Category: Covid-19

World Health Organization Director-General Tedros Adhanom Ghebreyesus speaks during a news conference this week in Geneva. Fabrice Coffrini/AFP via Getty Images hide caption

World Health Organization Director-General Tedros Adhanom Ghebreyesus speaks during a news conference this week in Geneva.

The head of the World Health Organization is warning that the COVID-19 pandemic is speeding up, and he criticized governments that have failed to establish reliable contact tracing to stop the spread of the coronavirus.

Speaking at a briefing in Geneva, Tedros Adhanom Ghebreyesus said: "We all want this to be over. We all want to get on with our lives. But the hard reality is this is not even close to being over."

"Although many countries have made some progress, globally the pandemic is actually speeding up," he said.

He said the solution is the same as it has been since the early days of the pandemic: "Test, trace, isolate and quarantine."

"If any country is saying contact tracing is difficult, it is a lame excuse," he said.

According to the latest tally from Johns Hopkins University, there have been more than 10 million confirmed coronavirus infections worldwide since the virus was first identified in China late last year, with more than a half-million deaths. The United States alone accounts for more than one-quarter of all confirmed cases with nearly 126,000 deaths.

"The lack of national unity and lack of global solidarity and the divided world ... is actually helping the virus to spread," Tedros said. "The worst is yet to come."

"I'm sorry to say that, but with this kind of environment and conditions we fear the worst," he said.

The head of WHO's emergencies program, Mike Ryan, said there had been "tremendous work" toward a coronavirus vaccine but said there's no guarantee of success.

In the U.S., a spike in coronavirus infections has been driven in part by people unwilling to heed public health guidelines to wear masks and continue social distancing.

Currently, the U.S. leads the world in both coronavirus infections and COVID-19 deaths. Brazil ranks second in the number of infections, followed by Russia, India and the United Kingdom.

President Trump has been highly critical of the WHO, accusing it of helping China cover up the extent of the pandemic within its borders. Earlier this month, the president announced that the U.S. was "terminating" its decades-long relationship with the WHO and would withdraw vital U.S. funding.

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WHO Chief On COVID-19 Pandemic: 'The Worst Is Yet To Come' - NPR

A gym in Redondo Beach, California, takes extreme measures to prevent COVID-19 transmission. A study in Norway suggests even with less stringent distancing, working out at the gym may be safe.

By Cathleen OGradyJun. 26, 2020 , 2:15 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

Wondering whether its safe to go back to the gym? Norwegian gymgoers may have some good news for you. A study on the risk of coronavirus transmission in Oslo found that people who went to a gym were no more likely to get infected, or sick, than people who didnt. Norway has reopened its gyms based on the tentative results, which were published as a preprint yesterday and still need to go through peer review.

But some epidemiologists arent so sure. Its possible that no one was infected at those Oslo gyms because there were very few COVID-19 cases in the city when the study was donenot because working up a sweat on the treadmill or lifting weights in the midst of a pandemic is safe.

So far, crucial decisions to reopen public spaces after lockdowns are being made on the basis of little evidence. Every child returning to school and every Zumba fan returning to class is taking part in a large, uncontrolled experiment. A much better approach is to carefully study the impact of each new step in reopening, argues Mette Kalager, a clinical epidemiologist at the University of Oslo and one of the lead scientists on the study.

Kalager and her colleagues worked with gyms in Oslo to recruit about 4000 participantsnone of whom had been tested for COVID-19in May and June. At that point, Norway had reported 8309 confirmed cases and 235 COVID-19related deaths since February, with the peak of the nationwide outbreak hitting in early May.

Although gyms across Norway were still closed, half of the participants were given the opportunity to train in five gyms that opened specifically for the study and upheld rigid standards of hygiene and social distancing, such as cleaning the machines after each use and keeping visitors 2 meters apart. The only people gymgoers encountered were other study participants and gym staff. More than 80% of people in this group made it to the gym at least once in the 2-week study period, and nearly 40% went more than six times. The other half werent allowed to visit the gym, and went about their daily lives as usual. After about 2 weeks, both groups tested themselves for SARS-CoV-2 using polymerase chain reaction swab tests.

Around 80% of the participants sent in their tests. None of 1868 people in the control group tested positive,and only one of 1896 gymgoers didbut that person had not yet been to the gym and likely was infected elsewhere, the researchers report in a preprint posted to medRxiv. Kalager and colleagues also searched Norways comprehensive public medical records and found that none of the participants in either group had been admitted to a hospital with COVID-19related complaints.

That doesnt mean gyms are safe, says Darren Dahly, an epidemiologist at University College Cork. Over the weeks of the study, Oslo was reporting only a handful of new cases per day, with a maximum of 24 in 1 day. That means people in the study were already at very low risk, he sayspossibly too low for a meaningful difference to be detected between the two groups.

Emily Smith, an epidemiologist at George Washington University, agrees. There were zero sick people who went to the gym in this study, she says. We need to know what happens when people who are sick with COVIDbut perhaps dont yet have symptoms or have mild symptomsgo to the gym, take a spin class, and share a locker room with others. Smith also points to the brief time period covered by the study: People who started to goto the gym a little later in the study period may have been exposed, but could have been tested too soon in the incubation period for the virus to be detectable.

Kalager agrees the results cant determine whether its safe to go to the gym in places like Arizona where the incidence of COVID-19 is much higher. But in places with low numbers of new cases, its safe, she says.

Widespread publicity of the results without noting the caveats could be harmful, says Hilda Bastian, a former consumer health care advocate and a Ph.D. student at Bond Universitywho studies evidence-based medicine. The risk is that people think it means all gyms are safe, if theres just some hygiene measures and a bit of social distancing, she says.

But Bastian applauds the use of a clinical trial to study the safety of reopening. Using trials to answer these kinds of questions is a good thing, Dahly agrees. Every reopening is an experiment, he says. The question is whether youre going to learn from it or not.

The next trial Kalager and her colleagues plan to run will compare infection risk at newly reopened gyms in Oslo that have more or less stringent hygiene and social distancing measures. With far higher numbers of attendees, she says, the trial will be able to offer stronger evidence on gyms safety and the success of hygiene measures.

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It's safe to go back to the gymif there's little COVID-19 around, study suggests - Science Magazine

Watch: Santa Clara County Public Health Department gives updates on COVID-19 and schools, June 30  The Mercury News

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Watch: Santa Clara County Public Health Department gives updates on COVID-19 and schools, June 30 - The Mercury News

A health worker in personal protective equipment stands in a COVID-19 intensive care unit in Taiz, Yemen. Ahmad Al-Basha /AFP via Getty Images hide caption

A health worker in personal protective equipment stands in a COVID-19 intensive care unit in Taiz, Yemen.

"I will kill you."

That's what a family member of a COVID-19 patient told a general practitioner at a private hospital in Aden, Yemen, amid the country's coronavirus outbreak in April.

Pointing a gun at the doctor, the family member pushed him to put the patient on oxygen and mechanical ventilation, two types of treatments for severe cases of COVID-19.

The doctor explained that he wouldn't be able to provide those options for the patient.

"We have a shortage of medical equipment," the doctor said, recalling the threat. "We even have to buy our own personal protective equipment."

But the family member didn't understand and kept pushing, the doctor said. "He said, 'Why? You want to kill my patient?' "

The doctor tried to calm the family member down and promised to do everything he could to help the patient. (He asked that his name be withheld to protect his identity. Health workers continue to receive threats in Yemen.)

Death threats, intimidation and violence are a part of the Yemeni doctor's daily reality as a health worker on the front lines of COVID-19 in Yemen, where there have been at least 992 confirmed coronavirus cases as of June 22. The danger he faces is part of a larger trend of attacks on health workers worldwide.

According to Insecurity Insight, a research group that documents violence against aid workers, there have been more than 400 reported global incidents of COVID-19-related violence affecting health care workers and facilities since January.

Insecurity Insight tracks attacks on health workers, including threats, assault, arrests and detention, kidnappings and conflict-related violence, along with a number of other types of attacks. Its researchers comb through incident reports from the World Health Organization and groups such as the Aid Worker Security Database and Physicians for Human Rights, along with media reports.

However, their data are "considerably understated," said Leonard Rubenstein, chair of the Safeguarding Health in Conflict Coalition and director of Johns Hopkins University's health, conflict and human rights program. While Insecurity Insight is a member of the coalition, Rubenstein did not work on the report.

"In almost all circumstances, the reliance on reporting by health facility operators tends to result in severe underreporting as they are too busy to report or see no advantage in taking the time to do so," he added.

Still, Rubenstein said he is "confident" in the report's data and that the information gives a good idea of what is happening at the moment.

"In the early weeks of the pandemic, a lot of the events were triggered by a fear of infection actually spreading," said Christina Wille, a founding member of Insecurity Insight.

On April 23 in Mexico, for example, two women were arrested in the beating of a health worker at a bus stop, accusing her of being infected with COVID-19 and putting others at risk. It's part of an uptick in attacks on doctors, nurses, ambulance drivers, Red Cross staff and other health workers in Mexico; people see them as "potential sources of infection," said Jordi Raich, head of the International Committee of the Red Cross regional delegation for Mexico and Central America in a statement.

The measures to control the pandemic have created new reasons for people to attack health workers, Wille said. Some people, terrified by being quarantined in an official facility, have used force to get themselves out. In Herat, Afghanistan, on March 16, for example, 38 patients at a health facility for two weeks fled early by breaking windows and attacking hospital staff.

"In the context of COVID-19, we are seeing more attacks by community members who do not normally figure among the perpetrators in our normal monitoring," she said.

Patients and their family members are not the only perpetrators. A police officer reportedly attacked an ambulance driver on March 26 in Burkina Faso over not complying with an imposed COVID-19 curfew.

Insecurity Insight also said that violence from existing conflicts has taken a toll on efforts by health care groups to control COVID-19. On April 6, for example, armed groups heavily shelled Al-Khadra Hospital in Tripoli, Libya. With 400 hospital beds, it was one of the only health facilities in the country to treat COVID-19 patients.

The type of threat that the Yemeni doctor experienced at his hospital is unfortunately "quite typical" around the world, Wille said.

The doctor estimates that at his Aden hospital a family member of a patient threatens a health worker with a gun or some kind of violence about three times a week.

Rayan Koteiche, a researcher with the group Physicians for Human Rights, which focuses on the Middle East and North Africa region, could not verify the doctor's account but said his group has corroborated the widespread use of guns to threaten health workers in Yemen.

"We've documented such incidents where family members, acquaintances, friends or colleagues of patients take it upon themselves to pressure, intimidate, threaten health workers to do more," Koteiche said.

Flashing a gun is not uncommon, he said: The proliferation of small arms in Yemen has been an issue for years, and it's not uncommon for civilians to carry "handguns, machine guns, automatic weapons they are very widespread."

Even before the pandemic, Yemen was a particularly dangerous place for health workers. Between March 2014 and December 2018, warring parties in the ongoing civil war carried out at least 120 attacks on medical facilities and health workers, according to a report co-authored by Koteiche titled " 'I Ripped the IV Out of My Arm and Started Running': Attacks on Health Care in Yemen."

The Yemeni doctor said some of his colleagues at the hospital have stopped working because they fear for their lives. He said he fears for his life, too.

When he was threatened in April, the first thing he thought about was his two children and wife: "I felt sad. What will they do if I get killed?"

Still, he continues his work. "We have to help people. We have to save lives," he said.

When asked if he had any special techniques or magical phrases to say to people who intimidate or threaten him on the job, the doctor said he just tries his best to de-escalate the situation. He tells them: "Pointing a gun won't help. It frightens the staff; it confuses them."

Health workers around the world are calling for more security measures to protect them while working.

Dr. Amara Khalid is a medical officer at the COVID-19 ward at Mayo Hospital in Lahore, Pakistan. On May 21, she wrote in a Facebook post that she and her husband were mobbed by about 25 people while working on the overnight shift at the hospital. They were "shouting that their patient was sick and doctors should check her ASAP," she wrote. With no security at the hospital, she and five workers were left to fend for themselves, trying to prevent the mob from entering the COVID-19 ward, then barricading themselves to call for help.

Khalid is working with a lawyer and petitioning the Lahore High Court to provide security provisions for health workers. "It's high time to do this, and it'll only be possible if we all unite for this cause," she wrote in an Instagram post aimed at Pakistani doctors.

"When we were attacked, I got really scared and even thought about leaving the job," Khalid said. "But there's already a shortage of doctors. And if there are no doctors in the hospital, then the chaos will increase. So somebody has to be there. Somebody has to sacrifice."

NPR correspondent Diaa Hadid in Pakistan contributed to this report.

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COVID-19 Health Workers Face Death Threats, Intimidation At Gunpoint : Goats and Soda - NPR

Earlier this month, the Bureau of Labor Statisticsreported that states and localities had already laid off 1.5 million government workers as a result of COVID-19-related budget woes. One might think that would have moved Congress to expedite much-needed relief to states and municipalities. After all,the layoffsepitomized the propensity for economic crises to turn government from a source of stability into one of added trauma.

However, because those disconcerting numbers were overshadowed by a positive jobs bounce in May, the plight of states and localities went overlooked. The broader, feel good employment numbers licensed a burst of complacency regarding the pandemics economic impact, at least among Republicans.

But that was then. Now, with COVID-19 casessurgingin Florida, Texas, and Arizona, the feel good moment of three weeks ago seems incredibly nave and remote. A sizable relief bill is essential amid fears about the fragility of the countrys nascent economic recovery. Yet in ways even beyond that, the case for significant aid to states and localities has come roaring back.

More layoffs are coming, as pandemic-related revenue crashes leave many cities and states billions of dollars in the red, forced to reckon with deep spending cuts because, generally, they must balance their budgets each year. In addition, the National League of Citiesreportedlast week that more than 700 cities have halted plans to improve roadways, buy new equipment, and complete upgrades to water systems and other critical infrastructure. All of this, too, portends postponed work, reduced job creation, and a drag on the economy, as do some cash-starved cities and states recent consideration oftax increasesto close budget shortfalls.

None of this is speculative.It has been well-documented that the drag of significant and protracted government layoffs meaningfully slowed the recovery from last decades Great Recession. According to Brookingss Hutchins Center Fiscal Impact Measure, cuts in state-financed spendinglowered real GDP growth about 1.2 percentage points between 2009 and 2012 (on average, 0.3 percentage point each year). It should give legislators pause that the potential budget cuts will be larger for the COVID-19 recession.

If more specific numbers are desired, a new report from Moodys Analyticswarns that doing nothing to address the economic perils of state layoffs and cutbacks could cost 4 million jobs in the next two years. According to Moodys, at least $500 billion in combined state and local aid is neededa figure much smaller than the $700 billion to $1 trillion infusionurgedby economist Timothy J. Bartik and myself in April. The magnitude of COVID-19s fiscal shock on states and localities is more than even the best-run state or local government can handle without having to make deep spending cuts or tax increases.

All of which underscores the need for sizable emergency aid for states and municipalities, along with supports for unemployed workers and struggling small businesses. The happy talk of a few weeks ago has dissipatedwhat we need now is action.

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As COVID-19 resurges, so does the threat to local budgets - Brookings Institution

Image caption Consultant neurologist Arvind Chandratheva points out brain damage on a scan

Stroke, delirium, anxiety, confusion, fatigue - the list goes on. If you think Covid-19 is just a respiratory disease, think again.

As each week passes, it is becoming increasingly clear that coronavirus can trigger a huge range of neurological problems.

Several people who've contacted me after comparatively mild illness have spoken of the lingering cognitive impact of the disease - problems with their memory, tiredness, staying focused.

But it's at the more severe end that there is most concern.

Chatting to Paul Mylrea, it's hard to imagine that he had two massive strokes, both caused by coronavirus infection.

The 64-year-old, who is director of communications at Cambridge University, is eloquent and, despite some lingering weakness on his right side, able-bodied.

He has made one of the most remarkable recoveries ever seen by doctors at the National Hospital for Neurology and Neurosurgery (NHNN) in London.

His first stroke happened while he was in intensive care at University College Hospital. Potentially deadly blood clots were also found in his lungs and legs, so he was put on powerful blood-thinning (anticoagulant) drugs.

A couple of days later he suffered a second, even bigger stroke and was immediately transferred to the NHNN in Queen Square.

Consultant neurologist Dr Arvind Chandratheva was just leaving hospital when the ambulance arrived.

"Paul had a blank expression on his face," he says. "He could only see on one side and he couldn't figure out how to use his phone or remember his passcode.

"I immediately thought that the blood thinners had caused a bleed in the brain, but what we saw was so strange and different."

Paul had suffered another acute stroke due to a clot, depriving vital areas of the brain of blood supply.

Tests showed that he had astonishingly high levels of a marker for the amount of clotting in the blood known as D-dimer.

Normally these are less than 300, and in stroke patients can rise to 1,000. Paul Mylrea's levels were over 80,000.

"I've never seen that level of clotting before - something about his body's response to the infection had caused his blood to become incredibly sticky," says Dr Chandratheva.

During lockdown there was a fall in the number of emergency stroke admissions. But in the space of two weeks, neurologists at the NHNN treated six Covid patients who'd had major strokes. These were not linked to the usual risk factors for stroke such as high blood pressure or diabetes. In each case they saw very high levels of clotting.

Part of the trigger for the strokes was a massive overreaction by the immune system which causes inflammation in the body and brain.

Dr Chandratheva projected Paul's brain images on a wall, highlighting the large areas of damage, shown as white blurs, affecting his vision, memory, coordination, and speech.

The stroke was so big that doctors thought it likely he would not survive, or be left hugely disabled.

"After my second stroke, my wife and daughters thought that was it, they would never see me again," Paul says. "The doctors told them there was not much they could do except wait. Then I somehow survived and have been getting progressively stronger."

One of the first encouraging signs was Paul's ability with languages - he speaks six - and he would switch from English to Portuguese to speak to one of his nurses.

"Unusually he learned several of his languages as an adult, and this will have created different wiring connections in the brain which have survived his stroke," says Dr Chandratheva.

Paul says he cannot read as fast as he used to, and is sometimes forgetful, but that's hardly surprising given the areas of damage in his brain.

His physical recovery has also been impressive, which doctors attribute to his previous very high level of fitness.

"I used to cycle for an hour a day, do a couple of gym sessions a week and swim in the river. My cycling and diving days are over, but I hope to get back to swimming," Paul says.

A study in the Lancet Psychiatry found brain complications in 125 seriously ill coronavirus patients in UK hospitals. Nearly half had suffered a stroke due to a blood clot while others had brain inflammation, psychosis, or dementia-like symptoms.

One of the report authors, Prof Tom Solomon of the University of Liverpool, told me, "It's clear now that this virus does cause problems in the brain whereas initially we thought it was all about the lungs. Part of it is due to lack of oxygen to the brain. But there appear to be many other factors, such as problems with blood clotting and a hyper-inflammatory response of the immune system. We should also ask whether the virus itself is infecting the brain."

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In Canada, neuroscientist Prof Adrian Owen has launched a global online study of how the virus affects cognition. Owen said: "We already know that ICU survivors are vulnerable to cognitive impairment. So as the number of recovered Covid-19 patients continues to climb, it's becoming increasingly apparent that getting sent home from the ICU is not the end for these people. It's just the beginning of their recovery."

"Sars and Mers, which are both caused by coronaviruses, were associated with some neurological disease, but we've never seen anything like this before," Dr Michael Zandi, consultant neurologist at the NHNN, told me. "The closest comparison is the 1918 flu pandemic. We saw then there was a lot of brain disease and problems that emerged over the next 10-20 years."

As the BBC's medical correspondent, since 2004 I have reported on global disease threats such as bird flu, swine flu, Sars and Mers - both coronaviruses - and Ebola. I've been waiting much of my career for a global pandemic, and yet when Covid-19 came along, the world was not as ready as it could have been. Sadly, we may have to live with coronavirus indefinitely. Here, I will be reflecting on that new reality.

A mysterious neurological syndrome known as encephalitis lethargica appeared around the end of World War One and went on to affect more than a million people worldwide. There is limited evidence of its causes, and whether the trigger was influenza or a post-infectious autoimmune disorder.

As well as a sleepiness coma, some patients had movement disorders that looked like Parkinson's disease, which affected them for the rest of their lives.

In his book Awakenings, the neurologist Oliver Sacks told the story of a group of patients who'd been frozen in sleep for decades, and how he used the drug L-Dopa to temporarily free them from their locked-in state.

We should be careful before reading too much into comparisons between Covid-19 and the 1918 Spanish flu pandemic. But with so many Covid patients having neurological symptoms, it will be important to look at the long-term effects on the brain.

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Coronavirus: What does Covid-19 do to the brain? - BBC News

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Seattle Times arts and culture reporter

Oktoberfest, one of Leavenworths biggest events, has been canceled due to concerns about COVID-19.

Our biggest concern was over our liquor permits being denied by the city and state, Projekt Bayern, the nonprofit that organizes Oktoberfest, wrote in its announcement, saying the states schedule of phased reopening from coronavirus closures had been too slow to accommodate the festival.

With little movement we decided to cancel the event to protect our patrons from losing their deposits for hotels and travel agendas, the announcement continued. The safety of our guests and employees was also a huge factor.

On June 27, the same day the Oktoberfest cancellation was announced, Gov. Jay Inslee and state Secretary of Health John Wiesman said that significant rebounds in COVID-19 activity led them to pause the states reopening schedule.

In 2018, the festival reported 35,000 people had attended for beer drinking, bands and Tyrolean dancing.

Next years Oktoberfest, the towns 25th, is scheduled for the weekends of Oct. 1-2, 8-9 and 15-16, 2021.

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Leavenworths Oktoberfest canceled due to COVID-19 concerns - Seattle Times

Our main goal was to get more Black and brown people in our communities tested, said Elizabeth Borchardt, a Mellowhood staff member. A lot of them may have barriers to getting to the other testing sites or they may be intimidated by the National Guard at the Alliant Energy Center, so Coach came up with the idea of bringing the testing to them where they feel comfortable.

Serving and aiding people of color has remained a topic of concern for public health officials and local leaders alike, as tensions continue to grow following the death of George Floyd and the protests that followed.

We recognize that when we set up the Alliant Energy Center site, while its great as a large testing site for a mass operation to take place, it didnt have that cultural competency and it wasnt super accessible, said Aurielle Smith, who leads Public Healths Policy, Planning and Evaluation division.

By providing a space in which community members are encouraged to ask questions, to say whats been stopping them from getting tested and create a more positive attitude toward testing, she said, site leaders hope to minimize fear.

Weve done a few tests where people have been anxious about testing so we let them watch us get tested, Smith said. I think the more we talk about testing and the more people share their experience about testing, the less fear will continue in our communities.

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Local organization seeks to make COVID-19 testing more inclusive for communities of color - Madison.com

Ohio's COVID-19 cases are rising, but not nearly as high as other states  ABC6OnYourSide.com

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Ohio's COVID-19 cases are rising, but not nearly as high as other states - ABC6OnYourSide.com

The world is being flooded with new terms in coverage of the COVID-19 global pandemic. Here's a glossary in case you're not up on the latest medical and testing jargon. We start with the nomenclature of the virus. Words are listed in thematic groupings (transmission and testing, for example).

Coronavirus: A category of viruses that can cause fever, breathing difficulties, pneumonia and diarrhea. Seven coronaviruses are known to infect humans, including four that can cause the common cold. Some are potentially fatal. The name comes from the Latin word "corona," which means crown. Under a microscope, these viruses are characterized by circles with spikes ending in little blobs.

Researchers have identified hundreds of coronaviruses in animals, such as camels, pigs, cats and bats, that are usually not transmissible to humans. In rare instances, a coronavirus mutates and can pass from animals to humans and then spread among people, as was the case with the SARS (severe acute respiratory syndrome) epidemic in the early 2000s and now with the COVID-19 pandemic.

SARS-COV-2 aka "novel coronavirus": The name for the virus that has spread rapidly around the world, causing infections in millions of people. The numeral "2" is meant to distinguish this coronavirus from the virus that caused the SARS epidemic.

COVID-19: The name of the disease that can be caused by SARS-COV-2. It stands for "coronavirus disease 2019," as doctors in Wuhan, China, first discovered patients ill with the disease in late 2019. The disease can present with a wide range of effects that researchers are still working to uncover. The evolving list of symptoms is broad, including: fever, dry cough, shortness of breath, headaches, chills, muscle pain, fatigue, diarrhea, nausea, vomiting and loss of taste or smell. Not every patient displays the full range of symptoms.

Epidemic: A sudden increase in the number of cases of a disease in a particular geographic area beyond the number health officials typically expect. An increase in a relatively small geographic area or among a small group of people may be called an "outbreak." The difference between an outbreak, an epidemic and a pandemic is subjective and depends on the opinions of scientists and health officials.

Pandemic: "An epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people," according to A Dictionary of Epidemiology. The World Health Organization declared COVID-19 a global pandemic on March 11, 2020, describing it as "the first pandemic caused by a coronavirus."

Transmission: How a virus gets from one individual to the next. In the case of SARS-COV-2, researchers think the virus is primarily spread via the respiratory route, through close contact with an infected person, whose virus-laden droplets are expelled from the nose or mouth and find their way into the eyes, noses and mouths of others. Other possible routes of transmission, currently under investigation, include touching virus-contaminated surfaces and then introducing those germs to one's eyes, nose or mouth; or breathing in clouds of tiny "aerosolized" virus particles that may be traveling on air currents.

Aerosolized virus particles: Smaller than droplets, these particles can be expelled by an infected individual. They hang in the air longer than larger droplets, which tend to fall due to gravity. But their role in transmission of COVID-19 is not yet clear.

Rate of transmission (RT): The average number of people each coronavirus carrier goes on to infect officially called the "effective reproductive number." If each subsequent generation of new infections decreases (if RT <1), the virus eventually disappears. An area's transmission rate depends on local policies and how people behave. "We can think of transmission risk with a simple phrase: time, space, people, place," Dr. William Miller, an epidemiologist at Ohio State University, told NPR. The more time a person spends in close spatial proximity to infected people, the higher the likelihood that the virus will spread. Interacting with more people raises the risk, and indoor places are riskier than the outdoors. RT can decrease in areas where many people acquire immunity to the virus, because the virus then runs out of new people to infect. (A related term, R0 pronounced "r nought" is the average rate of transmission in a population where no one has previously been affected.)

Superspreading event: When a person infected with a pathogen passes it on to an unusually high number of people. With COVID-19, large case clusters have resulted from business conferences, choir practices, funerals, family gatherings and cruises, among other settings. Virologists who researched superspreading events during the MERS outbreak say there are several possible reasons why these events emerge. Sometimes the virus may mutate to become more contagious. Or some people just exhale more virus from their lungs.

Viral shedding: When an infected person releases viral particles from their bodies, which may or may not be contagious depending on the stage of infection. This can happen through activities like breathing, speaking, singing, sneezing and coughing. For SARS-COV-2, researchers are measuring the length of time an infected person sheds virus by testing swab samples from infected people over time. An early study found that COVID-19 patients shed the virus for an average of 20 days. People also appear to shed the highest amounts of virus around the time symptoms first appear.

Fomite: An object covered with virus particles, possibly because someone recently sneezed or coughed respiratory droplets onto it. A countertop or a phone could become fomites if contaminated and serve as a potential source for "indirect" transmission if a person touches the virus-covered surface and then introduces the virus to their eyes, nose or mouth. The Centers for Disease Control and Prevention describes this as a "possible" route of coronavirus transmission but maintains that close contact between people is thought to be responsible for most new infections.

Asymptomatic: A person who is asymptomatic is infected with SARS-COV-2 but never develops any symptoms of the infection. Researchers are working to determine how many people who get infected fit into this category current estimates fall "anywhere between 6% and 41%," a World Health Organization official said June 9. "Asymptomatic" is sometimes used to describe anyone who shows no symptoms at the time of testing positive for the virus but some of these individuals may actually be "presymptomatic" and will develop symptoms over the next few days.

Asymptomatic/presymptomatic spread: When an infected person who has no symptoms of the disease transmits the novel coronavirus to someone else. It's not clear how frequently people with no symptoms are spreading the virus, but researchers have documented spread from both asymptomatic and presymptomatic cases. That is the main reason many health departments recommend mask-wearing in shared spaces to prevent the spread of the novel coronavirus, particularly from people who may not know they have it.

Herd immunity: The idea that if enough people in one place develop immunity to the virus, through exposure or vaccination, then the virus doesn't have any new people to spread to so it burns itself out. For COVID-19, the percentage of people who'd need immunity to slow the spread of the virus is estimated at 50 to 60%.

Comorbidity: A medical condition that increases a person's risk of becoming very sick if they develop COVID-19. These conditions include chronic kidney disease, COPD (chronic obstructive pulmonary disease), obesity, serious heart conditions and type 2 diabetes. Other conditions that may up someone's risk of severe COVID-19 disease include asthma, hypertension, compromised immune systems, smoking and type 1 diabetes.

Testing: A procedure to determine if the individual is, or has recently been, infected with a disease. The most common diagnostic test for the novel coronavirus involves taking a swab sample from someone's nose or throat and analyzing it for telltale signs of SARS-COV-2 viral RNA. Other tests look for proteins from the virus, or for antibodies in blood samples. For more information, check out NPR's testing primer.

Positive testing rate: The percentage of people tested who are confirmed to have the coronavirus. For SARS-COV-2, WHO officials say a positive testing rate of 10% or less may indicate that a community is conducting enough testing to find most cases.

Antibodies: Proteins produced by a person's immune system to fight an infection. In the case of the novel coronavirus, antibodies typically take about 1-3 weeks after infection to develop in measurable amounts. Antibodies may linger in the body after infection to provide ongoing protection against an invading pathogen. Public health officials are testing people's blood samples for antibodies against the novel coronavirus to see if they have been infected in the recent past. This will help researchers understand how widely the coronavirus has spread and gauge how many cases are asymptomatic.

Pool sampling: A testing strategy where samples from different people are combined into a larger batch that is tested for the presence of the coronavirus. If a batch tests positive, the samples would be retested individually to determine which ones contain the virus. The expectation is that, by testing several samples in one batch, more samples could be processed more quickly, and testing resources would be conserved. The FDA says pool sampling is most effective in populations where many negative results are expected, such as people with no symptoms of infection.

Peak: The day, or stretch of days, with the highest number of cases or deaths reported in a given period, as seen in a day-by-day breakdown (also called an epidemic curve). It generally indicates the "worst" point in an epidemic after the peak, case numbers subside. For more, see NPR's primer on "When will each state peak?"

Rolling average: The number of new confirmed cases or deaths, averaged over a couple of days. The duration is the researcher's choice different analysts have chosen to average the numbers of cases and deaths over 3, 5 and 7 days. The rolling average is a statistical analysis that smooths out day-to-day variations (such as a spike in cases due to changes in how they're reported) and helps spot longer trends. Also called "moving average."

Second wave: A fresh crop of coronavirus infections in an area where public health officials had brought virus transmission down to low levels. For instance, Hokkaido, Japan experienced double-digit increases in case numbers in April after reopening schools and allowing public gatherings. U.S. health officials have warned of a possible second wave of infections in the fall even as the country continues to battle its first wave.

Incubation period: The time from exposure to a pathogen to the time symptoms develop. The incubation period helps determine how long a person should be quarantined to prevent the spread of infection. For SARS-COV-2, the median incubation period is thought to be around 5 days. Most people who develop symptoms of COVID-19 will do so within 12 days which is why public health officials recommend a two-week quarantine for anyone who thinks they've been exposed to the novel coronavirus.

Isolation: Physically separating people who are known to be sick from those who are healthy. Hospitals commonly put patients who are sick in isolation to prevent the spread of disease.

Quarantine: The separation or restriction of movement of individuals who appear to be healthy but may have been exposed to an infectious disease to see if they become sick. The length of the quarantine depends on the incubation period for the disease. During the Ebola outbreak, for example, it was 21 days. For COVID-19, the recommended period is 14 days.

Contact tracing: Finding and notifying people who may have come into contact with a person infected with a disease so they can take measures to prevent the disease from possibly spreading. For the novel coronavirus, the CDC defines a close contact as somebody who has spent at least 15 minutes within 6 feet of a person with a confirmed or probable case of the coronavirus.

Social distancing: Staying a certain distance from other people in indoor and outdoor settings to lower one's chances of spreading or receiving virus-laden respiratory droplets the CDC suggests six feet. Widespread social distancing has been credited with reducing virus transmission in multiple countries. Also referred to as "physical distancing."

Zoonosis: Any disease that spreads from animals to people. The animals can range from tiny ticks to lumbering cattle. COVID-19 is considered a zoonotic disease it is thought to have originated in Chinese horseshoe bats and spread to humans, possibly with a stop in a different animal in-between.

Other helpful primers from NPR: Death Rate

Abraar Karan, a physician at Harvard Medical School, was a source for this glossary.

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Key Vocab For COVID-19: From Asymptomatic To Zoonotic : Goats and Soda - NPR