Category: Covid-19

Young, healthy people are dying of COVID-19 infections, even if most serious cases occur in the elderly and those with preexisting conditions. Now, scientists are looking to see if genes may explain why some people fall seriously ill while others show only mild symptoms, Science magazine reported.

Several ongoing projects aim to analyze and compare the DNA of those with severe COVID-19 infection to those with mild or asymptomatic cases. Differences may lie in genes that instruct human cells to build a receptor called ACE2, which the novel coronavirus relies on to enter cells, Science reported. Alternatively, it may be that genes that support the body's immune response to the virus differ between individuals, or that those with particular blood types carry protective genetic traits that shield them from illness, as suggested by a preliminary study from China.

For now, we don't know which genes might render people susceptible to serious COVID-19 infection, but given the pace of the pandemic, researchers could identify likely candidates within a few months, Andrea Ganna, a geneticist at the University of Helsinkis Institute for Molecular Medicine Finland (FIMM), told Science.

Related: 10 deadly diseases that hopped across species

Ganna and FIMM Director Mark Daly are heading an international effort to collect genetic data from COVID-19 patients, known as the COVID-19 Host Genetics Initiative. Several biobanks, including FinnGen in Finland and the 50,000-participant biobank at the Icahn School of Medicine at Mount Sinai in New York, have "expressed interest" in contributing data to the study, according to Science. Some groups working with the initiative plan to collect DNA samples from willing patients who are currently hospitalized with COVID-19 infections. Alessandra Renieri, a geneticist at the University of Siena in Italy, expects 11 Italian hospitals to participate in such a study with her own research group.

"It is my opinion that [host] genetic differences are a key factor for susceptibility to severe acute pneumonia," Renieri told Science. Jean-Laurent Casanova, a pediatrics researcher at the Rockefeller University, is organizing a similar effort within a global network of pediatricians. Their aim is to study "previously healthy" patients under age 50 who have developed severe COVID-19 infections, as their vulnerability to the virus likely lies in their genes, Casanova told Science.

As part of their own initiatives, the UK Biobank will also begin curating data from COVID-19 patients, and the Iceland-based company deCODE Genetics will partner with the country's government to do the same. In the U.S., the Personal Genome Project at Harvard University is recruiting volunteers to share their genetic data, tissue samples, health data and COVID-19 status, Science reported.

In the coming weeks and months, these and other projects may reveal why COVID-19 only triggers a transient cough in some people, while endangering the lives of many others.

Originally published on Live Science.

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Why are young, healthy people dying from COVID-19? Genes may reveal the answer. - Live Science

Executive Summary

The spread of Covid-19 is stretching operational systems in health care and beyond. The reason is both simple: Our economy and health care systems are geared to handle linear, incremental demand, while the virus grows at an exponential rate. Our national health system cannot keep up with this kind of explosive demand without the rapid and large-scale adoption of digital operating models.While we race to dampen the viruss spread, we can optimize our response mechanisms, digitizing as many steps as possible. Heres how some hospitals are employing artificial intelligence to handle the surge of patients.

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On Monday March 9, in an effort to address soaring patient demand in Boston, Partners HealthCare went live with a hotline for patients, clinicians, and anyone else with questions and concerns about Covid-19. The goals are to identify and reassure the people who do not need additional care (the vast majority of callers), to direct people with less serious symptoms to relevant information and virtual care options, and to direct the smaller number of high-risk and higher-acuity patients to the most appropriate resources, including testing sites, newly created respiratory illness clinics, or in certain cases, emergency departments. As the hotline became overwhelmed, the average wait time peaked at 30 minutes. Many callers gave up before they could speak with the expert team of nurses staffing the hotline. We were missing opportunities to facilitate pre-hospital triage to get the patient to the right care setting at the right time.

The Partners team, led by Lee Schwamm, Haipeng (Mark) Zhang, and Adam Landman, began considering technology options to address the growing need for patient self-triage, including interactive voice response systems and chatbots. We connected with Providence St. Joseph Health system in Seattle, which served some of the countrys first Covid-19 patients in early March. In collaboration with Microsoft, Providence built an online screening and triage tool that could rapidly differentiate between those who might really be sick with Covid-19 and those who appear to be suffering from less threatening ailments. In its first week, Providences tool served more than 40,000 patients, delivering care at an unprecedented scale.

Our team saw potential for this type of AI-based solution and worked to make a similar tool available to our patient population. The Partners Covid-19 Screener provides a simple, straightforward chat interface, presenting patients with a series of questions based on content from the U.S. Centers for Disease Control and Prevention (CDC) and Partners HealthCare experts. In this way, it too can screen enormous numbers of people and rapidly differentiate between those who might really be sick with Covid-19 and those who are likely to be suffering from less threatening ailments. We anticipate this AI bot will alleviate high volumes of patient traffic to the hotline, and extend and stratify the systems care in ways that would have been unimaginable until recently. Development is now under way to facilitate triage of patients with symptoms to most appropriate care setting, including virtual urgent care, primary care providers, respiratory illness clinics, or the emergency department. Most importantly, the chatbot can also serve as a near instantaneous dissemination method for supporting our widely distributed providers, as we have seen the need for frequent clinical triage algorithm updates based on a rapidly changing landscape.

Similarly, at both Brigham and Womens Hospital and at Massachusetts General Hospital, physician researchers are exploring the potential use of intelligent robots developed at Boston Dynamics and MIT to deploy in Covid surge clinics and inpatient wards to perform tasks (obtaining vital signs or delivering medication) that would otherwise require human contact in an effort to mitigate disease transmission.

Several governments and hospital systems around the world have leveraged AI-powered sensors to support triage in sophisticated ways. Chinese technology company Baidu developed a no-contact infrared sensor system to quickly single out individuals with a fever, even in crowds. Beijings Qinghe railway station is equipped with this system to identify potentially contagious individuals, replacing a cumbersome manual screening process. Similarly, Floridas Tampa General Hospital deployed an AI system in collaboration with Care.ai at its entrances to intercept individuals with potential Covid-19 symptoms from visiting patients. Through cameras positioned at entrances, the technology conducts a facial thermal scan and picks up on other symptoms, including sweat and discoloration, to ward off visitors with fever.

Beyond screening, AI is being used to monitor Covid-19 symptoms, provide decision support for CT scans, and automate hospital operations. Meanwhile, Zhongnan Hospital in China uses an AI-driven CT scan interpreter that identifies Covid-19 when radiologists arent available. Chinas Wuhan Wuchang Hospital established a smart field hospital staffed largely by robots. Patient vital signs were monitored using connected thermometers and bracelet-like devices. Intelligent robots delivered medicine and food to patients, alleviating physician exposure to the virus and easing the workload of health care workers experiencing exhaustion. And in South Korea, the government released an app allowing users to self-report symptoms, alerting them if they leave a quarantine zone in order to curb the impact of super-spreaders who would otherwise go on to infect large populations.

The spread of Covid-19 is stretching operational systems in health care and beyond. We have seen shortages of everything, from masks and gloves to ventilators, and from emergency room capacity to ICU beds to the speed and reliability of internet connectivity. The reason is both simple and terrifying: Our economy and health care systems are geared to handle linear, incremental demand, while the virus grows at an exponential rate. Our national health system cannot keep up with this kind of explosive demand without the rapid and large-scale adoption of digital operating models.

While we race to dampen the viruss spread, we can optimize our response mechanisms, digitizing as many steps as possible. This is because traditional processes those that rely on people to function in the critical path of signal processing are constrained by the rate at which we can train, organize, and deploy human labor. Moreover, traditional processes deliver decreasing returns as they scale. On the other hand, digital systems can be scaled up without such constraints, at virtually infinite rates. The only theoretical bottlenecks are computing power and storage capacity and we have plenty of both. Digital systems can keep pace with exponential growth.

Importantly, AI for health care must be balanced by the appropriate level of human clinical expertise for final decision-making to ensure we are delivering high quality, safe care. In many cases, human clinical reasoning and decision making cannot be easily replaced by AI, rather AI is a decision aid that helps human improve effectiveness and efficiency.

Digital transformation in health care has been lagging other industries. Our response to Covid today has accelerated the adoption and scaling of virtual and AI tools. From the AI bots deployed by Providence and Partners HealthCare to the Smart Field Hospital in Wuhan, rapid digital transformation is being employed to tackle the exponentially growing Covid threat. We hope and anticipate that after Covid-19 settles, we will have transformed the way we deliver health care in the future.

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How Hospitals Are Using AI to Battle Covid-19 - Harvard Business Review

Airbnb was built on the premise of bringing the world closer together. Tourists could travel like locals, while locals could cash in on their desirable neighbourhood properties by letting those visitors in. Last year the company was estimated to be worth more than US$30bn. It is scheduled to go public in 2020. Then came the Covid-19 pandemic.

Travel is suspended. Australians are almost entirely confined to their homes. Now the once heralded disruptor is seeing a collapse in bookings. The hosts who have become reliant on income-generating properties to pay their bills are being bled dry by a lack of business, and already-suspicious neighbours are up in arms over the potential that short-term renters may spread the virus.

In the decade before the pandemic, Airbnb became this very attractive thing, says Chris Martin, a senior research fellow at the University of New South Waless City Futures Research Centre. The platform, and others like it, fundamentally changed not only the travel industry but housing and rental markets. A home is no longer just a home, Martin says. [The company] tapped into the idea that a persons house can also be viewed as an asset that has capacity for generating income.

This shift massively upped the scale of [short-term rental], which in turn put pressure on residential rental markets. The changes have resulted in lawsuits in the US and a petition by 10 cities to the European parliament in 2019. There are more than seven million Airbnb listings spread across 100,000 cities with an estimated 346,581 listings between July 2016 and February 2019 in Australia alone.

Stephen Colman, who was an Airbnb host and ran an Airbnb management business up until last year, says the whole industry has fallen through. Many hosts are either pulling out of Airbnb to find cheaper long-term tenants or have been offering 14-day isolation suites.

The former, Colman says, will come with a long wait and big rent cuts, as everyone else rushes to do the same. The latter is even more fraught. This week the Greens state MP for Ballina, Tamara Smith, called on online holiday booking websites such as Airbnb and Stayz in the Byron Bay region to stop marketing regional properties as ideal places for self-isolation, saying it wasnt fair on regional hospitals and communities.

There are real concerns around cleaning stuff, Colman says, How many hours between checkout and check-in [Hosts] have seen a fightback from body corporates who are just outright cancelling the key fobs for anyone who they believe is doing Airbnb. Theyve just gone were going to take this hard line to protect the safety of our long-term tenants.

Jane Hearn, deputy chair of the Owners Corporation Network, has argued that opening Airbnb properties for quarantine increases the viral load on apartment owners and tenants. Resident advocacy groups such as We Live Here and Neighbours Not Strangers were already lobbying against Airbnb on behalf of local communities who were sick of rowdy travellers in their apartment complexes. In a letter to New South Wales premier Gladys Berejiklian on 1 April, Neighbours Not Strangers called for an immediate ban on all short-term rentals, due to the risks from Covid-19.

Airbnb does not support reservation requests from users who are showing symptoms, or those who are awaiting test results. Last week the company instituted a ban on any listings that reference Covid-19, coronavirus or quarantine and listings which incentivise bookings through Covid-19-related discounts, stocks of limited resources, or the highlighting of quarantine-friendly listing attributes. The companys updated instructions for cleaning and hygiene recommend hosts stock their properties with a few extras like antibacterial hand sanitizer, disposable gloves and wipes, hand soap, paper towels, tissues and toilet paper.

The government has now mandated that all international arrivals must complete their quarantine at designated pre-booked hotels. But, before that, some Australians were happy turning to Airbnb. Comedian Alice Fraser is currently in a good value Bondi Airbnb after returning from London. She saw Airbnb as the responsible option: [Its there] for people who dont have favours to call in, or family who happen to have a massive home that can be segmented into parts.

Lisa Porgazian and her husband have listed their three Gold Coast apartments on Airbnb for the past four years. Now the properties are empty, and the mortgage payments will come out of the couples superannuation. We were relying on this for our income, as well as our retirement plan, she says, distraught. Now thats completely died in the arse.

Porgazian, a 46-year-old former IT contractor, has been managing her property portfolio full-time. Shes unable to work in many other jobs due to rheumatoid arthritis. Im earning zero. My husbands earning zero. And weve still got these mortgages to pay.

With the spread of Covid-19, a downturn in business was inevitable. But many Airbnb hosts were shocked at how quickly it came. The company introduced a policy earlier this month allowing all guests who booked prior to 14 March (and were checking in no later than 31 May) to cancel existing bookings for free. Porgazian says this left hosts holding the cheque.

We lost everything straight away Everything is cancelled, basically until Christmas.

Susan Wheeldon, Airbnbs country manager for Australia and New Zealand, said offering these free cancellations wasnt an easy decision, but it was one made with public health considerations front of mind. The primary consideration for us was protecting the wellbeing of the community.

Travis Lipshus, a real estate agent in Byron Bay, thinks this chaos for Airbnb hosts could result in cheaper long-term rent for locals. Hes getting flooded with properties from Airbnb hosts who now need permanent tenants. But with so many of the towns hospitality staff and backpackers currently out of work theres not enough tenants to fill these places.

If rents did lower, it would be a massive relief. Its notoriously difficult for locals to find affordable rentals in Byron Bay, as 17.6% of properties are listed as holiday accommodation. Airbnb should be banned up here, Lipshus says. The cost of living is insane. Ive lived in all sorts of places here, and its not uncommon to pay at least 50% of your wage in rent.

Martin describes the current regulation around Airbnb as really quite liberal. He says at present, it didnt seem to fit well with highly local impacts. Local councils [should] have a strategy and a plan around short-term letting especially around limits.

For now, he is not so certain well see a drop in rents. Landlords may still withhold properties and leave them vacant instead, he says. For whatever reason, that seems to be a surprisingly common scenario in the high-pressure [locations].

Wheeldon says that Airbnb has not seen a material drop in the overall number of listings on our platform. While the Covid-19 crisis has significantly disrupted the tourism industry and wider economy, we know that travel is resilient in the long term and will ultimately recover.

But will the hosts recover?

We know our hosts are doing it tough, Wheeldon says. The peak body representing Airbnb and other short term rental companies has sought urgent support from the federal government for hosts in the form of mortgage payment deferrals, among other measures. For many, that may not be enough.

A lot of people have over-leveraged themselves with these properties, Lipshus says. The upper-middle class are probably going to be fine. But the middle class the ones taking risks, trying to get up that class ladder theyre going to be pretty fucked.

Lisa Porgazian knows what people are saying. The criticism that were getting is well you shouldnt have a business if you cant pay for it, but who ever predicted something like this?

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Disrupting the disruptors: how Covid-19 will shake up Airbnb - The Guardian

The number of people infected in the U.S. has exceeded 337,000, with the death toll climbing past 9,600. More than 4,100 of those deaths are in the state of New York, but a glimmer of hope there came on Sunday when Democratic Gov. Andrew Cuomo said his state registereda small dipin new fatalities over a 24-hour period. Still, Louisiana Gov. John Bel Edwards said his state may run out of ventilators by week's end.

Former Vice President Joe Biden suggested his party's presidential nominating convention, already pushed from July into August because of the outbreak, may have to movefully onlineto avoid packing thousands of people into an arena in Milwaukee.

Biden has all but clinched his party's presidential nomination and held an online town hall from his home in Delaware at the same time Trump was addressing reporters. His tone was far less confrontational than Trump, who clashed with reporters and criticized Democratic Illinois Gov. J.B. Pritzker as being demanding and complaining while having not performed well.

Biden sought to be uplifting and almost grandfatherly, taking questions from children with his wife. But he also said the president has been awful slow to use the powers of his office to compel private companies to make protective equipment for doctors and nurses, adding that we should be much more aggressive.

Trump angrily deflected questions regarding the slow pace of the federal governments response to the pandemic, praising federal officials he has elevated in recent weeks to coordinate the distribution of hard-to-find supplies.

The people that youre looking at, FEMA, the military, what theyve done is a miracle, Trump told reporters. What theyve done is a miracle in getting all of this stuff. What they have done for states is incredible.

For most people, the virus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, and death.

Also Sunday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said the toll in the coming week is "going to be shocking to some, but that's what is going to happen before it turns around, so just buckle down."

Fauci said the virus probably wont be wiped out entirely this year, and that unless the world gets it under control, it will assume a seasonal nature.

We need to be prepared that, since it unlikely will be completely eradicated from the planet, that as we get into next season, we may see the beginning of a resurgence, Fauci said. Thats the reason why were pushing so hard in getting our preparedness much better than it was.

The Defense Department released new requirements that all individuals on its property will wear cloth face coverings when they cannot maintain six feet of social distance in public areas or work centers. That is in compliance with new federal guidelines that Americans use face coverings when venturing out.

Trump had said previously that he's choosing not to wear a face mask and scoffed at the idea of using one while answering questions as he held news briefings like Sunday night's.

I would wear one," he said, but only if I thought it was important.

Associated Press

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Residents at another Taylorville apartment complex test positive for COVID-19 - Herald & Review

The Wisconsin Department of Health Services reports as of Monday, there are 2,440 coronavirus cases. That's a case increase of 173 cases since Sunday. Of the number of positive cases, there are 668 hospitalizations, or about 27% of cases.

DHS is also confirming 77 deaths.

So far, 26,574 have tested negative for COVID-19.

In central and northcentral Iron County and Waupaca County have each reported one death. In the NewsChannel 7 viewing area, Forest, Lincoln, Langlade and Price all have no confirmed cases.

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DHS: Number of Wisconsin COVID-19 deaths at 77, 26K test negative - WSAW

The majority of people who file taxes wind up with a refund each year. But what if you're in that smaller percentage of filers who owe the IRS money? Under normal circumstances, that's a stressful situation to contend with. During the ongoing COVID-19 crisis, it could spell disaster, especially if you happen to be out of work, which is the case for millions of Americans who have lost their jobs in the past few weeks.

If you're looking at a tax bill right now, here are a few things you can do to make the situation easier on yourself.

Normally, you only have until April 15 to file your previous year's tax return and pay the IRS any money it indicates that you owe. This year, however, because of COVID-19, the deadline to both file a tax return and pay a tax bill for 2019 has been pushed back three months to July 15, 2020. As such, if you've recently completed your 2019 return and see that you owe money, you can submit that return but hold off on paying the taxes associated with it for another three months (you're not required to make a payment the day you turn in your taxes). That way, you'll potentially have more time to scrounge up some cash.

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Even when we're not in the middle of a crisis, the IRS will usually work with people who don't have the means of paying their tax debt on time. If that's the situation you're in, reach out to the IRS and ask to get on an installment agreement. You can think of it as a payment plan, where instead of writing out a huge check, you pay your balance over time. And the best part? If you think you'll be able to pay off your balance within 120 days of when it's due (for this year, that means within 120 days of July 15), you won't pay a fee to set up that arrangement. Otherwise, you'll pay a modest fee for setting up a direct debit with the IRS, which may be reduced if you're a low enough earner.

With an offer in compromise, you offer to settle your tax debt with the IRS for less than the amount you owe. This option is not unique to the COVID-19 crisis; it's been around for years. But it's also extremely difficult to qualify for. In a nutshell, for the IRS to accept an offer in compromise, you need to prove that paying your tax debt in full will constitute an undue financial hardship, or that you truly don't have the means to pay it. And also, your offer will need to be reasonable. If you owe the IRS $8,000, it probably won't accept $1,000 of it and call it a day. But if you offer to pay half, the IRS may agree under the right circumstances.

Keep in mind that a layoff resulting from COVID-19 may not be a valid reason to not pay your tax bill in full. Though unemployment is rampant right now, many people in that boat are without a paycheck temporarily, so be careful when trying to point to the crisis as a reason to wipe out some of your debt.

Owing taxes in the middle of a pandemic is less than ideal. If that's the boat you're in, don't panic. Rather, explore your options and see what makes the most sense given your circumstances.

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Owe Taxes During the COVID-19 Outbreak? Here's What to Do. - Motley Fool

The city of Berkeleys health officer and other health officers around the region and state recommend that everyone cover their noses and mouths with cloth when leaving home for essential visits to doctors offices, supermarkets or pharmacies.

A bandana, fabric mask, neck gaiter or other cloth barrier helps prevent those who have mild or no COVID-19 symptoms from unknowingly spreading it to others. To protect yourself from others, use physical distance.

Do not use surgical masks or N-95s. Preserve the limited supply of medical-grade masks such as an N-95 for health care workers or first-responders, who cannot use physical distance to protect themselves, especially from people at their most symptomatic, infectious periods.

This new recommendation from the city of Berkeley, state and regional officials comes as scientists and doctors rapidly learn more about this new type of coronavirus, which was detected only four months ago and has no known medicine or vaccine.

Wear a bandana to protect others from an infection you might have, said Dr. Lisa Hernandez, the city of Berkeley health officer. When you see others wearing a cloth covering, know that they are protecting you.

Face coverings should cover the nose and mouth. Cloth materials can be improvised and should be washed repeatedly with detergent and dried on a hot cycle. Ideally, use a dedicated laundry bin so they are washed after each use.

Make sure the covering is comfortable you dont want to have to keep adjusting the mask, which means touching your face. Always wash your hands, or use hand sanitizer, before AND after touching your face or face coverings.

Health officials stress that staying home, frequent hand washing and physical distancing are the best ways to prevent the spread of COVID-19. Face coverings may also serve as a reminder to the critical order to shelter in place except for essential activities.

If you have sealed packages of masks, gloves, and other protective equipment to support Berkeleys emergency response youre able to donate, let us know.

Stay home except for essential activities, said Hernandez. When you must leave, help care for our community by keeping distance from others and covering your face.

Visitcityofberkeley.info/covid19for additional information on COVID-19, recommendations from Berkeley Public Health, andchanges to City services.

Berkeleyside relies on reader support so we can remain free to access for everyone in our community. Donate to help us continue to provide you with reliable, independent reporting.

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Message from Berkeley health officer: Cover face to limit COVID-19 spread - Berkeleyside

Imagine you are in a small boat far, far from shore. A surprise storm capsizes the boat and tosses you into the sea. You try to tame your panic, somehow find the boats flimsy but still floating life raft, and struggle into it. You catch your breath, look around, and try to think what to do next. Thinking clearly is hard to do after a near-drowning experience.

You do, though, realize two important things: First, the raft is saving your life for the moment and you need to stay in it until you have a better plan. Second, the raft is not a viable long-term option and you need to get to land.

In April 2020, the storm is the Covid-19 pandemic, the life raft is the combination of intense measures we are using to slow the spread of the virus, and dry land is the end to the pandemic.

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The U.S. is still in the clambering-into-the-life-raft phase of responding to Covid-19, and thinking clearly about what to do is still difficult. This confusion has made it hard to appreciate two facts: One is that social distancing combined with scaling up testing, production of medical equipment, and other countermeasures are essential and must be replicated across the country, intensified, and continued. The other is that if these measures have the desired effect of reducing the number of new cases accumulating each day, they provide only a temporary solution.

We still need to find a way to bring the pandemic to a permanent conclusion.

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Several countries in Asia controlled their epidemics before a majority of the population was infected. Some, like Taiwan and Singapore, did so by containing infections from the start. Others, like China and Korea, did so only after large outbreaks. The control they have reached is only a life raft, not dry land, because unless there have been extraordinarily high levels of infection that were so mild as to go unnoticed, most people in these countries remain susceptible to infection.

Viruses do not remember they were previously under control and will resurge when restrictions are lifted. Just look at what happened in 1918, when cities that had cracked down on the transmission of influenza lifted their restrictions and flu transmission rose again. Mathematical models of Covid-19 by our group and others that incorporate these lessons show that, in the short term, social distancing and other interventions can reduce the impact of the virus. But the same models show that when these interventions are eased, the problem returns.

Lets be clear. With something like Covid-19 there is the first peak, and theres the whole epidemic. For the first peak, the evidence so far points to a worrisome possibility of overwhelming our intensive care units even with the degree of social distancing weve achieved as were seeing in New York City. But every bit we slow and flatten the curve will make that less likely and less dramatic, if and when it happens.

It is very possible that after this first wave subsides, we will still have a largely susceptible population, though that depends on how well the social distancing works. Effective treatments and increased ICU capacity could reduce the demand for critical care, lightning the load on the health system, but again, these measures only delay things.

If the SARS-CoV-2 virus has a contagiousness of three, meaning every case infects three other people, then we wont get to the end of the epidemic until two-thirds of the population has become immune by infection or by vaccination. Successful control of the first peak of infections could leave a majority (perhaps a large majority) of the U.S. population still susceptible to the virus.

There are several broad ideas for how to get to dry land, which is widespread immunity in the population. But each has enormous problems.

One way is to let up on social distancing soon and let the epidemic run its course. That would lead to many deaths and completely overwhelm health care systems around the country. Another way is to maintain intense social distancing until there is a vaccine but the arrival of a vaccine is uncertain and, absent a miracle, will likely take more than a year. Meanwhile, society and the economy would suffer.

If the first wave really is controlled, another option would be to try multiple rounds of social distancing: instituting it to bring the epidemic under control then letting up, perhaps only in certain areas, to allow cases to occur and immunity to accumulate gradually in the population, and then again introducing another round of social distancing. Our model of this process shows that it would take multiple rounds and would be challenging to accomplish without errors that lead to ICU overload. It would also be difficult to maintain the political and social will to implement this.

The most ambitious approach would be to intensify social distancing and scale up testing until we have the ability to know about nearly every case of Covid-19, trace his or her contacts, and control the spread of the disease one case at a time. This, though, is hard to envision. Even though Singapore detected the infection early, Covid-19 has stretched the islands public health system to the limits, and our public health system has not had the practice and the resources devoted to stopping a pandemic that Singapore has invested since it faced down severe acute respiratory syndrome (SARS) in 2003. And continued risk of imported cases of Covid-19 from elsewhere in the world or even from other parts of the country would lead us in this best-case scenario to restrict and intensively screen travelers for an extended period.

As epidemics and responses to them are local, the scenario in one part of the U.S. could differ from that in another. A report from the Institute for Disease Modeling suggests that even Seattles relatively prompt response may have only slowed the spread of the infection and it may see a single-peaked epidemic with much of the population infected, despite social distancing efforts. If accurate, recently reported fever data from a networked thermometer company that illness rates may be coming down, not just growing more slowly, then we may see a second peak once social distancing efforts are lifted.

Clearly, we need more testing to understand each regions epidemic trajectory.

A vaccine is ultimately our best hope, but that is in the future many months away, if not a year or more, in the rosiest scenarios.

Whatever path we choose and it may be a mix of paths in different parts of the country, as the local epidemics and responses are so varying we should be working overtime to make use of the time we buy with social distancing. That means:

Despite the near-drowning of hospitals and intensive care units weve observed in many countries, and may soon witness in the U.S., we must think clearly and understand that getting through the first phase of this pandemic only gets us into the life raft, not to dry land.

Marc Lipsitch is professor of epidemiology and director of the Center for Communicable Disease Dynamics at the Harvard T.H. Chan School of Public Health, where Yonatan Grad is an assistant professor of immunology and infectious diseases.

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With Covid-19, we've made it to the life raft. Dry land is far away - STAT

A person waits in line to get tested for the COVID-19 virus at Brooklyn Hospital Center on Tuesday. Angela Weiss/AFP via Getty Images hide caption

A person waits in line to get tested for the COVID-19 virus at Brooklyn Hospital Center on Tuesday.

A new analysis from the Centers for Disease Control and Prevention finds that people with chronic conditions including diabetes, lung disease and heart disease appear to be at higher risk of severe illness from COVID-19.

The report finds 78% of COVID-19 patients in the U.S. requiring admission to the intensive care unit had at least one underlying condition. And 94% of hospitalized patients who died had an underlying condition. The analysis is a preliminary snapshot based on data from about 7,000 cases in the U.S. and about 200 deaths.

"These results are consistent with findings from China and Italy," the CDC researchers conclude in a report published in the MMWR, the Morbidity and Mortality Weekly Report, on Tuesday. These findings "highlight the importance of COVID-19 prevention in persons with underlying conditions," the paper concludes.

Among COVID-19 patients admitted to the ICU, 32% had diabetes, 29% had heart disease and 21% had chronic lung disease, which includes asthma, COPD and emphysema. In addition, 37% had other chronic conditions including hypertension or a history of cancer.

The report includes a snapshot of cases among children and teenagers, and it adds to the evidence that people of all ages are vulnerable to infection.

The analysis concludes that about 23% of the COVID-19 cases were among children and teens (under age 19). But only a small number of these young patients were known to be hospitalized. The CDC documented 48 hospitalizations among this age group. Eight young patients were sick enough to be admitted to the ICU. (The report does not distinguish within the 0-19 age group).

Keep in mind, this snapshot is preliminary. "The analysis was limited by small numbers and missing data because of the burden placed on reporting health departments with rapidly rising case counts," the researchers write. And the picture could change as more data becomes available.

Overall, this report bolsters the evidence that people with chronic disease may be hit hardest by COVID-19 in terms of severity of symptoms and complications. But it's important to note that about 60% of cases evaluated in this analysis were among people who did not have documented chronic conditions. Healthy, younger people can be vulnerable, too.

As we've reported, a prior analysis, also based on preliminary data, found that nearly 40% of people hospitalized in the U.S. were 55 years old and younger. And 20% were people ages 20-44.

See the original post here:

Who's Sickest From COVID-19? These Conditions Tied To Increased Risk - NPR

But what is most worrisome is the racial disparity in prior health conditions that exist in the United States. As Bloomberg reported about a study of the deaths in Italy: Almost half of the victims suffered from at least three prior illnesses, and about a fourth had either one or two previous conditions. More than 75 percent had high blood pressure, about 35 percent had diabetes and a third suffered from heart disease.

According to the Centers for Disease Control and Prevention, high blood pressure is most common in non-Hispanic black adults (54 percent), and black people have the highest death rate from heart disease.

As for diabetes, the 2015 National Medical Association Scientific Assembly, held in Detroit, where my friend died, delivered these stark statistics:

African-American patients are more likely than white patients to have diabetes. The risk of diabetes is 77 percent higher among African-Americans than among non-Hispanic white Americans. The rates of diagnosis of diabetes in non-Hispanic African-Americans is 18.7 percent compared to 7.1 percent.

The group went on to say that in 2006, African-Americans with diabetes were 1.5 times more likely to be hospitalized and 2.3 times more likely to die from diabetes than non-Hispanic whites.

In addition, many Southern states refused to expand Medicaid under the Affordable Care Act, and there is a rural hospital crisis in this country. But that crisis is compounded in the South, where, as the magazine Facing South points out, the rural areas have higher poverty rates, higher mortality rates, and lower life expectancies than other rural regions of the country.

This all worries me, because I take a lesson from the H.I.V./AIDS crisis. In the beginning, it was largely seen as a New York and San Francisco problem affecting white men who were gay. Over the decades, treatments became available, and those cities saw their new infection rates plummet.

But the disease remained very much alive, particularly in the South, particularly among black people, where it has reached epidemic proportions. In the United States, more than 40 percent of people living with H.I.V. and 40 percent of people with new infections are black, according to the C.D.C., and African-American men accounted for three-quarters of new H.I.V. infections among African-Americans in 2016, and 80 percent of these were among African-American gay and bisexual men.

Link:

The Racial Time Bomb in the Covid-19 Crisis - The New York Times