Category: Covid-19

ChARLESTON, W.Va. (DHHR) The West Virginia Department of Health and Human Resources (DHHR) reports as of 5:00 p.m., on April 11, 2020, there have been 15,819 residents tested for COVID-19, with 591 positive, 15,228 negative and six deaths. The sixth COVID-19 associated death is an 82-year old woman from Wayne County with underlying health conditions.

These are considered official numbers reported to the state, which will in turn, be reported to the U.S. Centers for Disease Control and Prevention (CDC). Medical providers and laboratories are required to report positive test results to DHHR.

Delays may be experienced with the reporting of cases from the local health department to the state health department. Its not uncommon for the local level to report case numbers first and then officially report it to the state.

CONFIRMED CASES PER COUNTY: Barbour (4), Berkeley (91), Boone (1), Braxton (1), Brooke (3), Cabell (22), Fayette (2), Greenbrier (3), Hampshire (4), Hancock (7), Hardy (2), Harrison (28), Jackson (23), Jefferson (48), Kanawha (83), Lewis (2), Logan (8), Marion (32), Marshall (6), Mason (8), McDowell (5), Mercer (8), Mineral (4), Monongalia (81), Monroe (1), Morgan (6), Nicholas (2), Ohio (21), Pendleton (1), Pleasants (1), Preston (6), Putnam (11), Raleigh (5), Randolph (4), Roane (2), Summers (1), Taylor (3), Tucker (4), Tyler (3), Upshur (3), Wayne (17), Wetzel (3), Wirt (2), Wood (18), Wyoming (1).

As case surveillance continues at the local health department level, it may reveal that those tested in a certain county may not be a resident of that county, or even the state as an individual in question may have crossed the state border to be tested.

A dashboard is available at http://www.coronavirus.wv.gov with West Virginia-specific data, including new information on the health status of COVID-19 positive patients and other information. A Frequently Asked Questions document has been developed regarding case counts and can be found here.

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W.Va. DHHR confirms total of 591 positive COVID-19 cases in the state - WDTV

A healthcare worker washes her hands during her shift at an intensive care unit (ICU) at the General ... [+] University Hospital where patients infected with the COVID-19 are treated in Prague, Czech Republic, Tuesday, April 7, 2020. (AP Photo/Petr David Josek)

A single person with COVID-19 may be more likely to infect up to 5 or 6 other people, rather than 2 or 3, suggests a new study of Chinese data from the CDC. Its not clear if this higher number applies only to the cases in China or if it will be similar in other countries.

If the higher number does remain true elsewhere, it means that more people in a population need to be immune from the diseaseeither from having already had it or from a vaccineto stop it from circulating.

The new study, published in the Emerging Infectious Diseases journal, shifts the R0 for COVID-19 from about 2.2 to about 5.7. With the lower number, only 55% of a population needs to be immune from COVID-19 to stop its spread through herd immunity. Herd immunity refers to enough of a population being immune to a disease that the disease cannot travel through it.

But if more people get infected from a single person with COVID-19, then more people need to be protected from the disease to stop it from continuing to spread. With an R0 of 5.7, approximately 82% of the population needs to be immune to reach herd immunity and stop the disease from spreading easily through the population, the researchers concluded.

The new calculations also estimate the incubation periodthe time from being exposed to the virus and developing symptomsto be an average of 4.2 days, which is in line with most other estimates (though symptoms can still take up to 14 days to show up).

Because people can be contagious before realizing they are infected, identifying and isolating patients, plus following up with people they interacted with, will only work to contain COVID-19 if only a small number of people with the disease arent aware theyre infected.

However, when 20% of transmission is driven by unidentified infected persons, high levels of social distancing efforts will be needed to contain the virus, highlighting the importance of early and effective surveillance, contact tracing, and quarantine, the authors wrote.

Like all studies, this one has limitations that mean the conclusions must be taken with a grain of salt. The researchers are using publicly available information to develop models, and models are only as reliable as the data and assumptions that go into them. Future data and calculations could shift understanding of this disease and its contagiousness further.

What Does R0 Mean?

Scientists measure how contagious a disease by its basic reproduction number, referred to as R0 (pronounced R nought). The R0 refers to how many people a single infected person will infect in a population.

For example, the R0 of influenza is 1.3, which means, statistically, one person with the flu will infect 1.3 others in the population. (Obviously you cannot infect one third of a person, but this mean that 3 people together with the flu will, on average, infect 4 other people.) The R0 of measles is estimated between 12-18 though theres debate about the exact rangeso a single person with measles will infect about 12-18 people in a population thats vulnerable to it (where no one has had it and no one has been vaccinated).

The R0 is calculated based on how fast an outbreak grows, how long it takes for a person exposed to the virus to become contagious (latent period), and how long an infected person is contagious (infectious period). The longer someone is contagious, the higher the R0 is. The authors relied on other researchers estimates that it takes approximately 7-8 days between the time an infected person shows symptoms and the time until someone they infect shows symptoms (the serial interval).

If that number is accurate, the researchers estimate the R0 of COVID-19 to be about 5.8. If they expand that period a little bit to 6-9 days to allow more margin for error, the R0 is 5.7.

The estimated R0 can be lower if the serial interval is shorter, the authors wrote. However, recent studies reported that persons can be infectious for a long period, such as 1-3 weeks after symptom onset, so they believe its unlikely that the average time between a person being infected and then passing along the disease is shorter than 6 days.

Why The Change Now?

Why has it taken this long to determine an accurate R0? First, the change is based on updated data, and it could change again with more recent, more accurate data. Its hard to study an emerging disease when youre still collecting data, and testing has been all over the map, literally. Different countries have used different tests and testing protocols, and varying strategies can influence how data is collected.

The authors point out that not having reliable diagnostic protocols early in the outbreak, changes to how cases are identified and tracked, and overwhelmed healthcare systems can throw a wrench into how well researchers can estimate the growth of an outbreak.

The early R0 of 2.2-2.7 was based on two things: early cases recorded in Wuhan before January 4, and on international flight data combined with infected people outside China.

Because of the low numbers of persons traveling abroad compared with the total population size in Wuhan, this approach leads to substantial uncertainties, the authors wrote. Basically, too little data existed to make reliable estimatescommon challenges associated with rapid and early outbreak analyses of a new pathogen, the authors add.

Calculating more reliable estimates takes time because it requires getting the most accurate data possible on surveillancethe total number of cases, including estimating those that havent been tested or identified yet.

The new study also uses data from China to estimate the growth of COVID-19 cases, but the researchers collected data from throughout Chinanot just Wuhanand included highly specific data from travel within China. The new calculations also will not be perfect, but they should be more precise and closer to being accurate than the previous ones.

The researchers used multiple modeling approaches, including one that relied on reports of 140 cases of COVID-19, mostly in China outside of Hubei Province (where Wuhan is the capital city). Although this number is relatively small, these cases represent many of the first or the first few persons who were confirmed to have SARS-CoV-2 virus infection in each province, where dates of departure from Wuhan were available. Since the researchers had details on when those people were diagnosed and when they left Wuhanbased on mobile phone datathe estimates have a better chance of precision and accuracy.

What Does This Change Mean?

The new R0 applies specifically to data collected in China. How contagious SARS-CoV-2 is in other countries remains to be seen, the authors wrote. Given the rapid rate of spread as seen in current outbreaks in Europe, we need to be aware of the difficulty of controlling SARS-CoV-2 once it establishes sustained human-to-human transmission in a new population.

That much is now obvious to people following the news on COVID-19s spread.The authors recommend the same strategies to control the disease that youve likely been hearing about.

Our results suggest that a combination of control measures, including early and active surveillance, quarantine, and especially strong social distancing efforts, are needed to slow down or stop the spread of the virus, the authors wrote. If these measures are not implemented early and strongly, the virus has the potential to spread rapidly and infect a large fraction of the population, overwhelming healthcare systems.

In other words, if we dont test early, identify cases quickly, isolate those people, and continue social distancing, it will be difficult or impossible to control the disease.

But the authors do offer a note of hope: Fortunately, the decline in newly confirmed cases in China and South Korea in March 2020 and the stably low incidences in Taiwan, Hong Kong, and Singapore strongly suggest that the spread of the virus can be contained with early and appropriate measures.

Full coverage and live updates on the Coronavirus

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The COVID-19 Coronavirus Disease May Be Twice As Contagious As We Thought - Forbes

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As people of color die from COVID-19 at a disproportionately higher rate, the importance of Black scientists is more critical than ever. U.S. Surgeon General, Dr. Jerome Adams, acknowledged that Black Americans are particularly vulnerable to COVID-19, due to health disparities and historic racism surrounding housing, education and employment.

Despite representing slightly under a third of the population in locations such as Chicago, Milwaukee and the state of Louisiana, Black Americans represent 70% of deaths from COVID-19.

Why focus on Black scientists fighting COVID-19? Because the younger generation cant be what they cant see. Representation is important in inspiring children who will someday become the medical professionals and scientists that help us battle diseases such as COVID-19.

Plus, diversity helps us reduce the marginalization of people of color, especially when it comes to medical care and health outcomes. Unconscious racial bias can result inunequal health outcomes, and this is more likely when medical professionals dont understand the culture of the community they are based in.

Earlier this year, 100 Black scientists were featured in the journal Cells CrossTalk blog. Some of these featured Black scientists include individuals working on fighting the COVID-19 pandemic. We feature four below:

Dr. Kizzmekia Corbett is a viral immunologist at the National Institutes of Health. She is leading the effort to develop an mRNA vaccine for COVID-19, which has moved into Phase 1 at record speed. Her prior research had focused on mRNA as a method to promote an immune response against virus, which may work for SARS-CoV-2.

Dr. Tomeka Suber is on the front lines as a pulmonologist and is an expert in acute respiratory distress syndrome.

Dr. Christopher Barnes is an HHMI Hanna Grays Fellow at California Institute of Technology. While he isnt on the front lines, he is helping find a cure by crystallizing antibodies to fight against COVID-19. This research is needed as scientists race to develop a vaccine or cure.

Dr. Michael Johnson isa professor at the University of Arizona investigating if copper could be used to alter the binding of SARS-CoV-2, the virus that causes COVID-19. When the spike proteins (which give coronavirus its name), interact with our cells, the proteins require zinc. Copper could potentially block the virus from being able to access zinc and stop coronavirus from entering our cells or replicating once it is inside. Research is still in early stages on a virus similar to SARS-CoV-2. The scientists hope that copper, in conjunction with other treatments, will deliver a solid one-two punch to COVID-19.

We are all in this pandemic together, but some of us will be hit harder than others. We wont be able to change this within the time of the pandemic, but as we move to diversify STEM fields, we must remember that representation and visibility can make all the difference to a young generation that is finishing their school year at home during a pandemic.

Many of these children will be inspired to help others as medical professionals and scientists. It is up to us to provide examples of excellence from people that look like them.

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From The Hospital To The Lab, Black Scientists Are Fighting COVID-19 - Forbes

Editors note: The Salt Lake Tribune is providing readers free access to critical local stories about the coronavirus during this time of heightened concern. See more coverage here. To support journalism like this, please consider donating or become a subscriber.

Another Utahn has died from the coronavirus, the Utah Department of Health announced on Saturday.

The fatality brings the states death toll to 18, after four deaths were added to the count on Friday. The patient was a Wasatch County man older than 60 who had been fighting the virus at a Salt Lake City hospital for nine days, a spokesman for that countys health department said. The man also had underlying health conditions.

Our community here in Wasatch County is like family and we are very saddened to lose one of our residents, Wasatch County Health Director Randall Probst said in a statement late Friday offering condolences.

The state Health Department was reporting 2,206 confirmed cases statewide as of Saturday, roughly a 5% increase from the day before. Hospitalizations from COVID-19 stood at 190, up by seven cases since Friday.

News of the Wasatch Countys mans death came as Davis Hospital in Layton reported the first COVID-19-infected patient treated there is now recovering at home and getting better every day.

The 50-year-old woman, who The Salt Lake Tribune has agreed not to name to protect her medical privacy, said she thought she had nothing more than a bad case of the flu in early March. She battled the illness for about two weeks on her own before her shortness of breath, cough and extreme fatigue significantly worsened.

It just didnt get any better and just continued to progress, you know, with body aches and no appetite, the woman said from her Layton-area home, where she is now recuperating under the care of her husband.

I just decided I wasnt getting better on my own, but I never in a million years thought I had the virus whatsoever, she said.

The woman never exhibited a fever but was hospitalized for pneumonia and doctors deemed her travel history reason enough to test for COVID-19, the hospital said.

A human-resources executive, the woman said she travels regularly in the southern U.S. for her job. She said shed grown more cautious on flights and in airports, practicing social distancing, washing her hands frequently and being wary of commonly touched surfaces.

"I was very diligent about using appropriate precautions and I still got it, she said.

During four days of intense treatment at Davis Hospital, she was kept in a negative air-flow room and limited to communicating with friends and loved ones via her smart phone. Her only direct human contact was with hospital workers in protective gear.

It was really kind of surreal. You know, youre sitting in a room by yourself. Youve got television and your phone, basically, she said. Youre pretty much out there on your own and I cant imagine being in there long term, you know, like some people are.

After IV treatments and extensive coaching on self-care and quarantine procedures from hospital staff, the woman said she was sent home for two weeks of full isolation. Her first craving upon leaving the hospital, she said, was for strawberry ice cream.

We dont have any, her husband told her. Well, youre going to have to go to the store and get some, she replied. It was one of those, just gotta have it things.

She was initially confined to her bedroom, taking her own temperature and reporting it daily when a nurse would call to check in. That was followed by less strict period of self-quarantining, where she could move around inside the house and interact with her husband, who has shown no signs of the disease.

The woman called the process of self-quarantining challenging but necessary to protect others.

On Monday, she got a clean bill of health after a visit to her physician, she said in a statement from the hospital.

Its been a slow recovery process, but Im getting there, the woman said, estimating that shes at about 75% of her usual self. Im looking forward to putting this all behind and getting used to a new normal.

One of her main comforts now, she told The Tribune, is venturing outside. It just feels like fresh air and sunshine go a long way.

Her cough persisted Saturday as she spoke and she said her energy is still depleted. I just try and do one thing at a time, you know, maybe load the dishwasher, then take a little while and then maybe later Ill change a load of laundry or something, the woman said.

I dont overdo it, she said, because I dont want to have a setback.

But the woman has also been heartened, she said, by an outpouring from friends, neighbors and especially her employer, who she described as fantastic. Her circle is delivering meals and much-needed supplies to her door or through the mail and helping with a host of errands.

"That has just been phenomenal, said the woman, who added she was able to work from home a few days last week and hopes to work more starting Monday.

She called COVID-19 the illness of a lifetime.

This will change me forever, the woman said. I think its going to take a long time for me to get comfortable again with going out in public, traveling or gathering with a large group of friends.

She said she wanted to share her story as a reminder to others to follow social distancing guidelines.

I want to emphasize the importance of staying in and staying safe, she said. Please comply with all precautions so you dont give the illness to anyone else who may not be able to recover.

One of the nurse practitioners who helped in the womans hospital treatment also had a message for the public, she said in a statement.

Im not afraid to care for my patients, but I am very careful, said the nurse, whos name was not released by the hospital. Knowledge gives me comfort and confidence in treating people. Its reassuring to see how proper treatment of the virus leads to a livable outcome.

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Another Utahn dies of COVID-19 as Davis Hospital says its first patient with the virus is now recovering at home - Salt Lake Tribune

A majority of people with COVID-19 are expected to have relatively mild symptoms that resolve at home.

While around 80 percent of COVID-19 cases are mild, even this mild infection can be a problem.

Before you even know you have an infection, odds are youve spread the virus to three other people. If theyre 70 or older, theres about an 8 percent chance theyll die.

Ive gone to work sicker than that. Im sure you have, too, said Cassie Garret, whose wife, Celeste Morrison, recently recovered from COVID-19.

Her description of the virus is what makes it all the more deadly: Even before people develop serious symptoms, they can spread the disease.

Even if people are feeling fairly well, theyre highly contagious and thats the real danger, said Dr. Robert Murphy, a Northwestern University infectious diseases specialist and global health expert.

And even for mild cases, COVID-19 can take a serious toll.

Morrison, a 37-year-old web developer who lives 60 miles north of Seattle, started to feel run down the evening of Monday, March 2.

First came the cough and extreme fatigue. Then her temperature rose to 99.7F (37.6C). Nothing too worrisome, so she decided to just work from home for a few days.

Garret recalls Morrison saying her lungs started to feel weird a few days later. I told her that, per literally everything I was reading, she should only go to the doctor if it was really serious, Garret told Healthline.

But later that week, Morrisons lips, fingers, and toes were tinged blue. They headed to the local emergency room.

Morrison tested negative for the flu, but her X-rays pointed to pneumonia. A nurse said theyd run a COVID-19 test, the results of which would be available in 24 to 48 hours.

In the days that followed, Morrisons fever bounced from 97.1F to 102.8F (36.2C to 39.3C).

She felt ill and had fatigue and a fever. Her symptoms worsened. She still hadnt received her coronavirus test results, so she visited a local clinic doing drive-thru COVID-19 testing on people with respiratory symptoms.

The clinic looked at Morrisons medical records and found the ER never ordered the COVID-19 test. They swabbed her nose, and 2 days later the test results came back: She had COVID-19.

Morrison quarantined herself in the bedroom and slept through most days. The virus completely wiped her out, zapping away her energy for 12 days.

Garret knew her wife would be OK; shes young and otherwise healthy. It was the rest of America she worried about.

I am terrified of the way this is progressing in her, for the rest of the country, Garret said. Everyone goes to work when they feel gross and have a slightly elevated temperature.

Elizabeth Schneider, 37, went to a house party in late February. A few days later she woke up feeling a bit run down.

She went to work anyway, figuring she just needed to take it easy and go to bed early that night. Halfway through the day, though, she started feeling feverish and went home to nap.

She awoke to a 101F (38C) degree fever. By nighttime, her fever spiked to 103F (39.4C), and she was shivering uncontrollably.

The fever was quite high, I was pretty surprised about that. Normally when you get a cold, maybe you get a 100-degree fever or something like that, but a 103-degree fever is pretty serious, she said.

Schneider took some over-the-counter pain medications and went to bed early. The next day, her temperature was back down to 101F (38C).

She soon got word that a dozen other people from the house party also felt sick.

Many of them had gone to a hospital and tested negative for the flu. Frustrated they werent also tested for COVID-19, the group decided to do at-home nasal swab COVID-19 test kits through University of Washingtons Seattle Flu Study.

Seven people tested positive, including Schneider. But by the time they received the results a week later, mostly everyone had already recovered, and there was no longer a need to self-isolate.

This whole time I thought I had just contracted the flu, Schneider said. On a scale of 1 to 10, she rates the illness at 6.5.

She was most struck by how depleted she felt and how long the illness lasted, which for her was 11 days. I was so tired, I just wanted to sleep, Schneider said. It definitely knocked me out.

Like Schneider and Morrison, the vast majority of people who get COVID-19 are going to have more moderate symptoms; some wont have any symptoms at all.

But they can easily transmit the virus to people who will develop a much more severe illness, need to be hospitalized, and potentially die.

If youre young and youre healthy and you have no underlying health conditions, like me, you most likely will be in the majority that has mild to moderate symptoms and will recover on your own without the aid of any medication or hospitalization, Schneider said. But please be cognizant of the fact there are people who are going to contract more serious forms of this.

Because weve never seen this virus before, theres no immunity in the population like we have with the flu, according to Murphy. It can spread readily from person to person, more quickly than other respiratory infections like the flu.

How someones body reacts to the virus comes down to what Murphy calls the host-pathogen interaction: You have the pathogen (in this case the new coronavirus), and then you have the host, or how an individuals immune system gears up and responds.

Does the host mount a good immunologic response that can get rid of the virus, does it not mount a good enough response so the virus is more lethal, or does it mount too much of an immunologic response and you have as much trouble from the immunologic response as you do from the virus? Murphy explained.

We need to get used to social distancing, Murphy says, as its currently our best bet at blunting the spread of the disease.

If we dont continue to adhere to strict social distancing, the cats out of the bag, Murphy said, and the virus will rip through the country.

Until we have enough immunity in the population to stop the virus from spreading, Murphy suspects things are going to get worse before they get better.

Around 80 percent of people who get COVID-19 will likely experience mild symptoms.

While this may be reassuring to some, thats exactly why the infection is such a threat.

Before you even realize youre sick, you could easily pass it on to people who have a greater chance of developing complications, being hospitalized, or dying from COVID-19.

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What It's Like to Have a 'Mild' Case of COVID-19 - Healthline

COVID-19 case tally: 1.72 million cases, 106,469 deaths and U.S. has highest number of fatalities  MarketWatch

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COVID-19 case tally: 1.72 million cases, 106,469 deaths and U.S. has highest number of fatalities - MarketWatch

On any digital dashboard tracking the spread of Covid-19, on any graphic comparing country-by-country case curves or death tolls, they were the champs. Singapore, Hong Kong, Taiwan, South Korealeaders there saw what was headed their way from China in the early days of the new coronavirus, before it became a pandemic. They remembered what happened two decades ago with SARS: People died, economies suffered. So they locked down their immigration hardest and soonest, deployed public health workers to follow up contacts of cases, got their hospitals shored up, and started publishing clear and consistent information and data. They flattened their curves before the rest of the world understood there would be curves to flatten. But in recent weeks, those curves have taken another chilling turn. The numbers of new cases in these places are creeping upward.

Hong Kongs slow and steady case count started going up on March 18, and took an 84-case jump on March 28. After months of new cases barely brushing double digits, Singapores count jumped by 47 on March 16, and since then the city-state has had three days with more than 70 new cases each. Taiwans new-cases-in-a-day peaked at 5 in late January and then jumped into the high 20s per day in, again, mid-March. South Korea had 86 new cases on April 3.

Plus: What it means to flatten the curve, and everything else you need to know about the coronavirus.

These new case numbers are still low, especially compared with the United States, which had 983 new cases on March 16 and 29,874 new cases on April 2 or Italy, which (hopefully) peaked on March 21 with 6,557 new cases. Whats alarming about the numbers of new cases in the would-be success-story locations is that theyre happening at allthat the numbers were going down, and now theyre creeping up. From the outside, that looks like a worst-case scenario: the return of the disease after a country eases off the measures to combat it. But that appearance is deceiving. The bad new numbers come from somewhere elseliterally. And that might have lessons for the next phase of the pandemic in the US.

The real problem is that viruses dont know what a border is. These countries are experiencing reimportation of the disease, infections that are the result of inbound travelers from places that arent winning their fight against Covid-19.

All these countries are, after all, on the same planet. In Singapore, Hong Kong, South Korea, and Taiwan, a few earlier cases from China made it through the barrier and got into the community. That resulted, throughout February, in community infections, or unlinked local cases. Those were worrying, but the overall spread was still slowuntil the pandemic went transnational, and boomeranged back around. There were just a small number, and then they kind of disappeared, says Ben Cowling, an epidemiologist at the University of Hong Kong. But at the end of February and early March we started to get more imported cases from Europe. Hong Kong got a lot from Europe, the US, and other parts of the world, and Taiwan got a lot from the US.

Those all led to a bunch of new unlinked local cases, and the numbers started going up again. In Taiwan, for example, they prolonged the winter break for kids by 10 days so they could prepare kids to go back to school with masks. A lot of people went to Europe for vacation, and they came back with it, says Jason Wang, director of the Center for Policy Outcomes and Prevention at Stanford University School of Medicine and an author of a paper on Taiwans early successes. We did stop all the flights from China before the WHO said we should. But then after we did that, we didnt do too much. So it was brewing in the community, and now we have community spread. And then people started to come back from Europe, and we didnt even think about that.

Until then, Singapore, Hong Kong, and Taiwan had all been able to maintain diligent containment within their own borders, following every infectionor nearly every infection, as it turned outback through its chain of contacts and isolating all those people from the general population. Taiwan had linked its immigration database to its national health system. Singapore had instituted harsh fines for anyone breaking social distancing and published detailed data on every case and cluster. The problem is, you dont pick up every single person, especially when the people with mild symptoms know if they get tested theyre going to be isolated, and their friends and family are going to be isolated, says Cowling. Theres a disincentive. Thats especially bad with Covid-19, which seems to spread in part because of a few days of pre-symptomatic infectiousness before the onset of heavy illness.

Other nations couldnt hold containment, or didnt try. In Europe and the United States, governments dithered about whether and when to institute draconian but necessary measures like social distancing, school closures, and shelter-in-place orders. Now those same governments and public health researchers have to figure out how long to maintain them. Theyre destructive to peoples psyches and the economy, but letting people swirl back into close contact with one another allows the disease to spread again.

In epidemiological terms, this tension is about taking control of whats called the reproductive number, the number of people a contagious person goes on to infect. At the top of the curve in Wuhan, where Covid-19 started to spread, that number was something like 2 or 2.5as it might now be in parts of the US and Europe. After the Chinese government quarantined Wuhan and forced everyone to stay home, it went down to perhaps as low as 0.3. In China, those rules went into effect in January; the government may lift them this week.

The viruss apparent return will spur different kinds of containment measures in different places. Hong Kongs were already strict, though theyd relaxed somewhat in the first weeks of March. Now, Singapore, Hong Kong, South Korea, and Taiwan have all instituted even stricter social distancing rules and immigration controls. Nationals who are allowed in can expect 14-day quarantines, in Hong Kong and Singapore monitored by smartphone app, though those apps efficacy may be doubtful. (Singapores numbers do seem to look better since officials started quarantining everyone coming in, rather than people from specific countries.) Singapore is also closing all schools and most workplaces.

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The Asian Countries That Beat Covid-19 Have to Do It Again - WIRED

Yesterday, we talked about the things that need to happen before we can begin to slowly re-open our cities: hospital bed supply catches up fully with demand; testing catches up fully with demand; we develop programs for quarantining new cases and informing their contacts that they may have been exposed to the disease; and the number of cases declines for 14 consecutive days.

Today lets zoom in (not Zoom in) on the third point: building systems to enforce quarantine and to trace the contacts of those who get infected. Both are areas where public health officials believe that technology can play a role. But I want to describe why that role might be more limited than you assume and, according to the experts Ive spoken with, much less important than staffing up public health agencies to do the primary work.

First lets talk about quarantine enforcement making sure that people the state has ordered to stay at home are actually doing so. This is an area where technology can play and is playing a huge role. Ive mentioned Taiwans electronic fence in this column a few times already, but heres a quick refresher from Reuters:

The system monitors phone signals to alert police and local officials if those in home quarantine move away from their address or turn off their phones. Jyan said authorities will contact or visit those who trigger an alert within 15 minutes.

The technology here is not particularly complicated. With the cooperation of a telecom company, you can tie a persons phone to a single cellular tower. If the phone pings another tower, or shuts off, the public health authorities contact you. This approach is invasive, somewhat disturbing, and by all accounts quite effective. Its not clear to me how a similar program could be implemented without new legislation giving telecom companies explicit permission to share this kind of data my inbox is full of lawmakers (appropriately!) calling for safeguards and oversight on any such government surveillance. But if the recent stimulus packages are any indication, that also seems like legislation that could be written and passed very quickly.

Note that tech alone doesnt solve the enforcement problem. You also need people calling patients whose phones appear to be moving or have been shut off. You need people doing spot checks to make sure the person under quarantine hasnt simply left their phone at the house and gone to church. And you probably need a place to house quarantined people that is not with their families, which are the most likely places for the coronavirus to spread. Tech is necessary, in other words, but not sufficient.

Now lets talk about what might be the most challenging piece in the entire stack: contact tracing. Public health experts tell me that getting in touch with people who may have been exposed to a known COVID-19 case is one of the most important steps well need to take to contain future outbreaks. But the how of it is complicated. While weve seen a Cambrian explosion of contact tracing apps around the world, it remains unclear how good or effective any of them have been. And as US government officials consider asking big tech companies to consider working on contact tracing solutions and Im told that they have already made inquiries with Facebook thats worth keeping in mind.

To get a sense of how this played out in one country that has done a relatively good job containing the coronavirus outbreak, lets turn to South Korea. Derek Thompson has a good piece on contact tracing in the Atlantic that describes how it has played out there. The country seemingly skipped over traditional contact tracing completely and went straight to putting new coronavirus victims on blast in the new public square other peoples smartphones:

The government uses several sources, such as cellphone-location data, CCTV, and credit-card records, to broadly monitor citizens activity. When somebody tests positive, local governments can send out an alert, a bit like a flood warning, that reportedly includes the individuals last name, sex, age, district of residence, and credit-card history, with a minute-to-minute record of their comings and goings from various local businesses. In some districts, public information includes which rooms of a building the person was in, when they visited a toilet, and whether or not they wore a mask, Mark Zastrow, a reporter for Nature, wrote. Even overnight stays at love motels have been noted.

New cases in South Korea have declined about 90 percent in the past 40 days, an extraordinary achievement. But the amount of information in South Koreas tracing alerts has turned some of its citizens into imperious armchair detectives, who scour the internet in an attempt to identify people who test positive and condemn them online. Choi Young-ae, the chair of South Koreas Human Rights Commission, has said that this harassment has made some Koreans less willing to be tested.

So far, South Korea appears to be an outlier in this approach. Other countries are opting to build much more targeted interventions, using phones GPS and Bluetooth signals to passively track the proximity between individuals and inform potential contacts after someone gets infected. Singapore, which built an app called TraceTogether that monitors Bluetooth activity, offers perhaps the most likely model for the West, Thompson writes. The country is making TraceTogether available as an open-source project.

To the extent that theyve been written about to date, these passive tracking apps are generally considered in terms of their privacy implications. Who collects the data? Where does it get shared? Can it be linked back to individual patients? How long should that information be stored?

Already, various academics and entrepreneurs are working on passive tracking apps that attempt to solve these issues. At Wired, Andy Greenberg reviews three such efforts, and all of them are absolute Rube Goldberg machines. Heres one of the apps under development:

Covid-Watch uses Bluetooth as a kind of proximity detector. The app constantly pings out Bluetooth signals to nearby phones, looking for others that might be running the app within about two meters, or six and a half feet. If two phones spend 15 minutes in range of each other, the app considers them to have had a contact event. They each generate a unique random number for that event, record the numbers, and transmit them to each other.

If a Covid-Watch user later believes theyre infected with Covid-19, they can ask their health care provider for a unique confirmation code. (Covid-Watch would distribute those confirmation codes only to caregivers, to prevent spammers or faulty self-diagnoses from flooding the system with false positives.) When that confirmation code is entered, the app would upload all the contact event numbers from that phone to a server. The server would then send out those contact event numbers to every phone in the system, where the app would check if any of the codes matched their own log of contact events from the last two weeks. If any of the numbers match, the app alerts the user that they made contact with an infected person, and displays instructions or a video about getting tested or self-quarantining.

All of these efforts seem to skip over the question of whether a Bluetooth-reported contact event is an effective method of contact tracing to begin with. On Thursday I spoke with Dr. Farzad Mostashari, the former national coordinator for health information technology at the Department of Health and Human Services. (Today hes the the CEO of Aledade, which makes management software for physicians.) Mostashari had recently posted a Twitter thread expressing skepticism over Bluetooth-based contact tracing, and I asked him to elaborate.

The first problem he described is getting a meaningful number of people to install the app and make sure its active as everyone makes their way through the world. Most countries have made app installation voluntary, and adoption has been low. In Singapore, Mostashari told me, adoption has been about 12 percent of the population. If the United States had similar adoption, youve now made your big contact-tracing bet on the likelihood that two people passing one another have both installed this app on your phone. The statistical likelihood of this is about 1.44 percent. (It could be higher in areas with greater population density or where the app was more widely installed.)

The second problem is that when these Bluetooth chips do pass in the night, you should expect a large number of false positives.

If I am in the wide open, my Bluetooth and your Bluetooth might ping each other even if youre much more than six feet away, Mostashari said. You could be through the wall from me in an apartment, and it could ping that were having a proximity event. You could be a on a different floor of the building and it could ping. You could be biking by me in the open air and it could ping.

All of this seems really problematic even before you consider asking Apple or Google or Facebook to make a contact tracing app and promote it through their own channels. Weve spent three and a half years having a discussion about the shortcomings of these companies when it comes to protecting our data privacy; putting them in a position to oversee a project as intimate and sensitive as disease infection seems like a bad idea. (My own sense in talking from executives at Google and Facebook in recent days is that they are eager to help with crisis response, and are already doing so in various ways, but basically have no interest in this particular part of the response.)

So that leaves us with two remaining questions: what should Big Tech do, and what should the government do?

Public health experts Ive talked with have been enthusiastic about efforts from Facebook and Google to use aggregated, anonymized data to display movement patterns an important measure of the effectiveness of stay-at-home orders. They like Apples COVID-19 screening tool and Facebooks collaboration with Carnegie Mellon University to encourage users to self-report symptoms to the university, not to Facebook. These projects wont solve the crisis on their own, but theyre good and useful tools for giving public health officials something close to a real-time look at how the disease is spreading through communities. And if there are other tools that they can build particularly ones that rely on aggregated and anonymized data, rather than personally identifiable information I think companies should continue exploring them.

And what about the government? The good news is that our public health infrastructure already has a lot of practice with contact tracing, thanks to our dear old friend the sexually transmitted infection. Come down with HIV, chlamydia, or gonorrhea, and a good county health agency will work with you to contact anyone you may have exposed since becoming infected. (Heres a good piece by Ryan Kost in the San Francisco Chronicle about how the citys experience with HIV/AIDS in the 1980s led it to dramatically beef up its public health infrastructure, which contributed to its admirably quick response to the threat of COVID-19.)

Those same tactics public health investigators making phone calls and working out in the community seem to be the most effective tool we have for contact tracing. And the good news is that savvy public health departments like San Franciscos are already ramping up. Heres James Temple in the MIT Tech Review on what he describes as one of the first such efforts in the country:

The Department of Public Health is supplementing its own staff with city librarians and dozens of researchers, medical students, and others from the University of California, San Francisco. City health workers have already been contact tracing on a small level, but they plan to significantly scale up the effort over the next few weeks. The team includes about 40 people and could rise as high as 150.

The task force will interview every patient who tests positive and provide necessary support to ensure that all are completely isolating themselves, down to helping them find and get to shelter if necessary. They also expect to reach out to between three and five people that patients came into contact with in the preceding days. Theyll alert them they may have been exposed, ask them to limit their contacts, and either encourage them to go in for a test or bring one to them. Those who test positive will trigger additional rounds of interviews and contact tracing.

Experts Ive spoken to say that there are software tools that could help public health workers: a website or app where people affected by COVID-19 can voluntarily upload their contacts, for example, making tracing easier for the health department. But you still need people to contact them.

Tom Frieden, a former director of the Centers for Disease Control and Prevention, told me a story to illustrate this point. Earlier in his career, when he was working on disease prevention with the New York City Department of Health and Mental Hygiene, his team was tracking a young man who suffered from drug-resistant tuberculosis. The man wound up in juvenile detention, but then escaped. He had no cell phone to trace. But Frieden dispatched a team to find him, and eventually succeeded and got him into treatment.

The point was that you cannot design a Bluetooth app that finds this man.

But you can hire people to find him. Frieden says we will need an extraordinary amount of people as many as 300,000, he says. Youre talking about something like a hundred-fold increase in public health capacity, Frieden said. A lot of it can be done by phone banking. But a lot of it involves going out there and knocking on doors.

The good news is that there are a lot of people who are recently out of work and may be considering new career opportunities. It seems like one of the best ways we could spend stimulus money is in helping state and county health programs expand their capacity to hire people for contact tracing.

And we can keep exploring new tech-driven solutions for contact tracing, too. But for now it seems worth saying that theres little evidence that phones are good at contact tracing and a lot of evidence that human beings are. As we prepare to begin re-opening society, the biggest investment we need to make is in people.

* * *

What did I miss? What did I leave out? Im a bit out of my comfort zone here, so if Ive made a mistake in my facts or logic please let me know so I can fix it and share with everyone in our next issue.

Today in news that could affect public perception of the big tech platforms.

Trending up: TikTok pledged $375 million in support of COVID-19 relief efforts. The aid includes $250 million in funds, $100 million in ad credits, and $25 million in ad space for public health information.

Trending up: Facebook is donating another $2 million to mental health resources amid fears that the pandemic will lead to increased depression and related issues.

Trending down: Amazon workers at a fulfillment center in Riverside, California filed a complaint yesterday, asking the state to investigate what they say are dangerous working conditions that pose a threat to public health during the coronavirus pandemic.

How Zoom CEO Eric Yuan built a conferencing app that suddenly became the social network of the pandemic. I never thought that overnight the whole world would be using Zoom, he says. Unfortunately, we did not prepare well, mentally and strategy-wise. (Drake Bennet and Nico Grant / Bloomberg)

Elizabeth Warren sent a letter to Zoom CEO Eric Yuan demanding information about the companys privacy policies, particularly as they relate to children. The letter details a number of Zooms recent security and privacy issues, including the recent Zoombombing harassment attacks. (Russell Brandom / The Verge)

Jeff Bezos made a surprise visit to an Amazon warehouse near Dallas, where employees are working hard to meet a surge in online orders as customers shelter at home. The move comes amid lingering concerns about worker safety at the companys warehouses. (Spencer Soper / Bloomberg)

A manager at an Amazon warehouse in Pennsylvania told staff not to touch shipments from another Amazon facility for 24 hours, since that facility had seen a cluster of COVID-19 cases. The Occupational Safety and Health Administration is opening an investigation into working conditions at the warehouse. (Matt Day, Spencer Soper, and Josh Eidelson / Bloomberg)

Instacart is introducing a pair of new delivery options in an attempt to deal with increased demand due to COVID-19. Fast & Flexible and Order Ahead are both designed to increase the number of available delivery windows, depending on whether customers are willing to be flexible with delivery times or if they want to plan ahead. (Jon Porter / The Verge)

Yelp is cutting 1,000 jobs and furloughing another 1,100 employees amid a massive drop in business. Its the latest company catering to small businesses that has seen much of its customer base decimated amid the COVID-19 outbreak and related shutdowns. (Ina Fried / Axios)

A simulation from researchers in Belgian showing runners and bikers put other people at risk by spreading droplets when they exhale, cough, or sneeze has gone viral. But the findings havent been published in a study (even one thats not peer-reviewed). Its another case of an armchair epidemiologist going viral on Medium with shoddy science. (Jason Koebler / Vice)

Universities are rolling out chatbots and virtual assistants whose speed and tone can simulate text conversation, as students continue to learn remotely. Some can help students navigate issues they might have learned about on a campus visit, like plans for orientation and choosing classes. (Laura Pappano / The New York Times)

Chinese companies are going to extreme lengths to stave off new outbreaks of the novel coronavirus as they reopen for business. Theyre now required to supply employees with face masks and check everyones temperature daily. Its a crucial test of whether a country can keep the infection curve flat after lifting social distancing. (Eva Dou / The Washington Post)

The Unicode Consortium, the group behind emoji releases, announced it wont release new emoji next year. The good news is that the emoji that were announced earlier this year, like the olive, beaver, and plunger, will still be available this fall. (Ashley Carman / The Verge)

Microsoft thinks the coronavirus pandemic will change how we work and learn forever. The company just released a report about remote work habits, noting that demand for Microsoft Teams surged worldwide last month, jumping from 32 million daily active users to 44 million in just a week. (Tom Warren / The Verge)

Webcams have become impossible to find as people stay quarantined at home. Third-party resellers have seized upon the scarcity by marking up webcams at ludicrous prices. (Chris Welch / The Verge)

A surge in internet usage is straining our networks. But its also prompting a wage of updates and upgrades that are making the internet stronger than ever. (Will Douglas Heaven / MIT Technology Review)

The volume of phone calls has surged more than internet use as people want to hear each others voices in the pandemic. Its a trend that has surprised even the biggest telecom providers. (Cecilia Kang / The New York Times)

Total cases in the US: At least 449,260

Total deaths in the US: More than 16,000

Reported cases in California: 19,043

Reported cases in New York: 159,937

Reported cases in New Jersey: 51,027

Reported cases in Michigan: 20,220

Reported cases in Louisiana: 18,283

Data from The New York Times.

The politics of 2020 now look much less ominous for Big Tech. The combination of changing priorities due to the coronavirus pandemic, along with critics like Bernie Sanders and Elizabeth Warren dropping out of the presidential race, mean the techlash has largely faded away. Heres Eric Newcomer at Bloomberg:

Bidens attacks have never provoked the concerns as those from Sanders and Warren. He has deep ties to the tech industry; his former director of communications, Jay Carney, is now Amazons top spokesman. Biden has also repeatedly framed his administration as a continuation of the Obama years, and several former Obama officials have set up shop in Silicon Valley.

While the tech industry rank-and-file mostly donated to the industrys antagonists, its executives seemed most excited about younger moderates Pete Buttigieg and Cory Booker. Biden is a happy consolation prize.

Antitrust regulators in France ordered Google to pay publishers to display snippets of their articles on the companys news service. The regulators gave Google three months to work out a deal with publishers. (Gaspard Sebag / Bloomberg)

Facebook is testing out a new feature called Campus which can only be accessed by college students, according to expert app researcher Jane Manchun Wong. The feature requires a .edu email address. Once youre in, you can fill out a profile with your graduation year, major, minor and dorm if you want to find friends. (Mariella Moon / Engadget)

Facebook is adding a quiet mode that mutes most notifications. This feels like a move from a time when we all cared about how much we were looking at our screens. (Nick Statt / The Verge)

Stuff to occupy you online during the quarantine.

Watch Sheryl Sandberg interview Dr. Julianne Holt-Lunstad, who researches the health impacts of loneliness, about staying emotionally healthy while physically distancing.

Watch a new music video from Thao & The Get Down made entirely on Zoom. The Oakland-based band had to pivot their plans for a live music video shoot due to the coronavirus pandemic. (Dani Deahl / The Verge)

Watch a new Saturday Night Live this weekend. The show is returning with fresh comedy with everyone working remotely.

Send us tips, comments, questions, and your tech solutions for contact tracing: casey@theverge.com and zoe@theverge.com.

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Why Bluetooth apps are bad at discovering new cases of COVID-19 - The Verge

The numbers seem catastrophic, overwhelming, beyond a magnitude that the human mind or heart can grasp: What do 60,000 or even 240,000 deaths look like?

Those are roughly the lower and upper limits of projected fatalities in the U.S. from Covid-19 in models that have been informing U.S. policy. Last month, when the lower estimate was 100,000, the White House recommended nationwide countermeasures. Those started with a ban on gatherings and quickly escalated to closing schools and businesses, advising people to wear face masks, and reminding them to stay physically apart. This week, when the lower estimate (from the Institute for Health Metrics and Evaluation) dropped to 60,000, reflecting how well those measures are working, it stoked optimism that the epidemic might soon end with less loss of life.

The lower number, 60,000, is a little more than the capacity of Dodger Stadium in Los Angeles. It is the number of passengers in 180 full jumbo jets. It is more than the number of U.S. combat deaths in the Vietnam War.

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And 240,000, of course, is four times any of the above.

But are these large numbers or small numbers? At the beginning of the pandemics spread in the U.S., President Trump dismissed early projections of thousands, even tens of thousands, of U.S. deaths as no worse than the lives lost in an average influenza year. So far this season, flu deaths total 24,000 to 63,000 (data from the Centers for Disease Control and Prevention are estimates with wide uncertainties).

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Whether you think a multiple of up to 10 on top of that is a tragedy or merely unfortunate is a personal call. For what its worth, about 8,000 Americans die every day from, almost overwhelmingly, diseases and other natural causes. Those, of course, havent stopped; Covid-19 deaths are in addition to those (with a caveat noted below).

To make these numbers easier to grasp, we show how 60,000 to 240,000 compares to some of the leading causes of death and to previous pandemics.

One note about methodology: The projected Covid-19 deaths come from models that see the number of cases and deaths plateauing nationally in the next few weeks, as they have already done in Seattle, San Francisco, and other places that were hit first. If stay-at-home orders and other countermeasures keep working, there should be few deaths after July. We therefore treated the 60,000 to 240,000 deaths as occurring over five months, from March to July, as the IHME researchers do, and therefore calculated five months worth of cancer, heart disease, and other deaths. Of course, as Anthony Fauci, a member of the White House Covid-19 task force, told a JAMA webcast this week, the new coronavirus is not going to disappear from the planet, for sure, after July.

But the concentration of deaths is truncated into weeks, said Fauci, director of the National Institute of Allergy and Infectious Diseases. That is what captures our attention and overwhelms hospitals.

Covid-19 is particularly severe in and more likely to kill the elderly and people with existing illnesses, including heart disease. Some people taken by Covid-19 would likely have died from these diseases even in the five-month time frame. We do not try to calculate how many of the Covid-19 deaths substitute for other deaths; that is an important calculation that researchers will be eager to do once the crisis passes.

You may believe a different methodology paints a truer picture of how Covid-19 deaths compare to others. As we said, how to think about deaths is deeply personal.

Originally posted here:

Here's how projected Covid-19 fatalities compare to other causes of death - STAT

As the rate of COVID-19 testing slowly creeps up in the US, public health experts have a new concern that many people with negative test results actually have the virus.

If you have had likely exposures and symptoms suggest Covid-19 infection, you probably have it even if your test is negative, wrote Harlan Krumholz, a professor of medicine at Yale, in The New York Times.

Doctors and clinicians struggle with test accuracy all the time, across all areas of medicine. No test is perfect. Under normal circumstances, though, they understand the factors that contribute to false negative or false positive results from a particular test. They might also have more extensive data on the test that helps them interpret what it says. Not in this case.

Theres a lot of talk saying its a bad test. I think its not that the test is bad, says Catherine Klapperich, director of the Laboratory for Diagnostics and Global Healthcare Technologies at Boston University. Instead, she says, the health care providers and patients dont have the information they need to fully understand their test results.

The bulk of the tests done in the US for COVID-19 use a technique called PCR, which looks for bits of the new coronavirus in a mucus sample taken from a patient. PCR works well, and it will flag a sample as positive even if there are only a few copies of the virus in it.

The problem is that the virus doesnt tend to stay in an easily accessible part of the body. It lurks in the nasopharynx, where the back of the nose meets the top of the throat. To test someone for the new coronavirus, doctors and nurses have to stick a very long swab very deep into their nose. Its not rocket science, but you have to be trained to do it, Klapperich says. Many false negative test results are probably because the swab wasnt done correctly.

Doctors also dont know when in the course of a COVID-19 illness the test works best. The data on the tests false negative rate jumbles together all of the tests that have been done. It hasnt broken out the false negative rates of tests done at different times during the progression of the disease. The false negative rate for tests done right when someone starts feeling sick, for instance, might be different than that same rate for tests done when people are hospitalized.

All tests are wrong sometimes, but clinicians are more comfortable with false results for certain types of tests than they are others. There are variables that affect your tolerance for false negatives and positives, Klapperich says.

On a screening test for HPV, a virus that can lead to cervical cancer, a false positive result is usually less dangerous than a false negative result. Someone with a positive test result will have additional follow-up tests to confirm if they actually have HPV and if they need additional treatment. In that case, if the positive result is incorrect, that can be corrected. If someone tests negative incorrectly, it could delay treatment. The anxiety and unnecessary follow-up tests that can come from a false positive result can cause harm. But for HPV, its not as risky as a false negative.

With the new coronavirus, its the opposite. If someone is told they have COVID-19, theyll be told to quarantine. Theyll be alone, and stressed but safe. If you tell them theyre negative and theyre not, they could infect other people, Klapperich says. As the consequences of this pandemic keep changing, health care workers treating patients with COIVD-19 are constantly reevaluating their tolerances for false positive or false negative testing results, she says.

Doctors have to decide if they can trust a negative test enough to stop wearing protective equipment when treating a hospitalized patient or if the clinical symptoms look enough like COVID-19 that the negative result doesnt matter.

Normally, retesting sick patients could be a straightforward way to compensate for a less-accurate test. For something like a strep test, when a result doesnt match a patients symptoms, a doctor can do a second type of test or a repeat test. Limited testing resources, though, make that much more challenging for COVID-19.

Ideally, if someone tests positive, youll say theyre positive. If theyre negative and have symptoms, they could get another test. We cant do that now, Klapperich says. We dont have luxury of rerunning a test or sending someone for a test thats complementary to get more data.

Instead, doctors and patients have to decide on the fly what to do with a single negative or positive COVID-19 test. When they have more experience with a test, theyre better equipped to make those decisions. Mammograms are good examples, Klapperich says. False positives on those tests, which screen for breast cancer, happen fairly often. People have the experience to say, oh, you have a spot. Clinicians are trained to say that this is usually not a big deal.

The coronavirus test is much newer than mammograms or tests for strep and HPV, and clinicians dont have as much clear data to inform their interpretation of results. Theres an interplay between the test and how well it does, and how people receive the test results, Klapperich says. Do they trust them? Do they trust the guidelines that go along with the test?

Klapperich thinks there will be better information for both patients and providers available soon. Many clinicians are keeping good records and storing patient samples after theyve been tested while carefully noting when in the course of an illness the sample was taken. Soon, she says, theyll be able to figure out how accurate the test is at different points in a case of COVID-19. That should help doctors make more confident recommendations that incorporate both when a test was done and what a patients symptoms are.

The limitation right now is that people doing the testing are focused on patients, she says. When things settle down, and they dont have to focus on patients every minute, theyll do those studies.

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COVID-19 clinicians wrestle with false negative results - The Verge