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

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

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

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

There is something confounding about the USs new coronavirus spikes: Cases are rising, but the country is seeing its lowest death counts since the pandemic first exploded.

The numbers are genuinely strange to the naked eye: On July 3, the US reported 56,567 new Covid-19 cases, a record high. On the same day, 589 new deaths were reported, continuing a long and gradual decline. We havent seen numbers that low since the end of March.

When laypeople observe those contradictory trends, they might naturally have a follow-up question: If deaths are not increasing along with cases, then why cant we keep reopening? The lockdowns took an extraordinary toll of their own, after all, in money and mental health and some lives. If we could reopen the economy without the loss of life we saw in April and May, then why shouldnt we?

I posed that very question to more than a dozen public health experts. All of them cautioned against complacency: This many cases mean many more deaths are probably in our future. And even if deaths dont increase to the same levels seen in April and May, there are still some very serious possible health consequences if you contract Covid-19.

The novel coronavirus, SARS-Cov-2, is a maddeningly slow-moving pathogen until its not. The sinking death rates reflect the state of the pandemic a month or more ago, experts say, when the original hot spots had been contained and other states had only just begun to open up restaurants and other businesses.

That means it could still be another few weeks before we really start to see the consequences, in lives lost, of the recent spikes in cases. And in the meantime, the virus is continuing to spread. By the time the death numbers show the crisis is here, it will already be too late. Difficult weeks will lie ahead.

Even if death rates stay low in the near term, that doesnt mean the risk of Covid-19 has evaporated. Thousands of Americans being hospitalized in the past few weeks with a disease that makes it hard to breathe is not a time to declare victory. Young people, who account for a bigger share of the recent cases, arent at nearly as high a risk of dying from the virus, but some small number of them will still die and a larger number will end up in the hospital. Early research also suggests that people infected with the coronavirus experience lung damage and other long-term complications that could lead to health problems down the road, even if they dont experience particularly bad symptoms during their illness.

And as long as the virus is spreading in the community, there is an increased risk that it will find its way to the more vulnerable populations.

More infected people means faster spread throughout society, Kumi Smith, who studies infectious diseases at the University of Minnesota, told me. And the more this virus spreads the more likely it is to eventually reach and infect someone who may die or be severely harmed by it.

This presents a communications challenge. Sadly, as Smith put it, please abstain from things you like to benefit others in ways that you may not be able to see or feel is not an easy message for people to accept after three-plus months in relative isolation.

But perhaps the bigger problem is the reluctance of our government to take the steps necessary to control the disease. Experts warned months ago that if states were too quick to relax their social distancing policies, without the necessary capacity for more testing or contact tracing, new outbreaks would flare up and be difficult to contain.

Thats exactly what happened and now states are scrambling to reimpose some restrictions. Unless the US gets smarter about its coronavirus response, the country seems doomed to repeat this cycle over and over again.

The contradiction between these two curves case numbers sloping upward, death counts downward is the primary reason some people are agitating to accelerate, not slow down, reopening in the face of these new coronavirus spikes.

The most important thing to understand is that this is actually to be expected. There is a long lag as long as six weeks, experts told me between when a person gets infected and when their death would be reported in the official tally.

Why arent todays deaths trending in the same way todays cases are trending? Thats completely not the way to think about it, Eleanor Murray, an epidemiologist at Boston University, told me. Todays cases represent infections that probably happened a week or two ago. Todays deaths represent cases that were diagnosed possibly up to a month ago, so infections that were up to six weeks ago or more.

Some people do get infected and die quickly, but the majority of people who die, it takes a while, Murray continued. Its not a matter of a one-week lag between cases and deaths. We expect something more on the order of a four-, five-, six-week lag.

As Whet Moser wrote for the Covid Tracking Project last week, the recent spikes in case counts really took off around June 18 and 19. So we would not expect them to show up in the death data yet.

Hospitalizations and deaths are both lagging indicators, because it takes time to progress through the course of illness, Caitlin Rivers at the Johns Hopkins Center for Health Security told me late last week. The recent surge started around two weeks ago, so its too soon to be confident that we wont see an uptick in hospitalizations and deaths.

The national numbers can also obscure local trends. According to the Covid Tracking Project, hospitalizations are spiking in the South and West, but, at the same time, they are dropping precipitously in the Northeast, the initial epicenter of the US outbreak.

And a similar regional shift in deaths may be underway, though it will take longer to reveal itself because the death numbers lag behind both cases and hospitalizations. But even now, Alabama, Arizona, Florida, Nevada, South Carolina, Tennessee, Texas, and Virginia have seen an uptick in their average daily deaths, according to Covid Exit Strategy, while Connecticut, Massachusetts, and New York have experienced a notable decline.

There are some reasons to be optimistic we will not see deaths accelerate to the same extent that cases are. For one, clinicians have identified treatments like remdesivir and dexamethasone that, respectively, appear to reduce peoples time in the hospital and their risk of dying if they are put on a ventilator.

The new infections are also, for now, skewing more toward younger people, who are at a much lower risk of dying of Covid-19 compared to older people. But that is not the case for complacency that it might superficially appear to be.

For starters, younger people can die of Covid-19. About 3,000 people under the age of 45 have died from the coronavirus, according to the CDCs statistics (which notably have a lower overall death count than other independent sources that rely on state data). That is a small percentage of the 130,000 and counting overall Covid-19 deaths in the US. But it does happen.

Moreover, younger people can also develop serious enough symptoms that they end up having to be hospitalized with the disease. Again, their risk is meaningfully lower than that of older people, but that doesnt mean its zero.

There can also be adverse outcomes that are not hospitalization or death. Illness is not a zero-sum game. A recent study published in Nature found that even asymptomatic Covid-19 patients showed abnormal lung scans. As Lois Parshley has documented for Vox, some people who recover from Covid-19 still report health problems for weeks after their initial sickness. Potential long-term issues include lung scarring, blood clotting and stroke, heart damage, and cognitive challenges.

In short, surviving Covid-19, even with relatively mild symptoms, does not mean a person simply reverts to normal. This is a new disease, and we are still learning the full extent of its effects on the human body.

But even if we recognize that young people face less of a threat directly from the coronavirus, there is still a big reason to worry if the virus is spreading in that population: It could very easily make the leap from less vulnerable people to those who are much more at risk of serious complications or death.

One response to the above set of facts might be: Well, we should just isolate the old and the sick, while the rest of us go on with our lives. That might sound good in theory (if youre not older or immunocompromised yourself), but it is much more difficult in practice.

The fact is that we live in communities that are all mixed up with each other. Thats the concern, Natalie Dean, a biostatistics professor at the University of Florida, says. Its not like theres some nice neat demarcation: youre at high risk, youre at low risk.

The numbers in Florida are telling. At first, in late May and into early June, new infections accelerated among the under-45 cohort. But after a lag of a week or so, new cases also started to pick up among the over-45 (i.e., more at-risk) population.

The rise in older adults is trailing behind, but it is starting to go up, Dean said.

Anecdotally, nursing homes in Arizona and Texas the two states with the most worrisome coronavirus trends right now have seen outbreaks in recent weeks as community spread increases. The people who work in nursing homes, after all, are living out in the community where Covid-19 is spreading. And, because they are younger, they may not show symptoms while they are going to work and potentially exposing those patients.

As one expert pointed out to me, both Massachusetts and Norway have seen about 60 percent of their deaths come in long-term care facilities, even though the former has a much higher total fatality count than the latter. That would suggest we have yet to find a good strategy for keeping the coronavirus away from those specific populations.

There is so far not much evidence that we know how to shield the most vulnerable when there is widespread community transmission, Marc Lipsitch, a Harvard epidemiologist, told me.

That means the best recourse is trying to contain community spread, which keeps the overall case and death counts lower (as in Norway) and prevents the health care system from being overwhelmed.

Arizona, Florida, and Texas still have 20 to 30 percent of their ICU and hospital beds available statewide, according to Covid Exit Strategy, even as case counts continue to rise. While some people use those numbers to argue that the health systems can handle an influx of Covid patients, the experts I spoke to warned that capacity can quickly evaporate.

Lets keep it that way, shall we? William Hanage at Harvard said. Hospitals are getting close to overwhelmed in some places, and that will be more places in future if action isnt taken now. Also not overwhelmed is a pretty low bar.

Hospital capacity is another example of how the lags created by Covid-19 can lull us into a false sense of security until a crisis presents itself and suddenly its too late. Because it can take up to two weeks between infection and hospitalization, we are only now beginning to see the impact of these recent spikes.

And, to be clear, hospitalizations are on the rise across the new hot spots. The number of people currently hospitalized with Covid-19 in Texas is up from less than 1,800 on June 1 to nearly 8,000 on July 4. Hospitalizations in Arizona have nearly tripled since the beginning of June, up to more than 3,100 today.

And the state-level data doesnt show local trends, which are what really matter when it comes to hospital capacity. Some of the hardest-hit cities in these states are feeling the strain, as Hanage pointed out. Hospitals in Houston have started transferring their Covid-19 patients to other cities, and they are implementing their surge capacity plans, anticipating a growing need because of the trendlines in the state.

Once a hospitals capacity is reached, its already too late. They will have to endure several rough weeks after that breach, because the virus has continued to infect more people in the interim, some of whom will get very sick and require hospitalization when there isnt any room available for them.

Were seeing some drastic measures being implemented right now in Texas and Arizona along those lines: using childrens hospitals for adults, going into crisis mode, etc., Tara Smith, who studies infectious diseases at Kent State University, told me. So it shows how quickly all of that can turn around.

And, on top of Covid-19, these health systems will continue to have the usual flow of emergencies from heart attacks, strokes, accidents, etc. Thats when experts start to worry people will die who wouldnt otherwise have. That is what social distancing, by slowing the spread of the coronavirus, is supposed to prevent.

Lockdowns are extraordinarily burdensome. Tens of millions of Americans have lost their jobs. Drug overdoses have spiked. There has been a worrying increase in heart-related deaths, which indicates people who otherwise would have sought medical treatment did not do so during the worst of the outbreak this spring.

But we cannot will the coronavirus out of existence. Experts warned months ago that if states reopened too early, cases would spike, which would strain health systems and put us at risk of losing more people to this virus. That appears to be whats starting to happen. And it may get worse; if the summer heat has suppressed the virus to any degree, we could see another rebound in the fall and winter.

So we must strike a balance, between the needs of a human society and the reality that most of us are still susceptible to an entirely novel pathogen that is much deadlier and more contagious than the flu.

That means, for starters, being smarter about how we reopen than we have been so far. There is strong evidence that states were too cavalier about ending stay-at-home orders and reopening businesses, with just a handful meeting the metrics for reopening laid out by experts, as Voxs German Lopez explained.

What Ive seen is that reopening is getting interpreted by many as reverting back to a Covid-free time where we could attend larger group gatherings, socialize regularly with many different people, or congregate without masks, Kumi Smith in Minnesota said. The virus hasnt changed since March, so theres no reasons why our precautions should either.

To date, most states have opened up bars again and kept schools closed. Lopez made a persuasive case last week that weve got that backward. One of the most thorough studies so far on how lockdowns affected Covid-19s spread found that closing restaurants and bars had a meaningful effect on the virus but closing schools did not.

That study also found that shelter-in-place orders had a sizable impact. While those measures may not be politically feasible anymore, individuals can still be cautious about going out and when they do, they can stick to outdoor activities with a small number of people.

Masks are not a panacea either, but the evidence is convincingly piling up that they also help reduce the coronaviruss spread. Whether a given state has a mandate to wear one or not, that is one small inconvenience to accept in order to get this outbreak back under control.

And, really, that is the point. While the current divergence between case and death counts can be confusing, the experts agree that Covid-19 still poses a significant risk to Americans and it is a risk that goes beyond literal life and death. We know some of the steps that we, as individuals, can take to help slow the spread. And we need our governments, from Washington to the state capitals, to get smarter about reopening.

It will require collective action to stave off the coronavirus for good. Other countries have done it. But we have to act now, before we find out its already too late.

This story appears in VoxCare, a newsletter from Vox on the latest twists and turns in Americas health care debate. Sign up to get VoxCare in your inbox along with more health care stats and news.

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