Category: Covid-19

Cloe Poisson :: CTMirror.org

A healthcare worker with 1199 SEIU holds a sign demanding more PPE, or Personal Protective Equipment, to protect from Covid-19 during a Caregivers Caravan of union nursing home workers at the state Capitol last week.

State health officials confirmed Monday that more than half of all coronavirus-related deaths in Connecticut involve nursing home residents despite very recent projections that it had been closer to one-third.

The state reclassified the cause of death last week to COVID-19 for some nursing home residents as they worked with local health officials to develop a more uniform method of assessing the pandemics impact on the industry.

We wanted to make sure we were reporting the deaths as accurately as possible, Dr. Lynn Sosa, deputy state epidemiologist, told the CT Mirror on Monday. There was a lot of data coming from multiple sources and we were really doing the best that we can.

Gov. Ned Lamont released a report last Thursday that showed 375 nursing home residents had died from the coronavirus between the pandemics start and April 14.

Thats a 76% percent increase 212 more COVID-19-related deaths among residents from the total reported on April 13.

Coronavirus-related deaths among residents hadnt increased by more than 30 people even once between April 7 and 13.

Put another way, the state report indicated 35% of all coronavirus-related deaths in Connecticut involved nursing home residents through April 13, but by the following day it had swelled to 56%.

Health care experts have warned repeatedly that patients over 60 are among the most vulnerable to complications from the disease and the average age of nursing home admissions in Connecticut is around 80.

Still, the April 14 death total was clearly an outlier or the totals reported earlier in the month likely were too low.

State health officials concluded the data collected from April 7-13 was the problem.

The administration began adding nursing home numbers to its daily briefings on April 7, assigning staff each morning to call all of the states 213 nursing homes, Sosa said. Information from the calls was placed in a spreadsheet that was constantly updated as nursing homes reported developments to the states epidemiology lab.

But even with those daily efforts, there was a hole.

State records on cause of death didnt always match up with those of local health districts.

And health officials discovered it April 14 and 15 when the administration took time off from reporting nursing home data to create a new digital reporting system to replace the daily phone calls.

In some instances, nursing home residents that were showing COVID-19 symptoms but had not been tested before dying were categorized differently. Some were reported as positive. Others simply were reported as having died from respiratory illnesses.

And a shortage of time and available test kits also meant it wasnt always feasible to clarify every uncertain case immediately, Sosa said.

After two days of conferring, state and local health officials had a better, unified understanding on how to identify COVID-19. Officials decided to conclude that the coronavirus was responsible for death when a preponderance of medical evidence pointed in that direction.

The grimmer data sparked calls from state legislators Monday to immediately channel more protective equipment and training into itsnursing home facilities.

We have to act now to stop this from creating any further spread in our most vulnerable population, said Deputy House Minority Leader Vincent J. Candelora, R-North Branford. With the new numbers we have, we have to be sounding the alarm.

Candelora said state government should immediately ensure that all nursing homes have adequate supplies of masks, gloves and other personal protection equipment, as well as the training to use them.

Its important that we have the best data so we can evaluate our response and the direction we go in as a state, said Rep. Toni E. Walker, D-New Haven, co-chairwoman of the Appropriations Committee. I know the administration is trying very hard to do everything that is possible. But the data is saying this is not working.

The Lamont administration announced Sunday it was expanding its emergency Medicaid rate increase for nursing homes from 10% to 15%. But this followed a letter from nursing home industry leaders warning facilities were days away from financial catastrophe due to increased coronavirus-related staffing and equipment costs.

McKnights, an online news site specializing in long-term care issues, published an analysis earlier this month of personal protection equipment cost increases amidst the pandemic.

Mark-ups included: 215% for hand sanitizer; 267% for latex gloves; 1,513% for N95 masks; and 2,000% for disposable gowns.

The Lamont administration also recently announced it would begin visits to every nursing home in the state to better understand their needs.

The states two largest nursing home associations called Monday for more careful government scrutiny of COVID-19 data going forward.

The incidents of COVID-related deaths are increasing in nursing homes, consistent with data indicating the impact the virus has on older populations wrote Matthew Barrett, president of the Connecticut Association of Health Care Facilities and Mag Morelli, president of LeadingAge Connecticut. We need to be sure the data we are collecting and the manner in which it is collected is gathered and reported consistently and accurately so that we can utilize it to the fullest extent in our efforts to fight this historic and unprecedented pandemic.

Staff writer Jacqueline Rabe Thomas contributed to this story.

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COVID-19 caused more deaths among CT nursing home residents than initially reported - The CT Mirror

COVID-19 in the USA: a question of time  The Lancet

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COVID-19 in the USA: a question of time - The Lancet

Only a tiny proportion of the global population maybe as few as 2% or 3% appear to have antibodies in the blood showing they have been infected with Covid-19, according to the World Health Organization, a finding that bodes ill for hopes that herd immunity will ease the exit from lockdown.

Easing restrictions is not the end of the epidemic in any country, said WHO director-general Dr Tedros Adhanom Ghebreyesus at a media briefing in Geneva on Monday. So-called lockdowns can help to take the heat out of a countrys epidemic.

But serological testing to find out how large a proportion of the population have had the infection and developed antibodies to it which it is hoped will mean they have some level of immunity suggests that the numbers are low.

Early data suggests that a relatively small percentage of the populations may have been infected, Tedros said. Not more than 2%-3%.

Dr Maria Van Kerkhove, an American infectious diseases expert who is the WHOs technical lead on Covid-19, said they had thought the number of people infected would be higher, but she stressed it was still too early to be sure. Initially, we see a lower proportion of people with antibodies than we were expecting, she said. A lower number of people are infected.

What is the World Health Organizations remit?

The World Health Organization (WHO) was founded as the UN global health body in 1948 in the aftermath of the second world war with a mandate topromote global health,protect against infectious disease and to serve the vulnerable.

Its current programme envisages expanding universal healthcare to a billion more people, protecting another billion from health emergencies and providing a further billion people with better health and wellbeing.

What does that involve?

The WHO acts as a clearing house for investigation, data and technical recommendations on emerging disease threats such as the coronavirus and Ebola. It also supports eradication of existing diseases such as malaria and polio and promotes global public health.

While its role on emerging diseases is most familiar in the developed world, its practical involvement is far more marked in the global south, where it has been working to expand basic healthcare, support vaccination and sustain weak and often stressed health systems through its emergencies programmes.

Why is the WHO under fire from Trump?

Trump has presented thefreezing of US funding to the WHOas a direct response to what he claims was its slow reaction in raising the alarm over the global threat from the coronavirus and being too China-centric in its response. The allegation that the WHO was slow to warn of the risk of human-to-human transmission, and that it failed to cross-examine Chinese transparency early on, is largely not borne out by the evidence. And the organisations funding was already in his sights on 7 February,when his administration was suggesting cutting the US contributionby half.

The WHO, to whom the US theoretically contributes roughly 10-15% of its budget as its largest contributor, has been appealing for an extra $1bn to help fight the coronavirus. While the suspension of funding by the US for 60-90 days is relatively small not least because the US is so far in arrears in its annual payments the potential for a general US withdrawal from global health funding under the cover of this announcement would be very serious and felt most profoundly in places that need the most support.

Peter BeaumontandSarah Boseley

On Friday, a study carried out in Santa Clara, California by Stanford University and released as a pre-print without peer review, found that 50 to 85 times more people had been infected with the virus than official figures showed.

Santa Clara county had 1,094 confirmed cases of Covid-19 at the time the study was carried out, but antibody tests suggest that between 48,000 and 81,000 people had been infected by early April, most of whom did not develop symptoms.

But even those high figures mean that within the whole population of the county, only 3% have been infected and have antibodies to the virus. A study in the Netherlands of 7,000 blood donors also found that just 3% had antibodies.

Van Kerkhove said they needed to look carefully at the way the studies were being carried out. A number of studies we are aware of in pre-print have suggested that small proportions of the population [have antibodies], she said. These were in single digits, up to 14% in Germany and France. It is really important to understand how the studies were done.

That would include asking how they found the people to test. Was it at random or were they blood donors, who tend to be healthy adults? They would also need to look at how well the blood tests were performed.

We are working with a number of countries carrying out these serology studies, she added. The WHO-supported studies would use robust methods and the tests would be validated for accuracy.

The hope will be that people who have had Covid-19 will be able to resume their lives. But Van Kerkhove last week said that even if tests showed a person had antibodies, it did not prove that they were immune.

There are a lot of countries that are suggesting using rapid diagnostic serological tests to be able to capture what they think will be a measure of immunity, she said. Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection.

The headline and opening paragraph of this article were amended on 20 April 2020 to clarify that the 2%-3% figure cited by the WHO referred to the population as a whole.

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WHO warns that few have developed antibodies to Covid-19 - The Guardian

CHARLESTON, W.Va. (WHSV) As of 10 a.m. on April 21, when the West Virginia Department of Health and Human Resources (DHHR) issued their morning update on the COVID-19 case total, there have been 914 confirmed cases across the Mountain State.

A total of 22,763 West Virginia residents have been tested, with 21,849 negative results, 914 positive results, and 26 confirmed deaths due to the virus.

It is with great sadness that we announce more lives lost to this pandemic, said Bill J. Crouch, Cabinet Secretary of DHHR. Our sympathies and thoughts go out to these families.

This past Friday, the West Virginia DHHR issued an order requiring all laboratories to submit their testing results, both positive and negative, to the state's electronic system in real-time.

Testing for many people across West Virginia has been very limited, with people reporting difficulties finding anywhere near them that can perform tests and a lot of people in rural areas having to travel miles to the closest hospital just to find out that they don't meet the screening requirements.

According to DHHR data, 20.68% of the patients with confirmed cases in West Virginia are currently hospitalized. About 50% of people with confirmed cases had pre-existing conditions.

As of April 20, 77 patients were hospitalized, 513 were in home isolation, and 290 had fully recovered from the virus in West Virginia.

All of that data and more can be found in a slideshow here, updated daily.

Medical providers and laboratories have been required to report positive test results to DHHR, but will now have to report all results and do so electronically. Once the DHHR has them, they then submit the official numbers to the CDC and update their state website.

State officials have said for weeks that negative and pending tests from commercial labs have been under-reported because some labs cannot electronically submit negative results. The new DHHR order is designed to combat that.

Across the state, these are the confirmed cases by county, as of 10 a.m. on April 21:

Barbour (4)Berkeley (113)Boone (2)Braxton (1)Brooke (3)Cabell (34)Fayette (5)Grant (1)Greenbrier (3)Hampshire (6)Hancock (7)Hardy (3)Harrison (30)Jackson (101)Jefferson (63)Kanawha (134)Lewis (2)Lincoln (1)Logan (8)Marion (43)Marshall (8)Mason (10)McDowell (6)Mercer (9)Mineral (10)Mingo (2)Monongalia (91)Monroe (5)Morgan (8)Nicholas (4)Ohio (23)Pendleton (2)Pleasants (2)Preston (10)Putnam (15)Raleigh (7)Randolph (4)Roane (2)Summers (1)Taylor (5)Tucker (4)Tyler (3)Upshur (4)Wayne (78)Wetzel (3)Wirt (2)Wood (31)Wyoming (1)

The DHHR notes that surveillance at the local health department level may reveal over time that some initial test results in counties were for residents of another county or another state.

Excerpt from:

COVID-19 cases in West Virginia rise to 914, with 26 deaths - WHSV

A research letter published yesterday in JAMA found that rates of COVID-19 co-infections with other respiratory pathogens are 21%, higher than previously thought, suggesting that identification of another pathogen may not rule out the presence of the novel coronavirus.

Also, a letter yesterday in the Annals of Internal Medicine detailing survey results on 272 primary care physicians in Lombardy, Italy, who cared for about 400,000 COVID-19 patients found that 40% had symptoms suggestive of the disease, and most had to buy their own personal protective equipment (PPE) and educate themselves on coronavirus management.

Early in the pandemic, reports from China indicated that co-infection of COVID-19 and other respiratory pathogens was uncommon, suggesting that patients who tested positive for other pathogens could be assumed to not have the novel coronavirus.

Also, the US Centers for Disease Control and Prevention recommended testing for other respiratory pathogens, saying that confirmation could help rule out COVID-19 amid the lack of widely available testing.

In the JAMA letter, Stanford University researchers performed real-time reverse transcriptase-polymerase chain reaction for COVID-19 and other respiratory pathogens on nose and throat swabs from 1,206 symptomatic patients from multiple sites in northern California from Mar 3 to 25.

Some sites tested the specimens for COVID-19 as well as influenza A and B, respiratory syncytial virus (RSV), nonCOVID-19 coronaviruses, adenovirus, parainfluenza 1 through 4, human metapneumovirus, rhinovirus/enterovirus, Chlamydia pneumoniae, and Mycoplasma pneumoniae.

They found that, of the 116 specimens that tested positive for COVID-19, 24 (20.7%) were positive for at least one other pathogen, versus 294 of the 1,101 specimens (26.7%) negative for the novel coronavirus (difference, 6.0 percentage points [95% confidence interval (CI), 2.3 to 14.3]).

The most common co-infections included rhinovirus/enterovirus (6.9%), RSV (5.2%), and nonCOVID-19 coronaviruses (4.3%). None of the differences in rates of nonCOVID-19 pathogens between specimens positive and negative for the novel coronavirus was statistically significant (P<.05).

Of 318 samples positive for at least one pathogen that was not SARS-CoV-2, the virus that causes COVID-19, 24 (7.5%) were also positive for the novel coronavirus. Of 899 samples negative for other pathogens, 92 (10.2%) were positive for SARS-CoV-2 (difference, 2.7 percentage points [95% CI, 1.0 to 6.4]).

"These results suggest that routine testing for nonSARS-CoV-2 respiratory pathogens during the COVID-19 pandemic is unlikely to provide clinical benefit unless a positive result would change disease management (eg, neuraminidase inhibitors for influenza in appropriate patients)," the authors said.

In the Annals of Internal Medicine letter, researchers from Humanitas University in Milan, Italy, describe how hospital overcrowding and inadequate PPE and training put healthcare workersparticularly frontline general practitioners (GPs)at high risk for COVID-19. As of Apr 8, more than 6,000 Italian medical workers had been infected, and 94 physicians had died, including more than 20 GPs in Lombardy.

Of the 272 GPs responding to the survey, 108 (38.7%) reported having symptoms of COVID-19 during January to March. Fifty-four (50.0%) had respiratory symptoms, 54 (50.0%) had gastrointestinal symptoms, and 31 (28.7%) had both.

Of those with gastrointestinal symptoms, 77.8% had diarrhea for 3 days or less, and about half of those with respiratory symptoms said their symptoms lasted at least 7 days.

Only 18 (6.6%) had a throat swab taken to test for COVID-19, half of them because they had symptoms (8.3% of all 108 symptomatic GPs). Only 2 swabs were positive, 1 in a GP with respiratory symptoms and 1 with only diarrhea.

Of the GPs, 125 (46.0%) had one or more contacts with a patient with confirmed COVID-19, and 76.0% of the patients they referred to the hospital with symptoms suggestive of the novel coronavirus were positive for it. In response to the pandemic, 238 GPs (87.5%) changed how they delivered patient care, with 73.1% doing so via phone calls, 24.4% with telemedicine, and 2.1% with other methods.

The vast majority (264 [97.1%]) adopted ways to avoid patient overcrowding at their clinic. Only 46% said that their local health department gave them PPE, including surgical masks (94.4%), gloves (92.0%), disposable respirators (16.0%), and hand sanitizer (33.6%). Most (84.6%) had to buy their own PPE, and only 18.4% could give PPE to patients in their waiting rooms.

Only 85 GPs (31.3%) received training on COVID-19 management, 67.1% through online sources and 32.9% through courses or meetings. Of the GPs, 3.5% received the training in January, 44.7% in February, and 51.8% in March. The other 187 GPs prepared themselves, 48.7% with medical journals, 28.9% with online courses, 11.8% with leaflets and newsletters from the Ministry of Health or local health departments, and 10.6% through the mass media.

One-third said that the PPE given to them was insufficient, 12.0% that the training was inadequate, 7.0% that diagnostic tests should be more available, and 18.0% that communication and coordination with health departments and institutions need improvement.

The study "provides early insight into the urgent need to test and isolate at least symptomatic GPs to prevent community spread, provide necessary and adequate PPE to all GPs to protect them from COVID-19 during their daily work, and educate GPs and provide clear guidance on how to manage patients during the COVID-19 outbreak," the authors wrote.

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Researchers report 21% COVID-19 co-infection rate - CIDRAP

A lot of people still believe we are in a worst-case scenario, and thats actually not true, said Dr. Peter Dunn, a vice president overseeing inpatient capacity management at Mass. General. The curve is flattening even more and it is due to all the many community- and government-based efforts to minimize the spread.

Dunn also cited the preparation we were able to put into place across all of the health care systems throughout Greater Boston.

Dunn warned, as others have, that hospital leaders and the public cannot let down their guard. But he said Mass. General started growing confident in the second half of March that the hospital and others in Eastern Massachusetts would be able to handle the surge of very sick patients. Though there have been spikes and anxieties, including a rapid rise of infected residents in Chelsea most recently, the teams predictions have largely panned out.

"That does not mean we are not in a really challenging scenario right now,'' Dunn said. "It may not be the extreme but its far more than any of our health systems were built for.''

When Mass. General officials started to prepare fully for the coronavirus outbreak in March, one scenario alarmed them. Doctors and mathematicians plugged such information as infection rates into a special calculator which predicted that, at worst, more than 1,000 COVID-19 patients could require hospital care in Mass General at once. The hospital has about 1,000 beds, but that projection did not include patients needing to be hospitalized with other illnesses.

Mass. General, like other hospitals, sprang into action and canceled hundreds of non-urgent elective surgeries and converted regular floors into extra intensive care units.

The modeling teams recent projections predict the hospital will have about 376 COVID-19 patients in the hospital each day, at least through the coming weekend, including 170 patients in its ICUs, according to the latest data shared with the Globe. If the situation somehow worsens quickly, the hospital could set up 370 ICU beds if necessary.

The team also analyzed its entire network, Partners HealthCare, which consists of nine acute care hospitals, including Brigham and Womens Hospital, Newton-Wellesley Hospital, and North Shore Medical Center. It predicts that patient admissions in those hospitals has also plateaued, with about 866 COVID-19 patients across the Partners network hospitalized each day.

The team does not make statewide predictions, but given Partners broad reach in Eastern Massachusetts, its experience is an important window into the region overall. Governor Charlie Baker echoed this optimism Monday, during an interview with Boston 25 News, indicating that even as more residents are diagnosed with coronavirus, there should be little fear that sick patients with COVID-19 will create unbearable strain on medical providers and require rationing of resources such as ventilators.

The state reported Monday that the death toll from the coronavirus outbreak in Massachusetts had risen by 103 cases to 1,809. The number of confirmed coronavirus cases climbed by 1,566 to 39,643.

Dunn said Monday that his teams projections held up last week and over the weekend, even after infections among residents mounted in nearby Chelsea. The virus has taken a strong hold in that densely-packed city on just one day last week, as part of Mass. Generals expanded testing in the city, about half of 178 people tested were positive for coronavirus.

Dr. Joseph Betancourt, vice president and chief equity and inclusion officer, said Monday that hospital admissions from Chelsea seem to have flattened over the previous five days. "I definitely feel like we have all the trains on the tracks and we are seeing some results,'' he wrote in an e-mail.

The Mass. General health care systems engineering team began in 2007 with a far humbler project: determining how many elevators would be needed to transport surgery patients during a hospital construction project. The group said two elevators would be more than enough, which was met with some disbelief but turned out to be correct. The team earned credibility for bigger projects.

In March, after the coronavirus pandemic exploded in China, the group began with a Weill Cornell Medical College COVID-19 case calculator, which estimates a hospitals caseload using a range of factors including its typical patient load in the region, infection rate, and hospitalization rate. But because many of these factors were uncertain, the calculator spit out best-case and worst-case predictions. Mass. General and all the Partners hospitals began drawing up plans to try to accommodate the heaviest possible caseload.

"We did not know where we were going to be between the two,'' Dunn said.

The modeling group turned to data from Italy to map out how fast the number of patients hospitalized with coronavirus was increasing. Very soon, as the hospital gathered its own real-time data, it could see that Mass. Generals curve was below the hard-hit Italian region of Lombardy.

At the same time, an influential modeling group at the University of Washington, the Institute for Health Metrics and Evaluation, was making its own predictions for Massachusetts and the country, which have fluctuated wildly. A week ago, it estimated a staggering 8,219 COVID-19 deaths in Massachusetts, nearly twice the states forecasts, saying its dire predictions were partly because the state had issued a stay-at-home advisory rather than an "order.'' It has since lowered its projections for Massachusetts on Monday to about 3,200 deaths by Aug. 4, citing a new way of determining how much a community is following social-distancing messaging.

Dunn and his team said these types of predictive models had often failed to account for local variation, such as how well residents keep their distance from one another, regardless of what the guidance is called. The Mass. General team does not forecast the number of deaths from the virus.

Still, there have been bumps in the road, as Mass. General experienced last week.

Amid growing numbers of very ill patients, many from Chelsea, arriving at the emergency department and requiring hospitalization, Mass. General stopped accepting transfers from other hospitals for 48 hours last week. The hospital still had 20 ICU beds available, Dunn said, but leaders like to stay ahead by much more than that.

So the decision was made to have Brigham and Womens Hospital, the other large academic medical center in Partners, take transfers from smaller hospitals during that period until Mass. General could build its capacity.

"We hated doing it,'' said Ann Prestipino, a senior vice president and incident commander, during a Zoom meeting last Wednesday with hospital leaders. "We were concerned about the number of COVID patients and we needed to preserve some capacity.''

Dr. Kyan Safavi, a member of the modeling team, explained there were now more than enough ICU beds.

Dunn said the big question now is how long the plateau will last and when numbers of hospitalized patients will start to fall, a question his team has not answered yet. But, he said, that could start to happen next week.

"That will be the next piece of work,'' he said. "We still need to maintain same level of preparedness day to day to make sure things arent changing.''

Liz Kowalczyk can be reached at lizbeth.kowalczyk@globe.com.

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Mass. General models show flattening curve; COVID-19 patients not expected to overwhelm the system during this weeks surge - The Boston Globe

The 20-year-old man moved restlessly on a gurney in the emergency department at Greenwich Hospital in Greenwich, Conn., on March 14. It was hard for him to get comfortable. His head ached; his lips and mouth felt as if they were on fire. His hands were too swollen to close, and the skin and muscles all over his body felt tender and sore. Two days earlier, his mother picked him up from his university just outside Philadelphia, which had closed because of the Covid-19 pandemic. Several of his friends had been showing signs of a Covid-like sickness, and the young man and his mother were worried that he was, too.

As soon as she saw him, she could tell he was sick. His face was pale and sweaty. His skin was hot; his eyes were glassy with fever. She put on a mask, and then drove him home. Once he was safely in his bedroom, she called the Yale Covid-19 call center for guidance on what to do next. By then the first case of Covid-19 in Connecticut had been reported, a few days earlier on March 8. Given his likely exposure at school and his fever there and now at home, her son met the criteria of someone who should be tested, she was told. The soonest he could have the test at the local drive-through center was in three days, on March 15. In the meantime, she should assume that her son was infected with the virus and should be quarantined.

Before he could get to the drive-through, he began to get sicker. The day after he got home, March 13, he lost his appetite and developed a strange red rash around his nose, mouth and chin. The next morning, after he started vomiting, his mother took him to the hospital.

In the emergency room, the young man had no fever. The rest of his exam was normal, except for the raw-looking rash on his face, hands and back. The blisters and the round red lesions they turned into were tender and made it hard for him to talk, eat or even use his hands. The masked nurse returned with news from the E.D. doctor: He was to be admitted. They would test him for Covid-19. The rash he had wasnt typical of that infection, though they still had a lot to learn about it.

His rash looked more like a herpetic infection or hand, foot and mouth disease, an infection usually caused by the Coxsackie virus and most commonly found in young children and occasionally in adolescents. As the nurse explained this to mother and son, the mother erupted into a prolonged episode of coughing. Ive had this tickle in my throat for the past few days, she explained to the nurse, apologizing for the interruption.

I dont like the sound of that cough, the nurse replied. She should really talk to her doctor about being tested for Covid-19.

The mother couldnt believe that she might have this viral infection. She had been very careful. She started wearing masks and gloves whenever she left the house at the end of February. People had looked at her as if she were crazy for wearing that kind of protection, but she didnt care. She wiped everything down with disinfectant before she brought it into the house and left her coat and shoes in the foyer. She washed her hands dozens of times a day and scrubbed her counters and keyboards before and after every use. She was caring for her 91-year-old mother, who lived just a block away, and was terrified that the family matriarch would get sick. Her mother had isolated herself when the first cases hit New York City and depended on her daughter for anything she needed from the outside world.

The woman suspected that her husband wasnt quite as careful as she was. He was commuting on the Metro North train to New York for work. He didnt wear a face mask, but he said he washed his hands frequently and wore gloves when he was outside his home or office. But he had been coughing for the past week or so. He didnt have a fever and didnt feel short of breath. He just had this little cough that, he said, was nothing.

She had a cough, too, which started a few days before her visit with her son to the E.D. on March 14. A week earlier, she had a headache that felt like sinusitis. She went to a walk-in clinic on March 10, and the doctor there gave her azithromycin, an antibiotic. When that didnt help, and with her son at home in bed, she went back to urgent care and was given a second antibiotic. That didnt do much, either. Now the nurse who took care of her son in the E.D. suggested that she should be tested for Covid-19 confirming her worst fears.

The next morning, March 15, the woman dialed the number for the Yale call center again. She explained about her headache, her cough and her sick son. A voice on the phone patiently explained that she didnt meet their criteria for testing, even though her son might have Covid-19. She should just assume that she had it and isolate herself for 14 days.

The woman hung up, discouraged. She told me that it felt important to know for sure whether she had the illness. She called the number again, and a different voice answered. She again described her symptoms and her sick son. The voice asked if shed had any fevers. The woman hesitated. She hadnt had a fever but suspected that if she said that again, she wouldnt get tested. Yes, she told the woman on the phone. She spoke to a doctor who told her she would need to be tested. She could go to the testing facility in Waterbury. But the results wouldnt be available for another few days.

Her son stayed in the hospital for three days. His Covid-19 test still hadnt come back by the time he was discharged on March 17, but the doctors suspected that he probably had hand, foot and mouth disease. Its an infection consisting of a low-grade fever and a rash of small blisters that break open and then heal over the course of a few days. They are usually limited to the mouth but can spread to the hands and feet, and sometimes to the torso and buttocks. Its quite contagious, but for reasons that are not well understood, adults rarely get it. A few days later, their hypothesis was confirmed: The patients Covid test was negative, and the test for the Coxsackie virus was positive.

Now that her son was home, the mothers goal was to stay away from him until she knew for certain whether she had Covid-19. Shed also moved into a different bedroom to separate herself from her husband. But the day after she brought her son home from the hospital, her husband told her he was going to the emergency room. He felt terrible, he said, really short of breath. Hed packed a small suitcase, just in case he had to stay.

He did have to stay. His oxygen level was low, and a chest X-ray showed that he had pneumonia in both lungs. He probably had Covid-19, he was told. He was put in an isolation room. Occasionally one of his doctors came in, though mostly he spoke to them on the phone. The results of his Covid-19 test and his wifes test came back the same day on March 19. Both were positive. He stayed in the hospital for nearly a week. And when it was time for him to come home, his wife was so worried that he might infect their son that he moved instead into the small apartment they had in the city.

The wifes headache slowly got better, as did her cough. She never had a fever. She is certain she got the virus from her husband. He wonders if he got it from her; he thinks his cough started well after hers. They will probably never know where it came from. As for their son, had he presented with the same rash and history at just about any other time, the diagnosis of hand, foot and mouth disease would have been obvious. But in this epidemic, with a bug we still know so little about and one that is moving so quickly, everything can look, at least at first, a lot like Covid-19.

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A Family of Three Gets Sick With Covid-19 Symptoms. Who Has It? - The New York Times

CHICAGO (CBS) Some people who get COVID-19 dont experience any symptoms, many get over it in a couple weeks, but severe coronavirus cases can cause shortness of breath for months. Thats what a New Lenox woman is facing after her fight with the disease.

Christina Hill shared her story with CBS 2 Morning Insider Tim McNicholas in hopes of warning others about just how bad it can get.

I would never wish this on anyone, Hill said.

She needs oxygen therapy to help her breathe these next few weeks, and shes grateful for each breath.

Im just happy that Im here. So, hopefully, with the oxygen, Ill get stronger and Ill go back to normal, she said.

Hill felt far from normal when she showed up at Silver Cross Hospital in New Lenox early this month. She had chills, body aches, a nasty cough, and a fever that had already lasted days. The staff did some tests and a nurse checked her temperature.

It was 102.1. She immediately said, Theres no way you are being discharged, Hill said.

She spent the next five days at the hospital, where her fever peaked at 104.

The nurse was just giving me ice packs to put on my body to keep the fever down. She was also giving me heated blankets, because I was shaking uncontrollably. I couldnt control it. I literally felt like i was gonna die, she said.

Her fever broke, and the body aches are gone, but her doctors told her she could experience shortness of breath for months. Thats because COVID-19 sometimes damages the lungs, so it could take months for patients to fully recover from some severe cases.

You can even see scarring in the lungs, and that scar can even be permanent, and this is the most severe cases, said Dr. Jason Rho, a pulmonologist with Northwestern Medicine Lake Forest Hospital.

Hill is hoping her lung damage is not permanent. She said, while she was sick, doctors upped her dosage of hydroxychloroquine, a medicine shed already been taking for her inflammatory arthritis.

Researchers with the University of Washington are currently studying whether the medicine can prevent COVID-19. Hill said, in her case, it apparently did not.

So maybe it helped me to the point where I didnt get even worse, but I dont know, she said.

Hill said shes not sure how she got COVID-19. She said she closely followed social distancing guidelines, and only went to stores for essentials a few times in late March.

Im scared to death to leave the house. I think thats something Im gonna have to deal with, and try to get over, but this is not a joke, she said.

Hill said she is very grateful for the nurses and doctors in the hospital. She repeatedly praised them for their work.

Experts have said other long-term effects of the virus could be mental. For example, patients could have various forms of anxiety even after recovering physically.

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I Would Never Wish This On Anyone; In Severe Cases, COVID-19 Can Leave Patients With Breathing Problems For Months - CBS Chicago

Her muscles are so weak, it takes her 45 minutes to take a quick shower.

"I basically had to learn how to walk again due to muscle atrophy from being 100% bedridden for 2 weeks. I'M LUCKY TO BE ALIVE," the post continued. "Stay in your house. Take the money they government is giving you. ... Stop complaining and be thankful for your health. Thank you Governor Evers for caring more about our HEALTH than our WEALTH."

Blomberg said she empathizes with protesters who are struggling financially -- she, too, lost her job as a real estate receptionist during this pandemic.

Blomberg said the protesters' demands are shortsighted because the virus is still spreading unabated.

"If you're in a hospital bed, you're not making any money anyway. In fact, you're putting yourself in further debt," Blomberg told CNN.

"If you're dead, it doesn't matter anyway -- you're not going to be able to provide for your family. You're going to have your medical bills, your funeral costs, you're going to be leaving that for them on top of it all."

'People don't understand how easily this spreads'

She started feeling flu-like symptoms on March 19. "I just felt like I got hit by a truck," Blomberg said "All the energy was gone, and literally everything in my body ached."

"It wasn't until the 24th when I didn't have the energy to make it to the bathroom in time -- when finally said to my husband, 'Take me to the ER,'" Blomberg said.

"They immediately called an ambulance to take me to a hospital that was accepting Covid patients. And when I got there, they said, 'You're not getting enough oxygen. We're going to have to intubate you.' So I was put in a medically induced coma and put on a ventilator."

She tested positive for coronavirus but still has "absolutely no idea" how she got infected.

"We didn't have anybody in our close circle that has gotten sick or died from this," Blomberg said.

"I didn't know I was at risk. I'm 35. I have no underlying medical conditions that would have compromised my immunity."

But since sharing her story on Facebook, she's received a torrent of messages from others who were suddenly impacted by Covid-19.

"I've gotten messages from people in Texas, Arkansas, Oklahoma, Florida, Pennsylvania," Blomberg said.

"A lot of these people reaching out either have been through what I've been through, or have a family member going through it. And people don't understand how easily this spreads."

Struggling to walk again

"The recovery is probably the worst," she said. "Basically it's having to learn to walk again, because your muscles .... it's like you've never used them before."

What used to be a 15-minute shower "is now 45 minutes ... and that's trying to do everything as quickly as possible," she said.

Her physical anguish is now compounded by the financial pain of hospital bills.

She's only received a portion of her medical bills, but owes $11,000 so far.

Blomberg laughed when she thought about how quickly her life has changed in the past few weeks.

"Not only do I not have a job, but now I don't have this money" for medical bills, she said.

A message for the protesters

Blomberg hopes sharing her ordeal will prevent others from suffering. And that means encouraging protesters to stay home and obey shelter-in-place orders.

"A lot of those people will not understand until it happens to them or someone they love. And it's really sad," Blomberg said.

"If you think things are tight now, if you get sick and get to the hospital, these 5-digit bills, 6-digit bills -- it's going to be even worse."

"That's a slap in the face: 'Oh yes, thank you to all these workers taking care of the sick ... and oh, by the way, you have Covid now.'" Blomberg said.

"There are hospital workers who have been put on ventilators and haven't made it. I pray I haven't infected any of the people who took such great care of me."

Like many Covid-19 patients, Blomberg said the hospital she was treated in was frantically busy.

"I was next to the nurses' station, and I constantly heard their alarms going off to go to patients' rooms," she said.

"If we were to open up right now, (hospitals) would definitely be overwhelmed."

When she sees protesters wanting to reopen the country right now, "all I can do is just shake my head," Blomberg said.

"We have to wait for the medical community to say it's OK. They're the ones who know what's going on. They're the ones who know, who have the facts, who have all the data. They're the ones who we ultimately should be listening to."

In the meantime, Blomberg wants everyone to know "this could happen to anyone."

"It's so frustrating -- to know how severe and how awful this is, and you still get people saying, 'It's a hoax. There's no one in hospitals. There's no one dying.' Open your eyes," she said.

"There are plenty, plenty of people in hospitals, (and) too many people dying."

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She spent 9 days in a coma and relearned how to walk. What this Covid-19 survivor wants protesters to know - CNN

LITTLE ROCK, Ark. -- A healthcare worker from Arkansas has died after testing positive for COVID-19.

This is the first reported death of a frontline healthcare worker in state from coronavirus, according to Arkansas Health Department Secretary Dr. Nate Smith.

The healthcare worker was under 65 years old and worked at Jefferson Regional Medlcal Center in Pine Bluff. Officials did not provide any other details.

This was one of two new deaths reported Sunday in Arkansas from COVID-19, raising the state's total to 40.

Additionally, Arkansas Gov. Asa Hutchinson said nearly 1,400 inmates at the Cummins Unit - Arkansas Department of Corrections have been tested for coronavirus.

Among those tests, 348 inmates have tested positive for COVID-19 and three are currently hospitalized. Around 630 tests results have been returned.

State officials also say nearly 2,000 inmates across the state of Arkansas are being reviewed for release amid the pandemic.

Arkansas state leaders released the following updates on the COVID-19 pandemic:

-1,781 cases in the state (40 new)-88 hospitalizations (2 new)-40 reported deaths (2 new)-1,022 active cases-719 recoveries

Watch the latest updates from Gov. Hutchinson on the stream below:

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Healthcare worker in Ark. dies of COVID-19; 348 inmates at Cummins prison test positive - KY3