Category: Covid-19

Today is one of our states highest days of reported deaths and hospitalizations since this crisis began, said NC Governor Roy Cooper.

For the second day in a row and the third time this week, hospitalizations for COVID-19 in North Carolina were at an all-time high.

NC Gov. Roy Cooper and members of the Coronavirus Task Force held a briefing to discuss the latest COVID-19 numbers and trends.

Thursday North Carolina reported 708 hospitalizations. Hospitalizations were at 702 Wednesday, which is a spike of 81 from Tuesday.

Today is one of our states highest days of reported deaths and hospitalizations since this crisis began, NC Governor Roy Cooper said. "In North Carolina, our case count has continued to go up. We know that one reason for this is increased testing, which is critical to reigniting our economy and keeping people safe. Weve increased our testing significantly."

Cooper says that for now, hospitals should be well-equipped to surge beds and resources to meet demand. But the trend is on health officials' radar as they consider reopening plans."We are concerned about the number of hospitalizations for COVID-19 continuing to go up. This is why we're in phase two and not opening everything up," said Cooper. "This is why we think we need to stay in phase 2 for a while to see how these numbers go."

The governor and Health and Human Services also addressed the past few days of increasing percent-positive cases.They say while there have been some ups and downs in the data, the overall rate of positives has been fairly steady, around 8 percent.

The state leader also says where testing is focused on a given day might cause fluctuations in the results."Sometimes when you do a lot of testing in congregate facilities you might have a higher number of positives," Cooper explained during the press conference.

Cooper says the North Carolina Department of Health and Human Services website has an interactive tool to find a testing site in your area. It includes more than 300 places where you can go and get tested. CVS announced 55 new drive through testing locations across the state, including Mecklenburg County. Those locations will begin testing this weekend.

The state also reported 33 new deaths Thursday, which brings the total of COVID-19 related deaths across the state to 827.

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NC hits COVID-19 hospitalization high for second day in a row - WCNC.com

They Hyrum JBS plant employs 1,400 people to run their beef processing facility.

HYRUM Meat processing plants across the country are COVID-19 hotspots and many have shuttered until they get control, modify their practices and facilities to keep the deadly virus at bay.

JBS in Hyrum is one meat processing facility that is still going strong and its parent company, Pilgrims Pride, has invested more than $200 million to support its team members and their communities in North America. There are reports that some JBS U.S. plants have been affected by the virus so one of the countrys top producers of meat has gone to great lengths to reduce the spread of the infection.

All JBS facilities are open and operating, said company spokesman Bruett Cameron.

We have had to fundamentally alter our operations due to coronavirus, he said. All of our facilities are currently open and operating.

The meat packing company adopted more than $100 million in enhanced safety measures to keep their workplaces and team members safe. JBS has also increased sanitation and disinfection efforts, health screening and temperature checking, team member training and physical distancing.

They are also trying to protect their employees with reduced line speeds and increased availability of personal protective equipment, including face masks and face shields.

Pilgrims Pride companies have hired more than 1,000 new team members to conduct additional, around-the-clock sanitation and cleaning services, and to provide education, training and enforcement of COVID-19 preventive measures.

Since the arrival of the global coronavirus pandemic, our priority has been and remains the safety of our team members providing food for all of us, said Andre Nogueira, JBS USA CEO in a statement. We recognize our responsibility as a food company during this crisis and we have continuously evolved our operations, based on the latest available guidance from experts, to improve our coronavirus preventive measures.

The company has invested more than $100 million to enhance safeguards for their workforce and more than $50 million to reward team members with thank-you bonuses.

JBS USA and Pilgrims will invest more than $50 million in the local communities where their team members live and work. The investment will include donations to alleviate food insecurity, strengthen long-term community infrastructure and well-being, and support COVID-19 emergency response and relief efforts.

The investment is part of the $120 million global social commitment recently announced by JBS USA.

The companies are also investing in innovative technologies to combat the potential spread of coronavirus in their facilities, including ultraviolet (UV) germicidal air sanitation and plasma air technology to neutralize potential viruses in plant ventilation and air purification systems.

JBS USA andPilgrimshave removed approximately 10 percent of the eligible workforce in the United States that are the most vulnerable populations from their facilities, with full pay and benefits.

The gesture exceeds any recommended guidance from the U.S. Centers for Disease Control and Prevention, Bruett said.

We salute the men and women who are supplying food to those who need it most and the local communities that have always sustained our business, Nogueira said. We are not perfect and this has not been an easy time for any of us, but we are working tirelessly to keep our team members safe and provide food during this pandemic. We are all in this fight together.

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COVID-19 causes JBS in Hyrum to make adjustments to their meat production - Cache Valley Daily

Its technically challenging to actually find pathogens like bacteria or viruses floating around in the air. But Wood has a proxy metric that might at least indicate when a room is potentially riskier to be in. He measures the level of carbon dioxidefiguring that as people breathe in the available oxygen and exhale CO2, everyone else in the room then inhales it, and any airborne pathogens as well.

In technical terms, standards for heating, ventilation, and air-conditioning systems measure ventilation by calculating how often the air in a room swaps out for fresh air from outsidethats air changes per hour. But CO2 levels could potentially be an easier way to alert people if a room needs an air swap for safety. Anything above 1,000 parts per million in an enclosed space, Wood says, would be a sign that its time to open the windows or clear out.

Heres where things get complicated. These variations in small-particle behavior dont just apply to individuals or single spaces, but how the disease moves across all of them. Epidemiologists are starting to see the spread of Covid-19 not as a cloud or wave moving ineluctably around the world, but instead more like signals moving through a network. The close-quarter, asymptomatic infections that small particles make more likely might also explain the patchy, checkerboard spread of Covid-19 through households, cities, and even across the country.

People intuitively think that population density, like in a big city, would lead to more transmissionand at first glance, the massive outbreak in New York City seems to confirm that. But people mostly transmit the virus within their own networks, their own contacts. Thats who the virus jumps to. I might have basically five to 10 friends that I tend to spend more than 15 minutes in close contact with on a regular basis, wherever Im living, Metcalf says. Yet big cities might lead to more contacts outside of our social networkscasual contacts like commuting may be more frequent, and of course social networks may also be more dense.

The result, she says, could be spikier outbreaks that change with urban forms and even the weather. (Some viruses are seasonal and transmit better in cold, dry air versus heat and humidity, but a sticky August outside can mean cranked-high AC inside, which can actually spread a virus if its not filtered correctly.) This is all part of what Benjamin Dalziel, a population biologist at Oregon State University, calls spatiotemporal heterogeneity, variability in the way the disease spreads in different places at different times. That spottiness in transmission means that different kinds of public health interventions will be more or less effective depending on when and where theyre usedpersonal protective equipment and serious ventilation in some settings, rigorously enforced social distancing in others, moving businesses outdoors, continued disinfecting of surfaces, and so on.

Thats how to stop the virus from moving through the world, and its what scientists are trying to understand. Its about the focal points of transmission within a population, and understanding that some places and times are more important for propagating spread than others, Dalziel says. Physical distancing measures are blunt tools that address a fundamental prerequisite for transmission, but they are untenable over the long term. It would be really wonderful if there were one, or a few, factors like that where we could efficiently identify them, make a change, and see a widespread reduction in transmission while still being able to reopen. Wouldnt that be fantastic? he asks. But whats probably more likely is that theres a large number of factors that all contribute. There isnt going to be a magic bullet.

Meanwhile, the CDC has released recommendations on opening restaurants and schools promoting six feet of space between people, doing things outdoors, and mask-wearingeven as the president says he thinks places of worship should be able to hold indoor services. It cant be true that large groups gathering in small spaces are dangerous if youre eating but safe if youre praying. Even if thats how the world looks to some people, its clearly not the world of the virus.

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To Beat Covid-19, You Have to Know How A Virus Moves - WIRED

The government has failed to disclose the number of people tested for Covid-19 for the seventh day running, prompting criticism from senior scientists who said this risked a perception that there is something to hide.

On Friday, figures showed that less than 131,500 daily tests were carried out the previous day. No 10 insisted that it was on target to hit 200,000 daily tests by 1 June, as promised by health secretary Matt Hancock.

However, no figure for the total number of people tested was provided and hasnt been for a week which experts said makes it impossible to judge whether an adequate regime is in place to support the newly launched test-and-trace system.

Paul Hunter, professor of medicine at the University of East Anglia, said: Whether or not the Department of Health is trying to hide these figures ... not making them publicly available could be perceived as that.

If the government is setting targets that its then going to judge itself by, the results should be publicly available so that people outside the small group of advisers to the government are able to judge them independently. It does feel that the openness is not there.

Prof Allyson Pollock,director of the Newcastle University Centre for Excellence in Regulatory Science, said the lack of transparency was concerning at a critical time when testing was required to ensure restrictions can be eased safely without triggering a resurgence of infections.

I have no idea whether weve got adequate testing [for track and trace] because we just dont have enough information, she said. We should know how many peoplehave been tested, why theyve been tested, where theyve been tested, who has done the test, the test results. We havent got those figures.

The latest figures provide the number of people tested in Pillar 1 (people in hospital and health and care workers), but not for Pillar 2 (tests for the wider population carried out at drive-through centres or through home testing) or overall figures. These numbers were last made available on 22 May.

The Department of Health website states: Reporting on the number of people tested has been temporarily paused to ensure consistent reporting across all pillars.

The most recent available figures for Pillar 2 show that there had been around 1.6 million tests to date, but just 1.1 million people tested in this category. The gap of roughly 500,000 is understood to be accounted for by people who have had retests and because tests mailed out for home testing and to satellite labs are only counted as people tested once they return to the system.

Only a small percentage of people in Pillar 2 have retests, according to the Department of Health, suggesting that hundreds of thousands of tests mailed out to homes and satellite labs potentially more than a third of those mailed out had not returned to the system by last week.

If this service is working properly we need to know that the tests are being done and not just disappearing into the postal service never to be seen again, said Hunter.

The Department of Health declined to say how many tests have been mailed out, but have not returned to the system or are awaiting use in satellite laboratories.

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'Something to hide': UK government accused over Covid-19 tests - The Guardian

The pandemic is gifting us an unprecedented opportunity to take innovative action and comprehensively confront the scourge of violence against women.

We have a unique window in which, as a human family, we are able to boldly address the social ills Covid-19 is unearthing, and redesign and rebuild our social fabric.

In this process of self-examination, we must work to root out the global epidemic of gender-based violence as aggressively as we are tackling the pandemic itself.

The lockdowns expose what many of us have always known our most intimate spaces, our homes, are not always safe places. Research by the UN Population Fund (UNFPA) predicts that there will be at least 15 million more cases of domestic violence around the world in 2020 for every three months that lockdowns are extended.

A pandemic within a pandemic has been exposed and we are confronted with the horrific reality that millions of women and children in every country are fighting for their survival not from Covid-19 but from the brutalities of abusers in the prisons of their homes.

Studies indicate domestic violence has increased by upwards of 25% in numerous countries as a result of shelter-in-place measures.

Abuse survivors are facing limited access to protective services during periods of quarantine. It is no secret that pandemic restrictions have negative ramifications for adults and children already living with someone who is abusive or controlling, and access to support services are significantly constrained.

Most unfortunate is while the need for survivor support is increasing, justice is proving hard to access. Resources are being diverted away from judicial systems towards more immediate public health measures. In every country, hotlines, crisis centres, shelters, as well as critical legal aid and social services, are being scaled back due to infection control measures. Many courts have closed their doors.

Necessity is the mother of invention, the saying goes. And Covid-19 just may be the midwife we need to help birth a flattening of the gender-based violence curve. We have an opportunity here for criminal justice systems to be completely overhauled to fight gender-based violence.

A UN Women report shows countries from Kenya to Trinidad are supporting justice systems to continue using remote technologies and other protective measures. Some courts are prioritising urgent interim restraining orders or child maintenance orders. Australias family courts have fast-tracked all lockdown-related cases.

Countries need to fund innovations promoting remote judicial services, invest in specialised protection services, work with the private sector and create more channels for accessing justice, such as by collaborating with community-based paralegals and non-lawyer legal assistance initiatives. The time is ripe to address the lack of sensitivity in police and court proceedings as well as rehabilitative support for offenders and survivors. We need to support justice leaders by creating a virtual forum for ministers to share best practice and highlight urgency.

There are many impressive practical initiatives taking steps to lessen the dangers women face at the hands of their abusers. Countries such as Spain and France have created emergency warning systems in supermarkets and pharmacies to offer counselling and help with reporting. Canada is keeping shelters open and earmarking resources in its relief bill, categorising them as essential services. Out of a necessity for more shelters, 20,000 hotel rooms for survivors will be paid for in France. Police in Odisha, India, have implemented a phone-up programme, where officers check up on women who previously filed reports of domestic violence before the lockdown. These innovative approaches need to go beyond the confines of borders, be adapted for local contexts and replicated at scale globally.

The innovation and resilience of grassroots justice groups continues to give me hope in these dark times. They too are on the frontlines, leading rights awareness campaigns, adapting to deliver legal advice remotely and ensuring disadvantaged groups are not overlooked.

As the global community mobilises funding for response and reconstruction, financing for civil society organisations should be built in from the start. The United Nations Multi-Partner Trust Fund for Covid-19 Response and Recovery has pledged to work in partnership with civil society. It must follow through and offer fast, flexible financing not only to community health initiatives, but also to civil society groups.

Social media is another powerful weapon at our disposal. Bold advocacy and awareness campaigns should become a common feature on our TV and phone screens.

We have been presented with the opportunity to reimagine and redesign our societies to be safe, vibrant and equitable. We are proving that we can come together as a united human family to holistically tackle Covid-19; let us apply an equally comprehensive, vigorous and unrelenting focus to eradicating gender-based violence as well.

Graa Machelis the deputy chairof global human rights organisationThe Elders, founder of theGraa Machel Trust, and an international advocate for womens and childrens rights

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Covid-19 has gifted us a chance to end gender-based violence. We must take it - The Guardian

The answer, though fanciful, illustrates just how hard it can be to understand exponential growth and doubling, two pieces of math that explain the spread of viruses like Covid-19.

Because by the time you made the 42nd fold, your stack of paper would reach the moon. It's not just a handy fact for trivia night: It shows how exponential growth can result in numbers that are nearly incomprehensible.

"Math concepts are really hard," she said. "It's not a surprise that the general public has a hard time grasping these."

And now, with a pandemic dominating global headlines, Covid-19 is putting Americans' knowledge to the test.

Classroom educators and education activists have said they're concerned by some aspects of the public response to the virus, including angry reactions to the guidelines designed by epidemiologists to keep America safe.

"If people understood how an outbreak could take off so quickly, and it does get back to this concept of exponential growth, they might be more careful about how they go about their day," Wasserman said.

Quiz time

Learning to think like a scientist

While the basics of viral spread, infection and other scientific ideas can help decode stories about Covid-19, many science educators say there's a broader perspective required when it comes to understanding what's happening in the world.

"It's impossible to teach students about everything," said Blake Touchet, who teaches biology at North Vermillion High School and Abbeville High School in Louisiana.

There's simply too much to know, he said. And the frontiers of scientific knowledge are always changing as theories get updated and revised. Instead, Touchet teaches his students to think like scientists.

"It's important that they understand how the process of science works, so that they can continue growing and learning even when they're out of school," he said.

One skill that Touchet emphasizes in his high school classes is called source evaluation, which can be applied to news articles, podcasts or even a study from a scientific journal.

"Analyzing and evaluating it to see if it has bias, or whether it's containing accurate information or whether it's reliable," he said.

In teaching students about the process of science, Touchet also emphasizes the significance of scientific consensus, which can bring clarity to contentious topics.

"There was a study that was published showing that 97% of scientists agree with anthropogenic climate change that humans are causing climate change," he said, offering an example of a clear scientific consensus.

In the news, Touchet said the situation is sometimes represented as an unresolved debate, despite the fact that most experts actually agree on the facts.

"That was a really good visualization of what we're thinking about when we're looking at scientific consensus," Touchet said. "We're not talking about people who are agreeing or disagreeing with each other. We're talking about data."

It's an idea that Touchet said is directly applicable to understanding news about Covid-19, especially when a lone scientist goes on television to tout a so-called cure with little support in the broader community.

America's education gap

Those skills of evaluating scientific ideas are more essential than ever, but Americans' grasp of science varies widely.

Where you went to school matters, too.

Students in some areas have few opportunities to engage with science outside of school, Reid said. She called these places "science deserts," and while the NCSE works in many rural areas, Reid explained that some urban students also lack access to learning opportunities.

Where science meet politics, that information gap feeds a dangerous division.

"Teacher education programs should anticipate, and equip future teachers to deal with, the politicization of science," the report found.

And while the challenges of understanding math and science are not limited to the United States, Americans' competencies in these subjects often fall far behind other developed countries.

In the most recent figures from the Programme for International Student Assessment, students from the United States ranked 37th in math among participating education systems. We did a bit better in science, coming in at 18th place.

Learning more about science at any age

Just because Americans lack some basic information about science doesn't mean they're not interested.

"The term 'anti-science' is thrown around a lot, and I don't think it captures the situation very well," Reid said.

"There are certain areas of science where there's a lot of misinformation pumped into the system, and people accept that information because it's coming from people they trust. But I don't think that makes them anti-science."

In fact, some of the same polls that revealed gaps in Americans' understanding of science spoke to their desire to learn more. A 2016 National Science Board study found that 95% of Americans were interested in new medical discoveries, and 84% were interested in scientific discoveries.

If you're one of the Americans who wants to learn more, there are plenty of free resources for brushing up on your understanding of science.

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Confused by the science behind Covid-19? You're not alone - CNN

Gov. Tim Walzs restrictions on businesses during the COVID-19 pandemic have had a profound economic impact in Minnesota, causing more than 710,000 people to apply for unemployment benefits since March 16. The Twin Cities metro area alone was down more than 270,000 jobs in April compared to April of 2019.

But the fallout from COVID-19 hasnt just affected employment. There has also been an increase in need for help paying for food, housing and other daily costs in Minnesota. One way to measure this increase is through calls to a statewide 211 helpline run by the Greater Twin Cities United Way. That organization has seen an explosion in the number of people needing assistance.

Hennepin County, on the other hand, has had only a modest influx in applications for cash aid like the Supplemental Nutrition Assistance Program (SNAP), which helps people buy groceries. While the county is bracing for greater need down the road, its even reporting something peculiar: a decrease in April applications for short-term, emergency assistance programs.

The United Way runs a free 211 helpline for people to call in seeking aid to meet their basic needs. When a person calls, texts, or chats online with 211 operators, they can get a referral for what service could best help them, including government aid programs.

Between March 16 and May 16, There was a 395 percent increase in referrals for food help over the same period in 2019. (Demand has also spiked at food shelves.) Utility referrals were up 153 percent and healthcare referrals jumped 85 percent.

There was also a 109 percent increase in referrals for clothing and household goods, which Julie Ogunleye, who leads the United Ways 211 information and referral program, said includes cleaning supplies and hygiene needs like toilet paper.

Julie Ogunleye

Ogunleye said theyre watching for an even larger increase once Walzs statewide eviction moratorium is lifted. The United Way didnt have data to compare the need for services and help to the Great Recession, but Ogunleye said that economic downturn was more of a slow moving disaster.

The state Department of Human Services had limited early data on how the pandemic is driving the need for Minnesotas most common forms of assistance. But average daily applications to SNAP rose from 394 in late February to 543 in late March.

Between March and April, 64,000 people were added to SNAP, a larger jump in participation compared to the first two months of the year, according to DHS. In 2019, the state averaged 400,000 total monthly recipients.

Daily applications to the Minnesota Family Investment Program (MFIP), a cash assistance program for low-income families with children, rose from 60 in late February to 116 during mid-to-late March. And daily applications were already rising to SNAP and MFIP, both of which are administered by county and tribal governments, before the pandemic.

In Hennepin County, applications to SNAP were up 12 percent in April compared to the same month in 2019, while applications for cash assistance like MFIP were up 10 percent in March and April compared to 2019.

MFIP helps low-income families with children get cash and food benefits. The cash help is dependent on the size of a family, though state lawmakers boosted the monthly payment by $100 in 2019, the first time it had been raised in 33 years.

Caseload for health care programs like Medicaid were up from 92,500 to 100,200 since March. In April 2019, the health care caseload was 92,390.

Applications for emergency assistance which includes programs that give short-term cash aid to people in financial crises, typically for housing needs like rent, mortgage and utility payments, home repairs, emergency temporary shelter and foreclosure prevention were up 10 percent in March compared to 2019. But in April, applications actually declined by 5 percent compared to the same period last year.

Jason Hedin, the countys human services program manager, said the 10 percent spike across programs in March and April has also come back down to at or below year over year trends.

The modest increase in applications has been surprising, Hedin said. But he added the state and federal aid such as the extra $600 a week in unemployment benefits and $1,200 cash payment for most Americans might be the reason there hasnt been a bigger spike in applications for these cash help programs. The moratorium on evictions and promises from utility companies to avoid shutting off services during the pandemic could also be preventing greater need, Hedin said.

The jump during March and April was still notable and higher than any typical seasonal fluctuation, Hedin said. And caseloads in the programs had been fairly even in the previous six months. But the dip in emergency assistance applications was still unexpected, Hedin said.

We know theres been an influx of other funding sources, Hedin said. In other sorts of economic downturns there maybe wasnt as many.

In Ramsey County, spokesman Chris Burns said applications to SNAP and MFIP have been fluctuating, and said its hard to get a full picture of trends caused by COVID-19. Preliminary data shows fewer approved SNAP applications in March of 2020 than March of 2019, though the information may be incomplete based on lag in how its recorded.

Still, Burns and Hedin said the early numbers may give way to a jump in need once federal payments and moratoriums on bills start to end. Given the current situation with job losses, we anticipate that the eventual trend will be more need for assistance, Burns said.

If the extra unemployment payments expire, will that then cause another increase or a spike in applications for the programs that were administering here? Hedin said.

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Beyond unemployment: How COVID-19 is affecting assistance programs throughout Minnesota - MinnPost

With physician offices not seeing patients with COVID-19 symptoms in April, Timothy Regan said he had little choice when Denver Health directed him first to its urgent care facility and then to its emergency room. "I felt bad, but I had been dealing with it for a while," he says. Ethan Welty for KHN hide caption

With physician offices not seeing patients with COVID-19 symptoms in April, Timothy Regan said he had little choice when Denver Health directed him first to its urgent care facility and then to its emergency room. "I felt bad, but I had been dealing with it for a while," he says.

From late March into April, Timothy Regan had severe coughing fits several times a day that often left him out of breath. He had a periodic low-grade fever too.

Wondering if he had COVID-19, Regan called a nurse hotline run by Denver Health, a large public health system in his city. A nurse listened to him describe his symptoms and told him to immediately go to the hospital system's urgent care facility.

When he arrived at Denver Health where the emergency room and urgent care facility sit side by side at its main location downtown a nurse directed him to the ER after he noted chest pain as one of his symptoms.

Regan was seen quickly and given a chest X-ray and electrocardiogram, known as an EKG, to check his lungs and heart. Both were normal.

A doctor prescribed an inhaler to help his breathing and told him he might have bronchitis. The doctor advised that he had to presume he had COVID-19 and must quarantine at home for two weeks.

At the time, on April 3, Denver Health reserved COVID-19 tests for sicker patients. Two hours after arriving at the hospital, Regan was back home. His longest wait was for his inhaler prescription to be filled.

Regan wasn't concerned about just his own health. His wife, Elissa, who is expecting their second child in August, and their 1-year-old son, Finn, also felt sick with symptoms like those of COVID-19 in April. "Nothing terrible but enough to make me worry," he said.

Regan, who is an estimator for a construction firm, worked from home throughout his sickness including while quarantined. (Construction in Colorado and many states has been considered an essential business and has continued to operate.) Regan said he was worried about taking a day off and losing his job.

"I was thinking I had to make all the money I could in case we all had to be hospitalized," he said. "All I could do was keep working in hopes that everything would be OK."

Within a couple of weeks, the whole family indeed was OK. "We got lucky," Elissa said.

Then the bill came.

The patient: Timothy Regan, 40, an estimator for a construction company. The family has health insurance through Elissa's job at a nonprofit in Denver.

Total bill: Denver Health billed Regan $3,278 for the ER visit. His insurer paid $1,042, leaving him with $2,236 to pay based on his $3,500 in-network deductible. The biggest part of the bill was the $2,921 general ER fee.

Service provider: Denver Health, a large public health system

Medical service: Regan was evaluated in the emergency room for COVID-19-like symptoms, including a severe cough, fever and chest pain. He was given several tests to check his heart and lungs, prescribed an inhaler and sent home.

What gives: When patients use hospital emergency rooms even for short visits with few tests it's not unusual for them to get billed thousands of dollars no matter how minor the treatment received. Hospitals say the high fees come from having to staff the ER with specialists 24 hours a day and keep lifesaving equipment up to date.

Denver Health coded Timothy's ER visit as a Level 4 the second highest and second most expensive on a 5-point scale. The other items on his bill were $225 for the EKG, $126 for the chest X-ray and $6 for his albuterol inhaler, a medication that provides quick relief for breathing problems.

The Regans knew they had a high deductible, and they try to avoid unnecessarily using the ER. But with physician offices not seeing patients with COVID-19 symptoms in April, Timothy said he had little choice when Denver Health directed him first to its urgent care and then to its ER. "I felt bad, but I had been dealing with it for a while," he said.

Elissa said they were trying hard to do everything by the book, including using a health provider in their plan's network.

"We did not anticipate being hit with such a huge bill for the visit," Elissa said. "We had intentionally called the nurse's line trying to be responsible, but that did not work."

In an effort to remove barriers to people getting tested and evaluated for COVID-19, UnitedHealthcare is one of many insurers that announced it will waive cost sharing for COVID-19 testing-related visits and treatment. But it is not clear how many people who had COVID-19 symptoms but who did not get tested when tests were in short supply have been billed as the Regans were.

Resolution: A Denver Health spokesperson said Regan was not tested for COVID-19 because he was not admitted and did not have risk factors such as diabetes, heart disease or asthma. He was not billed as a COVID-19 patient because he was not tested for the virus. The medical center has since expanded its testing capacity, the spokesperson said.

UnitedHealthcare officials reviewed Regan's case at the request of Kaiser Health News. Based on Regan's symptoms and the tests performed, Denver Health should have billed them using a COVID-19 billing code, an insurer spokesperson said. "We reprocessed Mr. Regan's original claims after reviewing the services that he received," a UnitedHealthcare spokesperson said. "All cost share for that visit has been waived."

Timothy and Elissa Regan say they try to avoid needlessly visiting the ER because of their high-deductible insurance plan. Denver Health billed $3,278 for Timothy's ER visit. Ethan Welty for KHN hide caption

Timothy and Elissa Regan say they try to avoid needlessly visiting the ER because of their high-deductible insurance plan. Denver Health billed $3,278 for Timothy's ER visit.

The Regans said they were thrilled with UHC's decision.

"That is wonderful news," Elissa said upon hearing from a KHN reporter that UHC would waive their costs. "We are very thankful. It is a huge relief."

The takeaway: The Regans said they initially found no satisfaction in calling the hospital or the insurer to resolve their dispute but it was the right thing to do.

"He's definitely not alone," said Sabrina Corlette, a research professor at Georgetown University's Center on Health Insurance Reforms. "The takeaway here is both the provider as well as insurance company are still on a learning curve with respect to this virus and how to bill and pay for it."

Corlette said Timothy should not have second-guessed his decision to use the Denver Health ER when directed there by a nurse. That, too, was the right call.

Insurers' move to waive costs associated with COVID-19 testing and related treatment is vital to stem the outbreak but it works only if patients can trust they won't get stuck with a large bill, she said. "It's a critical piece of the public health strategy to beat this disease," Corlette said.

To help with billing, she said, patients could ask their provider to note on their medical chart when they seek care for a possible case of COVID-19. But it's not patients' responsibility to make sure providers use the right billing code, she said. Patients need to know they have rights to appeal costs to their insurer. They can also seek assistance from their employer's benefits department and state insurance department.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

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COVID-19 Bill Of The Month: A Suspicious Cough Leads To ER : Shots - Health News - NPR

Getting infected with Covid-19 is a frightening, isolating experience. But as more people endure it, the community of survivors is growing and with them comes better guidance.

My husband and I got sick from the coronavirus in late March. We had so-called mild cases, meaning only that we werent hospitalized: In fact, we were sicker than we had ever been. Because we could breathe fine, we knew we werent supposed to go to the hospital. But what were we supposed to do?

The standard advice rest, fluids and fever reducers was and is essential, but at times it felt inadequate to the severity of the illness.

As we recovered, I spoke with many friends, colleagues and internet strangers going through similar ordeals. Here is some collective wisdom on how to manage noncritical cases of Covid-19.

First, of course, you need to be confident that your illness can be managed at home. Most cases of Covid-19 can be. But if you develop any symptoms on this list, including trouble breathing, persistent pain or pressure in the chest, new confusion, an inability to wake or stay awake and/or bluish lips or face, seek emergency care.

Some people will have relatively mild symptoms at first and then become more seriously ill. These patients are likely to develop shortness of breath four to eight days after their first symptoms, and thats really where people should start paying attention, said Dr. Pieter Cohen, an associate professor at Harvard Medical School and an internist at the Cambridge Health Alliance who was co-author of an article about the progression of Covid-19 symptoms.

If the shortness of breath worsens from day to day, Dr. Cohen said, thats a sign to call your doctor. Less commonly, patients with low oxygen levels may experience dizziness or lightheadedness instead of shortness of breath, so keep an eye out for that too.

Otherwise, read on.

If youre reading this while healthy, buy basic supplies now, including a thermometer, acetaminophen or ibuprofen, and rehydration drinks like Pedialyte.

A pulse oximeter can sometimes be helpful, both in flagging severe illness and in reassuring you of the opposite, my colleague Dana Goldstein says: If you feel short of breath but your oxygen level is normal, you may be able to avoid the hospital. (You should still contact your doctor.)

If youre sick and dont have supplies, see if a friend can pick them up for you, or if a grocery store or bodega will deliver. (Tip well!) Either way, avoid contact: Whether its a friend or a delivery person, have the bag left outside your door, and dont open the door until the delivery person is gone.

Over-the-counter drugs may not be enough. In particular, the coughing and nausea caused by Covid-19 can be severe enough to warrant prescription medication.

For my husband and me, benzonatate (for the cough) and promethazine (for the nausea) were lifesavers. Some colleagues were prescribed codeine-based cough medicine or Zofran. If you feel you might need them, ask your doctor about medications sooner rather than later. Dont wait until youre doubled over coughing or cant keep anything down.

If you dont have a primary care doctor, some urgent care clinics offer virtual appointments, and some pharmacies offer prescription delivery.

Dry air can exacerbate some symptoms such as coughing and chest tightness. If you have a humidifier, use it. If not, a hot shower works.

Several readers reported that they felt better when they lay on their stomach. A woman in Britain whose partner was sick for several weeks told me that a particular breathing exercise helped him:

You take a deep breath, hold it for 5 seconds and release. Do that 5 times, then on the 6th time on the release, cough hard. Do that cycle twice, then lie on your front and take slightly deeper breaths for 10 minutes. Try to do it a couple of times a day.

In some cases, your doctor may also prescribe an albuterol inhaler to reduce your cough and ease your breathing.

As soon as you get sick, start a detailed log. Every time you take your temperature do it several times a day, at consistent times log it. Every time you take a pill, log it. Every time you eat or drink, log it. If one symptom resolves or a new one develops, log it.

As my colleague Eliza Shapiro noted in a Twitter thread worth reading in full, this creates a detailed record to take along if you end up needing medical attention. It also helps you stay on top of your care.

Can I take more cough medicine yet? How long have I had this fever? Is it a little lower than it was yesterday? You wont be able to keep these things straight while shivering in bed, but a spreadsheet can.

Having Covid-19 is intensely stressful. Its not unusual to feel depressed or anxious, or to have panic attacks. Dont be embarrassed to talk to your doctor about your mental health its just as important as your physical health.

Derek Norman, a news assistant at The Times, says that in the worst moments of his illness, when he felt short of breath and panicky, he would sit upright, focus on breathing steadily and picture a vivid memory.

Id close my eyes and picture the exact details of a scene I had once experienced, and Id completely immerse myself in that memory. Something like sitting at an outdoor cafe in Morocco. Id try to recall the sounds of street life and the dry desert air on my skin, or the smell of the spices, hookah and exhaust swirling in the air. Very, very specific details that I look back fondly on. Id continue to slowly breathe through it.

Tim Herrera, our Smarter Living editor, emphasized fresh air. That can be hard to come by safely when youre contagious, but even if you live in a crowded area with no private outdoor space, it can help to open a window.

Its also OK to not be OK. You dont have to handle this well, whatever that means. You just have to get through each day. So go ahead and cry, binge Netflix, do a jigsaw puzzle, reread the entire Animorphs series whatever gets you through the day.

Some people have mild symptoms for the first few days and then suddenly get sicker. Some have fevers that go up and down repeatedly. Some are sick for two weeks straight, then have a few symptom-free days, then relapse. Some have lingering symptoms for months.

This is both maddening and very common. Give yourself as much time to rest as your job and financial situation will allow. For me and for several colleagues, that meant nearly three weeks of sick time.

Since tweeting about my experience last month, Ive received many emails from people in the this will never end phase. I share the same screenshot with all of them: a text I sent to a friend on April 5.

Why do I even bother giving good news when its only going to last a few hours? I wrote. Im just so tired of this. I dont know how to keep dealing with it.

Every day, more people will hit that wall and every day, more people will find their way past it. They will feel alone, but they wont be.

Sarah Maslin Nir contributed reporting.

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How to Recover From Covid-19 at Home - The New York Times

New estimates of the number of asymptomatic people with the coronavirus suggest that "silent" COVID-19 is much more prevalent than once thought, according to two studies published Wednesday.

The first study, published in JAMA Network Open, found that 42 percent of cases from a group of people in Wuhan, China, were asymptomatic. The second study, published in Thorax, found much higher rates of asymptomatic individuals: 81 percent of cases on a cruise to Antarctica.

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The study from Wuhan looked at 78 patients who tested positive for COVID-19, and found that 33 of the individuals had no symptoms of the illness. These patients were more likely to be women, and more likely to be younger, in their 20s, 30s and early 40s.

Meanwhile, the second study, from Australian researchers, looked at 217 people on a cruise bound for Antarctica. The ship set sail in mid-March, just after the World Health Organization declared the coronavirus a pandemic.

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The first fever on board was reported eight days into the voyage. Over the following two weeks, eight people had to be evacuated from the ship because they fell ill.

All of the 217 people who remained on board were tested for COVID-19. More than half (59 percent) tested positive, but just 19 percent of those patients had symptoms. The other 81 percent were symptom-free.

"Many people still haven't grasped the notion that asymptomatic people can be so common, and they wonder why it is they have to wear the mask when they're feeling well, or why they have to keep doing this social distancing stuff," Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Nashville, said.

"Simply exhaling can send out viral particles," said Schaffner, who wasn't involved with either study.

That's why the CDC encourages everyone to wear face coverings or masks in public to help prevent the spread of the virus. The agency's estimate of the prevalence of asymptomatic cases, based on mathematical modeling, is lower, at 35 percent.

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There was one positive finding, however, from the study in China: Asymptomatic individuals may not spread the virus for as long as symptomatic patients do. The patients without symptoms shed the virus for about eight days, compared with 19 days among those who did have symptoms, the researchers, from Zhongnan Hospital of Wuhan University, found.

Still, asymptomatic COVID-19 cases remain a concern.

"This is very important because, theoretically, you can spread the infection when you're shedding the virus because it's so highly contagious," Dr. Aditya Shah, an infectious disease fellow at Mayo Clinic in Rochester, Minnesota, said.

Though COVID-19 has proven it has the ability to sicken anyone at any age, people over age 65 and those with underlying chronic health conditions, such as type 2 diabetes, appear to be most vulnerable.

"I don't know of a single person, no matter how independently-minded they are, who has any desire to give this virus to anyone else," Schaffner said. "But they have to recognize that they could."

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Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."

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Asymptomatic COVID-19 cases may be more common than suspected - NBC News