In findings that could place another group onto the COVID at-risk list, researchers in the United Kingdom estimated in a research letter published yesterday that adults with Down syndrome are at almost five times the risk for COVID-19related hospitalization and 10 times the risk for related death.
The study, published in the Annals of Internal Medicine and led by researchers from the University of Oxford, involved 8.26 million adults, 4,053 of them diagnosed as having Down syndrome. The team analyzed information from a primary care database to determine if the abnormal immune responses, congenital heart disease, and lung abnormalities common in people who have the syndrome could be risk factors for severe COVID-19 illness.
From Jan 24 to Jun 30, 68 of 4,053 patients with Down syndrome died, 27 (39.7%) of them from coronavirus, 17 (25.0%) from pneumonia or pneumonitis (inflammation of lung tissue), and 24 (35.3%) of other causes. In contrast, 41,685 of the 8,252,105 patients without Down syndrome died, 8,457 (20.3%) from COVID-19, 5,999 (14.4%) of pneumonia or pneumonitis, and 27,229 (65.3%) of other causes.
After adjusting for age and sex, the hazard ratio (HR) for coronavirus-related deaths in adults with Down syndrome, versus those without, was 24.94. And after adjusting for age, sex, ethnicity, body mass index (BMI), residency in a long-term care facility, dementia or congenital heart disease, and other underlying conditions and treatments, the HR for COVID-19associated death was 10.39, and the HR for hospitalization was 4.94.
The researchers found no sign of interactions between Down syndrome and age, sex, or BMI, and the HR for death did not change with further adjustment for smoking status and alcohol intake (HR, 10.12). The adjusted HR for people with learning disabilities other than Down syndrome was 1.27.
The authors noted that Down syndrome is not on the US Centers for Disease Control and Prevention list or a similar one maintained in the United Kingdom of conditions that increase the risk of severe coronavirus disease.
The authors said that public health organizations, policymakers, and healthcare professionals should use the study findings to strategically protect people who are especially vulnerable to COVID-19 because of Down syndrome or other conditions.
"These estimated adjusted associations do not have a direct causal interpretation because some adjusted variables may lie on causal pathways, but they can inform policy and motivate further investigation," they wrote. "Participation in day care programs or immunologic deficits could be implicated, for example."
Maine reported 42 new cases of COVID-19 on Thursday, while an outbreak linked to a Waldo County church continued to grow.
Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention, said at an afternoon news briefing that the outbreak related to Brooks Pentecostal Church has increased from 46 cases to 49.
Also on Thursday, the Maine Department of Health and Human Services launched the $5 million StrengthenME campaign, which provides resources to Mainers who are feeling stress or anxiety from the pandemic.
The campaign will be a collaboration between state government and a coalition of community organizations to offer free stress management, wellness and resiliency resources, DHHS said in a news release.
The state has also set up a hotline for people to call if they need support. The number, (207) 221-8198, is in operation seven days a week, from 8 a.m. to 8 p.m.
The stress of the global pandemic at the local level on individuals, families and communities is real, said Jeanne Lambrew, Maines health and human services commissioner, who participated in Thursdays briefing.
Among the new cases reported, nine were in York County, six in Waldo County, five in Cumberland County and five in Kennebec County.
After subtracting previously reported cases that were listed as probable but turned out to be negative after testing, the net number of new cases in Maine was 37.
The outbreak stemming from services at Brooks Pentecostal Church grew from 17 cases over the weekend to 49 on Thursday. Fellowship gatherings that involved Brooks Pentecostal and other churches from Oct. 2-4 ignored the Mills administrations executive orders designed to protect public health during a pandemic, which included limiting indoor crowds to less than 50, wearing masks in indoor public places and social distancing by keeping 6 feet apart.
About 100 to 150 attended the events in early October, including parishioners from the Quaker Hill Christian Church in Unity and the Charleston Church and Faith Bible College in Charleston.
In addition, Brooks Pentecostal in early October held its own church services attended by 70 to 100 people, and public health rules were also ignored during those services, according to the Maine CDC.
While the agency is still tracking the outbreak and cases are expected to grow, it has yet to generate as many cases as a wedding and reception in the Millinocket area in August, which has been linked to more than 175 cases and eight deaths across the state. The geographic footprint of the outbreak in Waldo County is more confined, so far.
Within roughly the same time frame as the Waldo County outbreak about two-and-a-half weeks after the initial cases the Millinocket-area outbreak had grown to 60 cases and had been linked to further outbreaks in two other locations, the York County Jail and a Madison nursing home.
Cases connected to the church outbreak have been found at nearby public schools and at Bayview Manor, an assisted living center in Searsport. Bayview Manor completed a round of universal testing of all its staff and residents and found no additional cases, according to the Maine CDC.
When asked to compare what the Maine CDC has learned about controlling outbreaks in October compared to August, Shah said its hard to pinpoint any major breakthroughs. But he said state contact tracers and disease investigators are constantly learning new and better ways to respond, that taken together in the aggregate the refinements they make improve the response.
Since the pandemic began, 6,064 people in Maine have been infected with COVID-19, and 146 have died. There were no additional deaths reported on Thursday.
The seven-day average of daily new cases stood at 37, compared to 31 two weeks ago and 30.3 a month ago. Also on Thursday, the Maine Department of Corrections reported one employee at the Maine Correctional Center in Windham had tested positive for COVID-19. Earlier in the week, the corrections department recorded a case involving a staff member at the Maine State Prison in Warren.
Hospitalizations remained low, with seven currently hospitalized, and no one in intensive care.
The seven-day positivity rate which reflects the percentage of tests returned positive on Thursday was 0.53. The rate has hovered between 0.5 and 0.6 percent over the past month.
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There's increasing emphasis on wearing masks while flying. How much protection do they offer against COVID-19? James D. Morgan/Getty Images hide caption
There's increasing emphasis on wearing masks while flying. How much protection do they offer against COVID-19?
Early in the coronavirus pandemic, air travel looked like a risky endeavor. Some scientists even worried that airplanes could be sites of superspreading events. For example, in March a Vietnamese businesswoman with a sore throat and a cough boarded a flight in London. Ten hours later, she landed in Hanoi, Vietnam; she infected 15 people on the flight, including more than half of the passengers sitting with her in business class.
Then in April, airlines shifted course. Many started requiring passengers to wear masks on planes and some airlines even enforced the policy. Just on Monday, the Centers for Disease Control and Prevention said it now "strongly recommends" all passengers and crew members wear masks.
So the big question is this: How well do the masks work? Do they make it safe to fly across the country for a family visit?
Scientists are just beginning to answer that question. And their findings offer a glimmer of hope as well as fresh ideas about what's most important for protecting yourself on a plane.
The new evidence comes largely from Hong Kong, where health officials have been meticulously testing and tracking all passengers who land in the city. "They test everybody by PCR on arrival, quarantine them in single rooms for 14 days and then test the passengers again," says infectious disease doctor David O. Freedman at the University of Alabama at Birmingham. So health officials there know which passengers boarded the plane while already infected with the virus and whether they could have infected anyone else on the plane.
Freedman and his colleague have been analyzing these data, with a specific focus on one airline: Emirates.
"Since April, Emirates has had a very rigid masking policy," Freedman says. Not only does the airline require passengers and crew members to wear masks, but flight attendants also make sure everyone keeps on their masks, as much as possible, throughout the entire flight.
Freedman looked at all Emirates flights from Dubai to Hong Kong between June 16 and July 5. What he found is quite telling. During those three weeks, Emirates had five flights with seven or more infected passengers on each flight, for a total of 58 coronavirus-positive passengers flying on eight-hour trips. And yet, nobody else on the planes none of the other 1,500 to 2,000 passengers picked up the virus, Freedman and his colleague report in the Journal of Travel Medicine.
"Those were flights with higher risk, and yet there was no transmission," Freedman says.
On another Emirates flight, a whopping 27 coronavirus-positive people boarded the plane in Dubai. Guess how many other passengers were infected on the eight-hour flight?
"There appear to have been two in-flight transmissions," Freedman says.
Without the masks, he would have expected many more cases. Freedman and his colleague found several other high-risk flights with no transmission, including an executive jet that flew from Tokyo to Tel Aviv, Israel, with two of the 11 passengers infected with the coronavirus.
"They were all sitting in a very small environment because it was an executive jet," Freedman says. "And yet again, there was no transmission because passengers were meticulously masked. The crew supervised the masking."
In fact, since airlines have started to require masks, Freedman says, scientists have not documented one superspreading event on airlines. "Flights that had significant transmission documented were flights early on in the pandemic."
All together, these data suggest masks are working and working well. "There's encouraging evidence from a number of flights that masking does help greatly, but it would be nice to study it better," he says. "The circumstantial evidence is, your risk is low on a plane, if there is rigid masking."
And that last part is key. To keep the risk low on planes, everyone needs to keep their mask on while riding the plane.
Why? Planes have excellent air ventilation and filtration systems, which remove coronavirus particles from the air about every six minutes, the U.S. Transportation Command reported Thursday.
"So the only opportunity to breathe the virus in comes from the air that passes by you before it goes through that ventilation system," says engineer Linsey Marr at Virginia Tech. "And so that's only going to happen if you're sitting close to the person who's sick."
In other words, because of a plane's filtration systems, your risk of catching the coronavirus on a flight comes almost entirely from the people sitting around you. And that risk is lower when those fellow passengers wear masks.
The mask will block some of the virus particles a person releases into the air around them. It will also reduce how much virus you breathe in. And it will prevent big drops of spit and saliva from hitting your nose and mouth, Marr says.
For these reasons, Marr says, when she flies, she carefully chooses which mask to wear.
"I save my best mask for the plane. It has a couple layers of HEPA filters that remove more than 99% of particles," she says. "It's not my everyday mask. I can't just hang it around my neck. It's more troublesome than that."
You can't really buy N95 masks right now, but if you happen to have one, Marr recommends using it or even a P100 respirator, which includes a plastic facepiece and particulate filters or cartridges that remove 99.97% of virus particles. "On the plane, you want the best there is," she reiterates. "But just make sure it fits well, and keep in mind, the mask doesn't protect your eyes. So you might want to consider wearing a face shield or goggles or some other kind of eye protection."
Also remember to disinfect surfaces around your seat, such as the armrests, tray tables and seat backs. You can use hand sanitizer or bleach wipes, and try to do it regularly throughout the flight. Avoid touching your face as much as possible, Marr says. And keep chatter to a minimum. When you talk, you can emit 10 times the droplets and aerosols that you do when you're quiet.
Finally, Freedman says, don't forget to wear a mask and socially distance throughout the travel process while traveling to and from the airport, while waiting in the airport and while boarding and exiting the plane.
"To me, one of the scariest parts [of flying] is the disembarkation process," Freedman says. "Airlines can control people getting onto a plane, but getting off can be chaos because everybody rushes off the plane."
For this reason, Freedman says, he and his wife aren't flying this year for Thanksgiving. They're taking Amtrak instead.
Geri Andre-Major passes her 2 1/2-week-old son, Maverick, to her husband, Mo Major, as their other children Max, 5, and Marley, 4, eat breakfast on March 26, 2020, in Mount Vernon, New York. Both parents lost their jobs due to the coronavirus pandemic. (John Moore/Getty Images)
The COVID-19 recession has upended the lives of American workers, millions of whom remain without a job despite a recent upswing in hiring. Working parents have faced unique challenges as many schools and child care centers around the United States closed their doors due to the coronavirus outbreak. A new Pew Research Center analysis of government data finds that in the first six months of the pandemic, the workplace engagement of mothers and fathers with children younger than 18 at home has been affected about equally.
The shares of mothers and fathers who are working employed and on the job have fallen from 2019 to 2020, but the falloff has been comparable for each group. The shares of mothers who were not in the labor force edged up more than among fathers but, among those at work, fathers appear to have reduced their work hours more than mothers.
The COVID-19 outbreak has hindered the ability of child care centers and summer camps to resume normal operations and for many schools to fully open their doors to in-person learning. Many wondered if the outbreak would further entrench or widen the already substantial gap in the shares of mothers and fathers who are at work, and research into the initial impact of the downturn suggested this may be happening. This analysis looks at the impact on the labor market activities of mothers and fathers six months into the outbreak.
The focus is on the shares of mothers and fathers who are employed and at work, not absent for any reason. The employment level of men shows a seasonal pattern, peaking in the summer months. Absences from work, including for vacations, sick leave, maternity or paternity leave, child care or family obligations, also vary seasonally. Among women, the number employed and at work is typically lower in the summer months. For these reasons, our analysis focuses on changes from 2019 to 2020, largely eliminating the effect of seasonal variations.
Most estimates in this report are from a Pew Research Center analysis of data from the Current Population Survey (CPS), a survey of U.S. households conducted by the Bureau of Labor Statistics. The COVID-19 outbreak has affected data collection efforts by the U.S. government in its surveys, limiting in-person data collection and affecting the response rate. It is possible that some measures of labor market activity are and how they vary across demographic groups are affected by these changes in data collection.
Mothers and fathers refer to women and men 16 and older who are either the reference person in the survey or their partner and who have a child younger than 18 living in the household. Grandchildren and foster children are included in the count of children. Partners include those who are married to or are cohabiting with the reference person, whether of the opposite sex or not. In September 2020, there were 32 million mothers and 27 million fathers with a child at home in a population of 201 million women and men ages 16 and older who were either reference persons or partners.
The term employed and at work refers to employed workers, full-time or part-time, who are not absent from work for any reason. Some reasons why a worker may be absent from work are vacations, maternity or paternity leave, child care and family obligations, and a labor dispute.
The labor force consists of people 16 and older who are either employed or actively looking for work. A worker who is not employed must be actively seeking work to be counted among the unemployed. The terms unemployed and not employed are used interchangeably in this report.
Earlier studies found that some mothers more so than fathers were cutting back on their work hours or taking leave from work at the beginning of the pandemic. But, over the first six months of the outbreak, the labor market impact of COVID-19 has similarly affected mothers and fathers, and the wide gulf that exists in the workplace engagement of mothers and fathers persists virtually unchanged. The share of mothers and fathers who were employed and at work plunged with the onset of the coronavirus outbreak and had recovered only partially through September 2020. The gender gap in September (22 percentage points) is slightly greater than in February (20 points), but a similar gap was also present in September 2019.
Labor market outcomes alone do not capture the full extent of the experiences of parents, such as the loss in leisure time or additional stress as they juggle work, child care and online learning. Given that mothers already assumed greater responsibility for child care than fathers, it is likely that the additional duties during COVID-19 as many schools, day care centers and summer camps closed, at least temporarily have fallen more on their shoulders. It is possible that these effects vary across mothers and fathers and that the gender gap on this account may change as the coronavirus outbreak extends its run.
Here are five facts about how labor market activity among women and men with children at home has been affected in the first six months of the COVID-19 outbreak. The focus is on the shares of mothers and fathers who are working employed and at work in September 2020 and how that compares with where things stood in September 2019.
The shares of mothers and fathers who were employed and at work in September 2020 were smaller than in September 2019. Among mothers, this share decreased from 69.0% to 63.4% and, among fathers, it decreased from 90.5% to 85.6% over this period. The drop in the share of mothers working was about the same as the drop among fathers, 5.6 vs. 4.9 percentage points.
Mothers and fathers who are employed but not at work may be absent for a vacation, illness, maternity or paternity leave, child care, and other family obligations, among several reasons. Because vacations or sick leave may also be taken for family reasons, our analysis does not attempt to distinguish among the reasons for absence from work. In September 2020, the share of those absent from work was 2.9% among mothers and 2.1% among fathers. Mothers and fathers experienced the same increase in this share in comparison with September 2019.
The downturn did increase unemployment across the board. Among mothers, the share of the working-age population, ages 16 and older, that was not employed increased from 2.2% in September 2019 to 4.7% in September 2020. Fathers saw a similar rise in the share not employed, from 1.7% to 4.5%.
A key difference between mothers and fathers is in the share who are not in the labor force neither employed nor actively looking for work. Among mothers, 29.1% were not in the labor force in September 2020, compared with only 7.8% of fathers, a disparity driven in part by child care and other family obligations. This share was higher than in September 2019 among both mothers and fathers, with a slightly greater increase occurring among mothers than fathers (2.6 vs. 1.6 percentage points).
Among mothers, those with children ages 3 and older experienced a slightly greater decrease in the share employed and at work; among fathers, the decrease in this share was greater among those with children younger than 3. Reflecting the gender gap in childcare, mothers with children younger than 3 are less likely to be at work. In September 2020, 53.9% of these mothers were employed and at work, compared with 70.4% of mothers whose youngest child was 14 to 17 years old. These shares have dropped since September 2019 for all groups of mothers, with the decrease among mothers with children ages 3 to 5 or ages 6 to 13 (6.7 percentage points each) being greater than among other mothers.
Among fathers with children younger than 3, the share who were working fell from 91.9% in September 2019 to 85.0% in September 2020. The decrease in workplace activity was more modest among fathers with older children. For example, among fathers with children ages 14 to 17, the overall share who were at work fell from 87.5%% in September 2019 to 85.1% in September 2020.
Underlying these trends in the workplace engagement of mothers and fathers were changes in their labor force participation. Mothers with children ages 3 to 5 or ages 6 to 13 experienced more of a decrease in labor force participation, as did fathers with children younger than 3. Absences from work were largely unchanged among mothers and fathers regardless of the ages of their children.
Black, Asian and Hispanic mothers experienced a greater decrease in the shares who were at work in the COVID-19 downturn than White mothers. Among fathers, Black and Hispanic fathers saw a greater decrease in the share employed than White and Asian fathers.
In September 2019, 73.2% of Black mothers were at work, greater than the shares among White, Asian and Hispanic mothers. By September 2020, the share of Black mothers who were working stood at 65.8%, a drop of 7.4 percentage points. Asian and Hispanic mothers experienced drops of 7.3 and 8.0 points in the shares employed, respectively. The decreases in this share for White mothers 4.1 percentage points is also notable, but not as high, in keeping with the trends among women overall.
Black and Hispanic fathers saw a greater decrease in work activity than other fathers over the same period. In September 2019, 81.6% of Black fathers and 92.2% of Hispanic fathers were employed and at work. By September 2020, 75.3% of Black fathers and 85.0% of Hispanic fathers were at work. The decreases in the share working among White and Asian fathers were not as high.
Workplace engagement among Black, Asian and Hispanic mothers fell more than among White mothers because they left the labor force in greater proportions and they also experienced more of an increase in unemployment from September 2019 to September 2020. Similarly, Black and Hispanic fathers were more likely to have left the labor force than White and Asian fathers over this period, and unemployment increased more among Black, Asian and Hispanic fathers than among White fathers.
Fathers who are employed and at work cut back on the hours they spent on the job by a little more than mothers did. From September 2019 to September 2020, the average weekly hours worked by fathers fell from 43.3 to 40.5 nearly three hours per week. At the same time, mothers pared their average weekly hours from 36.8 to 35.0, close to two hours per week. The change in work hours among mothers and fathers did not vary notably by the ages of the youngest children at home.
The key difference among mothers and fathers is that mothers spend significantly less time on the job, and the gender gap on this front is largely intact. The demands of family life have a large impact on this disparity, as is partly evident in the fact that women with younger children work the least number of hours whereas the age of a child has no impact on the hours worked by fathers.
Another manifestation of the gender gap in work hours is that women are more likely than men to work part time. In September 2019, 21.0% of mothers worked part time compared with 3.9% of fathers. In September 2020, the shares working part time stood at 20.3% for mothers and 4.3% for fathers. The slight decrease in the share of mothers working part time is likely a consequence of the fact that employment fell more sharply among part-time workers than full-time workers in the COVID-19 downturn.
Because of the COVID-19 downturn, the share of men overall who are working is at a record low. Among women, the share who are working is the lowest since the mid-1980s, when labor force participation among women was much lower and still on the rise.
In September 2020, 49.2% of women ages 16 and older were employed and at work, down from 54.0% in September 2019. Among men, the share who are active decreased from 65.3% in September 2019 to 60.5% in September 2020, the lowest on record since 1976, when data first became available.
It is worth noting that mothers and fathers who are referenced in this analysis and with children younger than 18 at home are more likely to be working than women and men overall. One reason is that these parents are younger on average than women or men overall, among those 16 and older: The mean age of mothers in September 2020 was 39, compared with 48 for women overall. The mean age of fathers was 42 compared with 46 for men overall.
Our analysis of the labor market engagement of mothers and fathers finds that, in the first six months of the COVID-19 outbreak, the gender gap on this front is perhaps more reflective of long-standing patterns in the labor market than of a new dynamic brought on by the outbreak. As business closures peaked in April and May, researchers found that, among married parents with children younger than 13 at home, mothers reduced their time worked by about one hour more than fathers from February to April.
Another study estimated that employed mothers with school-age children were more likely to take leave from work if they lived in states that imposed closures earlier. But this study also observed that mothers in early closure states did not change their labor force participation differently than fathers. Meanwhile, a New York Times survey conducted in April found that both women and men were doing more housework and child care than usual, although the division was about the same as before COVID-19 emerged.
Looking forward, the impact of the COVID-19 downturn on working parents, especially mothers, may intensify if business and school closures remain in effect. In a survey conducted in July by the Federal Reserve Board, 23% of employed mothers and 15% of employed fathers said they expected to reduce their work hours if schools did not resume in-person classes in the fall. Another 4% of working mothers and 2% of working fathers said they might quit their jobs.
COVID-19 mortality rates are going down, according to studies of two large hospital systems, partly thanks to improvements in treatment. Here, clinicians care for a patient in July at an El Centro, Calif., hospital. Mario Tama/Getty Images hide caption
COVID-19 mortality rates are going down, according to studies of two large hospital systems, partly thanks to improvements in treatment. Here, clinicians care for a patient in July at an El Centro, Calif., hospital.
Two new peer-reviewed studies are showing a sharp drop in mortality among hospitalized COVID-19 patients. The drop is seen in all groups, including older patients and those with underlying conditions, suggesting that physicians are getting better at helping patients survive their illness.
"We find that the death rate has gone down substantially," says Leora Horwitz, a doctor who studies population health at New York University's Grossman School of Medicine and an author on one of the studies, which looked at thousands of patients from March to August.
The study, which was of a single health system, finds that mortality has dropped among hospitalized patients by 18 percentage points since the pandemic began. Patients in the study had a 25.6% chance of dying at the start of the pandemic; they now have a 7.6% chance.
That's a big improvement, but 7.6% is still a high risk compared with other diseases, and Horwitz and other researchers caution that COVID-19 remains dangerous.
The death rate "is still higher than many infectious diseases, including the flu," Horwitz says. And those who recover can suffer complications for months or even longer. "It still has the potential to be very harmful in terms of long-term consequences for many people."
Studying changes in death rate is tricky because although the overall U.S. death rate for COVID-19 seems to be dropping, the drop coincides with a change in whom the disease is sickening.
"The people who are getting hospitalized now tend to be much younger, tend to have fewer other diseases and tend to be less frail than people who were hospitalized in the early days of the epidemic," Horwitz says.
So have death rates dropped because of improvements in treatments? Or is it because of the change in who's getting sick?
To find out, Horwitz and her colleagues looked at more than 5,000 hospitalizations in the NYU Langone Health system between March and August. They adjusted for factors including age and other diseases, such as diabetes, to rule out the possibility that the numbers had dropped only because younger, healthier people were getting diagnosed. They found that death rates dropped for all groups, even older patients by 18 percentage points on average.
The research, an earlier version of which was shared online as a preprint in August, will appear next week in the Journal of Hospital Medicine.
"I would classify this as a silver lining to what has been quite a hard time for many people," says Bilal Mateen, a data science fellow at the Alan Turing Institute in the United Kingdom. He has conducted his own research of 21,000 hospitalized cases in England, which also found a similarly sharp drop in the death rate. The work, which will soon appear in the journal Critical Care Medicine and was released earlier in preprint, shows an unadjusted drop in death rates among hospitalized patients of around 20 percentage points since the worst days of the pandemic.
Mateen says drops are clear across ages, underlying conditions and racial groups. Although the paper does not provide adjusted mortality statistics, his rough estimates are comparable to those Horwitz and her team found in New York.
"Clearly, there's been something [that's] gone on that's improved the risk of individuals who go into these settings with COVID-19," he says.
Horwitz and others believe many things have led to the drop in the death rate. "All of the above is often the right answer in medicine, and I think that's the case here, too," she says.
Doctors around the country say that they're doing a lot of things differently in the fight against COVID-19 and that treatment is improving. "In March and April, you got put on a breathing machine, and we asked your family if they wanted to enroll you into some different trials we were participating in, and we hoped for the best," says Khalilah Gates, a critical care pulmonologist at Northwestern Memorial Hospital in Chicago. "Six plus months into this, we kind of have a rhythm, and so it has become an everyday standard patient for us at this point in time."
Doctors have gotten better at quickly recognizing when COVID-19 patients are at risk of experiencing blood clots or debilitating "cytokine storms," where the body's immune system turns on itself, says Amesh Adalja, an infectious disease, critical care and emergency medicine physician who works at the Johns Hopkins Center for Health Security.
He says that doctors have developed standardized treatments that have been promulgated by groups such as the Infectious Diseases Society of America.
"We know that when people are getting standardized treatment, it makes it much easier to deal with the complications that occur because you already have protocols in place," Adalja says. "And that's definitely what's happened in many hospitals around the country."
But Horwitz and Mateen say that factors outside of doctors' control are also playing a role in driving down mortality. Horwitz believes that mask-wearing may be helping by reducing the initial dose of virus a person receives, thereby lessening the overall severity of illness for many patients.
And Mateen says that his data strongly suggest that keeping hospitals below their maximum capacity also helps to increase survival rates. When cases surge and hospitals fill up, "staff are stretched, mistakes are made, it's no one's fault it's that the system isn't built to operate near 100%," he says.
For these reasons, Horwitz and Mateen believe that masking and social distancing will continue to play a big role in keeping the mortality rate down, especially as the U.S. and U.K. move into the fall and winter months.
Gates adds that the takeaway definitely should not be to cast the mask aside. There is still no cure for this disease, and even patients who recover can have long-term side effects. "A lot of my patients are still complaining of shortness of breath," she says. "Some of them have persistent changes on their CT scans and impacts on their lung functions."
And many people will continue to die, even if the rate has dropped. A recent estimate by the Institute for Health Metrics and Evaluation suggests the total death count could reach well over 300,000 Americans by February.
"I do think this is good news," Horwitz says of her research findings, "but it does not make the coronavirus a benign illness."
Even at a place like Harvard, it is feeling what feels like pain, said Rick Staisloff, a senior partner and founder of RPK Group, an Annapolis-based financial consulting company that works with colleges and universities. The pandemic is likely to hit less wealthy institutions even harder.
Most colleges have money squirreled away in reserves and got federal aid to help weather the early months of the pandemic, but this current fiscal year will be difficult and the next one even harder, Staisloff said.
Higher education held its breath going into the fall semester and was hoping beyond reasonable hope that it wouldnt be bad," he said. "Theyre waking up to the fact that spring isnt going to look better. Theyre starting that next budget cycle and going uh, oh.
Harvard blamed most of last fiscal years deficit on lost revenue after the university refunded room and board charges when it sent students home in March, closed research labs, canceled executive education programs, and shut down most events and reunions due to the pandemic. It also absorbed the cost of the early retirement program.
A $10 million deficit in Harvards $5.4 billion operating budget may seem small, but it represents a sharp reversal for a university and comes primarily from a decline in revenue. Harvard in recent years has reported 3 percent to 4 percent in revenue growth, and the last time the university reported a decline was during the 2008-2009 economic crisis.
The financial effects on Harvard from the onset of the pandemic in March of this year were significant and sudden, Thomas J. Hollister, Harvards vice president for finance, cowrote in a message Thursday that accompanied the universitys annual financial report. Sound financial management allowed the university to be in a position to cover sudden losses from operations, while also investing in the mission.
The value of Harvards endowment increased to $42 billion and offered a bright spot by providing 7.3 percent in returns and helping increase the universitys net assets by 2 percent to $50 billion.
But Harvard officials said that this current fiscal year also could end with operating deficits. The university is offering only online classes this fall and only first-year students and those facing hardships are staying in dormitories this semester, meaning that Harvard is forgoing significant room and board revenue. The university also is spending money to test students for coronavirus and reconfiguring labs to ensure social-distancing rules and safety.
How we manage declining revenue and rising need for investment in excellence amid new and necessary health protocols will, in part, determine our successors' ability to endure and thrive, Harvard President Lawrence Bacow said in a message to the university community.
Universities across the country faced significant losses last fiscal year when they had to suddenly move to remote learning to curb the spread of the novel coronavirus. Many have continued to teach online and reduced the number of students in their dormitories to meet social distancing rules. Student enrollment has also dropped at many campuses, as entering first-year students opted to defer college for a year instead of paying for a mostly-online experience.
Institutions, even wealthy ones, are going to have to start looking at making cuts to faculty, staff and programs, Staisloff said.
In the past, many colleges have contained their cuts to low-wage workers, by outsourcing food services or cleaning or cutting back on contracted employees. But they will likely have to make more significant reductions that could hit faculty due to the pandemic, Staisloff said.
For the first time, youre going to see widespread impact, he said.
Some of the financial challenges to higher education predate the pandemic, as families have balked at high tuition costs and questioned whether degrees always led to better paying jobs. The number of college-age students has also been declining, Staisloff said.
Covid has turned the dial up to 11, he said. Higher educations business model is not sustainable in the long term.
Deirdre Fernandes can be reached at deirdre.fernandes@globe.com. Follow her on Twitter @fernandesglobe.
The drug industry has been gradually migrating to the cloud for years. But the Covid-19 pandemic has rapidly accelerated that shift for a simple reason: Researchers needed to run the biggest experiment of their lives in record time, and they lacked the power to launch it.
In recent months, pharma companies have struck deals with tech giants like Amazon, Google, and Microsoft, which sell cloud services that could provide the computing power urgently needed to search vast libraries of molecules for a potential cure. Drug companies say transitioning to the cloud has cut down the time needed for certain research efforts from months to mere days precious time as the global health crisis rages on.
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Find all of the most important pandemic education news on Educating N.J., a special resource guide created for parents, students and educators.
The number of New Jersey schools where health investigations determined students or teachers transmitted COVID-19 in school or during extracurricular activities rose to 25 this week, according to the state's covid19.nj.gov website.
Since the start of the school year, at least 111 New Jersey students and educators have either contracted COVID-19 or passed it on to someone else while in the classroom, walking around their schools or participating in extracurricular activities, state officials said Thursday.
The totals include three new outbreaks at schools in Camden, Hudson and Somerset counties with a total of 28 new cases since last week, according to the data.
We knew going in that there would be cases in our schools and our job has been to work fast to put a lid on any outbreaks, Gov. Phil Murphy said at his coronavirus press briefing.
The 111 cases were part of 25 confirmed school outbreaks that local health investigations concluded were the result of students and teachers catching the coronavirus at school not at home, at parties or other gatherings, according to the state COVID-19 dashboard.
The numbers do not include the positive COVID-19 cases reported among New Jersey students and teachers who are suspected to have contracted the virus outside school. The state has not released those numbers, though a database maintained by the National Education Association says more than 220 New Jersey schools have reported at least one coronavirus case.
Though every case is taken seriously, Murphy said state officials believe the school outbreak numbers are still low as classes continue to practice social distancing and follow mask requirements. There have been outbreaks in less than 1% of the states more than 3,000 public and private schools, though not all of them are offering in-person classes.
So far, so good, Murphy said.
Citing privacy reasons, the state has not named the schools where the outbreaks occurred, nor the dates or any of the circumstances that led to the in-school transmission. However, the state has identified the counties where the schools are located.
The 25 outbreaks include:
Atlantic County: 1 school outbreak with 2 cases.
Bergen County: 3 school outbreaks with a total of 9 cases.
Burlington County: 2 school outbreaks with a total of 6 cases
Camden County: 3 school outbreaks with a total of 33 cases.
Cape May County: 3 school outbreaks with a total of 10 cases.
Gloucester County: 2 school outbreaks with a total of 10 cases.
Hudson County: 1 school outbreak with 4 cases.
Hunterdon County: 1 school outbreak with 3 cases.
Ocean County: 3 school outbreaks with a total of 9 cases.
Passaic County: 1 school outbreak with 9 cases.
Salem County: 2 school outbreaks with a total of 10 cases.
Somerset County: 2 school outbreak with a total of 4 cases.
Sussex County: 1 school outbreak with 2 cases.
Eight counties have reported no school outbreaks. They are: Cumberland, Essex, Mercer, Monmouth, Union, Warren, Morris and Middlesex counties.
Under New Jerseys guidelines, schools can shut down and switch to remote learning for two weeks if two or more students test positive for COVID-19 in different classrooms with the possibility they transmitted the virus to each other. Schools are required to inform families when there are COVID-19 cases in their classrooms, but the rest of the community might not be notified unless local health officials think it is necessary.
Most New Jersey school districts are operating under hybrid plans with a mix of in-person and at-home classes. Several school districts, including Paterson and Newark, are offering all-remote classes and plan to keep their school buildings closed until early 2021 due, in part, to the rise in outbreaks.
Thank you for relying on us to provide the journalism you can trust. Please consider supporting NJ.com with a subscription.
Kelly Heyboer may be reached at kheyboer@njadvancemedia.com.
Every player tested neg.
The text message seemed full of relief as much as hope.
It was sent Oct. 13 by Ernesto Lerma, a 78-year-old assistant coach for the Palmview High School football team in the Rio Grande Valley, where the southern tip of Texas forms the toe of a cowboy boot along the border with Mexico.
A day later, Lerma sent an ominous update.
Big left tackle tested positive.
This was what everyone had feared as the fall sports season approached.
The coronavirus pandemic had ravaged the valley in summer. In July, ambulances lined up in a grim parade, waiting to drop patients at emergency rooms. Some funeral homes ordered refrigerated trucks to store bodies.
During such a crisis, Palmview High Schools fragile effort to hold a football season might seem inconsequential. But the game is perhaps more urgent and galvanizing in Texas than anywhere else. As towns along or near the Rio Grande like La Joya, Palmview, Mission, Progreso, Weslaco, Rio Hondo have shut off their Friday night lights, or left them flickering in uncertainty, there has been a sense of cultural casualty.
In late August, the school district that includes Palmview High, La Joya High and Juarez-Lincoln High decided to cancel fall sports. But some parents and athletes protested, and in late September officials reconsidered. In the end, though, only Palmview decided to proceed with football and only with severe limitations and precautions.
Margarito Requnez, 44, the head coach, insisted that every player and coach be screened weekly for the virus. If anyone was infected, the season would be shut down to keep the spread from getting out of hand.
I dont want that on my conscience, he said.
Accommodations were made for Lerma, who as a septuagenarian would be especially vulnerable to effects of the virus. He coached the offensive line from the bleachers as Palmview opened practice, wearing a mask and gloves and spraying his whistle with disinfectant. For games, he planned to coach from the running track surrounding the field.
We have to be very cautious, Lerma said. This is a deadly disease.
Palmview hoped to play an abbreviated season, beginning Oct. 30. But 16 days before kickoff, a starting tackle had tested positive and was awaiting the results of a retest. So was one other player. Palmviews four scheduled games seemed in jeopardy.
Meeting today, Lerma texted on Oct. 14. Decision?
The valleys fields are rich with cotton and grapefruit and oranges, but its predominantly Latino population is among the poorest in Texas and among the most susceptible to the worst effects of the virus.
As of Wednesday, more than 63,200 coronavirus infections had been reported and more than 3,200 people had died in the four counties that constitute the valley more fatalities than in any of the urban centers of Houston, Dallas and San Antonio.
If this were a season of expectation instead of sickness, every team in the valley would be chasing the elusive accomplishment of Donna High School, which in 1961 became the first and last team in the region to win a state football championship.
The story of that team is legend. Eighteen players. A six-hour bus ride to Austin, the capital, to play the title game on a rainy evening. A stop to eat and perform a parking-lot rehearsal of a trick formation that proved decisive. A trip home in the middle of the night because the school could not afford hotel rooms. An early-morning walk of eight miles along Highway 83, accompanied by dozens of townspeople, to attend a celebratory Mass at the Basilica of Our Lady of San Juan del Valle.
Its community pride, said Luz Pedraza, now 76, the quarterback of that championship team. It shows anything is possible.
Surely, said Progreso High Schools coach, Jos Meza, every member of his Mighty Red Ants team has driven past the water tower in nearby Donna that commemorates the long-ago title. But Progresos season has been canceled. There is no championship to aim for.
Underclassmen are training for next season, flipping tractor tires and fashioning weights from gallons of water. The sounds of fall have gone silent the pompom verve of the cheerleaders, the brassy pep of the band.
It feels empty, said Meza, 45. Even the traffic level feels low. Its an eerie feeling walking the halls and theres nobody there.
At Rio Hondo High School, extracurricular activities will not be permitted until students return to classrooms, said Rocky James, 52, the football coach and athletic director. In-person schooling kept being pushed back, to next Monday or possibly into November. That would have left room for only two football games. So the season was shelved.
James said he might have expected dozens of calls of complaint. He got none.
If theyre too scared to come to school, how is it fair to play football? he said.
Only six offensive linemen were among the interested in playing at La Joya High.
Some parents didnt think it was safe, said Reuben Faras, 54, La Joyas head coach. No vaccine.
Faras understood. Over the summer, when he would normally have been preparing for the season, he instead found himself among the grieving. On July 18, his father, Ruben, died of a heart attack related to Covid-19. He was 83.
Ruben Faras was a longtime coach, teacher, administrator and school board member. After retirement, he still attended all of his sons games.
But he also possessed fragile health diabetes, kidney failure that required dialysis, a heart condition that forced him to wear a pacemaker conditions all too familiar to the valleys close-knit but vulnerable families. More than a third live in poverty. Up to half of the residents lack health insurance, and more than 60 percent are diabetic or prediabetic. Rates of obesity and heart disease, two of the conditions that tend to worsen effects of the virus, are among the nations highest.
While driving his father to a dialysis treatment in the spring, when the pandemic was imminent, Reuben Faras asked if he was prepared to die. The son remembered the answer as philosophical. His father said he had lived a good life. He had wanted to reach 75 and outlive his own mother. He had.
If I die today, Ruben Faras told his son, Im ready to go.
Elva Faras, 77, Rubens wife and Reubens mother, tested positive for the virus on July 17. Her husband felt fatigued that night and labored to breathe the next morning. He was admitted to a hospital, which determined he had pneumonia and the coronavirus, his son said. That afternoon, Ruben Faras had one heart attack, then another, and could not be resuscitated.
It was out of the question to hold the funeral immediately. Stricken with Covid-19, the family matriarch would not be able to attend. Reuben Faras moved in with his mother, leaving his own family and putting himself at risk of getting the virus, but he could not bear to leave her by herself at such a time.
Both of them developed symptoms of Covid-19 fever, fatigue, a cough, congestion. But Elva declined to go to a hospital, telling her son, Id rather die here at the house instead of alone at the hospital.
Eventually, they began to recover. After three weeks in isolation, they said, they tested negative for the virus and finally turned their attention to burying the family patriarch. Twenty-four days after he died, Ruben Faras was laid to rest.
Even in death, the coronavirus was disruptive. Drive-by funerals became part of the pandemic lexicon. Ruben Farass funeral procession stopped at Our Lady of Guadalupe Catholic Church in Mission, Texas, and a priest came outside to bless the coffin with incense and holy water. At the Rio Grande Valley State Veterans Cemetery, mourners remained in their cars. The priest approached Elva Faras, who lowered her window in her mask and face shield, and read from the Scriptures, standing close in his own mask so she could hear.
It was hard, everything we went through, Elva Faras said. I wouldnt wish this on anybody.
Two weeks after the funeral, when football was abandoned at Juarez-Lincoln High, Isabel Rocha, 42, felt a sense of relief. Her son, ngel Portillo, 17, was to be a senior cornerback. Rocha felt bad he would miss his final season, but said she had not wanted him to play. Her father and an uncle had died of Covid-19. She feared that her son might catch the coronavirus and spread it to their extended family. Portillo said he understood and would not have played.
I didnt want to be the one to hurt my family just to play football, he said. Safety over sport. Family over anything.
At Palmview, the safety concerns remained worrying into mid-October: The two Palmview players who had tested positive were being screened again. Practices for last Thursday and Friday were called off.
With our poor kids, it was a matter of time, Requnez, the coach, said. If colleges and pro teams are having trouble containing it, what makes us think a high school team that doesnt have the resources could?
On Friday, Palmview received good news. The initial tests turned out to be false positives. The retests were negative. Another weekly screening for the entire team took place on Monday. The results for 45 of the schools 60 or so players had been returned by Wednesday, all negative. Practice resumed after a week for those who were cleared.
I dont know how other school districts are doing it, Requnez said, referring to teams that have continued after players tested positive. I dont know how they can put peoples lives in jeopardy.
When one of your athletes gets sick, all you do is next man up, send him home and monitor the rest, he added. Were not going to do that. Were going to make sure we protect everybody.
But things continued to grow complicated at Palmview. A volunteer helping out the team tested positive early last week, Requnez said on Wednesday, so Lerma, the 78-year-old assistant, went into quarantine as a precaution. The season wont start now until Nov. 6.
Palmviews principal and the school districts athletic director suggested that football continue, Requnez said, to give the team every opportunity to play at least one game. He and his assistants agreed, as long as testing continued weekly, he said, and with the understanding that if there is a positive test once the season starts, Thats it, were done.
Were going to give it one more shot, Requnez said. If it happens, it happens. If it doesnt, it doesnt. But at least we tried.
This week, Grand Forks County tallied a record number of infections. Grand Forks Public Health Director Debbie Swanson said no longer are the county's COVID-19 numbers driven by individual outbreaks as they were early in the pandemic. Instead, she said the county is watching numbers rise due to uncontrolled spread throughout the community.
On Thursday, Oct. 22, 25 staff members and five residents have COVID-19 at Valley Senior Living on Columbia, the highest number of confirmed active cases at any Grand Forks senior living facility. Woodside Village has 11 staff members who have tested positive for COVID-19, Edgewood Parkwood Place has four positive staff members and three positive residents, and Wheatland Terrace has four positive staff members. There are no active cases of COVID-19 in Maple View Memory Care, St. Ann's Guest House or Tufte Manor, according to NDDOH.
Sally Grosgebauer, a spokesperson for Valley Senior Living, which operates multiple homes in Grand Forks, said nine residents are being treated at the organization's shared Covid Care Area at Valley Senior Living on Columbia. Of those, two are hospitalized. The number of patients in the Covid Care Area is down from last week, when there were 23 patients.
On Thursday, there were 609 active positive cases in Grand Forks County, including 59 new active positives reported Thursday morning. Forty-five people were reported to have newly recovered on Thursday.
Altru Health System Director of Quality and Safety Kari Jensen reported that, as cases have risen in Grand Forks, the hospital also has recorded an uptick in inpatients with COVID-19 over the past few weeks.
Though COVID-19 has stretched hospital resources thin throughout the state in recent weeks, Jensen said capacity at Altru changes constantly throughout the day. On Thursday, she reported there were 14 inpatients being treated for COVID-19, down from 21 the day before.
Data reported to NDDOH by Altru indicate that on Thursday, there were 16 available non-ICU beds at Altru, and one available ICU bed.
According to Jensen, there are beds available in the hospital's COVID-19 units, but an Altru spokesperson did not provide the exact number of available beds in COVID-19 versus non-COVID-19 units.
