Many experts say the huge pool of uninsured people in these states compounds the challenge of coping with the outbreak in several different ways, from leaving a large number of residents with underlying conditions that increase their vulnerability to the disease to extending the outbreak's spread by discouraging the uninsured from seeking early testing and treatment.
The new pressures emerging as the virus migrates to low-insurance Sun Belt states -- after striking first primarily in Northern and Western states that expanded Medicaid, almost all of which have lower uninsured rates than the national average -- is only one of the several respects in which the outbreak is raising the stakes in the debate over the ACA's future.
All of this could make the political debate over health care even more central in 2020 than it was in 2018, when Democratic promises to defend the ACA, and in particular its provisions protecting patients with preexisting conditions, were pivotal in the party's sweeping midterm election gains.
"All the same reasons that it was [important] in 2018 are in effect now, and all the [arguments] in the middle of a pandemic are even more potent," says Democratic pollster Nick Gourevitch.
Republican pollster Gene Ulm disagrees. He says that concerns directly relating to the coronavirus outbreak -- such as whether businesses and schools can reopen safely -- are eclipsing all other issues this year. "All the oxygen has just been squeezed out," he says. "Health care before meant, 'Will I be able to get coverage? How much will I have to pay for it?' Now it's all the Covid."
But Democrats are betting heavily that Ulm and other Republicans who share that perspective are wrong. Majority Forward, the issue advocacy arm of the Senate Democratic leadership, and the Senate Majority PAC, its campaign super PAC, are once again stressing health care more than any other issue in their advertising against Republican senators this year.
"I think health care -- to the surprise of a lot of people, maybe most directly Republicans -- is more urgent and even a greater priority than it was two years ago," insists J.B. Poersch, the president and CEO of the Senate Majority PAC.
Many experts believe the pandemic and the ACA could be connected in an even more visceral way in the weeks ahead. The reason: Most expect that insurance companies are likely to define exposure to coronavirus as a preexisting condition. That means many of the millions of Americans who have contracted the disease could face higher premiums and less access to coverage and care if the administration's lawsuit (and Republican legislative proposals throughout Donald Trump's presidency) to repeal the ACA's protections prevails.
"There's no question in my mind that insurance companies would treat Covid-19 as a preexisting condition if they were allowed to," said Larry Levitt, executive vice president for health policy at the nonpartisan Kaiser Family Foundation. That prospect, he adds, "connects the dots in a very tangible way between the ACA and the pandemic."
2018 vs. 2020
Democrats are again stressing the issue of preexisting conditions in House and Senate races this year. Majority Forward and the Senate Majority PAC have run television ads lashing GOP senators from Cory Gardner in Colorado and Martha McSally in Arizona to David Perdue in Georgia, Steve Daines in Montana and Thom Tillis in North Carolina for their votes earlier in Trump's term to repeal the ACA and its measure barring insurers from selling coverage at higher prices to patients with preexisting conditions.
These exchanges largely reprise the debate between the parties from 2018, albeit in the more highly charged atmosphere of the coronavirus crisis. But the outbreak -- combined with the ACA lawsuit -- may also be broadening the health care debate to focus more than in 2018 on the law's efforts to expand coverage to the uninsured.
"When you talk about the sheer number of people that aren't covered in a public health crisis, that is very relevant to the moment. That matters," says Poersch.
Republicans are generally countering Democratic calls to protect the ACA or to expand coverage to the remaining uninsured by accusing the party of seeking a government takeover of health care.
"Democrats showed the entire country what their objectives are on health care during the presidential primary: a government-controlled plan that seeks to eliminate employer-based coverage," Jesse Hunt, communications director for the National Republican Senatorial Committee, said in an email. "All roads lead to that outcome."
The issue of ensuring coverage during a pandemic, particularly by expanding Medicaid, is surfacing in races around the country.
But the issue may be most pointed in the primarily Sun Belt states that have refused to expand Medicaid under the ACA and thus remain among the states coping with the largest share of uninsured residents even as their coronavirus caseloads spike.
How they're campaigning
In North Carolina, where Republican state legislators have repeatedly blocked efforts by Democrats to expand Medicaid eligibility, the Senate Majority PAC has stressed the issue in its advertising against Tillis, who before his election to the US Senate helped lead the fight against Medicaid expansion as the GOP speaker in the state House of Representatives.
In Alabama, Democratic Sen. Doug Jones, who faces a difficult fight for reelection in a state where Trump romped in 2016, is running an ad where he endorses Medicaid expansion for the state and declares: "Too many folks face the Covid crisis without health care coverage."
In Texas, the issue is especially acute, both because it is the largest state that has not expanded Medicaid and because Republican Attorney General Ken Paxton has led the coalition of GOP states suing to invalidate the ACA. Democratic House candidate Sri Preston Kulkarni, who is running strongly for an open Republican seat outside Houston, one of the outbreak's epicenters, has stressed health care throughout his campaign and unequivocally insisted that Texas should expand Medicaid eligibility.
Likewise, Democrats are promising to expand Medicaid in their uphill, but achievable, bid to win control of Texas' state House of Representatives for the first time in years. Texas' coronavirus crisis "has brought in a very crystallized way the reality of what life is with health care, and what life is without it," says Democratic state Rep. Trey Martinez Fischer of San Antonio.
Contrary to the Democrats, Ulm says that in his research voters are not linking the outbreak with either the debate over protecting preexisting conditions or Trump's efforts to repeal the ACA. "It's not how people are looking at it," he says. "It's just not. They are looking at it more like: No one seems to understand this [disease]."
Such repositioning may reflect the enormous pressure that the coronavirus outbreak is imposing on health care systems, particularly in the states already strained by the large number of uninsured. The big uninsured population "makes it exponentially worse" to cope with the surge, says Texas state Rep. Fischer Martinez.
Challenges for non-expansion states
Medical experts say that the Sun Belt states have one big advantage over the states hit earlier this spring: Hospitals have developed more expertise on how to treat victims and reduce mortality. But in many other respects, experts say the large number of uninsured in many of these states complicates their situation. These challenges include:
In the presidential race, the coronavirus outbreak has eclipsed all other issues to the point that the health care debate hasn't been engaged as directly as in many of the Senate and House contests. But the virus' turn into the low coverage states that refused to expand Medicaid could eventually provide a vivid backdrop for one of the sharpest policy differences between Trump and presumptive Democratic nominee Joe Biden.
CNN's Tami Luhby contributed to this report.
TheWest Virginia Department of Health and Human Resources (DHHR)reports as of 6:00 p.m., on July 13, 2020, there have been 211,006total confirmatorylaboratory results received for COVID-19, with 4,313 totalcases and 97 deaths.
DHHR has confirmed the death of an 85-yearold female from Ohio County. Pleasejoin with me as we grieve the loss of another West Virginian, said DHHRCabinet Secretary Bill J. Crouch.
In alignment with updated definitions fromthe Centers for Disease Control and Prevention, the dashboard includes probablecases which are individuals that have symptoms and either serologic (antibody)or epidemiologic (e.g., a link to a confirmed case) evidence of disease, but noconfirmatory test.
CASESPER COUNTY (Case confirmed by lab test/Probable case):Barbour(20/0), Berkeley (518/19), Boone (34/0), Braxton (5/0), Brooke (27/1), Cabell(192/7), Calhoun (4/0), Clay (12/0), Fayette (84/0), Gilmer (13/0), Grant(21/1), Greenbrier (71/0), Hampshire (42/0), Hancock (41/3), Hardy (46/1),Harrison (122/0), Jackson (148/0), Jefferson (253/5), Kanawha (421/12), Lewis (21/1),Lincoln (9/0), Logan (39/0), Marion (106/3), Marshall (65/1), Mason (25/0),McDowell (8/0), Mercer (63/0), Mineral (66/2), Mingo (29/2), Monongalia(554/14), Monroe (14/1), Morgan (19/1), Nicholas (19/1), Ohio (147/0),Pendleton (15/1), Pleasants (4/1), Pocahontas (37/1), Preston (81/21), Putnam(90/1), Raleigh (80/3), Randolph (188/2), Ritchie (2/0), Roane (12/0), Summers(2/0), Taylor (22/1), Tucker (6/0), Tyler (10/0), Upshur (31/2), Wayne (127/1),Webster (1/0), Wetzel (37/0), Wirt (6/0), Wood (179/9), Wyoming (7/0).
As case surveillance continues at thelocal health department level, it may reveal that those tested in a certaincounty may not be a resident of that county, or even the state as an individualin question may have crossed the state border to be tested.Such is the case of Cabell, Lewis, Logan, Marion, Mingo, Nicholas, Ohio, andPreston counties in this report.
Please visit thedashboard at www.coronavirus.wv.gov for more detailed information.
Microsoft founder Bill Gates on Saturday said that Covid-19 medication and future vaccines should be distributed to people who need them the most and not to "the highest bidder."
"If we just let drugs and vaccines go to the highest bidder, instead of to the people and the places where they are most needed, we'll have a longer, more unjust deadlier pandemic," Gates, a billionaire philanthropist, said during a remote Covid-19 conference hosted by the International AIDS Society.
"We need leaders to make these hard decisions about distributing based on equity, not just on market-driven factors," he added.
As countries and companies race to bring a vaccine to the market, concerns have risen about wealthier nations receiving more drugs than developing countries.There have been calls for future coronavirus vaccines to be treated as public goods for everyone, without profit.
The World Health Organization said that 21 candidate vaccines are currently in clinical trials being tested on human volunteers, three of which are in the third phase of those trials.
U.S. biotech firmModerna,U.K. pharmaceutical companyAstraZenecaand China's Sinovac Biotech have made the most progress towards developing vaccine candidates for the coronavirus. However, Moderna, which is working with the U.S. National Institutes of Health, recently said that its late-stage trial for a vaccine will be delayed, possibly by a few weeks.
A potential vaccine being developed by the drug giantPfizerand the biotech firmBioNTechhas garnered immune responses in healthy patients, but also caused fever and other side effects.
Gates said a main takeaway from the battle against HIV/AIDS two decades ago is the significance of creating a fair global distribution system to make drugs available for everyone. He said the AIDS crisis serves as a model in making Covid-19 drugs more equally and widely available, pointing to the 2002 Global Fund to Fight AIDS, Tuberculosis, and Malaria as an example.
"Global cooperation, a resolve to invent the tools and get them out where they're needed most is critical," Gates said. "When we have those things, nations, institutions and advocates working together on this collective response, we do see remarkable impact."
Editors note:This is a live account of COVID-19 updates from Monday, July 11, as the day unfolded. It is no longer being updated. Clickhereto see all the most recent news about the pandemic, andclick hereto find additional resources.
Throughout Monday, on this page, well be posting Seattle Times journalists updates on the outbreak and its effects on the Seattle area, the Pacific Northwest and the world.
Updates from Sunday can be found here, and all our coronavirus coverage can be found here.
The following graphic includes the most recent numbers from the Washington State Department of Health, released Monday evening.
Washington health officials released two unusual numbers related to the coronavirus pandemic on Monday evening, confirming 1,101 additional COVID-19 cases and 39 fewer deaths than the day before.
That amounts to a record-high one-day count of diagnoses, bringing the total in the state to 41,757. The previous one-day high was 1,087, reported July 6, the Monday after the holiday weekend. Tallies are often slightly higher on Mondays as the state catches up with data from diagnoses over the weekend.
It's also a rare and significant drop in the death tally, bringing the state's total deaths to 1,399. The state Department of Health (DOH) did not immediately respond to requests for an explanation of the anomaly.
The updated numbers mean about 3.5% of people diagnosed in Washington have died,according to DOH.
So far, 708,274 tests for the novel coronavirus have been conducted in the state, per DOH. Of those, 5.9% have come back positive since testing began slightly higher than the rate of positive tests in the past week, whichthe state reportsis at 5.5%.
About 44.6% of the state's deaths have occurred in King County, Washington's most populous, where DOH on Monday confirmed 12,077 diagnoses and 624 deaths (13 fewer deaths than the state reported for King County on Sunday).
Elise Takahama
WASHINGTON With U.S. virus cases spiking and the death toll mounting, the White House is working to undercut its most trusted coronavirus expert, playing down the danger as President Donald Trump pushes to get the economy moving before he faces voters in November.
The U.S. has become a cautionary tale across the globe, with once-falling cases now spiraling. However, Trump suggests the severity of the pandemic that has killed more than 135,000 Americans is being overstated by critics to damage his reelection chances.
Trump on Monday retweeted a post by Chuck Woolery, once the host of TVs Love Connection, claiming that Everyone is lying about COVID-19. Woolerys tweet attacked not just the media and Democrats but the Centers for Disease Control and Prevention and most doctors that we are told to trust. I think its all about the election and keeping the economy from coming back, which is about the election.
At the same time, the president and top White House aides are ramping up attacks against Dr. Anthony Fauci, the nations top infectious diseases expert. Fauci has been increasingly sidelined by the White House as he sounds alarms about the virus, a most unwelcome message at a time when Trump is focused on pushing an economic rebound.
Associated Press
As scientists race to test coronavirus vaccines in humans, a parallel scramble is underway to produce billions of medical-grade vials and syringes that will be needed to inoculate the worlds population.
The job of delivering vaccine to a majority of humans within two years is so vast that global production of pharmaceutical vials needs to be ramped up by 5 to 10% within two years, a job the industry says requires immediate preparation and increases in production but is not an insurmountable challenge.
Governments and drug companies around the world are placing huge orders worth hundreds of millions of dollars and pushing the makers of vials and syringes to add manufacturing capacity.
Compared with the rush of laboratory studies and clinical trials needed to produce vaccines that can safely and effectively block the virus, the work of producing vials is prosaic stuff but just as important.
The Washington Post
President Donald Trump and Education Secretary Betsy DeVos have told public school districts they must open fully for the 2020-2021 school year during the coronavirus pandemic, and they threatened to withhold federal funding from school districts that dont comply.
The threats, however, are largely just that: threats without real teeth behind them.
While presidents can in some cases legally withhold funding appropriated by Congress, they cant do it without notifying Congress and in some cases getting approval. (Some have tried and been struck down by courts, and DeVos has been held in contempt of court as education secretary for refusing to stop collecting loans from former students of a chain of for-profit colleges that closed.)
Trump and DeVos who often talk about the importance of local control of education also have no authority to force schools to open at a particular time or in a specific way.
Those are state and local decisions, regardless of how much Trump and DeVos shout about it.
Read the full story here.
Valerie Strauss, The Washington Post
SACRAMENTO, Calif. California Gov. Gavin Newsom on Monday extended the closure of bars and indoor dining statewide and ordered gyms, churches and hair salons closed in most places as coronavirus cases keep rising in the nations most populated state.
On July 1, Newsom ordered 19 counties with a surging number of confirmed infections to close bars and indoor operations at restaurants, wineries, zoos and family entertainment centers like bowling alleys and miniature golf.
The Democratic governor extended that order statewide Monday. He also imposed additional restrictions on the 30 counties now with rising numbers, including the most populated of Los Angeles and San Diego, by ordering worship services to stop and gyms, hair salons, indoor malls and offices for noncritical industries to shut down.
The data suggests not everybody is practicing common sense, said Newsom, whose order takes effect immediately.
He didnt include schools, which are scheduled to resume in a few weeks in much of the state. But Monday, the states two largest school districts, San Diego and Los Angeles, announced their students would start the school year with online learning only. LA Unified is the second-largest public school district in the country.
Read the full story here.
The Associated Press
Mass transit systems around the world have taken unprecedented and expensive steps to curb the spread of the coronavirus, including New York shutting down its subways overnight and testing powerful ultraviolet lamps to disinfect seats, poles and floors.
The cleaning measures produced something commuters have not seen in a while, or possibly ever: thousands of freshly scrubbed cars that look, feel and even smell clean. But experts say those steps solve only part of the problem, and transit officials are studying more advanced methods that might someday automatically disinfect transit systems around the clock.
All that cleaning does cut the threat of catching the virus, experts say, but the benefits are limited.
The virus transmits predominantly through droplets in the air its everywhere and could be nowhere, said Robyn Gershon, a clinical professor of epidemiology at New York University.
Cleaning a train car at a maintenance yard overnight or even several times during the day, as New Yorks Metropolitan Transportation Authority does might not help the transit employee or passenger stuck in close quarters with a coughing person.
Wearing a face mask will protect us the most, having that control among ourselves, Gershon said. I think the rest of it is really more the illusion, and thats not a small thing because it plays with our psyches.
"But to what extent are we now overspending, or veering too far into security theater? asked Nick Sifuentes, executive director of the New York-based advocacy group Tri-State Transportation Campaign, which found that cleaning topped a list of actions people wanted before they would feel comfortable riding mass transit again.
Read the story here.
The Associated Press
Approximately 3 percent of front-line UW Medicine health care workers have COVID-19 antibodies, below the rate found in the general population, the UW MedicineVirology Labannounced Monday
These early results show that steps taken to protect health care workers are effective and that front-line workers at UW Medicine are at no greater risk than the the population at large, UW Medicine said in a statement.
UW Medicines goal in offering antibody testing to all employees has been to determine the prevalence of previous COVID-19 infection within the population of health care workers compared to the prevalence in the general public.
The initial phase of testing focused on staff at Harborview Medical Center, UW Medical Center, Airlift Northwest and UW Neighborhood Clinics with direct exposure to COVID-19 patients, including those working in the Emergency Department and dedicated COVID-19 intensive and acute care units.
A second phase of testing included health care workers from regular inpatient units. UW Medicine employees who fall outside of these two groups are also being offered the test in a third phase, UW Medicine said.
"Coronavirus transmission risk can be successfully mitigated if early and frequent testing and safety measures are implemented," the statement said. "This allows for the rapid isolation of known coronavirus cases, which creates a safer environment for hospital workers and patients while lowering risk to the general public they interact with outside of work."
Christine Clarridge
A Wisconsin congressman whose coughing fit at the state Republican Party convention drew widespread attention because masks were not required at the event was suffering from nothing more than a dry throat, his campaign said Monday.
U.S. Rep. Glenn Grothman, 65, began coughing Saturday when he started his speech at the convention before about 300 attendees at a Green Bay conference center. The event proceeded even as Wisconsin saw a spike in coronavirus cases, breaking a daily record for newly confirmed cases for a third straight day.
Its time to talk about Donald John Trump, said an unmasked Grothman, before coughing and loosening his tie. Grothman regained his composure and proceeded to give a defense of Trumps first term in office on a variety of issues.
One clip of him coughing that circulated on Twitter had been viewed more than 4.3 million times as of Monday morning. Democratic U.S. Rep. Mark Pocan, who represents the Madison area in Congress, commented on Grothmans coughing with, Wow.
Congressman Grothmans cough was due to a dry throat and a need for a drink of water, Grothmans campaign manager, Alec Hanna, said in an email Monday. It has not persisted and he is exhibiting no other symptoms associated with COVID-19. He previously took a COVID-19 test, with a negative result.
Read the story here.
The Associated Press
Amid pervasive backsliding on social distancing, Britain and France are weighing whether to require people to wear masks in public places.
Scientists say the two countries governments should have done so ever since they started easing lockdowns like many other European nations did instead of exposing their populations to the risk of infections from mass dance parties and summer vacationers who think theres no longer anything to worry about.
Whether to make masks mandatory isnt just a matter of debate in the United States, where infection rates are still climbing fast.
British Prime Minister Boris Johnson urged U.K. residents Monday to wear face coverings in shops and other tight indoor spaces but stopped short of making it compulsory.
Critics have accused Johnsons government of failing to provide clarity on mask-wearing in the days since he began backtracking on previous advice that suggested face covers were not necessary. After the prime minister then was photographed wearing one in a shop, government ministers appeared on TV urging personal choice in the mask issue.
Meanwhile, Frances government said Monday its considering requiring masks in all indoor public places amid signs of a small rise in confirmed virus cases and a big drop in public vigilance.
Read the story here.
The Associated Press
The United Nations says the ranks of the worlds hungry grew by 10 million last year, and warns that the coronavirus pandemic could push as many as 130 million more people into chronic hunger this year.
The grim assessment was contained in the latest edition of the State of Food Security and Nutrition in the World, an annual report released Monday by the five U.N. agencies that produced it.
Preliminary projections based on available global economic outlooks suggest the pandemic may add an additional 83 (million) to 132 million people to the ranks of the undernourished in 2020, the report said.
Compounding the situation is what the reports authors described as unprecedented Desert Locust outbreaks in Eastern Africa.
The U.N. agencies estimated that nearly 690 million people, or nearly 9% of the worlds population, went hungry last year, an increase of 10 million since 2018 and of nearly 60 million since 2014.
As a result of the pandemic, food supply disruptions, lost livelihoods and the inability of people working abroad to send remittances home to their families mean its even more difficult for the poorer and vulnerable populations to have access to healthy diets, the U.N. agencies concluded.
The report noted that after steadily declining for decades, chronic hunger slowly began to rise in 2014 and continues to do so.
Read the story here.
The Associated Press
The first states to endure the coronavirus this spring hoped the worst would be behind them.
Instead, the virus is coming back.
Many places that suffered most in the first wave of infections, including California, Louisiana, Michigan and Washington state, are seeing case counts climb again after months of declines. Its not just a matter of more testing. Hospitalizations and, in some places, deaths are rising, too.
The disease is raging Florida reported 15,300 cases Sunday, the biggest single-day increase of the U.S. pandemic and experts say the resurgence in the original battlegrounds has common causes. They include a population no longer willing to stay inside, Republicans who refuse face masks as a political statement, street protests over police violence and young people convinced the virus wont seriously hurt them.
And even though some of the states led by Democratic governors delayed restarting their economies until weeks after more eager peers like Georgia, they still jumped too soon, critics say.
I dont think theres any question about that anymore. Even in California, we opened up too fast, said John Swartzberg, a doctor who is a clinical professor emeritus at the University of California at Berkeley.
So far, the rebound hasnt reached the states hardest hit by the first wave: New York, New Jersey and Massachusetts. But New York Gov. Andrew Cuomo said Friday that its on its way.
Were going to go through an increase, and I can feel it coming, he told WAMC radio. The only question is how far up our rate goes. But you cant have it all across the country and then have it not come back.
Read the story here.
Bloomberg
Until now, California hospitals avoided the dreaded surge in coronavirus patients that threatened to overwhelm wards and stretch thin staff and supplies. But now, with coronavirus hospitalizations in the state at an all-time high, doctors and nurses at some hospitals say the nightmare has arrived.
Hospitals up and down the state report that their beds are filling up fast, staffers are tiring and medications used to treat coronavirus patients are running low. The surge has hit California unevenly, with some facilities reporting their numbers staying flat in recent weeks, while others have risen sharply.
Were getting to the point where were just overwhelmed emotionally, physically exhausted. We dont have enough workers for all these patients; were working extra shifts, said Mary Lynn Briggs, an intensive care unit nurse at Mercy Hospital in Bakersfield. Im expecting things to go from bad to worse over at least the next couple of weeks.
Sylvain Trepanier, chief clinical executive for Providence Southern California whose 13 hospitals in Orange, L.A. and San Bernardino counties had as of Friday experienced a 40% increase in COVID-19 patients over the last 10 days, said, Thank God we didnt see that wave [then] as big as we anticipated, but that allowed us to be ready.
The months since March allowed hospitals time to prepare for such a surge. Doctors learned more about how to treat COVID-19 patients, hospital administrators obtained more protective gear, and staffers know more about how the coronavirus is transmitted and how to protect themselves.
Recent projections suggest that the hospital system in California will be able to handle the demand, in part because busier hospitals can transfer patients to facilities with more space. But even still, the strain on some hospitals is unprecedented.
Statewide, the number of people hospitalized with COVID-19 has increased nearly 50% over the last two weeks and now sits at a record high. The earlier peak of 3,497 hospitalized patients in California on April 29 was surpassed June 20, and the number has continued to climb every day since then. On Saturday, 6,322 people were hospitalized with COVID-19 in California.
Health officials have linked the surge to an increase in transmission of the coronavirus thatbegan in late May,as some counties began reopening businesses, thousandsgathered in large protestsand some people, tired of staying home, met up with family and friends.
Read the full story here.
Los Angeles Times
The Texas Supreme Court on Monday upheld Houstons refusal to allow the state Republican convention to hold in-person events in the city due to the coronavirus pandemic.
The state GOP convention had been scheduled to begin Thursday at Houstons downtown convention center and was expected to draw thousands of participants.
Houston Mayor Sylvester Turner, a Democrat, said last week that he had directed city lawyers to terminate the contract because he believed the event could not be held safely. He denied that the convention was cancelled due to political differences and cited the potential risk to service workers and first responders if the virus spread through the convention.
The state party sued a day later, alleging the city illegally breached the contract and accusing Turner of shedding crocodile tears.
State District Judge Larry Weiman sided with Turner, citing Houston statistics that show major hospitals exceeding their base intensive-care capacity due to an influx of COVID-19 patients.
When it was all boiled down, people with COVID seemed to cluster into three broad immunotypes, said E. John Wherry, director of Penns Institute for Immunology. Loosely speaking, some patients immune systems seemed to have overreacted to the virus, while others were slow to react. In a third group, the immune system did not seem to respond much at all.
[Update] A yellow fever vaccine, which is already around 80 years old, also seems to work in a modified form against COVID-19. Virologists from the Rega Institute at the Belgian university KU Leuven have booked good results with this modified vaccine in tests on hamsters.
The Belgian researchers will begin the first clinical trials on humans at the end of this year.
The team led by Professor Johan Neyts and Dr. Kai Dallmeier started in January with the development of eight variants of a vaccine against the novel coronavirus. The trials identified one candidate vaccine that appears to work particularly well in hamsters. After the administration of this vaccine, the virus was no longer or barely detectable in the hamsters lungs.
We saw up to half a million times less of the virus infection in the hamsters that received the candidate vaccine than in the hamsters from the control groups. The animals were also spared any lung infections. By contrast, the lungs of the test animals in the control groups were clearly damaged, Neyts explains. Whats more, even a single dose of the candidate vaccine was enough to protect against the infection. This also occurred in several animals even within ten days of being vaccinated.
The candidate vaccine was produced based on the existing yellow fever vaccine and is thus able to trigger an immune response in both COVID-19 and yellow fever in the test animals. A piece of the genetic code of the SARS-CoV-2 virus was incorporated into the yellow fever vaccine. The team had already used this platform to make candidate vaccines against ebola, zika, and rabies.
The effectivity of the yellow fever vaccine has been proven more than once, Neyts goes on to explain. It has already been in use for about eighty years and almost 800 million people have been vaccinated with it during that period. One dose of the vaccine results in lifelong protection against yellow fever. Of the more than 160 vaccines under development to combat COVID-19, we are the only ones who are using yellow fever as a basis.
In order to select the most potent of the eight prototype vaccines, we not only tested which prototype generates the most antibodies in hamsters but also which one offers the most effective protection against infection. This increases our chances of finding a successful candidate, says Professor Neyts. Only by using an infection model will you be able to find out if one or more doses are needed and how quickly the vaccine will be effective enough after vaccination.
The candidate vaccine stimulates the body to produce antibodies against the corona viruss protrusions, thereby preventing the virus from attaching itself to healthy cells.
Given that an experimental vaccine from a research laboratory cannot be administered to people straightaway, a specialist company accredited for that purpose now needs to manufacture the candidate vaccine. This is done according to the strictest quality standards. The team is currently in talks with manufacturing partners.
If everything else continues to run smoothly, we expect to start the first clinical trials on humans by winter, says Kai Dallmeier, who runs the vaccine team. Normally it takes at least ten years to develop a vaccine. So, we worked at a very fast pace. And we are not alone: a lot of vaccines are being developed all over the world. Thats a good thing because at this stage its important to be able to bet on different horses.
The study A potent single-dose live-attenuated YF17D-vectored vaccine against SARS-CoV-2 by Lorena Sanchez Felipe et al. was published on the pre-print bioRxiv server pending peer review.
In an earlier release of this article, the suggestion was made that the vaccine being tested now is the eighty-year-old yellow fever vaccine. This is not accurate. It concerns a vaccine based on the old vaccine.
Written by M S Seshadri, T. Jacob John | New Delhi | Updated: July 14, 2020 4:06:49 pm Hydroxychloroquine, pulled out of WHO Solidarity trial, has now shown fresh promise in a Detroit study. (Getty Images)
The usefulness of hydroxychloroquine (HCQ) in Covid-19 has been controversial, without clarity or clear evidence one way or the other, until very recently. A study on more than 2,500 patients in six units under the Henry Ford Hospitals group in Detroit, Michigan, USA, peer-reviewed, accepted and ready for publication in the International Journal of Infectious Diseases, has found good evidence that HCQ reduces Covid-19 mortality significantly. It should be noted that conditions apply.
HCQ has been widely used as a drug to treat malaria and to prevent malaria in travellers to malaria-endemic zones, for decades. Once its anti-inflammatory and immune suppressant properties were identified, it began to be used the world over in autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. In fact, in developed countries without malaria, it is widely but almost exclusively used by rheumatologists. The side-effect profile has been well characterised and protocols for monitoring side effects are taught in all medical colleges. The drug has withstood the test of time.
When the chikungunya pandemic seeded epidemics in various states in India during 2002 through 2006, many patients in the post-chikungunya-fever phase developed persistent and disabling large joint pain and swelling, lasting months to years. HCQ came to their rescue and physicians have been using it with remarkable success, but with all due precautions.
HCQ in Covid pandemic
The story of HCQ and Covid-19 began in Wuhan, China, where patients who were on HCQ, attending rheumatology clinics, seemed to be relatively protected from serious Covid-19 than those attending other clinics. Looking for possible treatment options, Chinese physicians stumbled on HCQ . So they began using HCQ empirically for treating Covid-19.
French physicians, familiar with HCQ used against an endemic bacterial disease called Q fever, followed up with scientific studies for seeking objective evidence for HCQ use in Covid-19. There was laboratory evidence that HCQ acts against SARS coronavirus type 1 and, more recently, also against type 2 that causes Covid-19. The French reported that HCQ reduced both the viral load and duration of virus shedding in the upper respiratory tract of Covid-19 patients. That paved the way for global use of the drug for Covid-19, with believers and sceptics raising a cacophony of controversies. Adding fuel to the fire, indiscriminate use without due precautions, over-dosing, and prolonged usage resulted in many adverse side effects described in the books, even deaths. So the pendulum swung away from its use in many countries.
Express Explainedis now onTelegram. Clickhere to join our channel (@ieexplained)and stay updated with the latest
In the US, rheumatologists were unhappy because of shortage of HCQ for the legitimate needs of their patients, on account of heavy demand for the drug to prevent and treat Covid-19 based more on empiricism than evidence. India, the worlds largest producer of HCQ, exported huge supplies of the drug to the US and Brazil in April.
There was a widespread clamour for controlled clinical trials. There was the Recovery trial in the UK and the Veterans Administration trial in the US, both on seriously ill Covid-19 patients. HCQ did not reduce mortality and the pendulum swung against HCQ use in Covid-19. The World Health Organization (WHO) had the Solidarity trial with HCQ in one arm. A scientific paper on a large number of patients, published in The Lancet, reported an unacceptable frequency of serious HCQ side-effects, based on which WHO hastily withdrew it from the study. Within days, it became evident that the Lancet article was based on doubtful data and the journal withdrew the article with alacrity. Immediately WHO made a volte face and re-introduced HCQ in the Solidarity trial, only to withdraw it soon after the UK Recovery trial showed lack of benefits with the drug.
The Detroit study on Covid-19 patients aged 18 to 76, the majority with co-morbidities, was protocol-driven. In one group a short course of HCQ was started early, preferably on the first or latest second day of hospitalisation. In order to avoid serious side effects, the drug regimen was short 400 mg twice on day one, followed by 200 mg twice daily for four more days. Corticosteroids were used as adjunct therapy in a proportion of patients in both groups. The in-hospital mortality for Covid-19 was 26.4 per cent in those not given HCQ, reduced to 13.5 per cent in the HCQ-treated group.
The Detroit study has swung the pendulum all the way back, favourable to HCQ use in Covid-19. If the scientific evidence from France was for reduction of viral load in the upper respiratory tract, was it not likely that it reflected a reduction of viral load in all other infected body tissues also? When should the viral load be reduced late in the course of disease or early? Does it not make sense to use the drug early and not late?
The road ahead
HCQ is obviously not a panacea for severe cases of Covid-19. Given early, it helps reduce mortality by about half, compared to those not given HCQ. In India the drug is widely available and not expensive. A number of Indian states have already incorporated a short course of HCQ in their Covid-19 treatment protocol, and states that have not done so will do well to implement this quickly.
Two other therapies for mortality reduction are a short course of dexamethasone and convalescent plasma. Indian physicians have a golden opportunity to use the three modalities in sequence dexamethasone in those who do not improve with early use of HCQ and convalescent plasma for those who do not improve with dexamethasone. The outcome of this treatment sequence will inform the medical community how to save many lives.
Dont miss from Explained | What works (and does not) in Covid-19 treatment
Dr Seshadri is retired Professor of medical endocrinology, Christian Medical College, Vellore and currently Director, Thirumalai Mission Hospital Ranipet. Dr John is retired Professor of Clinical Virology, CMC, Vellore and Past President of Indian Academy of Pediatrics.
The Indian Express is now on Telegram. Click here to join our channel (@indianexpress) and stay updated with the latest headlines
For all the latest Explained News, download Indian Express App.
The Indian Express (P) Ltd
PARIS, FRANCE -- Patients who recover from coronavirus infections may lose their immunity to reinfection within months, according to research released on Monday that experts said could have a "significant" influence on how governments manage the pandemic.
In the first study of its kind, a team led by researchers from King's College London examined the levels of antibodies in more than 90 confirmed virus patients and how they changed over time.
Blood tests showed even individuals with only mild COVID-19 symptoms mounted some immune response to the virus.
Of the study group, 60 per cent showed a "potent" viral response in the first few weeks after infection.
However, after three months only 16.7 per cent had maintained high levels of COVID-19-neutralizing antibodies, and after 90 days several patients had no detectable antibodies in their bloodstream.
When the body encounters an external danger such as a virus, it mobilises cells to track down and kill the culprit.
As it does so, it produces proteins known as antibodies that are programmed to target the specific antigen the body is fighting, like a key cut for a particular lock.
As long as someone has enough antibodies, they will be able to snub out new infections, giving them immunity.
But Monday's research suggests immunity cannot be taken for granted and may not last more than a few months, as is true with other viruses such as influenza.
Experts said the findings may change how governments plan for the next phase of the pandemic, including how they fund and organise vaccine research and development.
"This is an important study that starts to define the longer-term dynamics of the antibody response to SARS-CoV-2," said Lawrence Young, professor of Molecular Oncology at the University of Warwick, using the full name of the virus strain.
"It further emphasises the need for us to better understand what a protective immune response looks like if we are to develop an effective vaccine," said Young, who was not involved in the research.
James Gill, an honorary Clinical Lecturer at Warwick Medical School, said the research reiterated the need for everyone to continue taking measures to mitigate the virus spreading, particularly at the start of Europe's holiday season.
"In the same way that these patients were surprised to have antibodies to COVID19, we should NOT be surprised if any protective benefit is mild, or at least transient," he said.
"If you played the lottery and won 10, you wouldn't immediately think that you had acquired increased natural luck, and used your life savings to buy further lottery tickets.
"Even those with a positive antibody test -- especially those who cannot account for where they may have been exposed -- should continue to use caution, social distancing and appropriate mask use."
The disease investigators arrived at the apartment in street clothes, carrying their gowns, gloves and face shields in Whole Foods bags. They didnt knock on the door.
Instead, they called the resident a man in his 50s, then Californias first known coronavirus case by phone. When he answered, he was instructed to move to the farthest corner of the apartment so the team could go inside and suit up.
They had come to the apartment building in Orange County to make sure the man was where he promised to be and that he was isolating there, completely alone.
First case. New virus. We werent going to take peoples word for it, recalled the countys medical director of communicable disease control, Dr. Matthew Zahn, who oversaw the operation.
They asked about symptoms in the patients wife, his child, his recent dinner guest.
So began what by many measures was the most extensive public health campaign in California: a rapid mobilization to identify people suffering from the novel coronavirus and prevent them from infecting others. In the early days, officials didnt know whether this would be a short-term undertaking to prevent community transmission in the state or an epic battle against a once-in-a-century pandemic.
But as the latter scenario played out, California found itself unprepared, overwhelmed and constantly lagging, a Los Angeles Times investigation has found. Those early failures left California far behind in the fight against the coronavirus, and it has struggled to keep up even as cases surge today.
In the beginning, dozens of investigators, called cluster busters, worked each case to try to contain the spread of the coronavirus. They aimed at identifying each strand of transmission and snipping it before the virus could take hold as a sturdy web across communities. They functioned as all-inclusive personal assistants: arranging child care, setting up WiFi, coordinating grocery drop-offs.
But data would later show that, long before the official case count began to climb, the virus was freewheeling. Federal officials grappling with a shortage of test kits issued narrow testing criteria; that meant key local spreaders in the states budding outbreak were going unnoticed and untraced.
Contact tracers were never alerted, for example, to people such as Margaret Cabanis-Wicht and her husband, a 41-year-old movie director in Rancho Palos Verdes who had attended a January gala in Beijing with hundreds from across China.
Twelve days after her husbands return to California, their 5-year-old daughter woke in the night with a 102-degree fever. Cabanis-Wicht had one, too. For days, they hounded their doctors, the state health department and even the Centers for Disease Control and Prevention. But the two were ineligible for coronavirus testing because, though living with a potential carrier, they hadnt left the country.
Well never know, Cabanis-Wicht said.
With a positive test result in the household, contact tracers would likely have visited the family, along with each of the children with whom the girl had played. Instead, Cabanis-Wicht watched in horror as school officials soon reported cases of influenza-like illness arising in the elementary school. In early March, a parent of a fellow student finally got a test and turned up positive.
Without a doubt, we were all aware that we were likely missing cases, said Zahn, citing the testing restrictions. We relied on test results. If you werent tested, we didnt identify you.
If the earliest potential spreaders werent eligible for coronavirus testing, how could cluster busters find them in time to curb a full-blown outbreak?
It was a question we were all asking, Zahn said.
Unprepared
The laboratory testing process relied on strikingly inefficient instruments: humans.
The strict protocol approved by federal health officials meant no automation at L.A. Countys public health lab. Lab workers hovered over patient samples, using the plastic droppers known as pipettes to manually extract genetic material from them, one by one.
They loaded samples into the wells of a testing machine that looked more like an outdated LaserJet office printer than the solution to a pandemic. It ran 18 hours a day, seven days a week. Still, by March 11, with infections likely spreading by the thousands, only about 70 peoples specimens had been tested in the Downey lab, the departments director said.
Other counties were worse off. One in four of the states public health laboratories closed entirely in recent years, and there remained less than one public health lab per million state residents. Many reported an annual equipment budget of zero dollars or were under review for closure until couriers began arriving with patient swabs and hand-scribbled test requests.
A technician processes specimens at the UCLA clinical microbiology lab in Brentwood.
(Brian van der Brug / Los Angeles Times)
Demand for testing surged after about 1,250 Californians who had been on a cruise ship with a coronavirus patient had unknowingly scattered across the state, likely proliferating the spread. Another 9,000 people in California had recently returned from countries experiencing severe outbreaks.
The pileup of samples left the countys testing infrastructure bottlenecked and on the brink of collapse. A county memo asked hospitals to turn away any suspected coronavirus patient with mild symptoms without a test and without reporting the case.
Dont call the public health department, one infection control coordinator wrote in an email to doctors.
The county reported a total of just 29 infections an obvious undercount.
Outmatched
On March 13, a Friday, Steve Rusckowski, the chief executive of Quest Diagnostics, approached the podium in the Rose Garden of the White House. President Trump patted him on the back.
Stephen, Trump said. Great job.
Stephen Rusckowski, chief executive of Quest Diagnostics, discusses the coronavirus at a White House news conference with President Trump on March 13.
(Alex Brandon / Associated Press)
With the testing infrastructure in public facilities crippled, the federal government had turned to private partners to scale up testing. Flanked by industry leaders and members of the federal task force, Rusckowski told television cameras and print reporters that the companys testing process was underway, adding that the number of tests available to the public will be considerably increased in the next few weeks.
It was. That day, Los Angeles County had reported just eight new coronavirus cases overnight; the following Friday, it reported 64 overnight. The one after that, it was 252. By the end of the month, total detection in the county surpassed 3,000 cases.
But unfortunately for Quest and other private players such as LabCorp the growing capacity to detect cases was only as good as supply lines. And quickly, every step in the process showed strain.
For tens of thousands of Californians to receive a coronavirus test, medical staff needed just as many cotton-tipped swabs the simplest piece and yet the No. 1 issue, said Dr. Clayton Kazan, medical director for the Los Angeles County Fire Department and former coronavirus testing coordinator for the county. A common type, called a flocked swab, is typically produced in Italy and China, where the outbreak had paralyzed manufacturing. More than 125 testing sites in California would later report swabs as their primary testing shortage.
After collection, a swab sample was immediately inserted into a plastic screw-top tube filled with transport medium a solution intended to preserve it on its journey. But the fluid was so scant that the U.S. Food and Drug Administration began endorsing the use of basic saline in its place.
Once it arrived at processing laboratories such as Quest or LabCorp, sample preparation required specific chemicals, known as reagents, to extract genetic material from the swab. Without the reagents, Gov. Gavin Newsom said, the test kits were like printers, but without ink.
But Qiagen, a top supplier, quickly fell behind. Patients in intensive care units waited more than a week for results; some nurses had to tell families that, in the pileup, the commercial labs had lost their relatives samples entirely.
Even on their deathbeds, they had no diagnoses.
Reagent manufacturing looked like having a garden hose on hand to fight a wildfire, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. The outbreak in Wuhan, China, demanded a full-blown fire hydrant, he added, and the global spread required virtually a canals worth.
And while states such as New York used expanded testing to screen every nursing home patient, California didnt have the means; about half of deaths in California are from these facilities.
The testing regime failure was federal, state and local. We all failed, Kazan said. If we could go back to January, when we saw what was happening in Wuhan, if we had taken that opportunity to scale ourselves up in anticipation, we could have been more prepared than we are now.
By March 25, Quest alone had 160,000 unprocessed tests about half of all the orders it had received.
The scramble
The backlog reached all the way to the office of Dr. Valerie Ng, the lab director at the Alameda Health System who one day in mid-March found herself piling patient samples into her car for a road trip to the state lab in Richmond. Two separate testing infrastructures had failed her. This was Plan C.
Earlier that month, the pileup at Quest had become insufferable; Dr. Ng had redirected samples to Alameda Countys public health lab. But their aging equipment delivered test results by fax; the head of labs at three hospitals and several clinics found herself relegated to watching for the LOW TONER light to illuminate on the printer.
Issues compounded when the lab equipments test results could not be validated. The deluge of specimens came to resemble the accelerating conveyor belt of confections in the classic chocolate factory episode of I Love Lucy, she said. She began chauffeuring them to Richmond.
When the surge came, it came to the lab, she said in an interview. Were swimming as fast as we can.
Meanwhile, at UC Berkeley, molecular biologist Fyodor Urnov formed what he called SEAL Team Six: hand-selected scientists, physicians and students who had constructed a volunteer lab in a matter of weeks to help relieve Quests backlog. They moved heaven and earth to get government certifications and create a highly automated lab that could run as many as 1,000 patient samples a day, he said.
But when Urnov told nearby hospitals he could provide free testing and results in 48 hours, the hospitals declined, saying their electronic records systems were still entangled at Quest and LabCorp. The volunteers were stunned.
We said, What? Are you kidding me? They have a direct link to a testing provider that has failed, Urnov said. Theres institutional inertia.
Silicon Valley steps in
Fred Turner has always been entrepreneurial. By 17, hed built a DNA machine in his bedroom to figure out why his brother was a redhead. At 20, he dropped out of Oxford to launch his first biotech start-up. And this spring, during an afternoon kicking back at his San Francisco flat, friends of the then-24-year-old talked him into upending his life to address a new problem: coronavirus testing.
Thanks to venture capitalists, Turner, within weeks, was in a hotel room in Southern California blasting out job openings for medical technicians, lab workers and programmers. DM if interested! Turner, the new chief executive of the brainchild, Curative, wrote on Twitter.
Staffers slept in sleeping bags between shifts at their new facility: a former NFL/MLB anti-doping laboratory in San Dimas, its glass walls and biosafety cabinets transformed into the most efficient coronavirus testing operation in the region. By late April, patient samples stuffed inside trash bags were arriving by the truckload on the ground floor of the facility, called KorvaLabs.
Each day, some 350 employees stepped into the assembly lines: sterilizing pouches and scanning bar codes, feeding racks of samples to an automated Tecan extraction robot and transferring plates into almost two dozen viral detection machines with a master mix of chemicals that run in tandem almost around the clock.
Industrial engineers used digital time stamps to track the daily workflow of each step, looking for lags. Were back to Henry Ford, said Dr. Jeffrey Klausner, professor of medicine and public health at UCLA, the medical director of the program.
By early May, California had gone from 2,000 to nearly 40,000 tests per day. The Curative-Korva lab was running 10,000 of them.
Back to the future
Dr. Zahns contact tracing team was back in action, and their caseload by late May was surging. Trading their gowns and gloves for phone lines and shared drives, tracers spend their days staring at computer screens glowing with the ever-growing lists of names.
Dont think Russell Crowe in A Beautiful Mind. Dont think Sherlock Holmes, said Zahn. There is no big opera music in the background. Think less glamorous: Excel spreadsheets.
Californias contact tracers librarians, Peace Corps volunteers and others called infected patients and asked for the phone number of each person theyd recently seen, vowing to keep the identity of the positive case concealed. Those contacts were asked about symptoms, and they, too, were requested to isolate at home.
But the challenges were overwhelming. Los Angeles County, after a massive team scale-up, still had only 1,759 contact tracers for more than 10 million residents, and, in the U.S., there was another unique hurdle: enforcement.
Effective methods to force compliance were in use elsewhere: Taiwan monitored quarantined people with digital fencing that sounded an enforcement alarm whenever one of some 50,000 quarantined citizens ventured too far from home. Contact tracers in South Korea and Singapore kept track of infected people through GPS and Bluetooth data.
But none of those options were available in California. Contact tracers lacked authority to insist that infectious individuals avoid exposing others.
I cant imagine an America where we can replicate exactly what they did in Asia, given the fact that we have freedoms and a Constitution, said Dr. Bob Kocher, a venture capital executive and former member of the governors task force on testing.
And the more contact tracers went about their work, the more their effectiveness was entirely dependent on the one thing they still couldnt control: testing.
The shadow of past failures and the legacy of ones still in the making lingered.
For example, L.A. County health officials in early June were still only about three-quarters of the way through testing residents and staff at the nearly 400 skilled nursing facilities. In jails, another hot spot for the virus, staff have reported running out of the rapid test kits used before booking new inmates. In rural towns and inner-city neighborhoods, California is scaling back its testing expansion, citing costs.
And, in a startling dj vu to the outbreaks inception, L.A. County public health officials on Wednesday limited the criteria for testing due to dwindling supplies. The ever-fragile testing infrastructure is once again threatened by shortages of swabs, reagents and, curiously enough, those tiny plastic pipette tips that lab workers had wielded by hand in the Downey lab.
The droppers now work robotically, but the plastic needed to manufacture the tips is shrinking across the globe, experts say. If labs run out of the tiny, crucial components, the entire system could grind to a halt by October, they say.
Without these little plastic tips, Kocher said, testing will break down again.
Times staff writers Melody Petersen, Anita Chabria, Sandhya Kambhampati, Matt Stiles and Sean Greene contributed to this report.
I'm hearing a lot of talk about the coronavirus spreading through aerosols is wearing a mask in a grocery store enough protection? What else should I do to stay safe?
Quick answer first: Going to the grocery store where you and everyone else is wearing a mask and keeping a distance from each other is still considered a low-risk activity. Go get your summer strawberries!
For background, aerosols are tiny microdroplets containing the virus that can be expelled when we talk or breathe and can stay aloft and travel on air currents. It's still unclear how much of a role they play in spreading the virus, but recently more than 200 scientists wrote an open letter asking the World Health Organization to pay more attention to them.
The agency still maintains that the greater risk of spread appears to be from droplets larger particles, also expelled when we talk or breathe, which settle more quickly and are less likely to accumulate in the air. However, WHO released a new scientific brief on July 9 saying that airborne transmission might be contributing to spread in crowded, poorly-ventilated indoor spaces such as gyms, choir practice rooms and nightclubs. But how much transmission aerosolized particles are responsible for, versus droplets and contaminated surfaces, they can't say for sure.
"What we are calling for is more systematic research to be done in these types of settings," said Maria Van Kerkhove, technical lead for WHO's health emergencies program, at a press conference on Friday. In other words, stay tuned.
Bottom line: It's impossible to rule out that some amount of transmission may be caused by aerosols. If you want to err on the side of caution, here's what some infectious disease researchers say can help minimize the risks:
Face away from people when you talk: When you're talking face to face with someone, you're in direct line of the plumes of breath that come out of their mouths when they speak. "If there's any scenario where I'm face to face, with someone, I move my head off-center so I'm no longer inhaling that direct plume," says Seema Lakdawala, a flu transmission researcher at the University of Pittsburgh. One tip that helps her is to not make direct eye contact with people. It can be awkward, she acknowledges, but "it's not just about protecting myself, but also about protecting other people," since it's possible to shed the virus without knowing you're infected.
Wear your mask properly: Wear a layered cloth mask in public spaces, especially if you're indoors or in a setting where you can't socially distance. Make sure it covers your nose and mouth. This will catch many of the droplets that come out when you breathe or speak and prevent them from getting into the air. Ideally, to take precautions against tiny, aerosolized microdroplets, "we should be masking everyone with better masks," says Abraar Karan, a physician at Harvard Medical School. But the N95 masks that effectively filter most aerosol particles are in short supply and uncomfortable to wear. Karan suggests well-fitting KN95 masks which have similar protection (but make sure your mask isn't counterfeit).
Make the indoors more like the outdoors: "You limit aerosol transmission by increasing ventilation and increasing air circulation by opening a window, putting on a fan and just moving the air," says Lakdawala, who keeps several fans running at all times in her lab and office space. Moving air disperses the particles in the air and makes it less likely that someone will breathe in a concentrated cloud of infectious virus. Donald Milton, an infectious disease aerobiologist at the University of Maryland and lead author on the open letter about aerosols, also recommends cleaning indoor air, through air filtration and ultraviolet sanitizing light. "You wouldn't drink water downstream from another town without treating it. But we breathe air from other people without treating it," he says.
Limit the amount of time you're in close contact with people: The public health rule of thumb for what counts as an exposure is close contact with an infected person for 15 minutes or more, so uncrowded grocery stores where everyone is masked and moving represents a relatively low-risk situation, both Lakdawala and Milton agree. Hopefully, you're not standing in one aisle for very long, but you're going to shop efficiently, says Lakdawala, "So even if there are fine aerosols that are getting released by somebody who is infected, they're getting diluted out as these people move in air currents." Indoor bars, restaurants and other situations where people are staying in one place for a period of time, and speaking or singing loudly, make Milton more wary. "I don't know how to drink a beer with a surgical mask on," he says. "And I wouldn't go sing at choir practice, OK?"
Keep a buffer of personal space: This isn't just important for the spray of droplets, it may also help when it comes to tiny airborne particles. If you are planning to sit and talk to a friend, keeping a distance of at least 6 feet creates more opportunities for airflow between you and others. "We have a happy hour in our neighborhood where everybody brings our chairs, and we sit on someone's lawn," says Lakdawala. "Everyone is spatially distanced, and we bring our own drinks and talk." Maintaining a distance from others means there's more ventilation and space for air to pass between you, says Lakdawala.
Each precaution adds another layer of safety from aerosolized particles, says Milton. "Wearing a mask means you're putting less virus droplets into the air, sucking less out [of the air]. Keeping distances means there's less of it near you. And having good ventilation or air sanitation means what's in the air is getting removed. All of those things add up to giving you good protection."
