Category: Covid-19

Martha Lackritz-Peltie works from her living room in Oakland, California, this month. (Julie Jammot/AFP via Getty Images)

As the spread of COVID-19 upends work, classes and even doctor appointments across the country, a majority of Americans are turning to digital means to stay connected and track information about the outbreak.

Amid this increased reliance, about nine-in-ten U.S. adults (93%) say that a major interruption to their internet or cellphone service during the outbreak would be a problem in their daily life, including 49% who foresee an outage being a very big problem for them and 28% who believe it would be a moderately big problem.

But while digital connections may provide an alternative during a time of social distancing, only a minority (27%) thinks interacting via these technologies will be as effective as in-person contact. Some 64% of Americans think the internet and phones will help but are not a replacement for face-to-face encounters.

These are key findings from a Pew Research Center survey of U.S. adults conducted online between March 19-24 on the Centers American Trends Panel.

Pew Research Center conducted this study to understand how Americans in different parts of the country are responding to the new coronavirus outbreak. This analysis focuses in particular on the role digital technology plays in peoples day-to-day lives during the outbreak. For this analysis, we surveyed 11,537 U.S. adults from March 19 to 24, 2020. Everyone who took part is a member of Pew Research Centers American Trends Panel (ATP), an online survey panel that is recruited through national, random sampling of residential addresses (see our Methods 101 explainer on random sampling). This way nearly all U.S. adults have a chance of selection. The survey is weighted to be representative of the U.S. adult population by gender, race, ethnicity, partisan affiliation, education and other categories. Read more about the ATPs methodology.

Here are the questions used for this report, along with responses, and its methodology.

Asked about a range of activities they have performed in response to the coronavirus outbreak, roughly three-quarters (76%) of Americans say they have used email or messaging services to communicate with others, while 70% report that they have searched online for information about the coronavirus. By comparison, fewer Americans though still about four-in-ten say they have shared or posted information about the outbreak on social media.

As more companies move to encouraging or requiring telework, one-quarter of those surveyed say they have used video calling or an online conferencing service, like Zoom or WebEx, to attend a work-related meeting due to the coronavirus outbreak. Smaller shares of Americans (16%) report using the internet or email to connect with doctors or other medical professionals as a result of the outbreak.

There are some differences by education level, age, and race and ethnicity when it comes to how these digital activities are used as the country copes with the virus.

For example, it is far more common for college graduates to hold virtual meetings than those with less formal education. Nearly half of college graduates (46%) say they have participated in a work meeting by using video calling or online conferencing, compared with 21% of those with some college experience and 11% who have a high school education or less. College graduates are also more likely than those who have some college experience or a high school education or less to say they have used email or messaging services to communicate with others or look up information online related to the outbreak.

There are also age differences across most of these experiences. The largest gap is evident when it comes to seeking outbreak-related information online. Some 52% of adults ages 65 and older say they have used the internet to search for information about the coronavirus, but that share rises to 64% among those ages 50 to 64 and 80% among adults under the age of 50.

Across each measure, rural Americans are less likely than those living in urban areas to report using these digital tools. And Hispanic adults (49%) are more likely than black (37%) or white adults (34%) to report using social media to share or post coronavirus-related content.

Previous Center surveys have found that Americans widely view a high-speed internet connection as essential or important. Mobile technology is also playing a large role in how people go online particularly for Americans who rely on their smartphone to do everything from getting news or searching for health information to looking for a job.

The new survey shows that majorities across demographic groups believe that losing internet or mobile connectivity during the outbreak would be disruptive to their daily lives, but how big of problem they foresee this causing varies substantially across demographic groups.

Roughly nine-in-ten Americans (93%) say that a major interruption in their internet or cellphone service during the coronavirus outbreak would be a problem for daily life in their household. This includes 49% who foresee this being a very big problem for them and 28% who believe this would be a moderately big problem. A smaller share says this would be a small problem (16%), and just 6% say it would not be a problem at all for daily life.

Roughly six-in-ten Americans who have a bachelors or advanced degree (59%) say a major interruption in their internet or cellphone service during the outbreak would be a very big problem in their daily lives, compared with 50% of those who have some college experience and 40% of those who have a high school diploma or less.

Adults under the age of 65 (53%) are far more likely than those 65 and older (38%) to see this kind of disruption as a very big problem for their daily life. On the other hand, those living in rural areas (39%) are far less likely to believe a major interruption to their internet or cellphone service would a very big problem for them than those living in urban (57%) or suburban (50%) areas.

There are also differences by race and ethnicity, as well as by gender. Black and Hispanic adults are more likely than white adults to view an interruption to their internet or cellphone service as a very big problem. And women are more likely than men to believe this would cause a significant issue in their daily life.

It is important to note that previous Center studies have shown that Americans digital connectedness and reliance on technology varies across demographic groups. For example, younger adults as well as those living in cities or suburbs use the internet more frequently. They are more likely to own a smartphone and to use that technology to perform digital tasks.

Even as the public describes a major interruption to their internet or phone service as disruptive, only a minority thinks interacting via these technologies would be just as good as face-to-face contact with others.

Asked what will happen if many of the everyday interactions they have in person have to be done online or by phone because of the coronavirus outbreak, 27% say these technologies will be just as good as in-person contact. By comparison, the largest share (64%) says these tools will be useful, but will not be a replacement for face-to-face communications, and just 8% say the internet or phones wont help much at all during this time. This pattern holds true across each major demographic group.

Still, there are some notable differences by educational attainment. Roughly three-quarters of college graduates (73%) say that if their everyday in-person interactions have to be done online or by phone, it will help but not be a replacement for in-person contact. That share falls to 63% among those who have some college experience and 56% among Americans with a high school education or less.

By contrast, there are more modest differences by age or race and ethnicity. White or Hispanic adults (65% each) are more likely than black adults (56%) to say interacting online or through a phone will be useful but wont be a full substitute for face-to-face communication. And adults under the age of 30 are somewhat more likely to express this view than those ages 30 and older (69% vs. 63%).

Note: Here are the questions used for this report, along with responses, and its methodology.

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Amid COVID-19, tech or internet outage seen as a very big problem by 49% in US - Pew Research Center

The economic impacts of COVID-19 are already shaping up to be significant, yet uneven, across the country. Not only are workers and businesses affected, but so too is the fiscal capacity of governments that rely on a healthy economy for their revenue. As the crisis unfolds, the impact on cities bottom line will be driven not only by overall economic conditions but specifically the parts of the economy where revenue is generated: retail sales, income and wages, and real estate.

To understand when cities can anticipate the brunt of COVID-19s impact on their general fund revenues, we examined the extent to which a city relies on general tax sources that respond quickly to economic swings. An important factor is whether the citys underlying regional economy is composed of industries that are more immediately exposed to coronavirus-related employment declines.

The results indicate an uneven geography of fiscal impact, with many heartland cities likely to be hit harder and more quickly than others.

Download the appendix table

Cities in the U.S. generate the majority of their revenue by designing their own tax and fee structures within the limits imposed by their states (e.g., property tax limits, debt limits, constraints on access to some tax sources). As a consequence, cities tax structures vary across the country, with some relying heavily on property taxes and others primarily on sales taxes. Only a few citiesapproximately one in 10rely most on income or wage taxes.

Federal aid amounts to some 5% of total municipal revenue, while state aid is 20% to 25%. In other words, a citys tax structure accounts for 70% to 75% of what it can spend to meet the health, safety, and welfare needs of its residents and visitors.

After less than a month of shelter-at-home edicts, its clear that retail sales have plummeted and unemployment is skyrocketing. A city that generates the majority of its revenue from sales or income taxes will be hit hard and immediately when it experiences such consumer declines and job losses.

A city that relies on property taxes, however, will not experience such an immediate collapse in its revenues. Local assessment practices require that cities wait to estimate the value of land and property until the property is exchanged on the market or an assessment is conducted. Current property tax bills, therefore, typically reflect values of the property anywhere from 18 months to several years prior to collection. Property tax collection is less responsive, or elastic, in the short termbut over time, as rising unemployment dampens real-estate demand, even these property-tax-dependent cities will feel COVID-19s impact.

In addition to taxes, approximately one-third of city-sourced revenues are derived from fees and charges for services such as trash collection and water. Although COVID-19 will adversely affect some fee-driven services (think transit and parking) because demand is reduced, it will affect other services (water, sewer, etc.) less severely, as residents remain in place and continue to use them.

To illustrate the impact of tax structures on city-revenue responses to COVID-19, we evaluated the share of regional employment in high-risk industries (mining/oil and gas, transportation, employment services, travel arrangements, and leisure and hospitality) and the share of general fund revenues from sales and income taxes across 139 cities. These cities are diverse in their geographies, economies, and revenue structures.

Cities with both a vulnerable economic composition (greater than 15% share of employment in high-risk industries) and a tax structure that is highly reliant on elastic sources of revenue (greater than 25% share of general fund revenues) will feel a dip in revenues more quickly than those with alternative economic and fiscal structures.

Map 1. Heartland Cities Stand to Be Most Fiscally Impacted More Immediately

Source: Authors' calculations of city budget data; Zandi, "Covid-19: A Fiscal Stimulus Plan," Moody's Analytics 2020; Brookings analysis of Emsi data.

Note: High risk industries include mining (NAICS 21), transportation (NAICS 48), employment services (NAICS 5613), travel arrangements (NAICS 5615), and leisure & hospitality (NAICS 71 & 72)

This analysis reveals that many of the most fiscally impacted cities in the shorter term are in Americas heartland. For example, 76% of Columbus, Ohios general fund comes from income taxes, and 16% of regional employment is in highly vulnerable industries. Cities in Ohio rely heavily on the flat income tax, which correlates immediately to changes in employment.

In places that rely heavily on sales taxessuch as Tulsa, Okla., Lincoln, Neb., and Denverthe closing of retail sales outlets will generate an immediate reduction in city revenue. Oklahoma Citys sales tax contributes 54% of its general fund revenues, for example, while 20% of its workers are in vulnerable industries.

A reliance on income taxes (as in Columbus) or sales taxes (as in Oklahoma City) will generate a strong shock to a citys fiscal system as the COVID-19 pandemic continues. The fiscal impacts will likely appear within a month or two, and require those cities to adjust their budgetary expenditures in short order.

Those cities likely to feel mid- to longer-term impact are more reliant on property taxes and have a less-exposed local economy. Durham, N.C., for example, does not have a local sales or income tax, and less than 12% of regional employment is in high-risk industries.

It is possible, however, that foreclosures in property-tax-dependent cities (due to unemployment and the inability to pay taxes and mortgages) might happen more quickly than anticipated, driving property tax revenue down sooner than the typical 18 to 24 months.

The immediately impacted citiesthose reliant on sales and incomes taxes with a high share of vulnerable industriesare likely to feel fiscal declines within the next month or two. Others are more likely to feel COVID-19s economic effects in the next few quarters to a year. Although higher reliance on property tax revenue is generally more favorable in the short term, a less-diversified structure will limit the resilience of city budgets in long term.

The fiscal capacity of local governments to manage public health and economic resilience in the face of COVID-19 is uncertain at best. The federal government has committed to providing much-needed assistance to cities to meet the immediate needs of residents, households, and small businesses on the economic margins. This includes expanded funding for Community Development Block Grants, transit, education, broadband, and housing and homelessness. Notably, cities with a population over 500,000 will also receive direct financial assistance via a stabilization grant program, the Coronavirus Relief Fund.

Unfortunately, the potential impact on most local budgets is largely unknown, because states will have maximum discretion to allocate resources to cities as they see fit based on population size. Future federal bills should consider much lower population thresholds for direct local funding.

Under the current bill, states and cities should coordinate in unprecedented ways to ensure that measures of local fiscal capacityincluding tax structures and the share of high-risk workersare considered in funding distribution.

States should also allow their local governments to modify tax structures so they are in line with their underlying economic bases. Flexibility to collect a better mix of sales, income, and property taxes will offer cities the tools they need to respond in the short and long term as economic conditions and the needs of their residents change. This flexibility will be especially important in the months ahead, as state revenues and aid to cities begin to take a hit.

American cities will face very different situations as COVID-19s economic impact becomes clear. The most effective solutions to this unprecedented situation will take into account the uneven magnitude and timing of the fiscal impact that cities will experience across the country.

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When will your city feel the fiscal impact of COVID-19? - Brookings Institution

CT Department of Public Health

The map of COVID-19 hospitalizations by county shows a migration to the east and north, roughly following the interstate highways.

Public health experts speak calmly of an approaching storm, one moving west to east, like most weather in New England. Dont forget your umbrella. The governor and hospital executives use more urgent language, warning of a surge, maybe even a tsunami. You can almost hear the distant wail of sirens.

The former police chief in charge of emergency services in Connecticut uses cop vernacular. James Rovella watches the novel coronavirus creep up I-684 to I-84 to Danbury and I-95 to Stamford and Norwalk, and he thinks of his experience with two less novel plagues, drugs and guns. He says, All they do is follow the highways.

The metaphors of the COVID-19 pandemic continue to evolve, as do the metrics and the statistical modeling guiding the governmental response.

The White House released statistical models Tuesday showing the U.S. can expect at least 100,000 deaths from COVID-19 in coming months, even factoring in the social distancing measures imposed by governors and mayors and strongly recommended by the president. Donald J. Trump no longer speaks of a return to normalcy by Easter.

I want every American to be prepared for the hard days that lie ahead, Trump said.

A dynamic forecasting tool developed by the Institute for Health Metrics and Evaluation at the University of Washington suggests the current death toll of 69 in Connecticut could jump sixfold in April, then plateau in May, about two weeks behind New York and a month ahead of the U.S. as a whole. The projections fluctuate as the states update their data.

CT Department of Public Health

The running tally of confirmed cases and fatalities by county.

The institute sees more than a tenfold increase in U.S. deaths in April, reaching 60,000.

Even before White House disclosed details of its model, Gov. Ned Lamont said Tuesday all the algorithms and models all point to the same conclusion: April will be a horrible month.

Connecticuts daily COVID-19 tally is posted on the Department of Public Health web site: The numbers of tests completed, cases confirmed, patients hospitalized, and the deaths. They are imperfect measures of what is happening on any given day and incomplete data sets feeding the forecasts of what is to come.

The DPH laboratory confirmed the states first two cases on March 9, none on March 10, then another on March 11.

The one-day total Tuesday was 557, and the state epidemiologist says the running total of confirmed cases, now 3,128, always will be just the tip of the iceberg. What lays unseen is much larger, perhaps by a magnitude of 10, perhaps more.

Our goal is to provide the maximum amount of data that we can, said Av Harris, the former public-radio reporter in charge of communications at the state Department of Public Health. Its not a simple process.

Connecticut publishes more details than some states, less than others. The contents of the daily update on the DPH web site was tweaked Monday and again Tuesday, offering clearer summaries and more data points. And over the weekend it shifted to hospitalization data gathered by the Connecticut Hospital Association, finding it more accurate.

We hear from a lot of different people who are stakeholders about what data they would like to see, Harris said. Were getting input from local public health departments, from legislators, from journalists, from the governors office.

There has been limited data on infections in nursing homes and none among hospital workers. And there are questions about the accuracy and timeliness of the death toll, given the death Thursday of 35-year-old Mike OBrien. It wasnt until Monday that the DPH summary statistics reflected the death of anyone under age 40.

On Monday, the death toll was 36. On Tuesday, the Lamont administration reported an additional 33 fatalities, a misleading measure of the diseases progress. Yes, there were a statistically significant 16 deaths in the previous 24 hours. But there also were 17 catchup deaths, ones that had not been previously reported by the DPH.

The DPH on Tuesday began offering some details on nursing home infections: 85 residents have been diagnosed with the disease; half have been hospitalized; and 11 have died. Thirty of the states 216 nursing homes have had at least one confirmed case, but the facilities have not been publicly identified since an initial outbreak in Stafford Springs.

With more private labs now conducting the tests, there is a noticeable lag in reporting some days. State law initially required private labs to only notify DPH of confirmed COVID-19 cases, not negative results. By executive order of Gov. Ned Lamont, the negatives are now reported.

As of Tuesday, there were 15,600 completed tests: 3,128 positive, about 20 percent of the total.

For the first time, the DPH put COVID-19 in a broader context on Monday, offering syndromic surveillance data that compares the percentage of people seeking care in hospital emergency departments for unexplained fever/flu symptoms this year against the past two flu seasons. It shows a dramatic spike, one indicator of the growing pressure on hospitals.

There is no fever graph showing how steeply the trajectory of confirmed cases or hospitalizations are pitching upward. But the numbers are there: hospitalizations nearly doubled overnight, from 205 on March 28 to 404 on the 29th and 517 on the 30th. On Tuesday, the number rose to 608.

We wanted to stay two and three and four weeks ahead, said Rovella, describing the states preparations to have sufficient hospital capacity. But I can hear the footsteps.

Hospitals in Fairfield County, the closest to New York, have the most COVID-19 patients, with 275; New Haven County has 202 and Hartford County, 110. Those statistics reflect where the patients are hospitalized, not where they are from.

Commissioner James RovellaDepartment of Emergency Services and Public Protection

An unknown numbers New Yorkers have taken shelter at second homes in Litchfield County or on the Connecticut shoreline. If they are tested positive while in Connecticut, the results will be reported and recorded in New York. There were no details on how many New Yorkers might be hospitalized in Greenwich, Stamford, Norwalk or Danbury hospitals.

At the insistence of Lamont, the hospitals are greatly expanding capacity. Less clear is how the staffing and related supplies, particularly personal protection equipment, can expand to serve patients who soon could be in beds in mobile hospitals, universities and exhibition halls at the Connecticut Convention Center and Mohegan Sun.

DPH officials declined to comment Tuesday on the latest projections released by the White House based on the administrations modeling.

The University of Washington forecasting tool was developed to give hospitals a sense of when to expect a surge of patients. While the death toll will not reach its apex until May, the peak demand on the hospitals is eight days away in New York and 12 in Connecticut.

Ryan Caron King :: Connecticut Public Radio

Members of the Connecticut National Guard unload equipment Tuesday for a 250-bed field hospital that will be staged at Southern Connecticut State University to facilitate overflow for regional hospitals.

The institute estimates the states overall hospital capacity can meet peak demand, but it will be short more than 100 intensive-care beds. It was described Monday by Wired in a deeply reported story as a data-crunching powerhouse with about 500 statisticians, computer scientists, and epidemiologists on staff.

Josh Geballe, the governors chief operating officer, said the University of Washington model is by far, the least severe of the ones reviewed by the state.He said modeling is an imperfect tool, given that the peak caseloads will not arrive uniformly, even in a small state like Connecticut.

The peak is going to happen at different places at different times. Fairfield County is going to go first, the second half of April the most likely peak, Geballe said. It will migrate to the north and east.

For many reasons, the true spread of a disease will remain one of educated conjecture for months.

Testing for active cases still falls short the demand, and no one is looking on a large scale yet for the antibodies that would show its reach across the state, as well as the level of community or herd immunity that might slow its spread.

A person infected by COVID-19 can have mild symptoms or be largely asymptomatic, one of the reasons why the state epidemiologist, Dr. Matthew Cartter, estimates the actual number of those infected is at least ten times larger than those with a laboratory-confirmed diagnosis.

Were only testing people with quite severe symptoms, said Manon Cox, a virologist and the former chief executive of Protein Sciences, where she learned first hand the difficulty of developing a vaccine for SARS, a severe respiratory disease caused by another coronavirus. Were not testing the many layers behind this.

Cox is skeptical about the likelihood of an effective COVID-19 vaccine being developed, and it ultimately might be shown to be unnecessary if the U.S. can widely test for antibodies through serology tests. Cox said antibody testing would be a boon to researchers struggling to precisely measure the spread of the disease and its mortality rate.

In the meantime, state officials say, the best they can do is prepare for scenarios outlined in the models, trying to match hospital capacity with the expected need.

If it turns out we didnt need it all, Geballe said, thats fine.

CT Department of Public Health

Stamford, Norwalk and Danbury have the most residents with laboratory-confirmed cases.

Read more here:

The metaphors, metrics and modeling of COVID-19 - The CT Mirror

This version updates the 27 March publication by providing definitions of droplets by particle size and adding three relevant publications.

Respiratory infections can be transmitted through droplets of different sizes: when the droplet particles are >5-10 m in diameter they are referred to as respiratory droplets, and when then are <5m in diameter, they are referred to as droplet nuclei.1 According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes.2-7 In an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported.8

Droplet transmission occurs when a person is in in close contact (within 1 m) with someone who has respiratory symptoms (e.g., coughing or sneezing) and is therefore at risk of having his/her mucosae (mouth and nose) or conjunctiva (eyes) exposed to potentially infective respiratory droplets. Transmission may also occur through fomites in the immediate environment around the infected person.8 Therefore, transmission of the COVID-19 virus can occur by direct contact with infected people and indirect contact with surfaces in the immediate environment or with objects used on the infected person (e.g., stethoscope or thermometer).

Airborne transmission is different from droplet transmission as it refers to the presence of microbes within droplet nuclei, which are generally considered to be particles <5m in diameter, can remain in the air for long periods of time and be transmitted to others over distances greater than 1 m.

In the context of COVID-19, airborne transmission may be possible in specific circumstances and settings in which procedures or support treatments that generate aerosols are performed; i.e., endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, manual ventilation before intubation, turning the patient to the prone position, disconnecting the patient from the ventilator, non-invasive positive-pressure ventilation, tracheostomy, and cardiopulmonary resuscitation.

There is some evidence that COVID-19 infection may lead to intestinal infection and be present in faeces. However, to date only one study has cultured the COVID-19 virus from a single stool specimen.9 There have been no reports of faecaloral transmission of the COVID-19 virus to date.

To date, some scientific publications provide initial evidence on whether the COVID-19 virus can be detected in the air and thus, some news outlets have suggested that there has been airborne transmission. These initial findings need to be interpreted carefully.

A recent publication in the New England Journal of Medicine has evaluated virus persistence of the COVID-19 virus.10 In this experimental study, aerosols were generated using a three-jet Collison nebulizer and fed into a Goldberg drum under controlled laboratory conditions. This is a high-powered machine that does not reflect normal human cough conditions. Further, the finding of COVID-19 virus in aerosol particles up to 3 hours does not reflect a clinical setting in which aerosol-generating procedures are performedthat is, this was an experimentally induced aerosol-generating procedure.

There are reports from settings where symptomatic COVID-19 patients have been admitted and in which no COVID-19 RNA was detected in air samples.11-12 WHO is aware of other studies which have evaluated the presence of COVID-19 RNA in air samples, but which are not yet published in peer-reviewed journals. It is important to note that the detection of RNA in environmental samples based on PCR-based assays is not indicative of viable virus that could be transmissible. Further studies are needed to determine whether it is possible to detect COVID-19 virus in air samples from patient rooms where no procedures or support treatments that generate aerosols are ongoing. As evidence emerges, it is important to know whether viable virus is found and what role it may play in transmission.

Based on the available evidence, including the recent publications mentioned above, WHO continues to recommend droplet and contact precautions for those people caring for COVID-19 patients. WHO continues to recommend airborne precautions for circumstances and settings in which aerosol generating procedures and support treatment are performed, according to risk assessment.13 These recommendations are consistent with other national and international guidelines, including those developed by the European Society of Intensive Care Medicine and Society of Critical Care Medicine14 and those currently used in Australia, Canada, and United Kingdom.15-17

At the same time, other countries and organizations, including the US Centers for Diseases Control and Prevention and the European Centre for Disease Prevention and Control, recommend airborne precautions for any situation involving the care of COVID-19 patients, and consider the use of medical masks as an acceptable option in case of shortages of respirators (N95, FFP2 or FFP3).18-19

Current WHO recommendations emphasize the importance of rational and appropriate use of all PPE,20 not only masks, which requires correct and rigorous behavior from health care workers, particularly in doffing procedures and hand hygiene practices.21 WHO also recommends staff training on these recommendations,22 as well as the adequate procurement and availability of the necessary PPE and other supplies and facilities. Finally, WHO continues to emphasize the utmost importance of frequent hand hygiene, respiratory etiquette, and environmental cleaning and disinfection, as well as the importance of maintaining physical distances and avoidance of close, unprotected contact with people with fever or respiratory symptoms.

WHO carefully monitors emerging evidence about this critical topic and will update this scientific brief as more information becomes available.

World Health Organization. Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections in health care. Geneva: World Health Organization; 2014 Available from: https://apps.who.int/iris/bitstream/handle/10665/112656/9789241507134_eng.pdf?sequence=1

Liu J, Liao X, Qian S et al. Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis 2020 doi.org/10.3201/eid2606.200239

Chan J, Yuan S, Kok K et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020 doi: 10.1016/S0140-6736(20)30154-9

Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020; doi:10.1056/NEJMoa2001316.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497506.

Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M,et al. Active monitoring of persons exposed to patients with confirmed COVID-19 United States, JanuaryFebruary 2020. MMWR Morb Mortal Wkly Rep. 2020 doi: 10.15585/mmwr.mm6909e1external icon

World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020 [Internet]. Geneva: World Health Organization; 2020 Available from: https://www.who.int/docs/default- source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020 Mar 4 [Epub ahead of print].

Zhang Y, Chen C, Zhu S et al. [Isolation of 2019-nCoV from a stool specimen of a laboratory-confirmed case of the coronavirus disease 2019 (COVID-19)]. China CDC Weekly. 2020;2(8):1234. (In Chinese)

van Doremalen N, Morris D, Bushmaker T et al. Aerosol and Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1. New Engl J Med 2020 doi: 10.1056/NEJMc2004973

Cheng V, Wong S-C, Chen J, Yip C, Chuang V, Tsang O, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020 Mar 5 [Epub ahead of print].

Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020

WHO Infection Prevention and Control Guidance for COVID-19 available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine DOI: 10.1007/s00134-020-06022-5 https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19

Interim guidelines for the clinical management of COVID-19 in adults Australasian Society for Infectious Diseases Limited (ASID) https://www.asid.net.au/documents/item/1873

Coronavirus disease (COVID-19): For health professionals. https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/health-professionals.html

Guidance on infection prevention and control for COVID-19 https://www.gov.uk/government/publications/wuhan-novel-coronavirus-infection-prevention-and-control

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

Infection prevention and control for COVID-19 in healthcare settings https://www.ecdc.europa.eu/en/publications-data/infection-prevention-and-control-covid-19-healthcare-settings

Rational use of PPE for COVID-19. https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf

Risk factors of Healthcare Workers with Corona Virus Disease 2019: A Retrospective Cohort Study in a Designated Hospital of Wuhan in China. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa287/5808788

Infection Prevention and Control (IPC) for Novel Coronavirus (COVID-19) Course. https://openwho.org/courses/COVID-19-IPC-EN

WHO continues to monitor the situation closely for any changes that may affect this interim guidance. Should any factors change, WHO will issue a further update. Otherwise, this scientific brief will expire 2 years after the date of publication.

World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license.

WHO reference number: WHO/2019-nCoV/Sci_Brief/Transmission_modes/2020.2

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Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations - World Health Organization

With schools closed and governments issuing orders for people to stay at home, a lot of kids have no choice but to turn to their screens for school and any kind of socializing. The debate over how much screentime is healthy is nothing new, but our devices have arguably never played as big a role in our lives as they do now when it comes to staying connected amid a global pandemic.

To understand how these changes might affect kids, The Verge spoke with Lloyda Williamson, a general and child psychiatrist and the chair of the psychiatry and behavioral sciences department at Meharry Medical College. This interview has been lightly edited for length and clarity.

Recent data shows that a majority of kids between the ages of six and 12 in the US are spending at least 50 percent more time in front of screens each day during the COVID-19 outbreaks. How might that affect kids development and mental health?

Its interesting because we have sort of mixed guidelines in terms of childrens exposure to digital technology. We of course have the educators that are really promoting the use of digital technology to help them to gain skills, to provide ways for them to be more engaged in science, technology, engineering, and math, and just help them to be prepared for a productive workforce in the future.

On the other hand, youve got the public health officials that are, I would say, not anti-digital but more cautious because of concerns about various aspects of health. One of the social concerns is that, of course, we have predatory individuals, theres cyberbullying. Some examples of emotional concerns might be just addictive behaviors toward digital technology and depression, as well as access to inappropriate content. With this increased time [on screens], a lot of times that means that these children are less active in terms of physical activity and exercise. And then, were understanding that theres a shortened or decreased attention span [when it comes to cognitive development].

Of course, as we look at digital technology were talking about lots of different platforms and types of media. And a lot of what were dealing with in terms of digital technology is new. So, what we have in terms of [studies on the effects of] screen time are primarily on television. And we realized that television is different than a lot of the platforms that we have where people are interacting in different ways. So I guess the short answer is we dont really know what the impact of digital technology is going to have, because it hasnt been out long enough to get these long-term studies.

What can parents and guardians do to counteract some of those potentially adverse effects? And how do we talk with kids about the pandemic?

One of the things that I think is very crucial, particularly since our children are at home, is the parental example of media use. One of the things we forget is that our children are watching us all the time. And so they see how much time were on social media using different digital media, and many times their behavior patterns and their patterns of use are patterned after us.

We have a thirst for news and as we are watching on the TV or listening on social media, our children are also exposed to that. That can be not only overwhelming for us, but also overwhelming for our children. So have some boundaries as to how much of this were going to watch and at what times of the day. Sometimes its just good to turn it off and do some other things instead of just keeping up with every news event.

As adults we do have to be aware of what our children are experiencing along with the increased tension in our community. Children are definitely aware that were experiencing a crisis. Many adolescents are resistant to staying at home and just really want to connect with their friends in person. And so, when those activities are restricted, that can bring out some feelings of sadness, depression, irritability, anger, frustration. For younger kids, when they realize that their lives are different, its a good opportunity for us to talk with them about whats going on. Have conversations about how theyre doing, what they miss about school, what they miss about having contact with their friends, and then just listening and giving them an opportunity to talk about their feelings.

I think its important to tell them facts according to their developmental level. Some people may say, Well, how do you talk about this coronavirus when people are dying? But we should be having some of these difficult conversations with children all along like being safe when you go out in public, not speaking to strangers and why thats important. We have these difficult conversations, and so this is another one: why its important to wash your hands, why its important for us to stay in our safe place at home during this time, and why, when people get ill, it can be very serious, to the point where some people are ending up in the hospital or maybe even die.

As parents are interacting with their children, they may want to know what are some signs of my child or my adolescent not doing well? Pay attention to changes in their behavior, changes in the way they communicate, and change in their personalities like theyre becoming more withdrawn, irritable, if theyre sleeping more, or if theyre arguing more. If it gets to the point that its really negatively impacting their ability to interact with the family, or where theyre not eating or sleeping, then they may want to reach out to their care provider and see if this may be a time that an evaluation needs to occur before it gets to the point that theres actually a serious psychiatric or mental health disorder.

With so many schools closed, how might online classes affect students learning?

We have more data in terms of college students, and we dont have as much of that data with younger children. And so I think were in a big experiment.

Its challenging for teachers to relate to different learning styles online. Different children learn differently. Some are more visual. Some are more auditory. Some have a mixed learning style. And then children have different levels of being able to be self motivated and participate in these online educational activities. There are a lot of different factors to consider, to see how people may respond positively or negatively or in mixed ways. But parents [can be] aware of their child, their childs learning style and personality, and check in with them.

Many parents have struggled with putting limits on screentime, even before outbreaks of COVID-19. Is that a good idea now, especially for kids who might feel like thats their only connection to the outside world while theyre stuck at home?

We dont want to do all or none. So we dont want to cut them off. Were looking for a sense of balance, in terms of communicating, learning, connecting. Lets also turn [screens] off for some time so they can connect together as a family and so that they can also perhaps engage in some other activities, whether its cooking, doing yard work outside, or drawing, or even interacting as a family with different games and things.

Theres so many resources out there, theres so many apps. I think the main thing is finding things that will help bring you a sense of peace, and using those things instead of things that would add more stress and more anxiety.

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How to talk with kids about screentime and COVID-19 - The Verge

AUGUSTA, Maine (WABI) A person has died from COVID-19 at the Alfond Center for Health in Augusta, marking the first death reported by MaineGeneral Health, and bringing the total number of virus related deaths in the state to five.

The other deaths reported include three in Cumberland County, and one in York County.

The newly reported deaths were that of two women both in their 80's, both died while in the hospital.

According to hospital officials, another person with the disease is hospitalized at that facility and a third patient was transferred to a different hospital due to their need for a higher level of care.

Two children have also tested positive for the virus, Dr. Nirav Shah says neither of those are school aged.

Tuesday morning the Maine CDC reported that there have now been 303 Mainers who have tested positive for the virus.

68 of those have recovered.

A total of 57 people are currently hospitalized.

Still showing with the largest number of patients with the illness are Cumberland and York counties.

Here is a breakdown of the numbers by county:

Androscoggin: 11Cumberland: 169Franklin: 2Kennebec: 12Knox: 5Lincoln: 8Oxford: 9Penobscot: 12Sagadahoc: 7Somerset: 1Waldo: 2York: 59

The counties of residence of six patients have yet to be identified.

The testing backlog is now is down to 600 tests, these are all tests of people in lowest risk category.

3 counties have more than ten cases, including Androscoggin, Penobscot, and Kennebec. This is one of two criteria used to determine if community transmission has occurred.

Officials are still working to confirm if community transmission exists in those areas.

Congregate settings are also of concern and remain a high priority for the CDC.

13 cases of COVID-19 are associated with congregate settings, one of those being a person who received services at a southern Maine homeless shelter.

On that note, Maine's Department of Corrections has tested 7 individuals. 4 of which have come back negative and 3 sets of results remain pending.

During Tuesday's briefing, Dr. Shah asked people to really consider how they are living their lives these days, "For the time being this uncertainty may be the new norm. I fully recognize that uncertainty is unsettling. I want to acknowledge that that feeling of uncertainty, those feelings of being unsettled are okay. We're all feeling it."

As to equipment, 90 of the 190 Intensive Care Unit beds remain available if conditions continue to escalate.

The majority of ventilators are also still available for patients experiencing severe respiratory distress, and a third shipment of personal protective equipment was delivered yesterday form the federal stockpile.

The state has ordered an additional piece of equipment that will help with providing faster test results- that is anticipated to arrive within the next two weeks.

With emergency response, Dr. Shah says it is always important to have a backup plan, as healthcare providers or laboratory staff are also at risk of becoming ill.

Part of that backup plan includes the use of an out of state lab that is assisting with testing.

As has been the situation, it is important to continue to listen to the officials who urge people to stay at home and practice social distancing, which has proven to be effective.

View original post here:

A total of five deaths from COVID-19 now reported in Maine - WABI

"Novel coronavirus" is the proper term for this brand-new virus wreaking havoc on our unprepared world.

But you can also call this nasty villain by its scientific name: severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2 for short.

Covid-19 seems to strike the elderly and immunocompromised the hardest, along with any of us with underlying health conditions such as diabetes, heart and lung disease. But the young shouldn't take anything for granted -- there have been numerous deaths among people aged 20 to 50, as well as a very few among children.

Covid-19 can also present with mild symptoms very similar to a typical cold or flu -- or no symptoms at all, which makes controlling the spread of the virus causing Covid-19 very difficult.

What is a coronavirus?

There they set up shop, producing millions of copies of themselves and causing those cells to rupture. Like the famous scene from the movie "Alien," the viral offspring shoot out into the bloodstream, with the goal of invading more and more cells.

As they multiply, humans began to spit them out into the universe with each exhalation, making us contagious days before we begin to cough, sneeze or have diarrhea -- all symptoms the virus creates to ensure it can leap from human to human, thus ensuring its survival.

This "virus zombie invasion" comes in all sort of shapes, sizes and genetic strategies. All coronaviruses are covered with pointy spires of protein, giving them the appearance of having a crown or "corona" -- hence the name. Coronaviruses use these spikes to latch onto and pierce our cells.

Coronaviruses are part of the RNA brigade of viruses, which are much less stable than their DNA-based comrades. Why is that important? Because instability leads to mistakes in copying genetic code.

That leads to mutations -- thousands, millions, billions of mutations. Sooner or later, one mutation hits pay dirt and allows the virus to cross the great divide between different species. A few million/billion/trillion more mistakes creates another mutation that allows that virus to spread easily. Now the virus is both in its new host and it is contagious.

It's that type of mutation which gives humanity viruses like SARS-CoV-2.

Where did the novel coronavirus come from?

Some of those coronviruses can cross species, such as between pigs, cats and dogs, but for the most part coronaviruses stay loyal to their original hosts. Until, of course, they become that lucky mutation.

"Usually viruses from one animal really don't effectively transmit to other animal species or even to people," said Dr. John Williams, chief of the division of pediatric infectious diseases at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh.

"So usually if a virus goes from an animal to a human, it's sort of dead end. That person gets sick but it doesn't spread further," said Williams, who has studied coronaviruses for decades.

"MERS is extremely deadly, about 30% of people who are infected with MERS will die," Williams said. "So the virus got over one of the barriers -- it's able to infect humans, grow in them and cause disease -- but thankfully it really doesn't spread well person to person, other than very, very close contacts."

SARS has been more difficult to pin down.

"SARS caused death in about 10% of people that became infected and it did spread person to person but not super effectively," Williams said. "There weren't many people walking around without symptoms or with mild symptoms, who could be spreading it.

"This new virus, SARS-CoV-2, has overcome more barriers," Williams added. "It spreads easily person to person and a lot of people can have either mild disease or they might not even have symptoms, yet they can have the virus and spread it."

At this time, scientists don't know where the novel coronavirus began.

"These things are more difficult than [identifying] dinosaurs, because there's no fossil record of a virus," Williams said. "For example, the main virus I study, human metapneumovirus, is clearly a virus that has circulated in humans for decades if not a few centuries.

"However, when you look at the genetics of the virus, its closest genetic relative is a bird virus," he added. "So, did that virus jump to humans way back and become established? That's what we think. But it isn't impossible that a human virus jumped to birds and became established there."

See the article here:

What is coronavirus and Covid-19? An explainer - CNN

Tuesday afternoon, Governor Gretchen Whitmer sat down with 9&10 News for an interview over video chat to give updates on the fight against COVID-19.

It can and will impact everyone so everyone of us needs to do our part, says Gov. Whitmer.

Its been exactly three weeks since Michigan announced their first positive COVID-19 tests.

As of Tuesday, the number is over 7,600 with more than 250 deaths.

This conversation that were having, people are looking at numbers on the news and not really pausing to take in that its a serious situation, says Whitmer.

She says the biggest hurdles are mitigating spread through executive order and keeping up with supplies from out of state sources.

112,000 masks sounds like we fixed the problem, says Whitmer, But really it just bought us a couple more days.

Last night, Bridge Magazine reported Whitmer will cancel the rest of the school year.

They do great reporting, says Whitmer, But theyre not on the mark on this one. I have not made a final decision yet.

Cancellation would cut the school year short by three months.

If it was a matter of just flipping a switch and saying we just all transition to online learning and everyone had the capacity to do it, that would be one thing, says Whitmer, But we know thats out of reach. Thats why its really important that we take the time to make sure that we get it right.

This morning, Representative Triston Cole asked for softer restrictions on the stay at home order for certain workers.

It is possible for many of the entities listed in the letter to conduct business while being responsible with social distancing, says Rep. Cole.

Like landscapers, construction workers and farmers.

I am hopeful, says Cole, That this is something that I will get a positive response from.

No, says Whitmer.

She says this is not the time to let up.

The more porous our policy, the less likely it is to work, says Whitmer, Thats precisely why we have to be aggressive. Weve been on the leading edge and yet were still a national hotspot right now.

The governor reassures this will eventually end and some good can come of this, like lessons for the future.

Its really important that we take these lessons and we get serious about building up the United States for times like these, says Whitmer, Because there will be more.

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Gov. Whitmer Talks School Closures And Relaxing COVID-19 Rules - 9&10 News

The United States Environmental Protection Agency (EPA) announced on Thursday that it is temporarily relaxing enforcement of environmental regulations and fines during the COVID-19 outbreak. The enforcement discretion policy applies retroactively to March 13, with no end date set yet.

The new policy follows lobbying from industries including oil and gas, which told the Trump administration that relaxed regulations will allow them to more efficiently distribute fuel during the outbreak, but because it is broadly written, it could potentially influence companies actions in a large range of industries, including tech.

It may also create new challenges for researchers and scientists, since while the policy is in effect, companies are being asked only to make data from monitoring available to the EPA if requested by the agency.

The EPA said the policy addresses different categories of noncompliance differently. For example, the EPA said it will not seek penalties for noncompliance with monitoring and reporting that are the result of the COVID-19 pandemic, but that it still expects public water systems to provide safe drinking water.

EPA is committed to protecting human health and the environment, but recognizes the challenges resulting from efforts to protect workers and the public from COVID-19 may directly impact the ability of regulated facilities to meet all federal regulatory requirements, said EPA administrator Andrew Wheeler in the agencys announcement.

The policy places more onus for adhering to environmental regulations on the private sector. Depending on how the policy is carried out and how long it lasts, it may impact the work of tech companies that are developing tools to measure air pollution (for example, Googles Project Air View, which launched last year to provide air quality data gathered with startup Aclimas sensors to scientists and researchers), or that focus on environmental monitoring and compliance.

Susan Parker Bodine, the assistant administrator for enforcement and compliance assurance at the EPA, wrote in a memo about the policy that in general, the EPA does not expect to seek penalties for violations of routine compliance monitoring, integrity testing, sampling, laboratory analysis, training, and reporting or certification obligations in situations where the EPA agrees that COVID-19 was the cause of the noncompliance and the entity provides supporting documentation to the EPA upon request.

In July 2019, data released by the EPA showed that the number of unhealthy air days in major U.S. cities had increased over the past two years, even as combined emissions of major air pollutants fell.

Critics say that the policy will not only result in more pollution, but also make it impossible to fully assess the environmental damage.

In a statement to the Hill, Cynthia Giles, who headed the EPAs Office of Enforcement during the Obama administration, said the new policy tells companies across the country that they will not face enforcement even if they emit unlawful air and water pollution in violation of environmental laws, so long as they claim that those failures are in some way caused by the virus pandemic. And it allows them an out on monitoring too, so we may never know how bad the violating pollution was.

Original post:

EPA relaxes enforcement of environmental laws during the COVID-19 outbreak - TechCrunch

WARREN (WJW)A couple months ago a Warrenfamily says they werent too concerned about the Coronavirus.

Irene Culetsu said she felt her family was safe. She said she, her husband and two adult sons did not recently travel outside the United States. They all worked locally, she as a teacher, and her husband at the Trumbull County maintenance department.

I figured we wouldnt get the Coronavirus because we dont do anything, Irene told the Fox 8 I-Team. We stay home, but boy was I wrong.

She, her husband, her two sons Dino and Manoli, and Dinos girlfriend, MaryFay Dimitriadis, all have tested positive for COVID-19.

It started around March 15, when her son Manoli, and her husband of 31 years, George, started coughing. At first, they thought it was just the normal cough George seems to get yearly but soon he developed a fever. He went to a drive-in test site on March 20 and was admitted to a hospital.

His oxygen levels were low and they said he had pneumonia, Irene said. He got worse and last Wednesday they put him on a ventilator.

On Friday they learned George tested positive for COVID-19. The family then got tested and learned they too had the virus. They are quarantined at home, while George remains hospitalized and in a medically induced coma.

We need a miracle, Irene said. When he was very sick and they were worried about him not making it, they said only two people can go to see him. How could I choose which son would come up with me? I couldnt so I had the priest came up with me.

They continue to call the hospital several times a day for an update.

Not being able to hold him, or talk to him is a nightmare, its a nightmare, Irene said. He needs a rotating bed to help him with his breathing and we are working with the doctors to try and get him one.

The family says they are praying for everyone who has the Coronavirus and are asking for prayers for George. He is 67-years-old and has a birthday Friday.

He is a good man, Irene said. We are praying for George, asking God to answer our prayers and put his hands over him and heal him.

See more here:

We need a miracle, Entire family tests positive for COVID-19, father in ICU - WJW FOX 8 News Cleveland