Category: Covid-19

Dr. Mark Schleiss thinks COVID-19 was circulating in the state in late 2019.

MINNEAPOLIS The first confirmed case of COVID-19 in Minnesota was announced March 6. The first confirmed case in the United States was announced in Washington state in January.

But was the virus circulating earlier?

"I don't think anyone really knows when this virus made its way to the United States," said Dr. Mark Schleiss, professor of pediatrics and the American Legion endowed chair of pediatric infectious diseases at the University of Minnesota Medical School.

Schleiss is now leading research which could shift Minnesota's timeline for the emergence of COVID-19.

The timeline for how the novel coronavirus emerged around the world has been put into question. In late April, officials in California announced two deaths in early February were due to COVID-19. Prior to that, the first U.S. death due to COVID-19 was believed to be February 28 in the Seattle area. Research published earlier this month reports SARS-COV-2, the virus which causes COVID-19, was spreading in France in late December 2019, a month before the first official cases in that country.

Schleiss is in a unique position to study this question. His work with pediatric infectious diseases means he has access to samples from 20,000 infant saliva swabs dating back to 2017. The samples, which are all anonymous, are also from newborns who were asymptomatic. Finding the virus in a sample prior to March 6, would indicate circulation earlier than currently documented.

"When COVID-19 came on the scene, we thought, well gosh, this might be an interesting resource to look at," said Schleiss.

Schleiss' research will test some of the samples for COVID-19 RNA.

"So we want to look over a period of a few months, from late 2019 into the spring of 2020, to see if we can pinpoint a time when we might see the infection appear in Minnesota," he said. "What we really want to try to do is get an epidemiological snapshot of when the first presence of COVID-19 might have been in Minnesota."

Schleiss thinks that presence was much earlier than March 6.

"I believe the virus was likely circulating in Minnesota prior to the first of the year, in late 2019," he said.

Dr. Schleiss says pinpointing when the virus was circulating is important, because studying samples from early cases could teach researchers more about the evolution of this strain.

"There are so many questions right now. If you are immune to it, can you get reinfected? Are there strains that mutate and change over time? If we had those [early] samples, we could really examine those samples in rigorous scientific fashion," he said.

If COVID-19 RNA is found in any of the samples, it could also help answer questions about infection in young children and possible transmission of COVID-19 from mother to unborn baby.

KARE 11s coverage of the coronavirus is rooted in Facts, not Fear. Visit kare11.com/coronavirusfor comprehensive coverage, find outwhat you need to know about the Midwest specifically, learn more about thesymptoms, and see what companies in Minnesota are hiring.Have a question? Text it to us at 763-797-7215. And get the latest coronavirus updates sent right to your inbox every morning. Subscribe to the KARE 11 Sunrise newsletter here. Help local families in need: http://www.kare11.com/give11.

The state of Minnesota has set up a hotline for general questions about coronavirus at651-201-3920or1-800-657-3903, available 7 a.m. to 7 p.m.

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When did COVID-19 get to MN? U of M research hopes to find out - KARE11.com

The Trump administration has repeatedly claimed that there are enough COVID-19 tests for states to begin reopening their economies. While that may be true for select locations, experts say more tests are needed, even if they dont agree on a particular number.

In the past couple of weeks, President Donald Trump and other members of the coronavirus task force have insisted that there are adequate levels of diagnostic testing for the coronavirus to allow states to lift stay-at-home orders and restart some businesses.

We are continuing to rapidly expand our capacity and confident that we have enough testing to begin reopening, Trump said in an April 27 briefing, adding, And the testing is not going to be a problem at all. In fact, its going to be one of the great assets that we have.

In the same briefing, Vice President Mike Pence said, [W]e have a sufficient amount of testing today for every state that qualifies to enter phase one to begin to reopen their economies.Phase one refers to the first part of the White Houses plan for a gradual return to quasi-normal life, which allows gyms, restaurants and movie theaters, for example, to open under continued social distancing, but for schools to remain closed and workplaces to encourage telework where possible.

The vice presidents office did not explain which metrics Pence and others were using to make that determination, so its hard to fully evaluate his statement. But while some places may have enough tests, multiple scientists told us that as a whole, the U.S. still lags behind whats needed to execute an effective strategy to rein in outbreaks.

Testing is still limited, Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, told us in response to Pences statement.

If youre not including testing as a large part of phase one opening, then sure, we have plenty of tests, he said. But I think most of us who are working on thinking about what are the safest and best ways to open up the economy again place pretty significant amounts of testing front and center to prevent outbreaks and monitor for them.

The question of how many tests it will take is hotly debated, with some groups recommending at least around half a million tests a day, and others suggesting several million or upwards of 20 million or even 35 million a day.

According to the COVID Tracking Project, testing for the coronavirus in the U.S. has steadily improved to around 264,000 a day, on average over the past week, up from about 217,000 tests per day on average for the week ending on April 26. But the nation is still below any of the proposed benchmarks from experts.

Those figures also mean there arent enough tests for every American who wants to return to work to get one, as Trump suggested in a May 5 interview with ABC News. When asked whether any worker whos nervous about going back would have access to both diagnostic tests for the virus and antibody, or serological tests, right now, Trump replied, There should be no problem.

But Yonatan Grad, a professor of immunology and infectious diseases at Harvard, said the answer is quite clearly no, adding, we dont yet have the capacity to offer broadly either virologic or serologic testing.

National Institute of Allergy and Infectious Diseases Director Anthony Fauci told CNNs Jake Tapper on April 28 that everyone who needs a test, according to the way were approaching the identification, isolation, contact tracing, keeping the country safe and healthy, should be able to get one by the end of May or the beginning of June.

Thats what Im being told by the people who are responsible for the testing, he added. I take them for their word.

Well review several of the estimates and explain why testing is so important but also why its not the only consideration for reopeningbusinesses, schools and other places that have been largely closed for a month or more.

Several groups have attempted to put a figure on how many tests are needed for the U.S. to reopen. On the lower end, researchers at the Harvard Global Health Institute calculated that the U.S. would need to do approximately 500,000 tests per day, as a bare minimum, by May 1 a figure they have since revised to 900,000 for May 15.

On the other extreme, theres Nobel laureate and New York University economist Paul Romers plan to test the entire U.S. population once every two weeks, or around 25 million tests a day. He has since raised that to 35 million tests per day, or more, to include daily testing of front-line workers.

In between, Harvard Universitys Edmond J. Safra Center for Ethics suggests 2 million tests per day to start, then ramping up to at least 5 million tests per day by early June to get the full workforce back in action with that growing to as many as 20 million tests per day.

The 5-million-a-day figure has received perhaps the most attention, in part because when asked about the number on April 28, the president claimed the U.S. would hit that goal very soon.

That morning, however, Adm. Brett Giroir, who is in charge of the governments COVID-19 testing efforts, told Time magazine that there is absolutely no way on Earth, on this planet or any other planet, that we can do 20 million tests a day, or even five million tests a day.

A day later, Trump insisted that he had never made such a claim. I think we will, he said, referring to hitting the 5-million-per-day benchmark, but I never said it.

There isnt a consensus on the number of tests, in part because the groups are making different assumptions and taking different approaches to tackling the pandemic on different timelines. Key to all of the strategies, however, is using testing to identify people who are infected so that they can be isolated and no longer spread the virus to others.

Many public health experts endorse testing combined withcontact tracing, which involves tracking down otherswith whomthe infected personhad contact, so that thosepeoplecan be warned, and ideally be put into quarantine or be tested as well.

Without ubiquitous testing testing everyone with symptoms, and those they have come in contact with we simply cannot be confident that a reported decline in cases represents a true decline in infections and that its safe to open, explained Ashish Jha, faculty director of Harvard Global Health Institute, or HGHI, and a co-author of the groups estimates, in a Time editorial. If a state misjudges its true underlying infection trajectory, it may suffer large flare-ups of the disease, necessitating a long and painful lockdown again.

The HGHI estimates were calculated in two main ways. In the first, the team followed a strategy of testing everyone with flu-like symptoms and the contacts of those who test positive. Assuming that 1% of cases prove fatal, the group worked backward from a projected number of deaths to estimate the number ofnewinfections in the U.S.on a given day, which for May 15, is about 100,000. To then approximate the number of tests, the group assumed that three-fourths of those people would have symptoms and be tested, and each person would have 10 contacts to trace.

Thomas Tsai, a surgeon and health policy researcher on the HGHI team, told us the team looked through the literature to determine the number of contacts, and ended up choosing a middle-of-the-road estimate.

Then the group added in the typical number of influenza-like illness cases for the season, reaching a total of around 900,000 tests per day. A similar calculation, based on trying to get the percentage of positive tests below 10% in line with recommendations from the World Health Organization produced a similar figure.

The researchers, however, caution that their approach in every way veers toward an undercount, and therefore should be viewed as a floor, not a goal.

If we dont ramp up our testing, said Tsai, were just condemned to repeating the mistakes of both February, March and April.

The Harvard Safra figures, which were based on modeling efforts described in two white papers, assume an intensive testing, isolation and contact tracing approach.

Danielle Allen, the director of the center and co-author of the groups April 20 report, told us the numbers were generated by aiming to have each infected person spread the disease to less than one other person (specifically 0.75 people), which would allow the outbreak to eventually fizzle out.

With just essential workers, or about 40% of the workforce in action, the group estimated the U.S. would need 2 million tests per day, rising to 5 million for 100% of the workforce.

Both of these numbers depend on effective contact tracing, Allen said. If contact tracing is moderately effective the amount of testing needed rises to 20 million a day.

Allen, however, said that with subsequent modeling, the group now thinks 5 million tests per day may be sufficient, and is planning to revise the numbers in a forthcoming report.

Two other groups, also adopting a contact tracing strategy, offer other testing benchmarks. The Rockefeller Foundation suggests an initial 3 million tests per week, or about 430,000 tests per day, by mid-June, then growing that number 10-fold over another six months.

Resolve to Save Lives, a public health initiative headed by former Centers for Disease Control and Prevention Director Tom Frieden, tallied up the number of highest-priority people who need tests, and came up with a lower bound number of 350,000 to 700,000 tests per day. This includes high-risk patients with COVID-19 symptoms and any sick hospital workers, public safety officers, prisoners, or nursing home residents and their symptomatic contacts.

The minimum number of tests that need to be done per day, the groups report notes, will depend on the stage of the epidemic and number of outbreaks, hospitalization rates, number of cases and contacts identified, and decisions about the frequency and extent of testing in nursing homes, hospitals, and essential services.

If contact tracing is not part of the equation, even more tests are needed because the approach becomes an untargeted national surveillance method. Because diagnostic testing only reveals whether someone has detectable virus in their body at one point in time, tests must be given to pretty much everyone repeatedly to ensure those who are infected are aware and can be isolated.

Thats how one arrives at the even higher figures, such as Romers 25-million-per-day goal. Instead of prioritizing people who are sick, as is being done now and is recommended in the vast majority of proposals Romers plan calls for tests to go first to people without symptoms to pick out those who are spreading the virus unwittingly.

While most of the test estimates are for the entire country, the reality is that for any targeted testing strategy which is the only strategy thats currently possible locations with relatively few infections wont need as much testing as places with huge outbreaks.

You cant just take the national number and scale it to states by their population, HGHIs Jha told the health news website STAT, in a story sharing an updated state-by-state breakdown of the groups original estimate. You have to base it on the size of the outbreak in a state.

The latest figures from HGHI show that just nine states, the majority of which are clustered in the sparsely-populated West, are close to or have surpassed their testing targets. The analysis also reveals that even states that have been performing a large number of tests per capita, such as Rhode Island and Massachusetts, are still short of their estimated minimums. Conversely, some states that have relatively low per-capita testing rates, such as Hawaii and Alaska, are exceeding their targets.

Because the estimates were made using a model that assumed states would stay locked down until May 15, the researchers caution that states could very well need more tests than their calculations suggest if social distancing measures are loosened.

The moment you relax, the number of cases will start climbing, Jha noted in the groups write-up of the project. And therefore, the number of tests you need to keep your society, your state from having large outbreaks will also start climbing.

None of the other estimates provide state-level figures, although Allen said the Harvard Safra group plans to release another report breaking down its national numbers to make visible what is necessary in high prevalence, low prevalence, and no prevalence locales.

Short of a specific test threshold, one metric experts say can get at whether a country or state is doing something close to enough testing is the test positivity rate.

Caitlin Rivers, an epidemiologist at Johns Hopkins University, told us that its very difficult to say what the right number of tests is, but because a high fraction of tests are still positive, it is clear we need more capacity.

As a Johns Hopkins website explains, if a large proportion of tests are positive, that suggests a community is only able to test the sickest patients, and is likely missing people with milder infections who can still spread the disease.

The WHO has said that countries doing extensive testing see around 3-12% of tests come back positive, and has recommended that nations aim for or a test positivity of roughly 10% to make sure theres enough testing happening to detect all of the cases.

As of May 8, about 15% of all tests in the U.S. have been positive, according to data from the COVID Tracking Project. In the last few days, the current test positivity rate has begun to dip below 10%, although many states have a significantly higher percentage of positive tests.

I prefer positivity to numbers of tests or tests per capita because positivity is tied to the burden of disease in a location, said Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, in an email.

Nuzzo noted, for example, that the U.S. has conducted around 10 times as many tests per capita as Taiwan, but the American epidemic is some 200 times bigger.

And she has concerns about many states that are thinking of or have already reopened. [W]eve found that a number of these [states] arent doing enough testing and have too high positivities, she said. This makes me worried that they are missing the bottom of the iceberg in terms of infections and not seeing the full picture of illness in their communities.

Jeffrey Shaman, an epidemiologist at Columbia Universitys Mailman School of Public Health, agreed that per-capita test numbers are not as informative as looking at testing per positive infection identified.

The U.S., he said, has done only about six tests per confirmed case, whereas South Korea has done 60. Theyre testing 10 times as many per infection found, he said in an interview.

This is especially relevant because Trump has frequently boasted of the total number of tests the U.S. has performed, and has suggested that the U.S. is outpacing South Korea and other nations.

Speaking in Arizona on May 5, Trump said, Were over 7 million tests. Germany is at two and a half. Italy is less than that. Japan is down here and South Korea, which we talk about, and again, Im very friendly with South Korea, and with the president of South Korea, and he calls to congratulate us on our great testing. South Korea is over here.

Trump is correct that the U.S. has done more total testing, but all of the other countries he mentioned have still performed more tests per positive case, meaning theyve been able to do more testing relative to the size of their outbreaks.

The next day, White House Press Secretary Kayleigh McEnany again referenced South Korea. We always hear about South Korea and their tests, there are 11 tests per thousand, she said. Here in the United States, thats 17 tests per thousand.

McEnanys statistics are slightly off for May 4, Our World in Data shows South Korea with 12 tests per thousand people and the U.S. with 22.

But again, the comparison is misleading because it ignores the fact, as we have previously written, that South Korea rapidly expanded testing early on in the outbreak. Ultimately, the country was able to successfully halt its outbreak something the U.S. has failed to do.

On May 8, the country posted just 12 new cases, while the U.S. is still seeing around25,000new infections per day, or approximately 325 times more cases than South Korea when adjusted for the population. It took months until April 17 for the U.S. to catch up to South Koreas per-capita testing level, and the U.S. has yet to match the nations less than 2% test positivity rate. South Korea doesnt need to compete with the U.S. on per-capita tests because the country is already doing a massive amount of testing compared to its caseload.

While experts say increased testing is a requirement for reopening, they also emphasize that by itself, its not enough.

Whats more important now is not so much the testing number, said HGHIs Tsai. Its really the testing strategy and transparency around the goalposts as states come up with their specific plans for reopening.

A key question is whether states will be able to snuff out new chains of viral transmission through contact tracing, as many experts advise. While a staple of public health, contact tracing is a resource-intensive process, and involves not just piecing together an infected persons contacts, but also providing support to those who are quarantined or isolated.

They may need food. They may need medicines, said Emily Gurley, an epidemiologist at Johns Hopkins, on a call with journalists. They may need help with simple things like doing their laundry.

Gurley contributed to a report, written in collaboration with the Association of State and Territorial Health Officials, that estimated the U.S. would need to add around 100,000 contact tracers to combat the spread of the coronavirus.

While Shaman thinks contact tracing is absolutely critical, he noted that South Korea was exceptionally well set-up to make the technique more effective.

Following an outbreak of MERS in 2015, he said, the country passed laws that allowed the government to monitor peoples credit cards and phones and also to arrest anyone refusing to participate in a quarantine.

Those levers arent available in the U.S., and privacy concerns may keep at bay proposals to deploy more scalable technology-based contact tracing tools.

Other scientists are pessimistic that contact tracing will work in the U.S., especially if case numbers remain high.

Its clear that you can do a lot of control if you do contact tracing really well. Singapore managed with mainly contact tracing for several months, said Marc Lipsitch, an epidemiologist at Harvard University, in a call with reporters. But then eventually even Singapore lost its control of the epidemic and had to resort to social distancing types of measures.

In conjunction with really aggressive measures to get case numbers down and significant resources contact tracing can be a useful piece of the control approach, he added. But I think its very challenging with an ongoing epidemic.

According to a New York Times analysis, 21 states are planning to or have already begun to reopen, even though they have not cleared all of the criteria set forth by the White House guidelines. Most of the states do not meet the gating criteria for COVID-19 cases, which can be met by showing either a downward trajectory of documented cases within a 14-day period or a downward trajectory of positive tests as a percent of total tests within a 14-day period.

Opening before states have solid testing infrastructures and strategies that they know are working, Tsai said, would be premature. Its basically just turning back the hands of time to February, he said.

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How Many COVID-19 Tests Are 'Needed' to Reopen? - FactCheck.org

The number of COVID-19 inpatients at most of Maines hospitals remained flat for a fourth week, though there were upticks at the major hospitals serving Portland and Bangor, data collected from the hospitals by the Press Herald show.

The data, current as of Thursday, show low numbers of hospitalized COVID-19 patients across the state over the past week, further evidence that strict social distancing measures have slowed the pandemic and protected medical facilities from being overwhelmed.

Statewide, 39 people were hospitalized Thursday, though that number jumped to 44 Friday, according to the Maine Center for Disease Control and Prevention. Thats up from 35 a week earlier. Gov. Janet Mills has said the hospitalization trend is one of several metrics her administration is watching as it makes decisions about the states phased reopening.

Maine Medical Center, which has had roughly half of the states confirmed coronavirus inpatients through most of the crisis, had just 10 patients on May 2, its lowest burden since March 24, but that number rose to 17 by Thursday. Portlands other major hospital, Mercy, had no patients for two weeks in mid-April, but its patient count has crept up from one to three since April 29.

Eastern Maine Medical Center in Bangor has had between six and seven COVID-19 patients since May 3, up from three most of last week.

Maine saw its largest single-day increase in coronavirus cases Thursday, the Maine CDC reported, largely because of outbreaks at the Tyson Foods plant in Portland, the Springbrook Center nursing home in Westbrook, and a homeless shelter in Bangor. The uptick in hospitalizations is likely related to these outbreaks, though hospitals do not disclose such information in order to protect patient privacy.

The data is also unlikely to reflect the effects of reopening barber shops, hair salons and other business May 1 or of the large gathering of mask-less customers at a defiant Bethel brewpub May 1 because there is a generally at least a week-long lag between exposures to the virus and hospitalizations. The median incubation period before experiencing symptoms is 5.1 days, according to a May 5 study in the Annals of Internal Medicine.

Central Maine Medical Center in Lewiston has had between one and three COVID-19 inpatients since May 3 after going seven days without one. Franklin Memorial in Farmington had an inpatient count of one for much of the week, its only pandemic hospitalizations apart from April 3, when it had three.

Hospitals in most other parts of the state continued to see flat or gently declining caseloads for the fourth week running. Southern Maine Health Center in Biddeford and MaineGeneral in Augusta, the hospitals that have had the greatest burden from the pandemic after Maine Med, each had just one COVID-19 inpatient Thursday, the lowest level for both since March 26.

Mid Coast Hospital in Brunswick has had one or two patients for the past two weeks, down from a peak of five on April 13. York Hospital did not provide its weekly numbers, making its trend impossible to gauge, but said it had no patients Friday. Waldo Memorial in Belfast had a patient count of one all week, while Bridgton had none.

In all cases, hospitalizations can end three ways: recovery, death or transfer to another facility. The data does not include outpatients or inpatients who were suspected of having the virus but never tested.

Governments worldwide have introduced social distancing measures to flatten the curve in an effort to slow the pandemics spread so that hospital intensive care units are not overwhelmed by a massive wave of patients. On May 1, Maine began lifting some of the restrictions imposed March 31.

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COVID-19 hospitalizations in Maine flat for 4th week, but upticks in Portland and Bangor - Press Herald

Research suggests that around 14% of people in the United States would avoid seeking treatment if they experienced the key symptoms of COVID-19.

New research conducted by the analytics firm Gallup and the nonprofit organization West Health has found 1 in 7 people in the U.S. would avoid seeking treatment for the key symptoms of COVID-19 because of concerns over cost.

The study shines a light on the U.S. healthcare system and the barriers it places on people with low incomes from accessing healthcare.

In the U.S., healthcare is generally not paid for by the state but by the individual, typically through the health insurance that many people access as a benefit of employment.

However, those out of work or working on precarious contracts may not have access to health insurance. This makes them vulnerable to significant charges if they do require healthcare.

In the context of the COVID-19 pandemic, this situation has become even starker.

According to the research, while insurance companies have agreed to waive any additional payments related to COVID-19 testing, people could still end up with out-of-pocket expenses.

Gallup conducted a representative poll of 1,017 adults, asking them two questions. The first question was, [i]f you or a family member had a fever and a dry cough, would you avoid seeking treatment due to concerns about the cost of care?

The second question was [i]f you thought that you might have been infected by the coronavirus, would you avoid seeking treatment due to concerns about the cost of care?

Gallup found that 1 in 7 people 14% of those polled would avoid seeking treatment if they experienced a dry cough and fever.

When the question changed to ask the respondents directly about suspected COVID-19, Gallup found that 9% of people would still avoid seeking health care due to concerns over cost.

The researchers think that uncertainty surrounding the key symptoms of COVID-19 could account for the difference between the two questions. This was evident particularly in the 1829 year age group in which 22% would avoid care due to costs for the two key symptoms, but only 12% would avoid care when coronavirus was specifically mentioned.

Unsurprisingly, for both questions, a persons income was a key factor in whether they would avoid seeking treatment due to worries about cost.

While only 5% of people whose annual household income was over $100,000 would avoid seeking medical care if they had a dry cough or fever, this figure jumped to 22% for people whose annual household income was below $40,000.

Likewise, for those who suspected they had COVID-19 and had an annual household income of $100,000 or more, only 3% would avoid seeking treatment due to cost. The figure for those whose household income was under $40,000 was 14%.

According to Tim Lash, chief strategy officer for West Health, [m]illions of Americans, even in the face of a disease that has brought a country to its knees, would forgo care due to the potential expense and still others may not be clear on the common symptoms of COVID-19.

While physicians and healthcare workers are doing courageous and lifesaving work, the pandemic magnifies the longstanding perils and flaws of a high cost healthcare system in need of reform.

While the poll makes clear that income affects the extent to which someone is likely to seek medical treatment, current U.S. government advice regarding COVID-19 may have affected the results of the poll.

According to the Centers for Disease Control and Prevention (CDC), if a person has a fever, dry cough, or other symptoms of COVID-19, then the official advice is to stay at home and self-care. Only if their symptoms get more severe should a person seek medical treatment.

The CDC have also clarified that all those with symptoms of COVID-19 are a priority for testing. They also express concern that if people are avoiding testing for fear of healthcare costs, it could affect the future monitoring of how the virus spreads when the government relaxes lockdown measures.

It may be that the respondents of the poll, knowing the official advice, would not seek treatment whatever their income.

Nonetheless, some people who responded to the poll were clearly concerned about costs. The results showed a clear correlation between these concerned people and relative annual household income.

The research also polled people on access to care, asking the respondents whether [] you or a family member been denied care by a hospital or a doctor due to heavy patient volume brought on by the coronavirus outbreak?

Here, the researchers found that 6% of respondents had been denied access to care. However, again, the responses varied by annual household income: while only 3% of those whose annual household income was over $100,000 had been denied care, this figure rose to 11% for those whose annual household income was below $40,000.

According to Dan Witters, Gallup senior researcher, [t]hese new findings align with previous research by West Health and Gallup on the impact of high healthcare costs in the U.S.

Last year, over 13% of respondents, representing more than 30 million adults, reported having a friend or family member who died in the last 5 years after not being able to afford necessary care.

Add to that the challenges associated with COVID-19, and Americans find themselves in a quagmire as many of them turn to a system they cant afford or that cant accommodate them.

For live updates on the latest developments regarding the novel coronavirus and COVID-19, click here.

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COVID-19: Cost of care puts off 1 in 7 people from seeking treatment - Medical News Today

Ryan and Britta Kockelman's wedding was supposed to be on May, 24th, but COVID-19 had other plans.

"I was super sad when we were kind of anticipating having this conversation with our parents and just seeing the trajectory of how this Coronavirus was supposed to be spreading... I was super super upset," said Britta.

After talking about what their options could be, they decided to go through with the ceremony and moved their wedding date up to April 11th. Guests were welcome to attend through Facebook Live.

"Our pastor who did the ceremony had like a tripod you could put a phone on and I have the iPhone XR one so the camera is super good and we mounted that on there and we're like, I guess we'll see who tunes in," says Ryan.

Instead of having to worry about a 400 person guest list, over 1,000 people were able to watch.

Ryan says it was cool to see everyone tune in, "I have friends who live overseas like in Europe and other countries and they're commenting and talking about watching and messaging me and I'm like... they wouldn't have got to be there so it's actually cool that they got to watch it!"

But, one moment Britta was looking forward to most was having their first dance as a married couple. Knowing this, Ryan made sure to make this unexpected day, even more memorable.

"We had booked the White House Co., it's the rental company in town, they have a cute warehouse and when Ryan and I arrived, there were a bunch of candles all lit up in a circle all on the floor and Ryan took me over and said, "you were sad you weren't going to be able to have your first dance so I wanted to make that happen." Then we had our first dance and our photographer got to capture it so it was really special and really sweet.

A wedding they never thought they would have, becoming a day they'll never forget.

Plus, to make it even better, they saved their wedding plans for spring of 2021. They plan to do a vow renewal and have the reception as a celebration for their one year anniversary.

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Local couple doesn't let COVID-19 stand in the way of their wedding day - Valley News Live

Fever, cough and shortness of breath were early on identified as symptoms of COVID-19, but additional symptoms are emerging. megamix/Getty Images hide caption

Fever, cough and shortness of breath were early on identified as symptoms of COVID-19, but additional symptoms are emerging.

When the coronavirus pandemic first emerged, public health officials told the world to watch out for its telltale symptoms: fever, dry cough and shortness of breath. But as the virus has spread across the globe, researchers have developed a more nuanced picture of how symptoms of infection can manifest themselves, especially in milder cases.

We're getting a "better understanding of how these symptoms express in the general population and not necessarily in hospitalized patients," which is whom most of the earlier studies from China looked at. "So it's a bit of a bigger picture," says Charitini Stavropoulou, an associate professor in health services research at City, University of London in the U.K., who led an analysis of known symptoms in milder cases as part of a collaboration with Oxford University.

Some of these symptoms, such as loss of smell or taste, are highly distinctive and a strong indicator of infection. Others, like headaches, chills or sore throat, are common to lots of illnesses. So how do you know when a symptom is cause to seek medical advice or testing? We asked doctors and public health and infectious disease researchers for their insights.

THE STANDARD 3

Fever: Some patients can experience fevers that last for days, while others might see their temperature go up and down, with peaks often occurring in the evening, says Dr. David Aronoff, chief of the Division of Infectious Diseases at Vanderbilt University Medical Center. "I think if someone has a fever, regardless of how long it's lasting, unless they can clearly attribute it to something else, that's a very reasonable symptom to seek an evaluation for," he says.

Stavropoulou's systematic review of the medical literature found that fever was reported in 82% to 87% of mild to moderate cases.

Dry cough: Cough was the second most common symptom after fever, though "coughing was not always there," Stavropoulou notes. "So while we think it's a main symptom, it appears only two out of three times for patients with COVID-19."

That said, cough remains a "very, very common symptom of the pneumonia that the virus can cause," says Aronoff. Given this fact, "if someone has a new cough or a new shortness of breath that's cropped up in the last three days or so, they should definitely get tested."

Shortness of breath: Stavropoulou's review found that this symptom occurs more frequently in severe cases "and indeed, in some studies, was a marker of severe disease." The two largest studies she looked at found that shortness of breath occurred in fewer than 8% of milder cases.

THE NEW 6 FROM THE CDC:

Chills/repeated shaking with chills: The chills generally precede a fever, though people don't always perceive when their temperature has spiked, Aronoff says. Sometimes, those chills can be accompanied by shaking, since shivering is our bodies' way of generating heat and raising our temperature, he says.

Muscle pain: Nearly 15% of COVID-19 patients experience muscle pain, according to a report published by the World Health Organization in February that analyzed nearly 56,000 confirmed cases in China. But that's hardly unique to this disease: Lots of viral infections can cause muscle aches and pains, which can result from an inflammatory response to a virus.

"I think all of us who have had the winter cold or flu have had experience with muscle pain, headache, sore throat," notes Aronoff. Given that we're no longer in the typical cold and flu season, if you're experiencing muscle pains and other flu-like symptoms, "we know that those can be associated with COVID-19," he says. "And it is very reasonable to get people thinking, you know, maybe I should get tested."

He added: "I would also include new-onset fatigue, out of proportion to what a patient would expect to be experiencing under whatever circumstances they are [in]," as a symptom.

However, fatigue on its own is not very predictive of disease, because it is also frequently reported by people who don't test positive, says Claire Steves, a geriatrician and senior lecturer at King's College London. She's one of the lead researchers on the COVID Symptom Tracker, an app-based project that has so far recruited 3 million people across the U.K. to log any symptoms even if they are not feeling sick. Researchers can use data from those who are eventually diagnosed with COVID-19 as an early radar on how symptoms develop in the population. (The COVID Symptom Tracker is now recruiting people in the U.S. to sign up as well.)

Steves' research is finding that certain symptoms tend to cluster together in people who test positive. For instance, fitter people in the 20-70 age range who experience loss of smell often also experience fatigue, and they tend to have a milder course of the disease, she says.

Headache: Headaches are a common experience for many adults. On its own, a headache should probably not be cause for alarm, especially if it behaves like other headaches you've experienced, says Aronoff.

"If somebody is only going to use headache as a trigger to go get tested for COVID[-19], that headache should be something that either is a headache that's new for them or that is sticking around a bit longer than they are used to," he says. "Or it's associated with another symptom that may also be subtle, like fatigue or feeling kind of worn out" especially if there's no good reason for the tiredness.

In fact, Steves says research out of the COVID Symptom Tracker suggests that headache "is an important symptom" seen early on in the course of the disease and it commonly occurs alongside other symptoms.

Sore throat: "We're seeing sore throat in COVID-19 patients," says Aronoff. "But it's what I would say [is] a minor symptom" one that's common to lots of other ailments.

Loss of taste or smell: This symptom has emerged as a strong indicator of infection one distinctive enough that it alone should be cause to seek testing, says Dr. Carol Yan, an otolaryngologist and head and neck surgeon at UC San Diego Health.

If someone is experiencing this symptom, "I would tell them that they should consider self-quarantining themselves and contacting their health care providers," says Yan. Most people who experience loss of smell or taste also have other symptoms, commonly fever, fatigue and malaise, she says. "But there's certainly a subset of people that we know have only smell and taste loss and no other symptoms" who ultimately test positive.

Yan's research has found that about 7 out of 10 patients reported an acute loss of sense of smell or taste at the time of their diagnosis.

Similar findings have emerged from the COVID Symptom Tracker. Among fit and healthy people ages 20 to 70, "the loss of sense of smell is a really good marker" of infection, Steves says.

In fact, this symptom is seen as such a strong indicator of infection that patients at UC San Diego Health are now routinely asked not just if they have a cough or fever but also if they're experiencing a loss of smell or taste, says Yan. "It's really being used as a good screening question and in helping triage patients."

The good news is that both Yan and Steves have found that people who lose their sense of smell or taste tend to experience a milder course of the disease. Yan says patients generally recover these senses in two to four weeks on average.

OTHER POTENTIAL RED FLAGS

Confusion and gastrointestinal issues: Stavropoulou's review of the medical literature found that, in most studies, gastrointestinal issues were reported in fewer than 10% of mild cases of COVID-19.

But Steves says emerging data from the COVID Symptom Tracker suggest that problems like diarrhea, nausea and abdominal pain tend to be more prominent in the frail elderly people who are over 70 and need help to get around. Acute confusion also seems to be an important symptom in this group, she says.

"Older and frailer and more co-morbid people" those with underlying conditions such as heart disease, diabetes or obesity "tend to be getting this cluster of abdominal symptoms and delirium symptoms and headache as well," Steves says.

She says it's important for caregivers to recognize that these symptoms in the frail elderly could be indicative of COVID-19, particularly in situations like nursing homes, "because that's where spread could occur."

AND THEN THERE'S THIS ...

Chilblains (pictured) are itchy, red, pink or purple inflammations of the skin's small blood vessels that can develop in body parts such as toes and fingers from exposure to colder temperatures or wet conditions. A similar-looking inflammation of the toes is an emerging symptom of COVID-19 and is being referred to as "COVID toes." Science Source hide caption

"COVID toes" and other skin manifestations: Dermatologists are now reporting that certain skin conditions appear to be emerging as symptoms of infection in milder cases. Among the most common and striking is "COVID toes," a condition resembling chilblains, or pernio, on the feet or toes, says Dr. Esther Freeman, director of global health dermatology at Massachusetts General Hospital and director of the international Dermatology COVID-19 Registry. The registry has received more than 400 reports from dermatologists in 21 countries, and a little under half are cases of COVID toes, she says.

Normally with chilblains, "you would see pink, red or purple lesions on the toes or sometimes on the hands," Freeman says. "That's often accompanied by swelling and can also be accompanied by a burning, itching or tender sensation," she says.

Chilblains are caused by inflammation in the small blood vessels of the skin, usually in reaction to colder temperatures or damp weather, Freeman says. "So, for example, spending a lot of time outside in wet socks could do it."

What's unusual is that during the coronavirus pandemic, "we're seeing patients who are living in warm climates or patients who have been sheltering inside and staying warm developing these lesions for the first time," she says.

"I have seen more toe consults in the past two weeks than I have in my entire prior career combined," Freeman says.

She says some patients develop COVID toes early on, along with other symptoms such as fever or cough. Others develop the condition well after their other symptoms have passed, almost like a post-viral response. And a third category of patients seems to develop COVID toes as the sole symptom.

Other skin conditions reported include hives and morbilliform, a measles-like rash on the chest, back, arms or legs. Freeman notes that viruses for example, those that cause measles or chickenpox often cause rashes, so dermatologists were expecting that with the coronavirus. But the toe manifestations were surprising.

While data are still emerging, Freeman says that in her opinion, dermatologic symptoms, such as COVID toes, should be considered as criteria for testing. But if you're having these symptoms, she says, "Please don't panic. Most of our patients who are developing these COVID toes are doing extremely well and are able to recover fully at home."

"I think it's also important to know that the purple lesions will go away on their own," she adds.

See the article here:

Is It COVID-19 Or Something Else? What Experts Are Learning About Symptoms : Goats and Soda - NPR

SEATTLE Amid growing impatience over stay-at-home orders and rising unemployment, public health experts have worried that some people may try to expose themselves to the coronavirus in a risky bid to gain immunity.

County health officials in southeastern Washington State reported this week that they had evidence that one or more such gatherings had been linked to at least two new coronavirus cases. But on Wednesday night, the officials retracted those comments and said the so-called Covid-19 parties may have been more innocent gatherings.

Meghan DeBolt, the director of community health for Walla Walla County, said county officials were learning more about the cases that have emerged from the recent social gatherings. She said they were still hearing reports of parties where infected people were present but do not have evidence that the people who became ill after the gatherings had attended out of a desire to be exposed.

The county had said in a news release on Monday that the authorities were receiving reports of Covid-19 parties occurring in our community, where non-infected people mingle with an infected person in an effort to catch the virus. Officials later elaborated on those reports in interviews, saying the parties were discovered after tracing the paths of people who were found to be infected after the gatherings.

Officials in Walla Walla have been working in recent weeks to contain a large outbreak at a meat processing facility in the area. Ms. DeBolt said the county was not close to halting the rise in infections, and health officials are concerned that more people are engaging in ill-advised social interactions despite stay-at-home requirements.

We know that people are exhausted from isolation and quarantine, Ms. DeBolt said. We want to be able to reopen, too. We want to be able to go to restaurants and socialize with friends and family members. We need our communitys help to be diligent for a little bit longer so that we can get ahead of this.

The prospect of infection parties for people who wish to quickly contract the disease in the hope of gaining immunity has been a fear among some health experts because the country has a long history of people choosing purposeful infection.

Read the rest here:

Covid-19 Parties Probably Didnt Involve Intentional Spread - The New York Times

They arent frontline workers. They arent riding New York City subways. They arent stuck in jails or homeless shelters or other congregate facilities where the disease could spread easily.

The vast majority of New Yorkers still walking into hospitals with COVID-19 have been sheltering at home and avoiding mass transit. Very few were even traveling on foot or in their own cars on a daily basis, according to a survey of new patients from over 100 hospitals across the state over a three-day span. Of those surveyed, 66% were at home before entering the hospital.

Gov. Andrew Cuomo, who presented the preliminary findings on Wednesday, said they underscore the need for people to double-down on protecting themselves and their families with things like masks, hand washing and staying away from the most vulnerable.

We were thinking that maybe we were going to find a higher percentage of essential employees were getting sick because they were going to work. That this maybe was nurses, doctors, transit workersthats not the case, Cuomo said. Some 83% of new patients are out of work or retired, and arent even leaving their home on a daily basis.

This is a surprise. Overwhelmingly, the people were at home, he added.

Cuomo announced over the weekend that hospitals would start collecting additional data about incoming COVID-19 patients, the number of which has declined but not as steeply as hoped. Health-care facilities statewide confirmed 600 new coronavirus patients on Tuesday, down from the more than 3,000 daily hospitalizations recorded at the outbreaks peak in early April.

The persistent spread of the disease prompted questions about who such as medical staff, inmates or nursing home residents needed better protecting.

But that largely wasnt the case. Of the 1,270 new patients surveyed, 18% were from nursing homes across New York state, 4% were from assisted living facilities, 2% were homeless and less than 1% were from prisons or jails. Two in three people coming into hospitals with the virus were simply at home, Cuomo said.

On top of that, only 4% of those newly infected said they took public transportation on a daily basis.

We thought maybe they were taking public transportation, and weve taken special precautions on public transportation. But no, these people were literally at home, Cuomo said.

Also on MarketWatch: Economic expert with perfect record calling recessions is betting this one will be over by the end of 2020

There were also less surprising statistics. Minorities comprised a disproportionate amount of new cases, reflecting known health disparities.

Most new cases are happening downstate, which has been the epicenter of the outbreak since the beginning. More than half of all the new COVID patients were from New York City, including 21% from Manhattan; 18% were from Long Island and 11% from Westchester and Rockland counties, both directly north of the city.

Another unsurprising statistic is that 96% of those hospitalized in recent days have underlying health issues, things like cancer, asthma and diabetes, that can make COVID-19 more severe. Three in four new patients were 51 or older.

See: The science behind why older immune systems are more vulnerable to COVID-19

That whole vulnerable population being old well old is now 51 and up, so think about that, Cuomo said, adding that he felt particularly sensitive about that stat.

The takeaway, however, is that people need to be even more vigilant about protecting themselves and others.

Dont miss: New York Citys essential workers could face cuts and furloughs, mayor says

Everything is closed down. Government has done everything it could, Society has done everything it could. Now its up to you. Are you wearing the mask? Are you doing the hand sanitizer? he said. Are you staying away from older people?

Inflammatory Disease: The New York State Department of Health has issued an advisory to health-care providers about an inflammatory disease affecting children that is thought to be linked to COVID-19. As of Tuesday, 64 potential cases of Pediatric Multi-System Inflammatory Syndrome Associated with COVID-19 have been reported in the state.

Fatalities: Coronavirus resulted in the deaths of 232 New Yorkers on Tuesday alone. Though far lower than April's peak of 799 deaths in a single day, the total has inched up marginally for two consecutive days, from 226 on Sunday and from 230 on Monday. The total number of fatalities in New York state stands at 19,645.

Read the original:

Majority of new COVID-19 hospitalizations in New York are people who stayed at home - MarketWatch

Fifteen children, many of whom had the coronavirus, have recently been hospitalized in New York City with a mysterious syndrome that doctors do not yet fully understand but that has also been reported in several European countries, health officials announced on Monday night.

Reached late Monday night, the state health commissioner, Dr. Howard A. Zucker, said state officials were also investigating the unexplained syndrome.

The syndrome has received growing attention in recent weeks as cases began appearing in European countries hit hard by the coronavirus.

There are some recent rare descriptions of children in some European countries that have had this inflammatory syndrome, which is similar to the Kawasaki syndrome, but it seems to be very rare, Dr. Maria Van Kerkhove, a World Health Organization scientist, said at a news briefing last week.

Covid-19, the disease caused by the coronavirus, tends to be much more dangerous for older people and those with underlying health conditions. Children are less likely to become seriously ill than adults. But some do. In New York City, six children have died of Covid-19, according to data from the health department.

The bulletin said that most of the 15 children had a fever and many had a rash, vomiting or diarrhea. Since being hospitalized, five of them have needed a mechanical ventilator to help them breathe, and most of the 15 required blood pressure support.

The full spectrum of disease is not yet known, the bulletin said. Of the 15 patients, most either tested positive for the coronavirus or were found, through antibody testing, to likely have been previously infected.

The citys health commissioner, Dr. Oxiris Barbot, said in a statement: Even though the relationship of this syndrome to Covid-19 is not yet defined, and not all of these cases have tested positive for Covid-19 by either DNA test or serology, the clinical nature of this virus is such that we are asking all providers to contact us immediately if they see patients who meet the criteria weve outlined.

And to parents, she added, if your child has symptoms like fever, rash, abdominal pain or vomiting, call your doctor right away.

Conjunctivitis, or inflammation of the eye, and swollen lymph nodes are also symptoms of Kawasaki disease.

The health department identified the 15 patients by contacting hospital pediatric intensive care units across the city in recent days. Only severe cases may have been recognized at this time, the bulletin said.

The 15 patients were all hospitalized on or after April 17.

WNBC-TV previously reported that Mount Sinai Kravis Childrens Hospital had treated some patients believed to have this syndrome and that some had developed heart problems and low blood pressure.

Dr. Zucker, the state health commissioner, was asked last week about reports of toxic shock in younger patients. He responded that officials were aware that the virus attacks different organs, including the lining of blood vessels, something some doctors believe may be contributing to blood clots in some coronavirus patients.

What we have been seeing is that there are some children who may have an inflammation of those blood vessels, and are developing a toxic-shock-like syndrome, he said, adding that he had spoken to number of hospital directors about a small number of cases.

On Monday night, Dr. Zucker reiterated that state health officials were aware of multiple cases of this syndrome in New York City hospitals, and that he had spoken with medical providers statewide about it.

Dr. Zucker said the state health department was also looking at Kawasaki-like cases in children and adolescents in Europe, which were the subject of an international webinar last weekend.

So far, from what we understand, this is a rare complication in the pediatric population that they believe is related to Covid-19, Dr. Zucker said, adding, We are following it very closely.

Pediatricians in several European countries, including Italy, Britain, France and Spain, have reported dozens of cases of children presenting these kind of symptoms.

No deaths have been recorded, and although many of the children tested positive for the coronavirus, others didnt.

In Italys northern town of Bergamo, a hot spot for the outbreak, one hospital had 20 cases in April alone. In four Parisian hospitals, 20 children were hospitalized with inflammatory heart conditions, and in Britain, over a dozen children with such symptoms have required intensive care.

Spain has recorded a few dozen cases throughout the country, and Switzerland and Belgium have reported a handful.

Pediatricians have urged families whose children have high fever, rashes or stomach pains to call doctors immediately. Some have said they were concerned that parents might not take their children to the hospitals because of the pandemic.

As those countries are weighing how to reopen schools, health experts said the small number of these unusual cases shouldnt prevent the authorities from doing so.

Jesse McKinley and Elian Peltier contributed reporting.

Read the original post:

15 Children Are Hospitalized With Mysterious Illness Possibly Tied to Covid-19 - The New York Times

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A 10th Alaskan has died from COVID-19, the state said Wednesday.

The most recent victim of the infectious disease caused by the coronavirus was an Anchor Point man in his 80s, according to new data published by the Alaska Department of Health and Social Services.

The man had pre-existing medical conditions, state officials say. He tested positive for the virus at South Peninsula Hospital when he was admitted there and subsequently died.

His case was first reported to the state on April 30 and the onset date was listed as April 28. The man contracted the virus through community spread.

One of the states other 10 deaths was also an Anchor Point resident in his 30s who died out of state on March 29. Several of the other people to die from the virus contracted it or died out of state. Six of the states COVID-19 victims were people in their 60s or 70s.

A Mat-Su woman in her 30s died April 12 -- the most recent fatality until this week.

There was one new case of COVID-19 reported in Alaska on Wednesday, bringing the total case count to 372, with 284 people considered recovered. The new case was diagnosed in a Tok resident, a woman in her 70s, health officials say. Hers is the first known case of the disease in that community.

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Alaska reports 10th death from COVID-19, the first in weeks - Anchorage Daily News