The number of COVID-19 infections in Orange County may be several times higher than previously thought, a new antibody study shows.
While the screening, a collaborative effort between UC Irvine and the O.C. Health Care Agency, demonstrates that the coronavirus may be far more widespread though less deadly than official numbers indicate, researchers said more work is needed to understand the level of protection that antibodies provide and how best to address disparities in how the virus affects different populations.
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Our study demonstrates that, while a significant number of O.C. residents were already exposed and developed antibodies to COVID-19, much of the county still remains vulnerable to the virus, Bernadette Boden-Albala, director of the universitys Program in Public Health, said in a statement. For researchers, there is a lot more work to be done.
From July 10 to Aug. 16, nearly 3,000 county residents were tested for an array of coronavirus antibodies, which are produced as part of the bodys natural immune response to a virus.
Of those screened, 11.5% were found to have antibodies for COVID-19.
There was this lurking suspicion that theres a large fraction of people who have had it that did not know, Tim Bruckner, an associate professor of public health at UCI, said in a statement. Either they had symptoms and did not seek care, or they did not have symptoms and had no reason to go.
As of Thursday, 59,442 cases had been confirmed countywide throughout the course of the pandemic.
That figure represents just under 1.9% of the countys population of nearly 3.2 million. An 11.5% infection rate, on the other hand, would equate to more than 367,000 cases.
A total of 1,468 people are known to have died from COVID-19 in Orange County to date.
Health officials and researchers have previously said that the true number of those infected by the coronavirus likely outpaces confirmed cases, as many people may not have gotten tested or needed medical attention.
I think it would just confirm our predictions that transmission is in the community and that there are people who are walking around asymptomatic and, if they dont get tested, we dont know, Dr. Clayton Chau, county health officer and Health Care Agency director, said during a media briefing Thursday. Thats why we encourage people to get tested, especially essential workers.
The latest study also reflects previously noted disparities regarding COVID-19 infection. Researchers said the highest prevalence of antibodies was found among Latino residents, 17%, and low-income residents, 15%.
Boden-Albala said that the greater prevalence among Latinos is consistent with some of the testing and hospital data that has come out of Orange County and nationwide and that as we look toward the fall and flu season, this data also justifies enhanced planning and resources in communities likely to be hit hardest.
Hispanic and Latino residents account for roughly 48% of Orange Countys confirmed coronavirus cases for which that demographic information is available, and 43% of total deaths even though they make up only 35% of the regions population, according to Health Care Agency data.
Chau said the studys findings further illustrate that the county needs to be laser-focused on tackling disparities in healthcare.
While those issues are not new, nor are they unique to Orange County, Chau said that the pandemic truly brings and has pushed the issue of health equity to the forefront.
While the proportion of Orange County residents with COVID-19 antibodies is significantly higher than previously estimated, researchers said the studys findings do not mean the county is anywhere near herd immunity a term that refers to the point at which enough of the population is sufficiently resistant to a disease that its unlikely to spread from person to person.
Researchers said that would require at least 70% of residents to have antibodies.
Though Orange Countys new COVID-19 case rate remains well below most of its Southern California neighbors, Chau said that to additionally stem the spread everybody needs to do their part in terms of the nonmedical public health measures such as regular hand washing, wearing face coverings in public and observing physical distancing.
All of us are working very hard; all of us are trying to work together as a region to ensure that the community is not running into the fatigue issue with masks, social distancing and what have you, he said.
Another area of concern, particularly heading into the holiday season, is gatherings.
We know that as we are getting toward the holidays that the community will have a very hard time adjusting to not getting together, because thats who we are as Americans: We celebrate our holidays with our loved ones, Chau said.
But health officials throughout the state have said holding celebrations attended by many different households creates an environment thats ripe for potential coronavirus spread.
As an immense new surge in coronavirus cases sweeps the country, President Trump is closing his re-election campaign by pleading with voters to ignore the evidence of a calamity unfolding before their eyes and trust his word that the disease is already disappearing as a threat to their personal health and economic well being.
The president has continued to declare before large and largely maskless crowds that the virus is vanishing, even as case counts soar, fatalities climb, the stock market dips and a fresh outbreak grips the staff of Vice President Mike Pence. Hopping from one state to the next, he has made a personal mantra out of declaring that the country is rounding the corner.
Mr. Trump has attacked Democratic governors and other local officials for keeping public-health restrictions in place, denouncing them as needless restraints on the economy. And venting self-pity, the president has been describing the pandemic as a political hindrance inflicted on him by a familiar adversary.
With the fake news, everything is Covid, Covid, Covid, Covid, Mr. Trump complained at a rally in Omaha on Tuesday, chiding the news media and pointing to his own recovery from the illness to downplay its gravity: I had it. Here I am, right?
Earlier the same day, Mr. Trump ridiculed the notion that the virus was spreading rapidly again, falsely telling a crowd in Lansing, Mich., that the reported spike in cases was merely a reflection of increased testing. The 74-year-old president pointed to his teenage son, who was diagnosed with the virus earlier this month, to suggest that many of those cases were of only trivial concern.
Do you ever notice, they dont use the word death, they use the word cases? Mr. Trump said. Like, Barron Trump is a case. He has sniffles, he was sniffling. One Kleenex, thats all he needed, and he was better. But hes a case.
As a political matter, the presidents approach amounts to an Obi Wan-like attempt to wave his hand before the electorate and tell voters that they are not experiencing a pandemic that is tearing through their neighborhoods and filling hospitals. His determination to brush aside the ongoing crisis as a campaign issue has become the defining choice of his bid for a second term and the core of his message throughout the campaigns endgame.
There is considerable evidence it is not working. The stock market, long the focal point of Mr. Trumps cheerleading efforts, plunged by more than 900 points on Wednesday, suffering its worst drop in months as investors grappled with the mounting disruptions wrought by the pandemic. Polling and interviews with voters show that most are not inclined to trust Mr. Trumps sunny forecast.
Mr. Trumps description of the disease is ungrounded in fact, and his theory of countering it has clashed with the preferences of medical officials at every level of government. The country has reported more than 8.8 million cases of the coronavirus, including a 39 percent increase in new cases over the last 14 days. More than 227,000 Americans have perished from the disease.
In Bullhead City, Ariz., on Wednesday, Mr. Trump promised voters that a vaccine would be available momentarily, though scientists and pharmaceutical companies say no such breakthrough is assured. Using a phrase that has become a refrain for him at rallies, he insisted the country was rounding the turn on the virus.
Keep up with Election 2020
In the states Mr. Trump is visiting, his presence can stir as much anxiety as excitement, as voters fear the impact of large public gatherings.
Allison Drennan, an independent voter from Gastonia, N.C., said she was voting for Joseph R. Biden Jr., the Democratic nominee, in part because of Mr. Trumps mishandling of the coronavirus. Last week, she was dismayed to see that Mr. Trump was holding a rally in her area, because it had the potential to help spread the disease.
I think its a huge mistake, Ms. Drennan, 29, said of the rally, citing specific details about the local impact of the pandemic. We have 77 people in our hospitals in Gastonia with Covid already. Ive decided Im going to self-isolate to the extent that I can for the next two weeks.
The numbers in North Carolina support her inclination toward caution. While the state has managed to keep the disease more contained than some other large states, its average daily case count has risen by 13 percent over the last two weeks. There have been more than 266,000 cases in the state, with a death toll of 4,269 as of Wednesday afternoon.
Ashley Narten, 37, of Minocqua, Wis., lost her job as a waitress for five months this year when her restaurant cut back shifts. When she finally went back to work in September, she got the virus herself.
After completing quarantine, she took her young sons to see her cast a ballot for Mr. Biden. She said she was deeply pessimistic about the trajectory of the pandemic.
I just dont know how we can live and have an economy while its going around, she said.
In Wisconsin, which on Tuesday reported record totals for new cases and deaths, a Marquette University Law School poll published Wednesday showed that 58 percent of voters there disapproved of the presidents handling of the pandemic. Mr. Biden was leading Mr. Trump in the crucial state by five percentage points.
Like much else about Mr. Trumps mode of leadership, his view of the pandemic has found an enthusiastic audience from a minority of the country. A national poll published recently by The Times found that nearly two in five voters agreed with Mr. Trump that the worst of the crisis was over. The presidents push to fully reopen the economy is not without appeal, at least to the voters who already support him, and they have remained loyal through various personal and political scandals, policy breakdowns and an impeachment trial.
Oct. 29, 2020, 7:49 p.m. ET
But polls show that far more Americans are rejecting the Trump approach. In the same Times survey, most voters said that the worst of the pandemic was still ahead, including half of independent voters and a fifth of Republicans. By a 12-point margin, voters said they preferred Mr. Biden to lead the response to the pandemic rather than Mr. Trump. And 59 percent of voters said they favored a national mask mandate, including majorities of Democratic and independent voters, and three in 10 Republicans.
Felix Vristow, 40, of Philadelphia, said he believed Mr. Trump had been dishonest about the disease.
Our leader lied to us, in my eyes, Mr. Vristow said, adding, We experienced way too many deaths, and it could have been prevented if the situation was addressed earlier or more honestly.
Mr. Biden has spent the general election campaign offering himself to those voters as a responsible alternative. Seeking both to model good behavior and to protect his own health, Mr. Biden, 77, has kept a strictly limited campaign schedule, holding no large rallies and traveling far less frequently than a typical presidential nominee. On Wednesday, rather than appearing in a swing state, he made remarks from his home state, Delaware, rebuking what he called Mr. Trumps declaration of surrender to the virus.
Just as notably, some senior federal officials have also pushed back in recent days against the presidents rhetoric about the coronavirus and his false claims that case counts are going up only because testing has increased. Mr. Trump has often spoken about testing as a kind of public-relations problem, shifting line graphs that track the virus in an unhelpful direction for him.
In a television interview Wednesday, Adm. Brett Giroir, the administrations testing czar, rebutted Mr. Trumps characterization of the pandemic without chiding the president by name. The rising case count, he said, was not just a function of testing.
Yes, were getting more cases identified, but the cases are actually going up, Admiral Giroir said, urging Americans to wear masks and avoid clustering indoors.
In a different kind of departure from Mr. Trumps upbeat line, Mark Meadows, the White House chief of staff, acknowledged last weekend on television that the administration was not going to control the pandemic a remark Mr. Biden brandished as confirmation that Mr. Trump was capitulating.
Still, Mr. Trump has continued to pack airplane hangars and outdoor spaces with sympathetic fans who have embraced his account of a country quickly returning to normalcy. In Wisconsin, where new cases have skyrocketed by 46 percent in the last two weeks, Mike Mitchell, a retail manager who backs Mr. Trump, blamed out-of-town visitors for the uptick in his area.
We saw personally what happened here when things reopened for tourism the cases skyrocketed, said Mr. Mitchell, faulting interlopers from Milwaukee and Chicago rather than Mr. Trump.
In Florida, where residents spent the summer battling a wave of infections, at least some Trump admirers were still willing to give the president the benefit of the doubt on the virus. One of them is John DAmato, a Republican retiree who moved to Southwest Florida from Minnesota.
I may not agree with the way he tweets and everything else, but hes turned this country around, and hell do it again, said Mr. DAmato, 71, who wore a mask to vote near downtown Fort Myers last week.
For most voters, however, Mr. Trumps insistence that happy days are almost here again has fallen flat.
As Ken Hueftle waited in line to vote outside Philadelphias City Hall, he described an up-close experience of the pandemic that could not have diverged more starkly from Mr. Trumps prognosis. Mr. Hueftle, a 30-year-old physician assistant, said he had seen from his work at Thomas Jefferson University Hospital that the governments response to the virus had been awful.
Mr. Hueftle said he was voting accordingly.
At this point, theres no choice, he said. You have to vote. Its life or death.
Reporting was contributed by Patricia Mazzei from Fort Myers, Fla.; Nick Corasaniti from Philadelphia; Annie Karni from Gastonia, N.C.; and Reid J. Epstein from Minocqua, Wis.
AMSTERDAM As coronavirus cases have shot through the roof, waiting times for tests and results have grown so lengthy that the health authorities have considered sending samples to labs in Abu Dhabi. Contact tracing, divided among 25 competing contractors, has never gotten off the ground.
After months of discouraging the use of masks, saying they promote a false sense of security, the government just did an about face, calling for them to be worn in all public spaces.
And topping it all off, the royal family, ignoring the governments advice to travel as little as possible, flew off to their luxurious holiday home in Greece, adding to growing mistrust and resentment at home.
Britain? Spain? No. Its the Netherlands, one of Europes wealthiest countries, renowned for its efficient and organized government in most circumstances but not, apparently, in the pandemic.
The infection numbers keep rising, to a record 10,346 new cases on Monday in a country of 17 million people one-19th the size of the United States, which is reporting in the neighborhood of 75,000 new cases a day. And it is hard to keep track of the true toll, with the countrys official data incomplete because of technical errors.
Last week, new coronavirus patients had to be transferred by helicopter to Germany to relieve Dutch intensive-care units.
After weeks of taking incremental steps to curb the spread of the virus, the government announced Oct. 14 that, in addition to the new rules on face masks, all bars and restaurants would close for at least four weeks. With infections still rising, the authorities are considering establishing an evening curfew to keep people indoors, or even a two-week circuit breaker lockdown.
For the Dutch, who generally regard their country as one of the best run in the world with at times an undertone of superiority the level of institutional chaos has been a hard reckoning.
Its shocking really. I always thought we were one of the best countries in the world, best organized, said Rob Elgersma, 18, an agriculture student. But now, they have the ability to fix things but cant get their act together. What happened to us?
Thats a question a lot of Dutch people are asking right now.
When a country runs as smoothly as the Netherlands, even the smallest disturbance becomes a nuisance. If a train arrives two minutes late, passengers become annoyed. For a cyclist to wander slightly out of the designated lane is to invite a chorus of curses from others. And if anything beyond the control of the individual should go wrong, its the authorities who are to blame.
In contrast to many, if not most, Western democracies today, most Dutch people still have faith in their leaders, who are called bestuurders, which translates best as managers. Critics say they live up to that title in the poldermodel: a system of subjecting every major decision to review by every institution, representative or even individual involved.
Prime Minister Mark Rutte is widely acknowledged as a master of the process, which works fine under normal circumstances but can be a prescription for disaster during a crisis.
We are not a country where top-down leadership is much appreciated, said Alexander Rinnooy Kan, a former member of the Dutch Senate. Everything is done based on consensus.
Mr. Rinnooy Kan spent most of his career aligning the interests of different institutions, a system that he says has served the Netherlands well on many occasions. But it is a time-consuming process and has made us poorly positioned to deal with a demanding crisis such as this one, he said.
The Dutch culturally value the individual. They raise their children from an early age to be independent, critical thinkers, even sometimes dropping them in the forest without adults on summer nights and telling them to find their way home.
But the individual approach to strict social distancing measures in a pandemic works only when everyone acts together as a collective. And they did at first, going along with an intelligent lockdown in which bars and restaurants were closed but other shops remained open and people were free to move about as they pleased, while observing social distancing rules.
Nevertheless, the Netherlands was hard hit by the first wave. The Dutch statistical organization, the C.B.S., calculated that 10,000 people have died in the country because of the virus more than in Sweden, even taking account of the population difference.
The lockdown was lifted in June after the first wave subsided, and people returned to bars, parks, beaches and restaurants with a vengeance, paying little heed to social distancing rules.
Mr. Rutte continues to reiterate that the Netherlands is a mature democracy, home to proud adults, and urges people to adhere to the rules if they want the numbers to go down. But compliance has been spotty, and for now only nine other countries outpace the Netherlands 56 globally.
This has obviously been a colossal political miscalculation, said Ilja Leonard Pfeijffer, a popular Dutch novelist who lives in Genoa, Italy. Everybody does as they like and are free to decide themselves. Even positive patients in the Netherlands arent ordered to stay indoors. This is absolutely bonkers. In Italy, youll be thrown in jail.
With the virus now raging, opinion polls show that a majority favors reimposing a full lockdown.
But Mr. Rinnooy Kan said that taking charge on that level was difficult for any politician in the Netherlands. There are so many competing interests vying for attention, he said, and there is very little patience for blanket measures.
As in the United States and other lagging countries, the governmental chaos surrounding the virus response has provided fertile ground for a coterie of conspiracy theorists, pseudo scientists and concerned citizens who feel that the pandemic is being used as an excuse to deprive people of their rights.
First, they played down the virus. Then they said there was a shortage of medical face masks, followed by a shortage of medicine, said Willem Engel, who leads a group called Virus Waarheid, or Virus Truth. They use measures that dont work.
All those things make me think there is something else behind this, he said. It cant just be mismanagement. I dont believe that.
Perhaps hubris is a better way to explain the failed policy, said the journalist Addie Schulte, who wrote an opinion article in the leading NRC Handelsblad newspaper, arguing that the governmental disorganization and incompetence laid bare by the pandemic also revealed a blind spot among the Dutch elite.
Simply put, he said, we havent been able to manage even the most basic services, and allowed this crisis to get out of hand.
Rosanne Kropman contributed reporting.
"The fact that a pandemic may or may not be occurring changes nothing about the meaning or intent of state's constitution and the preservation of our inalienable rights," says Karey Hanks, who is running unopposed for a state House seat, in the video.
McGeachin, who has repeatedly clashed with Republican Gov. Brad Little over what she believes to be his onerous response to the pandemic, is featured in the video holding a Bible -- and then placing a gun on said Bible -- as she reads from the state's Constitution.
Despite those numbers, McGeachin immediately criticized Little's move.
McGeachin has clashed with Little repeatedly since the start of the pandemic.
Earlier this year, the Idaho Statesman's Cynthia Sewell reported that the two top Republican elected officials hadn't spoken to each other in weeks, and that McGeachin had personally defied Little's executive orders to control the spread of the coronavirus in the Gem State.
"She left the Legislature's 2020 session early the lieutenant governor presides over the Senate to attend to her family business, a restaurant and pub in Idaho Falls. She has attended or supported rallies opposing Little's stay-home order and has been urging him to let businesses re-open. She defied his state order earlier this month to attend an event at a North Idaho brewery that re-opened despite Little's order."
McGeachin's high-profile critique of Little is explained by, you guessed it, politics! The governor and lieutenant governor in Idaho are not elected as a ticket, meaning that McGeachin holds no real loyalty to Little despite the fact that they are both Republicans.
While he spent a decade as lieutenant governor, she is a former state representative and small business owner. He represents the establishment within the GOP; she stands for the Trump wing.
The tension could well come to a head in 2022, when Little will be up for a second term and McGeachin will have the right of refusal when it comes to challenging him.
The problem, at one time, was large gatherings: bars, restaurants, right? Mr. Cuomo said. Now, he said, its these small gatherings that are creating issues.
The aftermath of the Long Island birthday party, which adhered to state restrictions, underscored the governors point.
About 50 people attended the party in Bellport on Oct. 17, officials said. Nonetheless, inadequate social distancing resulted in 26 guests testing positive for the virus and 132 people being forced to quarantine, officials said.
Although there was nothing illegal about the party, Mr. Bellone said, it was important for county residents to consider the potential harm that even seemingly modest family gatherings could do.
These kinds of superspreader events are a threat to our public health and to our continued economic recovery, Mr. Bellone said.
In addition to fining the country club that hosted the wedding, officials said on Wednesday that for the first time since the pandemic began, the county was penalizing a local homeowner for violating the restrictions on gatherings.
The homeowner, Kim Catalanotto, was hit with a $2,500 fine after the county police broke up a party at her Farmingville house, where 200 to 300 people, most of them underage, had gathered and were consuming alcohol last Saturday, officials said. No virus cases had been linked to the party as of Wednesday, Mr. Bellone said.
Ms. Catalanotto could not be reached for comment.
Alain Delaqurire contributed research.
The third and final clinical trial for Modernas coronavirus vaccine is still underway, but the company is already setting an aggressive schedule to manufacture and ship the vaccine immediately if the Food and Drug Administration approves it.
By the end of this year, we expect to have approximately 20 million doses ready to ship in the U.S., Moderna chief medical officer Dr. Tal Zaks said at an investor briefing on Thursday. From a distribution standpoint, were ready.
The company has also agreed to supply several other countries including Japan, Canada, Switzerland, Israel and Qatar with tens of millions of doses, Zaks said. By the end of 2021, the company hopes to supply the world with up to a billion doses or 500 million full courses of the two-dose vaccine.
But that hinges on whether the FDA and the equivalent regulatory agencies of other countries approve Modernas product, which is built on a new and untried vaccine technology. Modernas vaccine uses RNA, a type of genetic code that also served as the inspiration for Modernas name a portmanteau of the words Mode and RNA. This genetic code instructs human cells to produce a coronavirus protein. The bodys immune system then generates a defensive response to that protein.
The ongoing third clinical trial for the vaccine will determine if that immune response is enough to protect against coronavirus infection. Until the results of that trial are out, there's no saying if the vaccine will really work.
"The fact that developers are mass-producing their vaccines and all of them are doesn't mean the vaccine is going to work," said Dr. Dan Barouch, an immunologist at the Beth Israel Deaconess Medical Center who also worked on Johnson & Johnson's coronavirus vaccine candidate. "It just means they're taking a financial risk because of the severity of the pandemic, and they want to minimize the time required between approval and distribution."
According to the FDA, Zaks said, a final analysis of the clinical trial would need to show the vaccine is at least 50 percent effective for approval. But, he added, Moderna is setting a higher bar.
In order to call it a success, we will need to show a vaccine efficacy of 74% or greater, Zaks said during the investor meeting.
Thirty thousand participants are enrolled in the trial. Researchers selected participants to reflect the ethnic and racial diversity of the United States,Moderna corporate affairs lead Ray Jordan said. Many participants were already at a higher risk for COVID complications due to age or pre-existing health conditions.
We wanted to look at different communities of color because the severity of disease tends to be higher among those communities, Jordan said. We ended up with about 6,000 participants who were Hispanic or Latinx and about 3,000 that were African American.
If the FDA approves Modernas vaccine, each dose will cost between $32 and $37. In the United States, Zaks said, the first 100 million doses may work out to roughly $25 each when accounting for certain federal grants and other payments.
And yet, the pandemic is not impossible to control, contrary to what White House Chief of Staff Mark Meadows recently suggested. Many other nations have successfully controlled it, some more than once. Masks can stop people from transmitting the virus. Shutting down nonessential indoor venues and improving ventilation can limit the number of super-spreading events. Rapid tests and contact tracing can identify clusters of infection, which can be contained if people have the space and financial security to isolate themselves. Social interventions such as paid sick leave can give vulnerable people the option of protecting their lives without risking their livelihoods.
Read: America is trapped in a pandemic spiral
The playbook is clear, but it demands something that has thus far been missingfederal coordination. Only the federal government can fund and orchestrate public-health measures at a scale necessary to corral the coronavirus. But Trump has abdicated responsibility, leaving states to fend for themselves. In May, I asked several health experts whether governors and mayors could hold the line on their own. Most were doubtful, and the ensuing months have substantiated their fears.
There are three small mercies that Americans can be thankful for. First, COVID-19 is a starter pandemic, and SARS-CoV-2 is neither as contagious nor as lethal as other pathogens. Second, it is the only major epidemic that Trump has faced during his presidency. (By contrast, Barack Obama dealt with the H1N1 flu and MERS in his first term, and Ebola and Zika in his second.) Third, it occurred not during the dawn of his term but at its twilight, when Americans have an opportunity to avert further incompetence.
Whatever the outcome of the election, the coming winter will be difficult. And whoever occupies the White House on January 21 will probably have to deal with another major epidemic before his term is over. With luck, that event wont begin until the COVID-19 threat has subsided, but overlapping outbreaks are also possible. We do not know how Joe Biden would fare, and if he is elected, the U.S. will still be riddled with systemic weaknesses and inequities that another pathogen could also exploit. But we do know exactly how Trump will react to the next crisis. The U.S. is trapped in a pandemic spiral, and so is Donald Trump.
Science values replicationrepeated experiments that verify whether the same outcome occurs. But in this case, that work is unnecessary. The U.S. has now clearly seen what happens when a pandemic occurs under Trump. It is an experiment that no one should ever want to rerun.
Listen to Ed Yong discuss this story on an episode of Social Distance, The Atlantics guide to the pandemic:
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In some people, as COVID-19 decreases lung function, it may deprive the heart of adequate oxygen.
How does COVID-19 affect the heart?
Even though its known as a respiratory virus, doctors believe the coronavirus can directly infect the heart muscle and cause other problems leading to heart damage.
In some people, as COVID-19 decreases lung function, it may deprive the heart of adequate oxygen. Sometimes it causes an overwhelming inflammatory reaction that taxes the heart as the body tries to fight off the infection.
The virus can also invade blood vessels or cause inflammation within them, leading to blood clots that can cause heart attacks.
Clots throughout the body have been found in many COVID-19 patients. That has led some doctors to try blood thinners, although there is no consensus on that treatment.
Dr. Sean Pinney of the University of Chicago says people with heart disease are most at risk for virus-related damage to the heart. But heart complications also have been found in COVID-19 patients with no known previous disease.
A recent review in the Journal of the American College of Cardiology notes that evidence of heart involvement has been found in at least 25% of hospitalized coronavirus patients. At some centers, the rate is 30% or higher. And some studies have found elevated enzyme levels and other signs suggesting heart damage even in patients with milder disease. It is not known whether that damage is permanent.
One small study found evidence of the virus in the hearts of COVID-19 patients who died from pneumonia. Another, using heart imaging, found inflammation of the heart muscle in four college athletes who had recovered from mild COVID-19 infections. There were no images available from before the athletes got sick, and therefore no way to know if they had pre-existing heart problems.
Dr. Tom Maddox, an American College of Cardiology board member, says it's unclear if the virus can cause a normal heart to become dysfunctional.
Theres still so much we dont know," Maddox said.
The United States has more than 8.8 million confirmed cases of COVID-19, according to data from Johns Hopkins University.
As of Wednesday, the U.S. had more than 227,000 deaths from the virus. Worldwide, there are more than 44 million confirmed cases with more than 1.1 million deaths.
Figure out how the coronavirus case numbers look near you with the map below. Hover on specific areas to see the zip code, town and number of cases. The data are provided by the Maine Center for Disease Control and Prevention, and are updated on a weekly basis.
But because they were set up to sample the city sector by sector, they were able to switch gears and begin sampling sewage for evidence of coronavirus.
"We were ready for this," Inchausti told CNN.
Now the city is regularly sampling sewers to keep an eye on the pandemic. And things are not looking good in parts of Tempe.
And they're not looking good in Boston, or in Reno, Nevada, or in many other cities across the country.
As daily coronavirus counts top 70,000 as measured by standard testing, sewage testing suggests things are going to get a whole lot worse.
"It's a leading indicator," Inchausti said. "The proof is in the poop."
Across the country, cities and universities are testing sewage to monitor the virus. Studies suggest it's a useful way to augment standard person-by-person coronavirus testing and while a sewage sample cannot point to an infected individual, it can give an indication that infections are circulating in an area, a neighborhood or even in an individual building.
Early on in the pandemic, it became clear that Covid-19 virus makes its way into the digestive system and could be found in human feces. From there, it's just a quick flush into the sewers.
Mariana Matus, co-founder and CEO of Biobot Analytics, which is analyzing sewage for dozens of customers, said sewage testing can show virus is starting to circulate even before people start showing up at hospitals and clinics and before they start lining up for Covid-19 tests.
"People start shedding virus pretty quickly after they are infected and before they start showing symptoms," Matus told CNN.
"We are seeing an upturn in the wastewater data which I think broadly matches what we are seeing across the country," Matus said. "It's been interesting seeing this almost second wave."
Massachusetts still has a low percentage of coronavirus tests coming back positive at 1.5%. But the growing number of positive hits from the sewage indicate more positive tests are to come, Matus said.
"I think that it is pretty good evidence that we need to pay attention. Communities need to pay attention," said Matus, a biologist who started the company with a small group of colleagues at the Massachusetts Institute of Technology.
The little startup has been deluged with requests to test wastewater systems, she said. "Who doesn't like a poop story?" Matus asked.
Testing the sewage for evidence of Covid-19 is like preparing a weather forecast, said Krishna Pagilla, chair of civil and environmental engineering at the University of Nevada, Reno and director of the Nevada Water Innovation Institute.
"This is something that we should have concentrated on from the beginning in every community," Reno's Pagilla told CNN.
The coronavirus breaks down fairly quickly once it's flushed. Wastewater testing doesn't recover whole virus, but instead pulls out two specific pieces of viral material called RNA. It can no longer infect people, but is easy to identify.
Finding this RNA in the sewage tells researchers someone infected is using the system. The more RNA is there, the more people are infected.
"We will know a few days in advance. We can inform the health authorities," Pagilla said.
It's especially useful in a college town, Pagilla said
"People are reluctant to get tested now," he said. "Or we have students who say 'hey I am having symptoms but I am going to hang out at home.' They don't get seriously ill, so they don't get tested. But then maybe they decide to go to the gym."
In Tempe, Inchausti said the city makes even more direct use of the information.
"The relationship is never just to have the data and look at it and say, 'that's nice,' she said.
One, designated Area 6, abuts the Arizona State University campus. Its 8,100 residents are largely low-income. When coronavirus RNA counts went up in the sewage there recently, Inchausti said, "we spent $15,000 blitzing it with masks."
"We met people where they are," she added. "We understood they were going to the laundromat, so we helped them understand how to stay safe in the laundromat. We provided Covid-19 saliva testing in the school, in the neighborhood." Now they're analyzing test data to see if the intervention made a difference.
"I believe what Tempe is doing is the right way to do it," Pagilla said.
Cresten Mansfeldt says he thinks it made a difference on the campus at the University of Colorado in Boulder.
The school has coordinated saliva tests for on-campus residents with regular wastewater monitoring conducted by students.
"They look at the data daily," said Mansfeldt, an assistant professor of environmental engineering, who normally studies how microbes interact with the chemicals people excrete in their waste.
"There is a lot of information that people flush down the toilet," Mansfeldt said.
Numbers shot up in the weeks after students returned to campus in late August, peaking at 130 positive PCR tests on September 17. But they plummeted to just a few a day after the city and county of Boulder instituted restrictions on college-aged residents that prevented gatherings of any size -- not even two people -- for two weeks. Officials relented after a week when students complained of safety issues, allowing those age 18 to 22 to travel in pairs.
Currently, 18- to 22-year-olds are no longer restricted any more than any other age group in Boulder county.
Now campus cases are ticking up again, from one case on October 16 to five on October 22 and eight on October 26. But Mansfeldt said the wastewater indicators look good. "Most sewers are testing negative," he said.
Inchausti and Pagilla both said they hoped state and federal officials would pay attention and start using sewage data to monitor the pandemic across the country as a whole -- and to respond.
"At this time, point estimates of community infection based on wastewater measurements should not be used," the CDC advises.
