There isnt enough experience with SARS-CoV-2, the virus that causes COVID-19, to know whether mothers can transmit it via breast milk, but according to the Centers for Disease Control and Prevention (CDC), available data suggests breastfeeding isnt a likely source of transmission.
What should you do if you are breastfeeding and have COVID-19 symptoms or a confirmed infection?
Breast milk is still the best source of nutrition for babies and can protect against many diseases, said Kristina A. Bryant, M.D., pediatric infectious disease specialist with Norton Childrens Infectious Diseases, affiliated with the UofL School of Medicine.While it appears that transmitting the coronavirus to a baby while feeding with breast milk is unlikely, you should take precautions. One option is for a mother to express breast milk and have a healthy caregiver feed it to her baby until her own infectious period ends.
If you are breastfeeding and suspect you have COVID-19 or have had confirmation through a nasal swab test, your baby should remain in isolation with you for the duration of your isolation period and for 14 days after that, according to the CDC. The same applies to a baby who has had any other ongoing close contact with a suspected or confirmed COVID-19 patient.
It is still important for your newborn to be seen for all recommended medical visits, so inform your doctor that your baby has potential risk for COVID-19 when making the appointment so the office can take appropriate precautions.
Premature babies often are fed pasteurized breast milk from a donor. While there is no information available about what pasteurization does to the coronavirus, similar viruses are inactivated through pasteurization, according to the CDC.
And, remember, do not put a mask on a child under age 2.
CHICAGO Chicago could close businesses and go back to Phase 3 if new cases continue to climb, Mayor Lori Lightfoot warned Wednesday morning.
The announcement comes as the citys average number of new cases continues to climb, as does the positivity rate. Young people are driving the uptick in new cases, with people age 18-29 now accounting for 30 percent of coronavirus cases reported in recent weeks in Chicago, officials said.
The Lincoln Park area is the spot thats seen the most increases in cases of people age 18-29.
Lightfoot said people age 18-29 must stop gathering in large groups and start wearing masks in public if the city wants to stay on track.
After that age group, the most new cases have been seen among people 30-39 and 40-49 years old, officials said.
The rise in cases comes as other cities across the country are rolling back their reopenings because theyve faced more significant surges in new cases.
Yes, our metrics are tracking better than the rest of the country, but that doesnt mean that we can ever let our guard down, Lightfoot said. It means our precautions are working and that we need to continue to be diligent.
The city is now seeing an average of 192 new cases per day. That number has been slowly climbing for weeks and its now worryingly close to 200, the number at which Chicago goes back to being considered a city with a high incidence of coronavirus.
And Dr. Allison Arwady, commissioner of the Chicago Department of Public Health, said she expects new cases to keep climbing.
When we get back above 200 were back in a high incidence state, and for me that means we are back in a caution state, Arwady said during Wednesdays press conference. At another point, she added, I think there is wishful thinking happening that COVID is over.
It is not over.
Hitting and staying above 200 will be a great concern for officials, Arwady said. Lightfoot said they had the press conference so they could warn Chicagoans theyre close to the 200 mark; they hope the warning can keep people from violating social distancing rules and driving up new cases.
If the city does hit more than 200 cases per day, it will not equal an automatic rollback to Phase 3, but officials will look at problem areas, Arwady said. If theyre seeing cases come from bars, theyd consider closing bars, for example.
For you following every day how were doing in Chicago, thats the number I want you to watch, Arwady said. And I want you to help us drive that number down. Its how we move ahead in Chicago and not backwards.
What things are closed or rolled back would depend on how much cases increase and how quickly, but the city could consider a full move back into Phase 3 if Chicago was seeing an average of more than 400 new cases per day, officials said.
An uptick would mean Chicago has no choice but to go back to Phase 3, Lightfoot said. Thatd mean an end to indoor dining, the closing of businesses like theaters and prohibiting people from gathering in groups larger than 10. Thered be restrictions on mobility again, as well, Lightfoot said.
Lightfoot said people must wear masks in public and stop gathering in large groups if they want to prevent a rollback and keep businesses open.
Minimize gathering in large groups. I repeat: The larger the group the higher risk that someone in that group has COVID-19. So minimize gathering in large groups, Lightfoot said. Wear a face covering when you leave your house everywhere not just some of the time, but all of the time. Thats critically important to reduce the spread.
Young people are at less risk for serious adverse effects of COVID-19, but they can happen, Arwady said. A Chicago woman in her 20s who had no significant underlying conditions had to get a double lung transplant last month coronavirus severely damaged her lungs.
You are not immune to COVID-19, Lightfoot said to young people. The reality is actually quite different, and the data proves it. Were seeing these increases across race and ethnicity and all over the city [among young people]. And this should be the proof that you need: If you are in the 18-to-29-year-old cohort, you are catching COVID-19. You are getting sick.
The problem isnt just that youre hurting yourself. The problem isnt just that youre hurting people in your network. Youre hurting the whole city.
Officials also pointed out young people could transmit the virus to older people, who are more at risk from COVID-19. Arwady said shes concerned Chicago could see an increase in cases among elderly people.
Especially if youre in a younger age group, Im not surprised youre out more, Arwady said. Youre at a lower risk, it is true, for these serious outcomes; but, if you have in your close circle people who have underlying conditions or especially people in those older age groups, I need you to be extra careful with those vulnerable folks in your life.
Still, Arwady noted, Chicago has seen fewer deaths in recent weeks. The city is down to an average of four deaths per day from coronavirus, the lowest that number has been since March. The doctor expects there will soon be a day when Chicago sees no deaths from COVID-19.
And hospitalization data looks great, Arwady said, with the numbers of people hospitalized, in the ICU and using a ventilator all declining.
Lightfoot said she wants to avoid shutting down the economy again, but, if we must, we must.
We are dangerously close to going back to a dangerous state of conditions, she said.
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But vaccines spritzed through the nose or mouth would also tap into another set of immune cells that hang around mucosal tissues. The B cells that reside here can make another type of antibody, called IgA, that plays a large role in bringing gut and airway pathogens to heel. And T cells in this neighborhood can memorize the features of specific pathogens, then spend the rest of their lives patrolling the places they first encountered them.
These mucosal immune responses seem to underlie the success of the oral polio vaccine, which contains a weakened form of polio virus and has helped most of the world eradicate polio. When it debuted in the 1960s, the vaccine was considered, in many ways, an enormous improvement over its injected predecessor because it targeted the bodys immune response in the gut, where the virus thrives. Many people who took the oral vaccine seemed to quash infections even before they felt symptoms or passed the germ on to others.
It was a fabulous vaccine to stop the transmission of polio, said Dr. Anna Durbin, a vaccine expert at Johns Hopkins University. It helped induce herd immunity, she said, referring to the threshold of the population that needs to be immune to a pathogen to keep it from spreading.
Vaccines given through muscle are great for prompting the body to churn out antibodies in the bloodstream, like IgG. If a pathogen shows up, hordes of these on-call molecules will rush to meet it.
For many respiratory infections, thats good enough.
The majority of respiratory vaccines, like the measles vaccine, are given intramuscularly, and it works, Dr. Iwasaki said. If enough antibodies reach the right mucosal surface, it doesnt really matter how they were induced.
Still, relying on that strategy alone can be risky a bit like shoring up a banks security at every entrance except for the one a thief would most likely hit. Sentinels roving throughout the building could subdue the interloper after they trip the alarm. But by that point, some damage has probably already been done.
Updated July 16, 2020
Its mainly a timing issue, Dr. Bhattacharya said. If you have circulating cells and molecules, theyll eventually find the infection. But youd rather have a more immediate response.
Now the economy is traveling sideways, as business failures mount and the virus continues to maim and kill. New applications for unemployment insurance, for instance, are leveling off at more than 1 million a weekmore than double the highest rate reached during the Great Recession, a sign that more job losses are becoming permanent. After rising when the government sent stimulus checks and expanded unemployment-insurance payments, consumer spending is falling again, down 10 percent from where it was a year ago. Homebase, a provider of human-resources software, says that the rebound has hit a plateau, in terms of hours worked, share of employees working, and number of businesses open.
The next, terrifying phase of the coronavirus recession is here: a damaged economy, a virus spreading faster than it was in March. The disease itself continues to take a bloody, direct toll on workers, with more than 60,000 Americans testing positive a day and tens of thousands suffering from extended illness. The statistical value of American lives already lost to the disease is something like $675 billion. The current phase of the pandemic is also taking an enormous secondary toll. States with unmitigated outbreaks have been forced to go back into lockdown, or to pause their reopening, killing weakened businesses and roiling the labor market. Where the virus spreads, the economy stops.
That is not just due to government edicts, either. Some consumers have rushed back to bars and restaurants, and resumed shopping and traveling. Young people, who tend to get less sick from the coronavirus than the elderly, appear to be driving todays pandemic. But millions more are making it clear that they will not risk their life or the life of others in their community to go out. Avoidance of the virus, more so than shutdown orders, seems to be affecting consumer behavior. Places without official lockdowns have seen similar financial collapses to those with them, and a study by University of Chicago economists showed that decreases in economic activity are closely tied to fears of infection and are highly influenced by the number of COVID deaths reported in a given county.
Read: A devastating new stage of the pandemic
In other ways, the spread of COVID-19 is keeping Americans from going back to work. The perception of public transit as unsafe, for example, makes it expensive and tough for commuters to get to their jobs. Schools and day-care centers are struggling to figure out how to reopen safely, meaning millions of parents are facing a fall juggling work and child care. This is a disaster. The lingering uncertainty about whether in-person education will resume isnt the result of malfeasance, but utter nonfeasance, the former Department of Homeland Security official Juliette Kayyem has argued in The Atlantic. Four months of stay-at-home orders have proved that, if schools are unavailable, a city cannot work, a community cannot function, a nation cannot safeguard itself.
Well, I was writing just the other day about what we dont know about the T-cell response to coronavirus infection, and as of today we know quite a bit more. And from what I can see, we have encouraging news, mixed with some things that were going to need to keep an eye on.
Heres a post from May on a paper in Cell that looked at T cell responses in recovering SARS CoV-2 patients and compared them to reports of people who had been infected with original SARS back in 2003, and to people who had never encountered either. It also has some background on T cells in general, which might be useful if you dont have that info right at the top of your brains queue. Thats the paper that showed that the T-cell response to this virus is less Spike-o-centric than it was to SARS. It also showed that there are, in fact, people who have both CD4+ and CD8+ T cells that recognize protein antigens from the new coronavirus even though they have never been exposed to SARS, MERS, or the new virus. The paper speculated that this might be due to cross-reactivity with proteins from the common cold coronaviruses, and raised the possibility that there might be a part of the population that has at least some existing protection against the current pandemic.
Now comes a new paper in press atNature. It confirms that convalescent patients from the current epidemic show T-cell responses (mostly CD4+ but some CD8+ as well) to various epitopes of the N (nucleocapsid) protein, which the earlier paper had identified as one of the main antigens as well (along with the Spike and M proteins, among others, with differences between the CD4+ and CD8+ responses as well). Turning to patients who had caught SARS back in 2003 and recovered, it is already known (and worried about) that their antibody responses faded within two or three years. But this paper shows that these patients still have (17 years later!) a robust T-cell response to the original SARS coronaviruss N protein, which extends an earlier report of such responses going out to 11 years. This new work finds that these cross-react with the new SARS CoV-2 N protein as well. This makes one think, as many have been wondering, that T-cell driven immunity is perhaps the way to reconcile the apparent paradox between (1) antibody responses that seem to be dropping week by week in convalescent patients but (2) few (if any) reliable reports of actual re-infection. That would be good news indeed.
And turning to patients who have never been exposed to either SARS or the latest SARS CoV-2, this new work confirms that there are people who nonetheless have T cells that are reactive to protein antigens from the new virus. As in the earlier paper, these cells have a different pattern of reactivity compared to people who have recovered from the current pandemic (which also serves to confirm that they truly have not been infected this time around). Recognition of the nsp7 and nsp13 proteins is prominent, as well as the N protein. And when they looked at that nsp7 response, it turns out that the T cells are recognizing particular protein regions that have low homology to those found in the common cold coronaviruses but do have very high homology to various animal coronaviruses.
Very interesting indeed! That would argue that there has been past zoonotic coronavirus transmission in humans, unknown viruses that apparently did not lead to serious disease, which have provided some people with a level of T-cell based protection to the current pandemic. This could potentially help to resolve another gap in our knowledge, as mentioned in that recent post: when antibody surveys come back saying that (say) 95% of a given population does not appear to have been exposed to the current virus, does that mean that all 95% of them are vulnerable or not? Ill reiterate the point of that post here: antibody profiling (while very important) is not the whole story, and we need to know what were missing.
There are still major gaps in our knowledge: how many people have such unknown-coronavirus-induced T-cells? How protective are they? How long-lasting is the T-cell response in people who have been infected with the current SARS CoV-2 virus, and how protective is it in the declining-antibody situation that seems to be common? What sorts of T cell responses will be induced by the various vaccine candidates? We just dont know yet. But were going to find out.
Since the beginning of the pandemic, the World Health Organization has stressed that, primarily, Covid-19 spreads through very close personal contact. The virus-laden droplets exhaled from a sick persons mouth and nose, the thinking goes, are heavy, and fall to the ground before they can get much farther than 6 feet.
But as the pandemic has unfolded, contact tracing studies have shown this isnt always the case. In China, an air conditioner pushed virus-laden air across three tables in a restaurant, infecting people seated at each one. Researchers reviewed video from the restaurant and saw many of these patrons were more than 6 feet apart from one another, suggesting that the virus traveled through the air.
In Washington state, one person at a choir practice infected 52 of the other participants; its thought the singing could have led more virus to linger in the air. Carefully controlled laboratory studies are also suggesting that under the right indoor conditions, SARS-CoV-2, the virus that causes Covid-19, can float in the air and, to a certain degree, spread that way.
Last Thursday, the WHO changed its language to recognize that fact. Short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out, the WHO now states. Previously, the organization maintained that airborne transmission was unlikely to occur outside the hospital setting, where some procedures can generate super-small particles that linger in the air longer than large respiratory drops.
This change comes after a letter appeared in the journal Clinical Infectious Diseases, co-signed by 239 scientists and engineers, which implored WHO and other public health agencies that its time to address airborne transmission of Covid-19. With the WHOs recognition of this mode of transmission, the authors hope, communities can think more about the ventilation of indoor spaces and perhaps engineer solutions to make these spaces safer.
It turns out scientists have been debating whether respiratory diseases like the flu and coronavirus should be labeled airborne for a century. More commonly, the airborne designation is only applicable to extremely contagious diseases, like measles.
A lot of these terms are confusing (even to the scientists), and they dont answer the question laypeople care about: Which air is safe to breathe in during the Covid-19 pandemic, and which air is not safe?
To answer that question, its helpful to understand two different scientific perspectives on the matter. One is: What physically happens when a sick person breathes, sneezes, or coughs into a room? The other is: What patterns have epidemiologists observed in the way people are exposed to the virus and get sick?
Lets start with the first.
Theres a relatively simple, if outdated, way of thinking about how respiratory diseases can spread.
It starts like this: When you exhale, sneeze, or cough, you release a cloud of gas and liquid droplets.
If those droplets are relatively big, theyre heavy and fall to the ground before evaporating, like raindrops do. Others are smaller, and made smaller still by evaporation. These smaller droplets can linger in the air longer, drifting on air currents for perhaps hours. If a droplet is small enough, the moisture in it evaporates before it has the chance to reach the ground (provided the humidity in the room is average). If theres stuff like germs in that droplet, they become light enough to float on air currents, like the dust you can see suspended in the air. These particles are often called aerosols.
This framework is old, and it comes from William Wells, a scientist who studied tuberculosis transmission in the 1930s. In a 1934 paper, Wells concluded: It appears, therefore, that transmission of infection through air may take one of two forms depending upon the size of the infected droplet.
When it comes to Covid-19, one of the first questions epidemiologists tried to answer was: Is the virus spread in the dust that floats or the big drops that fall?
If its the small dust, alarm bells go off. These are the prototypical airborne diseases. They include measles, chickenpox, and tuberculosis, and they are extremely contagious. On average, one person infected with measles will infect 12 to 18 others.
If its the big drops, its still concerning. Diseases like the flu, whooping cough, the common cold, and coronaviruses are primarily large droplet-borne. With these diseases, only the closest contacts to an infected person get infected because large droplets quickly fall to the ground (within 6 feet or so). Its also possible for these big drops to fall on surfaces, and those surfaces can become contaminated too. Luckily, in the case of Covid-19, theres a growing consensus that getting sick from touching contaminated surfaces is rare. But keep washing your hands!
(Interestingly, theres no one reason a new virus, like SARS-CoV-2, would go one route or the other. Its possible, says University of Leicester virologist Julian Tang, that there may be a difference in the immune response with these airborne diseases that makes saliva and mucous less viscous, leading to more virus in small drops. Also, Tang writes in an email, it is possible (though no one has studied this yet) that exhaled breath from measles/chickenpox cases may just be shedding much more virus (maybe millions of virus per minute) compared to respiratory viruses, which only exhale 100s to 1000s of viruses per minute.)
A part of why the terminology here is so confusing, and theres so much debate about it, is that the words aerosol and droplet mean different things to different scientific disciplines.
An aerosol is a particle in the air, said Lidia Morawska, an engineer and the director of the International Laboratory for Air Quality and Health at Queensland University of Technology. A droplet is a liquid aerosol. To her, the distinction between droplets and aerosols doesnt make any sense. To her, they are all aerosols.
Wells outlined a clear distinction between droplets and aerosols according to their size. Big drops fall, and little aerosolized drops float. Its now appreciated that the actual picture is a lot more complicated.
Were always exhaling, in fact, a gas cloud that contains within it a continuum spectrum of droplet sizes, says Lydia Bourouiba, an MIT researcher who studies the fluid dynamics of infections. And, as she explained in a March paper in JAMA, the conditions of the cloud itself can affect the range of some of the droplets. If propelled by a cough or sneeze, Bourouiba finds, droplets can travel upward of 20 feet. The cloud mixture, not the drop sizes, determines the initial range of the drops and their fate in indoor environments.
The speed of the cloud, the temperature and humidity of the environment, and the individual droplet makeup of each cloud determines how long the droplets persist in the air, Bourouiba explained in JAMA.
Which is to say: There are conditions (coughing and sneezing) under which large drops dont immediately fall to the floor and can spread more than 6 feet away from a person, and they can linger in the air for longer.
Theres growing theoretical evidence for the airborne spread of the coronavirus. Lab studies, in idealized conditions, also show that the virus can live in an aerosolized form for up to 16 hours (the scientists in this case intentionally created aerosolized droplets with a machine).
Another study tracked with lasers the various droplets expelled from a human mouth during speech. It found normal speech generates airborne droplets that can remain suspended for tens of minutes or longer and are eminently capable of transmitting disease in confined spaces.
Some studies, the WHO reports, have found evidence of the viruss RNA in the air of hospital rooms, but notes no studies have found viable virus in air samples, meaning the virus was either incapable of infecting others or was in very small quantities unlikely to infect others.
What we are trying to say is, well, lets not worry about whether you call it aerosol or whether you call it a droplet, Morawska, the co-author of the recent commentary imploring the WHO and others to address airborne transmission of Covid-19, says. It is in the air, she says, and you inhale it. Its coming from our nose from our mouths. Its lingering in the air and others can inhale it.
That the WHO updated its language is a sign that its starting to appreciate this perspective.
But this perspective is limited. These lab studies cant perfectly generalize to the real-world conditions in which the virus spreads and infects others. Just because a virus travels far in a drop doesnt mean it can infect people across great distances. Viruses can degrade quickly outside the body. Also, dose matters. Small exposures to the virus may not be enough to get a person sick.
So to find out how people actually get sick with Covid-19, we need contact tracing studies.
Lab studies note the theoretical possibility of airborne transmission. But thats only one part of the answer to the question which air is safe to breathe? Epidemiologists come at this question from another angle, looking at patterns of virus spread observed in the real world and working backward to determine if airborne spread factors in.
Contact tracing studies show us that while droplets being inhaled by people within 6 feet of an infected person explains most of the transmission of Covid-19, there are limited times and environments in which SARS-CoV-2 can behave a bit like an airborne virus.
So we need to define which types of contact, which type of environments, lead to that type of transmission, Muge Cevik, a physician and virology expert at the University of St. Andrews, says. In households, she says, an infected person can be isolated in one room and not spread the virus to others in the home (if they remain isolated). A systematic review of studies in The Lancet of both SARS-CoV-2 and similar viruses found large reductions in risk if people just stay 1 meter (3 feet) away from one another. This suggests a lot of the risk of catching Covid-19 is from the large drops that fall quickly to the ground.
But then there are cases where people are packed together in an enclosed space like a church, with singing or shouting where the transmission looks a little more like airborne transmission.
The infamous choir practice in Washington state is an example of where airborne transmission might have happened. But what made this event so risky was the convergence of many risk factors: the singing activity (during which the infected person released viral particles into the air), the time spent together (the practice was 2.5 hours), and the interaction between the choir members in an enclosed space (not only did they all practice together, they also split up into smaller groups and shared cookies and tea).
Another study from China investigated an outbreak that started at a Buddhist temple event, tracing much of the spread to the confines of one of the buses transporting people to the function. The bus had one sick person aboard, and 24 out of 67 people on that bus got sick, possibly indicating airborne transmission. Those who sat by the windows fared better, indicating the importance of ventilation.
I think we just need to get away from this terminology and give much more clear definitions, Cevik says. For her, its about getting people to think critically about which situations are riskier than others. Risk is a spectrum. Its not only the distance, but its about timing, what type of activities youre involved in. I know its a bit complex, but thats the reality.
Perhaps part of the reason the WHO has been slow to address the airborne transmission of Covid-19 is because in a health care setting, airborne means a very specific thing.
Though infection prevention experts know theres a fuzzy boundary between drops that fall and specks that float, the dichotomy between airborne and droplet-borne is baked into how health care workers are trained to respond to outbreaks. Weve trained [health care workers] for decades to say, airborne is tuberculosis, measles, chickenpox, droplet is flu and pertussis and meningitis, Saskia Popescu, a hospital epidemiologist in Arizona, says. And thats, unfortunately, kind of antiquated. But thats how weve always done it.
They do it because there are very specific sets of guidelines in place to deal with extremely contagious airborne diseases in a hospital setting. For instance, a patient with a dangerous airborne disease often needs to be put in a room with an air pressure lower than the rest of the rooms in the building. That way, no virus in the air of that room can escape it (since air flows from high pressure to low pressure).
For droplet transmission, health care workers can be a little more lax; they can wear simple surgical masks during routine care and can save high-filtration (and sometimes scarce) respirators for the most dangerous procedures and cases.
In this light, it makes some sense that the WHO has been hesitant to label Covid-19 an airborne infection. Its not an airborne infection like measles is. It is not as contagious. Contact tracing studies consistently find that Covid-19 is spread most readily among people in the closest physical contact to one another. Airborne means something very specific, very resource-intensive, and very scary for hospitals and the people who work in them. And Covid-19 doesnt match that definition.
The debate often isnt very nuanced because of these rigid categories, Daniel Diekema, an infectious diseases physician and epidemiologist at the University of Iowa, says. As soon as you say airborne in the hospital infection prevention world, it brings to mind pathogens like tuberculosis, measles, chickenpox. Its clear the respiratory viruses, influenza, coronaviruses, are not airborne in the same way that the measles, varicella [chickenpox] become airborne.
But at the same time, with Covid-19 and other respiratory viruses, there definitely are small-particle aerosols produced, he says. And in the right setting, where theres poor ventilation, indoors, and a crowded environment, there is a risk for transmission among individuals, even if they may be more than 6 feet apart.
Neither contact tracing studies nor lab studies can perfectly answer the question of which air is safe? But thats science for you. Scientists use imperfect methods, attacking from many angles, to try to arrive at the truth, which can take a while to nail down precisely.
Overall, the recognition that Covid-19 can spread through the air shouldnt really change how we, individually, protect ourselves and others against it. Six feet of distance between people is still a good barrier to prevent spread via large drops. Mask-wearing could help prevent both large drops and small drops from being released in the first place. Time matters too: the longer we spend in an enclosed, poorly ventilated space with others, the greater the chances of being exposed to an infectious dose of the virus.
The bottom line, as a trio of engineers from Clarkson University writes in the Conversation, is that while staying six feet from other people reduces exposure, it might not be sufficient in all situations, such as in enclosed, poorly ventilated rooms.
We still need to think about the environments were in: Indoors is much riskier than outdoors (where greater airflow can disperse drops and aerosols more quickly, and where the environment is less conducive to SARS-CoV-2 survival). And indoors, ventilation can make a big difference. An indoor space where the air is constantly refreshed with air from the outdoors is better than one where the air is stagnant. (The American Society of Heating, Refrigerating and Air-Conditioning Engineers has published extensive guidelines on how to reopen buildings with increased ventilation during the pandemic.)
We also still need to think about the activity were engaging in. Shouting, singing, and other such activities produce more droplets (of any size) than just sitting quietly.
Morawska hopes that in bringing attention to airborne spread of Covid-19, there can be more attention paid to engineering solutions for indoor spaces to mitigate the spread of the pandemic.
Public health officials have continually stressed social distancing, mask-wearing, and hand-washing as ways to stop the spread of Covid-19. But have you ever heard a restaurant reopening announce theyve improved ventilation or increased ventilation? No. This is really the point, Morawska says. If Covid-19 is in indoor air, we should also be doing something about the air.
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One woman who was waiting to be tested said came because her daughter-in-law recently tested positive for the virus.
>> PHOTOS: Lines form early in Huber Heights
Though they hadnt seen each other for 12 days, the woman said she just wanted to be sure.
The woman, who said shes dealing with cancer, added that she was in favor of wearing face masks.
Its going to be here to stay, she said. We might as well just get used to it.
Public health is also hosting free pop-up testing sites at Trotwood Madison High School on Friday and at the Montgomery County Fairgrounds in Jefferson Twp. on Monday.
>> DeWine pleads with Ohioans to mask up to slow virus spread
Anyone with questions can call public healths COVID-19 information line at 937-225-6217.
Following pop-up testing in Xenia and Dayton in June, 62 people tested positive for coronavirus.
Nine people who were tested in Xenia received positive positive results and 948 were negative, according to Five Rivers Health Centers.
In Dayton, 53 people tested positive and 1,268 were negative.
As the coronavirus pandemic continues to surge in parts of the US, some companies have moved forward with plans to let their employees re-enter the office after months of working from home.
In the absence of federal guidelines around best practices, office managers will likely need to rely on an abundance of caution. This may turn offices into ghost towns of their former selves, with gatherings by the water cooler, big meetings, and buzzing shared spaces disappearing for the foreseeable future.
If your office decides to move forward with reopening, you may start to hear the phrase de-densifying in conversations about how to do so safely. The term, which many schools have used when laying out plans for reopening in the fall, refers to restricting the number of people who have access to a given space at any one time, in order to ensure social distancing.
For offices, that could mean phased re-openings. It is important to note that not all employees will return to a location at the same time, said JPMorgan Chase in a May memo to employees, obtained by the Guardian. It will happen in waves over a period of time, with business leaders prioritizing who returns when.
It could also mean major changes to the physical layout of your office. The 100-person tech firm Submittable reports experimenting with different seating arrangements to avoid clustered workspaces. It is also planning staggered workdays, with teams rotating between designated days in the office.
With health officials predicting another wave of the virus in the fall, this staggered standard will likely continue over the next six to twelve months.
While big office meetings may not officially be a thing of the past yet, theyre most certainly arent a thing of the immediate future, said Asta So, Head of People at Submittable. We may have smaller groups in large meeting rooms, while everyones wearing a face mask. The virtual meetings and social gatherings that have developed over the last two months will likely remain the norm.
Stations for personal protective equipment, like hand sanitizer, masks and gloves, will be new permanent fixtures in offices, placed at entrances, exits and other strategic locations. Forward-thinking businesses may have stations for you to recycle your masks and gloves as well. Branded, individual back-to-work safety kits will now be as common as zip drives and pens: companies like iPromo, a Chicago-based bulk supplier, have been selling personal kits to offices by the thousands. Some of these include sanitizer, masks, gloves, tissues, soap, a stylus pen for use on high-touch surfaces like printers and elevator buttons, and brass antimicrobial hook-style keys that can open door handles.
Even though we now believe the virus is not as easily transmitted via contact with contaminated surfaces, workers will likely need to get into the habit of wiping down their desk and other office supplies. Most janitorial services cant keep up with the now-constant disinfectant requirements of things like elevator buttons and faucet buttons.
We might add wiping high-touch surfaces to office task lists, So said. And well be asking employees to make choices that avoid touching potentially contaminated surfaces, like taking the stairs instead of the elevator.
No-touch infrared thermometers have already been spotted in certain businesses, including airports and restaurants. Even though experts have said these tools have limitations for curbing the spread of Covid-19, including reporting false positives and user error, workers can still expect these to make more frequent appearances in the office.
The state of Connecticut, for example, announced in May that it would distribute 50,000 infrared thermometers to small businesses and non-profits. Some businesses may even spring for a body thermal scanner at office entrances, like Amazon has done at its warehouses. High-tech fever detectors are coming, said Friedman.
A recent survey of employers conducted by Willis Towers Watson found that almost half of companies surveyed (47%) are enhancing health care benefits for employees in the face of Covid-19. Forty-five percent of respondents reported expanding wellbeing coverage, and 33% reported planning changes to paid time off policies. While coverage of Covid-19 treatment for employees isnt federally mandated, new legislation, effective 18 March, required group health plans to cover testing and related services without cost sharing.
At the same time, experts predict that health insurance premiums for employers will rise in 2021 anywhere from 4% to 40%, based on recent filings from health insurance companies with the District of Columbias Department of Insurance, Securities and Banking. A report from Covered California predicted employers no longer being able to offer affordable coverage, or dramatically shifting costs to employees.
Theres no point in sugar-coating this. The U.S. response to the Covid-19 pandemic is a raging dumpster fire.
Where a number of countries in Asia and Europe have managed to dampen spread of the SARS-CoV-2 virus to the point where they can consider returning to a semblance of normalcy friends from Paris just emailed me pictures from their Sicilian vacation many international borders remain closed to Americans.
On Sunday, Florida reported more than 15,000 cases in a single day. South Korea hasnt registered 15,000 cases in the entire pandemic to date. One day last week the U.S. recorded more than 68,000 cases.
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The website Covidexitstrategy.org has updated its previously tri-colored U.S. map, which showed states as either green, signifying they are trending better; yellow, making progress; or red, trending poorly. A fourth designation, called bruised red, signals states with uncontrolled spread; criteria for this category includes hospitals nearing capacity both in terms of overall beds and ICU space. Already 17 states are wearing bruised red.
The virus suppression gains earned through the painful societal shutdowns of March, April, and May the flattened epidemiological curves have been squandered in many parts of the country, dejected public health experts agree. A vaccine for the masses is still months away. What can be done?
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One thing is clear, according to public health experts: Widespread returns to lockdown must be a last resort and may not be doable.
It would be really a morale breaker, Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told STAT. The stress and strain that people were under during prolonged lockdown is the genesis of why, when they were given the opportunity to try and open up, they rebounded so abruptly. Because what I think happened is, they overshot.
But this is not a binary choice between societal lockdowns and the party like its 2019 approach that put the country in the bind its in now. With that in mind, STAT asked a number of public health experts for a single suggestion of how we get ourselves out of this mess. We got lots.
None is a magic bullet. This is going to be a painful and slow process. But there are things individuals, public health departments, state and local governments, and the Trump administration can do.
The fire brigade needs us all.
Pent-up people embraced newfound freedoms over-exuberantly, Fauci said. He suggests going back to Phase 1 of the reopening process and then working forward with more caution. Do it the way they should have done it in the beginning, he said.
If we do that, particularly closing the bars, avoiding anything that has a congregation of a large number of people, wearing masks outside essentially all the time, keep distancing I would almost guarantee that we would see a turnaround of the resurgence that were seeing now.
Ashish Jha, director of Harvards Global Health Institute, favors banning all indoor public activities that bring together groups of people, for now including church services.
My best read of the data is that a large chunk of the transmission is happening when people gather indoors. So, cut out the indoors. No restaurants, no bars, no nightclubs, obviously no schools right now, Jha said.
Hed close stores, except pharmacies and grocery stores, and require those to limit the number of people they admit at any one time. Staff and customers would have to wear face coverings.
Saskia Popescu, an infection prevention epidemiologist at the University of Arizona, thinks advice like this needs to be pragmatic and take into account that conditions vary across the country. Like where she lives, in sweltering Phoenix.
Everyone likes to say eat outside! she notes. You cant do that in 115 F heat, so lets give people the tools to apply infection prevention strategies for these environments.
Social responsibility is huge, but if we dont do effective risk communication and education, youre failing people, Popescu said.
Marm Kilpatrick listens to a lot of NPR. On NPR, he hears a lot of public service announcements from the Centers for Disease Control and Prevention urging people to cover their coughs, wash their hands, practice social distancing. Kilpatrick, an infectious diseases dynamics researcher at the University of California, Santa Cruz, thinks most of that advice is, by now, not useful.
People should be wearing masks, so by definition coughs are covered. (Plus, people who are coughing should be staying home.) Fomites viruses coughed onto surfaces are no longer thought to be major mode of transmission. And people dont really get how to social distance except avoid strangers, he said.
They need better, more useful messages telling them how to do the things they want to do, but safely. Kilpatrick gives it a go: Wear a mask. Meet outside. Give space.
One thing I notice is that when people ask me a question, they say yet. Can I do this yet? said Amesh Adalja, an expert on emerging infectious disease and pandemic preparedness at Johns Hopkins. And I say, There is no yet.
He suggests borrowing a page from the harm reduction work that has been done to address sexually transmitted diseases and the opioid epidemic helping people figure out the risks they face and how to navigate them.
We have to get better at individual risk calculus, Adalja said. Its not something that people are very good at. And I think thats why when bars opened in certain places it was like the whole town turned 21.
We need to learn to live with SARS-CoV-2, said Michael Osterholm, director of the University of Minnesotas Center for Infectious Diseases Research and Policy.
Pretending the virus is not a threat or trying to will it away is a recipe for disaster. You have less chance of winning a policy debate against this virus than you do of winning a debate against 2,000 angry 2-year-olds, Osterholm said.
People have to understand that. Its like trying to defy gravity. Just because you want to doesnt mean you can.
Public health is amassing lots of information about who is getting sick and where theyre getting infected. That data should be put to better use, said Caitlin Rivers, an assistant professor of epidemiology at the Johns Hopkins Center for Health Security.
We can use that information to better direct resources and interventions, for example by closing high-risk activities rather than broad shutdowns, Rivers said. These kinds of analyses will need to be ongoing, because conditions will change, and should be made public to help people assess their personal risks and guide their decision-making.
Data mining could be used to develop local forecasting services, said William Hanage, an epidemiologist at Harvards T.H. Chan School of Public Health.
He envisages something like: Covid activity in your area is currently low. While the risk is not zero, all you need to do is wear a mask while indoors in a public space, or Covid activity is expected to be very high and you are advised to shelter in place. Please avoid contact with at-risk persons.
Enough with the but the flu and its getting better and its going to go away on its own talk. There needs to be consistent communications from all levels of government about the risk the virus poses, said Alessandro Vespignani, director of the Network Science Institute at Northeastern University.
I know it sounds trivial, Vespignani said, but I have the feeling that is impossible to win the fight if a large fraction of the population is not believing there is something to fight.
With more than six months worth of experience with Covid-19, the world has good evidence about what works to suppress spread of the virus. All levels of government should be urging people to take those steps, said Tom Inglesby, director of the Center for Health Security at Johns Hopkins.
If leaders from this point forwardspoke with the same messages, consistently, clearly, without division,they likelyhave the power to changetheviews of many who have been less convinced of the right things to do because of conflicting, confusing messages they have been hearing, he said.
Leaders should also practice what they preach masks in public, avoiding large gatherings and be guided by science, Inglesby said.
Black, Latinx, and Native American communities have been disproportionately hard hit by this pandemic, said Richard Besser, president and CEO of the Robert Wood Johnson Foundation. And too little has been done to ensure that essential workers, many in low-paying jobs, have the tools to protect their health and the health of their families and communities.
Fixing this means providing income support so people who are sick or exposed can stay home, and ensuring they have sick leave and family medical leave. It also means funding unemployment insurance for the millions of people who have lost their jobs in the pandemic, and extending rent forgiveness and moratoriums on evictions and foreclosures, Besser said, as well as providing safe places for people who need to isolate or quarantine but dont have the space to do it at home.
Natalie Dean said more geographically focused testing would turn up cases that are being missed. And bringing the tests to where the people are would result in a lot more people being tested. Dean, an assistant professor of biostatistics at the University of Florida, said more mobile testing vans could help identify where transmission is happening. Thats a different approach than the efforts to find and quarantine people who have been contacts of confirmed cases.
So, it is less about using tracing to reconstruct a chain, and more about identifying a hot spot and trying to flood the area with tests, she said.
Low-cost $1 a day or less home testing for Covid-19 is doable, said Michael Mina, a Harvard epidemiologist and associate medical director of clinical microbiology at Bostons Brigham and Womens Hospital.
The tests exist. The technology exists. They could be manufactured tomorrow and they would detect people on the days that they are most likely to be transmitting, Mina said.
These tests arent as sensitive as laboratory tests they miss some cases but they have the advantage of giving an instant answer. The turnaround for lab testing can be a week. If everyone in a high transmission zone could test themselves daily and stay home while they test positive, it would dramatically lower transmission, he said, arguing the government should pay for these tests.
Too few states have the capacity to do effective contact tracing, says Crystal Watson, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.
We need this capacity now and we will need it in the fall, said Watson, alluding to the fact that Covid-19 and influenza will be co-circulating as we get into the autumn and winter. The White House should embrace a national initiative for contact tracing, and Congress should provide additional funding for state and local public health authorities to expand contact tracing capacity.
New York City had its first 24-hour period since March without a death from the coronavirus on Saturday. Here, people dine outdoors on July Fourth in Manhattan's Little Italy. Byron Smith/Getty Images hide caption
New York City had its first 24-hour period since March without a death from the coronavirus on Saturday. Here, people dine outdoors on July Fourth in Manhattan's Little Italy.
For the first time in months, there was a 24-hour period in which no one in New York City died of the coronavirus.
The New York City Department of Health and Mental Hygiene reported zero deaths on Saturday, but that number could change as death data can lag and new deaths could be confirmed retroactively at any point. The city's first confirmed coronavirus death was March 11.
Mayor Bill de Blasio called the milestone a statement about "how this city fights back and people do not ever give in."
"It's something that should make us hopeful, but it's very hard to take a victory lap because we know we have so much more ahead. This disease is far from beaten," de Blasio said during a news conference Monday. "And we look around the country and we look at what so many other Americans are going through and so many other states and cities hurting so bad right now. So no one can celebrate, but we can at least take a moment to appreciate that every one of you did so much to get us to this point."
New York City has had 18,708 confirmed deaths due to COVID-19 as well as 4,615 probable deaths.
"Twenty-four hours where no one died," the mayor said. "Let's have many more days like that."
De Blasio also called upon President Trump to invoke the Defense Production Act to speed up the processing of coronavirus tests:
"Mr. President, all you have to do is say, 'I am now invoking the Defense Production Act to expand lab capacity in the United States of America, to make sure we have everything we need to get tests to people quickly.' You can do that with the stroke of a pen. We need it not only here in New York; we need it all over this country."
Trump previously invoked the act in March to boost production of masks and ventilators.
"The federal government has to step up now, because now it's becoming a national crisis," the mayor said. "We used to have almost no testing. Now we have more testing, but if you can't get the results in real time, it doesn't help you enough."
Amid the huge reduction of coronavirus cases in the city, there is one worrying trend: a rising infection rate among young adults, particularly 20- to 29-year-olds.
"I understand for so many younger adults it has been a really difficult time cooped up, disconnected, away from loved ones," de Blasio said. "I understand that people are just yearning to break out of that, but we've got to keep telling everyone, particularly our younger adults, how important it is to stick to what has worked: the social distancing, the face coverings, getting tested."
The city plans to expand its outreach to young people through social media influencers, mask giveaways and mobile testing vans. There will also be 10 new free, walk-up testing sites in the Bronx, Brooklyn and Queens.
As more people return to work indoors and go back to using the subways, de Blasio urged New Yorkers to wear face coverings whenever they are indoors outside their homes, even if other people aren't in close proximity.
On Monday, the city reported a 2% positivity rating for coronavirus testing. Fifty-six patients were admitted to the hospital, and 279 patients were in intensive care units.
