Category: Covid-19

WASHINGTON Older people remain most at risk of dying as the new coronavirus continues its rampage around the globe, but theyre far from the only ones vulnerable. One of many mysteries: Men seem to be faring worse than women.

And as cases skyrocket in the U.S. and Europe, its becoming more clear that how healthy you were before the pandemic began plays a key role in how you fare regardless of how old you are.

The majority of people who get COVID-19 have mild or moderate symptoms. But majority doesnt mean all, and that raises an important question: Who should worry most that theyll be among the seriously ill? While it will be months before scientists have enough data to say for sure who is most at risk and why, preliminary numbers from early cases around the world are starting to offer hints.

NOT JUST THE OLD WHO GET SICK

Senior citizens undoubtedly are the hardest hit by COVID-19. In China, 80% of deaths were among people in their 60s or older, and that general trend is playing out elsewhere.

The graying of the population means some countries face particular risk. Italy has the worlds second oldest population after Japan. While death rates fluctuate wildly early in an outbreak, Italy has reported more than 80% of deaths so far were among those 70 or older.

But, the idea that this is purely a disease that causes death in older people we need to be very, very careful with, Dr. Mike Ryan, the World Health Organizations emergencies chief, warned.

As much as 10% to 15% of people under 50 have moderate to severe infection, he said Friday.

Even if they survive, the middle-aged can spend weeks in the hospital. In France, more than half of the first 300 people admitted to intensive care units were under 60.

Young people are not invincible, WHOs Maria Van Kerkhove added, saying more information is needed about the disease in all age groups.

Italy reported that a quarter of its cases so far were among people ages 19 to 50. In Spain, a third are under age 44. In the U.S., the Centers for Disease Control and Preventions first snapshot of cases found 29% were ages 20 to 44.

Then theres the puzzle of children, who have made up a small fraction of the worlds case counts to date. But while most appear only mildly ill, in the journal Pediatrics researchers traced 2,100 infected children in China and noted one death, a 14-year-old, and that nearly 6% were seriously ill.

However, a Cook County infant with COVID-19 died, Gov. Pritzker announced Saturday.

Another question is what role kids have in spreading the virus: There is an urgent need for further investigation of the role children have in the chain of transmission, researchers at Canadas Dalhousie University wrote in The Lancet Infectious Diseases.

THE RISKIEST HEALTH CONDITIONS

Put aside age: Underlying health plays a big role. In China, 40% of people who required critical care had other chronic health problems. And there, deaths were highest among people who had heart disease, diabetes or chronic lung diseases before they got COVID-19.

Preexisting health problems also can increase risk of infection, such as people who have weak immune systems including from cancer treatment.

Other countries now are seeing how pre-pandemic health plays a role, and more such threats are likely to be discovered. Italy reported that of the first nine people younger than 40 who died of COVID-19, seven were confirmed to have grave pathologies such as heart disease.

The more health problems, the worse they fare. Italy also reports about half of people who died with COVID-19 had three or more underlying conditions, while just 2% of deaths were in people with no preexisting ailments.

Heart disease is a very broad term, but so far it looks like those most at risk have significant cardiovascular diseases such as congestive heart failure or severely stiffened and clogged arteries, said Dr. Trish Perl, infectious disease chief at UT Southwestern Medical Center.

Any sort of infection tends to make diabetes harder to control, but its not clear why diabetics appear to be at particular risk with COVID-19.

Risks in the less healthy may have something to do with how they hold up if their immune systems overreact to the virus. Patients who die often seemed to have been improving after a week or so only to suddenly deteriorate experiencing organ-damaging inflammation.

As for preexisting lung problems, this is really happening in people who have less lung capacity, Perl said, because of diseases such as COPD chronic obstructive pulmonary disease or cystic fibrosis.

Asthma also is on the worry list. No one really knows about the risk from very mild asthma, although even routine respiratory infections often leave patients using their inhalers more often and theyll need monitoring with COVID-19, she said. What about a prior bout of pneumonia? Unless it was severe enough to put you on a ventilator, that alone shouldnt have caused any significant lingering damage, she said.

THE GENDER MYSTERY

Perhaps the gender imbalance shouldnt be a surprise: During previous outbreaks of SARS and MERS cousins to COVID-19 scientists noticed men seemed more susceptible than women.

This time around, slightly more than half the COVID-19 deaths in China were among men. Other parts of Asia saw similar numbers. Then Europe, too, spotted what Dr. Deborah Birx, the White House coronavirus coordinator, labeled a concerning trend.

In Italy, where men so far make up 58% of infections, male deaths are outpacing female deaths and the increased risk starts at age 50, according to a report from Italys COVID-19 surveillance group.

The U.S. CDC hasnt yet released details. But one report about the first nearly 200 British patients admitted to critical care found about two-thirds were male.

One suspect: Globally, men are more likely to have smoked more heavily and for longer periods than women. The European Center for Disease Prevention and Control is urging research into smokings connection to COVID-19.

Hormones may play a role, too. In 2017, University of Iowa researchers infected mice with SARS and, just like had happened in people, males were more likely to die. Estrogen seemed protective when their ovaries were removed, deaths among female mice jumped, the team reported in the Journal of Immunology.

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Age is not the only risk for severe COVID-19 disease - WGN TV Chicago

Sometimes being a journalist means having to improvise. It was Sunday 23 February when Italy announced draconian measures to stop people leaving or entering 11 towns that had been put under quarantine - 10 in the Lombardy region and one in Veneto. I got up early that day to hike around Lake Albano in Castel Gandolfo, about 40 minutes by train from Rome. I had left home more prepared for the possibility of needing to work bringing with me a notepad and pen than I did for the hike.

Sure enough, 20 minutes into the walk the announcement came. I stopped, found a spot by the lake, and wrote the first 600 words that began the Guardians coverage of Italys coronavirus outbreak. Fortunately, I have a robust smartphone. Sitting by the lake, I had a feeling that life as we knew it had stopped. By the end of that day, three people had died of the virus and 152 were infected.

We knew Covid-19 had made it to Italy in late January, when two Chinese tourists in Rome were confirmed to have contracted it. No more masks signs started to appear on the windows of chemists; my neighbour in Rome began disinfecting the banisters of the buildings stairwell and door handles. You never know, he said one morning, smoking a cigarette. I chalked most of this up to paranoia, not quite grasping that something that was happening so far away in China could reach Europe.

So when the outbreak suddenly emerged, it caught most of us off guard. As with any major breaking news story, a journalists first instinct is to get to the scene quickly. In recent years, Ive covered an earthquake, an avalanche and the collapse of Genoas Morandi bridge. All of those were tragedies that had a profound impact, but they were also ones in which the cause of the events and level of destruction was known and clearly visible. Covering the coronavirus outbreak, especially in the early stages, has been different in the sense that the threat is there, but cannot be seen or properly understood. Coverage needs more caution and planning.

With journalists unable to cross into the quarantined towns, the closest I got to the centre of the outbreak was Milan. That was on 25 February. I was fairly relaxed, worrying most about meeting my deadline. This time I had my computer with me, and filed the story from the foyer of a hotel close to the cathedral. A group of tourists were sitting nearby, coughing repeatedly. Did they have coronavirus? I became hypervigilant for potential symptoms.

Since then, most of my reporting has been done by phone, as the country rapidly shut down.

The death toll and number of people infected kept going up. However, the high number of those recovering, including the two Chinese tourists, was reassuring. Three people I spoke to who had recovered said their symptoms were mild. My first insight into the viruss real destructiveness only came when I spoke to Costantino Pesatori, the mayor of Castiglione dAdda, one of the first Lombardy towns under quarantine, on 6 March. The town lost 18 citizens in less than two weeks, one of them a 55-year-old man who had no known underlying health issues. Three of the towns five doctors were in quarantine, the other two hospitalised with the virus. We have many people with a fever who are at home and who are unable to be visited by a doctor, Pesatori said.

Still, at that point, the voices including some medics saying this is no worse than flu or millions die of flu were louder than the voices of people such as Pesatori. The media came under attack. In one post shared on Facebook, coronavirus was described as a godsend for journalists who were using it to enjoy a moment in the limelight. Seeing friends who run small businesses in Italy worrying about their livelihoods, I felt guilty. Was I being irresponsible? But the more I wrote, the more I learned about the virus. I thought about family and friends who would be vulnerable to it, those either suffering or recovering from cancer, those with heart issues, diabetes, or high blood pressure. This wasnt an illness that affected only the elderly or frail. People were dying before their time, regardless of their age.

As we told stories about the victims, the overwhelmed hospitals and how Italy was struggling to bury its dead, the horror of the viruss impact started to hit home, especially abroad. When a reader emailed thanking us for our responsible coverage, I cried. The reader had shared a story about Bergamo, the worst-affected province, with friends in the UK and said it had made an impact in terms of the message sinking in there.

The whole of Italy has been under lockdown for almost three weeks. Every day at 6pm the population solemnly tunes in for the war bulletin, when the civil protection authority gives an update on the number of deaths and infected. There was hope on Monday when, for two days in a row, the numbers for both had decreased. All we have now is hope that Italy will soon turn a corner. And when it does, I look forward to finishing the hike around Lake Albano.

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Reporting on Covid-19 in Italy: 'Life as we've known it has stopped' - The Guardian

DALLAS (NEXSTAR) With a limited number of tests available for COVID-19, whether or not you can get tested for the virus depends on where you live and how bad your symptoms might be. If youre wondering whether you should be tested, here are three signs you might need to contact a medical professional:

You show common symptoms and are in a prioritized group

The main symptoms of COVID-19 are fever, dry cough and shortness of breath.

Initially, the CDC was only recommending testing for peoplewith exposure to an infected person.However, all that changed once community spread was confirmed in theUnited States. In response, the CDCchanged its recommendations to allow anyone with COVID-19-like symptoms to betested as long as a doctor approved the request.

Maureen Ferran, Associate Professor of Biology at RochesterInstitute of Technology, noted its not feasible to test everyone who is sickin the US. In an article published by The Conversation, Ferran wrote mosthealth officials believe it is important to prioritize the testing of peoplewho need it the most: those at high risk such as health care workers who havebeen in contact with COVID-19 patients; symptomatic people in areas with highinfection rates; and people 65 years of age and older with chronic healthissues, such as heart disease, lung disease or diabetes.

The CDC says you should get immediate medical attention ifyou experience any of these COVID-19 emergency warning sings: troublebreathing, persistent pain or pressure in the chest, new confusion or inabilityto arouse and bluish lips or face.

Exposure to an infected person

If youre considered a close contact who has been exposed toa lab-confirmed case of COVID-19, youre considered high-priority. In some cases, doctors have asked asymptomaticpeople to monitor their temperature and quarantine. In other cases, theyve chosen to give thosepeople COVID-19 tests.

If youve been exposed to someone with COVID-19, you shouldcontact a medical professional for further guidance.

The CDC has guidance for who should be tested, but decisions about testing are at the discretion of state and local health departments and/or individual clinicians.

You make it through Apples COVID-19 screening site

Apple on Friday released a website and an iOS app that allow users to screen themselves for coronavirus symptoms, marking another response to the pandemic by a major tech platform.

Both tools were developed in partnership with the Centersfor Disease Control and Prevention, as well as the White Houses CoronavirusTask Force and the Federal Emergency Management Agency, Apple said in astatement to CNN Business. The app and website include a questionnaire andinformation about the novel coronavirus.

The software may suggest you self-isolate, seek professional medical advice or try to get tested.

(A portion of this was republished fromThe Conversationunder a Creative Commons license. Read theoriginal article.)

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Should I be tested for COVID-19? 3 signs you may need the test - KFOR Oklahoma City

The fury of the virus illustrates the folly of war, he said. That is why today, I am calling for an immediate global ceasefire in all corners of the world.It is time to put armed conflict on lockdown and focus together on the true fight of our lives.

The ceasefire would allow humanitarians toreach populations that are most vulnerable to the spread of COVID-19, which first emerged in Wuhan, China, last December, and has now been reported in more than 180 countries.

So far, there are nearly300,000 cases worldwide, and more than 12,700 deaths, according to the World Health Organization (WHO).

Asthe UN chiefpointed out,COVID-19does not care about nationality or ethnicity, or otherdifferences between people, and attacks all, relentlessly, including during wartime.

Itis the most vulnerable-women and children, people with disabilities, the marginalized, displaced and refugees-who pay the highest price during conflict and who are most at risk of suffering devastating losses from the disease.

Furthermore,health systems in war-ravaged countries haveoften reached the point oftotalcollapse, while the few health workers who remainare also seen as targets.

The UN chief called on warring parties topull back from hostilities, put aside mistrust and animosity, and silence the guns;stop the artillery; end the airstrikes.

This is crucial, he said, tohelp create corridors for life-saving aid.Toopen preciouswindows for diplomacy.Tobring hope toplaces among themost vulnerableto COVID-19.

Whileinspired bynew rapprochement and dialoguebetween combatantsto enable jointapproaches topush backthe disease, the Secretary-Generalsaid morestillneeds to be done.

End the sickness of war and fight thedisease that is ravaging our world, he appealed. It starts by stopping the fighting everywhere. Now.That is what our human familyneeds, now more than ever.

The Secretary-Generals appeal was broadcast live over the Internet from a virtual press conference held at UN Headquarters in New York, where most staff are now working from home to help curb further spread of COVID-19.

He answered questions from reporters which were read by Melissa Fleming, head of the UN Department of Global Communications, the parent office of UN News.

The UN chief said his Special Envoys will work with warring parties to make sure the cease-fire appeal leads to action.

Asked how he was feeling, Mr. Guterres responded that he is strongly determined, underlining that the UN must be active at this moment.

The UN must fully assume its responsibilities first doing what we have to do our peacekeeping operations, our humanitarian agencies, our support to the different bodies of the international community, the Security Council, the General Assembly but, at the same time, its a moment in which the UN must be able to address the peoples of the world and appeal for a massive mobilisation and for a massive pressure on governments to make sure that we are able to respond to this crisis, not to mitigate it but to suppress it, to suppress the disease and to address the dramatic economic and social impacts of the disease, he said.

And we can only do it if we do it together, if we do in a coordinated way, if we do it with intense solidarity and cooperation, and that is the raison detre of the United Nations itself.

Excerpt from:

COVID-19: UN chief calls for global ceasefire to focus on 'the true fight of our lives' - UN News

Link/share: http://www.kingcounty.gov/covid/schools

On March 12, 2020 Washington State Governor Jay Inslee announced that all schools in King, Snohomish, and Pierce counties will close from Tuesday, March 17 through Friday, April 24. The decision was made in response to the spread of COVID-19 in the Washington counties hit hardest by the virus. With this in mind, weve created resources for child cares and families for how to care for children while school is out (see below).

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New COVID-19 Public Health recommendations: how do these ...

Dutch models of COVID-19 are designed to help prevent overloading of hospitals and the need to transfer patients.

Jacco Wallinga's computer simulations are about to face a high-stakes reality check. Wallinga is a mathematician and the chief epidemic modeler at the National Institute for Public Health and the Environment (RIVM), which is advising the Dutch government on what actions, such as closing schools and businesses, will help control the spread of the novel coronavirus in the country.

The Netherlands has so far chosen a softer set of measures than most Western European countries; it was late to close its schools and restaurants and hasn't ordered a full lockdown. In a 17 March speech, Prime Minister Mark Rutte rejected working endlessly to contain the virus and shutting down the country completely. Instead, he opted for controlled spread of the virus while making sure the health system isn't swamped with COVID-19 patients. He called on the public to respect RIVM's expertise on how to thread that needle. Wallinga's models predict that the number of infected people needing hospitalization, his most important metric, will taper off next week. But if the models are wrong, the demand for intensive care beds could outstrip supply, as it has, tragically, in Italy and Spain.

COVID-19 isn't the first infectious disease scientists have modeledEbola and Zika are recent examplesbut never has so much depended on their work. Entire cities and countries have been locked down based on hastily done forecasts that often haven't been peer reviewed. It's a huge responsibility, says epidemiologist Caitlin Rivers of the Johns Hopkins University Center for Health Security, who co-authored a report about the future of outbreak modeling in the United States that her center released this week.

Just how influential those models are became apparent over the past 2 weeks in the United Kingdom. Based partly on modeling work by a group at Imperial College London, the U.K. government at first implemented fewer measures than many other countriesnot unlike the strategy the Netherlands is pursuing. Citywide lockdowns and school closures, as China initially mandated, would result in a large second epidemic once measures were lifted, a group of modelers that advises the government concluded in a statement. Less severe controls would still reduce the epidemic's peak and make any rebound less severe, they predicted.

But on 16 March, the Imperial College group published a dramatically revised model that concludedbased on fresh data from the United Kingdom and Italythat even a reduced peak would fill twice as many intensive care beds as estimated previously, overwhelming capacity. The only choice, they concluded, was to go all out on control measures. At best, strict measures might be periodically eased for short periods, the group said (see graphic, below). The U.K. government shifted course within days and announced a strict lockdown.

It's not that the science behind epidemic modeling is controversial. Wallinga uses a well-established model that divides the Dutch population into four groups, or compartments in the field's lingo: healthy, sick, recovered, or dead. Equations determine how many people move between compartments as weeks and months pass. The mathematical side is pretty textbook, he says. But model outcomes vary widely depending on the characteristics of a pathogen and the affected population.

Because the virus that causes COVID-19 is new, modelers need estimates for key model parameters. Wallinga is now confident that the number of new infections caused by each infected person when no control measures are takenwhich epidemiologists call R0is just over two. And he trusts data showing that 3 to 6 days elapse between the moment someone is infected and the time they start to infect others.

From a 2017 survey of the Dutch population, the RIVM team also has good estimates of how many contacts people of different ages have at home, school, work, and during leisure. Wallinga says he's least confident about the susceptibility of each age group to infection and the rate at which people of various ages transmit the virus.

Compartment models assume the population is homogeneously mixed, a reasonable assumption for a small country like the Netherlands. Other modeling groups don't use compartments but simulate the day-to-day interactions of millions of individuals. Such models are better able to depict heterogeneous countries, such as the United States, or all of Europe. The World Health Organization organizes regular calls for COVID-19 modelers to compare strategies and outcomes, Wallinga says: That's a huge help in reducing discrepancies between the models that policymakers find difficult to handle.

In their review of U.S. outbreak modeling, Rivers and her colleagues note that most of the key players are academics with little role in policy. They don't typically participate in the decision-making processes they sort of pivot into a new world when an emergency hits, she says. Rivers argues for the creation of a National Infectious Disease Forecasting Center, akin to the National Weather Service. It would be the primary source of models in a crisis and strengthen outbreak science in peacetime.

Policymakers have relied too heavily on COVID-19 models, says Devi Sridhar, a global health expert at the University of Edinburgh. I'm not really sure whether the theoretical models will play out in real life. And it's dangerous for politicians to trust models that claim to show how a littlestudied virus can be kept in check, says Harvard University epidemiologist William Hanage. It's like, you've decided you've got to ride a tiger, he says, except you don't know where the tiger is, how big it is, or how many tigers there actually are.

Models are at their most useful when they identify something that is not obvious, says Adam Kucharski, a modeler at the London School of Hygiene & Tropical Medicine. One valuable function, he says, was to flag that temperature screening at airports will miss most coronavirus-infected people.

There's also a lot that models don't capture. They cannot anticipate, say, an effective antiviral that reduces the need for hospital beds. Nor do most models factor in the anguish of social distancing, or whether the public obeys orders to stay home. In Hong Kong and Singapore, It's 2 months already [of such measures], and people are really getting very tired, says University of Hong Kong modeler Gabriel Leung. Recent data suggest the virus may be spreading faster again in both cities, putting them on the brink of a major outbreak, he adds.

Long lockdowns to slow a disease have catastrophic economic impacts and may devastate public health themselves. It's a three-way tussle, Leung says, between protecting health, protecting the economy, and protecting people's well-being and emotional health.

The economic fallout isn't something epidemic models address, says Ira Longini, a modeler at the University of Floridabut that may have to change. We should probably hook up with some economic modelers and try to factor that in, he says.

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With COVID-19, modeling takes on life and death importance - Science Magazine

Nurses wait for the next patient to be screened for coronavirus at a UW Medicine testing station. (UW Medicine Photo / Randy Carnell)

If gaps in health care resources arent filled, more than 80,000 Americans will die over the next four months due to the coronavirus pandemic, epidemiologists at the University of Washington predict.

The grim forecast based on an analysis of statistics from the World Health Organization, as well as from national and local governments and hospitals is laid out today in a research paper thats being submitted to the MedRxiv preprint server but hasnt yet been peer-reviewed.

Researchers at the UWs Institute for Health Metrics and Evaluation say their forecast takes current policies on social distancing into account. The problem is that shortages of hospital beds and medical supplies are projected to boost the death toll nevertheless.

Peak excess demand is projected to occur in the second week of April, when the researchers predict a shortage of 64,000 beds and more than 19,000 ventilators. The date of peak excess demand by state varies from the second week of April through May, the researchers say.

With those inputs, the computer models project a total of 81,114 deaths in the U.S. over the next four months. Most of those deaths are expected to occur during April, peaking at more than 2,300 deaths per day. That rate is projected to drop below 10 deaths per day sometime between May 31 and June 6.

There are also state-by-state projections of hospital resource usage and deaths. In Washington state, for example, the peak resource use is projected to occur on April 19, the death rate is projected to rise to a maximum of 27 per day, and total COVID-19 deaths are projected to amount to 1,429 through Aug. 4. As of today, Washington states cumulative COVID-19 death toll is 147.

The researchers say patients suffering from other diseases will face increased risk as well. In addition to a large number of deaths from COVID-19, the epidemic in the U.S. will place a load well beyond the current capacity of hospitals to manage, especially for ICU care, they say.

If the forecast proves correct, that suggests a dramatic upswing in the U.S. outbreak. Todays figures from the Coronavirus Research Center at the Johns Hopkins School of Medicine show nearly 1,200 U.S. deaths to date due to COVID-19, out of more than 82,000 confirmed cases.

The global death toll has risen above 23,000, with 523,000 confirmed cases worldwide. Just today, the United States took the top spot on JHUs nation-by-nation tally of confirmed cases, surpassing China and Italy.

The UW teams predictions are couched in statistical caveats. For example, the death toll projection of 81,114 has a 95% confidence interval of 7,977 to 251,059 deaths.

Additional travel restrictions and social distancing policies could make a difference in states that havent taken such measures so far. But based on the modeling, the most urgent measures would be to boost available beds and medical supplies by reducing the demand for medical services not related to COVID-19, and increasing system capacity by any means possible.

These are urgently needed, given that peak volumes are estimated to be only three weeks away, the researchers say.

The preprint research paper, Forecasting COVID-19 Impact on Hospital Bed-Days, ICU-Days, Ventilator-Days and Deaths by US State in the Next Four Months, comes from the IHME COVID-19 Health Service Utilization Forecasting Team under the direction of UW Professor Christopher J.L. Murray.

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Univ. of Washington researchers predict 80,000 COVID-19 deaths in U.S. by July - GeekWire

Bobbi Johnson, a worker at an Amazon warehouse south of Detroit, first saw the rumors on Facebook over the weekend. Kelly McIntosh-Butler, another worker at the facility, heard about them on Monday from her daughter, who works at another Amazon warehouse nearby. But it wasnt until Tuesday, when Johnson and others confronted someone from human resources in the break room, that they received confirmation that someone at the facility had tested positive for COVID-19.

Six workers at the sortation center DTW5 say they only learned of the case from coworkers or after McIntosh-Butler, frustrated with the lack of transparency, tipped off Local Four News, which received confirmation from Amazon Tuesday. In the information vacuum, they are left wondering whether theyve been exposed and whether its safe to continue working. Last week, Johnsons son, who has asthma, began having trouble breathing. This week, her daughter developed a dry cough. She hasnt been able to get either tested, and she worries she was an unknowing vector for COVID-19. She decided to stay home, without pay, to care for her children and avoid potentially spreading the virus.

They should have closed that building down and sanitized that whole building before they let us come in, Johnson tells The Verge. And they should have given everyone a robocall, because you never know if you bumped into that person in the bathroom or anything, because not only are you putting your life at risk, youre putting the people that you come in contact withs lives at stake.

Workers at DTW5 say that after they confronted management, they were told that five workers who had been in contact with the infected person had been informed. Workers feel that is far from sufficient. Their jobs often take them to different parts of the warehouse and they share break rooms, restrooms, and equipment, making it difficult to say precisely who may have been exposed. Many are balancing the need to receive a paycheck with potential risks to themselves and their loved ones, and without being notified of potential exposure, they fear they are making decisions in the dark.

Here I am, a week after being exposed to it, and Ive already been to work three other times, three other days breathing on people, McIntosh-Butler says. This is how this thing is getting out of control right now.

Several workers at DTW5 say they hear hacking coughs, sneezes, and other potential symptoms in the facility, but no one is being screened upon arrival. Though the workers have been told cleaning has been ramped up, they say theyve seen no evidence of it, and that sanitary wipes and other cleaning material is often in short supply or nonexistent. Yesterday, another worker at the facility said she was experiencing COVID-like symptoms, hasnt been able to get tested, and has decided to self-quarantine, according to screenshots shared with The Verge. (Update: Three workers at DTW5 received an automated call on Thursday morning informing them there had been a second confirmed case of COVID-19 at the facility, though several other workers say they have yet to be notified.)

Workers have been diagnosed with COVID-19 at 10 Amazon warehouses in the US so far. At many of them, workers only confirmed the infection after confronting management or hearing news reports. In Jacksonville, Florida, workers learned of a coronavirus case at their warehouse from the local news. At a New York City sortation center last week, the first known case of an Amazon warehouse worker contracting COVID-19, Amazon sent day shift workers home while the company disinfected the facility, but workers on the following shift only learned of the case after getting a text from a workers group. When the night shift arrived, they refused to work, shutting down the facility. On Tuesday, an Amazon worker at a Staten Island fulfillment center tested positive, and again workers received no email, text, or call from Amazon.

At the MDW2 warehouse in Joliet, Illinois, Stephanie Haynes heard through coworkers that someone who works near her had tested positive. She approached someone from human resources, who confirmed it.

Me and some other ladies went to human resources and confronted them about it, and we thought theyll do something as far as shutting the building down or doing a lot of cleaning, Haynes said during a call organized by Athena, a coalition of groups critical of Amazon. Instead, management claimed to have checked the cameras and found that the workers had not been close enough to the infected person to be in danger, Haynes says, and told the workers to continue coming in. The building wasnt shut down management told workers the facility would be cleaned as they worked.

Haynes, who has asthma and whose husband has diabetes, putting them at higher risk from COVID-19, decided to self-quarantine anyway. Though Amazon has said it will provide two weeks paid leave for any workers diagnosed with COVID-19 or placed in quarantine, unless the company calls to recommend she should quarantine, her time away is unpaid. Amazon needs to do a lot more to protect us, she says. We need to know how theyre going to handle things when somebody is in a warehouse and gets sick.

Amazon has the capacity to quickly notify workers. The company frequently messages all workers at a given facility for things like schedule changes or mandatory overtime. When California shut down all non-essential businesses last week, Amazon workers received automated calls telling them they were essential and should continue coming to their warehouses. You guys call us to tell us that were getting extra pay or that we can come in, but nobody was notified that there was a confirmed case? says Johnson at DTW5.

Asked about the lack of notification for workers at DTW5 and elsewhere, Amazon said only that it had made employees aware of confirmed cases and asked anyone in close contact with diagnosed individuals to self-quarantine for 14 days with pay. We are supporting the individuals, following guidelines from local officials, and are taking extreme measures to ensure the safety of all the employees at our sites, the company said in a statement.

Millions of Americans told to stay home have turned to Amazon as a means of getting basic necessities, and the company has embraced its role as an essential service, scaling up operations as governments order other businesses closed. But the situation puts Amazon workers in a difficult position, forced to choose between going without a paycheck or venturing into crowded warehouses where many feel inadequate safety precautions are being taken. On Facebook, workers have begun changing their profiles to read, I cant stay home, I work at Amazon.

More than 1,500 workers have signed a petition calling on the company to improve safety measures, provide sick leave regardless of a COVID-19 diagnosis, and shut down facilities where workers test positive for cleaning. The company says it has implemented new cleaning procedures and taken steps to avoid people crowding together, but workers at DTW5 and elsewhere say cleaning supplies are often lacking, the pace of work doesnt leave them time to use them, and their jobs still require them being in close proximity to each other. While Amazon shut down a returns-processing warehouse in Kentucky Wednesday after three workers tested positive, it has so far refused to close facilities more integral to its distribution network. In Italy and Spain, the companys decision to keep warehouses running despite infections prompted protests and absenteeism.

Amazon, meanwhile, is struggling to staff up to meet surging demand. Last week, the company raised pay by $2 per hour, increased pay for overtime, and announced plans to hire 100,000 workers. Amazon also changed its policies to allow workers to take unlimited time off without pay (previously they would have been fired for taking more than a certain amount), and even before Amazon workers began getting infected, many were choosing to stay home or leave early, fearing an outbreak was inevitable. As orders flood in, delivery times for some items now stretch to a month or more.

A lot of people are coming to work, working two or three hours, and leaving because theyre thinking overexposure is scary, McIntosh-Butler says. Management is mad, and if they tell anybody that we had a positive case, theyre thinking people arent even going to show up to work.

But at DTW5, the fact that workers had to confront management over rumors to learn a coworker tested positive has only heightened their anxiety. One worker said that after HR confirmed the case on Tuesday, more than 100 workers walked out, and now shes weighing whether to work her next shift. She needs to make rent, but shes also in frequent contact with her father, who has cystic fibrosis, potentially making him more vulnerable to COVID-19. Another worker said that as a single mother of three, she cant afford to go without a paycheck, but also fears getting the virus and infecting her kids. Its very scary, she says.

McIntosh-Butlers husband has seen work dry up during the pandemic, but shes only going to work one more shift this week and then stay away. Shell wear a bandana over her face, as many workers at the facility have begun doing, even though she knows it wont do much.

Ill have my $200 check and they can have the rest, McIntosh-Butler says. I just think that its too dangerous right now, because I dont know who Im coming into contact with, and HR isnt taking it seriously.

Update March 26th, 11:30AM ET: The story has been updated with information about a second confirmed COVID-19 case at DTW5. Several workers received an automated call about the case after publication.

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Amazon isnt notifying workers about COVID-19 cases at their warehouses - The Verge

As the virus that causes Covid-19 spreads worldwide, this dashboard offers a snapshot of the crisis right now. Click on a country name to get a more detailed geographic breakdown at the state, province, or county level. Please note that because of limited testing capacity in some areas, the actual number of cases is believed to be higher.

The datasets are drawn from the Johns Hopkins University Center for Systems Science and Engineering, from the COVID Tracking Project,and from USAFacts. In some cases, data on hospitalizations were not available.

This dashboard was produced through a partnership between STAT and Applied XL, a Newlab Venture Studio company. This tool will be updated with new datasets in the future, based on additional reporting and reader input. You can participate by sharing your ideas. What kind of data should we explore next? Let us know.

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The Covid-19 Tracker The Covid-19 Tracker - STAT

Medical staff treat a patient with the novel coronavirus this month in Wuhan, China.

With cases of the new coronavirus disease 2019 (COVID-19) climbing steeply everywhere from Madrid to Manhattan , overwhelming one hospital after another and pushing the global death toll past 17,000, the sprint to find treatments has dramatically accelerated. Drugs that stop the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could save the lives of severely ill patients, protect health care workers and others at high risk of infection, and reduce the time patients spend in hospital beds.

The World Health Organization (WHO) last week announced a major study to compare treatment strategies in a streamlined clinical trial design that doctors around the world can join. Other trials are also underway; all told, at least 12 potential COVID-19 treatments are being tested, including drugs already in use for HIV and malaria, experimental compounds that work against an array of viruses in animal experiments, and antibody-rich plasma from people who have recovered from COVID-19. More than one strategy may prove its worth, and effective treatments may work at different stages of infection, says Thomas Gallagher, a coronavirus researcher at Loyola University Chicago's Health Sciences Campus. The big challenge may be at the clinical end determining when to use the drugs.

Researchers want to avoid repeating the mistakes of the 201416 West African Ebola epidemic, in which willy-nilly experiments proliferated but randomized clinical trials were set up so late that many ended up not recruiting enough patients. The lesson is you start trials now, says Arthur Caplan, a bioethicist at New York University's Langone Medical Center. Make it a part of what you're doing so that you can move rapidly to have the most efficacious interventions come to the front.

To that end, WHO on 20 March announced the launch of SOLIDARITY, an unprecedented, coordinated push to collect robust scientific data rapidly during a pandemic. The study, which could include many thousands of patients in dozens of countries, has emphasized simplicity so that even hospitals overwhelmed by an onslaught of COVID-19 patients can participate. WHO's website will randomize patients to local standard care or one of the four drug regimens, using only ones available at the patient's hospital. Physicians will simply record the day the patient left the hospital or died, the duration of the hospital stay, and whether the patient required oxygen or ventilation. That's all, says Ana Maria Henao Restrepo, a medical officer at WHO's Department of Immunization Vaccines and Biologicals.

The design is not blinded: Patients will know they received a drug candidate, and that could cause a placebo effect, Henao Restrepo concedes. But it is in the interest of speed, she says. We are doing this in record time. The agency hopes to start to enroll patients this week.

Rather than taking years to develop and test compounds from scratch, WHO and others want to repurpose drugs that are already approved for other diseases and have acceptable safety profiles. They're also looking at experimental drugs that have performed well in animal studies against the other two deadly coronaviruses, which cause SARS and Middle East respiratory syndrome (MERS). And they are focusing on compounds plentiful enough to treat a substantial number of patients.

For its study, WHO chose an experimental antiviral called remdesivir; the malaria medication chloroquine (or its chemical cousin hydroxychloroquine); a combination of the HIV drugs lopinavir and ritonavir; and that combination plus interferon-beta, an immune system messenger that can help cripple viruses. The treatments would stop the virus by different mechanisms, but each has drawbacks.

Remdesivir, developed by Gilead Sciences to combat Ebola and related viruses, shuts down viral replication by inhibiting a key viral enzyme, the RNA polymerase. It didn't help patients with Ebola in a test during the 2019 outbreak in the Democratic Republic of the Congo. But in 2017, researchers showed in test tube and animal studies that the drug can inhibit the SARS and MERS viruses.

The drug, which is given intravenously, has been used in hundreds of COVID-19 patients in the United States and Europe under what's known as compassionate use, which required Gilead to review patient records; some doctors have reported anecdotal evidence of benefit, but no hard data. Gilead says it is now starting to supply remdesivir under a simpler expanded use designation. Five other clinical trials underway in China and the United States are testing it and may have preliminary results soon. Of the drugs in the SOLIDARITY trial, remdesivir has the best potential, says Shibo Jiang of Fudan University, who works on coronavirus therapeutics.

Like most drugs for acute infections, remdesivir may be much more potent if given early, says Stanley Perlman, a coronavirus researcher at the University of Iowaand that could be a challenge. What you really want to do is give a drug like that to people who walk in with mild symptoms, he says. And you can't do that because it's an [intravenous] drug, it's expensive, and 85 out of 100 people don't need it because they won't develop severe disease.

Chloroquine and hydroxychloroquine have received intense attention because of positive results from small studies and an endorsement from President Donald Trump, who said, I feel good about it. The drugs decrease acidity in endosomes, compartments that cells use to ingest outside material and that some viruses co-opt during infection. But SARSCoV- 2's main entryway is different: It uses its so-called spike protein to attach to a receptor on the surface of human cells. Studies in cell culture have suggested chloroquine can cripple the virus, but the doses needed are usually high and could cause severe toxicity. Researchers have tried this drug on virus after virus, and it never works out in humans, says Susanne Herold, an expert on pulmonary infections at the University of Giessen.

Results from COVID-19 patients are murky. Chinese researchers who treated more than 100 patients touted chloroquine's benefits in a letter in BioScience, but they did not publish data. And WHO says no data has been shared from more than 20 other COVID-19 studies in China using chloroquine or hydroxychloroquine. French microbiologist Didier Raoult and colleagues published a study of hydroxychloroquine in 20 COVID-19 patients that concluded the drug had reduced viral load in nasal swabs. (It seemed to work even better with the antibiotic azithromycin.) But the trial, reported in the International Journal of Antimicrobial Agents, was not randomized, and it didn't report clinical outcomes such as deaths.

Hydroxychloroquine might actually do more harm than good. It has many side effects and can, in rare cases, harm the heartand people with heart conditions are at higher risk of severe COVID-19, says David Smith, an infectious disease physician at the University of California, San Diego. This is a warning signal, but we still need to do the trial, he says. There have also been reports of chloroquine poisoning in people who self-medicated.

Many coronavirus researchers are similarly skeptical of the lopinavir-ritonavir combination. Abbott Laboratories developed the drugs to inhibit the protease of HIV, an enzyme that cleaves a long protein chain during assembly of new viruses. The combination has worked in marmosets infected with the MERS virus, and has also been tested in patients with SARS and MERS, though those results are ambiguous. But the first trial with COVID-19 was not encouraging. When doctors in Wuhan, China, gave 199 patients standard care with or without lopinavir-ritonavir, the outcomes did not differ significantly, they reported in The New England Journal of Medicine on 15 March. The authors say the patients were very ill and treatment may have started too late.

The fourth arm of SOLIDARITY combines these two antivirals with interferon-beta, a molecule involved in regulating inflammation that has lessened disease severity in marmosets infected with MERS. But interferon-beta might be risky for patients with severe COVID-19, Herold says. If it is given late in the disease it could easily lead to worse tissue damage, instead of helping patients, she cautions.

SOLIDARITY is designed to provide a quick, useful verdict, based on the outcomes that are the most relevant for public health, says virologist Christian Drosten of the Charit University Hospital in Berlin. More detailed data could come from an add-on trial in Europe, announced on 23 March by the French biomedical research agency INSERM. To include 3200 patients, it will test the same drugs, including hydroxychloroquine but not chloroquine, and collect additional data such as blood gas levels or lung imaging.

Other approved and experimental treatments are in testing against coronavirus or likely soon to be. They include drugs that can reduce inflammation, such as corticosteroids and baricitinib, a treatment for rheumatoid arthritis. Some researchers have high hopes for camostat mesylate, a drug licensed in Japan for pancreatitis, which inhibits a human protein involved with infection. Other antivirals will also get a chance, including the influenza drug favipiravir and additional HIV antiretrovirals. Researchers also plan to try to boost immunity with convalescent plasma from recovered COVID-19 patients or monoclonal antibodies directed at SARS-CoV-2.

Perlman says the smartest way to test the drugs is in people in early stages of disease who doctors think are most likely to get much worse. How would you determine that? That is the key question, he says. Researchers might find a biomarker in blood that helps them predict disease course.

Crucially, doctors and researchers around the world are tackling the problem with urgency, Henao Restrepo says. This is a crisis like no other and we will have to work together, she says. That is the only way perhaps we are going to find a solution.

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Race to find COVID-19 treatments accelerates - Science Magazine