports as of 5:00 p.m., on July 6, 2020, there have been 188,875 total confirmatory laboratory results receivedfor COVID-19, with 3,442 total cases and 95 deaths.

In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.

CASES PER COUNTY (Caseconfirmed by lab test/Probable case): Barbour(17/0), Berkeley (474/18), Boone (24/0), Braxton (3/0), Brooke (14/1), Cabell(161/6), Calhoun (2/0), Clay (11/0), Fayette (72/0), Gilmer (13/0), Grant(15/1), Greenbrier (66/0), Hampshire (42/0), Hancock (29/3), Hardy (44/1),Harrison (79/0), Jackson (145/0), Jefferson (240/5), Kanawha (346/9), Lewis(19/1), Lincoln (9/0), Logan (26/0), Marion (85/3), Marshall (43/1), Mason(21/0), McDowell (6/0), Mercer (57/0), Mineral (56/2), Mingo (20/3), Monongalia(285/14), Monroe (15/1), Morgan (19/1), Nicholas (14/1), Ohio (109/1),Pendleton (13/1), Pleasants (4/1), Pocahontas (30/1), Preston (73/16), Putnam(68/1), Raleigh (62/1), Randolph (169/2), Ritchie (2/0), Roane (11/0), Summers(2/0), Taylor (16/1), Tucker (6/0), Tyler (5/0), Upshur (20/1), Wayne (119/1),Webster (1/0), Wetzel (18/0), Wirt (5/0), Wood (124/8), Wyoming (7/0).

As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county, or even the state as an individualin question may have crossed the state border to be tested.Such is the case of Monroe and Nicholas counties in this report.

Please visit thedashboard at http://www.coronavirus.wv.gov for more information.

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COVID-19 Daily Update 7-6-2020 - 5 PM - West Virginia Department of Health and Human Resources