COLUMBUS, Ohio - Gov. Mike DeWine, while not divulging whether hes going to impose more coronavirus restrictions in the state, said he will extend the overnight curfew, which will expire Thursday after three weeks.
It will need to be extended, DeWine said during a Monday coronavirus briefing. Well talk more about that Thursday,
Beyond that, it remains to be seen whether more action will be taken to stem the spread of the coronavirus.
The Ohio Department of Healths medical director, Dr. Bruce Vanderhoff, appears to advocate more restrictions.
Vanderhoff said during the same briefing on Monday that the rate of new cases in Ohio, according to the White House Coronavirus Task Force, higher than the national average and that all of Ohios neighbors have lower testing positivity rates.
You put all that together, and you have a picture of us having had some degree of success in slowing the rate of increase, he said. But I think that as the governor indicated, were going to need to go further if were going to even get a flattening.
Vanderhoff is referring to comments DeWine made last week, saying the state will have to do more to stem the spread of the coronavirus.
We dont have any choice, he said Friday.
Medical experts across the country debated the effectiveness of the overnight curfew when DeWine first announced it -- with some saying it would stop the riskiest behavior that is behind the latest COVID-19 wave, others saying it would have little impact because most people are at home from 10 p.m. to 5 a.m. and yet others warning that if the times people are allowed to be out are condensed, there could even be more spread.
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1. How COVID-19 is affecting the globe
Confirmed cases of COVID-19 have now passed 67.6 million globally, according to the Johns Hopkins Coronavirus Resource Center. The number of confirmed deaths stands at more than 1.54 million.
Greece has said it will not re-open schools, restaurants or courts until 7 January. A nationwide lockdown was first introduced in November, and extended twice since.
Canada is set to receive its first does of the Pfizer/BioNTech vaccine before the end of the year.
Japan's household spending rose in October for the first time in over a year. The news came as the government announced a fresh $708 billion economic stimulus package.
Western Australia has begun to allow travellers from Victoria and New South Wales to enter without quarantining for the first time in 8 months.
Hong Kong is set to impose further restrictions to slow the spread of COVID-19, including a ban on dining in restaurants after 6pm.
The United Nations General Assembly has declared that 27 December will be the 'International Day of Epidemic Preparedness' in a bid to ensure lessons are learned for future health crisis.
World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus has warned that studies show us "most of the world's population remains susceptible to infection with the COVID-19 virus."
As part of work identifying promising technology use cases to combat COVID, The Boston Consulting Group recently used contextual AI to analyze more than 150 million English language media articles from 30 countries published between December 2019 to May 2020.
The result is a compendium of hundreds of technology use cases. It more than triples the number of solutions, providing better visibility into the diverse uses of technology for the COVID-19 response.
To see a full list of 200+ exciting technology use cases during COVID please follow this link.
2. Merkel warns of tougher restrictions
She told party colleagues "the situation is getting very serious: these measures will not be enough to get us through winter".
New daily cases have plateaued in Germany.
Image: Our World in Data
Bars and restaurants are currently closed, with shops admitting limited numbers. Bavarian leader Markus Soeder said he was certain tighter restrictions would be agreed before Christmas.
Some states - including Bavaria - have already introduced their own, heightened, restrictions.
3. California introduces new restrictions
Restaurants in Southern California, the San Francisco Bay Area and the San Joaquin Valley have been forced to close, except for takeaway and delivery, as part of new measures introduced by California state governor, Gavin Newsom.
Playgrounds have also been closed, stores operating at reduced capacity and hair salons and barbershops closed.
The rules apply to places where fewer than 15% of intensive-care hospital beds remain available, so far affecting Southern California and the San Joaquin Valley. Localities in the San Francisco Bay Area imposed similar orders.
Some schools remain open, but Los Angeles Unified School District closed campuses that had been partially open to offer in-person services and tutoring.
Worst-case scenario, Covid-19 cases could peak around Jan. 20 the same day as President-elect Joe Biden's inauguration ceremony in Washington D.C.
On that day, the number of daily Covid-19 infections could reach over 1 million, according to the latest projection from the Institute of Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington. (IHME estimates are total infections, meaning whether or not they are confirmed by tests.)
But the Jan. 20 peak projection reflects "the worst-case scenario in our modeling, if states do not re-impose any social distancing mandates," according to a IHME spokesperson. The number does assume a vaccine rollout in this case a 90 day rollout with 3 million doses delivered per day, starting on Dec. 15 for Pfizer/BioNTech vaccine, Dec. 22 for the Moderna vaccine and Jan. 7 for the AstraZeneca/Oxford vaccine. (None of the vaccines have yet received emergency use authorization from the Food and Drug Administration but Pfizer's and Moderna's vaccines are expected to soon.)
If states were to re-impose social distancing mandates (which under IHME's model are enforced when a state reaches the level of eight daily deaths per million of that state's population), the projected number of daily infections is reduced to about 448,000 on Jan. 20, according to the model. (Some states, like California, have begun re-instituting lockdown measures.)
Under a scenario with a more rapid vaccine rollout assuming 6 million vaccines distributed daily over 45 days the peak would be 847,000 daily infections by Dec. 26, according to the projection. If social distancing mandates were added, that peak could drop to 526,000 infections daily.
Dr. Anthony Fauci, who last week accepted the offer to serve as President-Elect Biden's chief medical adviser, told Newsweek in a feature published Saturday that January is going to be a tough month.
"I think January is gonna be terrible, because you're gonna have the Thanksgiving surge super-imposed upon the Christmas surge. So it's entirely conceivable that January could be the worst," Fauci told Newsweek. Fauci added that he believes Americans will see Covid cases increase this week and next from Thanksgiving.
As for the inauguration perhaps coinciding with a Covid-19 peak, Paige Waltz, communications director for the Joint Congressional Committee on Inaugural Ceremonies (JCCIC), which is made up of House and Senate lawmakers who plan the inauguration ceremony, says the committee is working on "a layered approach in terms of health and safety measures" that includes masks, social distancing and testing, "specifically for anyone on the platform near the president-elect."
"The attendance and ticketing process is being assessed in order to provide an Inaugural that is as safe and inclusive as possible," Waltz says. And the JCCIC is "continuing to monitor the situation, and will make adjustments accordingly."
On Friday, President-Elect Biden said his staff is currently consulting with public health experts as they formulate their plans for Inauguration Day, but he said the ceremony will likely emulate the virtual Democratic National Convention held in August.
"There probably will not be a gigantic inaugural parade down Pennsylvania Avenue," Biden said. "But my guess is you'll see a lot of virtual activity in states all across America, engaging even more people than before."
As of Tuesday, new confirmed daily Covid cases in the U.S., as a seven-day average, are at an all-time high of more than 200,000, according to a CNBC analysis of Johns Hopkins University data. There have been 14.95 million confirmed cases of Covid-19 in the U.S. with at least 284,000 deaths, according to data compiled by Johns Hopkins University.
As spokesperson for President-Elect Joe Biden did not immediately respond to CNBC Make It's request for comment regarding IHME's projection.
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President Donald Trump after his release from the hospital for treatment of coronavirus told Americans to not "be afraid of it." But for those who are suffering the effects of the illness after getting sick, it's tough not to be dominated by it. (Oct. 9) AP Domestic
Gloria Vettese of Warren ishaunted bythe terror she felt in late March and early April, when she lay awake night after night, waiting and wondering whether COVID-19 would kill her and make her only child an orphan.
She managed to survive the virus, and is nowamong the nearly 200,000 Michiganders considered recovered so far in the coronavirus pandemic.
But the only criteria to beincluded in the state's recovery statisticsis to be alive 30 days after symptoms began. It doesn't mean life is back to the way it was before the virus struck.
For 56-year-old Vettese and a growing number of other survivors,nothing about life post-COVID is normal.
They're what's come to be known as long-haulers in a pandemicthat's killing about2,500 Americans a day as case numbers soar from coast to coast.
Those whosurvive COVID-19are often left with puzzling and sometimes debilitating conditions months after they are considered recovered from the infectious part of the disease.
Research now suggests that although SARS-CoV-2 is a respiratory virus, it can cause inflammation and changes to the vascular system that can injureblood vessels and leadto blood clots and organ damage.
Gloria Vettese was diagnosed with COVID-19 in the Spring but is still experiencing health issues. She is losing hair and has had cognitive changes along with a constant ringing in her ears. Vettese's son managed to avoid the virus despite being around his mom when she was diagnosed. She likes to take walks during the day to get fresh air.(Photo: Antranik Tavitian, Detroit Free Press)
To long-haulers like Vettese,the story of this pandemicisn't onlyabout who lives andwho dies. It's also about thepeoplewhose recoveriesareslow and uncertain, who wonder if what they're feeling in this moment will be as good as it gets for as long as they live.
"I have friends and close family members who are anti-maskers and who go to five bars anight, and are pretty much, you know, just, 'I need to live my life' " Vettese said. "I feel disrespected by that and I feel hurt by that.When the people who know you ... don't take it seriously, it makes itlike, OK, do you think I'm making it up?"
When coronavirus knockeddown Vettese, she wasn't sure she'd get through it."It was just 10 days of living hell," she said.
"I couldn't take a whole breath in, and so I would force myself to breathe." She knew she probably should have gone to the hospital, but Vettese said if she did, there would have beenno one to care for Aaron, her 13-year-old son.
She had a debilitating headache, fever, and body pain. Her appetite disappeared. Her vision had gone fuzzy, too.
"I would just sit here and I would be thinking,'My brain is gonna blow. I'm going to have an aneurysm. I'm going to have stroke. I'm going to have an embolism," she said. "I was worried about blood clotsbecause I couldn't move. ... At that point, I almost didn't even care if I died because it just hurt, and ... you just feel so bad that it just didn't matter.' "
But when Easter Sunday dawned, Vettese said the headache vanished. An incessant ringing in Vettese's ears replaced the headache, and that still hasn't gone away.
Now, she leaves the television on low most of the time "to try to muffle the sounds in my head," she said. "IfI'm sitting incomplete quiet, itdominates."
She's working toward a bachelor's degree, but said the brain fog and cognitive changes are so pronounced, it's been hard to get the straight-As she used to have.
"Timed online tests and quizzes aren't new to me and I'm not a slow learner and I'm not a slow test taker," Vettese said. But post-COVID,"I couldn't finish my work.I couldn't finish my quizzes.
"I've described it as like almost feeling kind of like a bubble around your head, likesomething that needs to pop so you can get connected with reality."
She has PTSD, too, reliving what it felt like when the virus had her in its grips.
"I would lay down at night and I would feel like ... it's going to get me because I'm going to let my guard down and close my eyes and go to sleep, and it's going to come and kill me in my sleep," Vettesesaid.
New researchpublishedin November in theAnnals of Internal Medicineprovides evidence that COVID-19does have a long-term impact for some people.
"It was sobering"to see the outcome of the study of 1,648patients treated at 38 Michigan hospitals from March to early July, said Dr. Vineet Chopra, who led the research.
Of them, 25% died while hospitalized. Another 7% died within two months of being discharged and 15% had to be readmitted to ahospital for ongoing health problems.
Among the488survivors who participated in thefollow-up surveysin theMI-COVID19 Initiativeregistry two monthsafter they were discharged, the number who saidthey were back to normal and free of lingering health effects was "vanishingly small," said Chopra, who ischief of hospital medicine at Michigan Medicine at theUniversity of Michigan.
Thirty-nine percent reported persistent health problems that kept them from doingnormal activities and 12% said they couldn't even do basic things to care for themselves.
"I think the part that really affected me the most was just the whole devastationpost COVID, which was around notbeing able to get back to work, for example, because of physical ailments, not being able to really do the things they needed to do for their daily living, like breathing and going to the bathroom and cleaning up the house and goinggrocery shopping because of persistentweakness, irritabilityor fatigue overall," Chopra said.
More than half reported that they were emotionally affected by their health conditions two months into recovery, and33% reportedseeking mental health care because of it.
About40% reported they couldn't return to work within two months of being discharged from the hospitalbecause they weren't well enough or had lost their jobs. About 26% reported only being able to work a reduced schedule.
University of Michigan Dr. Veneet Chopra, left, talks with hospital staff as he oversees Michigan Medicine's emergency response team to the COVID-19 outbreak.(Photo: Michigan Medicine)
"The financial toll of this," Chopra said, "was so closely intertwined to the emotional and mental health concerns, where a lot of patients said, 'We havewiped out our savings as a result of COVID' or 'We were rationing food or rationing medications as a way to kind of makeends meet.' "
The research shows there is much work to be done to ensurepeople who are consideredrecoveredfrom COVID-19 are getting the care they need tomanage their lives in the months that follow the initial illness, he said.
"In our medical dogma, ... we oftenthink about a treatment and a cure, but I think that the cure here isn't just resolution of the actual illness," Chopra said. "There's a lot more beyond it. And so it is time to start thinking about survivorship, which is not dissimilar to how we think about cancer survivorship, right?
"You're never done with it. You kind of put the beast in its cage for a while, perhaps, and you're in remission, and you hope you will stay in remission. But you really need help dealing with all of the challenges of being the patient in that situation. And I think a similar model is really needed for COVID patients."
Nicole Vaughn, 50, of Detroit remembers eatingcorned beef and cabbage for St. Patrick's Day dinner. It was her last big mealbefore COVID-19 stole her appetite and brought her to her knees.
"I had to give the duties of cooking to my eldest sonbecause I'm burning food. ...I couldn't smell things andI'm cooking with onions and garlic," said Vaughn,the single mother of five adopted children, who works asa counselor in theDetroit Public Schools.
She was sick to her stomach. Fatigue and exhaustion took hold, and by March 27, everything, including breathing, became a struggle.
"I'm weak," she said."I could ... barely get out of bed.I go to the bathroom to take my shower, and ... feeling as though I'm going to collapse, faint. So I get back to my room, and I text my sister on my cell phone. And I say, 'Please come and get me. Take me to the hospital.'My eyes areburning as ifhot sauce or something had been poured in my eyes."
Her 14-year-old daughter, Leah, helped her put on her shoes, and Vaughn's sister took her to the University of Michigan in Ann Arbor, where tests confirmed that she had double pneumonia and COVID-19.
She was given supplemental oxygen, but the day after she was admitted, it became clear she needed more help. Vaughnneeded ventilator support.
Nicole Vaughn, a 50-year-old single mom of five adopted kids, had COVID-19 in March. She was hospitalized at the University of Michigan in Ann Arbor and put on a ventilator. Vaughn is a counselor for the Detroit Public Schools and says she's having ongoing problems months after she contracted the virus. She has insomnia now, and night sweats. She also has brain fog, difficulty controlling her blood sugar, and worries about what her COVID-19 infection means for her long-term health and survival.(Photo: Ryan Garza, Detroit Free Press)
"I took a nap is what I call it," Vaughn said. "My sister said I was in a coma. ... When I came out of sedation, it was April 1."
Waking up was an unsettling experience. She couldn't speak because the tube from the ventilator was still in place, making her feel like she was choking. Her nurse gave her a dry-erase board so she could ask questions and write messages.
Grammy-Award winning soul artistBill Withers had died while Vaughn was unconscious, so when she learned the news, she listened to some of his biggest hits, like"Ain't No Sunshine" and "Lean on Me," and wrote out her final will and testamenton that dry-erase board.
"I wasn't sure what the outcome was going to be," Vaughn said. "I hadwritten out everything I wanted each one of my children to have."
Nicole Vaughn, 50, is a single mom of five adopted kids. When she came down with COVID-19 in March and was hospitalized and put on a ventilator, she remembers writing out her final will and testament on a dry-erase board in the ICU so she could be sure her final wishes were known. Happily, she never needed it.(Photo: Ryan Garza, Detroit Free Press)
But she never needed that will scrawled in dry-erase marker. Vaughn went home on April 6, still feeling tired and weak, but grateful.
As the months passed, she improved, but some symptoms lingered, and continue to nag at her even now.
"I do have the fatigue," she said. "I also have what I'm referring to asnight sweats, so it's almost like wheremy body can't regulate the temperature like it should.
"And from time to time, I'll have what is called brain fog."
Vaughn is highly educated she has four master's degreesbut said every now and then, "I'll forget a particular word and I know what I want to say, and it takes me a minute for it to come back to me." At times, simple math can stump her.
Vaughn didn't have high blood pressure before she contracted the virus, but her cardiologist is now considering putting her on medicine to help control it. Managingher blood sugar is also harder than it ever was before she contracted coronavirus.
"That's the one thing I recognized with COVID, it impacts everyone differently," Vaughn said. "So even if there are underlying health conditions or underlying hereditary conditions, it seems like it exacerbates those things.
"That's why I don't understand people not wanting to wear their mask. You know, COVID is not the flu.I've had the flu before. This issomething that you do not want. You definitely don't want it."
For people who survive COVID-19 hospitalization, Chopra said "the physical toll this takes on you is profound."
He's seen it in the patients he's treated at Michigan Medicine, and he's seen it through the lens of the broader study of how patients around the state have fared 60 days after being discharged from hospitals.
"It's not an acute sort of illness where you feel weakand then you come right back to normal. There's a persistent weakness and debility," Chopra explained. "And I've seen it in healthy 25-year-olds who run marathons, who got COVID, came in and within a day or two, could barelyget out of bed and use the bathroom without support. All the way to older patients who are obviously more at risk of adverse disease, and also more at risk of physical instability and deconditioning."
The disease affectsmore than the lungs.
"This COVID fog that patientsdescribe where they have trouble with memory, trouble recollecting events and it's not justaround the time they were in the hospital with COVID it's remote memories, almost likea vascular dementia-like syndrome," Chopra said.
"There's the laying in bed, there's the circulatory changes, but there's probably something also with muscles and deconditioningthat's important to keep in mind.The other thing thatI think is important to link this to and to think about is just the toll of a condition called sepsis, which is, in many ways, very similar to COVID.
"COVID is a viral illness that basically causes a sepsis-like syndrome, where the body's immune system kind of goes haywire, which is our current understanding of sepsis."
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Sepsis is defined as the body's over-reaction to an infection. It triggers a massive inflammatory response that can cause tissue damage, organ failure and death, according to the U.S. Centers for Disease Control and Prevention.
"It's one of the reasons why we give steroids now to these patients," Chopra said."We think they get better because we help the immune system kind of not get so dysregulated.
"But I think the clue there for us moving forward is that the therapeutics that we're likely to see the most benefit from are likely going to have some degree of overlap with managing patients who have severe sepsis. And that's where a lot of the work on the anticoagulants, the anti-inflammatories, and some of the immune-modulating sort of drugs I hope it will lead us to. We've seen glimmers of hope there withthe monoclonal antibodies now, too."
Nina Lewellen admits she got a little lax in the summer about following the recommendations to avoid large gatherings.In late June, she and her mom went to a baptism and first birthday party for an extended family member.
"We all wore masks and the tables were 6 feetapart, and we stayed at tables with members of our immediate family," she said. But soon after,both she and her mom developed coronavirus symptoms headache, fatigue, and congestion.
Nina Lewellen, 30, of Lincoln Park had COVID-19 in July. She says she's mostly recovered, but is still losing her hair.(Photo: Lewellen Family)
Lewellen, 30,a single mother who works for DTE Energy,went to an urgent care center near her home in Lincoln Park and got a coronavirus test.The result was negative, so Lewellen tried not to worry about it.She thought it might be a summertime cold or sinus infection.
But the more time passed, the sicker Lewellen grew. She becameuncharacteristically tired, and achy. And by Independence Day, she had a fever.She began to cough and had difficulty breathing.
A few days after that, she said, "I couldn't functionat all. I mean, the burning in my lungs had gotten so bad that I couldn't even stand up. ... I just remember gasping, just gasping and gasping for air and taking short shallow breaths because really any movement just caused it to trigger aspasm.
"The point when I realized I needed to go to the hospital is when I would stand up and my hearing started to fade and my vision started to fade," Lewellen said.
She was admitted to Henry Ford Wyandotte Hospital July 9.Lewellenhad none of the major risk factors that experts warnwould put someone at high risk for severe illness from COVID-19.
"I am that young and healthy" person, she said, who's supposed to only have minor illness when infected by this novel coronavirus.
"But I'll never forget ... how itfelt physically. I will never forget how it felt emotionally. I will never forget sobbing whilemy 3-year-oldtried to climb on my lap and asked me to read him a story, and I couldn'teven do that."
She was on steroids and blood thinners in the hospital and slowly began to improve. Lewellenwas well enough to go home July 13. Her mother had a more severe case of the virus, was hospitalized longer and alsonow suffers some of the long-hauler after-effects of COVID-19.
"My mom was in really bad shape," Lewellen said."She was on oxygen. She came home with oxygen. She just wasn't good."
They were both hospitalized in mid-summer, when Michigan's coronavirus case counts hadbottomed out, and fewer people were being treated in hospitals for it. Lewellen sometimeswonders whether her momwould have survived if they'd have contracted the virus during theMarch surge, when metro Detroit's health care systems were in crisis.
"I don't know if my mom's outcome would have been differentjust because of the overload in the hospitals and all of that," Lewellen said. "There's a lot of guilt associated with that and I think about that every time people claim, 'I'm not living in fear.I'm gonna go live my life.' Likeyeah, you might be fine, but somebody that you love might not be fine. And that's guiltthat no one ... could live with."
The virus took atoll on Lewellen, too.
For weeks after she came home from the hospital, her muscles felt weak. Straightforward things were somehow confusing, and insomnia taunted her, keeping her awake even though her body desperately needed rest.
"I couldn't sleep for days. I would sleep maybe for 20 minutes, and then wake up," Lewellen said. "And I got to the pointthat I was delirious from the lack of sleep.
"I could not take care of kids. ...I could barely take care of myself. Just the fatigue. ... I couldn't make it one block down the street with my son before I had to turn around and come home and that's something that really gives you pause and really gives you a lot of frustration and anger.
"I'm healthy and I'm young and people count on me and I can't. I just can't. And that's really hard to come to terms with emotionally."
While many of those problems have improved, Lewellen said she is stilllosing her hair and has brain fog from time to time. She'sconcerned not only about the unknowns and about what having COVID-19 might mean for her health long-term in 5 years, 10 years or even 50 years from now.
"I don't want anybody else to go through what I went through. ...We know now about all of these long-term issues that people are having, and there's still so much that we don't know," Lewellen said.
And if the political winds shift in the future, she thinks about what her history with coronavirus might mean for her insurability.
"I'm concerned aboutthe Affordable Care Act getting reversed," Lewellen said. "I had COVID. Is my health care not going to be covered? Are there certain things in the future that won't be covered? I know that's just speculation, ... but COVID's becomemy pre-existing condition."
Although the last year has led to much new understanding about this novel coronavirus, so muchremains unknown, said Dr. Dawn Misra, department chair and professor of epidemiology and biostatistics at the Michigan State University College of Human Medicine.
"This idea that only the elderly and only those with chronic conditions or obesityare really at riskleads people to not fully appreciate their own risk," Misra said. "We have tracked numerous cases of people who don't fit any of those criteria and still die. We also don't know long-term what's going to happen."
Research from the 1918 flu pandemic, she said, showed that children born to women who had the Spanish flu during pregnancywent on to have more chronic conditions and a shorter life expectancy than those whose mothers didn't contract the flu while pregnant.
It could be decades before we have a more complete picture about just what this virus can do.
"We are just scratching the surface of understanding what it is," Misra said. "So for those who are getting it and do not seemto be that sick, I don't think that makes it OK. ... Nobody should be having this virus, if possible. And so survivingand just notdyingreally is not good enough."
Dr. Dawn Misra, department chair and professor of epidemiology and biostatistics at the Michigan State University College of Human Medicine.(Photo: Michigan State University)
What's been evident even this early on in the pandemic, Chopra said, is that there are gaps in the social safety net for helping people recover long-term from severe COVID-19 illness physically, mentally and financially.
"You can't help but get emotional, especially when there's people that you care for, and you call them after a while and you hear their stories," he said."It'sgut-wrenchingin many ways.
"But I'm hopeful that the silver lining here is that by shining a spotlight on this, and then pointing to all the challenges beyond just the acute state that we'll come up with a way to kind of help these people, because I do think we need a better way to do it."
Ideally, Chopra said he'd like to seespecialized post-COVID care clinics where physicians would do fullassessments, and target patient care to what they people most need.Thosewho'vehad blood clots from COVID-19, for example, wouldbe assessed to be sure they're on theright anti-coagulants. Patients who havememory deficits wouldgetfollow-up to be sure they aren't living alone and have help to keep them safe.
News Release
Monday, December 7, 2020
Online calculator computes costs of testing and offers strategies for preventing infections in schools and businesses.
It can be an enormous challenge for schools and businesses to determine how to establish an effective COVID-19 testing program, particularly with the multiple testing options now on the market. An innovative online tool funded by the National Institute of Biomedical Imaging and Bioengineering (NIBIB), part of the National Institutes of Health, helps organizations choose a COVID-19 testing strategy that will work best for their specific needs. The COVID-19 Testing Impact Calculator is a free resource that shows how different approaches to testing and other mitigation measures, such as mask use, can curb the spread of the virus in any organization. It is the first online tool in the nation to provide schools and businesses with clear guidance on risk-reducing behaviors and testing to help them stay open safely.
A team led by the Consortia for Improving Medicine with Innovation and Technology (CIMIT) at Massachusetts General Hospital, Boston, and researchers at the Massachusetts Institute of Technology (MIT), Cambridge, developed the tool to model the costs and benefits of COVID-19 testing strategies for individual organizations. The team developed their mathematical model and calculator as part of NIHs Rapid Acceleration of Diagnostics (RADx) Tech program. The calculator is simple--a user enters a few specifics about their site and the tool produces customized scenarios for surveillance testing. The tool models four different COVID-19 testing methods, including onsite and lab-based, and calculates the number of people to test each day. It shows the estimated cost of each testing option and outlines the tradeoffs in the speed and accuracy of each kind of test.
The NIH RADx initiative has enabled innovation and growth in the creation of new, rapid COVID-19 testing technologies, said Bruce J. Tromberg, Ph.D., director of NIBIB and lead for the RADx Tech program.Using this tool, school administrators and business owners can quickly evaluate the cost and performance of different tests to help find the best match for their unique organization.
The COVID-19 Testing Impact Calculator also shows how other Centers for Disease Control and Prevention-recommended countermeasures, such as masks, contact tracing and social distancing, can work in concert with testing to keep people safe. Users enter which of these measures are in place in their organization and the tool integrates this information to produce testing recommendations. By adjusting these entries, users get a startling demonstration of how implementing simple countermeasures can drastically reduce their testing costs. For example, for a site that allows mask-less activities such as meetings or dining, reducing the group size on the calculator from 12 to six cuts the cost of the recommended testing strategy by more than half. Thus, the tool can inform leaders about how implementing these practices in addition to testing can keep their school or business open safely and with less expense.
Co-developer of the tool, Anette (Peko) Hosoi, Ph.D., is associate dean of engineering and the Neil and Jane Pappalardo Professor of Mechanical Engineering at MIT. She also is an affiliate of the universitys Institute for Data, Systems, and Society (IDSS), where students and researchers combine cutting-edge data analysis with social science methodology to tackle pressing societal challenges like the coronavirus pandemic.
A false dichotomy is often perpetuated that we must either stop COVID or reopen the economy, said Hosoi. But we know a lot now about how this disease spreads and the answer is not an either/or proposition. We know what kinds of measures are necessary to keep things running and mitigate the spread while operating maybe not under normal conditions, but certainly under functional conditions.
Co-developer Paul Tessier, Ph.D., is product development director at CIMIT, the RADx Tech coordinating center. The calculator is a major enabler for test-technologies being developed, commercialized and deployed with help from the RADx Tech program, Tessier said. He explained that implementing a testing program carries weighty considerations, including cost and number of testing instruments, arranging for test takers, and determining the optimal frequency for testing. We are excited to join forces with MITs IDSS to advance a decision-making tool for operating safely.
The COVID-19 Testing Impact Calculator is at www.whentotest.org.
This project was fundedbythe National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, throughthe NIH RADxInitiative via grant #U54EB015408 and contracts #75N92020P00132 and #75N92020P00171.
About the Rapid Acceleration of Diagnostics (RADxSM) initiative:The RADx initiative was launched on April 29, 2020, to speed innovation in the development, commercialization, and implementation of technologies for COVID-19 testing. The initiative has four programs: RADx Tech, RADx Advanced Technology Platforms, RADx Underserved Populations and RADx Radical. It leverages the existing NIH Point-of-Care Technology Research Network. The RADx initiative partners with federal agencies, including the Office of the Assistant Secretary of Health, Department of Defense, the Biomedical Advanced Research and Development Authority, and U.S. Food and Drug Administration. Learn more about the RADx initiative and its programs:https://www.nih.gov/radx.
About the National Institute of Biomedical Imaging and Bioengineering (NIBIB):NIBIBs mission is to improve health by leading the development and accelerating the application of biomedical technologies. The Institute is committed to integrating the physical and engineering sciences with the life sciences to advance basic research and medical care. NIBIB supports emerging technology research and development within its internal laboratories and through grants, collaborations, and training. More information is available at the NIBIB website:https://www.nibib.nih.gov.
About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIHTurning Discovery Into Health
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Before the Covid-19 pandemic, the Southampton, New York-based writer attended a few sessions with different therapists in person. Once the pandemic hit, however, she decided she didn't want to be inside a confined space with someone who could possibly be a vector for the virus.
So Talty improvised, and for a group session with another family member she asked to meet with a new therapist in the therapist's backyard.
The three wore masks until they sat, then took them off. They all sat a minimum of 6 feet apart. Save for the therapist's dog, which periodically yipped and yapped at Talty's feet, the experience was typical Talty and her family member shared feelings, answered questions and did a whole lot of reflecting. Everything just unfolded outside.
"Outdoor therapy is a great alternative for people who wouldn't feel comfortable going into an office right now," Talty, 32, said. "It's definitely something I would do again."
Talty isn't the only person seeking out this kind of therapy these days. As the pandemic rages on and public health officials advise against sessions indoors, psychologists and licensed marriage and family therapists are embracing alternatives to traditional forms of therapy.
Bringing the inside out
The most common form of outdoor therapy looks like what Talty experienced: traditional talk therapy sessions held in a yard or on a patio, balcony or roof.
These experiences are similar to pre-Covid therapy; seated far enough apart from each other, patients and therapists can remove their face coverings and focus on psychological healing instead of worrying about potential risks in transmitting virus.
Tatyana Kholodkov, a psychologist in Durham, North Carolina, said the setup also enables therapists to observe facial expressions the same way they would in a regular indoor session an important tool for therapists to get at how a patient might be feeling.
"It is difficult to do therapy with face masks," said Kholodkov, whose private wellness practice is dubbed Project YES. "There is a lot of information that gets lost when you can't see someone's entire face."
Still, there are potential pitfalls to this approach.
First, of course, is privacy if sessions are unfolding outside, there's always a possibility that passersby might hear what's being said, which could make patients more reticent to open up. With unpredictable variables such as construction and animals, Kholodkov said, outdoor sessions also can threaten the controlled environment that therapists work so hard to cultivate in their offices.
Another challenge: the elements. Rain or snow would force a therapist to reschedule, and Talty noted that she had to rebook her appointment because the original session was slated to take place on a blazing hot day.
Walking and talking
Other forms of outdoor therapy revolve around nature completely. Dubbed eco-therapy, this practice involves sessions that unfold in parks, forests, beaches and other open spaces.
"Just being in the sun and moving your body a little bit will decrease the emotional intensity of a situation, and then you can put your thinking cap on," said Page, a nurse practitioner who launched Trailtalk in the fall of 2010. "That helps get you some clarity. With that, you can figure things out."
Page said her sessions can last anywhere from an hour to a half a day. She also offers intensive sessions "theracations" that amount to 10 hours of tune-ups over the course of four or five days.
If a patient is feeling particularly vulnerable or would rather not be outside, Page can conduct the session in a Sprinter van she's tricked out like an office. In these instances, the patient sits inside the van and Page sits outside so her patients aren't sharing the same space.
Connecting with nature
Near San Francisco, licensed marriage and family therapist Dave Talamo has been known to take a similar walk-and-talk approach. Talamo also prides himself on a different type of eco-therapy something that could be called a "walk-and-sit" or "walk-and-pause" approach.
With this, Talamo will meet a patient at a trailhead and walk until they find a calm and secluded spot for the rest of the session to unfold.
Sometimes the spot might be a deserted meadow; other times it might be atop a bluff overlooking the ocean. Talamo noted it may or may not be a spot that others find remarkable.
During a recent session, he chose to meet a patient who was suffering from anxiety and depression at a redwood grove near the patient's home. The two stopped near the base of a tree, and the patient began ranting about how adrift he felt during the pandemic. Talamo stopped him and had the young man lean back to feel the support of a tree that has endured for many human lifetimes.
In another session, Talamo said a patient was having trouble expressing himself at precisely the same moment that a crow flew over and started vocalizing loudly.
The crow's ability to "speak" helped the patient unlock thoughts and put them into words.
"Sometimes we need these connections to nature, that reminder that as uncertain as things are right now, it will be OK," said Talamo, who is based in San Rafael, California. "Those simple experiences can mean more than any back-and-forth we might have sitting on a couch."
Dangers of eco-therapy
While it does offer benefits, this type of therapy isn't all rainbows and unicorns. Lezlie Scaliatine, a clinical psychologist and certified eco-therapist in Santa Rosa, California, said there are several considerations that therapists must address before they begin seeing patients outside.
For starters, Scaliatine said therapists must carry a different level of liability for outdoor sessions than they do for sessions that unfold indoors, because there are potential risks. Specifically, she noted, therapists should check to make sure their malpractice insurance covers outdoor sessions.
Scaliatine added that while taking patients outside into nature is a good treatment approach, therapists should have basic skills around safety.
"You really should know first aid and CPR, in the event that something were to happen," Scaliatine said. "What do you do if your client gets stung by a bee or steps in poison oak? You definitely want to be prepared."
Page agreed, adding that outdoor therapy is not a panacea but instead another tool.
Specifically, she noted that people with certain personality types may prefer a therapeutic experience delivered through a computer screen, and that therapists must determine what works best for whom.
"Just as there are going to be therapists who maybe wouldn't or couldn't embrace (outdoor therapy), there also are going to be patients who aren't going to like it either," she said.
"The model works for extroverts, kinesthetic learners (who need to move) and people who need people at a time like this. For introverts and individuals who don't need as much of a connection, teletherapy might work just fine."
Matt Villano is a writer and editor in Northern California. He expects to FaceTime with family during holidays this year.
The COVID-19 pandemic has affected all people, but not necessarily in the same way.
Scientists have shown that racial and ethnic minorities are more likely than white people to catch, be hospitalized because of and ultimately die from the virus.
In explaining these findings, researchers often point to patterns within society that advantage white people over racial and ethnic minorities.
These patterns reflect systemic racism or institutional racism. As Mary Frances O'Dowd, a senior lecturer of Indigenous Studies at CQUniversity Australia, explains, these refer to how ideas of white superiority are captured in everyday thinking at a systems level: taking in the big picture of how society operates, rather than looking at one-on-one interactions.
As researchers who study diversity and health, we put this idea to the test. Specifically, we tested whether different forms of racism at the county level were linked to COVID-19 cases and deaths. The answer is yes, racism predicts COVID-19 outcomes, even after taking into account a host of other health and demographic factors.
Racism at the county level
We focused on two kinds of racial attitudes. The first, explicit, represents those attitudes that people intentionally maintain. Here, people express negative attitudes toward a group, or toward people they think belong to that group. An example came in Minnesota, where health workers offering free COVID-19 testing were called various racial epithets.
We also examined implicit racial attitudes. These are the automatic, unintentional responses people have. Though they take a different form, implicit racial attitudes can and do affect peoples behaviors. A health-related example comes when people make an automatic assumption that actual physicians or nurses are white.
Most social science researchers focus on explicit and implicit attitudes that individuals have and the way these attitudes influence individual behavior and decisions. But, as it turns out, the relationship between personal biases and subsequent behaviors is not necessarily a strong one.
A different story emerges, though, when looking at bias at the aggregate level, or a broader view seen by bringing together various parts.
As University of North Carolina psychology professor Keith Payne and his colleagues explain, peoples social interactions, the media they consume and other environmental cues are likely to influence their attitudes about race. If this is the case, then racial attitudes captured at aggregate level, whether a metropolitan area, county or state, reflect the bias of crowds.
Collective biases, more than individual ones, help to shape people and systems. To illustrate, researchers have shown that community-level racism can help explain racial gaps in preterm births and infant birth weight, lethal force used by police, punishment in schools and reactions to social justice movements, among others.
Extending this work, we focused on racial attitudes at the county level. We asked how the racial attitudes of the broader community influence COVID-19 health-related outcomes.
Our study design
In our recent study, we collected data from a variety of publicly available data sets. The racial attitude data came from a long-time Harvard study, and the researchers post the data (without identifying information) online. This meant taking over 80,000 responses and aggregating these data to the county level. We ultimately had data for 817 counties in the U.S.
For COVID-19 cases and deaths, we relied on the data from USAFacts. This is the same source the Centers for Disease Control and Prevention uses. We looked at the total cases and deaths from Jan. 22 through Aug. 31, 2020.
We also wanted to consider other factors that might impact the results, all of which were publicly available. This included how county residents rated their own health, if they had plenty of food, if they had health insurance and their family income. We also accounted for county demographics, including the residents age, gender, race and ethnicity.
Racism and COVID-19
We found that, even after taking into account the health and demographics of the county residents, explicit and implicit racial attitudes were related to COVID-19 cases. The stronger the racism, the more COVID-19 cases the county recorded.
Further, the relationship between racism and COVID-19 cases was stronger when counties had a high number of Black residents. We also found that implicit racial attitudes predicted COVID-19 deaths. Again, this was even beyond the effects of the health and demographic factors.
In short, racism at the county level was predictive of COVID-19 health-related outcomes.
Implications
Our results provide clear evidence that county-level racism is linked with COVID-19 health-related outcomes.
But why? We suggest that, when examined at the aggregate level, racial attitudes reflect systemic forms of racism. They show the bias of crowds and the deeper biases that are embedded in society. Systemic forms of racism are those where values, policies and the ways we go about life are structured in a way that advantage white people over racial and ethnic minorities. Racial disparities in access to health, quality education, safe housing, wealth and the criminal justice system are just a few indicators, out of many.
Our study is not the only one to show the impact of racism on health-related outcomes. Consider a recent study of machine learning. Here, the researchers found that health inequalities over time resulted in algorithms that were racially biased. The end result was that software used to manage population health actually advantaged white people over Black people.
And, as we noted before, county-level racism is linked with other health outcomes, including mortality rates and infant health.
Public health implications
Our results also underscore the importance of recognizing that racism is a public health issue. A variety of organizations, like the American Public Health Association and the American Medical Association, have made statements to this effect.
We see many action steps to take.
First, health care providers should participate in regular training aimed at recognizing their explicit and implicit racial biases. This is a necessary first step toward reducing health inequalities among racial and ethnic minority patients.
Beyond a focus on individual health care providers, local, county and state governments can take steps to improve access and quality of health care for all people.
This article is republished from The Conversation under a Creative Commons license. Read the original article.
NEW YORK,8 December2020The number of schoolchildren affected by COVID-19-related school closures soared by 38 per cent in November, placing significant strain on the learning progress and well-being of an additional 90 million students globally.
According to data collected by UNESCO, classrooms for nearly 1 in 5 schoolchildren globally or 320 million are closed as of 1 December, an increase of nearly 90 million from 232 million on 1 November. In contrast, the month of October saw the number of schoolchildren affected by school closures decrease nearly three-fold.
In spite of everything we have learned about COVID-19, the role of schools in community transmission, and the steps we can take to keep children safe at school, we are moving in the wrong directionand doing so very quickly, said Robert Jenkins, UNICEF Global Chief of Education. Evidence shows that schools are not the main drivers of this pandemic. Yet, we are seeing an alarming trend whereby governments are once again closing down schools as a first recourse rather than a last resort. In some cases, this is being done nationwide, rather than community by community, and children are continuing to suffer the devastating impacts on their learning, mental and physical well-being and safety.
When schools close, children risk losing their learning, support system, food and safety, with the most marginalized children who are the most likely to drop out altogether paying the heaviest price. And, as millions of children remain out of their classrooms for more than nine months, and many more are re-living the upheaval, UNICEF fears that too many schools are closing unnecessarily, and not enough emphasis has been placed on taking the necessary steps to make schools safe from COVID-19.
A recent global study using data from 191 countries showed no association between school status and COVID-19 infection rates in the community. With little evidence that schools contribute to higher rates of transmission, UNICEF urges governments to prioritize reopening schools and take all actions possible to make them as safe as possible.
School re-opening plans must include expanding access to education, including remote learning, especially formarginalizedgroups. Education systems must also be adapted and built to withstand future crises.
UNICEFs Framework for Reopening Schools, issued jointly with UNESCO, UNHCR, WFP and the World Bank, offers practical advice for national and local authorities. The guidelines focus on policy reform; financing requirements; safe operations; compensatory learning; wellness and protection and reaching the most marginalized children.
What we have learned about schooling during the time of COVID is clear: the benefits of keeping schools open far outweigh the costs of closing them, and nationwide closures of schools should be avoided at all costs, said Jenkins.
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HHS plans to distribute $523 million to more than 9,000 nursing homes for their performance in handling COVID-19, the agency said Monday. The payments, which will be made through the Health Resources and Services Administration, will be sent to nursing homes that reduced COVID-19 deaths and infections from September to October, HHS said.
"As we approach the rollout of safe and effective vaccines for our most vulnerable, we continue the innovative program we created this year to incentivize and assist nursing homes in battling COVID-19 and applying the right infection control practices," HHS Secretary Alex Azar said in a prepared statement. "This half a billion dollars in incentive payments will reward nursing homes that have shown results in their tireless work to keep their residents safe from the virus."
The payments are the second in a five-phase $2-billion incentive program, the Nursing Home Quality Incentive Program, and will be distributed starting Dec. 9.
During a press call Monday, a senior HHS official said the agency "would be delighted if the payments for the November period continue to exceed $500 million" because that would mean facilities were improving on infection and mortality rates, even though that could exceed the $2-billion pool of funds set aside for the program. In October, HHS doled out $333 million to more than 10,000 nursing homes for September performance.
In the second round, 9,24869% of those eligiblemet the program's infection control criteria, compared to 10,631 nursing homes the previous month, HHS said.
"While less than the first cycle, the collective efforts of these nursing homes resulted in over 3,900 fewer infections relative to the rates seen in the communities where they exist," HHS said.
There were 9,128 nursing homes68% of those eligiblethat met the program's mortality criteria in the second round.
News of the new funding comes days after the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practice recommended that healthcare workers and nursing home residents should be in the first phase of those receiving COVID-19 vaccination.
"Placing nursing home residents and health care personnel at the top of the list for the COVID-19 vaccine will be a game-changer in what has been a difficult fight against the pandemic," HHS said Monday.
As of Nov. 22, there were 354,313 confirmed COVID-19 cases, 169,711 suspected cases and 72,642 deaths among nursing homes residents in the U.S., according to the latest CMS data. American Health Care Association and National Center for Assisted Living President and CEO Mark Parkinson said Monday that nursing home cases are increasing by 18,000 per week and nursing home deaths are increasing by 2,000 per week.
Katie Smith Sloan, president and CEO of LeadingAge, which represents aging services providers, said the second round of funding "is a testament to the perseverance and commitment of nursing homes to ensuring residents' well-being under tremendously challenging circumstances."
Smith Sloan said that nursing homes could protect more residents and staff with additional resources and called on Congress to send more relief to long-term care.
This year, the 16 Days of Activism against Gender-Based Violence comes at a time when there is unprecedented global attention on violence against women and children (VAW/C). The theme of "Fund, Respond, Prevent and Collect!" puts a focus on the need for increased financing to support survivors and prevent future violence, as well as the importance of data collection, rigorous analysis and research to guide effective financing and policy decision making.
Seeking to prevent a "return to normal," since the start of the COVID-19 crisis, we have sought to provide decision-makers with a clearer understanding of the pathways through which violence is likely to increase and potential policy responses to prioritize. As COVID-specific evidence on violence dynamics emerged, we began to synthesize this evidence base through periodic research round ups and an open access evidence tracker of global studies.
In June, we summarized 17 rigorous research studies that had been published since the start of the pandemic, and in September we reviewed an additional 28 studies. With a growing number of diverse research questions and innovative data sources in this third round up, we add an additional 29 studies. Consistent with the approach taken in our previous round ups, we focus on reports, working papers and publications across disciplines and methodologies that move beyond simple month-to-month comparisons from single sources. While we strive to be inclusive, we seek to balance this with rigor, so we do not include papers that do not present a full methodology, samples or VAW/C indicators behind their analysis.
