Category: Covid-19

Gov. Doug Burgum said at a press conference on Thursday, March 26, that the state has 58 confirmed cases of COVID-19, up from 45 on Wednesday.

This is our biggest increase yet, he said, noting 11 people so far have been hospitalized with the illness in North Dakota.

One of the cases was a child in McIntosh County, according to the North Dakota Department of Health.

Burgum said it is assumed that the numbers of positive cases will continue to rise in the state in the coming days.

It doesnt matter whether or not theres zero positives reported in a county, the governor said. By the end of the week we will assume with the rate of spread that we will have positive cases in every county.

Burgum said one concern is not having enough medical supplies, but promised the state is working around the clock to meet the challenges.

So far, 2,261 people have been tested in North Dakota; 2,203 tests have come back negative.

Burgum did not issue an executive order on Thursday, but said there will be changes to elections and tax filings, the latter being delayed until July 15 without any fear of penalty, according to Tax Commissioner Ryan Rauschenberger.

Among the changes for elections, the state is waiving the requirement to have at least one physical polling location during a primary election in counties that use mail ballots, though he said counties have the ability to opt out.

He also said unemployment claims in the state continue to rise, with just under 14,000 insurance and benefit claims filed in nine days.

Burgum also discussed operating guidelines for child care providers during the pandemic, saying efforts are being made to protect child care providers so their businesses are not only functional now but also after the pandemic.

A male child from McIntosh County was listed among those infected, according to the health department. The child is between the ages of 0-9. On March 18, the state confirmed the virus in a Morton County girl age 10-19.

Other new cases include five from Burleigh County, three from Stark County, two from Cass County, and one each from McIntosh, McHenry and Ward counties.

The McHenry County case was a result of community spread, according to the health department. Most of the cases have so far come from Burleigh and Morton counties.

On Wednesday Minnesota Gov. Tim Walz issued an order that residents shelter in place beginning at 11:59 p.m. Friday, March 27.

For now, there is no shelter-in-place order for North Dakota residents.

Earlier in the day, Lt. Gov. Brent Sanford said there were no plans to immediately issue a shelter-in-place order for North Dakota residents, though that may change as the situation around the coronavirus evolves.

Sanford made the remarks to address concerns of North Dakotans located in the eastern part of the state -- where many work in Minnesota, and are wondering what will happen to them should the order be given. He made the remarks via teleconference call to a gathering of nearly 1,000 members of the Greater North Dakota Chamber of Commerce.

I can tell you that's not the direction that we're headed today, Sanford said. We feel that the restrictions on moving around and the restrictions in the public spaces that have happened, to date, are where we want to be today, so hopefully that answers that question.

Sanford said North Dakota residents and businesses are self-regulating the situation by practicing social distancing and correct flu etiquettes.

These are things that we're doing as North Dakotans and we feel that really is limiting the community spread, Sanford said. We're doing a good job with that, and we want to continue forward with that direction.

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UPDATED: Child among new positive cases of COVID-19 in North Dakota; total rises to 58 - Grand Forks Herald

The failures of the United States initial response to the Covid-19 pandemic are already well established: We were too slow to recognize the threat of the disease and too slow to get diagnostic testing in place, and were ill prepared for the strain on our health care system.

But now, largely, were doing something right: social distancing.

The outright lockdowns of movement in some cities, as well as the less severe policies in place across the country, can slow the spread of the pandemic. And per at least one poll, people are, by and large, complying.

Frustratingly, though, we must be patient in our isolation. The impacts of social distancing lag in case-count data and may take a few weeks to show up. Right now, there are infections out there, in the public, that were seeded long before these orders came into effect. It can take 10 days or more between when a person is infected and when they show symptoms during which they can spread the virus to others.

The social distancing measures in place also arent airtight, so these infections will still seed some others. And just the cases that are already out there are expected to overrun hospitals.

Its important to recognize it could be months until it's safe to lift social distancing restrictions. And the timeline might vary depending on where you live and when the virus strikes the hardest.

We need social distancing because it slows the spread of the disease to manageable levels. When that happens, we can move to a more sustainable mitigation strategy. But well need to be careful. Just look at Hong Kong: After a month of strong control measures, including social distancing, cases are on the rise again, perhaps fueled by residents returning from abroad.

Know this: Ceaseless social distancing is not the only way to end this outbreak. And President Trump paints a false choice between saving lives and saving the economy. We can find a balance. Its just that the current orders of social distancing would need to be replaced by a comprehensive, extremely ambitious plan.

Epidemiologists have been telling me about what it would take to end social distancing safely while fighting the spread of Covid-19. It isnt easy. It will require an immense amount of leadership, coordination, and more sacrifice. It would take a sort of moonshot-level effort. But the tactics they outline arent unfamiliar. Theyre textbook epidemiology they just need to be scaled up to a level never really seen before.

We really do need a Manhattan Project effort to get this stuff in place in really a two- or three-month period, Jeremy Konyndyk, a senior policy fellow at the Center for Global Development, says.

We need social distancing across the country, and we need to keep it in place for some weeks, if not months, to buy time. If social distancing works, is enacted broadly, and is kept up, the number of new infections could decrease. It would give us a pause in the action, to potentially move on from social distancing to a more targeted pandemic strategy. Right now is the time to get plans ready so when that pause comes, we can make things right.

Its understandable that some maybe most people want life to go back to normal already. Trump is anxious too, saying he hopes to reopen the country by Easter, April 12.

But that could be dangerously too soon. Its a nightmare scenario for epidemiologists and health care workers, says Tara Smith, who studies emerging infectious diseases at Kent State University. Imagine the mixing of populations that would happen at Easter if given the all clear people who may be carrying the virus without knowing it, hugging their loved ones, spending hours in close contact, and then everyone going back home afterward.

As when a doctor asks you to consult them before ending a medication, we cannot end social distancing abruptly and without expert advice. (Think about when youre on a course of antibiotic medication you have to complete the whole regimen of pills even when you start feeling better. Social distancing is a little like that.)

And like vaccines, the distancing isnt just for you (although data shows that all age groups and people without preexisting risk factors can fall critically ill from the disease). It crucially protects vulnerable people from the disease. Without it, they become vulnerable again.

If we all just went right back to how things were before, transmission would start again with the same intensity, says Caitlin Rivers, a professor at Johns Hopkins Center for Health Security. Its hard to experience so many restrictions, and so many hardships, and not feel like its not working. We need to recognize that we are doing the right things. You just have to be a little bit patient.

Its worth remembering why were in this situation. The facts remain that we wasted a lot of time in terms of ramping up testing, Saad Omer, director of the Yale Institute for Global Health, says. Testing in an outbreak provides two functions. One is to diagnose those who are sick. The other is surveillance: to see where the virus may be lurking, especially in cases where symptoms are mild or dont manifest at all. The US has barely had enough testing capacity to test the sickest, let alone the capacity to do surveillance. Many doctors are telling patients with milder symptoms to just stay home and not get a test.

Social distancing is basically a sledgehammer, Konyndyk, who has worked on past outbreaks, like Ebola, says. Youre just stopping everything and hoping that in the process you will also slow transmission. What we need to do, he says, is turn that sledgehammer of social distancing into a scalpel: widespread testing and contact tracing.

The classic epidemiological approach to controlling disease is not to shut down society; its to target the people you know to have the disease and understand who theyre spreading it to, Konyndyk says. We cant do that right now because we dont have enough testing to know who has the disease.

Not only do we need more testing, we also need testing that can be completed within minutes. I would just be so happy if we had rapid diagnostics, Saskia Popescu, a hospital epidemiologist in Phoenix, Arizona, says. If youve ever been to an urgent care, when they do a flu test, in many cases it takes, like, 10 minutes. So if we can move to more of a rapid diagnostic where its a very, very quick turnaround, then we can make sure that those people go home and isolate themselves. Currently, it can take days to get a diagnostic test back, and people may not be sure of what to do while they wait.

These rapid tests are in the works. But were going to need other kinds of testing, too. Were also going to need serology testing of peoples blood. That way, we can figure out who has already had the disease and is now immune and can safely return to be in contact with others in society. (Though scientists still need to do more work in determining what immunity looks like in any given person.)

The first piece of the moonshot is what were doing now, and will hopefully sustain, which is mass social distancing to do the sledgehammer to bring down the numbers, Konyndyk says. Once you bring down the numbers back to a manageable level, he says, we need to go back to some textbook epidemiology.

Once theres widespread testing, there needs to be a huge team of public health workers in place to trace the contacts of those who test positive. Everyone who tests positive or who has come into contact with someone who tests positive then needs to be put into quarantine or isolation, to not spread the virus any further. This is how authorities routinely beat outbreaks even of incredibly infectious diseases like measles.

In South Korea, this work was aided by technology. Authorities used GPS data from peoples cellphones to figure out whom they may have been in contact with. The GPS data may prove more reliable than their memory. We need to take a good look at what South Korea has done, and what people here are willing to accept as far as some of those intrusions of public health into their normal lives, their privacy, Smith says. Also helpful would be a forecasting function for the ebb and flow of the disease at the community level, Konyndyk says. The country already has tools to forecast flu outbreaks. We could adapt them for Covid-19. With such a forecasting tool, we could see an upsurge in cases, and then dial the social distancing back up, he says.

Even aided by technology, this work would require an enormous number of workers. Its very labor-intensive to find contacts of people who are sick, Rivers says. A part of this part of what we do with contact tracing is to check on them every day to see if they have become sick. Keeping some measures of social distancing in place might make this work easier, too: If people have fewer places to go, fewer crowds to assemble in, there will be fewer contacts to track.

Konyndyk suggests this effort would take tens of thousands of people, maybe more.

So these are the questions our leaders need to be asking now: Who will do this work? Will it be the National Guard? Could we employ and train laid-off workers from the concurrent economic crisis to provide support? I think theres lots of options, but starting with the vision and the strategy is kind of where we should begin, Rivers says.

And right now these experts dont see that vision coming from the federal government. By and large, the response to this outbreak is in the hands of state and local leaders. But you want the federal government laying out, Heres the strategy, heres the path, and getting the ball rolling, Konyndyk says.

And even in this aggressive test-and-trace scenario, there could be many disruptions to our lives. It could mean a lot of people still under quarantine orders. Some level of general social distancing might also still need to be put in place. Perhaps, for example, schools could reopen but adults would still be encouraged to telework, and sporting events and other mass gatherings would be canceled. Its not the case that everything could go back to normal. Its the case that we could let some things go back to normal. Social distancing is a treatment wed need to gently taper off. (Wed also need to be vigilant about the possibility we still could import new cases from abroad.)

Researchers at the Imperial College of London suggested another way to taper off in a paper last week: pulsing. That is, we can relax social distancing policies when hospitals seem to be managing cases, and ramp them up when ICU beds are in short supply. But this isnt ideal. How would life look like if went on, and then we went off, and then on, and off, I think it would be hard to envision how life would unfold under that scenario, Rivers says. This likely wouldnt end the pandemic, but it would spread its pain over a longer period.

In any case, well probably have to take a step-wise approach off social distancing and see how we can best balance it with returning to some small slice of normal life. In time, well learn how to achieve that balance. For now and because there are just so many things about this virus that are still not known we need to stay put.

The ultimate goal in stopping a pandemic is a safe and effective vaccine that can prevent people from getting the virus. The good news is that these are already being tested. The bad news is that it could take a year or more to prove they are safe and effective. Honestly, I think the vaccine in 12 to 18 months is a moonshot, Smith says.

In the meantime, we might be able to find a treatment sooner. The World Health Organization is currently facilitating a multinational clinical trial, testing medicines and combinations of medicines to treat Covid-19. If scientists do discover drugs that decrease the ICU time by 20 to 30 percent, that would add up, Omer says, and ease the strain on hospitals. But even those drugs wouldnt necessarily stop the outbreak.

It would be really great, I think, for saving lives, Rivers says. But you wouldnt really expect it to slow transmission at all. People could still be getting sick and spreading the virus. And we would need to be vigilant, and patient, in this scenario, too. Even if we reduce the risk of severe disease and death, if we increase the number of cases, more people can still get sick and die.

The scientists I spoke to for this piece all understand the extreme weight and burden of social distancing. The economic concerns have real impact on health, Omer says. Its not that were being cavalier about this stuff. The economic ramifications of the pandemic are only adding to existing mental health strain. The scientists want it to end too.

But a balance is needed. I dont want to turn the economy back on in a way that just nukes our hospital system, and thats what we would do right now if we abruptly ended social distancing, Konyndyk says.

So whatever time we buy with social distancing we need to use wisely. We need to ramp up production of critical hospital supplies; we need to establish supply chains for the massive testing regime that will be needed. We need to train more people to help. And we can do this. Amazon was born in this country, UPS was created in this country, and we are teaching supply chain logistics in every management school, and we cant have a stable supply chain of personal protective equipment? Omer says. Clearly, we can and need to do better.

But all this requires leadership. President Trump is not using the full power of his office to make sure companies produce the needed supplies. If anything, he frequently uses his office to downplay the harms of the virus and hawk unproven cures.

Right now, we still have a chance to reduce the amount of harm this virus could cause. How? Lets figure out testing, lets get enough PPE [personal protective equipment] for first responders, Smith says. Lets get enough swabs. Lets buy more ventilators, build more ventilators to have this second chance at not messing things up.

We need to do this as a nation. While the pandemic is now hitting the New York region the hardest, it will in time likely hit other cities hard as well.

The greatest power we have right now is patience. Its not easy to muster in the face of such sacrifice. And at times, it can feel ineffective. But where you find it, drink it in. Currently, its likely our best chance at a cure.

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How to safely end social distancing and ease the Covid-19 pandemic - Vox.com

U.S. hospitals, public health authorities, and digital health companies have quickly deployed online symptom checkers to screen patients for signs of Covid-19. The idea is simple: By using a chatbot powered by artificial intelligence, they can keep anxious patients from inundating emergency rooms and deliver sound health advice from afar.

Or at least that was the pitch.

Late last week, a colleague and I drilled more than a half-dozen chatbots on a common set of symptoms fever, sore throat, runny nose to assess how they worked and the consistency and clarity of their advice. What I got back was a conflicting, sometimes confusing, patchwork of information about the level of risk posed by these symptoms and what I should do about them.

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A chatbot posted on the website of the Centers for Disease Control and Prevention determined that I had one or more symptom(s) that may be related to COVID-19 and advised me to contact a health care provider within 24 hours and start home isolation immediately.

But a symptom checker from Buoy Health, which says it is based on current CDC guidelines, found that my risk of a serious Novel Coronavirus (COVID-19) infection is low right now and told me to keep monitoring my symptoms and check back if anything changes. Others concluded I was at medium risk or might have the infection.

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Most people will probably consult just one of these bots, not eight different versions as I did. But experts on epidemiology and the use of artificial intelligence in medicine said the wide variability in their responses undermines the value of automated symptom checkers to advise people at a time when above all else they are looking for reliable information and clear guidance.

These tools generally make me sort of nervous because its very hard to validate how accurate they are, said Andrew Beam, an artificial intelligence researcher in the department of epidemiology at the Harvard TH Chan School of Public Health. If you dont really know how good the tool is, its hard to understand if youre actually helping or hurting from a public health perspective.

The rush to deploy these chatbots underscores a broader tension in the coronavirus outbreak between the desire of technology companies and digital health startups to pitch new software solutions in the face of a fast-moving and unprecedented crisis, and the solemn duty of medical professionals to ensure that these interventions truly benefit patients and dont cause harm or spread misinformation. A 2015 study published by researchers at Harvard and several Boston hospitals found that symptom checkers for a range of conditions often reach errant conclusions when used for triage and diagnosis.

Told of STATs findings, Buoys chief executive, Andrew Le, said he would synchronize the companys symptom checker with the CDCs. Now that they have a tool, we are going to use it and adopt the same kind of screening protocols that they suggest and put it on ours, he said. This is probably just a discrepancy in time, because weve been attending all of their calls and trying to stay as close to their guidelines as possible.

The CDC did not respond to a request for comment.

Before I continue, I should note that neither I nor my colleague is feeling ill. We devised a simple test to assess the chatbots and limited the experiment to the web- and smartphone-based tools themselves so as not to waste the time of front-line clinicians. We chose a set of symptoms that were general enough to be any number of things, from a common cold, to the flu, to yes, coronavirus. The CDC says the early symptoms of Covid-19 are fever, cough, and shortness of breath.

The differences in the advice we received are understandable to an extent, given that these chatbots are designed for slightly different purposes some are meant to determine the risk of coronavirus infection, and others seek to triage patients or assess whether they should be tested. They also collect and analyze different pieces of information. Buoys bot asked me more than 30 questions, while Cleveland Clinics and bots created by several other providers posed fewer than 10.

But the widely varying recommendations highlighted the difficulty of distinguishing coronavirus from more common illnesses, and delivering consistent advice to patients.

The Cleveland Clinics tool determined that I was at medium risk and should either take an online questionnaire, set up a virtual visit, or call my primary care physician. Amy Merino, a physician and the clinics chief medical information officer, said the tool is designed to package the CDCs guidelines in an interactive experience. We do think that as we learn more, we can optimize these tools to enable patients to provide additional personal details to personalize the results, she said.

Meanwhile, another tool created by Verily, Alphabets life sciences arm, to help determine who in certain northern California counties should be tested for Covid-19, concluded that my San Francisco-based colleague, who typed in the same set of symptoms, was not eligible for testing.

But in the next sentence, the chatbot said: Please note that this is not a recommendation of whether you should be tested. In other words, a non-recommendation recommendation.

A spokeswoman for Verily wrote in an email that the language the company uses is meant to reinforce that the screening tool is complementary to testing happening in a clinical care situation. She wrote that more than 12,000 people have completed the online screening exam, which is based on criteria provided by the California Department of Public Health.

The challenge facing creators of chatbots is magnified when it comes to products that are built on limited data and guidelines that are changing by the minute, including which symptoms characterize infection and how patients should be treated. A non-peer-reviewed study published online Friday by researchers at Stanford University found that using symptoms alone to distinguish between respiratory infections was only marginally effective.

A week ago, if you had a chatbot that was saying, Here are the current recommendations, it would be unrecognizable from where we are today, because things have just moved so rapidly, said Karandeep Singh, a physician and professor at the University of Michigan who researches artificial intelligence and digital health tools. Everyone is rethinking things right now and theres a lot of uncertainty.

To keep up, chatbot developers will have to constantly update their products, which rely on branching logic or statistical inference to deliver information based on knowledge that is encoded into them. That means keeping up to date on new data that are being published every day on the number of Covid-19 cases in different parts of the world, who should be tested based on available resources, and the severity of illness it is causing in different types of people.

Differences I found in the information being collected by the chatbots seemed to reflect the challenges of keeping current. All asked if I had traveled to China or Iran, but thats where commonality ended. The Cleveland Clinic asked whether I had visited a single country in Europe Italy, which has the second most confirmed Covid-19 cases in the world while Buoy asked whether I had visited any European country. Providence St. Joseph Health, a hospital network based in Washington state, broke out a list of several countries in Europe, including Italy, Spain, France, and Germany.

After STAT inquired about limiting its chatbots focus to Italy, Cleveland Clinic updated its tool to include the United Kingdom, Ireland, and the 26 European countries included in the Schengen area.

The differences also included the symptoms they asked about and the granularity of information they were capable of collecting and analyzing. Buoys bot, which suggested I had a common cold, was able to collect detailed information, such as specific temperature ranges associated with my fever and whether my sore throat was moderate or severe.

But Providence St. Joseph asked only whether I had experienced any one of several symptoms, including fever, sore throat, runny nose, cough, or body aches. I checked yes to that question, and no to queries about whether I had traveled to an affected country or come in contact with someone with a lab-confirmed case of Covid-19. The bot (built, like the CDC one, with tools from Microsoft) offered the following conclusion: You might be infected with the coronavirus. Please do one of the following call your primary care physician to schedule an evaluation or call 911 for a life threatening emergency.

All of the chatbots I consulted included some form of disclaimer urging users to contact their doctors or otherwise consult with medical professionals when making decisions about their care. But the fact that most offered a menu of fairly obvious options about what I should do seemed to undercut the value of the exercise.

Beam, the professor at Harvard, said putting out inaccurate or confusing information in the middle of a public health crisis can result in severe consequences.

If youre too sensitive, and youre sending everyone to the emergency room, youre going to overwhelm the health system, he said. Likewise, if youre not sensitive enough, you could be telling people who are ill that they dont need emergency medical care. Its certainly no replacement for picking up the phone and calling your primary care physician.

If anyone would be enthusiastic about the possibilities of deploying artificial intelligence in epidemiology, Beam would be the guy. His research is focused on applying AI in ways that help improve the understanding of infectious diseases and the threat they pose. And even though he said the effort to deploy automated screening tools is well intentioned and that digital health companies can help stretch resources in the face of Covid-19 he cautioned providers to be careful not to get ahead of the technologys capabilities.

My sense is that we should err to the centralized expertise of public health experts instead of giving people 1,000 different messages they dont know what to do with, he said. I want to take this kind of technology and integrate it with traditional epidemiology and public health techniques.

In the long run Im very bullish on these two worlds becoming integrated with one another, he added. But were not there yet.

Erin Brodwin contributed reporting.

This is part of a yearlong series of articles exploring the use of artificial intelligence in health care that is partly funded by a grant from theCommonwealth Fund.

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I asked eight chatbots if I had Covid-19. The answers varied widely - STAT

Self-testing at home to find out whether somebody has had Covid-19 is an efficient way to find out if they are safe to return to work, a senior health official has said.

Prof Yvonne Doyle, the medical director of Public Health England, told the health select committee that finger-prick home tests would be available very soon. We expect that to come within a couple of weeks, but I wouldnt want to promise on that, she said.

It was critical to understand what is going on and allow people to return to work she said. Self-testing was not new and was well understood by the public, with routine tests available such as the pregnancy test. The intention is to allow people to do as much of this as they validly can. It is by far the most efficient way, if the technology will support it, she said.

On Wednesday Prof Sharon Peacock, from Public Health England, told MPs on the science and technology committee that a home test to detect antibodies indicating somebody has had Covid-19 was being evaluated this week in Oxford to make sure it worked as well as is claimed and would be available next week. Government advisers later cautioned that the test might not be ready so quickly.

But the health secretary, Matt Hancock, has said the government has bought 3.5m antibody tests and will buy more.

Governments around the world are all seeking better and faster tests to show whether people have the disease or have had had it and recovered.

Singapore developed an antibody test as early as February. The US Covid-19 co-ordinator, Dr Deborah Birx, has said the US government is interested in it, and private US companies are also developing antibody tests. They include California-based Biomerica, which is selling to Europe and the Middle East, and New York-based Chembio Diagnostics, which is selling to Brazil.

Some are developed now. We are looking at the ones in Singapore, Birx said on Monday at a White House press briefing. We are very quality-oriented. We dont want false positives.

UK firms and academics have also developed self-test kits for Covid-19 that are expected to be available to buy in the coming weeks or months.

One cheap test is made by Mologic, a diagnostic test firm based in Bedford. Another kit has been developed by researchers at three UK universities led by Brunel University.

Mologic has produced the first prototypes of an antibody test for Covid-19, building on its experience of developing a rapid test kit for Ebola. Assessment and validation of the test began this week at the Liverpool School of Tropical Medicine and St Georges, University of London.

The company said it would take three to four months before the test is available in the UK and other countries. It will cost 1 in the UK and will be as simple to use as a home pregnancy test but will use saliva or blood rather than urine, with results ready in 10 minutes.

Mologic, which received 1m from the UK government to develop the test, will be able to make 8m kits a year at facilities in the UK and Senegal. In Senegal it will be sold for less than $1.

These tests could be a game-changer for diagnosis and follow-up of patients both in hospital and in the community, allowing us to detect cases early and isolate patients and their families rapidly, said Dr Emily Adams, a senior lecturer in diagnostics for infectious disease at the Liverpool School of Tropical Medicine.

The test kit developed by researchers at Brunel University London, Lancaster University and the University of Surrey is based on science evaluated in the Philippines to check chickens for viral infections.

The battery-operated handheld device processes nasal or throat swabs that are inserted into it, and delivers the results within 30 to 45 minutes via a smartphone app. The team has approached UK, US and European regulators for approval and is in talks with 60 manufacturers. It could be available to the public within a few weeks.

The device will be priced at 100 and can test six people at once. The test can detect the virus in individuals who show no symptoms because it recognises the DNA structure of the virus in the samples.

Read more:

Covid-19 self-test could allow return to work, say health officials - The Guardian

Sudden loss of a sense of smell could be a sign of a COVID-19 infection, doctors recently reported.

The complete loss of smell, or anosmia, is already associated with viruses; about 40% of anosmia cases occur after a viral infection, according to a statement published online on March 21 by ENT UK at The Royal College of Surgeons of England, an association of ear, nose and throat physicians in the United Kingdom.

However, a growing body of data from COVID-19 patients in several countries strongly suggests that "significant numbers" of those patients experienced anosmia as one of the disease's symptoms, according to the ENT UK statement.

Anecdotal evidence further describes the loss of smell and the loss of taste known as dysgeusia in people who had no other symptoms but who tested positive for COVID-19, representatives of the American Academy of OtolaryngologyHead and Neck Surgery (AAOHNS) in Alexandria, Virginia, said in a March 22 statement.

Related: Coronavirus outbreak: Live updates

Doctors with AAOHNS recommended in the statement that loss of taste and smell be added to the list of symptoms when screening for signs of COVID-19, particularly when these sensory losses are isolated that is, not accompanied by any signs of respiratory illness.

Such cases of isolated anosmia have been reported in Iran, the U.S., France and northern Italy, according to the ENT UK statement. Dr. Claire Hopkins, president of the British Rhinological Society, said in the statement that she had personally examined four patients during the past week, all under the age of 40, who exhibited no symptoms other than the sudden loss of smell.

"I think these patients may be some of the hitherto hidden carriers that have facilitated the rapid spread of COVID-19," Hopkins said.

When doctors at the University Hospital Bonn in Germany recently interviewed more than 100 patients infected with COVID-19, they discovered that nearly 70% "described a loss of smell and taste lasting several days," said Dr. Hendrik Streeck, head of the hospital's Institute of Virology.

"It goes so far that a mother could not smell the full diaper of her child.Others could no longer smell their shampoo, and food began to taste bland," Streeck toldthe German news site Frankfurter Allgemeine.

Though the doctors could not say for sure when the loss of smell and taste first appeared in these patients, they suspect that the symptoms manifested as a later stage of the infection, Streeck added.

If people who have anosmia but no other symptoms were to self-isolate for seven days, "we might be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors," according to the ENT UK statement.

Originally published on Live Science.

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Loss of smell could be a symptom of COVID-19 - Livescience.com

Today the Surgeon General of the United States, Jerome Adams, MD, said on the Today Show that this week could get bad for many Americans who will face a growing rise of COVID-19 cases in their communities.

"Everyone needs to act as if they have the virus right now. So, test or no test, we need you to understand you could be spreading it to someone else. Or you could be getting it from someone else. Stay at home," Adams said, while admonishing young Americans who are still crowding on beaches from coast to coast for not taking national calls for social distancing seriously.

Confirmed US cases rose by 9,541 today, to 42,817, according to the Johns Hopkins online tracker, with 458 associated deaths.

For the second day in a row, democratic US senators blocked a nearly $2 trillion coronavirus stimulus bill, saying the bill offered too much protection to corporations and failed to protect individuals who have lost or will lose their jobs because of the pandemic.

The Washington Post reported that several million Americans have already lost their jobs because of the virus, and the Dow Jones industrial average has lost more than 10,000 points in 6 weeks, dropping below 19,000 points today.

Included in the bill is a provision to send some American households a check for $1,200 in April, and give $350 billion to small businesses who have lost workers and consumers in recent weeks.

Over the weekend Senator Rand Paul (R-Ky), became the first senator to test positive for the virus, and Senator Amy Klobuchar (D-MN) said today her husband was hospitalized in Maryland and receiving oxygen after being diagnosed as having COVID-19.

Late last week governors in New York, New Jersey, California, Connecticut, Oregon, and Illinois all told citizens to stay home, except for essential workers. Over the weekend and through today, governors in Wisconsin, Indiana, Michigan, Ohio, West Virginia, Delaware, and Louisiana also issued similar orders.

"I know this has been difficult and has disrupted the lives of people across our state. That's why issuing a #SaferAtHome order isnt something I thought we'd have to do, and it's not something I take lightly," said Wisconsin Governor Tony Evers on Twitter. "But here's the bottom line: folks need to start taking this seriously."

"You can still get out and walk the dogsit's good exercise and its good for everyones mental healthbut please don't take any other unnecessary trips, and limit your travel to essential needs like going to the doctor, grabbing groceries, or getting medication," he said.

Governors in Maryland and Massachusetts did not issue shelter-in-place measures, but did order the closing of all non-essential businesses in each state, Politico reported. Last week Pennsylvania took a similar step.

The orders mean more than 100 million Americas, or about one third of the country, are under stay-at-home restrictions. But as governors take decisive actions, there were signs on Twitter that President Donald Trump may be considering reversing his "15 days to slow the spread" social distancing campaign, which was announced over a week ago.

"WE CANNOT LET THE CURE BE WORSE THAN THE PROBLEM ITSELF. AT THE END OF THE 15 DAY PERIOD, WE WILL MAKE A DECISION AS TO WHICH WAY WE WANT TO GO!" Trump tweeted late last night.

New York Governor Andrew Cuomo late last week also shuttered non-essential businesses, but he calls his plan a "pause" for New York. That order went into effect last night.

New York has emerged as the nations biggest hot spot of the coronavirus, with 6% of the cases detected in the world, the New York Times reported. Today Cuomo ordered a new directive to state hospitals: increase capacity by at least 50%. Cuomo also announced that a 1,000-bed field hospital will be constructed at the Javits Center, and be operational by the end of next week.

Today New York reported a total of 20,875 cases, including 12,305 in New York City. According to the New York Times tracker, there have ben 125 deaths in the state.

In Washington state, the first to be hit hard with the virus, case totals stood at 1,996, with 95 deaths.

Continue reading here:

Surgeon General on COVID-19: 'This week it's going to get bad' - CIDRAP

This blog is part of a series providing regional analysis on the effects of the coronavirus.

By Jihad Azour

, Franais,

The impact of COVID-19 and the oil price plunge in the Middle East and the Caucasus and Central Asia has been substantial and could intensify. With three-quarters of the countries reporting at least one confirmed case of COVID-19 and some facing a major outbreak, the coronavirus pandemic has become the largest near-term challenge to the region. Like much of the rest of the world, people in these countries were taken utterly by surprise with this development, and I would like to express my solidarity with them as they cope with this unprecedented health crisis.

This challenge will be especially daunting for the regions fragile and conflict-torn statessuch as Iraq, Sudan, and Yemenwhere the difficulty of preparing weak health systems for the outbreak could be compounded by reduced imports due to disruptions in global trade, giving rise to shortages of medical supplies and other goods and resulting in substantial price increases.

Uncertainty about the nature and duration of the shocks has complicated the policy response.

Beyond the devastating toll on human health, the pandemic is causing significant economic turmoil in the region through simultaneous shocksa drop in domestic and external demand, a reduction in trade, disruption of production, a fall in consumer confidence, and tightening of financial conditions. The regions oil exporters face the additional shock of plummeting oil prices. Travel restrictions following the public health crisis have reduced the global demand for oil, and the absence of a new production agreement among OPEC+ members has led to a glut in oil supply. As a result, oil prices have fallen by over 50 percent since the start of the public health crisis. The intertwined shocks are expected to deal a severe blow to economic activity in the region, at least in the first half of this year, with potentially lasting consequences.

Channels of economic impact

Heres what we know.

First, measures to contain the pandemics spread are hurting key job-rich sectors: tourist cancellations in Egypt have reached 80 percent, while hospitality and retail have been affected in the United Arab Emirates and elsewhere. Given the large numbers of people employed in the service sector, there will be wide reverberations if unemployment rises and wages and remittances fall.

Production and manufacturing are also being disrupted and investment plans put on hold. These adverse shocks are compounded by a plunge in business and consumer confidence, as we have observed in economies around the world.

In addition to the economic disruptions from COVID-19, the regions oil exporters are affected by lower commodity prices. Lower export receipts will weaken external positions and reduce revenue, putting pressures on government budgets and spilling over to the rest of the economy. Oil importers, on the other hand, will likely be affected by second-round effects, including lower remittance inflows and weaker demand for goods and services from the rest of the region.

Finally, sharp spikes in global risk aversion and the flight of capital to safe assets have led to a decline in portfolio flows to the region by near $2 billion since mid-February, with sizable outflows observed in recent weeksa risk I underscored in a recent blog. Equity prices have fallen, and bond spreads have risen. Such a tightening in financial conditions could prove to be a major challenge, given the regions estimated $35 billion in maturing external sovereign debt in 2020.

Against this challenging backdrop, the region is likely to see a big drop in growth this year.

Policy priorities

The immediate policy priority for the region is to protect the population from the coronavirus. Efforts should focus on mitigation and containment measures to protect public health. Governments should spare no expense to ensure that health systems and social safety nets are adequately prepared to meet the needs of their populations, even in countries where budgets are already squeezed. Governments in the Caucasus and Central Asia, for example, are increasing health spending and considering broader measures to support to the vulnerable and shore up demand. In the Islamic Republic of Iran, where the coronavirus outbreak has been particularly severe, the government is ramping up health spending, providing additional funding to its Ministry of Health.

Beyond that overarching imperative, economic policy responses should be directed at preventing the pandemica temporary health crisisfrom developing into a protracted economic recession with lasting welfare losses to the society through increased unemployment and bankruptcies. However, the uncertainty about the nature and duration of the shocks has complicated the policy response. Where policy space is available, governments can achieve this goal using a mix of timely and targeted policies on hard-hit sectors and populations, including temporary tax relief and cash transfers.

Temporary fiscal support should consist of measures that provide well-targeted support to affected households and businesses. This support should aim to help workers and firms weather the significant, but hopefully temporary, stop in economic activity that the health measures being implemented to control the spread of the coronavirus will entail. This support will have to take account of the fiscal space that is available, and where policy space is limited be accommodated by reprioritizing revenue and spending objectives within existing fiscal envelopes. Where liquidity shortages are a major concern, central banks should stand ready to provide ample liquidity to banks, particularly those lending to small and medium-sized enterprises, while regulators could support prudent restructuring of distressed loans without compromising loan classification and provisioning rules.

When the immediate crisis from the coronavirus has begun to dissipate, consideration could be given to more conventional fiscal measures to support the economy, such as restarting infrastructure spending, although fiscal space has been significantly eroded over the last decade. Given the nature of the current slowdown, trying to stimulate the economy at this time is unlikely to be successful and would risk eliminating the limited fiscal space that is still available.

Many countries are already introducing targeted measures. For example, several countriesKazakhstan, Qatar, Saudi Arabia, and the United Arab Emirates, to name a fewhave announced large financial packages to support the private sector. These packages include targeted measures to defer taxes and government fees, defer loan payments, and increase concessional financing for small and medium-sized enterprises.

Other countries, particularly the regions oil importers, have more limited policy space. Lower revenues resulting from lower importson top of additional pandemic mitigation spendingare expected to widen fiscal deficits in these economies. And while well-targeted health spending should not be sacrificed, very high debt in many of these oil-importing countries means that they will lack the resources to respond adequately to the broader economic slowdown. As such, these countries should try to strike a balance between easing credit conditions and avoiding vulnerability to capital outflows, and, where possible, allow the exchange rate to cushion some of the shocks. Sizeable financing needs are likely to arise in some countries.

Support from the IMF

Since the outbreak of COVID-19, we have been in continuous interaction with the authorities in our region to offer advice and assistance, especially those in urgent need of financing to withstand the shocks. The Fund has several tools at its disposal to help its members surmount this crisis and limit its human and economic cost, and a dozen countries from the region have already approached the Fund for financial support. Work is ongoing to expedite approval of such requestslater this week, our Executive Board will consider a request from the Kyrgyz Republic for emergency financing, likely the first such disbursement since the outbreak of the COVID-19 pandemic. A few other requests will be considered by the Executive Board in the coming days. Now, more than ever, international cooperation is vital if we hope to prevent lasting economic scars.

The IMF and COVID-19

Originally posted here:

COVID-19 Pandemic and the Middle East and Central Asia: Region Facing Dual Shock - International Monetary Fund

The U.S. Food and Drug Administration (FDA) has updated its rules around use of experimental treatments for the ongoing COVID-19 pandemic to include use of convalescent plasma, in cases where the patients life is seriously or immediately threatened. This isnt an approval of the procedure as a certified treatment, but rather an emergency clearance that applies only on a case-by-case basis, and only in extreme cases, as a means of helping further research being done into the possible efficacy of plasma collected from patients who have already contracted, and subsequently recovered from, a case of COVID-19.

Plasma is a component of human blood specifically the liquid part which contains, among other things, antibodies that contribute to a bodys immune response. Use of plasma, through direct transfusion into a patient, like every other proposed treatment for COVID-19 (and the SARS-CoV-2 virus that causes it), has not undergone the clinical studies needed to show that its actually safe and effective in combating the disease.

Despite a lack of completed clinical trials, the FDA has granted this temporary authorization under its Investigational New Drug Applicants (eINDS) exemption, in light of the extent and nature of the current public health threat that COVID-19 represents. A number of pre-clinical and clinical trials around use of plasma from patients who have recovered are underway, however, and there are some promising signs that convalescent plasma could indeed be effective against SARS-CoV-2.

This is hardly the first time that convalescent plasma has been proposed or attempted to fight off a disease. People who have had a virus and subsequently recovered from it typically build up an immunity to it either long-term, as with chicken pox, or short-term, as with the seasonal flu. Logically, it stands to reason that it should be possible, at least in theory, to take the antibodies from one individual who has already developed them, and transfuse them into a patient whose immune system is not doing a good enough job producing its own.

Convalescent plasma transfusions have been used in previous outbreaks, including against the H1N1 flu, as well as the original SARS and MERS epidemics, with varying results.

A number of research projects are underway regarding use of plasma against COVID-19, including a study by a team of Chinese medical professionals published in pre-print format (prior to any peer review) that studied 10 severe patients who received donations from recently recovered patients. That study found that in five of the 10 cases, the level of antibodies increased rapidly immediately post-transfusion (four other patients already had a high level of antibodies, and that persisted), and that within a week, the presence of the virus was undetectable in seven patients.

That still isnt a formal clinical study, but other small-scale investigations from clinical practice have shown similar results. A group of doctors and researchers have also put together a set of protocols for use by doctors working with both donors and recipients to help align efforts across investigations and ensure that everyone working on this problem in the medical science community is working from the same playbook.

New York Governor Andrew Cuomo announced that state health agencies would be beginning a convalescent plasma trial this week, and it was cited by FDA Director Dr. Stephen Hahn as an area of early promise last week during a White House coronavirus task force briefing.

All donor patients would have to be tested to confirm that they are not at risk of transmitting the virus, and they must also qualify as a blood donor under the existing rules in place by state and federal agencies. While some early studies have shown that plasma transfusions could be effective in prophylactic use (meaning treating healthy people before they encounter the virus), this FDA specifically prohibits any prophylactic use.

As with all the treatments currently under development, this will take a lot of testing and research both to validate, and then to certify for general use though there are a lot of researchers working on those challenges, because work to date shows this is likely to be more effective as a strategy in cases that havent yet progressed to the severe symptom stage. Convalescent plasma treatment isnt new, or even all that sophisticated, but it does have the advantage of being relatively safe (in line with standard blood transfusions, once a person is confirmed to no longer be carrying any active virus), so this could be something to watch for more active updates versus some of the longer-lead treatment technologies in development.

More here:

FDA now allows treatment of life-threatening COVID-19 cases using blood from patients who have recovered - TechCrunch

Downloadable COVID-19 Coronavirus Resources

Please be advised that any and all information, comments, analysis, and/or recommendations set forth above relative to the possible impact of COVID-19 on potential insurance coverage or other policy implications are intended solely for informational purposes and should not be relied upon as legal advice. As an insurance broker, we have no authority to make coverage decisions as that ability rests solely with the issuing carrier. Therefore, all claims should be submitted to the carrier for evaluation. The positions expressed herein are opinions only and are not to be construed as any form of guarantee or warranty. Finally, given the extremely dynamic and rapidly evolving COVID-19 situation, comments above do not take into account any applicable pending or future legislation introduced with the intent to override, alter or amend current policy language.

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Coronavirus - COVID-19 Resources - Brown & Brown Insurance

Greta Thunberg, the 17-year-old Swedish climate activist, announced on Tuesday that she and her father, Svante, had symptoms of Covid-19 and that while hers were mild, it was extremely likely that she had contracted the virus. She used the announcement to urge young people to stay at home, even if they dont feel sick, to protect those who are more vulnerable.

Many (especially young people) might not notice any symptoms at all, or very mild symptoms, she said on Instagram, where she has 10 million followers. Then they dont know they have the virus and can pass it on to people in risk groups.

We who dont belong to a risk group have an enormous responsibility, our actions can be the difference between life and death for many others, she said.

Ms. Thunberg spoke to European Union lawmakers at a meeting in Brussels in early March. In an effort to protect her mother and her sister at home in Stockholm, Ms. Thunberg said she and her father, who accompanies her on her travels, had isolated themselves in a separate apartment.

She said she had felt tired, had shivers, a sore throat and coughed. Her father, she said, felt far worse and had a fever. Sweden offers Covid-19 tests only to those who need urgent medical care, she wrote, which meant that she was not tested.

Ms. Thunbergs solo climate strikes helped fuel a global youth movement pressing world leaders to take action to slow down catastrophic climate change. For the last several weeks, the virus has compelled climate activists to take their protests off the streets and onto the internet.

In a crisis we change our behavior and adapt to the new circumstances for the greater good of society, she said on Twitter in mid-March, urging climate protesters to post pictures of themselves online. She posted a picture of herself, with her two dogs, and her famous homemade sign that read, in Swedish, School Strike for the Climate.

On Tuesday, in her Instagram post, she urged young people to follow the advice from experts and your local authorities and #StayAtHome to slow the spread of the virus.

Originally posted here:

Greta Thunberg Says Its Extremely Likely That She Had Coronavirus - The New York Times