Category: Covid-19

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

Memorial Day weekend at Robert Moses State Park on Fire Island, N.Y. As the pandemic continues, Harvard's Dr. Ashish Jha says, mask wearing, social distancing and robust strategies of testing and contact tracing will be even more important. Jeenah Moon/Bloomberg via Getty Images hide caption

Memorial Day weekend at Robert Moses State Park on Fire Island, N.Y. As the pandemic continues, Harvard's Dr. Ashish Jha says, mask wearing, social distancing and robust strategies of testing and contact tracing will be even more important.

The bleak milestone the U.S. is about to hit 100,000 deaths from COVID-19 is far above the number of deaths seen from the pandemic in any other country.

So far, the impact of the coronavirus has been felt unevenly, striking certain cities and regions and particular segments of society much harder than others.

To get a sense of how that may change, and where in the course of the epidemic the U.S. is right now, NPR's Morning Edition host David Greene spoke Tuesday with Dr. Ashish Jha, director of the Harvard Global Health Institute and professor of health policy at the Harvard T.H. Chan School of Public Health.

Their conversation has been edited for length and clarity.

As you look at this number looming now, what are you reflecting on?

Well, a couple of things. First of all, it is a solemn moment to reflect on the idea that about 100,000 Americans have died mostly just in the last two months. The speed with which this has happened is really devastating. Of course, we've had very little opportunity to mourn all those losses because most of us have been shut down. And I've been thinking about where we go into the future and fall and reminding myself and others that we're early in this outbreak. We're not anywhere near done.

The U.S. ... has had more deaths than any country in the world. Do you think that the country is absorbing the significance of these numbers?

I think for a majority of Americans, this doesn't quite feel real because the deaths have been concentrated in [a] few places. Obviously, New York has been hit very hard, and some other places like Seattle, Chicago some of the big cities. And so people who don't live in those areas may not be absorbing it.

But the nature of this pandemic is that it starts and kind of accelerates in big cities, but then it moves out into the suburbs and into the rural areas. So, by the time we're done with this, I think every American will have felt it much more up close and personal. That's what I worry about that it shouldn't have to take that for people to really understand how tragic this is and how calamitous in many ways this is.

Q: We're coming out of Memorial Day weekend, and we saw many regulations relaxed in many parts of the country. As you were watching that, what are you predicting in terms of what we could see by the end of summer?

If you look at all of the models out there and most models have been relatively accurate a few of them have been too optimistic. But then, if you sort of look at the models of models the ones that really sort of combine it all and put it together and make projections the projections are that we're probably going to see 70,000 to 100,000 deaths between now and the end of the summer.

While the pace will slow down, because we are doing some amount of social distancing and testing is ramping up we're going to, unfortunately, see a lot more sickness and, unfortunately, a lot more deaths in the upcoming months.

Q: There's been talk of a seasonal aspect to this. Whatever happens over the summer, do we face even more deaths as we head later in the year?

Yes. I'm hoping that the models of the summer of an additional 70,000 to 100,000 deaths are too pessimistic. And they may be, because we may get a seasonal benefit because of the summer: People are outside more.

But the flip side of the seasonal benefit of the summer is what will almost surely be a pretty tough fall and winter with a surge of cases a wave that might be bigger than the wave we just went through. And we've got to prepare for that, because we can't be caught flat-footed the way we were this time around.

Q: What can we do to prepare? We're seeing so many states relax restrictions right now. Is it a matter of potentially putting those restrictions back in place where they need to be? Or are there other things we could be doing?

There are two things that I would say. First of all, people can't be locked down for the rest of this pandemic. I understand that people need to get out, and being outside is a good thing. But we have to maintain a certain amount of social distancing. I think mask wearing is really important.

The only other tool we have in our toolbox is a really robust testing, tracing, isolation program. You know, if you think about how it is that South Korea and Germany have been able to do much, much better? They have had a really aggressive testing, tracing, isolation program. We know that works. It allows us to kind of have more of our lives back without the number of deaths that we've suffered. So I really think that still remains and should remain one of our priority areas.

Q: The federal government's new strategic testing plan calls on states to take a lot of the responsibility for testing. ... Do you see that as the best approach?

I think this is a real missed opportunity and very unfortunate in many ways, because while states have a critical role to play, testing capacity and testing supply chains are national and international.

We don't want 50 states competing. We want a federal strategy that helps states. And I'm worried that we're just not getting that from the federal government.

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Nearing 100000 COVID-19 Deaths, U.S. Is Still 'Early In This Outbreak' - NPR

Staff work at a drive-through coronavirus testing site outside the American Airlines center in North Dallas in late March. Dan Tian/Xinhua News Agency/Getty Images hide caption

Staff work at a drive-through coronavirus testing site outside the American Airlines center in North Dallas in late March.

As COVID-19 continues to spread across the country, state and local health officials rush to try to detect and contain outbreaks before they get out of control. A key to that is testing, and despite a slow start, testing has increased around the country.

But it's still not always easy to get a test. While many things can affect access to testing, location is an important starting point.

NPR investigated the location of public testing sites in Texas, one of the first states to reopen, to see how they were distributed between predominantly white and predominantly minority areas. The investigation found that in four out of six of the largest cities in Texas, testing sites are disproportionately located in whiter neighborhoods.

With evidence growing that black and Latino communities are harder hit by this deadly disease, community leaders say that testing disparities are problematic. Many experts warn that if communities don't test the most vulnerable, they could miss pockets of infection and have new large outbreaks.

"If you're casting a very small net, and you're shining a flashlight on a small portion of infections that are out there, you might think you're doing OK," says Dr. Jennifer Nuzzo, lead epidemiologist for the Johns Hopkins COVID Testing Insights Initiative. "Whereas there's this whole pool of infections that you haven't seen."

Nationally, it's hard to determine where there may be testing disparities because data is scarce. Most states and cities across the country either do not track or do not report the racial breakdown of tests that are conducted. But there are media reports of racial disparities that suggest that the patterns identified in Texas are happening in other parts of the country.

"I was acutely concerned from the very beginning," says Dr. Wayne Frederick, president of Howard University, a historically black college in Washington, D.C., who is leading efforts by the university to bring more testing to black neighborhoods. The lack of attention paid to minority health care, he says, "is not a good strategy for our health care system and for the vulnerable part of our community."

Texas: Whiter neighborhoods have more testing sites

In Dallas, a stark divide exists between the north and south ends of town. Interstate 30 bisects the city and largely serves as a borderline between the city's predominantly white neighborhoods to the north and the predominantly black or Hispanic neighborhoods in the south.

In North Dallas there are 20 testing sites. Southern Dallas has nine, with a third of those sitting within a mile of the interstate.

Dallas County, home to the city of Dallas, has the second-highest COVID-19 case count in the state.

In three other cities, the trend was the same: More testing sites were in whiter neighborhoods. In each city, NPR ranked neighborhoods based on their density of white residents. The analysis then focused on the half with the lowest density of white residents to see how many testing sites that are open to the public are located in those areas:

To determine where permanent testing sites were located, NPR contacted health care providers in those six largest cities in Texas representing a total population of 7.9 million by most recent Census estimates and reviewed government, health care and news websites.

The testing site locations include facilities where residents can go to get diagnostic testing for active infection, such as urgent care clinics, hospitals and drive-through testing sites. They don't include sites such as doctor's offices and some hospitals that may provide tests for admitted patients but are not available to the public. Mobile sites, where locations regularly change, are also not included. Reporters analyzed the racial breakdown in areas where testing sites are located using census tract data.

NPR offered city and county health officials the opportunity to review the findings and point to additional testing sites.

These disparities could point to a larger problem in Texas, says Nuzzo. Without good testing access in places where minorities live, the state could be missing cases. She notes that Texas has a low rate of positive cases a measure that can indicate a community is conducting sufficient testing but it also has one of the lowest rates of testing among states.

"It's either that there's just not that much infection in Texas, or that there is infection, but they're testing the wrong people," says Nuzzo. "And it's been hard for me to believe that there's not that much infection in Texas."

The Texas Division of Emergency Management and the Department of State Health Services did not make anyone available for an interview on the state's testing plan.

The national picture

Testing disparities have also been reported in New York City and Chicago.

Some communities across the country are starting to identify and tackle the issue, but only four states currently publish racial breakdowns of who is being tested: Nevada, Delaware, Kansas and Illinois. In New York City, authorities have identified hotspots in low-income and minority neighborhoods and have set up testing sites at over 70 faith-based organizations to target those communities. And in Wisconsin, where some of the first reports of stark racial disparities emerged, free testing is now available to all black, Hispanic, and Native American residents.

At the federal level, the House of Representatives passed a wide-ranging coronavirus relief bill this month that would, in part, fund testing centers in minority communities. Continuing negotiations on the bill, however, make it unlikely that it will pass the Republican-controlled Senate in its current form. Democratic Rep. Bobby Rush of Illinois has introduced a separate bill that would fund testing sites, prioritizing those around coronavirus hot spots and in underserved communities.

"We don't know the numbers, we don't know the number of people who have not been diagnosed," says Rush, who represents a mostly black district in Chicago, recalling his early response to Chicago's outbreak. "We were operating blindly regarding the individual community response to COVID-19, and the white community was better informed."

The House Energy and Commerce committee also announced Tuesday it would hold a hearing on states' testing plans, including access to testing for minority communities.

But local communities might have trouble piecing together what testing access looks like. Local public health departments have dealt with years of underfunding, and the federal government isn't keeping track of and publishing its own list of testing sites. States may not have complete data either. Texas has its own state map, but some sites located by NPR were missing or out of date.

"For the most part across the U.S., it's really, really hard to rely on those government websites for the information," says Tarryn Marcus, who leads a volunteer effort called Get Tested COVID-19, which is attempting to compile a national database of testing locations. "There's a lot of inconsistency, a lot of outdated information stuff that was true maybe a month ago or a few weeks ago but it's no longer true."

Marcus' organization is attempting to fill in the gaps with their database, which was compiled over two months by more than 80 volunteers. Though it's still not complete, their data reinforce what NPR found in Texas cities. Marcus' team analyzed the sites they do have to look at where there were large numbers of people without a nearby testing site. Across the country, most of the areas with gaps, she says, were in blue collar communities with low income.

Cities in Texas vary in their approach

Not all cities in Texas have a disparity in testing site locations. In San Antonio, the state's second largest city, testing sites are equally distributed by race. Houston, the state's largest city, has more testing sites in minority neighborhoods than white neighborhoods. The city says it took into account risk factors for disease, as well as CDC testing data, to determine where to target its testing.

But in Dallas, recent research by the UT Health School of Public Health identified parts of South Dallas as vulnerable to COVID-19 hospitalization because of higher concentration of some chronic conditions like asthma, diabetes and obesity. These were the same areas predominantly minority neighborhoods that NPR's analysis show to lack testing sites. The state does not provide detailed data on the races of coronavirus patients, and Dallas County's is incomplete.

"If we're looking to protect our most vulnerable in the population, then we need to concentrate some testing resources in the areas where they're more likely to live," says Dr. Stephen Linder, one of the UT Health researchers.

Dr. Philip Huang, director of Dallas County Health and Human Services, said many of the testing sites in north Dallas are at private sector providers. That's where most of Dallas' hospitals are as well.

Huang said the county has tried to focus public sector testing efforts towards underserved communities as much as possible.

"We have been trying to definitely target those resources that we have control over into those areas," he said, including two federally-funded drive-thru sites, one in South Dallas and the other downtown. Combined, they can test 1,000 people a day. "A lot of the disparity ... is reflecting some of that private sector availability of tests in the northern part of Dallas compared to southern Dallas."

In an attempt to fill the gaps, in mid-May the city started sending health care workers to residents' homes if they don't have transportation to get to a testing site. That effort has averaged 20 tests per day, according to figures provided by the city. Other cities have set up temporary sites that are open for days at a time before moving on to the next location.

Even the public health systems, which exist to fill these gaps, present obstacles for someone trying to get a test. Parkland, the public hospital system in Dallas, does have clinics in South Dallas that can test, but you have to be a patient already or be seen through the ER. You can also be referred to Parkland through one of the area's federally qualified health centers, but those centers don't do testing themselves.

For cities that have testing disparities like these, the solution involves not just opening an equal number of testing sites in minority neighborhoods, but actually focusing on those that are most at risk, says Dr. William Owen, a medical school administrator whose work has focused on health care access for racial minorities.

In other words, Owen says, communities should make sure it's easy to get tested in places carrying the heaviest burden of the disease.

"That's where I'm going to plot my testing sites," he says. "Direct your resources specifically while they're limited which is what they are right now to where you think you'll get the most hits."

Other barriers to testing

Location, of course, isn't the only factor that determines whether at-risk people will get tested for the disease. Other barriers can keep someone from being tested, including whether a doctor needs to refer you to a testing center or whether you can just walk in; how much the tests cost if you're uninsured; and how much time you have to wait at a testing site. Cost could be an issue in a place like Texas, which has not expanded Medicaid and has the highest uninsured rate in the country. Lack of transportation and concerns about being able to work after testing positive can also keep people away from testing sites.

These challenges can be especially difficult for people of color to navigate: They're more likely to be uninsured and, in some places, more likely to work in essential services, making it difficult or impossible to spend hours traveling or waiting at a testing site.

"This disease has absolutely highlighted many disparities that we have in our country when it comes to public health," says Angela Clendenin, an instructional assistant professor of epidemiology at the Texas A&M School of Public Health. "And it boils down to access."

One way to deal with these challenges is to work with community leaders and groups that people are already familiar with to encourage them to get tested, says Owen, the medical school administrator. Leaning on faith-based leaders to stress the importance of testing, along with setting up makeshift testing sites at community centers like churches, could bring large-scale public health efforts to the doors of people who might otherwise be excluded.

A South Dallas church, for example, hosted a two-day mobile testing event last week, sponsored by the state and National Guard.

"How do you do voter registration? You do it at the local high school. You maybe have someone in front of the grocery store in the neighborhood. You have somebody at the church," Owen says. "If I were the mayor, I'd say, 'Great, let's have the arena. But by the way, we're going to have a small testing center at the big churches.'"

NPR gathered addresses of permanent testing sites from county, city and state websites, health care providers and news reports. NPR verified these sites by contacting health care providers and city officials by phone or email. City and county officials were offered the opportunity to review the findings and point to additional testing sites. Mobile and temporary testing sites are not included in this dataset. Sites that only perform antibody testing are not included.

NPR geocoded testing site locations on an online geocoding platform to determine what census tract they were within. A reporter verified each location with a geocoding "accuracy score" of below 0.9. For each city, the analysis included only census tracts within the city's official boundaries, which do not include suburbs. The Census Bureau provided median household income and demographic data, which were used along with data from the Social Vulnerability Index (SVI). The main demographic measure referenced in this story was the percent of the population who identify as 'white alone.' For income, percent white and SVI, NPR calculated the number of sites and distance from a site for tracts above and below the city's overall median for that measure. Medians referenced are medians of census tracts, not population medians, and may therefore differ slightly from population medians.

The dataset used in this analysis is available on Google Sheets.

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COVID-19 Racial Disparities Could Be Worsened By Location Of Test Sites : Shots - Health News - NPR

Two months into the stay-at-home order, nearly every sector of life along the Midpeninsula is moving ahead at a new pace: Real estate activity and consumer spending have plummeted, but so have pollution, traffic and overall crime. Schools and cities are preparing for massive budget cuts while hospitals are seeing an unprecedented outpouring of donations. Meanwhile, unemployment has surged along with local volunteer efforts.

The pandemic is changing how we live and has revealed the community at its best and worst along the way. To show how the COVID-19 pandemic has impacted daily life, the Palo Alto Weekly has woven together local, regional and national numbers into a series of interactive infographics, which can be found here.

Small businesses have been among the hardest hit. Only 58% of business owners surveyed in Palo Alto said they are likely to reopen. The community has already seen iconic eateries, such as Mountain View's 75-year-old Clarke's Charcoal Broiler, shutter. It has also seen patrons near and far pitch in to raise $130,000 to save Menlo Park's Cafe Borrone.

Overall, Silicon Valley consumers have decreased their spending at restaurants by 25%, and their retail spending has dropped 59% compared to the same time last year, leaving at least 8,560 service employees at risk of losing their jobs in coming months, according to an April consumer spending report from the Joint Venture Silicon Valleys Institute for Regional Studies.

In April alone, 20.5 million Americans lost their jobs, pushing the national unemployment rate to 14.3%, according to the U.S. Department of Labor. Local unemployment rates in cities along the Midpeninsula now range between 5.5% and 12.4%.

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Interactive: A by-the-numbers look at the COVID-19 pandemic's impact on daily life - Palo Alto Online

How dangerous is it to live in New York City during this pandemic? How much safer is it in other places? Is the risk of dying from Covid-19 comparable to driving to work every day, skydiving or being a soldier in a war?

We are awash in statistics about Covid-19: number of deaths, fatality rates, contagion rates. But what does this all mean in terms of personal risk?

In 2011, another invisible danger, radiation, sowed fear and confusion in Japan, where I served as the U.S. Ambassadors science adviser after the nuclear meltdown at Fukushima Daiichi. Then, as now, the news was full of scary numbers. And then, as now, there wasnt nearly enough context for people to make sense of them, much less act upon them.

Fortunately, there are tools for assessing risk that can help us put the daily torrent of numbers in perspective. I found the best way to communicate the level of risk was to put it in terms that allowed easier comparison to other, more familiar, risks. One could then talk, for instance, about how dangerous living in a contaminated city was compared to smoking a pack of cigarettes a day.

A useful way to understand risks is by comparing them with what is called a micromort, which measures a one-in-a-million chance of dying. Note that we are considering only fatality risks here, not the risk of growing sick from coronavirus, or morbidity. The micromort allows one to easily compare the risk of dying from skydiving, for example (7 micromorts per jump), or going under general anesthesia in the United States (5 micromorts), to that of giving birth in the United States (210 micromorts).

The average American endures about one micromort of risk per day, or one in a million chance of dying, from nonnatural causes, such as being electrocuted, dying in a car wreck or being struck by an asteroid (the list is long).

Lets apply this concept to Covid-19.

Using data from the Centers for Disease Control and Prevention, New York City experienced approximately 24,000 excess deaths from March 15 to May 9, when the pandemic was peaking. Thats 24,000 more deaths than would have normally occurred during the same time period in previous years, without this pandemic. This statistic is considered a more accurate estimate of the overall mortality risk related to Covid-19 than using the reported number of deaths resulting from confirmed cases, since it captures indirect deaths associated with Covid-19 (because of an overwhelmed health care system, for example) as well as the deaths caused by the virus itself.

Converting this to micromort language, an individual living in New York City has experienced roughly 50 additional micromorts of risk per day because of Covid-19. That means you were roughly twice as likely to die as you would have been if you were serving in the U.S. armed forces in Afghanistan throughout 2010, a particularly deadly year.

The quality of data varies from state and state, and continues to be updated. But for comparison, using the C.D.C. data, Michigan had approximately 6,200 excess deaths during this same time period. That is roughly the same risk of dying as driving a motorcycle 44 miles every day (11 micromorts per day). Living in Maryland during this time would be roughly as risky as doing one skydiving jump a day for that duration (7 micromorts per jump).

Now, if youre infected with the virus, your odds of dying jump dramatically. Estimates of the fatality rate vary as doctors continue to learn more about this virus and how to care for people sickened by it, but lets assume it is 1 percent for sake of this discussion. That translates into 10,000 micromorts. That risk is comparable to your chances of dying on a climb in the Himalayas if you go above 26,000 feet, where the tallest peaks, such as Everest and K2, stand (using climbing data taken between 1990 and 2006).

But that risk estimate is for the entire population, with an average age of 38. If you happen to be older, the fatality rate can be as much as 10 times higher, which is just slightly less than flying four Royal Air Force bombing missions over Germany during World War II.

The acceptability of risk depends, of course, on ones own attitudes and proclivity to take risks, and whether one has a choice in the matter. Unlike skydiving or hang-gliding, in which the risk is limited to the person making the leap, with Covid-19 the actions of the individual change the risk levels of everyone in the community.

So while there are many thrill seekers who happily jump out of planes, they might think twice about forcing their frail grandmothers, or their neighbors, to jump with them.

David Roberts (@DRobertsNYC), a former academic physicist, served as the U.S. Ambassadors science adviser in Tokyo during the post-Fukushima recovery. Micromort examples came from The Norm Chronicles by Michael Blastland and David Spiegelhalter (2014).

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Putting the Risk of Covid-19 in Perspective - The New York Times

HENDRY COUNTY

More people are testing positive for the coronavirus in Hendry County and the health department said its working around the clock to find out whats behind the increase.

The Department of Health in Hendry County said they found a spike in people testing positive, mostly from one cluster people in one spot, in close contact with each other and spreading the virus. Theyre tracking down those who have been in contact with known positive cases.

They said being a smaller county actually helps.

Our team has been working seven days a week, 12, 14 hours a day to try to keep the community safe, said Brenda Barnes with the Florida Department of Health in Hendry County/Glades County.

Ten people are working to keep around 42,000 people healthy and alive in Hendry County.

We have some known clusters in the community. What that means is with contract tracing in our community, an individual that tested positive or other individuals in the same family or who work very closely together on the job, Barnes said.

The contact tracing team calls people who might have been exposed. Those people can self-isolate, monitor for symptoms or get tested if they need to.

The team also helps to educate a business where there could be exposure.

Now thats definitely a plus, being a small community in that we know the business owners, a lot of them. we know the people in our community. Its easier to have those conversations, Barnes said.

The latest numbers from the Florida Department of Health show that there are 339 known positive cases in Hendry County, with 12 deaths attributed to COVID-19.

The health department said there are six testing sites in Hendry County, with drive-thru testing in LaBelle at 1140 Pratt Blvd., and in Clewiston at 1100 S. Olympia.

Those tests are available to anyone, but they do ask that you make an appointment. Call 863-983-1408 in Clewiston or 863-674-4041 in Clewiston.

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Hendry County sees spike in positive cases of COVID-19 - Wink News

HURON, S.D. (KELO) Huron was an early hotspot for COVID-19. Two people died, including state lawmaker Bob Glanzer. Then, the northeastern South Dakota town went nearly six weeks without a reported case.

But now Beadle County is reporting 163 cases of coronavirus.

Because Huron is home to the state fair, the school year doesnt start until after Labor Day and ends tomorrow. But with the rash of new cases in Huron, precautions are in place for students turning in their iPads and supplies. Due to construction out front, Huron High School has setup a tent at a side door to accept students materials.

Its all going to be carried in by people in face masks, put along the walls of the hallwaysthe hallway is secured and then nothing will be touched for 48 hours and then theyll start processing the materials, Nebelsick said.

School District Superintendent Terry Nebelsick says theyre taking every precaution after at least three students and some of their parents tested positive for COVID-19.

There was a kindergartener, that had identified positive, along with a parent and there was a kid who graduated in our virtual graduation this past Sunday that identified and then I knew from last Fridays information from health officials that we had an eighth grader who had identified positive along with his father, Nebelsick said.

Nebelsick does not know their conditions.

Its not panic up here, its more like, here we go again. Lets be as diligent as we can and get through this, Nebelsick said.

Over at the Dakota Provisions meat processing plant, cases have also spiked, now at 16. Dakota Provisions Mark (Smokey) Heuston told the Huron COVID-19 Task Force that the plants early sanitizing measures and other precautions worked to keep cases out of the plant until recently.

One couple chose to ignore these guidelines and travel to Aberdeen on Mothers Day weekend and visit relatives. One of these relatives worked at the beef plant in Aberdeen. When this couple returned to Huron, they learned one of the people they visited had now tested positive for coronavirus. That mistake took us to where we are today, Heuston said during task force meeting.

Sick employees are being paid to stay home while the plant takes steps to prevent further spread.

Several of our employees wear a paper mask, a cloth mask and a face shield all at the same time. Last month we built a pavilion at the plant on the east side so employees can practice better social distancing during break periods, Heuston said.

Meanwhile, Hurons School Board is considering plans for how to start classes up again in the fall in the face of future spikes.

When the conditions are right, well get to school, well get as much as we canbut when there is a surge in any one of the communities in South Dakota, like we are now, then were going to have to take it outside-what I see as 14 dayshit a restart and go again. Nothing is finalized yet, but thats our vision of what we need to do, because its not going to go away until there is a vaccine, Nebelsick said.

The task force has set up of a drive through testing site, but according to the state website theyre doing fewer than 40 tests in Beadle County per day. About half of them are coming back positive, which could indicate there isnt enough testing.

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Thousands of residents apply for SFPUC's COVID-19 discount on water, sewer, electricity bills  San Francisco Examiner

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Thousands of residents apply for SFPUC's COVID-19 discount on water, sewer, electricity bills - San Francisco Examiner

NORTH MANKATO Expanded testing at North Mankatos Oak Terrace Assisted Living recently identified COVID-19 in 27 residents and 20 staff members including the facilitys administrator.

Nicollet County health officials released the facilitys numbers Wednesday. The county has had four COVID-19 deaths since Monday and its seven total are the most in south-central Minnesota since the pandemic began.

Oak Terrace had been grappling with some COVID-19 exposures among staff and residents since April, but the testing in recent weeks revealed a concerning number of asymptomatic cases, said Administrator Drew Hood.

We have residents and staff who were completely asymptomatic who, if we didnt do the testing, we never wouldve known, he said.

Hood was one of the asymptomatic cases who has since recovered.

Nicollet County officials and Eric Weller from the South Central Minnesota Health Care Coalition recently helped coordinate testing for all residents on multiple occasions, which Hood said will help mitigation efforts.

The county and the assisted living facility are working together on ongoing mitigation. Their plans include continued testing of residents and staff, continuing to restrict visitors and isolating residents with symptoms.

Asymptomatic residents and staff also will be isolated, with the recent broad testing being the first real way to identify those more elusive cases. With no national testing strategy from the beginning of the pandemic, states have only recently been able to expand testing enough to offer it to asymptomatic people.

The potential for asymptomatic spread is why health experts are stressing the need for masks and other mitigation efforts for the public, said Cassandra Sassenberg, Nicollet Countys director of health and human services.

I think people are getting the idea that because theyre feeling well they can interact with vulnerable populations and things will be OK, she said. If youre asymptomatic, you could be spreading it to people who are at really high risk.

She praised Oak Terrace for working with the county to monitor residents and staff and isolate cases when they arise. Oak Terrace is using a dedicated wing to treat residents with COVID-19, which staff modified to make more room Wednesday.

The facility had a wing ready early in the pandemic, despite smaller numbers of cases identified on-site in April. Hood said hes thankful the facility prepared.

It sat empty for five weeks but Im glad we had it, he said. Weve been able to separate residents and have dedicated staff.

He commended staff for working long hours to care for residents during the pandemic. The facility isnt experiencing major worker shortages, despite some staff needing to isolate, although it did have to use staffing agencies to bring in help for the first time.

Oak Terrace includes memory care and independent living along with assisted living. Long-term care facilities have been hit hard by COVID-19 with 81% of Minnesotas 932 deaths occurring in people who resided in them.

The North Mankato facility was one of the first long-term care facilities in south-central Minnesota with COVID-19 exposures, and it wasnt the last. Pillars of Mankato in Blue Earth County, St. John Lutheran Home in Brown County, Friendship Court in Faribault County and Temperance Lake Ridge in Martin County are the other facilities with known cases so far the Minnesota Department of Health only lists facilities with at least 10 residents.

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Oak Terrace grappling with COVID-19 outbreak - Mankato Free Press

We are in the midst of an historic event that will change many aspects of our world. There will be major impacts on the global economy, geopolitics and our societies. It is clear that these global impacts and risks are highly interdependent and are changing the current and future global risk landscape, a fact highlighted in the World Economic Forum's recently published COVID-19 Risks Outlook report.

We are already seeing record levels of unemployment due to lockdown measures to control transmission and have re-learned hard lessons, in particular that social deprivation determines health outcomes.

The long-term societal impacts, such as an exacerbation of inequality and changes in consumer behaviours, the nature of work and the role of technology - both at work and at home - will change our way of life forever, for us as individuals, as a workforce, and as a society. These social dimensions of the crisis, including generational frictions and continued stress on peoples wellbeing, will be felt by people worldwide and will create substantial societal consequences for the long term.

In the business community, we have made sure our employees are supported and our customers too. In some sectors and around the world, a combination of furloughing and fiscal policies have also helped put economies on hold. As countries emerge from the immediate health crisis and re-start their economies, changed working practices, attitudes towards travelling, commuting and consumption will change employment prospects. Already, the International Labour Organisation has identified that the SME and informal sectors will have particular difficulty in sustaining and recovering business.

How has the lockdown affected us?

Image: COVID-19 Risks Outlook 2020

Consumer behaviours are already changing, even during the stabilization phase that most economies are in right now. In March, global consumer spending decreased every week. In the last two weeks of April and early May, however, consumer spending recovered a little each week in anticipation of a move into a normalisation phase - where economies reduce lockdown measures and show signs of economic recovery. At first, the expenditure was on basics, such as groceries, but now spending is more focused on home improvements and clothing. There is not yet any significant expenditure on entertainment.

Human resources departments have rarely had such an important role. Working remotely increases the risk of isolation, as well as alcohol dependency, smoking too much, and bad backs through poor ergonomic posture. Whats fascinating is that the state was previously seen as the ultimate safety net; now, employers have had to accept that they too have to protect their workers in order to survive and thrive. This should be a long-term change in attitude in the historic public vs private debate.

For many, returning to work will be a psychological as well as a physical challenge

Image: COVID-19 Risks Outlook 2020

Getting back to a pre-COVID-19 growth phase is likely to be a long and difficult task, at least until there is an effective health crisis exit strategy that involves a combination of a widely available vaccine and therapeutic drugs. In the intervening period, there are likely to be continued cutbacks in travel and in the hardest-hit industries, such as tourism and hospitality. Not all those who have been laid off will return to work, and businesses will likely use fewer employees in the future. The challenge to return to the 'new normal' is, therefore, as much a psychological as economic choice.

We have to reconcile the natural fears we feel, which have been reinforced by government messages to help enforce the lockdowns, with acceptance of the uncertainties. The effectiveness of government messaging, combined with data on infection rates and the sad reality of the numbers of COVID-19 deaths, has made the challenge of changing those simple messages to stay at home confusing. The perceived lack of transparency may lead to an erosion of trust and greater complications in the long run.

The timing and speed of the economic recovery, dependent as it is on solving the health crisis, is likely to exacerbate inequality, mental health problems, and lack of societal cohesion. It is also likely to widen the wealth gap between young and old, as well as pose significant educational and employment challenges that risk a second lost generation.

Image: COVID-19 Risks Outlook 2020

The COVID-19 economic crisis has already hit poorer people and those in more socially disadvantaged groups disproportionately harder. In many places, people are having to face the moral dilemma of choosing between going to work to generate income for bare necessities or staying at home to protect their health - and that of their family. Continued exposure to health risks faced by essential workers, who are often among the lowest paid, raises the concern of heightened death rates amongst this group. This highlights societal, income and health inequalities. We need to focus on addressing this inequality during the COVID-19 recovery and normalization process.

The economic and societal disruptions of the lockdowns are taking a toll on young peoples mental health and wellbeing. As one teenager puts it: The life you thought was boring, is the life youre hoping to get back to right now.

Even more concerning are the long-lasting effects to their prospects. Youth employment in developed economies has only just recently returned to pre-2008 financial crisis levels. In developing economies, youth unemployment has risen steadily, creating a real risk of social unrest.

For young people in education, the pandemic is likely to cause new inequalities. Currently 80% of the worlds students - more than 1.6 billion young people - are not attending school. Many students in poorer communities lack the necessary tools to access online courses or face difficulties working at home. The consequences of these educational inequalities, especially for girls and young women, will disadvantage them in labour markets and further exacerbate inequality.

From a business perspective, companies generally cannot be successful in societies that are not functioning well. This is where stakeholder capitalism has a role to play.

Businesses need to bring their skills and assets to help invest in a better society. We see this very clearly in financial inclusion, where we have to bring the best of all sectors - both public and private - to bear on these problems.

Image: COVID-19 Risks Outlook 2020

We do have cause for optimism, but how we get out of this crisis is deeply concerning. We need to focus not only on a healthcare solution, but a recovery that is focused on the climate, sustainability, and on societal risks, such as inequality, mental health, the lack of societal cohesion and inclusion. If we do not do this, then the gaps in inequality - especially financial - are likely to remain and increase.

We have a chance at a clean, green and sustainable recovery that allows growth to return, but with people and communities at the centre of our efforts. As responsible businesses, we must grab this chance with both hands to help society to adapt and come back.

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Written by

John Scott, Head of Sustainability Risk, Zurich Insurance Group

The views expressed in this article are those of the author alone and not the World Economic Forum.

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What risks does COVID-19 pose to society in the long-term? - World Economic Forum