Additional 132 positive COVID-19 tests returned from Green Bay Correctional Institution Fox11online.com
Norton Wound Healing Center Brownsboros oxygen-rich hyperbaric chamber recently helped save the fingers and toes of a woman whose blood vessels were damaged by COVID-19.
The chamber typically is used to help cancer patients blood vessels heal after radiation treatment.
When the patient arrived at the Norton Brownsboro Hospital campus for an appointment with a Norton Louisville Arm & Hand surgeon, providers quickly recognized she was in pain and several fingertips already were damaged severely from lack of oxygen. She was taken to the Norton Wound Healing Center immediately.
She had a lot of places on the bottom of her feet that were as bad as her hands were, said J. Neal Sharpe, M.D., a surgeon and medical director of Norton Wound Healing Center. We were able to stop that. I think her feet would have gotten as bad as her hands were. I dont think she will need any surgery on her toes and feet.
Norton Wound Healing Center Audubon and Norton Wound Healing Center Brownsboro are among only a few hyperbaric oxygen and wound treatment programs available in the region. Our care teams diagnose and treat difficult-to-heal wounds.
The patient still will need hand surgery on some of her fingertips.
Saving her feet and preventing further damage to her hands required twice-a-day treatments of pure oxygen for 15 consecutive days at Norton Wound Healing Center Brownsboro. Nurses Anissa Rivera and Deborah Christian cared for the patient throughout the stretch, working two weekends including Mothers Day.
We did it because we want our patients to get better, Anissa said. We think of them as family.
A hyperbaric chamber increases oxygen in blood moving through the body. A patient lies down in the clear chamber and receives 100% oxygen for 2 hours under pressure. The air we breathe normally is 21% oxygen. The pressure in a hyperbaric chamber is the same as being 33 feet underwater.
The patient had been treated at Norton Audubon Hospital for COVID-19. Once she stabilized, she returned home. Then, the virus began attacking her hands and feet.
Inflammation from the bodys response to the virus often affects the airways and makes it hard for patients with COVID-19 to breathe. It also can cause heart, liver or kidney problems. In this patients case, the inflammation caused small blood vessels in her hands and feet to swell and close off, threatening to starve nearby tissue of oxygen.
According to Anissa, at the end of the two weeks, the patients spirits were better, her pain had lessened and the damage had been limited to several fingertips.
I felt good about what we did for her, Anissa said.
The patient was so grateful that she presented each of the nurses with a bouquet.
She brought us flowers, and her family gave us a little card telling us how appreciative they were and how they could tell we love what we do. That made me cry, Anissa said.
Governor Tom Wolf and Secretary of Health Dr. Rachel Levine today released a weekly status update detailing the states mitigation efforts based on the COVID-19 Early Warning Monitoring System Dashboard. Updates will be released each Monday beginning today.
The update includes the following:
The dashboard is designed to provide early warning signs of factors that affect the states mitigation efforts. The data available on the early warning monitoring dashboard includes week-over-week case differences, incidence rates, test percent-positivity, and rates of hospitalizations, ventilations and emergency room visits tied to COVID-19. This weeks update compares the period of August 14 August 20 to the previous seven days, August 7 August 13.
Our percent positivity decreased significantly this week, representing the fourth straight week that the percent positivity has decreased, Gov. Wolf said. This is a testament that our actions are working, but we still have more work to do. The virus is still circulating, and we must continue to wear masks, practice social distancing and avoid large gatherings to keep our numbers low, stop the spread and allow more freedom.
As of Thursday, August 20, the state has seen a seven-day case increase of 4,456; the previous seven-day increase was 5,598, indicating a 1,142-case decrease across the state over the past week.
The statewide percent-positivity went down to 3.4% from 4.0% last week. Counties with concerning percent-positivity include Perry (9.1%), Huntingdon (7.8%), Northumberland (7.3%), Indiana (7.1%), Union (5.9%), Susquehanna (5.7%), York (5.5%), Beaver (5.3%), and Blair (5.0%). Each of these counties bears watching as the state continues to monitor all available data.
Community TransmissionAs of Fridays data, Union County was the one county in the substantial level with several known sources of outbreaks fueling community transmission. The departments of Education and Health will speak with school district representatives in Union County to discuss the implications of this level of transmission.
For the week ending August 20, 21 counties were in the low level of transmission, 45 counties in the moderate level, with one with substantial transmission:
Business VisitsThe Department of Health is providing weekly data on the number of individuals who responded to case investigators that they spent time at business establishments (restaurants, bars, gym/fitness centers, salon/barbershops) and at mass gatherings 14 days prior to the onset of COVID-19 symptoms.
Of the 5,649 confirmed cases reported between August 9 and August 15, 45 percent (2,541) provided an answer to the question as to whether they spent time at a business establishment.
Of those who did provide an answer, 13 percent, or 320, answered yes, they visited a business establishment 14 days prior to onset of symptoms:
Of the 5,649 confirmed cases, 48 percent (2,710) answered the question as to whether they attended a mass gathering or other large event. Of the 48 percent, nearly 12 percent (326) answered yes to whether they attended a mass gathering or other large event 14 days prior to onset of symptoms.
Compared to data reported on August 14, this weeks data saw an increase in people who reported visiting a restaurant (50 percent vs. 47 percent), people who reported going to some other business (23 percent vs. 19 percent), and people going to a salon/barbershop (12 percent vs. 9 percent). Numbers went down for this weeks data for going to a bar (17 percent vs. 24 percent), going to a gym/fitness center (8 percent vs. 10 percent). The number of those who attended a mass gathering or other large event remained the same (nearly 12 percent).
Case investigator notes included frequent mentions of visits to bars and restaurants among positive cases. To better understand this emerging trend, on July 13 contact tracers began asking more specific questions on the types of businesses visited and if individuals attended a mass gathering, defined as more than 250 people in attendance outdoors or more than 25 indoors.
The numbers above highlight business settings and mass gatherings as possible sites for transmission. With less than half of those asked about what types of businesses they visited or if they attended a mass gathering responding to the question, the department is reminding Pennsylvanians that it is essential that people answer the phone when case investigators call and to provide full and complete information to these clinical professionals.
Travel RecommendationsAlso today, the Department of Health updated its travel recommendations, originally announced on July 2, to remove Arizona from the list of states recommended for domestic travelers returning from to quarantine for 14 days upon return to Pennsylvania. No new states were added.
It is important that people understand that this recommendation is in place to prevent the spread of COVID-19 in Pennsylvania. A concerning number of recent cases have been linked to travel, and if people are going to travel, we need them to take steps to protect themselves, their loved ones and their community, and that involves quarantining.
Gov. Wolf continues to prioritize the health and safety of all Pennsylvanians through the COVID-19 pandemic. Pennsylvanians should continue to take actions to prevent the spread of COVID-19, regardless of in what county they live. This includes wearing a mask or face covering anytime they are in public. COVID-19 has been shown to spread easily in the air and contagious carriers can be asymptomatic.
By: Norma Garcia, DO DHR Health Womens Hospital
Based on what we currently know, pregnant women may be at increased risk for severe illness from COVID-19 infection, sometimes requiring ICU admission. Additionally, pregnant women infected with COVID-19 may have an increased risk for all pregnancy related complications, including preterm labor. It is important to protect yourself and take increased precautions if you think you might be pregnant or are already pregnant.
Research is currently being performed so that doctors can learn if COVID-19 can pass through the breast milk and cause infection to a newborn baby. Most information we have has shown that it is safe to breastfeed your baby if you have COVID-19. Mothers have to remember that breast milk is the best source of nutrition for most babies. Breast milk helps protect babies from illnesses, including infections of the ears, lungs, and digestive system for at least the first 6 months of the infants life. For the above reasons, having COVID-19 should not stop you from giving your baby breast milk. Some moms with COVID-19 choose to use a breast pump and express breast milk so that a non-infected family member or nursing staff can feed the newborn. Always make sure to thoroughly clean the breast pump and all necessary supplies in between feeds. If you do choose to breastfeed your child, remember to always wear a facemask and wash your hands for at least 20 seconds before each feeding.
If you plan to breastfeed after delivery and are found to have COVID-19, talk with your OBGYN, pediatrician or other qualified health care provider. Together, you can come up with a plan to allow safe and appropriate breastfeeding for your newborn infant.
Sources: CDC and ACOG
WINK NEWS
Lee Health reports fewer new coronavirus patients by the day. It says there is plenty of personal protective equipment, ICU beds and ventilators.
Community members we spoke to Monday believe weve learned the tough lesson: Wearing masks and social distancing are a must to keep the virus down. They all hope the downward trend in the coronavirus cases reported by Florida Department of Health is a sign the worst of the pandemic is behind us all.
Costco mandated masks at its locations in May. When Gov. Ron DeSantis refused to order Floridians to wear masks, Walmart and Publix took action in July. Target completed the list of big box stores requiring masks Aug. 1.
I think people are paying attention, said Mel Reinhart in Cape Coral. Theyre wearing their masks and doing what they think is necessary, avoiding the crowds.
Reinhart and his wife are crossing their fingers the downward trend were seeing continues.
I hope we can get back to a normal life, whatever that is, Reinhart said. Going back to working out and going back to church when we want. Just doing everything we were doing.
Florida has gone nine straight days with less than 5,000 new daily cases.
Corina Tiemeyer is among community members who are holding onto hope the worst of COVID-19 is behind us.
I volunteer at Hope Hospice and at HealthPark and at my church, Tiemeyer said. I had to give all of that up.
With COPD, Tiemeyer is in a COVID-19 high-risk category. What she and so many others really long for is a change to what has become the norm.
Taking the mask off, hugging my kids, Mimi Thorne said. Getting back to being with people.
One of the reasons Covid-19 has spread so swiftly around the globe is that for the first days after infection, people feel healthy. Instead of staying home in bed, they may be out and about, unknowingly passing the virus along. But in addition to these pre-symptomatic patients, the relentless silent spread of this pandemic is also facilitated by a more mysterious group of people: the so-called asymptomatics.
According to various estimates, between 20and 45 percent of the people who get Covid-19 and possibly more, according to a recent study from the Centers for Disease Control and Prevention sail through a coronavirus infection without realizing they ever had it. No fever or chills. No loss of smell or taste. No breathing difficulties. They dont feel a thing.
Asymptomatic cases are not unique to Covid-19. They occur with the regular flu, and probably also featured in the 1918 pandemic, according to epidemiologist Neil Ferguson of Imperial College London. But scientists arent sure why certain people weather Covid-19 unscathed. That is a tremendous mystery at this point, says Donald Thea, an infectious disease expert at Boston Universitys School of Public Health.
The prevailing theory is that their immune systems fight off the virus so efficiently that they never get sick. But some scientists are confident that the immune systems aggressive response, the churning out of antibodies and other molecules to eliminate an infection, is only part of the story.
These experts are learning that the human body may not always wage an all-out war on viruses and other pathogens. It may also be capable of accommodating an infection, sometimes so seamlessly that no symptoms emerge. This phenomenon, known as disease tolerance, is well-known in plants but has only been documented in animals within the last 15 years.
Disease tolerance is the ability of an individual, due to a genetic predisposition or some aspect of behavior or lifestyle, to thrive despite being infected with an amount of pathogen that sickens others. Tolerance takes different forms, depending on the infection. For example, when infected with cholera, which causes watery diarrhea that can quickly kill through dehydration, the body might mobilize mechanisms that maintain fluid and electrolyte balance. During other infections, the body might tweak metabolism or activate gut microbes whatever internal adjustment is needed to prevent or repair tissue damage or to make a germ less vicious.
Researchers who study these processes rely on invasive experiments that cannot be done in people. Nevertheless, they view asymptomatic infections as evidence that disease tolerance occurs in humans. At least 90 percent of those infected with the tuberculosis bacterium dont get sick. The same is true for many of the 1.5 billion of people globally who live with parasitic worms called helminths in their intestines. Despite the fact that these worms are very large organisms and they basically migrate through your tissues and cause damage, many people are asymptomatic. They dont even know theyre infected, says Irah King, a professor of immunology at McGill University. And so then the question becomes, what does the body do to tolerate these types of invasive infections?
While scientists have observed the physiological processes that minimize tissue damage during infections in animals for decades, its only more recently that theyve begun to think about them in terms of disease tolerance. For example, King and colleagues have identified specific immune cells in mice that increase the resilience of blood vessels during a helminth infection, leading to less intestinal bleeding, even when the same number of worms are present.
This has been demonstrated in plants, bacteria, other mammalian species, King says.
Why would we think that humans would not have developed these types of mechanisms to promote and maintain our health in the face of infection? he adds.
In a recent Frontiers in Immunology editorial, King and his McGill colleague Maziar Divangahi describe their long-term hopes for the field: A deeper understanding of disease tolerance, they write, could lead to a new golden age of infectious disease research and discovery.
Scientists have traditionally viewed germs as the enemy, an approach that has generated invaluable antibiotics and vaccines. But more recently, researchers have come to understand that the human body is colonized by trillions of microbes that are essential to optimal health, and that the relationship between humans and germs is more nuanced.
Meddlesome viruses and bacteria have been around since life began, so it makes sense that animals evolved ways to manage as well as fight them. Attacking a pathogen can be effective, but it can also backfire. For one thing, infectious agents find ways to evade the immune system. Moreover, the immune response itself, if unchecked, can turn lethal, applying its destructive force to the bodys own organs.
With things like Covid, I think its going to be very parallel to TB, where you have this Goldilocks situation, says Andrew Olive, an immunologist at Michigan State University, where you need that perfect amount of inflammation to control the virus and not damage the lungs.
Some of the key disease tolerance mechanisms scientists have identified aim to keep inflammation within that narrow window. For example, immune cells called alveolar macrophages in the lung suppress inflammation once the threat posed by the pathogen diminishes.
A deeper understanding of disease tolerance could lead to a new golden age of infectious disease research and discovery, write King and Divangahi.
Much is still unknown about why there is such a wide range of responses to Covid-19, from asymptomatic to mildly sick to out of commission for weeks at home to full-on organ failure. Its very, very early days here, says Andrew Read, an infectious disease expert at Pennsylvania State University who helped identify disease tolerance in animals. Read believes disease tolerance may at least partially explain why some infected people have mild symptoms or none at all. This may be because theyre better at scavenging toxic byproducts, he says, or replenishing their lung tissues at faster rates, those sorts of things.
The mainstream scientific view of asymptomatics is that their immune systems are especially well-tuned. This could explain why children and young adults make up the majority of people without symptoms because the immune system naturally deteriorates with age. Its also possible that the immune systems of asymptomatics have been primed by a previous infection with a milder coronavirus, like those that cause the common cold.
Asymptomatic cases dont get much attention from medical researchers, in part because these people dont go to the doctor and thus are tough to track down. But Janelle Ayres, a physiologist and infectious disease expert at the Salk Institute For Biological Studies who has been a leader in disease tolerance research, studies precisely the mice that dont get sick.
The staple of this research is something called the lethal dose 50 test, which consists of giving a group of mice enough pathogen to kill half. By comparing the mice that live with those that die, she pinpoints the specific aspects of their physiology that enable them to survive the infection. She has performed this experiment scores of times using a variety of pathogens. The goal is to figure out how to activate health-sustaining responses in all animals.
A hallmark of these experiments and something that surprised her at first is that the half that survive the lethal dose are perky. They are completely unruffled by the same quantity of pathogen that kills their counterparts. I thought going into this that all would get sick, that half would live and half would die, but that isnt what I found, Ayres says. I found that half got sick and died, and the other half never got sick and lived.
Ayres sees something similar happening in the Covid-19 pandemic. Like her mice, asymptomatics seem to have similar amounts of the virus in their bodies as the people who fall ill, yet for some reason they stay healthy. Studies show that their lungs often display damage on CT scans, yet they are not struggling for breath (though it remains to be seen whether they will fully escape long-term impacts). Moreover, a small recent study suggests that asymptomatics mount a weaker immune response than the people who get sick suggesting that mechanisms are at work that have nothing to do with fighting infection.
Why, if they have these abnormalities, are they healthy? asks Ayres. Potentially because they have disease tolerance mechanisms engaged. These are the people we need to study.
The goal of disease tolerance research is to decipher the mechanisms that keep infected people healthy and turn them into therapies that benefit everyone. You want to have a drought-tolerant plant, for obvious reasons, so why wouldnt we want to have a virus-tolerant person? Read asks.
A 2018 experiment in Ayres lab offered proof of concept for that goal. The team gave a diarrhea-causing infection to mice in a lethal dose 50 trial, then compared tissue from the mice that died with those that survived, looking for differences. They discovered that the asymptomatic mice had utilized their iron stores to route extra glucose to the hungry bacteria, and that the pacified germs no longer posed a threat. The team subsequently turned this observation into a treatment. In further experiments, they administered iron supplements to the mice and all the animals survived, even when the pathogen dose was upped a thousandfold.
When the pandemic hit, Ayres was already studying mice with pneumonia and the signature malady of Covid-19, acute respiratory distress syndrome, which can be triggered by various infections. Her lab has identified markers that may inform candidate pathways to target for treatment. The next step is to compare people who progressed to severe stages of Covid-19 with asymptomatics to see whether markers emerge that resemble the ones shes found in mice.
Why, if they have these abnormalities, are they healthy? asks Ayres. Potentially because they have disease tolerance mechanisms engaged. These are the people we need to study.
If a medicine is developed, it would work differently from anything thats currently on the market because it would be lung-specific, not disease-specific, and would ease respiratory distress regardless of which pathogen is responsible.
But intriguing as this prospect is, most experts caution that disease tolerance is a new field and tangible benefits are likely many years off. The work involves measuring not only symptoms but the levels of a pathogen in the body, which means killing an animal and searching all of its tissues. You cant really do controlled biological experiments in humans, Olive says.
In addition, there are countless disease tolerance pathways. Every time we figure one out, we find we have 10 more things we dont understand, King says. Things will differ with each disease, he adds, so that becomes a bit overwhelming.
Nevertheless, a growing number of experts agree that disease tolerance research could have profound implications for treating infectious disease in the future. Microbiology and infectious disease research has all been focused on the pathogen as an invader that has to be eliminated some way, says virologist Jeremy Luban of the University of Massachusetts Medical School. And as Ayres makes clear, he says, what we really should be thinking about is how do we keep the person from getting sick.
Emily Laber-Warren directs the health and science reporting program at the Craig Newmark Graduate School of Journalism at CUNY.
Editors note: The Salt Lake Tribune is providing free access to critical stories about the coronavirus. Sign up for our Top Stories newsletter, sent to your inbox every weekday morning. To support journalism like this, please donate or become a subscriber.
Utahs rate of new coronavirus cases remained relatively low Monday but the state also charted the lowest number of new tests results reported since mid-April.
There were 249 new coronavirus cases reported on Monday, for a seven-day average of 350 new cases per day, according to the Utah Department of Health.
But there were only 1,518 test results reported since Sunday, the health department wrote in a news statement a fraction of the states capacity for about 9,000 tests per day, and the lowest number of new test results since April 15, when testing capacity had barely begun to stabilize after widespread shortages of testing chemicals and supplies.
Testing demand has been dropping since late July, state officials and hospital administrators have said; in mid-July, the state was reporting more than 7,000 new test results per day, on average.
UDOH spokesman Tom Hudachko said Monday that data on COVID-19 lab tests has been artificially low the last several days because of a delay in reporting results to the states Electronic Laboratory Reporting system.
In particular, one lab has been reporting its positive results, but not its negative ones, Hudachko said. UDOH is working with the lab to fix the problem and adjust the negative results.
Statewide, Utah's rate of positive tests have been above 5% since May 25, according to UDOH data.
Hospitalizations were down slightly on Monday, with 130 Utah patients admitted, UDOH reported. On average, 134 patients have been receiving treatment in Utah hospitals each day for the past week, continuing a consistent 12-day decline and well below the peak average of 211 patients hospitalized a little more than two weeks ago.
In total, 2,941 patients have been hospitalized in Utah for COVID-19, up 15 from Sunday.
Utahs death toll from the coronavirus stood at 390 on Monday, with five fatalities reported since Sunday:
Of 49,364 Utahns who have tested positive for COVID-19, 41,164 are considered recovered that is, they have survived for at least three weeks after being diagnosed.
Researchers in Hong Kong on Monday reported what appears to be the first confirmed case of Covid-19 reinfection, a 33-year-old man who was first infected by SARS-CoV-2 in late March and then, four and a half months later, seemingly contracted the virus again while traveling in Europe.
The caseraises questions about the durability of immune protection from the coronavirus. But it was also met with caution by other scientists, who questioned the extent to which the case pointed to broader concerns about reinfection.
There have been scattered reports of cases of Covid-19 reinfection. Those reports, though, have been based on anecdotal evidence and largely attributed to flaws in testing.
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But in this case, researchers at the University of Hong Kong sequenced the virus from the patients two infections and found that they did not match, indicating the second infection was not tied to the first. There was a difference of 24 nucleotides the letters that make up the virus RNA between the two infections.
This is the worlds first documentation of a patient who recovered from Covid-19 but got another episode of Covid-19 afterwards, the researchers said in a statement.
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Experts cautioned that this patients case could be an outlier among the tens of millions of cases around the world and that immune protection may generally last longer than just a few months. They said that ongoing studies tracking patients who had recovered from Covid-19 would help reach more definitive conclusions. They also noted that the mans second case was milder than his first, indicating that his immune system was providing some level of protection, even if it could not prevent the infection entirely.
Theres been more than 24 million cases reported to date, Maria Van Kerkhove, a coronavirus expert at the World Health Organization, said at a briefing Monday, when asked about the Hong Kong report. And we need to look at something like this at a population level.
The question of how long someone is protected from Covid-19 after being infected and recovering looms large.
Studies are increasingly finding that most people who recover from the illness mount a robust immune response involving both antibodies (molecules that can block the virus from infecting cells again) and T cells (which can help clear the virus). This has suggested that people would be protected from another case for some amount of time.
But based on what happens with other coronaviruses, experts knew that immunity to SARS-CoV-2 would not last forever. People generally become susceptible again to the coronaviruses that cause the common cold after a year or even less, while protection against SARS-1and MERS appears to last for a few years.
What we are learning about infection is that people do develop an immune response, and what is not completely clear yet is how strong that immune response is and for how long that immune response lasts, Van Kerkhove said. She added she was still reviewing the Hong Kong case.
The strength and durability of the immune response is also a crucial factor in how long vaccines will be effective for, and for how often people might need a booster dose.
In the Hong Kong case, the man had traveled to Spain and returned to Hong Kong via the United Kingdom. A saliva sample was taken upon arrival in Hong Kong as part of a screening protocol and tested positive for SARS-CoV-2 on Aug. 15.
During his second infection, the man did not have any symptoms. Some patients go through their course of Covid-19 without showing symptoms, but researchers have also hypothesized that secondary cases of the coronavirus will generally be milder than the first. Even if immune systems cant stop the virus from infecting cells, they might still rally some level of response that keeps us from getting sicker. During his first case, the patient had classic Covid-19 symptoms of cough, fever, sore throat, and headache.
Experts said it was also important to consider the immune response the patient generated after his first infection. While most people seem to mount a solid response, there has been indication that some people do not produce neutralizing antibodies those that can block the virus from infecting cells at very high levels, for unclear reasons.
The fact that somebody may get reinfected is not surprising, said Malik Peiris, a virologist at the University of Hong Kong, who is not an author of the paper describing the reinfection but is familiar with the case. But the reinfection didnt cause disease, so thats the first point. And the second thing is that it is important to know whether the patient mounted a neutralizing antibody response to the first infection or not. Because the vast majority of patients in our experience do mount a good neutralizing antibody response. So is this person an outlier or is he likely to be the average person infected?
Even if the Hong Kong case is an outlier, it points to a few implications: For one, people who have recovered from Covid-19 should also be vaccinated, the researchers said. And they should continue following precautions like wearing a mask and physical distancing.
Helen Branswell contributed reporting.
A judge struck down a state order requiring most Florida schools to open for in-person instruction.
A Florida judge ruled on Monday that the states requirement that public schools open their classrooms for in-person instruction violates the Florida constitution because it arbitrarily disregards safety and denies local school boards the ability to decide when students can safely return.
The ruling was a victory for the American Federation of Teachers, the nations second-largest teachers union, and one of its affiliates, the Florida Education Association. The unions sued Gov. Ron DeSantis and Richard Corcoran, the education commissioner, last month in the first lawsuit of its kind in the country.
The states order required that school districts give students the option to go back to school in person by Aug. 31 or risk losing crucial state funding. An exception was made only for Miami-Dade, Broward and Palm Beach counties, which have been the hardest hit by the coronavirus and plan to start the school year online.
The districts have no meaningful alternative, Judge Charles W. Dodson of the Leon County Circuit Court wrote of the rest of the states schools. If an individual school district chooses safety, that is, delaying the start of schools until it individually determines it is safe to do so for its county, it risks losing state funding, even though every student is being taught.
Later Monday, the state filed an appeal to the ruling, prompting an immediate stay.
This fight has been, and will continue to be, about giving every parent, every teacher and every student a choice, regardless of what educational option they choose, Mr. Corcoran said in a statement.
In Tampa, the states reopening order prevented the Hillsborough County school district from starting the school year with four weeks of online-only instruction, as the school board wanted to do. The Hillsborough board is scheduled to meet on Tuesday, although no vote is expected, a district spokeswoman said. The superintendent, Addison Davis, said in a statement after the ruling that the school system continued to plan to start classes on Aug. 31 with a choice of in-person or online instruction.
During a three-day hearing last week, the unions presented testimony from public health experts and teachers concerned about risking their health. One teacher said he would quit to avoid exposure to the virus. Another, who is quadriplegic, said he could not afford to leave his job, though his doctor had warned him that Covid-19 would threaten his life.
In a pandemic, none of these things are great victories, but it is a reprieve for human life, said Randi Weingarten, the president of the American Federation of Teachers. It is a pushback on reckless disregard of human life. It is a pushback on politics overtaking safety and the science and the well-being of communities.
With a federal eviction moratorium coming to an end in the United States, legal aid lawyers say they are preparing to defend renters in housing court.
The fourth-month moratorium followed by a 30-day notice period, protected about 12 million tenants living in qualifying properties. Local moratoriums in some states have protected others not covered by the federal law.
For tenants, especially those with limited means, having a lawyer can be the difference between being evicted and being able to stay, but tenants in housing courts rarely have legal representation. Surveys in several big cities over the years have found that at least 80 percent of landlords, but fewer than 10 percent of tenants, tend to have lawyers.
The presidents recent executive order on assistance to renters doesnt offer much immediate hope for people facing eviction; it merely directs federal agencies to consider what they could do using existing authority and budgets.
Tenants are not equipped to represent themselves, and eviction court places them on an uneven playing field, said Ellie Pepper of the National Housing Resource Center.
Demand for legal assistance with housing issues is on the rise in states where local moratoriums have ended. Our caseloads havent yet exploded, because the courts just started hearing cases that were pending before the pandemic struck, said Lindsey Siegel, a lawyer with Atlanta Legal Aid. But its coming.
A 33-year-old man was infected a second time with the coronavirus more than four months after his first bout, the first documented case of so-called reinfection, researchers in Hong Kong reported Monday.
The finding was not unexpected, especially given the millions of people who have been infected worldwide, experts said. And the man had no symptoms the second time, suggesting that even though the prior exposure did not prevent the reinfection, his immune system kept the virus somewhat in check.
The second infection was completely asymptomatic his immune response prevented the disease from getting worse, said Akiko Iwasaki, an immunologist at Yale University who was not involved with the work but reviewed the report at The New York Timess request. Its kind of a textbook example of how immunity should work.
People who do not have symptoms may still spread the virus to others, however, underscoring the importance of vaccines, Dr. Iwasaki said. In the mans case, she added, natural infection created immunity that prevented disease but not reinfection.
In order to provide herd immunity, a potent vaccine is needed to induce immunity that prevents both reinfection and disease, Dr. Iwasaki said.
Doctors have reported several cases of presumed reinfection in the United States and elsewhere, but none of those cases have been confirmed with rigorous testing. Recovered people are known to carry viral fragments for weeks, which can lead to positive test results in the absence of live virus.
But the Hong Kong researchers sequenced the virus from both of the mans infections and found significant differences, suggesting that the patient had been infected a second time.
The study is to be published in the journal Clinical Infectious Diseases. The Times obtained the manuscript from the University of Hong Kong.
The mans first case was diagnosed on March 26, and he had only mild symptoms. He later tested negative for the virus twice and had no detectable antibodies after that first bout. He was positive again for the coronavirus on a saliva test on Aug. 15 after a trip to Spain via the United Kingdom. The man had picked up a strain that was circulating in Europe in July and August, the researchers said.
His infections were clearly caused by different versions of the coronavirus, Dr. Kelvin Kai-Wang To, a clinical microbiologist at the University of Hong Kong, said: Our results prove that his second infection is caused by a new virus that he acquired recently, rather than prolonged viral shedding.
Common cold coronaviruses are known to cause reinfections in less than a year, but experts had hoped that the new coronavirus might behave more like its cousins SARS and MERS, which seemed to produce protection lasting a few years.
Its still unclear how common reinfection from the new coronavirus might be, because few researchers have sequenced the virus from each infection.
EDUCATION ROUNDUP
The video call service Zoom reported partial outages on Monday morning, causing problems on the first day of remote classes for many schools in the United States.
Zoom said it began receiving reports of users being unable to start or join meetings at about 8:50 a.m. on the East Coast, as working and school hours began. About two hours later, the company said that it was deploying a fix across our cloud, and at about 12:45 p.m. it said everything should be working properly now.
As the pandemic has kept students out of classrooms and workers out of offices, Zoom has quickly become critical infrastructure for many school districts, companies and local governments. The partial disruption in service, which lasted approximately four hours in some areas, adds another element to the contentious debate over how to safely and effectively resume learning this fall.
The Atlanta school district, which serves about 50,000 students, was among those affected by the outage. And students and professors at Penn State University reported widespread problems on campus on Monday morning, as did Michigans Supreme Court, which has conducted hearings online since the pandemic began.
Another online learning platform, Canvas, also experienced technical issues on Monday. Cory Edwards, a spokesman for the company, said the system had slowed down for about 75 percent of its U.S. customers for about a half-hour on Monday morning. The problem probably resulted from heavy usage as many students returned to school this week, he said.
The website DownDetector, which tracks outages at social media companies and tech companies, showed significant Zoom outages in major cities around the country, including New York, Washington, Atlanta, Chicago, St. Louis and San Francisco. The site reported more than 15,000 outages by about 10 a.m. Eastern time.
Many courthouses also rely on Zoom to conduct hearings, city councils govern through virtual meetings, and the police face reporters in video news conferences.
Here are other key education developments:
Following months of pressure to set up outdoor classrooms in New York City, Mayor Bill de Blasio said Monday that principals can apply by this Friday to create outdoor classes in their schoolyards. The citys public school system, the nations largest, is scheduled to reopen in just under three weeks in a hybrid model, leaving schools little time to move classroom infrastructure outdoors. The city will prioritize 27 neighborhoods badly hit by the virus with schools that do not have usable outdoor space. The mayor said that outdoor learning wont work every day because of bad weather, but that it was still a good alternative for many schools.
The University of Illinois, Urbana-Champaign, became the latest college to find a significant number of students testing positive for coronavirus upon their return to campus, university and county health officials said on Monday. The university said it had recorded 326 positive results since Aug. 15. On its website, the university said that it has conducted more than 87,000 tests since early July, with an average positive rate of .74 percent over the past five days considered quite low. The college began modified in-person instruction on Monday.
More than 730 American colleges and universities have announced at least one case on campus among students, faculty or staff since the beginning of the pandemic, according to a New York Times database. Among the latest: Millikin University in Decatur, Ill., which reported its first case on Monday, the first day of fall classes.
The University of Kansas, where fall classes began Monday in Lawrence, issued 14-day public health bans to two fraternities on Sunday for violating university policies on mask wearing and social distancing. The universitys chancellor said in a statement that Kappa Sigma and Phi Kappa Psi were ordered not to host any event without approval from the university.
The University of Nebraska in Lincoln announced Sunday that students at the Kappa Alpha Theta sorority have been placed under quarantine after five cases were identified.
After tests and temperature checks, 336 Republican delegates representing 50 states, five territories and Washington, D.C., gathered in Charlotte, N.C., on Monday and officially renominated President Trump. It was the only in-person event of either political partys quadrennial convention.
In a surprise speech at the convention, Mr. Trump accused his opponents of using Covid to steal the election, repeating claims that voting by mail was part of plot to cost him the election.
Mr. Trump also criticized Roy Cooper, the Democratic governor of North Carolina, telling the crowd in Charlotte that Mr. Cooper and other Democratic governors had enacted virus restrictions simply to hurt his re-election chances and would lift them after Election Day.
You have a governor who is in a total shutdown mood, he said. I guarantee you on November 4, it will all open up.
Outside of the convention hall, public health officials in Mecklenburg County, which includes Charlotte, continue to fight to contain the spread of the virus, with an average of 1,100 new cases a day over the past week, according to a New York Times database.
Just six representatives from each state and territory are in the room, masked and seated at a distance from one another. Each speaker is required to wear a mask before he or she reaches the podium, and the microphone will be cleaned between speakers, according to a person briefed on the protocols.
Mr. Trump and Vice President Mike Pence spoke to the delegates, and Mr. Trump plans to appear every night during the convention.
Despite the precautions in place inside the convention hall, photographs of crowds gathered by the stage while Mr. Trump spoke showed people not social distancing, some wearing masks and some without.
Authorities in the blockaded Gaza Strip announced the first coronavirus cases transmitted through the community on Monday, raising concerns that the pandemic could spread widely in the densely populated and impoverished coastal enclave.
Before Mondays announcement, authorities had found infections only at quarantine facilities, where all returning travelers were required to quarantine for three weeks and pass two tests before being permitted to leave.
Ashraf al-Qidra, a spokesman for the Hamas-run Health Ministry, told a news conference that four people in the Maghazi refugee camp in central Gaza tested positive for Covid-19, while noting officials were carrying out epidemiological investigations.
Mr. Qidra said that authorities tested the four individuals after learning they had been in contact with a resident of Gaza who tested positive for the disease at the Augusta Victoria Hospital in East Jerusalem.
Salama Maroof, the head of the Hamas-operated government media office, said that the entire territory would be placed under curfew for 48 hours.
We call on everyone to exercise the greatest degree of carefulness, stay in their homes and follow the health measures, he said at the news conference.
Early Tuesday morning, police cars were seen driving around Gaza using loudspeakers to call on residents to remain in their homes.
Experts have warned that Gazas health sector, already devastated by years of war and conflict, lacked the resources to deal with a widespread outbreak.
Gerald Rockenschaub, the head of the World Health Organizations mission, said medical institutions carry only about 100 adult ventilators, most of which are already in use.
As of early Tuesday, 113 virus cases had been recorded in Gaza and only a single fatality. But only about 17,000 tests have been conducted during the pandemic, according to the Hamas-run Health Ministry, meaning some cases could have gone undetected.
The small number of cases relative to the tens of thousands in Israel and the West Bank has largely been seen as a result of the coastal enclaves isolation and Hamass strict quarantine policy for returning travelers.
In other global news:
A tsunami of job cuts is about to hit Europe as companies prepare to carry out sweeping downsizing plans to offset a collapse in business. Government-backed furlough programs that have helped keep about a third of Europes work force financially secure are set to unwind in the coming months. As many as 59 million jobs are at risk of cuts in hours or pay, temporary furloughs or permanent layoffs, especially in industries like transportation and retail, according to a study by McKinsey & Company.
For 40 days, millions of people in Urumqi, the capital of the Xinjiang region in western China, have been unable to leave their homes because of a sweeping lockdown to fight a virus resurgence. Now, with the outbreak seemingly under control but the restrictions still largely in place, many residents say they are being confined to their homes unnecessarily and denied access to critical services like health care. The ruling Communist Party has been widely criticized in recent years for a harsh crackdown on the regions Muslim minority.
The United Nations said Monday that up to 100 million jobs directly reliant on international tourism are at risk because of the pandemic and that revenue generated by the global tourist industry could fall by as much as $1.2 trillion this year. U.N. officials, who have called the pandemic the biggest challenge in the organizations 75-year existence, also said in the report that some of the smallest countries are particularly vulnerable, as tourism represents a large chunk of their economic output.
Bali, Indonesias leading tourist destination, has abandoned its plan to allow foreign tourists starting Sept. 11, Gov. I Wayan Koster announced, and will wait at least until the end of the year before opening to them. Balis economy contracted 11 percent during the second quarter, with about 2,700 tourism workers laid off and another 74,000 on unpaid leave, the governor said.
Prime Minister Jacinda Ardern of New Zealand extended a lockdown in Auckland, New Zealands largest city, until Sunday night. The restrictions had been set to expire on Wednesday, but Ms. Ardern said the extra time was necessary to ensure that a virus cluster had been brought under control. Eight new confirmed or probable cases were announced on Monday, bringing the total to 101.
The first volunteer was inoculated with a made in Italy vaccine on Monday at Spallanzani hospital in Rome, which specializes in infectious diseases. The vaccine is produced by ReiThera, a biotechnology company based near Rome but headquartered in Switzerland.
Health authorities in France said a virus outbreak at a nudist camp in the southern resort town of Le Cap dAgde was very worrying. More than 140 people have tested positive in the town, the Agence Rgionale de Sant (ARS), Frances health agency, said on Sunday, and 310 more are awaiting results.
KEY DATA OF THE DAY
Officials in Connecticut have issued a public health warning for the city of Danbury, urging residents to stay home when possible and limit gatherings after new cases jumped sharply there in the first 20 days of August.
Danbury, a city of about 84,000 people near the New York border, reported 178 new cases in that time, the state said, more than quadruple the figure for the prior two weeks.
The states public health department now recommends that residents not attend large church services or outdoor gatherings, or any gathering indoors with people other than those they live with.
It does worry us that the number has gone up quite a bit, Gov. Ned Lamont said at a news conference on Monday afternoon, referring to the share of positive test results in Danbury. He also urged people to self-quarantine, wear face coverings, social distance and get tested.
In a statement on Friday, officials said that many new cases in Danbury appeared linked to recent domestic and international travel. Connecticut currently requires travelers from dozens of states and two territories to quarantine for 14 days upon arrival.
Danbury was among the states hardest-hit places earlier this year; Connecticuts first confirmed case worked at Danbury Hospital.
Danburys public schools will start the year with distance learning because of the outbreak, the superintendent said in a letter posted to Facebook on Monday.
Elsewhere in the region:
After a cripplingly slow vote count in New Yorks June primary, marred by thousands of disqualified ballots, Gov. Andrew M. Cuomo said on Monday that he would sign a series of executive orders to make it easier for voters to cast valid absentee ballots in November. The orders will require local officials to take steps to be ready to start counting votes ASAP, after the Nov. 3 election. The governor also ordered a redesign of ballot-return envelopes to make it clear where they should be signed, addressing a common reason for disqualification.
New testing sites will be set up at LaGuardia and Kennedy airports for many out-of-state travelers, Mr. Cuomo said.
SPORTS ROUNDUP
When 11 National Football League teams were notified over the weekend that a total of 77 people, including players and staff members, had apparently tested positive, they scrambled to respond, holding players out of practice and rescheduling training sessions.
Then on Monday came word from the testing lab: Never mind.
The results were all false positives, BioReference Laboratories said in a news release on Monday, citing isolated contamination during test preparation at one of its facilities in New Jersey.
All individuals impacted have been confirmed negative and informed, Dr. Jon R. Cohen, BioReferences executive chairman, said in the news release.
N.F.L. officials said on Sunday that the affected clubs were following contact tracing, isolation and rescheduling protocols that were outlined by the league and players association. Among the 11 affected teams were the Minnesota Vikings, Chicago Bears and Buffalo Bills.
Eight Vikings athletes with false positives watched team meetings virtually on Sunday, unable to attend practice. The New York Jets, Cleveland Browns and Bears all rescheduled training sessions before getting the all clear; the Pittsburgh Steelers, Philadelphia Eagles and Detroit Lions held out players who had falsely tested positive.
The leagues regular season is expected to start Sept. 10.
Elsewhere in sports:
Usain Bolt, the Jamaican sprinter who won eight gold medals over the course of three Olympics, will go into quarantine just to be safe as he awaits results from a test, he said in an Instagram post on Monday. He celebrated turning 34 on Friday at a surprise party attended by, among others, his girlfriend, his newborn daughter and the prominent soccer players Raheem Sterling and Leon Bailey. Videos posted by the music news outlet Urban Islandz showed attendees dancing near one another without wearing masks. It was not clear whether any others at the party had tested positive. Jamaica has recently had a spike in cases.
In New York, school-sponsored sports that are considered lower risk, including tennis, soccer, cross country, field hockey and swimming, may practice and play with limits starting Sept. 21 statewide, the governor said Monday. Teams may not travel to play outside of the schools region or contiguous regions or counties until Oct. 19. Sports with more physical contact that are considered higher risk, including football, wrestling, rugby and hockey, may begin practicing with limits but cannot play until a later date or Dec. 31.
U.S. ROUNDUP
Many of the states with the biggest decreases per million people also had some of the countrys worst outbreaks in July.
Experts said that the drop in reported cases could not be attributed to the recent drop in testing volume. They explained that decreased hospitalizations and a lower share of positive tests indicated that the spread had most likely slowed.
A July surge in Florida affected young people in particular. Statewide bar closures following earlier reopenings and local mask mandates are among the policies that have helped reverse the trend, said Mary Jo Trepka, the chair of the Florida International University epidemiology department. Deaths were greater in July for residents under 65 than for those over 90.
And though Florida is doing better now, the state did surpass 600,000 cases on Sunday.
Arizona and Louisiana have also seen cases drop after taking mask mandates and other measures came into force.
Elsewhere in the United States:
Louisiana shut down its coronavirus testing sites on Monday as the state braced for two tropical storms, Marco and Laura, in quick succession. Hospitals and urgent care facilities can still perform tests, said Kevin Litten, a spokesman for the Louisiana Department of Health. The shutdown of the state sites, and any power outages the storms cause, will probably lead to some kind of disruption in data collection, Mr. Litten said, followed by a jump in cases when testing resumes afterward. Similar effects were seen after Tropical Storm Isaias, which disrupted testing in Florida and the Carolinas early this month. Coastal Louisiana is among the hardest-hit areas of a state that has recorded at least 143,000 coronavirus cases and nearly 4,750 deaths, according to a New York Times database.
Joseph R. Biden Jr. and Senator Kamala Harris will be tested regularly for Covid-19 as Election Day approaches, the Biden campaign said on Monday, a day after a senior Biden official said Mr. Biden had not yet been tested. The Biden team said that with the potential of additional events over the remainder of the campaign, it had increased its health protocols. Staff members who interact with Mr. Biden and Ms. Harris will also be tested regularly, and the campaign said it would announce publicly if either candidate ever has a confirmed case of coronavirus.
