Nick Turkal Published 9:00 a.m. CT Sept. 25, 2020
For most of us around the world, the last six months have been, to say the least, difficult and confusing.And now many of us are experiencing "pandemic fatigue."As a physician, Im frequently asked by family, friendsand colleagues, How are you staying healthy during the pandemic?
First, lets set aside the politics of the issue. In a presidential election year, it is no surprise that issues around the pandemic have become political. Perhaps the surprise is how political every aspect has become. I prefer to look at the evolving facts.
As a physician and scientist, my personal decisionsand recommendations to friends, familiesand patients are based on science. While the knowledge and science on this pandemic have continued to evolve, there are some things that we know.We should use these facts, and the recommendations that flow from them, as a frame of reference for making good decisions for ourselves, our families, our communities, our nationand our world.
What do we know?
We need to accept that we are in an international pandemic and that the U.S. is not faring well. We will likely far exceed 200,000 U.S. deaths in the coming months.That is likea city the size of Madison simply disappearing.We need to accept that our world has changed.The pandemic will not simply disappear. We need to fight it with good public health approaches, and eventually with a vaccine.
The virus has both short- and long-term effects. While the majority of cases are mild, we are seeing unfortunate lingering effects.These include cardiac problems like myocarditis (inflammation of the heart muscle), breathing problems similar to asthmaand sleep disorders.We shouldnt be surprised.Viruses can affect most parts of the body.For example, the 1917 influenza pandemic left survivors at risk for Parkinsons disease. We should be vigilant in the coming months and years, to gain the best scientific understanding of the long-term effects of COVID-19.
RELATED: Chicago again restricts travel to and from Wisconsin, orders 14-day quarantine to limit exposure
What should we do?The answers are pretty simple.Stay cautious, stay practical, stay healthy. There are some specific things we can do that significantly increase our odds of staying safe.
Wear a mask this is our very best defense against the spread of the virus. Remember, when you are wearing a mask correctly (over your mouth and nose), you protect yourself.But most importantly you are protecting others! If you have been infected with COVID, you can spread the disease before you even know that you are infected.Wearing a mask protects others. It is the right thing to do. None of us enjoys this aspect of the pandemic, but we need to stay safe. Look at it this way: Would you jump into the deep water to save your child? Would run into a burning room to save your parent?There is no guarantee of success, but would you try?Of course.Now, would you wear a mask to save someone?
RELATED: How coronavirus spreads and how you can slow it down
Keep a safe distance. Physical distancing (at least 6 feet) protects you against the virus. We would all like to be closer to friends and family. But right now, we need to keep a safe distance.
Wash your hands. Good handwashing, or use of alcohol gel, is a great way to keep from spreading the virus.
Take care of your mental and physical health. In this difficult time, it is more important than ever to eat a healthy diet, get enough rest, exercise as your health allows, avoid excessive alcohol intakeand seek help if you are having significant anxiety, depressionor thoughts of suicide.Call your providers, go online for counselingor take advantage of suicide hotlines.Most providers offer telehealth appointments, allowing access to better mental health right in your own home. During this time, its important to take care of our personal and family health issues.
PLEASE get your flu shot! Influenza is a serious illness that kills about 40,000 Americans each year. It is preventable with an easy vaccination, which is now available.And dont forget about regular childhood and adult immunizations.During the pandemic, many families have fallen behind on vaccinations.
Dr. Nick W. Turkal is the former CEO of Aurora Health Care.(Photo: Aurora Health Care)
As the weather gets colder, and we grow ever more fatigued with this pandemic, it is easy to let our guards down. But now is when we need to stand firmly against this virus, and be safe. This is a fight worth fighting. Lets work on this togetherand get to a healthier place for 2021.
Dr. NickTurkal is the former CEO of Aurora Health Care.He recently headed the efforts for the McCormick Place Field Hospital in Chicago.He is a practicing physician in the Milwaukee area.
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Another 43 coronavirus cases have been reported in Maine, health officials said Thursday.
Thursdays report brings the total number of coronavirus cases in Maine to 5,215. Of those, 4,677 have been confirmed positive, while 538 were classified as probable cases, according to the Maine Center for Disease Control and Prevention.
The agency revised Wednesdays cumulative total to 5,172, up from 5,171, meaning there was an increase of 44 over the previous days report, state data show. As the Maine CDC continues to investigate previously reported cases, some are determined to have not been the coronavirus, or coronavirus cases not involving Mainers. Those are removed from the states cumulative total.
New cases were reported in Androscoggin (5), Aroostook (1), Cumberland (11), Kennebec (2), Lincoln (1), Oxford (3), Penobscot (1) and York (19) counties, state data show.
The seven-day average for new coronavirus cases has risen to 38, up from 30.1 a week ago and 21.7 a month ago.
No new deaths were reported Thursday, leaving the statewide death toll at 140. Nearly all deaths have been in Mainers over age 60.
So far, 442 Mainers have been hospitalized at some point with COVID-19, the illness caused by the coronavirus. Of those, 14 people are currently hospitalized, with one in critical care.
Meanwhile, 33 more people have recovered from the coronavirus, bringing total recoveries to 4,478. That means there are 597 active confirmed and probable cases in the state, which is up from 586 on Wednesday.
A majority of the cases 3,017 have been in Mainers under age 50, while more cases have been reported in women than men, according to the Maine CDC.
As of Thursday, there have been 402,382 negative test results out of 409,669 overall. About 1.5 percent of all tests have come back positive, Maine CDC data show.
The coronavirus has hit hardest in Cumberland County, where 2,301 cases have been reported and where the bulk of virus deaths 70 have been concentrated. It is one of four counties the others are Androscoggin, Penobscot and York, with 698, 253 and 1,133 cases, respectively where community transmission has been confirmed, according to the Maine CDC.
There are two criteria for establishing community transmission: at least 10 confirmed cases and that at least 25 percent of those are not connected to either known cases or travel. That second condition has not yet been satisfied in other counties.
Other cases have been reported in Aroostook (44), Franklin (60), Hancock (53), Kennebec (209), Knox (36), Lincoln (42), Oxford (137), Piscataquis (9), Sagadahoc (65), Somerset (85), Waldo (73) and Washington (16) counties.
As of Thursday morning, the coronavirus had sickened 6,945,987 people in all 50 states, the District of Columbia, Puerto Rico, Guam, the Northern Mariana Islands and the U.S. Virgin Islands, as well as caused 202,247 deaths, according to Johns Hopkins University of Medicine.
Think back through the pandemic. Think about the moments that stand out as beacons in the haze signposts of how it would change all of our lives.
Not all of these moments were clear at the time. Chinas decision to shut down cities of millions of people in January was staggering, but to most Americans, this new coronavirus remained an ocean away, not something that would demand our own version of a lockdown.
Other moments form pits in our stomachs when we look back. Perhaps, for you, its when the Centers for Disease Control and Prevention touted it was developing its own test for SARS-CoV-2 instead of relying on international designs. Or when leaders in New York delayed containment plans as cases built. Or when President Trump embraced the unproven and ultimately fruitless hydroxychloroquine as a miracle drug.
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Then there were moments when the new reality arrived with the subtlety of a sonic boom. Take March 11: Trump halted most travel from Europe. Tom Hanks and Rita Wilson announced they had Covid-19. The NBA suspended its season.
Now with health authorities saying it may not be until at least the end of 2021 before theres a degree of post-Covid normalcy in our lives look forward. Imagine the next 15 months and what life will be like.
In this project, STAT describes 30 key moments, possible turning points that could steer the pandemic onto a different course or barometers for how the virus is reshaping our lives, from rituals like Halloween and the Super Bowl, to what school could look like, to just how long we might be incorporating precautions into our routines.
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This road map is informed by insights from more than three dozen experts, including Anthony Fauci and Bill Gates, people on the frontlines at schools and hospitals, as well as STAT reporters. It largely focuses on the U.S.
Perhaps making forecasts during whats habitually described as unprecedented is foolish. Im kind of done predicting none of my predictions worked out for me, Kelly Wroblewski of the Association of Public Health Laboratories said, with a resigned laugh, about when she thought the testing problems that have dogged us from the earliest days might get resolved. And indeed, some of the events will unfold in different ways and at other times than weve charted out.
Yet for all thats caught us off guard about Covid-19, some factors like how a virus spilled from animals and swept around the world are straight out of pandemic playbooks. We can see the coming crossroads.
So many challenges still lie ahead. Flu season. An ongoing child care quandary. A tumultuous election and potential transition of power. Whoever wins, well need them to shepherd a vaccine rollout a logistical and public relations campaign without (heres that word again) precedent.
The virus is not through with us yet, said family physician and epidemiologist Camara Phyllis Jones of Morehouse School of Medicine. The virus has only one job. And thats to replicate itself, and to go from person to person to person and it doesnt care which person.
Throughout the pandemic, whats maddened U.S. public health experts has been the nations inability and unwillingness to take the steps that could reduce illness and death, steps that other countries have used with success. Instead, were trying to force the activities commerce, schools, and festivities that controlling the virus in the first place would enable but that, in our case, are contributing to infection counts.
Theres this attitude that public health measures are getting in the way of opening up the country, Fauci, the countrys most prominent infectious disease expert, told STAT. Its exactly the opposite. In a prudent way, the public health measures are the gateway, the vehicle, the pathway to opening the country. Thats the point that gets lost in this thats so frustrating.
As Fauci monitors the coronavirus trajectory, so do the rest of us, wondering what other hallmarks the pandemic will soon touch like Thanksgiving feasts. At Adams Turkey Farm in Westford, Vt., theyre anticipating this year selling fewer of their signature birds around 24 pounds Oh my gosh, theyre beautiful, said owner Judy Adams and more smaller birds. The holiday meal will still happen; there just might be fewer people squeezing around the table.
Weve weathered different things certainly not a pandemic but I just trust in the holiday, I trust in the turkeys, Adams said. But if this is the year that we make less money, well, that will be OK, and we will get through this.
Overstretched ambulance crews. Overflowing hospitals. Overstuffed morgues. The grimmest images from the spring and summer peaks could appear again this fall and winter if the country doesnt drive its case count down urgently.
If were not going into the fall with a huge running start in terms of having cases at very, very low levels we run the risk of having uncontrollable outbreaks, said Michael Mina, an epidemiologist at Harvards T.H. Chan School of Public Health.
People are returning to offices or schools and interacting with others more. Residents of the northern half of the country, who embraced al-fresco summers, will move indoors. States and cities are inclined to keep easing restrictions.
Then theres the virus itself.
While this is our first fall with SARS-2, experts believe that its activity could accelerate as temperatures drop, as is the case with other viruses, including the four coronaviruses that cause common colds. These viruses survive longer in cold, dry settings, tied to a measure called absolute humidity.
But the virus spread like gossip this summer in the South. Was the heat really slowing it down?
To an extent, experts think. But whatever advantage summer provided was overtaken by the fact that none of us was protected against the virus, and that restrictions like closing bars were lifted. The summer epidemic probably would have been worse if it had been winter, said disease ecologist Marta Shocket of UCLA.
Some communities will have one partial shield this fall: a level of population immunity. Most people who recover from Covid-19 will be protected from a second case for some time, its thought. In hard-hit areas, 20% of residents or more have had the illness already many without knowing it meaning fewer people can be infected and spread the virus.
Were not dealing with a situation like we were in February and March when it was a totally naive population, said epidemiologist Wafaa El-Sadr of Columbia University. These areas have not reached herd immunity when the percentage of protected people is high enough that the spread burns out but, El-Sadr said, its a plus.
Mathematical epidemiologist Gerardo Chowell of Georgia State University has what could be considered an almost optimistic autumnal outlook: a flat number of cases, as increases in the northern half of the country offset declines in the South and some safeguards are kept up.
But Chowell doesnt imagine the real glass-half-full scenario: cases going down. Having seen how U.S. society is split on face masks, Im not very hopeful, he said.
Its possible the fall wont realize our worst fears. The flu season could be mild. Outbreaks in nursing homes and prisons could be prevented. But were approaching the danger zone with lots of virus circulating, when it was presumed that the country would be in a better position.
Ahead of the fall, we were envisioning that there would be a continued downward trajectory of Covid-19, new infections and deaths, Brian Hainline, the NCAAs chief medical officer, said in August. That there would be a national surveillance system, national testing, and national contact tracing that would allow us to really navigate this pandemic and to resocialize both in sport and in the rest of society. And that hasnt happened.
For colleges, theres one over-arching dilemma: How can they safely keep students on campus?
As we look for clues, the University of Wisconsin-Madison is one to watch. Desperate to contain the virus, the school this month mandated that residents of two dormitories and 22 Greek houses quarantine for two weeks. I literally felt like I was being arrested, one student told a TV reporter.
As the students emerge in the coming days, it will become clear whether the gambit worked.
If it does, it could show that universities might be able to hem in the virus and slog through this semester. If it doesnt, it might be a sign that more schools will have to throw in the towel, following the likes of Colorado College and the University of North Carolina in canceling their in-person plans after students showed up. Some schools have gone from in-person to virtual teaching and then given in-person another chance.
College clusters are fueling a sizable portion of new Covid-19 infections around the country. But some schools are soldiering on: The University of Illinois at Urbana-Champaign and schools in New England, for example, have unveiled ambitious testing schemes. Some are holding lectures in basketball gyms or in tents.
But colleges, by design, bring packs of people close together. If cases crop up, they easily beget more. And if one things clear from the start of the semester, its that college kids like to party, Covid or not.
It would be pure luck if you didnt have clusters of cases at some point during the semester, said epidemiologist Nita Bharti of Pennsylvania State University.
The colleges that allowed students to return did so in part because its what students wanted. They pleaded they were missing out on spontaneous 3 a.m. philosophical discussions and intellectual breakthroughs that come only after a group all-nighter. But for the schools, it was also a grasp at a financial lifeline as budgets collapsed.
Universities are in such a hard place, said Meira Levinson, an educational ethicist at Harvard. They are educating people who have the transmission patterns of adults but who are developmentally not making choices the way older adults would.
The deeper impact of college closures could come if schools dont sequester students before sending them home. Absent that, they could spray the virus across the country like shrapnel.
You can practically mouth the script: On stage at Case Western Reserve University in Cleveland (and before a limited audience), former Vice President Joe Biden lambastes Trump for the nations disastrous pandemic response and for failing the American people. Trump tries to convince millions of viewers that the U.S. has turned a corner that his administration defeated the virus and is this close to a vaccine.
And with that, experts say, the election discourse poses real risks.
Since the beginning of the pandemic, scientists have struggled to address Covid-19 misinformation from the administration. While they would normally advise looking to the Food and Drug Administration or CDC, the agencies at times have become megaphones for White House messaging.
We have offices that have credibility and we have noncredible people in those offices, said Penn States Bharti. That has created a disconnect for us for how to handle misinformation.
Trumps attempts to paint a rosier picture of the situation could make it worse, experts say. If politicians prematurely declare victory, it sends the message that people no longer need to wear masks or distance from others.
Im worried that if leaders say to the public like they did back in April or May, that this will be over, if those messages come back, it will confuse people again and well see another surge in cases, said Tom Inglesby, director of the Johns Hopkins Center for Health Security. Its really important for leaders not to sugarcoat things when they are not going well.
Picture the cable news coverage of Septembers unemployment report, a crucial proxy for the economy and the last one before the election. A flashing chart showing the pandemics toll on jobs, and an immediate pivot to the political implications. Trump will likely be watching.
There had been hopes that the economy would bounce back from the depths of the spring in a V-shaped recession. Jobs returned as states allowed more business activity heading into the summer, but only to an extent, and hiring has since cooled. A bad or stagnant jobs report, then, could drive Trump to demand that states lift the remaining restrictions meant to keep a lid on Covid-19.
But the central reason for the sputtering economy, economists say, is the uncontrolled epidemic. Government restrictions certainly dampened activity, but much of the persistent drag is because people do not feel safe traveling or hitting the town or spending money in their usual ways.
People look around and say, the risks are too high, Im not going to go about my activities, said economist Kosali Simon of Indiana University.
This recession stands out for how quickly the economy cratered and for how it devastated select industries while leaving others unscathed. Its also amplified the divide between white-collar workers who could slide into working from home, and lower-wage employees, many of whom lost their jobs or risked infection at their workplaces.
The looming concern is that the pain may spread. Government spending has kept components of the economy treading water. If that support ends before a vaccine arrives, demand could collapse, unemployment could become long-term, and the recession could become entrenched.
Were setting the stage for another decade of massive unemployment and a lost generation of workers, said Harvard economist James Stock. A public health response is not only about saving lives, its holding the economy in its hands.
The solution is not another lockdown, said Stock, whos studying the effectiveness of interventions. Simple but sustained strategies, he said, can sufficiently drive infections down: donning masks, minimizing super-spreading opportunities, maintaining distancing, and restricting indoor activity. Build up testing. If cases get low enough, contact tracing becomes feasible.
Its essential that the country embraces these measures uniformly, Fauci said. If one area in the country does it really well, and another area is careless and it surges up, thats like playing whack-a-mole.
Its too early to say weve overcome all the horrors of testing, from a CDC test that didnt work to shortages of swabs and reagents to delayed (and thus meaningless) results.
But, perhaps, finally, things are looking up. A lot more ubiquitous testing is coming, Ashish Jha, the dean of Brown Universitys public health school, said at a STAT event in September. Ive been saying that for months, but maybe now it will actually be coming.
Faster and cheaper tests are becoming available, supported by a National Institutes of Health program. The Trump administration is distributing millions of antigen tests (which detect viral proteins) to nursing homes. Employers and universities have hatched ambitious testing strategies that could be models.
A potentially more potent tool could also arrive in the coming months: rapid, at-home coronavirus tests, akin to pregnancy tests. This type of antigen test, which could use a saliva sample and is still in development, is not as accurate as PCR diagnostics (which detect the virus genetic material). But the vision is that it could offer individuals a pretty good clue as to whether they have infectious Covid-19 within minutes information that would allow them to go about their lives (with precautions) or isolate themselves. Having a test that can find you when youre transmissible is the whole goal, Harvards Mina said.
Still, plenty of challenges remain. Experts say testing capacity needs to be expanded many times over. Test kits abound on movie sets and in professional sports, yet many people still have trouble locating one. Whatever national testing strategy exists is defined by deferring to states, leaving local labs more vulnerable to supply chain snags and to getting overwhelmed.
The idea of what a rational testing plan looked like you know, we were on the phone with all the key people in the federal government in those key months [February and March], and it just didnt happen, Bill Gates told STAT.
Within two weeks of schools in Cherokee County, Ga., opening in August, when local coronavirus transmission was still high, more than 1,000 students and staff found themselves in quarantine and three high schools reverted to online learning.
In the Northeast, as schools considered welcoming students for in-person instruction in September, communities generally had low Covid-19 rates the surest signal that schools can reopen safely. But even there, last-minute snafus threw some plans into disarray, showing the difficulty of trying to hold together a strategy in a changing pandemic.
New York City, which planned to open schools for a mix of classroom and remote learning Sept. 21, delayed for another week on Sept. 17. In Carle Place School District on Long Island, the superintendent made the call to switch to virtual learning two days before school started, after parties led to a spike in Covid-19 cases. As we are learning the hard way, the actions of a few can impact the many, Superintendent Christine Finn wrote in a letter to families.
By mid-October, the northeastern schools that did welcome students back will be a month in time for a report card on their strategies. Rhode Island, for example, opened schools in most districts, starting with some students as they moved toward full classes. There will also be signals whether schools that needed more time to get staff on board with in-person plans or to retrofit classrooms to meet safety standards can get kids back.
Other countries have made it clear that low community transmission levels and rigorous strategies can enable schools to reopen and stay open. In a recent editorial in Science, researchers wrote that with distancing, limited classroom size, ventilation, and masks, transmission within schools has been rare. But in the U.S., schools havent been prioritized. In some places, movie theaters and gyms and indoor dining came back, even as local viral levels were deemed too high for in-person teaching. Were making choices that dont necessarily make a lot of sense, said Zo McLaren, a health policy expert at the University of Maryland, Baltimore County.
Cases will be detected at school, experts stress. The question is what happens then. Districts need plans for how extensive quarantines should be, how many cases would trigger a shutdown, and how long that should last.
Returning to school, of course, is not just about the risk to kids, who are much less likely to get serious Covid-19 cases than adults. About 40% of teachers and 40% of adults living with children have health conditions that increase the likelihood of more severe Covid-19, according to one study. Many children live with a grandparent. Households have been key transmission points during the pandemic, and kids cant isolate from their family. If your kid gets sick, youre probably going to get sick too, said Maia Majumder, a computational epidemiologist at Boston Childrens Hospital.
The first treatments specifically crafted to fight SARS-2 could join clinicians armaments this fall.
Called monoclonal antibodies, they are designed to block the virus from slipping into cells. A number of candidates are in clinical trials, with results possible starting in October.
The real boon could be if monoclonals keep patients with mild Covid-19 from progressing to more severe illness. They are also in earlier-stage testing to see if they can stop infection, akin to a vaccine.
What we really need are therapies that can be administered early to prevent someone from actually needing to go to the hospital, Fauci said. Thats the big gap that we have.
When the pandemic erupted, the worlds medicine cabinet was bare of any coronavirus therapies. Researchers adapted, finding that an experimental antiviral called remdesivir helped hospitalized patients recover faster and that common steroids reduced deaths. Theyre exploring blood thinners to stop clots, and ways to calm overhyped immune systems that paradoxically cause many patients deaths. And then theres the still maybe-beneficial convalescent plasma an antibody-rich blood component donated by people recovered from Covid-19.
Monoclonals have been seen as providing a bridge for the pandemic a treatment for patients who get sick while vaccines are being rolled out. But there are questions about whether their development will take too long to make a real impact. There hasnt been a significant push, for example, to manufacture them en masse.
It makes sense for something like Ebola, sure, when there arent that many people who get infected at a time, said Juliet Morrison, a University of California, Riverside, virologist. But with Covid-19, can we scale up to really do that for the whole population?
Usually, these meetings are eye-glazing to anyone beyond scientists and drug companies, yet another expert gathering in a conference room at the FDAs suburban Maryland campus. But the topic will be Covid-19 vaccines, and given the timing 12 days before the election people nervous about potential White House interference in the FDAs evaluations have this date circled on their calendars.
At a routine meeting of these outside scientific advisers, the group might discuss the composition of that years flu shot or debate clinical trial data for a vaccine. At this one, its expected that results from Covid-19 vaccine candidates wont be ready. Still, the (virtual) meeting could be a chance for the experts to build up a scientific bulwark against meddling from Trump a moment when they will punctuate the importance of a rigorous review of immunizations, conducted only once adequate safety and efficacy data are available.
The medical science community must stop this dance as we get closer to rolling out a vaccine for Covid-19 because we now know that we wont get any help from the federal government, Holden Thorp, the editor-in-chief of the Science journals, wrote in an editorial. Were on our own.
FDA Commissioner Stephen Hahn has said that the meeting is part of the agencys commitment to being as open and transparent as possible and that it will help the public understand the data needed to facilitate [vaccines] authorization or licensure. Hahn has pledged that politics and pressure from the White House wont force the agencys hand.
But the president has already accused the agency of harboring the deep state and slowing treatment development. Hes also staked his reelection on a vaccine, promising at the Republican National Convention that we will produce a vaccine before the end of the year, maybe even sooner, without mentioning the uncertainty around clinical trials.
OK, so this one might not happen.
But if it does, imagine the juxtaposition. A spike-the-football Trump tweet, and scientists fretting that a hastily released vaccine desecrated the regulatory process.
To be clear, there is a small but legitimate possibility that, should one of the vaccine candidates be wildly effective, clinical trials could demonstrate that by the end of October. Executives at Pfizer have said they could have results by then. But most experts think that the requisite data wont be available until later.
Everyone involved in the vaccine review process, including the companies testing them, says they are committed to ensuring the safety and efficacy of immunizations. And yet experts still cant shake the feeling that something untoward might happen before the election. Call it an October surprise, pandemic style.
Perhaps the FDA will try to thread the needle. Hahn has suggested a possible authorization for a vaccine for certain populations, such as health workers. But the great fear is that, if some issue emerges with a vaccine after it is authorized, it will only steepen the uphill climb vaccine campaigns are facing. A not insignificant portion of Americans are dubious about Covid-19 vaccines. Unforced errors could only entrench their uneasiness.
If [the FDA] is bullied on this for vaccines, there are going to be a lot of people who stand up and say, I wouldnt get this vaccine. And then what youve done is youve scared people and you only get one chance to make a first impression, Paul Offit, director of the Vaccine Education Center at Childrens Hospital of Philadelphia, said in August.
Even if a vaccine meets the standards for an emergency use authorization, it might still raise eyebrows. The track record of the FDA for EUAs with Covid has not been good, said UMBCs McLaren, citing the flip-flop on the hydroxychloroquine EUA and the politicization around the convalescent plasma EUA.
The endgame is not vaccine No. 1, McLaren said, noting that the world will need multiple vaccines to have enough supply. If trust in the EUA pathway is further damaged with vaccine No. 1, its going to hurt vaccines No. 2, 3, 4.
Parents, it may be time to have a difficult talk with your children.
Los Angeles County has advised against trick-or-treating. Towns in Ohio have canceled public trick-or-treating events. And in Salem, Mass., a city of 43,000 that normally hosts a monthlong Haunted Happenings festival that welcomes half a million people, pretty much all the events had to be canceled, rescheduled, or go virtual, said Kate Fox of Destination Salem. Fox said people will still make the pilgrimage to Salem, but stressed that Massachusetts requires a negative Covid-19 test or a quarantine for people coming from most states.
Perhaps nothing will change, or everything will.
If Biden is elected, he has said his first post-election phone call would be to Fauci, with a request that the scientist continue his service. He has a plan to assemble a new team of health officials to guide the country out of the pandemic. If Trump is re-elected, dont expect any major shifts in strategy.
But its not Covid-19 policy differences driving voters, said Robert Blendon of Harvard, an expert on the intersection of politics and health policy. When it comes to the pandemic, voters are thinking pragmatically how a Trump or Biden presidency would affect whether they can go to work and send their kids to school, or whether their businesses will survive.
And, Blendon added, Whats important to understand is that if there was some public health miracle in October, the polls would change dramatically.
In 2018, so many people came down with the flu that Pennsylvanias Lehigh Valley Health Network threw up tents to handle the influx of patients. In April of this year, the hospital almost had to turn operating rooms into ICUs for Covid-19 patients. The question for Lehigh Valley is: What would a double whammy look like?
My hope is that with all the education of the public, maybe its not as bad, Jennifer Rovella, the systems chief of critical care, said about the approaching flu season.
Its clear why experts worry about a wave of Covid-19 coinciding with a bad flu season whats been dubbed the twindemic. But its also possible that all the precautions against SARS-2 will reduce transmission of influenza; the Southern Hemispheres flu season, for instance, was remarkably mild.
Health officials arent taking chances. Theyre warning that people could get infected by both viruses, potentially making them more likely to get seriously ill. Theyre pleading with the public to get flu shots, which, even if they dont prevent infection, reduce the chances of severe disease. Weve ordered about twice the number of flu vaccines as we normally do, said Rachel Levine, Pennsylvanias health secretary.
Beyond the threat to health systems, distinguishing between the infections will be a head-scratcher for clinicians. Flu and Covid-19 have overlapping symptoms, including cough, fever, and aches. Doctors often dont even test for flu and diagnose a case based on an exam, but they wont be able to do that this year. Some tests that detect both viruses are being rolled out, but the urgency to tell if someone has flu or Covid-19 or both with implications for isolation and contact tracing could worsen bottlenecks.
You rely on the same laboratories and very similar testing supplies and equipment, said the lab associations Wroblewski.
Media Advisory
Thursday, September 24, 2020
New findings by scientists at the National Institutes of Health and their collaborators help explain why some people with COVID-19 develop severe disease. The findings also may provide the first molecular explanation for why more men than women die from COVID-19.
The researchers found that more than 10% of people who develop severe COVID-19 have misguided antibodiesautoantibodiesthat attack the immune system rather than the virus that causes the disease. Another 3.5% or more of people who develop severe COVID-19 carry a specific kind of genetic mutation that impacts immunity. Consequently, both groups lack effective immune responses that depend on type I interferon, a set of 17 proteins crucial for protecting cells and the body from viruses. Whether these proteins have been neutralized by autoantibodies orbecause of a faulty genewere produced in insufficient amounts or induced an inadequate antiviral response, their absence appears to be a commonality among a subgroup of people who suffer from life-threatening COVID-19 pneumonia.
These findings are the first published results from the COVID Human Genetic Effort, an international project spanning more than 50 genetic sequencing hubs and hundreds of hospitals. The effort is co-led by Helen Su, M.D., Ph.D., a senior investigator at the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH; and Jean-Laurent Casanova, M.D., Ph.D., head of the St. Giles Laboratory of Human Genetics of Infectious Diseases at The Rockefeller University in New York. Major contributions were made by Luigi Notarangelo, M.D., chief of the NIAID Laboratory of Clinical Immunology and Microbiology (LCIM); Steven Holland, M.D., director of the NIAID Division of Intramural Research and senior investigator in the NIAID LCIM; clinicians and investigators in hospitals in the Italian cities of Brescia, Monza and Pavia, which were heavily hit by COVID-19; and researchers at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.
The wide variation in the severity of disease caused by SARS-CoV-2, the virus behind COVID-19, has puzzled scientists and clinicians. SARS-CoV-2 can cause anything from a symptom-free infection to death, with many different outcomes in between. Since February 2020, Drs. Su and Casanova and their collaborators have enrolled thousands of COVID-19 patients to find out whether a genetic factor drives these disparate clinical outcomes.
The researchers discovered that among nearly 660 people with severe COVID-19, a significant number carried rare genetic variants in 13 genes known to be critical in the bodys defense against influenza virus, and more than 3.5% were completely missing a functioning gene. Further experiments showed that immune cells from those 3.5% did not produce any detectable type I interferons in response to SARS-CoV-2.
Examining nearly 1,000 patients with life-threatening COVID-19 pneumonia, the researchers also found that more than 10% had autoantibodies against interferons at the onset of their infection, and 95% of those patients were men. Biochemical experiments confirmed that the autoantibodies block the activity of interferon type I.
Q Zhang et al. Inborn errors of type I IFN immunity in patients with life-threatening COVID-19. Science DOI: 10.1126/science.abd4570 (2020).
P Bastard et al. Auto-antibodies against type I IFNs in patients with life-threatening COVID-19. Science DOI: 10.1126/science.abd4585 (2020).
NIAID Director Anthony S. Fauci, M.D., NIAID Senior Investigator Helen C. Su, M.D., Ph.D., and Luigi Notarangelo, M.D., chief of the NIAID Laboratory of Clinical Immunology and Microbiology, are available for interviews.
To schedule interviews, please contact NIAID Office of Communications, (301) 402-1663, NIAIDNews@niaid.nih.gov.
NIAID conducts and supports research at NIH, throughout the United States, and worldwide to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIHTurning Discovery Into Health
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Fully work-from-home has worked for corporate America as a temporary solution to the coronavirus pandemic, but top executives at some of the largest companies say their firms are still working out what the new employee normal will be, and burnout is a big risk.
"The myth that work from home is not productive has been busted," said Harmit Singh, CFO at Levi Strauss & Co. at a recent CNBC @Work virtual event. "I believe we will settle into a culture where working from anywhere will be the new norm, with work from homeor office or a hybrid arrangement."
Levi Strauss "pulled the plug" on any new commercial real estate it was exploring this year, the CFO said, as it attempts to figure out what the new workplace structure will look like, and that includes concerns about productivity declines.
"Employee burnout is a core issue," Singh said.
Changes to work scheduling that Levi Strauss already has made to mitigate this productivity challenge include a mandate that meetings be shorter, that no meetings be scheduled on Fridays, and making the last Friday of every month a day off.
"I believe we will go through a second wave of team member or employee duress," Schuyler said. "The first wave was when the crisis first hit us in the spring, and the second is settling in ... and it will be longer term," he said.
With schools back in session and parents having to balance many needs of school-age children, "the second wave of duress is gonna hit and it is causing lower productivity," the Hilton CHRO said. "With the isolation from work from home, we can expect to see more of it," he added. "Keeping the workforce connected remotely was sustainable for a period of time, but it is harder as it goes on."
Senior human resources and financial executives say work will be hybrid, with both work from home and some return to offices part of a new normal, and figuring out how to relieve employee stress and isolation are top concerns.
Clara Margais | picture alliance via Getty Images
Schuyler said Hilton is looking at ways to engage not just virtually, but get offices reopened to safely engage in person, and as a lodging company, the problem is at the property level as well. since it is reopening across 6,200 properties around the world and that includes dynamics likes employees delivering hospitality at a local level while wearing personal protective equipment.
"Employee well-being matters and we are learning as we go," Schuyler said.
Hilton is surveying its workers more than ever before to gather feedback, as often as on an hourly basis.
Both Levi Strauss and Hilton have been forced to make layoffs.Levi Strauss announced in July it was cutting about 15% of its global corporate workforce, impacting about 700 jobs. Hilton laid off 22% of its corporate staff in June.
The accelerating digitization of corporate spending is not only focused on the consumer experience.
Schuyler said its threshold in managing through a crisis was to start by protecting its core, and in hospitality, the core is people. From a financial perspective, the lodging company had to make tradeoffs and invest where it can receive the highest return from its people, and that ranges from operations being completely suspended to those that are just reopening, and how to reopen more efficiently. That requires leveraging the acceleration of technology for bothwork-from-home employees and the guest experience from booking to the property-level using technology in a touchless way, "socially distanced hospitality delivery."
Levi Strauss, which cut its overall spending plan from $200 million to $150 million, made cuts related to opening new stores and maintenance,while it pivoted spending to digitization of consumer experience, AI, and connecting with employees. Digital investments included support for buying online and picking up in stores, shipping from stores, ideas that went from being in the pre-Covid pipeline for future years toto being rolled out in months, according to Singh, but also included spending on digitization of employees working remotely.
"It is clear these are changes that will be here for the long term," Singh said.
Major companies are taking divergent approaches in the current uncertain environment.
Alphabet said this week that it will lean in to a hybrid work model as most of its employees dont want to come in every day.
Netflix CEO Reed Hastings recently said working from home is "a pure negative"but a return to the office for the majority of employees won't happen until there is a vaccine.
Wall Street firms including JP Morgan are having key employees such as traders return to the office, but already facing Covid-19 cases and was forced to send workers home again.
For now, the days of six-month plans, annual plans, or plans even longer than that, are "gone," according to the Levi Strauss CFO. "We're uncertain about timing of a vaccine and it is not even one crisis. We've had crisis after crisis ... the pandemic and recession and social injustice and fires and floods."
For more on tech, transformation and the future of work, join the most influential voices disrupting the next decade of work at the nextCNBC @Work Summitthis October.
The Taj Mahal reopened to visitors on Monday in a symbolic business-as-usual gesture even as India looks set to overtake the U.S. as the global leader in coronavirus infections. Sajjad Hussain/AFP via Getty Images hide caption
The Taj Mahal reopened to visitors on Monday in a symbolic business-as-usual gesture even as India looks set to overtake the U.S. as the global leader in coronavirus infections.
India is poised to overtake the U.S. as the country with the most COVID-19 cases. This week the Taj Mahal reopened to tourists for the first time in more than six months. NPR correspondent Lauren Frayer reports on how that's not an indication that the pandemic there has subsided.
Across Europe, countries are also seeing cases surge. NPR correspondents Frank Langfitt, Eleanor Beardsley, and Rob Schmitz discuss the rise in cases, new restrictions and how people are coping in the U.K., France and Germany.
In participating regions, you'll also hear a local news segment that will help you make sense of what's going on in your community.
Email us at considerthis@npr.org.
This episode was produced by Brianna Scott, Lee Hale and Brent Baughman. It was edited by Sami Yenigun with help from Wynne Davis, Rebecca Davis, and Scott Hensley. Additional reporting from Allison Aubrey. Our executive producer is Cara Tallo.
Editor's Note The views expressed in this commentary are solely those of the writer. CNN is showcasing the work of The Conversation, a collaboration between journalists and academics to provide news analysis and commentary. The content is produced solely by The Conversation.
(CNN) The coronavirus pandemic has reshaped the 2020 US presidential campaign, limiting the number of rallies and in-person appearances of the candidates.
When candidates do venture out, a familiar form of campaign transportation, the campaign bus, is likely to remain grounded, as tight quarters make social distancing nearly impossible.
Until recently, candidates have relied primarily on social media to reach voters. But this medium and campaigning from home -- or from your front porch, as Warren Harding did in 1920 at the end of another pandemic -- cannot sufficiently substitute for in-person contact with voters.
Aircraft have played a role in US presidential campaigns for decades. As an aviation historian attentive to the evolution of the general aviation sector, I think the pandemic has increased their importance in 2020, forcing candidates to make more strategic use of aircraft as the quickest and safest way to campaign.
Campaigns take flight
The use of airplanes in presidential campaigns has evolved from something so daring -- even death-defying -- that it made headlines, to a convenient, necessary tool.
Today it's the safest way for candidates to travel -- not simply because of aviation's safety record but due to the dangers candidates face amid the pandemic.
With the Great Depression hanging over the 1932 presidential election, New York Gov. Franklin D. Roosevelt believed the country would respond to bold leadership. His campaign hatched a plan to break with protocol and accept the Democratic presidential nomination in person -- and in dramatic fashion.
Working with American Airways --now known as American Airlines -- Roosevelt's secretary, Guernsey Cross, arranged to charter a Ford Tri-Motor, a standard commercial aircraft of the early 1930s, to fly the governor from Albany to Chicago. During a year when only 474,000 Americans traveled via commercial aircraft, the flight captured media attention.
The plane took off at about 8:30 a.m. on July 2, 1932, and after stops in Buffalo and Cleveland arrived in Chicago at 4:30 p.m., two hours behind schedule due to bad weather. Roosevelt used the time to work on his speech. That evening he accepted the nomination in person and promised Americans a "new deal."
Roosevelt's flight, however, did not immediately lead to more presidential air travel. Although First Lady Eleanor Roosevelt would use aircraft extensively, air travel was considered too risky for the president. FDR would not fly as president until 1943, when he used a military aircraft to travel to the Casablanca Conference in Morocco, to attend a crucial strategy meeting with Winston Churchill.
Private planes gain prominence, come under fire
During his 1960 campaign, John F. Kennedy catches some rest while en route from St. Louis to New York City.
Bettmann/Bettmann/Bettmann Archive
Presidential air travel was well established when, during the 1960 presidential campaign, John F. Kennedy became the first candidate to use his own private aircraft -- a Convair CV-240 -- to campaign.
It's probably an exaggeration to argue that the plane -- dubbed "Caroline" for his young daughter -- provided Kennedy with his margin of victory in the hotly contested race, as claimed by The Smithsonian.
But it did allow Kennedy to travel more than 225,000 miles and campaign more efficiently. And since then, presidential candidates have made extensive use of private aircraft during their campaigns. Most campaign aircraft are chartered or owned by the campaign.
There was nothing particularly controversial about campaigning with private aircraft until the 2008 financial crisis. As the nation plunged into the Great Recession, automobile industry CEOs came under fire for using corporate aircraft to fly to Washington, D.C. for congressional hearings focused on the huge bailout packages the industry had received from the government. Intense public backlash led to a drastic market downtown for corporate jets. That backlash might explain the then Senator Barack Obama's 2008 whistle-stop campaign train tour, where he chose an historic mode of presidential transportation over the newly controversial one.
By 2012, however, memories of the 2008 controversy had faded and candidates again used private jets for campaign travel. Mitt Romney leased a 1990 MD-83, while his running mate, Paul Ryan, utilized a 1970 DC-9-32. Both aircraft, bearing the slogan "Believe in America," debuted at a campaign rally in Lakeland, Florida.
Mitt Romney (right) and running mate Paul Ryan stand outside the 1970 DC-9-32 aircraft.
Justin Sullivan/Getty Images
But perhaps the most visible use of a private aircraft in a presidential campaign came with Donald Trump's use of his own Boeing 757 in the 2016 presidential race.
Trump used the plane, emblazoned with his name, as a backdrop at campaign rallies (see the photo at the top of the story). The plane, thus, not only allowed him to travel easily and extensively, but it also helped him promote his personal Trump brand at every campaign stop.
Safety during the pandemic
Though commercial aviation has witnessed a small recovery since the start of the COVID-19 pandemic, private aircraft have reemerged as the safest way to travel. They permit greater control over passengers and make social distancing easier. Both Air Force One and private aircraft have featured prominently in the 2020 presidential election.
Both candidates are in their seventies and at greater risk from infection. The Secret Service will continue to take precautions to keep President Trump safe on Air Force One. And Biden's campaign can more easily enforce health guidelines on a private plane, especially protocols on masks and social distancing. Although the Biden campaign has decided against leasing a dedicated campaign plane, when necessary -- such as for his recent trip to Kenosha, Wisconsin -- Biden can and undoubtedly will make use of private aircraft.
The 2020 presidential election began amid stay-at-home orders, with President Trump and Joe Biden largely confined during the first few months. As Trump and Biden seek to get their messages out in the final weeks of the campaign, both will use aircraft when necessary and in what they determine to be the best interests of their respective races for the White House.
Janet Bednarek is Professor of History at University of Dayton.
DARWIN, Australia Alison Richards, a 38-year-old graphic designer, had been living in Britain for five years when she decided to move home to Australia. Then she got sick with Covid-19 and lost her job.
It was an awful experience, said Ms. Richards, who spent six weeks without leaving her apartment, except for the night she became so ill she called an ambulance. I thought, Ill just pull myself through this and get home.
Shes still waiting.
Ms. Richards is among tens of thousands of Australians stranded abroad because of government coronavirus restrictions that cap the number of people allowed on flights into the country. In mid-June, Ms. Richards booked a ticket to Sydney, but she has been bumped twice from her flight as a result of the caps.
Australia is one of the few places in the world that is barring citizens from leaving their own country and limiting the number of those who can return. The tough regulations have raised legal concerns about the right to freedom of movement, and have been especially painful for the large numbers of Australians who turn to travel as a balm against the tyranny of distance from the rest of the world.
We wanted to take our kids out of the Australian bubble, Daniel Tusia, 40, said of his familys decision to travel internationally for a year. Mr. Tusia ended up spending $14,000 on business-class tickets to get his wife and their two children, one of whom has special needs, back to Australia after weeks of trying to get home.
It never entered our mind before this point that Australia would actually physically and legally obstruct you from entering, he said.
Scott Morrison, Australias prime minister, has framed the countrys hard-line approach as crucial to avoiding the kind of rampant spread of the virus experienced in countries that have travel restrictions that are looser or nonexistent, as in the United States.
As an island continent, control of our borders has been a means by which we have kept Australians safe, he wrote in a letter in August sent to those requesting consular assistance to return. He acknowledged that the measures were frustrating, but said they were necessary.
But as many of those stranded abroad have become more publicly vocal about their plight, some opposition politicians have expressed more empathy. These are people who have the right to come back to their country, because they are Australians, Kristina Keneally, the Labor Partys top official for home affairs, told Parliament in September.
Last week, under growing pressure, Mr. Morrison said the caps on passengers entering the country would be raised to 6,000 per week from 4,000. Those numbers, though, depend on cooperation from the states and their capacity to quarantine arrivals, and travel industry experts said they still fell far short of demand.
They encouraged Mr. Morrison to pursue alternatives like allowing people traveling from countries with low infection rates to self-isolate, instead of mandating quarantine in government-designated facilities. Similar programs have been successful in Hong Kong, Singapore and Qatar.
While the authorities estimate that there are more than 35,000 citizens who want to return home, the airline industry says that based on booking statistics, as well as figures from the Australian Bureau of Statistics, the number is most likely closer to 100,000.
In the first week of September, more than 140 international flights with about 30,000 seats arrived in Australia, but only about 4,000 were filled. Often, business- and first-class seats are prioritized, meaning that only some can afford to come home.
Mohammad Khan, who has been stuck in Pakistan with his wife since March, said he was forced to buy business-class tickets after four of his economy tickets were canceled.
The couple could not afford the flights, but needed to return to Australia by December to ensure that Mr. Khans wife did not violate her visa requirements. So they sold their car in Australia. We are in a miserable condition here, running out of money and time, he said by email.
Emily Costello, 27, who began a job teaching English in South Korea last September, said there are just two flights to Australia before her visa expires, and they are both booked up.
She said she could not afford to return in March, when the pandemic began to escalate and Australia urged its citizens to come home. She has since finished her contract and has been couch surfing with a colleague while petitioning the Australian government for answers.
Im not sleeping, Im vomiting a lot because of the stress, my hands have started shaking, said Ms. Costello, who suffers from depression and anxiety. It shouldnt be a lottery.
Barry Abrams, the executive director of the Board of Airline Representatives of Australia, said that the travel caps had the punitive effect of leaving people out in the cold for decisions made during a period of extreme uncertainty.
Australians have a high propensity to travel, he said, adding: Regardless of whether the person could have heeded the call, they are now in a very difficult situation. Is it really right not to have arrangements in place to bring them home?
He added that it was not just the number of incoming passengers, but also those leaving the country, that needed to be expanded. Currently, Australians wanting to go abroad have to apply for exemptions, and many have been denied.
I never in a million years thought I would be helping Australians to leave the country, said Sonia Campanaro, a Melbourne immigration lawyer.
For those still stuck overseas, repatriation might be up to six months away. Some say they are considering a class-action suit against the federal government. Others have launched petitions and campaigns, including one through Amnesty International that asserts that leaving people stranded overseas is a breach of their human rights.
While it is true that international conventions ensure the right of people to return to their countries, the Australian government is not technically barring citizens from returning home, even if the airline caps are having that effect, law experts said.
Anyone bringing legal action against the government for stranding them would have to prove that the reasons for doing so were unjustified, they added.
For Ms. Richards, the graphic designer, her frustration at not being repatriated, especially when she followed government guidelines to remain in Britain until her illness passed, is building.
Im really, really angry, she said. All those people who say, Oh, you should have come home sooner, I say, Oh, would you have liked me to come home and infected an entire planeload of people?
While contending with long-term complications of Covid-19, including heart palpitations and brain fog, Ms. Richards has written to numerous politicians pleading for assistance. She is currently booked on a flight out of London on Sunday, but is doubtful that it will go ahead, given the previous cancellations.
Its still confirmed, but I keep checking it every hour of every day, Ms. Richards said. Hopefully, Ill be flying.
CLEVELAND, Ohio - Nine Ohio counties are now under red alert in the states coronavirus advisory system, with Cuyahoga County continuing a step lower at orange for the the sixth consecutive week, Gov. Mike DeWine announced Thursday.
The red counties because of growing or lingering COVID-19 spread include the addition of five this week - Ashland, Delaware, Pike, Scioto and Stark. Four others remain there from the previous week - Butler, Mercer, Montgomery and Putnam.
A week ago there were five red counties, the lowest number since DeWine introduced the four-level advisory system July 2. Red is considered a Level 3 public emergency because of very high exposure and spread. Purple is the highest level, a step above red, but no county yet has been placed on Level 4 purple alert.
The red counties last week were Butler, Mercer, Montgomery, Putnam and Portage, with the governor at the time blaming off-campus gatherings around Kent State for the increased infections that led to Portage County being on that list. Portage dropped back down to orange in this weeks update, meeting three of the states seven criteria for concern.
Cuyahoga County on July 2 started out on red and stayed there until dropping to Level 2 orange on Aug. 20.
Case numbers have improved dramatically for Cuyahoga County, but not enough to drop to Level 1 yellow. For the fifth straight week, Cuyahoga has been flagged for two of the seven areas of concern. That needs to drop to one to go to yellow.
For new cases in the last two weeks, one of the criteria that has kept Cuyahoga in orange, Cuyahoga has dropped from 139.4 cases per 100,000 in the July 30 update to 54.6 this week. Yet it needs to be below 50 for a county not to be flagged for this measure. Fifty-two of the 88 counties are at 50 cases per 100,000 or above.
The other area where Cuyahoga County has been flagged regularly is for more than 50% of its new cases being outside congregate living areas, such as nursing home, in at least one of the last three weeks.
Like Cuyahoga, nearly every county in the state was flagged for not staying below this threshold. Seventy-nine of the states 88 counties currently are flagged this.
Cuyahoga County was flagged for meeting two of seven coronavirus-concern measures this week, keeping the county at orange alert. The number of indicators must drop to one before a county is assigned the lower yellow alert.Ohio Department of Health
This week there are 32 yellow counties statewide, and 47 in orange.
In the Greater Cleveland area, Cuyahoga and Portage are joined in orange by Lorain and Summit counties. Yellow this week are Geauga, Lake and Medina counties
See the chart at the bottom of the story for how each Ohio county graded.
Each county is graded on seven criteria. Meeting none or one of the criteria places a county on Level 1 yellow; two or three on Level 2 orange; four or five on Level 3 red; and six or seven on Level 4 purple. No county has ever been placed on purple alert.
* 1. New cases - Alert triggered when there are 50 new cases per cases 100,000 residents over the last two weeks.
* 2. Increase in new cases - Alert triggered by an increase in cases for five straight days at any point over the last three weeks. This is based on the date of onset of symptoms, not when the cases are reported.
* 3. Non-congregate living cases - Alert triggered when at least 50% of the new cases in one of the last three weeks have occurred in outside congregate living spaces such as nursing homes and prisons.
* 4. Emergency rooms - Alert triggered when there is an increase in visits for COVID-like symptoms or a diagnosis for five straight days at any point in the last three weeks.
* 5. Doctor visits - Alert triggered when there is an increase in out-patient visits resulting in confirmed cases or suspected diagnosis for COVID-19 for five straight days at any point in the last three weeks.
* 6. Hospitalizations - Alert triggered when there is an increase in new COVID-19 patients for five straight days at any point over the last three weeks. This is based on the county or residence, not the location of the hospital.
* 7. Intensive Care Unit occupancy - Alert triggered when ICU occupancy in a region exceeds 80% of total ICU beds and at least 20% of the beds are being used for coronavirus patients for at least three days in the last week.
Rich Exner, data analysis editor for cleveland.com, writes about numbers on a variety of topics. Follow on Twitter @RichExner. See other data-related stories at cleveland.com/datacentral.
Here is how each Ohio county graded this week in Gov. Mike DeWine's coronavirus alert system.Ohio Department of Health
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About 16,400 Ohioans currently have coronavirus, based on latest total of known cases
Michelle Vargas of Granite City, Illinois, has always vaccinated her 10-year-old daughter, Madison. They both typically get flu shots. But when a vaccine for the coronavirus eventually comes out, Vargas will not be giving it to her daughter even if Madison's school district requires it.
"There is no way in hell I would be playing politics with my daughter's health and safety," said Vargas, 36, an online fitness instructor. If the public school Madison attends and loves says the vaccine is mandatory, "we would find other options," she said.
As pharmaceutical companies race to manufacture a Covid-19 vaccine, many people are wary of a shot that is working its way through the approval process at record speed during a highly politicized pandemic. While some professions could require employees to get the vaccine, experts say schools almost certainly will require students to potentially setting the stage for a showdown between reluctant parents and education officials.
"We want to make sure kids return to in-person learning as quickly as possible, and we do see a vaccine playing a huge part in the process," said school law attorney Brian Schwartz, an adjunct professor of education law at the University of Illinois Springfield. "This is going to be a huge issue, and I don't think most people understand that yet."
It is an especially delicate time for parents to hesitate about vaccinating their children. Vaccines have long been a hot button issue, particularly as a small but vociferous group has spread false information, such as the debunked myth that the measles-mumps-rubella shot causes autism.
As with other vaccines, the decision whether to require one for Covid-19 in schools will be made at the state and school district levels. While all 50 states require student vaccinations, a patchwork of laws allows for parental objections: All states allow for exemptions for children with medical reasons, and 45 states plus Washington, D.C., grant exemptions on the basis of religious objections, according to the National Conference of State Legislatures. On top of that, 15 states allow for philosophical exemptions for people who object to immunizations on the basis of personal, moral or other grounds.
Opponents have already started sharing outlandish lies on social media about the Covid-19 vaccines in development, but this time, conspiracy theories have not been needed to sway some who otherwise dutifully immunize their children.
A Gallup poll released in August found that 1 out of 3 Americans would not get the Covid-19 vaccine if it were ready now, even if the vaccine were free. A month later, a smaller USA Today/Suffolk University poll found that two-thirds of U.S. voters do not want to get the coronavirus vaccine when it becomes available. Those polled said that they felt there will be insufficient data on the long-term effects of a rushed vaccine and that they are suspicious that pressure from President Donald Trump ahead of the election could compromise its safety standards.
Vargas, who has never before considered herself opposed to vaccinations, shares those worries.
"I understand that time is of the essence and a lot of people want to get on with their lives," she said. "But any time anything is rushed, integrity goes out the window."
There is no question that the hunt for a worthy coronavirus vaccine is happening on an accelerated timetable.
Vaccines typically take years, sometimes decades, to develop. Yet in April, through an initiative called Operation Warp Speed, the Trump administration announced that it aimed to "deliver 300 million doses of a safe, effective vaccine for COVID-19 by January 2021." It's a lofty promise that the government's top infectious diseases expert, Dr. Anthony Fauci, has said he believes could be possible although he has added that he fears that the "Star Trek"-inspired moniker of the operation could fuel public distrust in it.
The Covid-19 vaccine will come as public health officials battle a growing number of anti-vaccine hot spots across the United States, which have contributed to outbreaks of diseases such as measles that were once eradicated in this country,
It also comes as several groups are uniting in their doubts about public health initiatives, said Dr. Howard Markel, a pediatrician who is director of the Center for the History of Medicine at the University of Michigan.
"You've got anti-vaxxers who are protesting along with libertarians and anti-government people and people who don't trust science or politicians. It's not a monolithic group," he said. "I don't know how it's going to roll out, but it's not going to be pretty."
Despite the unparalleled speed of the Covid-19 vaccine trials, experts said they have confidence that the protocols for safety and efficacy are being followed. An incident this month, when reported spinal cord damage in one participant briefly halted AstraZeneca's vaccine trials, proved that "the system worked," Markel said.
Dr. Yvonne "Bonnie" Maldonado, a professor of pediatrics, epidemiology and population health at the Stanford University School of Medicine, urged parents to ask trusted providers, such as their pediatricians, for as much information as possible about the vaccine whenever it comes out.
"I don't think we can make a decision one way or the other until these trials are finished and we have the data in front of us," she said. "But I think it's even more important to emphasize that we have a lot of confidence in the vaccine development structure in the U.S. and elsewhere, and you really see that the process seems to be working well so far."
"What we want to do is certainly maximize the number of children who receive the vaccine, which will, in turn, help build herd immunity for those kids who aren't vaccinated or can't be vaccinated."
Schwartz echoed the need for parents to be educated.
"Once we do have a safe and reliable vaccine, it's really incumbent on school districts and public health departments to provide information," he said. "What we want to do is certainly maximize the number of children who receive the vaccine, which will, in turn, help build herd immunity for those kids who aren't vaccinated or can't be vaccinated."
Officials have some time to convince hesitant parents.
Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, has said a Covid-19 vaccine will likely not be widely available until summer or fall 2021. And if the vaccine does get approved in the coming months, children are so far down on the priority list for it that they would not be offered it right away: Health care workers, those with underlying conditions that put them at higher risk and older people are in line to get the first batch, while teachers are among those supposed to get the second.
But some educators, particularly those returning to in-person classes, may push for students to be moved higher up in the queue. While children generally do not get as severely ill from the coronavirus as adults do, research is mixed on whether kids, especially those under 10, can transmit it as easily as adults.
At the moment, no children are included in the vaccine trials, another source of concern among some parents. Regardless, the surgeon general has authorized pharmacists to administer the future vaccine to children ages 3 and older.
Katie Otteni, 24, of Hickory, North Carolina, has never vaccinated her 22-month-old son, Dallas, and she has used the religious exemption to skirt his day care center's vaccine requirement. She and other like-minded friends embark on postcard campaigns to educate others about what they say are the dangers of vaccines, and she has been encouraged to see parents who normally do not agree with her expressing reluctance about any coming Covid-19 vaccine.
"It's crazy, because this one vaccine they feel this way towards, but if they knew there was the same situation going on with the others, they would probably think differently," said Otteni, a waitress. "But it's a start."
Doctors and public health officials disagree. Vaccinations are considered one of the 10 greatest public health achievements of the 20th century, and by and large, they have repeatedly been proven to be safe.
With the pandemic, a vaccine may be our only way out, said Dr. Lauren Grossman, an assistant professor of emergency medicine and general internal medicine at the University of Colorado School of Medicine.
"In this particular case, I don't see how we have much of a choice, to be honest," she said. "Look at what we're going through now with schools reopening."
While various childhood immunizations are required to attend public schools, the annual flu shot is not mandated in most states although this year, some school districts have deemed it necessary to reduce the possibility of simultaneous flu and Covid-19 outbreaks.
The new requirement has been met with consternation in some places. In Massachusetts, hundreds of parents protested the flu shot rule in August, holding signs in front of the State House that read, "My child, my choice," The Republican newspaper of Springfield reported.
"It's a bigger lift for school districts to require flu shots than it is for vaccines," said Dan Domenech, executive director of AASA, The School Superintendents Association, an advocacy organization for the 14,000 superintendents in the U.S. "The other vaccines you don't have to get every year. Once you have it, you have it."
The response to flu shots could be a bellwether of what school districts will face if they require the coronavirus vaccine. Domenech said he expects lawsuits from parents who do not feel comfortable injecting their children with a new vaccine should schools eventually require it, especially because each person could need two doses to gain even some immunity an even bigger ask of parents.
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But Schwartz, the education law attorney, said such lawsuits would be unlikely to hold up in court as long as schools offer an alternative to in-person learning for students whose families refuse to vaccinate them.
"My take is that as long as the school system provided the child with a quality instructional program, whether it be in person or remote, that the parent is going to have an uphill battle in a lawsuit against the district," he said.
Vargas, the Illinois mother, sees a flu shot with an extensive safety record as very different from a brand new vaccine.
"This is not something you want. Period. And if we can prevent it, we need to do so."
"People want to get it out there and go on with their lives," she said. "But at what cost?"
Markel, the medical historian, sees a greater danger in not having a vaccine. His mother died of Covid-19, and he has patients who are enduring long-lasting neurological symptoms.
"Kids can get it," he said. "This is not something you want. Period. And if we can prevent it, we need to do so."
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